1 00:00:20,055 --> 00:00:20,635 Hey everybody. 2 00:00:27,345 --> 00:00:29,125 We do appreciate everyone showing us. 3 00:00:29,515 --> 00:00:31,365 It's long way, just us. Yeah. 4 00:00:34,235 --> 00:00:35,975 We are gonna go into open session. 5 00:00:36,455 --> 00:00:38,735 I can ask counsel to report on actions taken in 6 00:00:39,045 --> 00:00:40,055 session. Yep. 7 00:00:40,455 --> 00:00:42,055 We had four actions in closed session. 8 00:00:42,955 --> 00:00:46,655 The first action, 5.1 0.1, 9 00:00:46,675 --> 00:00:50,935 and 5.1 0.2 passed five to zero. 10 00:00:52,745 --> 00:00:55,095 Those were the closed session meeting minutes 11 00:00:55,855 --> 00:00:58,855 5.2 hearing on the service recovery report. 12 00:00:59,615 --> 00:01:01,175 Motion passed five to zero. 13 00:01:02,215 --> 00:01:05,215 Item 5.3, the complaints and grievance report. 14 00:01:05,275 --> 00:01:07,415 Motion passed five to zero, 15 00:01:08,635 --> 00:01:12,095 and then we had item number 5.4, 16 00:01:12,275 --> 00:01:14,655 the medical staff credentials also passed. 17 00:01:14,685 --> 00:01:16,095 Five to zero. Thanks. 18 00:01:16,985 --> 00:01:17,335 Thank, 19 00:01:21,775 --> 00:01:22,995 Do you have any deletions 20 00:01:23,375 --> 00:01:26,695 or corrections to the posted open session agenda? 21 00:01:30,415 --> 00:01:31,675 No. Moving on. Item 10. 22 00:01:32,375 --> 00:01:34,915 Do we have any input from audience this evening? 23 00:01:34,915 --> 00:01:37,355 Again, this would be for items not on the posted agenda. 24 00:01:40,595 --> 00:01:42,795 I have a whole spiel about public comment, 25 00:01:42,855 --> 00:01:45,395 but since no one's moving, I'll spare us that time. 26 00:01:47,715 --> 00:01:51,495 Or do we have any, any online? Nope. Thank you. 27 00:01:51,495 --> 00:01:53,815 That's a, that's a new one for us. Thank you, Sarah. 28 00:01:55,975 --> 00:01:57,135 Employee associations. Item 11. 29 00:01:57,135 --> 00:01:59,575 Any input from employee associations let's anyone here 30 00:02:00,635 --> 00:02:04,215 moving on to what's become the highlight of the show 31 00:02:04,845 --> 00:02:06,815 president and CEO monthly 32 00:02:07,545 --> 00:02:11,195 Highlights. Good evening, Anna. 33 00:02:12,185 --> 00:02:14,235 Good evening chair members of the board. 34 00:02:14,615 --> 00:02:16,755 It, it is very nice to be with you tonight. 35 00:02:16,835 --> 00:02:18,595 I wanna thank members of the audience 36 00:02:19,055 --> 00:02:21,395 and people joining both from our staff 37 00:02:21,395 --> 00:02:23,635 and our community who are doing this virtually. 38 00:02:24,665 --> 00:02:26,915 This is actually gonna be a fun 39 00:02:27,135 --> 00:02:29,755 and much quicker than last month report, 40 00:02:30,435 --> 00:02:32,475 but I am gonna bring a couple highlights to you. 41 00:02:33,365 --> 00:02:36,915 We've been talking a lot about the true north 42 00:02:37,015 --> 00:02:38,995 and we've talked to you a lot about what it is. 43 00:02:39,755 --> 00:02:41,035 Tonight we're gonna talk a little bit about 44 00:02:41,175 --> 00:02:44,595 how we're gonna do it, how we're gonna actually get there. 45 00:02:45,375 --> 00:02:47,755 And so we're gonna, we're gonna go over just a quick 46 00:02:48,475 --> 00:02:52,955 overview of the Structure 47 00:02:52,985 --> 00:02:54,275 that we're putting in place, sort 48 00:02:54,275 --> 00:02:56,075 of lead this portfolio of work. 49 00:02:57,135 --> 00:03:01,565 As a reminder, true North has three priority areas. 50 00:03:01,945 --> 00:03:05,125 It is our single strategic plan. 51 00:03:05,215 --> 00:03:07,965 There is no other strategic plan. It is the true north. 52 00:03:08,785 --> 00:03:10,765 And so you will find sort of everything kind 53 00:03:10,765 --> 00:03:13,685 of making its way and being connected to that plan 54 00:03:13,685 --> 00:03:15,525 or that plan being connected to everything, 55 00:03:15,525 --> 00:03:18,125 which is maybe a more accurate way to say that. 56 00:03:19,465 --> 00:03:20,565 The other thing I wanna say 57 00:03:20,565 --> 00:03:22,005 before I lay out this 58 00:03:23,495 --> 00:03:26,205 leadership structure is do not get out a chisel 59 00:03:26,265 --> 00:03:28,765 or a piece of marble and like carve this in stone 60 00:03:28,765 --> 00:03:32,165 because this will, like most things, this is a, 61 00:03:32,765 --> 00:03:34,205 a new process. 62 00:03:34,505 --> 00:03:37,205 And so it will be, I anticipate, 63 00:03:37,205 --> 00:03:42,125 and I almost predict that this will for sure transform 64 00:03:42,385 --> 00:03:44,645 as we go and be refined as we go 65 00:03:44,825 --> 00:03:49,165 and maybe look a little bit different months, 66 00:03:49,545 --> 00:03:51,725 for sure years from now, but even maybe months from now. 67 00:03:52,065 --> 00:03:55,245 So one of the things that really, that 68 00:03:55,825 --> 00:03:58,565 we have empowered the teams to do is be a learning, 69 00:03:59,325 --> 00:04:00,485 learning organization. 70 00:04:00,665 --> 00:04:02,365 And that means you're allowed to, we, 71 00:04:02,385 --> 00:04:03,805 you have permission to improve. 72 00:04:04,185 --> 00:04:07,285 We kind of, we start where we think we start at a point we 73 00:04:07,285 --> 00:04:09,405 feel good about, 74 00:04:09,745 --> 00:04:12,285 but we also wanna make sure people understand you have the 75 00:04:12,285 --> 00:04:15,045 power to like actually outdo this and do 76 00:04:15,145 --> 00:04:16,485 and even improve it. 77 00:04:16,545 --> 00:04:19,205 So it, I would anticipate this will change. 78 00:04:19,545 --> 00:04:22,725 But without further ado, let me just introduce you to some 79 00:04:22,725 --> 00:04:24,205 of the teams and some 80 00:04:24,205 --> 00:04:26,165 of those team leads are in the room tonight. 81 00:04:26,825 --> 00:04:30,045 And we will start with, let shoot my, 82 00:04:30,175 --> 00:04:31,285 where do I shoot my laser? 83 00:04:33,925 --> 00:04:35,665 Oh, shoot it there. Okay. 84 00:04:35,765 --> 00:04:38,145 How about somebody advance this slide for me? Great. Okay. 85 00:04:38,145 --> 00:04:41,425 So we'll start with, we'll start with health within reach. 86 00:04:42,085 --> 00:04:45,545 And as you recall, we have two key areas kind of 87 00:04:45,545 --> 00:04:47,825 that we're working on there that is really sort of access 88 00:04:48,805 --> 00:04:49,985 and operations. 89 00:04:50,085 --> 00:04:53,905 And so we are going to, we have Debbie Stanley. 90 00:04:53,975 --> 00:04:56,065 This is gonna be no small task for Debbie. 91 00:04:56,205 --> 00:04:58,105 She is actually gonna be the work stream lead 92 00:04:58,445 --> 00:05:00,425 and that's gonna be really around improving 93 00:05:00,485 --> 00:05:01,705 access to primary care. 94 00:05:02,405 --> 00:05:04,545 That's around sort of the work that's gonna be happening 95 00:05:04,545 --> 00:05:05,985 around the scheduling, navigation, 96 00:05:06,055 --> 00:05:08,185 virtual care, extended care hours. 97 00:05:09,085 --> 00:05:12,985 And then also in within that scope, 98 00:05:13,315 --> 00:05:15,265 there is actually gonna be the improvement 99 00:05:15,265 --> 00:05:16,545 of financial navigation. 100 00:05:16,955 --> 00:05:19,345 Dylan will be the executive sponsor of that. 101 00:05:20,525 --> 00:05:22,025 And again, they're, they're here. 102 00:05:22,525 --> 00:05:24,465 So you could ask them questions if you 103 00:05:24,465 --> 00:05:25,825 have questions about that. 104 00:05:26,625 --> 00:05:28,145 And within this, I just wanna 105 00:05:28,145 --> 00:05:29,305 say they're not the only people. 106 00:05:29,315 --> 00:05:31,025 There will be whole teams underneath them. 107 00:05:32,245 --> 00:05:35,865 So the, the next, the next area is operations. 108 00:05:35,925 --> 00:05:37,825 And we know kind of that there's a lot 109 00:05:37,925 --> 00:05:39,785 of downstream operational 110 00:05:41,335 --> 00:05:42,865 performance work that has to happen. 111 00:05:43,365 --> 00:05:44,745 And actually Lauren Ard, 112 00:05:44,745 --> 00:05:47,705 because we haven't piled her plate high enough yet. 113 00:05:48,905 --> 00:05:51,765 I don't How long have you been here, Lauren? Five months. 114 00:05:51,825 --> 00:05:53,685 So I mean, yeah, she's got a few months 115 00:05:53,685 --> 00:05:54,725 before it's like, yeah. 116 00:05:55,145 --> 00:05:59,725 So, but she, she will be working, the executive sponsor 117 00:05:59,725 --> 00:06:02,605 of this will be Louie Ward, our Chief operating officer, 118 00:06:02,705 --> 00:06:04,765 and she'll be working around that sort 119 00:06:04,765 --> 00:06:06,445 of downstream operational performance. 120 00:06:06,855 --> 00:06:09,605 Again, this is, you're gonna see a lot of overlap 121 00:06:09,605 --> 00:06:12,445 because you can actually really improve access 122 00:06:12,665 --> 00:06:15,805 and your, your scheduling system 123 00:06:16,185 --> 00:06:17,245 and, you know, access 124 00:06:17,245 --> 00:06:20,725 to financial navigation without also improving 125 00:06:21,315 --> 00:06:22,765 operational performance 126 00:06:22,945 --> 00:06:25,285 and really thinking about the ancillaries. 127 00:06:26,025 --> 00:06:28,885 And actually also, as you know, when we talked about 128 00:06:29,785 --> 00:06:31,445 our measurement strategy, we talked about those 129 00:06:33,075 --> 00:06:34,085 balancing measures. 130 00:06:34,085 --> 00:06:36,205 And you can see that Lauren has one of those in there 131 00:06:36,205 --> 00:06:38,565 that maintaining the highest level of patient satisfaction. 132 00:06:38,985 --> 00:06:41,165 We, we know that we're gonna be doing a lot of changes 133 00:06:41,225 --> 00:06:43,925 and we wanna make sure that those don't come at the cost 134 00:06:43,945 --> 00:06:46,765 of things that are really, really important to our system. 135 00:06:47,995 --> 00:06:52,595 Next slide. So people in 136 00:06:52,675 --> 00:06:55,995 leadership, this is, again, we, we have kind of, 137 00:06:55,995 --> 00:06:58,075 this is really under that community guided. 138 00:06:58,975 --> 00:07:02,355 And this is really about amplifying the voice 139 00:07:02,375 --> 00:07:03,795 of both the people who work here 140 00:07:03,935 --> 00:07:05,955 and the people who use our, our system 141 00:07:06,055 --> 00:07:09,315 and rely on our system to live their healthiest life. 142 00:07:10,245 --> 00:07:12,715 Again, the work stream lead for the people 143 00:07:12,715 --> 00:07:15,435 and leadership piece will be Lauren Caprio 144 00:07:15,655 --> 00:07:16,915 to her executive sponsor. 145 00:07:17,215 --> 00:07:19,395 And the executive sponsor of this entire 146 00:07:20,225 --> 00:07:23,875 work stream will be Lisa Faust, who again, she's also, 147 00:07:24,365 --> 00:07:26,555 she's also gonna be starting actually next week. 148 00:07:26,555 --> 00:07:28,875 So we can still pile a bunch of stuff on her plate. 149 00:07:29,395 --> 00:07:31,635 Just kidding. I'm kidding. 150 00:07:31,775 --> 00:07:34,115 I'm, I, I feel confident she's actually watching tonight. 151 00:07:34,135 --> 00:07:35,875 So Lisa, I'm definitely kidding. 152 00:07:38,645 --> 00:07:42,625 But this is really to work on, you know, advance, enhancing 153 00:07:42,625 --> 00:07:45,545 that engagement, the culture work. 154 00:07:45,745 --> 00:07:47,665 I mean there's a lot of this is already going on. 155 00:07:47,825 --> 00:07:50,065 I mean this, this will feel very familiar to us, 156 00:07:50,565 --> 00:07:53,785 but also this is also going to include 157 00:07:54,825 --> 00:07:56,305 probably a little more solid scope 158 00:07:56,305 --> 00:07:58,905 around leadership development as well 159 00:07:58,905 --> 00:07:59,905 as succession planning. 160 00:08:00,665 --> 00:08:03,345 Because we, we just, there's so much talent here, 161 00:08:03,445 --> 00:08:05,585 but we wanna kind of line that talent up in a, 162 00:08:05,585 --> 00:08:08,545 on a bench here so that when people leave, 163 00:08:08,545 --> 00:08:10,585 because we have so much talent 164 00:08:10,765 --> 00:08:13,585 and we're kind of a, you know, a, a very, 165 00:08:13,745 --> 00:08:16,105 a right sized organization, we are, we're, 166 00:08:16,105 --> 00:08:19,305 we don't have thousands and thousands of people to draw on. 167 00:08:19,365 --> 00:08:21,945 We have 1500. 168 00:08:22,685 --> 00:08:25,105 And so sometimes when a key leader leaves, 169 00:08:25,175 --> 00:08:26,985 it's a pretty big, it's a pretty big thing. 170 00:08:27,245 --> 00:08:29,025 And as you all know, and I think that 171 00:08:29,745 --> 00:08:30,865 a great example will be the, 172 00:08:30,925 --> 00:08:34,745 the chief human resources officer that, that took a year 173 00:08:35,205 --> 00:08:36,505 to hire into that position. 174 00:08:36,565 --> 00:08:39,545 So we really want to have a very formal scope 175 00:08:39,565 --> 00:08:40,985 of succession planning happening. 176 00:08:42,285 --> 00:08:45,905 And then again, just kind of making sure that we align kind 177 00:08:45,905 --> 00:08:47,905 of that all of our performance management 178 00:08:47,905 --> 00:08:51,065 and our recognition with the things that we were told 179 00:08:51,085 --> 00:08:53,905 by the community and by our workforce that really matter. 180 00:08:54,905 --> 00:08:56,445 The second piece of 181 00:08:56,445 --> 00:08:58,525 that community guided is actually governance. 182 00:08:59,155 --> 00:09:01,485 That should feel, that should feel very familiar 183 00:09:01,625 --> 00:09:02,965 to our governing board, 184 00:09:03,385 --> 00:09:06,485 but I also really want to make sure 185 00:09:06,485 --> 00:09:09,165 that the community's able to follow along with that. 186 00:09:09,185 --> 00:09:12,285 And that is really gonna be your, your board clerk. 187 00:09:12,725 --> 00:09:15,445 Sarah Jackson is the, is the work stream lead for that. 188 00:09:15,865 --> 00:09:17,885 And Kim Mcar, our chief strategy officer, 189 00:09:17,915 --> 00:09:22,165 will be the executive overseeing that portfolio of work. 190 00:09:22,165 --> 00:09:23,565 There's a lot of work, a lot 191 00:09:23,565 --> 00:09:26,245 of this work is gonna be working directly with our board, 192 00:09:26,545 --> 00:09:28,445 but it's not just gonna be working with the board. 193 00:09:28,475 --> 00:09:30,325 It's also about looking at policies, 194 00:09:30,325 --> 00:09:31,765 it's about looking at charters. 195 00:09:32,085 --> 00:09:34,445 I mean that's the really exciting stuff, right, Sarah? 196 00:09:35,505 --> 00:09:37,045 And, but you know, there's a lot 197 00:09:37,065 --> 00:09:40,085 of structural things I think we have like, that are, 198 00:09:40,345 --> 00:09:42,805 we have a lot of opportunity I think to strengthen. 199 00:09:43,145 --> 00:09:47,765 But, and it's also, I anticipate again 200 00:09:47,765 --> 00:09:51,725 that this will start to transform what shape it takes 201 00:09:51,865 --> 00:09:54,245 as we think about how we, 202 00:09:56,845 --> 00:09:58,325 I wouldn't say the word succession plan 203 00:09:58,325 --> 00:10:00,085 because our board is an elected board, 204 00:10:00,105 --> 00:10:02,525 but how we create a bench and, 205 00:10:02,545 --> 00:10:05,405 and really tap how our board is positioned to be able 206 00:10:05,405 --> 00:10:08,005 to tap into the deep well of knowledge within this region 207 00:10:08,265 --> 00:10:12,645 as we have just an abundance of, of skill 208 00:10:12,745 --> 00:10:13,845 and knowledge in this region. 209 00:10:14,505 --> 00:10:18,845 And we're very lucky to have such an amazing community who, 210 00:10:19,065 --> 00:10:22,645 who by the way, I think this has come up many times, 211 00:10:22,865 --> 00:10:25,925 but is always been rooting for 212 00:10:26,065 --> 00:10:28,645 and always very generous to with Tahoe Forest, 213 00:10:28,675 --> 00:10:30,645 with their time, their skill, their spirit, 214 00:10:31,665 --> 00:10:33,045 and really even, you know, 215 00:10:33,505 --> 00:10:35,925 we have really benefited in our foundations from, 216 00:10:35,995 --> 00:10:38,205 from their active engagement as well. 217 00:10:39,865 --> 00:10:42,365 The next slide is the, we talked a little bit 218 00:10:42,365 --> 00:10:43,845 that's about the transformation. 219 00:10:44,385 --> 00:10:49,005 And again, this is, this is really, there's like a couple 220 00:10:49,005 --> 00:10:51,085 of scopes of work here that are very specific 221 00:10:51,465 --> 00:10:55,125 and I, I do wanna say we have scoped this to specific pieces 222 00:10:55,465 --> 00:10:57,925 of a portfolio, not the whole portfolio. 223 00:10:58,025 --> 00:10:59,445 So this is an all transformation, 224 00:10:59,445 --> 00:11:03,565 but we realize that really strengthening the partnership 225 00:11:03,565 --> 00:11:05,845 with the medical staff is a major 226 00:11:06,245 --> 00:11:07,325 priority for the organization. 227 00:11:07,465 --> 00:11:09,765 And I think that's not, you know, it's not a secret 228 00:11:10,195 --> 00:11:12,125 that Anna Roth, you know, discovered. 229 00:11:12,165 --> 00:11:14,005 I think when I was even interviewing for this job. 230 00:11:14,125 --> 00:11:16,965 I think the board was very clear, we would like to see this 231 00:11:17,485 --> 00:11:20,285 strengthened and we, and I think we have made many gains 232 00:11:20,285 --> 00:11:21,685 this in this last year, 233 00:11:21,985 --> 00:11:24,005 but we would like to institutionalize 234 00:11:24,005 --> 00:11:25,165 that and formalize that. 235 00:11:25,225 --> 00:11:28,405 The, this is a really critical stakeholder group. 236 00:11:28,785 --> 00:11:31,965 And so we're, we're, Sam Smith is going 237 00:11:31,965 --> 00:11:33,805 to be leading up this work stream 238 00:11:33,905 --> 00:11:37,765 and it, Dr. Evans will be the executive sponsor. 239 00:11:38,325 --> 00:11:39,925 I would anticipate that you'll see 240 00:11:40,565 --> 00:11:42,445 the med staff president somewhere in 241 00:11:42,445 --> 00:11:43,845 this, in this mix as well. 242 00:11:43,965 --> 00:11:47,005 I mean certainly the med staff president has been extremely 243 00:11:47,245 --> 00:11:49,205 involved this last year and we're very 244 00:11:49,485 --> 00:11:51,085 grateful for her leadership. 245 00:11:51,865 --> 00:11:54,405 But this will really be, again, around, again, 246 00:11:54,405 --> 00:11:56,445 around improving medical staff engagement, 247 00:11:57,395 --> 00:11:59,245 modernizing those care delivery models, 248 00:11:59,305 --> 00:12:02,965 but making sure those modernizations, those introductions 249 00:12:02,965 --> 00:12:05,565 of any changes are really in the vision of 250 00:12:05,565 --> 00:12:08,405 what the medical staff say, this is it, it needs 251 00:12:08,405 --> 00:12:11,805 to be an improvement that meets their standards. 252 00:12:12,005 --> 00:12:15,085 I mean they are the standard setters for care in our, 253 00:12:15,105 --> 00:12:16,565 in our system and in this region. 254 00:12:17,305 --> 00:12:20,245 And then again, aligning incentives, 255 00:12:20,985 --> 00:12:22,285 access, quality outcomes. 256 00:12:23,815 --> 00:12:28,805 Again, I would say that this will be go far beyond kind of a 257 00:12:30,655 --> 00:12:33,125 Press Ganey survey engagement survey or something. 258 00:12:33,125 --> 00:12:37,045 This is this, this will be about having meaningful 259 00:12:37,695 --> 00:12:40,205 engagement and meaningful participation 260 00:12:40,505 --> 00:12:42,405 and you know, not even just participation 261 00:12:42,405 --> 00:12:44,605 but partnership with the med staff. 262 00:12:44,665 --> 00:12:47,685 And I think, again, I think we, we recognize 263 00:12:47,685 --> 00:12:52,405 that we'll be much better for it if we are able to really, 264 00:12:52,865 --> 00:12:54,085 really lean into that. 265 00:12:54,305 --> 00:12:56,685 And then finally, finance, this is Crystal's 266 00:12:56,885 --> 00:12:58,485 favorite category. 267 00:12:58,545 --> 00:13:01,165 She is the executive sponsor and for hod, 268 00:13:01,795 --> 00:13:04,125 because we haven't piled his plate on enough too 269 00:13:04,905 --> 00:13:06,605 for hod will be leading that work stream. 270 00:13:07,145 --> 00:13:09,325 And this is really, again, I think you're gonna see 271 00:13:09,705 --> 00:13:11,005 as we've seen this last year, 272 00:13:11,025 --> 00:13:13,125 and I just wanna really acknowledge both finance 273 00:13:14,285 --> 00:13:15,765 'cause Crystal really like kind 274 00:13:15,765 --> 00:13:17,805 of weaving finance into the strategy. 275 00:13:18,265 --> 00:13:20,605 And then also all of the gains 276 00:13:20,845 --> 00:13:23,205 with really business intelligence, which has really again, 277 00:13:23,715 --> 00:13:26,725 been a big for HOD 278 00:13:26,985 --> 00:13:29,005 and Crystal have really been thought leaders 279 00:13:29,185 --> 00:13:30,805 for our organization in this area. 280 00:13:31,495 --> 00:13:35,405 We've actually moved business intelligence under crystal, 281 00:13:35,495 --> 00:13:38,885 under finance and there will be a lot, 282 00:13:38,965 --> 00:13:41,685 I think you're gonna see as much change this coming year 283 00:13:41,685 --> 00:13:44,525 as we saw this last year with financial modeling, 284 00:13:45,155 --> 00:13:46,285 with modeling. 285 00:13:46,465 --> 00:13:49,565 And, and I think somebody floated a question to us tonight 286 00:13:49,585 --> 00:13:52,125 and even I think Dylan's 287 00:13:52,145 --> 00:13:54,525 or Sam is gonna come back with some modeling. 288 00:13:55,045 --> 00:13:56,765 We have the answer for you on one 289 00:13:56,765 --> 00:13:58,085 of your questions around access. 290 00:13:58,665 --> 00:14:02,205 But I think you're gonna see another quantum sort 291 00:14:02,205 --> 00:14:04,445 of gained this year around kind of finance 292 00:14:04,625 --> 00:14:07,285 and how finance really dovetails with the strategy. 293 00:14:07,705 --> 00:14:09,925 The affordability pilots is a really big deal. 294 00:14:09,925 --> 00:14:11,085 We're gonna talk about that tonight, 295 00:14:11,085 --> 00:14:14,645 but we're not gonna talk about like the pricing, we're going 296 00:14:14,645 --> 00:14:17,045 to talk about the communication piece of that tonight 297 00:14:17,045 --> 00:14:19,645 because as you know, we're rolling that out August 1st, 298 00:14:19,815 --> 00:14:21,285 which is very exciting. 299 00:14:22,005 --> 00:14:25,925 But it's also, you know, understandably nerve wracking 300 00:14:26,145 --> 00:14:28,725 for the staff, for our community. 301 00:14:28,745 --> 00:14:30,765 And we really want to make sure we do the work 302 00:14:30,765 --> 00:14:34,605 around communicating and we also want people to know 303 00:14:34,605 --> 00:14:36,245 that there are redundancy sort of there 304 00:14:36,905 --> 00:14:39,685 and we have sort of other pathways 305 00:14:39,745 --> 00:14:40,925 so that, that we're building. 306 00:14:41,065 --> 00:14:44,405 And so anyway, more on that so that 307 00:14:45,185 --> 00:14:46,485 if we can go to the next slide. 308 00:14:47,045 --> 00:14:49,325 I, I will just say that is our, before we, maybe 309 00:14:49,325 --> 00:14:50,765 before we go to that, sorry, if we can go back, 310 00:14:51,715 --> 00:14:53,685 that is our teams that are gonna be kind of, 311 00:14:54,215 --> 00:14:56,165 those people are carrying the balls down the 312 00:14:56,165 --> 00:14:57,245 field this, this year. 313 00:14:59,585 --> 00:15:02,325 So I don't know if anybody has any questions about that, 314 00:15:02,425 --> 00:15:04,485 but we'll be happy to answer those. 315 00:15:04,605 --> 00:15:05,925 I have many of them here in the audience, 316 00:15:06,345 --> 00:15:10,165 but I, I wanna just recognize Kim McCall who kind 317 00:15:10,165 --> 00:15:12,405 of has been working with the steering 318 00:15:12,405 --> 00:15:14,205 committee to put this together. 319 00:15:14,845 --> 00:15:17,805 'cause it, it's a, it's a lot of moving parts to figure out 320 00:15:17,945 --> 00:15:21,845 how, as you'll see, and I, I think we talked about this. 321 00:15:21,845 --> 00:15:23,405 Again, these are one of these things, I'm, 322 00:15:23,425 --> 00:15:27,165 I'm making a point to put a pin in a deliverable 323 00:15:27,425 --> 00:15:29,525 and that is, when I first came to talk to you, 324 00:15:29,645 --> 00:15:33,365 I talked about not a like kind of viewing the organization 325 00:15:33,365 --> 00:15:35,925 and the leadership team as a team, but as a system. 326 00:15:36,545 --> 00:15:39,605 And as you can see, this is more of a leadership system 327 00:15:40,025 --> 00:15:41,525 and there's a lot of overlap. 328 00:15:41,945 --> 00:15:44,965 And most of these leaders, like Dylan 329 00:15:45,265 --> 00:15:47,085 and Crystal were joking today. 330 00:15:47,085 --> 00:15:50,565 Like they've already kind of melded their teams together. 331 00:15:50,635 --> 00:15:52,165 Like they're not crystal's, 332 00:15:52,165 --> 00:15:53,885 like we're not making any decisions without each other 333 00:15:53,885 --> 00:15:56,205 because they're so intertwined and, 334 00:15:56,905 --> 00:16:01,605 and really it, this really does recognize 335 00:16:01,745 --> 00:16:04,685 and acknowledge the hard work of what it is 336 00:16:04,685 --> 00:16:07,485 to be the difference between being kind of a hospital 337 00:16:07,755 --> 00:16:10,965 with some clinics to being an integrated health system. 338 00:16:11,345 --> 00:16:14,125 And I, I, you know, it, it sounds really easy to say, 339 00:16:14,125 --> 00:16:16,285 but it's actually a big change. 340 00:16:16,665 --> 00:16:19,365 So I just wanna acknowledge all of the people 341 00:16:19,365 --> 00:16:21,405 who have signed up for this, we, nobody got a raise 342 00:16:21,505 --> 00:16:23,645 nor they even get a parking place for doing this. 343 00:16:23,705 --> 00:16:27,605 But what, but we really are gonna work on making sure 344 00:16:27,635 --> 00:16:29,925 that if, you know, for those who are stepping forward 345 00:16:29,925 --> 00:16:31,085 to both lead these teams 346 00:16:31,185 --> 00:16:34,005 and beyond these teams, we wanna make sure 347 00:16:34,005 --> 00:16:35,605 that they get the tools that they need 348 00:16:35,605 --> 00:16:38,445 and the support from the, from the, the leadership team 349 00:16:38,445 --> 00:16:40,605 as well as the board because we are asking them 350 00:16:40,665 --> 00:16:42,445 to lead change. 351 00:16:42,745 --> 00:16:45,485 And it's, even if it's a great thing, it's, 352 00:16:45,595 --> 00:16:46,965 it's hard to lead change. 353 00:16:46,985 --> 00:16:49,765 So I just wanna thank them all for, for doing 354 00:16:49,765 --> 00:16:51,485 that and for being with us. 355 00:16:52,145 --> 00:16:55,045 And now let's get to the happy stuff. 356 00:16:55,045 --> 00:16:58,325 There's those big scissors and I talked about that. 357 00:16:58,385 --> 00:17:01,605 So see the date, August 21st, we are opening, 358 00:17:02,065 --> 00:17:05,645 we are doing the ribbon cutting ceremony for an open house 359 00:17:05,825 --> 00:17:09,485 for the North Shore clinic over in 360 00:17:10,705 --> 00:17:14,565 Dollar Hill or Tahoe City or Fabian Way. 361 00:17:14,585 --> 00:17:16,525 It depends on who you are and how you reference it, 362 00:17:16,525 --> 00:17:17,525 but it's all the same place. 363 00:17:17,785 --> 00:17:18,965 That's what I've learned. 364 00:17:20,945 --> 00:17:24,685 But we'll be, we'll be we'll be doing that 2:00 PM 365 00:17:24,985 --> 00:17:28,005 and we hope that all of you as well 366 00:17:28,005 --> 00:17:30,045 as our community can join us that day. 367 00:17:30,105 --> 00:17:32,605 The care team will be on site, we'll be doing clinics. 368 00:17:33,245 --> 00:17:36,085 There will, there truly will be a big pair of scissors 369 00:17:36,085 --> 00:17:37,605 and somebody's gonna be doing those. 370 00:17:37,825 --> 00:17:41,245 And I think that there was a question about that 371 00:17:41,385 --> 00:17:42,965 and I wanna just pause for a second 372 00:17:43,265 --> 00:17:47,565 and ask if Dale, you wanted us to talk about 373 00:17:48,185 --> 00:17:51,095 the access, what this might mean to access, 374 00:17:51,965 --> 00:17:53,935 because we are prepared to answer that 375 00:17:55,155 --> 00:17:56,655 and so we can stop here 376 00:17:56,655 --> 00:17:58,375 or we can do it at the end of the talk. 377 00:17:58,645 --> 00:18:02,615 Well, I, I, I was gonna pull 14.3 0.1 from the agenda, 378 00:18:02,795 --> 00:18:04,695 but this is appropriate time too. 379 00:18:04,835 --> 00:18:07,935 If you think I, I would like to raise the question. We 380 00:18:07,935 --> 00:18:10,175 Can do it at 14, then we'll do it at 14. Okay. 381 00:18:10,845 --> 00:18:14,055 Consent. Oh, you, or talk about it. I mean, 382 00:18:14,685 --> 00:18:16,935 What do you prefer, Dale or Anybody? 383 00:18:16,995 --> 00:18:20,575 You tell me what if, if this is appropriate, Dylan, you, 384 00:18:21,285 --> 00:18:22,895 it's on topic, you can talk about it now, 385 00:18:22,955 --> 00:18:24,935 but if it's Yeah, it's on topic. 386 00:18:25,045 --> 00:18:27,535 Yeah, yeah. It's about this one topic. 387 00:18:27,605 --> 00:18:29,175 It's just timing. It was, yeah. 388 00:18:29,205 --> 00:18:30,415 Okay. So we could talk about it 389 00:18:30,415 --> 00:18:31,615 either place, but we could talk about there. 390 00:18:31,635 --> 00:18:32,655 So why don't you ask your question. 391 00:18:32,835 --> 00:18:36,335 So the question I, Sam, I, the question I raised actually 392 00:18:36,555 --> 00:18:41,095 for Brian Evans, our chief medical officer was, you know, 393 00:18:41,095 --> 00:18:44,905 it's one thing to open up new space for 394 00:18:45,625 --> 00:18:48,105 doctor's offices, but the question is how, 395 00:18:48,165 --> 00:18:50,905 how do we man them and how are we manning them? 396 00:18:53,005 --> 00:18:56,185 And Dylan wrote me back, he said, 397 00:18:56,185 --> 00:18:58,505 we have four new physicians coming in or, 398 00:18:59,005 --> 00:19:01,625 and some advanced 399 00:19:02,745 --> 00:19:04,625 practice providers. 400 00:19:04,725 --> 00:19:06,665 Is that, what am I saying that correctly? Yeah. 401 00:19:08,565 --> 00:19:12,845 And so the, the question I had was what kind 402 00:19:12,845 --> 00:19:15,265 of luck are we having? 403 00:19:15,535 --> 00:19:18,345 It's a two part question. What kinda luck are we having in 404 00:19:18,345 --> 00:19:20,585 getting people who want to work full time? 405 00:19:21,165 --> 00:19:22,905 Is there a new trend coming? 406 00:19:23,005 --> 00:19:27,345 Are we make it part of our, our our efforts to recruit? 407 00:19:28,725 --> 00:19:33,335 And also, are we going 408 00:19:33,335 --> 00:19:36,695 to improve our access significantly as a result 409 00:19:36,695 --> 00:19:37,815 of the opening of this office? 410 00:19:37,955 --> 00:19:39,015 Is there any estimate 411 00:19:39,155 --> 00:19:42,695 of much our access is gonna improve as a result? 412 00:19:43,275 --> 00:19:45,175 And those were the questions I had, so Great. 413 00:19:45,355 --> 00:19:46,695 I'm happy to answer that. Okay. 414 00:19:46,995 --> 00:19:49,335 And I'm Sam Smith, administrative medical director. 415 00:19:49,835 --> 00:19:51,055 So that's a great question. 416 00:19:51,535 --> 00:19:54,015 We actually have five new providers coming on board. 417 00:19:54,155 --> 00:19:57,695 So we have two advanced practice providers, 418 00:19:57,695 --> 00:20:00,135 they're nurse practitioners and three physicians 419 00:20:00,995 --> 00:20:04,415 and four out of five of those hires are full-time. 420 00:20:04,715 --> 00:20:06,495 So we are really excited for that. 421 00:20:06,515 --> 00:20:10,055 We feel like it's a very promising short-term trend. 422 00:20:10,455 --> 00:20:12,135 I don't know that we have enough information 423 00:20:12,155 --> 00:20:14,495 to project a long-term trend in terms of hiring, 424 00:20:14,675 --> 00:20:17,215 but it is our intent to open full-time positions 425 00:20:17,215 --> 00:20:18,895 because that's what we need. 426 00:20:18,895 --> 00:20:20,255 That's what our community needs. 427 00:20:21,115 --> 00:20:25,455 And so that's our intent as far as expanding access. 428 00:20:25,555 --> 00:20:28,055 We know that with those clinicians coming on board, 429 00:20:28,075 --> 00:20:32,375 we anticipate a 13% increase in volume for this fiscal year. 430 00:20:32,835 --> 00:20:35,575 And then an improvement in our third next available in 431 00:20:35,575 --> 00:20:39,775 primary care by 8% with those new providers coming on, which 432 00:20:40,245 --> 00:20:42,135 with projections thanks to Dylan 433 00:20:42,235 --> 00:20:43,615 and for ho taking a look at this, 434 00:20:43,825 --> 00:20:46,335 we're looking at about 3.2 days impact 435 00:20:46,335 --> 00:20:47,500 on our third next available. 436 00:20:48,985 --> 00:20:50,965 And so our current third next available 437 00:20:51,025 --> 00:20:52,725 for primary care is 41 days. 438 00:20:52,755 --> 00:20:55,045 That would bring us down to 37.8. 439 00:20:55,505 --> 00:20:58,165 So again, successful short term trend, 440 00:20:58,225 --> 00:20:59,565 I'm not sure we have enough information 441 00:20:59,565 --> 00:21:00,565 to project long term, 442 00:21:01,145 --> 00:21:03,605 but we're really excited about some of our moves in terms 443 00:21:03,605 --> 00:21:04,765 of opening up space 444 00:21:04,905 --> 00:21:07,125 and we're ready to keep the momentum going. 445 00:21:07,765 --> 00:21:08,885 A lot of interest in coming 446 00:21:08,885 --> 00:21:11,285 to this community that is not a problem. Yeah. 447 00:21:11,665 --> 00:21:13,765 And so during the interview process, 448 00:21:14,085 --> 00:21:16,485 I assume then you kind of say we're looking for full-time. 449 00:21:17,085 --> 00:21:18,565 Absolutely, yeah. And the, the positions 450 00:21:18,565 --> 00:21:19,605 are posted as full-time. 451 00:21:20,155 --> 00:21:21,285 This one position 452 00:21:21,355 --> 00:21:24,405 that was part-time was actually just a replacement position 453 00:21:25,225 --> 00:21:28,125 for me actually because ica, I came out 454 00:21:28,125 --> 00:21:29,805 of a part-time clinical practice. 455 00:21:29,805 --> 00:21:32,325 Okay. So that's why that one wasn't part-time. Yeah, 456 00:21:32,335 --> 00:21:33,335 Thank you. 457 00:21:33,335 --> 00:21:36,205 Yeah, Sam, these new positions, the ones 458 00:21:36,205 --> 00:21:38,365 that are gonna fill the space, it's their, 459 00:21:39,305 --> 00:21:41,645 The new space a gateway actually those are just gonna 460 00:21:41,645 --> 00:21:42,725 fill our current space. 461 00:21:42,865 --> 00:21:45,325 So most of those, four out of five 462 00:21:45,325 --> 00:21:47,885 of those clinicians are coming on in the next few months. 463 00:21:49,025 --> 00:21:50,845 And we'll be here in Truckee 464 00:21:50,865 --> 00:21:52,445 and then one of those positions, 465 00:21:52,655 --> 00:21:54,765 we're still looking at space planning, 466 00:21:54,905 --> 00:21:57,485 but potentially at the new North Shore clinic, 467 00:22:00,795 --> 00:22:04,415 How many positions are we looking for in total right now? 468 00:22:04,535 --> 00:22:06,335 I mean for the new clinic. And 469 00:22:07,225 --> 00:22:10,095 We're just starting to look at, we're not just starting, 470 00:22:10,235 --> 00:22:14,175 we are in the process of looking at, it's not as simple as 471 00:22:14,355 --> 00:22:15,855 how many FTE do we need? 472 00:22:15,855 --> 00:22:18,335 Because sometimes if you shift schedule slightly 473 00:22:18,475 --> 00:22:21,855 or time slightly, you actually open up a lot more space. 474 00:22:22,315 --> 00:22:23,415 And so we are in the process 475 00:22:23,475 --> 00:22:25,095 of really looking at that for Gateway. 476 00:22:27,935 --> 00:22:28,955 Do you wanna add something Dylan? 477 00:22:32,995 --> 00:22:35,685 Yeah, if I could just comment on the FTE projection. 478 00:22:35,785 --> 00:22:39,405 So in line with our investments that have been approved 479 00:22:39,405 --> 00:22:41,285 for this fiscal year with our mobile clinic, 480 00:22:41,465 --> 00:22:44,805 our telehealth services weekend after hours, 481 00:22:45,065 --> 00:22:47,645 and then in addition to the North Shore clinic, 482 00:22:47,735 --> 00:22:51,245 we'll also be realizing some capacities with the first phase 483 00:22:51,265 --> 00:22:52,565 of gateway scheduled 484 00:22:52,565 --> 00:22:54,605 to open at the later part of this fiscal year. 485 00:22:55,265 --> 00:22:57,125 So we are rebalancing, 486 00:22:57,275 --> 00:23:00,245 obviously there's been a high priority on access as well 487 00:23:00,245 --> 00:23:02,125 as visit volume for both of those. 488 00:23:02,545 --> 00:23:03,965 And we're complimenting both. 489 00:23:04,145 --> 00:23:07,365 So we do have FTE projections for both of those. 490 00:23:07,625 --> 00:23:11,885 We appreciate the board goals and incentives put on those. 491 00:23:11,985 --> 00:23:14,445 So we are trying to maximize the space 492 00:23:14,585 --> 00:23:15,885 and realize those gains 493 00:23:15,885 --> 00:23:17,885 and access capacities as soon as possible. 494 00:23:18,345 --> 00:23:21,605 And we're actually considering some additional 495 00:23:21,705 --> 00:23:23,605 and changing some strategic plans 496 00:23:24,385 --> 00:23:26,165 to realize those as quick as possible. 497 00:23:29,925 --> 00:23:32,105 And as a reminder, I was gonna say, don't, 498 00:23:32,105 --> 00:23:35,625 don't go too far away, Dylan, as a reminder, not all, 499 00:23:35,805 --> 00:23:38,825 you know, not it won't, it not everything is going 500 00:23:38,825 --> 00:23:42,105 to be an FTE, you know, some of it's going to be, 501 00:23:42,105 --> 00:23:44,345 we're going to bring in more vir virtual providers. 502 00:23:44,425 --> 00:23:48,065 I think that was really, you know, that really speaks 503 00:23:48,085 --> 00:23:51,025 to kind of the importance around the credentialing 504 00:23:51,045 --> 00:23:54,065 and that sort of, you know, the cycle times around that. 505 00:23:54,485 --> 00:23:58,825 But also we are looking at considering 506 00:23:59,885 --> 00:24:00,905 either our partner 507 00:24:01,125 --> 00:24:05,065 or even our own, our own staff around extending hours too. 508 00:24:05,245 --> 00:24:07,865 So it's not just gonna be a kind of a one for one. 509 00:24:07,865 --> 00:24:08,985 We're kind of looking at all of it. 510 00:24:09,885 --> 00:24:12,385 So just as a reminder. Yeah. Can 511 00:24:12,385 --> 00:24:13,385 I add one thing? 512 00:24:13,385 --> 00:24:15,425 Yeah. I would say too, to build on that, 513 00:24:15,455 --> 00:24:17,025 it's also about the care delivery model. 514 00:24:17,125 --> 00:24:20,945 So sometimes you have two FTEs 515 00:24:21,245 --> 00:24:24,865 and you can actually, based on changing some efficiencies 516 00:24:24,975 --> 00:24:26,745 that make it easier for patients 517 00:24:26,885 --> 00:24:29,465 and our clinicians, we can actually make them 518 00:24:30,805 --> 00:24:32,825 be a lot more efficient just if they work together 519 00:24:32,845 --> 00:24:33,945 in a specific kind of way. 520 00:24:33,965 --> 00:24:36,065 So we're starting to explore those care delivery models. 521 00:24:40,965 --> 00:24:43,565 Yeah, thank you. It's a good question. 522 00:24:45,985 --> 00:24:49,925 So, so we'll see you on August 21st 523 00:24:49,985 --> 00:24:53,005 and I think there, there will be some more, you know, 524 00:24:53,005 --> 00:24:56,285 social media and that sort of thing, inviting the, 525 00:24:56,425 --> 00:24:57,485 the local community. 526 00:24:58,245 --> 00:25:00,325 I think that there also is gonna be some stuff 527 00:25:00,325 --> 00:25:01,525 out in Tahoe City. 528 00:25:02,225 --> 00:25:04,165 So we will, we'll look forward to seeing everybody. 529 00:25:04,195 --> 00:25:06,485 Then if we go to the next slide, 530 00:25:06,525 --> 00:25:08,685 I wanna talk a little bit about community guided 531 00:25:08,865 --> 00:25:12,045 and we actually, I'm gonna invite Lauren to come up 532 00:25:12,325 --> 00:25:14,045 and I just wanted to talk a little bit about, 533 00:25:14,835 --> 00:25:17,325 I'll talk about, I'll talk from the right 534 00:25:17,435 --> 00:25:18,765 side to, and we'll go left. 535 00:25:19,025 --> 00:25:22,445 But I do, I just wanna say that we had a great 536 00:25:24,085 --> 00:25:26,285 presence at the Truckee 4th of July parade. 537 00:25:27,065 --> 00:25:31,485 We had thousands of residents and visitors visit our table. 538 00:25:31,765 --> 00:25:34,045 I I just wanna really acknowledge Lauren 539 00:25:34,265 --> 00:25:35,485 and team that was there. 540 00:25:35,665 --> 00:25:39,285 It was, it was, it was a very busy table. 541 00:25:39,625 --> 00:25:41,805 And I know when our intern was there, 542 00:25:41,825 --> 00:25:44,525 we had an intern there, we had some of our HR was there, 543 00:25:44,865 --> 00:25:46,045 we had community health there. 544 00:25:46,785 --> 00:25:50,405 So it was, I saw our t-shirts on people 545 00:25:50,405 --> 00:25:51,445 like all over the parade. 546 00:25:51,905 --> 00:25:53,325 So again, I think we 547 00:25:53,685 --> 00:25:55,765 provided, you know, you know, a lot of information, 548 00:25:56,945 --> 00:25:59,725 but also just presence in the, in these community events. 549 00:25:59,725 --> 00:26:00,725 It, it's really important. 550 00:26:00,745 --> 00:26:03,365 So I just wanna acknowledge our team for, while many 551 00:26:03,365 --> 00:26:04,485 of us were at barbecues 552 00:26:04,485 --> 00:26:05,965 and stuff, they were out working that table 553 00:26:06,665 --> 00:26:08,085 and it was pretty hot that day. 554 00:26:09,305 --> 00:26:10,525 You know, the navigation center. 555 00:26:10,685 --> 00:26:13,845 I wanna just remind the board 556 00:26:14,145 --> 00:26:16,085 or just thank the board, acknowledge the board 557 00:26:16,105 --> 00:26:19,365 for the navigation center supporting that navigation center. 558 00:26:19,715 --> 00:26:24,245 That navigation center has stayed at 94% capacity 559 00:26:24,935 --> 00:26:25,965 throughout the year. 560 00:26:26,305 --> 00:26:30,085 It has been, as you recall, this is a 16 bed facility, 561 00:26:30,185 --> 00:26:32,805 six beds of them are, are interim housing 562 00:26:33,105 --> 00:26:36,685 and 10 of them are emergency. 563 00:26:39,295 --> 00:26:40,475 We don't call it shelter anymore, 564 00:26:40,475 --> 00:26:43,725 but the emergency, the short term emergency bed beds. 565 00:26:44,625 --> 00:26:48,565 And it's one of the things that I think that I, I know that, 566 00:26:48,625 --> 00:26:52,805 and I know that Alice is your representative on the, the TAC 567 00:26:52,805 --> 00:26:56,645 and, and Ted Owens, of course has been on that also. 568 00:26:56,645 --> 00:26:59,725 And he's, he's actually at a different, he has a different 569 00:27:00,285 --> 00:27:01,885 conflict tonight that, so he couldn't be here. 570 00:27:01,985 --> 00:27:04,965 But this has been such a critical 571 00:27:07,395 --> 00:27:09,945 asset to add to the, the, this region. 572 00:27:10,365 --> 00:27:14,425 And it's sometimes these numbers at the 94% bed occupancy. 573 00:27:14,765 --> 00:27:17,785 It doesn't, what we don't have now though, 574 00:27:17,855 --> 00:27:21,505 because our volumes were never super high, is like how 575 00:27:21,505 --> 00:27:22,705 to measure what didn't happen. 576 00:27:23,245 --> 00:27:26,825 But there was so many, you know, 577 00:27:26,845 --> 00:27:29,185 our emergency room didn't, you know, have people 578 00:27:29,705 --> 00:27:31,825 spending the night throughout the, the winter, 579 00:27:31,825 --> 00:27:34,545 through the winter, once this, once this 580 00:27:35,115 --> 00:27:36,385 navigation center opened. 581 00:27:36,965 --> 00:27:38,105 And that allows 582 00:27:38,165 --> 00:27:41,105 for throughput within the emergency department is just, 583 00:27:41,325 --> 00:27:42,825 our emergency department is designed 584 00:27:42,825 --> 00:27:45,185 to provide emergency care, not provide shelter. 585 00:27:45,365 --> 00:27:46,825 So it's very disruptive. 586 00:27:46,935 --> 00:27:48,905 It's, even though it may feel like 587 00:27:48,905 --> 00:27:50,265 to people like, what's the big deal? 588 00:27:50,415 --> 00:27:51,905 Like it's, they're just sitting there. 589 00:27:51,925 --> 00:27:54,505 It is, it's very, it's it's just not designed for that. 590 00:27:54,925 --> 00:27:58,785 So it's really hard to put words to how much it has meant. 591 00:27:58,805 --> 00:28:01,105 But you know, I, I know that Dr. 592 00:28:01,255 --> 00:28:04,585 Gladman has been a, a staun champion of this 593 00:28:04,685 --> 00:28:09,065 and has been really a, you know, advocating leader 594 00:28:09,165 --> 00:28:11,465 around kind of the importance of this navigation center. 595 00:28:11,685 --> 00:28:13,465 And I just wanna recognize and thank the board. 596 00:28:13,485 --> 00:28:16,945 And I also wanna remind you that in October we're going to, 597 00:28:16,945 --> 00:28:19,625 we're planning to, we're trying to work on our schedules 598 00:28:19,625 --> 00:28:22,105 and have a joint meeting with the town of Truckee 599 00:28:22,285 --> 00:28:23,305 to talk about kind of 600 00:28:23,305 --> 00:28:24,705 what happened in those first six months. 601 00:28:24,705 --> 00:28:25,785 So we'll have a lot more data. 602 00:28:25,885 --> 00:28:27,905 So this is just giving you a snapshot. 603 00:28:27,905 --> 00:28:30,185 There'll be a lot more data, we'll hear from the te cac, 604 00:28:30,965 --> 00:28:32,345 you know, in person and probably 605 00:28:32,345 --> 00:28:33,785 and from Volunteers of America 606 00:28:34,165 --> 00:28:36,305 and the other people who are kind of in, you know, 607 00:28:36,305 --> 00:28:37,385 much closer to that work. 608 00:28:37,885 --> 00:28:40,305 And then finally, I wanted to invite Lauren up 609 00:28:40,305 --> 00:28:43,345 to talk a little bit about the next two items and, 610 00:28:43,445 --> 00:28:46,425 and so Lauren, without further ado, I'll just hand to you. 611 00:28:47,585 --> 00:28:49,735 Thank you so much for being pleasure. 612 00:28:49,935 --> 00:28:52,015 My name's Lauren, I'm director of community health 613 00:28:52,155 --> 00:28:54,135 and I have a distinct honor 614 00:28:54,435 --> 00:28:58,295 and humbly to present the Tower Forest. I'm sorry. 615 00:28:58,685 --> 00:29:00,695 Nope. Just gonna keep talking on my own. There we go. 616 00:29:02,495 --> 00:29:05,995 Should I repeat myself or are we good? Okay, excellent. 617 00:29:06,285 --> 00:29:08,635 Sorry you guys, the distinct honor 618 00:29:08,655 --> 00:29:11,355 to present the Tower Forest Community Partnership Award 619 00:29:11,535 --> 00:29:13,035 to the Sierra Community House. 620 00:29:13,615 --> 00:29:17,755 And this award is really to honor the incredible dedication 621 00:29:17,755 --> 00:29:19,755 that Sierra Community House provides 622 00:29:19,815 --> 00:29:21,635 to community partners from incline 623 00:29:22,175 --> 00:29:24,195 all the way throughout our entire hospital district. 624 00:29:24,615 --> 00:29:27,155 And what this award is, is it's $150,000 625 00:29:27,575 --> 00:29:29,275 and I just wanna read real quick what it is. 626 00:29:29,375 --> 00:29:30,475 I'm happy to answer questions 627 00:29:30,475 --> 00:29:34,875 and then also present it to anal Cordova Sosa, 628 00:29:34,875 --> 00:29:36,395 who is the deputy Executive director 629 00:29:36,395 --> 00:29:37,475 of the Sierra Community House. 630 00:29:38,175 --> 00:29:40,515 So the community partnership award provides, 631 00:29:40,825 --> 00:29:44,325 will provide flexible food access for, and that's $100,000. 632 00:29:44,865 --> 00:29:47,765 And then the second $50,000 is to support 633 00:29:47,765 --> 00:29:48,925 and design the implementation 634 00:29:48,925 --> 00:29:52,405 of a collaborative pilot initiative led in partnership 635 00:29:52,405 --> 00:29:53,925 with the Tahoe Forest Hospital District 636 00:29:54,105 --> 00:29:55,845 and the, the Sierra Community House 637 00:29:56,145 --> 00:29:58,805 to develop a coordinated community informed project 638 00:29:59,065 --> 00:30:00,765 to explore an innovative approach 639 00:30:00,765 --> 00:30:02,445 to food insecurity in our region. 640 00:30:03,405 --> 00:30:04,465 So just wanna be able to, 641 00:30:05,695 --> 00:30:06,695 Same thing. 642 00:30:10,715 --> 00:30:13,625 Thank you very much. We we're so grateful 643 00:30:13,805 --> 00:30:15,345 for our partnership 644 00:30:15,525 --> 00:30:18,665 and our collaboration for so many, so many years. 645 00:30:19,665 --> 00:30:24,625 I can, I can say that literally thousands 646 00:30:24,885 --> 00:30:28,465 of of community members in the last 647 00:30:29,405 --> 00:30:34,385 10 plus years of our collaboration have had the chance 648 00:30:34,405 --> 00:30:37,385 to access services and supports that 649 00:30:37,735 --> 00:30:42,545 otherwise would've not had the chance of accessing. 650 00:30:42,805 --> 00:30:45,185 So thank you very much for your support, 651 00:30:45,185 --> 00:30:46,945 your continued support. 652 00:30:47,005 --> 00:30:50,825 And we are so excited in particular about this, this topic. 653 00:30:50,935 --> 00:30:54,725 Food security, we serve around 60, 654 00:30:56,025 --> 00:30:59,605 I'm sorry, 600 families households 655 00:31:00,775 --> 00:31:02,565 every week in the, 656 00:31:02,585 --> 00:31:05,805 in the entire North Tahoe Track region. 657 00:31:06,465 --> 00:31:11,285 So this is critical support for the community 658 00:31:11,285 --> 00:31:12,925 and we are so grateful that, that we have your, 659 00:31:14,175 --> 00:31:18,645 we're support, continued support to, to be able to continue 660 00:31:19,975 --> 00:31:23,365 supporting our community members with, with the type of 661 00:31:23,385 --> 00:31:25,125 of need they, they have. 662 00:31:25,265 --> 00:31:27,845 So thank you very much again. Thank you. Yeah. 663 00:31:30,555 --> 00:31:32,855 And I just wanna say that this award really emerged 664 00:31:32,855 --> 00:31:35,815 to help honor the incredible financial pressure 665 00:31:35,815 --> 00:31:38,455 that is on the CER community house distinctly right now 666 00:31:38,805 --> 00:31:41,855 with the changing financial security of families 667 00:31:41,875 --> 00:31:43,535 and also the cost of resources. 668 00:31:43,595 --> 00:31:45,495 So for the hospital district to be able 669 00:31:45,495 --> 00:31:48,135 to step in at this critical point and give that flexibility 670 00:31:48,155 --> 00:31:50,815 and provision of services is, is huge. 671 00:31:50,875 --> 00:31:54,735 So thank you for the incredible support across the community 672 00:31:54,735 --> 00:31:57,215 and the board and we're excited about the pilot all 673 00:31:57,315 --> 00:32:00,285 as well. Any questions or? 674 00:32:00,675 --> 00:32:03,725 Yeah, I would hope please. Thank you. 675 00:32:06,185 --> 00:32:08,565 I'd be curious when you, when you figure out that 676 00:32:08,565 --> 00:32:11,165 that second $50,000 and, 677 00:32:11,165 --> 00:32:14,805 and the creative ways that we can expand the, 678 00:32:14,825 --> 00:32:16,005 the food accessibility 679 00:32:16,105 --> 00:32:18,565 and the like, would you come back and let us know? 680 00:32:18,785 --> 00:32:22,405 Oh yes, Mary, I'll always come back and talk about it. 681 00:32:23,235 --> 00:32:26,205 This is, this exciting pilot is actually, the goal of it is 682 00:32:26,205 --> 00:32:28,525 to really produce a program 683 00:32:28,635 --> 00:32:31,005 that will have pilot data evaluation 684 00:32:31,025 --> 00:32:33,285 and be ready for a full proposal to pitch either 685 00:32:33,305 --> 00:32:35,925 to the foundation or to a federal or state grant. 686 00:32:35,945 --> 00:32:39,045 So the real key is to get work with partners to understand 687 00:32:39,210 --> 00:32:41,685 what barriers are and try something new, flexible, 688 00:32:41,685 --> 00:32:42,725 innovative that they might 689 00:32:42,725 --> 00:32:45,245 otherwise not have been able to do, maybe with a little bit 690 00:32:45,245 --> 00:32:46,685 of risk and evaluate it 691 00:32:46,685 --> 00:32:48,805 and then be able to dial in for a project that goes 692 00:32:48,805 --> 00:32:49,965 to a bigger grant source. 693 00:32:50,225 --> 00:32:51,885 So we will absolutely report out. 694 00:32:53,965 --> 00:32:56,915 Thank you. Thank 695 00:32:56,915 --> 00:32:57,915 You. 696 00:32:57,915 --> 00:32:58,555 Thank you. Don't sit down yet, Lauren. 697 00:33:02,075 --> 00:33:04,405 Yeah, so it, you know, 698 00:33:04,425 --> 00:33:07,245 and I just, I too wanna just say how, 699 00:33:09,495 --> 00:33:12,795 How critical Sierra Community House is for our community 700 00:33:12,935 --> 00:33:16,635 and really we're just so pleased to be able to have 701 00:33:17,155 --> 00:33:19,275 such a rich resource in this region 702 00:33:20,095 --> 00:33:21,715 and with such deep connections and, 703 00:33:21,735 --> 00:33:23,115 and frankly we look to, 704 00:33:24,615 --> 00:33:27,075 to organizations like Sierra Community House 705 00:33:27,095 --> 00:33:28,595 to really understand 706 00:33:28,695 --> 00:33:30,595 how did you create those deep connections. 707 00:33:30,795 --> 00:33:34,795 'cause we really aspire to follow you in 708 00:33:34,795 --> 00:33:36,515 that path deep into the community. 709 00:33:37,815 --> 00:33:40,595 And on that note, it's a, it's a little bit unusual for us, 710 00:33:40,615 --> 00:33:43,835 but actually Tahoe Forest got an award this last month 711 00:33:44,975 --> 00:33:48,715 and that was really, we were recognized, we were selected 712 00:33:48,775 --> 00:33:52,555 as the, as the community partnership award recipient 713 00:33:53,265 --> 00:33:54,595 from Angel Flight West. 714 00:33:54,785 --> 00:33:57,755 This is a network of volunteer pilots 715 00:33:57,755 --> 00:34:00,755 that provide medical transportation to people in need. 716 00:34:01,935 --> 00:34:05,715 And they have been working with us since 2012 and have 717 00:34:05,995 --> 00:34:10,075 provided more than 150 flights transports. 718 00:34:10,615 --> 00:34:12,075 And so Lauren accepted that 719 00:34:14,805 --> 00:34:17,475 award on behalf of our system along with me, 720 00:34:17,475 --> 00:34:20,715 and they actually flew out here to, to give us this award. 721 00:34:20,715 --> 00:34:22,795 And it was a, it was a, it was lovely. 722 00:34:22,865 --> 00:34:25,755 They, we tried, we could not get them lined up 723 00:34:25,755 --> 00:34:27,315 with a board meeting because 724 00:34:27,555 --> 00:34:28,675 apparently they have to fly to a lot of places. 725 00:34:29,455 --> 00:34:33,355 But again, I think this is is just another 726 00:34:34,505 --> 00:34:38,315 example of work that we've been doing in the community 727 00:34:38,315 --> 00:34:40,315 that I think to some degree we're pretty, 728 00:34:40,485 --> 00:34:42,595 we're we're pretty modest and quiet about, 729 00:34:42,695 --> 00:34:45,235 but actually we really wanna start sort 730 00:34:45,235 --> 00:34:47,355 of lifting this a little bit so that the board, 731 00:34:47,535 --> 00:34:49,915 not only the board, but our community really understands 732 00:34:49,915 --> 00:34:51,955 kind of the, the, the role 733 00:34:51,955 --> 00:34:54,395 that we're playing in this region. 734 00:34:54,575 --> 00:34:56,515 And it isn't always that we are the provider, 735 00:34:56,685 --> 00:34:59,515 maybe we are the bridge to the, to a to a provider 736 00:34:59,515 --> 00:35:00,915 that's better suited and, 737 00:35:00,935 --> 00:35:03,035 and it's really an honor to be able to work with 738 00:35:04,065 --> 00:35:07,595 community organizations like Sierra Community House 739 00:35:07,595 --> 00:35:10,275 and Angel Flight West and, and many others. 740 00:35:10,495 --> 00:35:12,435 So just wanted to acknowledge that. 741 00:35:12,455 --> 00:35:14,835 And Lauren is is out there 742 00:35:15,465 --> 00:35:17,955 because as you know, she's working on the mobile clinic, 743 00:35:18,045 --> 00:35:19,195 she's out there, she's meeting 744 00:35:19,215 --> 00:35:20,995 and greeting everybody now she's got our 745 00:35:20,995 --> 00:35:22,355 clinics guy going everywhere. 746 00:35:23,895 --> 00:35:27,875 So I just wanna again, recognize Lauren in the, in the work 747 00:35:27,995 --> 00:35:31,915 that she's doing on that and just express gratitude 748 00:35:31,915 --> 00:35:32,915 For that. 749 00:35:32,915 --> 00:35:33,955 Thank you. And just real quick note, 750 00:35:33,955 --> 00:35:35,835 this is the first time they've ever given a community 751 00:35:35,835 --> 00:35:37,285 partnership award, angel Flight West, 752 00:35:37,465 --> 00:35:38,605 and they serve 12 states 753 00:35:38,665 --> 00:35:40,805 and we're the first healthcare system they chose. 754 00:35:41,065 --> 00:35:44,405 So it's, it was really exciting. So thank you so much. 755 00:35:44,795 --> 00:35:49,105 Yeah. And finally, 756 00:35:49,205 --> 00:35:51,625 I'm gonna end on a high note, a really high note. 757 00:35:52,885 --> 00:35:56,185 So this is really another safe date. 758 00:35:57,055 --> 00:35:58,705 This is September 25th. 759 00:35:58,765 --> 00:36:01,185 We are doing our, what we were calling 760 00:36:01,205 --> 00:36:02,665 before the fall forum. 761 00:36:02,675 --> 00:36:04,425 We're now calling it beyond possible. 762 00:36:05,135 --> 00:36:07,385 This is, you know, we'll also feature 763 00:36:08,165 --> 00:36:11,265 the Thomas Hobb Day medical lectureship, our keynote, 764 00:36:11,445 --> 00:36:12,665 we have two keynotes. 765 00:36:13,245 --> 00:36:16,265 Dr. Dal will be the Thomas Hobb Hobday medical 766 00:36:16,535 --> 00:36:17,625 lectureship speaker. 767 00:36:18,465 --> 00:36:21,025 And he is an expert on AI 768 00:36:21,285 --> 00:36:24,105 and its impact on medical care. 769 00:36:25,095 --> 00:36:26,585 He's a very dynamic speaker. 770 00:36:27,685 --> 00:36:30,065 I'm very grateful to Dr. Evans for booking him 771 00:36:30,065 --> 00:36:33,945 before he was featured in the Atlantic because, but 772 00:36:34,305 --> 00:36:35,945 because then everybody wanted to book him. 773 00:36:36,525 --> 00:36:40,705 But also I think just really, really exciting, I mean is 774 00:36:40,705 --> 00:36:44,625 that we are also gonna have Jim Morrison, who, 775 00:36:46,125 --> 00:36:49,825 as some of you may know, who is the first person to 776 00:36:51,595 --> 00:36:54,135 ski down the north side of Mount Everest. 777 00:36:54,995 --> 00:36:58,255 And not, and not only that, he was the sixth person 778 00:36:58,975 --> 00:37:01,695 because only five people had ever ha had ever 779 00:37:01,695 --> 00:37:03,015 summited on the north side. 780 00:37:03,315 --> 00:37:06,055 So he's like part of the team of, it's really six 781 00:37:06,055 --> 00:37:07,895 through, there was 12 people with him. 782 00:37:08,275 --> 00:37:12,575 But he will be coming to, to provide us 783 00:37:12,575 --> 00:37:13,975 with some inspiration 784 00:37:14,835 --> 00:37:19,375 and really talk about kind of how one even sets out to do, 785 00:37:20,155 --> 00:37:22,575 do you know, to think outside of the boundaries. 786 00:37:23,715 --> 00:37:25,695 The other, the other group that isn't on here. 787 00:37:25,695 --> 00:37:27,455 But, we'll, you know, this is sort of, 788 00:37:27,455 --> 00:37:30,735 you'll be getting now regular, I think regular updates 789 00:37:30,755 --> 00:37:33,735 and advertising invites to come to this, to the forum. 790 00:37:34,315 --> 00:37:38,855 And that will be, we are also going to have a panel 791 00:37:38,875 --> 00:37:41,415 of medical experts, our, of our medical staff. 792 00:37:41,635 --> 00:37:44,095 And Sam, do you know who those they are? I know it's Dr. 793 00:37:45,875 --> 00:37:49,835 Rad and I know, say Dr. Cooper. Oh, Dr. 794 00:37:50,055 --> 00:37:52,375 Bey knows we, 795 00:37:55,575 --> 00:37:58,125 we'll have a, a group of lo inter local, 796 00:37:58,825 --> 00:38:00,165 our own medical experts. 797 00:38:00,225 --> 00:38:03,005 So your care providers will be there on stage 798 00:38:03,465 --> 00:38:06,205 and you know, if you are a member of the community, 799 00:38:06,205 --> 00:38:07,805 you can come and you can ask them anything. 800 00:38:08,745 --> 00:38:10,285 And that will be facilitated. 801 00:38:10,285 --> 00:38:15,065 And then we also are gonna have the north, 802 00:38:16,185 --> 00:38:19,145 the, the search and rescue, the North Lake Tahoe search 803 00:38:19,165 --> 00:38:21,745 and rescue team, is that what they're called? 804 00:38:22,125 --> 00:38:23,985 The North Lake Tahoe Search and Rescue team. 805 00:38:24,645 --> 00:38:25,985 And they're gonna, and then we, 806 00:38:26,165 --> 00:38:29,945 and so that we have some exciting facilitation happening 807 00:38:30,085 --> 00:38:32,585 and so, you know, come bring your tennis shoes. 808 00:38:33,065 --> 00:38:35,105 I don't know what's gonna happen, but it sounds like it's 809 00:38:35,205 --> 00:38:36,245 gonna be a really exciting day. 810 00:38:36,665 --> 00:38:40,245 But, you know, I think what, what, what the purpose of the 811 00:38:40,905 --> 00:38:44,085 really, this is partly to create a space for our own staff 812 00:38:44,225 --> 00:38:47,805 to really see the abundance in this region 813 00:38:48,345 --> 00:38:52,205 and really tap into kind of the thinking that some 814 00:38:52,225 --> 00:38:53,525 of these people who kind 815 00:38:53,565 --> 00:38:55,165 of have thought in totally different ways, 816 00:38:55,905 --> 00:38:59,405 but also also highlight some 817 00:38:59,405 --> 00:39:00,845 of our staff because they're incredible. 818 00:39:01,825 --> 00:39:04,605 And so I think we wanted to kind of both give them a day 819 00:39:04,785 --> 00:39:08,085 for kind of learning and inspiration, 820 00:39:08,085 --> 00:39:11,245 but also we, we were so impressed with our own staff 821 00:39:11,245 --> 00:39:13,205 that we also wanted to feature them too. 822 00:39:13,345 --> 00:39:15,045 So I think we're kind of, we're, 823 00:39:15,055 --> 00:39:16,325 we're trying to balance that. 824 00:39:16,325 --> 00:39:18,245 So we don't put 'em to work too much that day, 825 00:39:18,585 --> 00:39:20,005 but I think it's gonna be a really, 826 00:39:20,965 --> 00:39:23,285 a really interesting day. 827 00:39:23,465 --> 00:39:26,365 And I think what we are hoping to come out of this is that, 828 00:39:26,625 --> 00:39:28,045 you know, a deeper partnership 829 00:39:28,985 --> 00:39:32,045 and ideas around how we can collaborate with our community 830 00:39:32,305 --> 00:39:34,805 to kind of achieve and move beyond kind of what, 831 00:39:35,195 --> 00:39:37,125 what we're all, what everyone else is doing. 832 00:39:37,185 --> 00:39:40,245 And kind of think about things that feel like they're, 833 00:39:41,225 --> 00:39:44,645 you know, because of all the change and technology 834 00:39:44,645 --> 00:39:47,885 and stuff, it just kind of changes the adjacent possible. 835 00:39:48,525 --> 00:39:51,325 And so I think, again, these are people who kind of 836 00:39:51,835 --> 00:39:53,405 went like, okay, well that's what everybody, 837 00:39:53,405 --> 00:39:55,205 most everybody does, but we're gonna go do this. 838 00:39:55,345 --> 00:39:59,285 And so I think again, it, which is I think really aligned 839 00:39:59,285 --> 00:40:00,525 with the Tahoe Forest spirit. 840 00:40:00,945 --> 00:40:02,845 So I think it's gonna be a great day. 841 00:40:02,845 --> 00:40:03,885 And those are my highlights. 842 00:40:04,345 --> 00:40:05,725 I'm happy to answer any questions. 843 00:40:05,805 --> 00:40:09,485 I think we kind of talk through most of it as it went, 844 00:40:09,545 --> 00:40:12,685 but happy to answer any questions or hand back to the chair. 845 00:40:14,135 --> 00:40:15,705 Wonderful highlights as always. 846 00:40:15,805 --> 00:40:16,905 Yes, we did have questions throughout, 847 00:40:16,905 --> 00:40:18,785 but any additional comments, questions from the board? 848 00:40:19,855 --> 00:40:23,865 I've got one. Wonderful. If I could back to this 849 00:40:24,845 --> 00:40:26,505 med staff engagement all, 850 00:40:26,625 --> 00:40:28,265 I think we've called it alignment too. 851 00:40:29,605 --> 00:40:33,265 Are those words used interchangeably, engagement, alignment? 852 00:40:36,325 --> 00:40:39,185 The experts over there are, yeah. Si come on up. 853 00:40:40,605 --> 00:40:43,945 You know, I, I think we've called it lots of things. Yeah. 854 00:40:43,945 --> 00:40:45,185 And I think that's that, you know, 855 00:40:45,185 --> 00:40:48,425 and I think that, I think we're all, we're, we're trying 856 00:40:48,425 --> 00:40:49,465 to aim in a certain direction, 857 00:40:49,465 --> 00:40:52,785 but we're trying to really now institutionalize kind 858 00:40:52,785 --> 00:40:54,105 of amplifying the voice 859 00:40:54,325 --> 00:40:58,025 and the position of the med staff in decision making. And, 860 00:40:58,935 --> 00:41:00,265 Okay, well here, here's my question. 861 00:41:00,525 --> 00:41:03,505 You know, fortunately in case of Crystal's work, 862 00:41:03,825 --> 00:41:06,625 I mean we know when our finances are made 863 00:41:06,625 --> 00:41:08,545 or they're not made, you set a goal, 864 00:41:08,545 --> 00:41:09,945 you either make it or you don't make it. 865 00:41:10,375 --> 00:41:13,385 Same with the patient satisfaction scores, et cetera. 866 00:41:14,045 --> 00:41:18,865 But physician alignment in the past years has been a, 867 00:41:19,815 --> 00:41:21,675 an issue with this hospital 868 00:41:21,935 --> 00:41:26,315 and ultimately led to us hiring you 869 00:41:26,335 --> 00:41:30,435 as you well know, because of the issues that we were having 870 00:41:30,465 --> 00:41:34,125 with, with physicians not being as aligned 871 00:41:34,465 --> 00:41:36,765 or engaged with the operation at 872 00:41:36,765 --> 00:41:37,765 His. 873 00:41:37,765 --> 00:41:41,645 I just wanna make sure this is tied to agenda item. Is it 874 00:41:42,175 --> 00:41:43,175 Right here? 875 00:41:43,175 --> 00:41:43,805 Medical staff? Yeah, 876 00:41:44,335 --> 00:41:45,385 Medical staff. Which 877 00:41:45,645 --> 00:41:47,865 He is, I think he's referring to the team. Yeah, 878 00:41:47,925 --> 00:41:48,925 The teams. 879 00:41:48,925 --> 00:41:51,385 So the medical staff partnership on transformation. 880 00:41:51,535 --> 00:41:52,905 Yeah, it was on there. 881 00:41:53,445 --> 00:41:55,865 So, so the question I'm I'm getting to is 882 00:41:57,125 --> 00:42:00,345 how are we going about measuring, how will we know 883 00:42:00,975 --> 00:42:04,145 when we are finally aligned, engaged? 884 00:42:05,585 --> 00:42:07,645 Is there some magic 885 00:42:10,165 --> 00:42:12,545 You can take it and then I'm happy to jump in after. 886 00:42:12,775 --> 00:42:13,945 Yeah, yeah. This is, 887 00:42:14,885 --> 00:42:16,705 So in answering your question, alignment 888 00:42:16,805 --> 00:42:18,385 and engagement are slightly different. 889 00:42:18,385 --> 00:42:22,225 They're not interchangeable. As was mentioned earlier. 890 00:42:22,745 --> 00:42:25,425 I think the scope of this work stream is gonna go on. You 891 00:42:25,425 --> 00:42:26,945 Turn the microphone What red 892 00:42:27,995 --> 00:42:28,995 Now is it on? 893 00:42:28,995 --> 00:42:30,535 Oh, it was on before we left it on. 894 00:42:31,195 --> 00:42:32,735 So to answer your question, alignment 895 00:42:32,795 --> 00:42:34,575 and engagement are slightly different. 896 00:42:35,635 --> 00:42:38,215 The scope of this project I think will be broad. 897 00:42:38,275 --> 00:42:40,055 It hasn't been completely defined 898 00:42:40,055 --> 00:42:42,335 because really what we wanna do is work 899 00:42:42,335 --> 00:42:46,135 with the medical staff to look at some of our direction 900 00:42:46,135 --> 00:42:48,335 that's on here and really look at 901 00:42:48,335 --> 00:42:49,695 opportunities for how to improve. 902 00:42:49,875 --> 00:42:53,375 So what we, it's beyond just a Press Ganey survey, right? 903 00:42:53,485 --> 00:42:57,415 It's like how much is the medical staff rowing in the same 904 00:42:57,415 --> 00:42:58,895 direction as the board 905 00:42:58,995 --> 00:43:01,535 and our strategic direction and the community. 906 00:43:01,535 --> 00:43:03,895 Like we wanna make sure that we're all all aligned 907 00:43:03,895 --> 00:43:08,535 and working together and we often have a very highly 908 00:43:08,685 --> 00:43:11,175 engaged medical staff with the community 909 00:43:11,435 --> 00:43:13,735 and with clinical practice, 910 00:43:14,435 --> 00:43:17,175 but sometimes that can put them at risk 911 00:43:17,315 --> 00:43:20,695 for burnout if they're not always aligned with everyone. 912 00:43:20,995 --> 00:43:22,975 And so they are two slightly different things. 913 00:43:23,615 --> 00:43:25,695 I think this project will really dig into that 914 00:43:25,795 --> 00:43:27,575 and really understand from the medical staff 915 00:43:27,575 --> 00:43:29,535 what our opportunities are and how to improve. 916 00:43:30,315 --> 00:43:33,175 And, and I just wanna comment on one, you said 917 00:43:33,175 --> 00:43:34,375 how will we know when we arrive? 918 00:43:35,015 --> 00:43:37,055 I think this is gonna be lifelong project. 919 00:43:37,405 --> 00:43:39,655 Like, just like anything process improvement, 920 00:43:39,675 --> 00:43:40,895 you don't ever arrive, right? 921 00:43:40,895 --> 00:43:43,415 You're always building and learning 922 00:43:43,635 --> 00:43:44,775 and looking for opportunities, 923 00:43:45,195 --> 00:43:47,975 but I think this will be a huge start for our medical staff. 924 00:43:50,885 --> 00:43:53,335 This reminded me of two things, so I apologize 925 00:43:53,435 --> 00:43:54,615 to chair one. 926 00:43:54,755 --> 00:43:57,535 One is, I think I absolutely everything Sam said, 927 00:43:57,535 --> 00:44:00,055 and I would just say this, I also, I think I didn't mean to 928 00:44:00,735 --> 00:44:02,295 misspeak, it's not 929 00:44:02,295 --> 00:44:05,255 that we aren't gonna measure engagement like we have, 930 00:44:05,855 --> 00:44:08,415 you know, we'll, we'll still do the physician engagement, 931 00:44:08,615 --> 00:44:11,855 although we are talking about merging that kind 932 00:44:11,855 --> 00:44:13,615 of into one survey because we don't 933 00:44:13,615 --> 00:44:14,735 wanna have survey fatigue. 934 00:44:15,075 --> 00:44:16,415 But, so we're still gonna measure it, 935 00:44:16,515 --> 00:44:18,855 but it's also to indicate that's not enough. 936 00:44:18,855 --> 00:44:20,415 Because I will just say last year 937 00:44:21,155 --> 00:44:25,335 we actually had the single highest jump press ganeys ever 938 00:44:25,335 --> 00:44:26,815 seen in med staff engagement. 939 00:44:26,815 --> 00:44:29,535 Yeah. But, you know, we could pat ourselves on the back for 940 00:44:29,535 --> 00:44:32,245 that, but also we were really, really low before. 941 00:44:32,745 --> 00:44:35,085 And, and I think the other thing is that's, you know, 942 00:44:35,305 --> 00:44:38,045 that's not, that's, that's important, 943 00:44:38,105 --> 00:44:39,365 but it won't be sufficient. 944 00:44:39,625 --> 00:44:41,925 And so I think, you know what, how will we know, 945 00:44:42,185 --> 00:44:44,485 you know, we might not know. 946 00:44:44,925 --> 00:44:47,565 I think what we, what this really isn't a knowing 947 00:44:47,585 --> 00:44:50,165 or not, I mean, this is a commitment that we are going 948 00:44:50,165 --> 00:44:52,125 to share power with the medical staff 949 00:44:52,225 --> 00:44:55,285 and we want, well we want to, and I, 950 00:44:55,285 --> 00:44:56,845 and I don't mean share power in that way. 951 00:44:56,865 --> 00:44:58,525 We wanna empower the medical staff 952 00:44:58,525 --> 00:45:01,965 and we wanna also lean in to kind of amplify the voice 953 00:45:01,965 --> 00:45:06,045 of the medical staff because those, you know, that kind of, 954 00:45:06,765 --> 00:45:08,245 I don't know, for lack of a better word, 955 00:45:08,265 --> 00:45:11,165 but patient satisfaction, loyalty, 956 00:45:11,435 --> 00:45:12,845 passion around this system. 957 00:45:13,235 --> 00:45:15,725 It's not because everybody loves their administrators. 958 00:45:15,965 --> 00:45:17,205 I mean, they love their doctors. 959 00:45:17,705 --> 00:45:21,265 Do you know, I mean, I just wanna be, no offense to any 960 00:45:21,265 --> 00:45:22,945 of the administrators, I'll take responsibility, 961 00:45:23,405 --> 00:45:27,425 but I'm just saying that, you know, the doctors, you know, 962 00:45:28,125 --> 00:45:31,545 you know, really set the, you know, they, they are, 963 00:45:31,885 --> 00:45:34,225 you know, in the truest sense, you know, they 964 00:45:34,845 --> 00:45:39,545 are the guardians of clinical quality and care, you know, 965 00:45:39,645 --> 00:45:43,745 and so, you know, the, we need to create formal space for 966 00:45:43,745 --> 00:45:45,985 that beyond sort of the quality committee 967 00:45:46,365 --> 00:45:47,425 and a, and a survey. 968 00:45:47,885 --> 00:45:50,945 And so that actually has to be embedded into every 969 00:45:51,365 --> 00:45:52,425 how we make our decisions. 970 00:45:52,565 --> 00:45:54,305 And I just wanna add onto that to say, 971 00:45:54,455 --> 00:45:58,705 earlier when I talked about operations and, and Louie 972 00:45:59,205 --> 00:46:01,985 and Lauren Lessard, I will just say, you know, 973 00:46:02,125 --> 00:46:05,065 to the nurses, you're, you're not forgotten. 974 00:46:05,205 --> 00:46:09,425 I'm, I'm a nurse and actually I did, I I did stop by today 975 00:46:09,445 --> 00:46:12,025 and talk to Jan and actually Lauren 976 00:46:12,165 --> 00:46:15,065 and Trent had already gotten together this morning. 977 00:46:15,525 --> 00:46:17,505 And so there's going to be something similar 978 00:46:18,125 --> 00:46:19,145 for the nursing staff, 979 00:46:19,165 --> 00:46:21,185 but not just not quite, maybe not, not 980 00:46:21,365 --> 00:46:23,585 to quite take this shape and it's still taking shape. 981 00:46:23,585 --> 00:46:28,065 So I just didn't wanna get in front of Jan and Lauren 982 00:46:28,205 --> 00:46:30,145 and Tran to who are thinking about this. 983 00:46:30,165 --> 00:46:32,665 And so again, that, you know, fair warning, 984 00:46:32,695 --> 00:46:34,145 this will transform a little bit. 985 00:46:34,205 --> 00:46:36,305 But again, I think it's a great question 986 00:46:36,405 --> 00:46:39,465 and the answer is we probably won't know, 987 00:46:39,725 --> 00:46:42,345 but I can tell you this, you'll know if they're not aligned. 988 00:46:42,665 --> 00:46:45,945 Yeah, yeah. And we have in the past. Yeah. 989 00:46:46,285 --> 00:46:48,465 So it's really more of a commitment. You 990 00:46:48,465 --> 00:46:49,665 Have one thing to that as well. 991 00:46:50,065 --> 00:46:52,385 I would just say that I think as you continue 992 00:46:52,385 --> 00:46:54,985 to have these meetings and you get reports back from Sam on 993 00:46:54,985 --> 00:46:56,425 our medical staff advisory committee, 994 00:46:56,425 --> 00:46:58,625 which we're all really excited about being developed, 995 00:46:58,875 --> 00:47:00,665 which is essentially a group of physicians 996 00:47:00,665 --> 00:47:02,465 and other medical staff members that are going 997 00:47:02,465 --> 00:47:06,145 to evaluate all of the projects that we as medical directors 998 00:47:06,325 --> 00:47:09,625 and department chairs bring up as big things 999 00:47:09,625 --> 00:47:11,945 that we wanna work on or initiatives within our department 1000 00:47:11,945 --> 00:47:14,665 that we wanna do that will directly impact either physician 1001 00:47:15,025 --> 00:47:16,985 satisfaction in their workflows or patient care. 1002 00:47:17,645 --> 00:47:18,825 We all have a ton of ideas 1003 00:47:18,885 --> 00:47:20,665 and one of our biggest frustrations has been 1004 00:47:20,665 --> 00:47:21,705 that we haven't had a pathway 1005 00:47:21,965 --> 00:47:23,905 to put these ideas into practice 1006 00:47:23,905 --> 00:47:26,385 and have them evaluated from an administrative level 1007 00:47:26,605 --> 00:47:29,165 and said, this is a priority, this isn't a priority. 1008 00:47:29,165 --> 00:47:30,925 And we were waiting for our strategic plan now. 1009 00:47:30,925 --> 00:47:33,045 So it was just amazing that we have this guidance to sort 1010 00:47:33,045 --> 00:47:35,365 of a foundation to guide us in those decisions 1011 00:47:35,365 --> 00:47:37,045 and prioritization of those projects. 1012 00:47:37,065 --> 00:47:40,525 But what you would see back is a report from Anna that says, 1013 00:47:40,525 --> 00:47:41,605 these are the things that came out 1014 00:47:41,605 --> 00:47:42,925 of our medical staff advisory committee. 1015 00:47:42,925 --> 00:47:45,045 These are the projects that were physician initiated 1016 00:47:45,105 --> 00:47:49,205 and driven from their clinics and from their departments. 1017 00:47:49,585 --> 00:47:51,125 So that would be one way that you would know. 1018 00:47:51,145 --> 00:47:52,605 And you know, that those projects 1019 00:47:52,605 --> 00:47:53,645 were kind of coming from us. 1020 00:47:54,245 --> 00:47:56,045 Additionally, we have engagement hours, which is part 1021 00:47:56,045 --> 00:47:57,525 of most of our compensation plans. 1022 00:47:57,825 --> 00:47:59,245 And this is where physicians elect 1023 00:47:59,245 --> 00:48:01,325 to spend additional time working on specific projects 1024 00:48:01,325 --> 00:48:03,965 that their department chairs kind of review and approve 1025 00:48:03,965 --> 00:48:06,525 and say, this is a, you know, a good project to work on. 1026 00:48:06,785 --> 00:48:08,845 And so that's another sort of more tangible thing 1027 00:48:08,845 --> 00:48:10,445 that could be tracked to say that we, I don't know 1028 00:48:10,445 --> 00:48:13,085 what our physician engagement hour utilization is at this 1029 00:48:13,085 --> 00:48:13,965 point, but that could be 1030 00:48:13,965 --> 00:48:15,005 something that could be tracked as well. 1031 00:48:15,065 --> 00:48:16,365 So, didn't wanna take up time, but just 1032 00:48:16,365 --> 00:48:17,525 wanna say, you'll know. 1033 00:48:18,555 --> 00:48:20,485 Yeah, we'll know. I i 1034 00:48:20,645 --> 00:48:21,925 I, I do want, we do have some items 1035 00:48:22,865 --> 00:48:24,365 for board action tonight. 1036 00:48:24,465 --> 00:48:26,645 So this is obviously just for discussion and purpose. 1037 00:48:26,705 --> 00:48:31,605 So I am gonna step in and encourage us to move on. 1038 00:48:35,725 --> 00:48:37,465 I'm 13 medical staff executive committee. 1039 00:48:37,465 --> 00:48:40,525 There is no consent agenda for tonight, 1040 00:48:40,525 --> 00:48:42,005 so we'll skip that. Oh, real 1041 00:48:42,005 --> 00:48:43,005 Fast. 1042 00:48:43,005 --> 00:48:45,245 Just because it was itemized as an an action. 1043 00:48:45,295 --> 00:48:46,965 Let's ask for public comment. You 1044 00:48:47,955 --> 00:48:48,955 Okay? 1045 00:48:48,955 --> 00:48:53,165 I'm not sure what we would comment on. Item 13. 1046 00:48:53,235 --> 00:48:54,445 Yeah. Isn't a just if 1047 00:48:54,445 --> 00:48:56,885 Anyone had a, But there is, there's no item, 1048 00:48:57,565 --> 00:48:59,135 there's no consent agenda to approve. 1049 00:49:00,085 --> 00:49:01,735 Okay. No. Oh, 1050 00:49:01,735 --> 00:49:02,735 Sorry. 1051 00:49:02,735 --> 00:49:03,495 I just see an action item here, 1052 00:49:03,495 --> 00:49:04,975 so I just wanted to make sure that consent. 1053 00:49:04,975 --> 00:49:06,615 Yeah, typically consent didn't thinking they could 1054 00:49:06,615 --> 00:49:08,895 Consent agenda that we, we, they, they present 1055 00:49:08,915 --> 00:49:10,855 and then okay, but there's nothing to, yeah. 1056 00:49:11,035 --> 00:49:14,635 So perfect. Item 14 1057 00:49:14,935 --> 00:49:16,115 is the consent calendar. 1058 00:49:16,295 --> 00:49:17,715 And again, just a reminder, these are items 1059 00:49:17,715 --> 00:49:19,955 that are expected to be routine, non-controversial. 1060 00:49:20,055 --> 00:49:23,795 The board will take action on them without discussion. 1061 00:49:23,795 --> 00:49:26,395 However, there's an opportunity to pull items if needed. 1062 00:49:27,435 --> 00:49:28,715 Dale, you had mentioned one, but I think we 1063 00:49:28,715 --> 00:49:29,835 covered that. Yeah, 1064 00:49:29,995 --> 00:49:30,995 14.3 0.1. 1065 00:49:31,285 --> 00:49:33,845 We're fine. Okay. Any other items 1066 00:49:34,825 --> 00:49:36,045 to be pulled or discussed? 1067 00:49:38,245 --> 00:49:40,745 I'd like to pull 14.6 0.1. 1068 00:49:41,815 --> 00:49:43,315 How many on health and hospice? 1069 00:49:44,965 --> 00:49:45,255 Okay. 1070 00:49:50,155 --> 00:49:54,435 Yeah, she is Actually, we're gonna pull, 1071 00:49:54,435 --> 00:49:56,795 we won't discuss it until later in the meeting though, 1072 00:49:58,455 --> 00:50:01,555 So You just, you just stay close there, 1073 00:50:02,025 --> 00:50:04,395 Baby. She worked on, 1074 00:50:04,695 --> 00:50:06,835 All right, so then nursing Assistant, 1075 00:50:08,315 --> 00:50:10,335 We would be looking for approval 1076 00:50:10,635 --> 00:50:15,375 To move approval to approve the consent calendar. 1077 00:50:15,815 --> 00:50:18,415 Calendar, right calendar without, 1078 00:50:19,605 --> 00:50:24,415 with 14.6 0.1 removed. I a second the motion. 1079 00:50:25,075 --> 00:50:28,245 Motion in a second. All in favor? Aye. Aye. Opposed? 1080 00:50:29,375 --> 00:50:33,345 Alright, we will discuss item 14 1081 00:50:33,525 --> 00:50:36,025 six at the back end of the meeting. 1082 00:50:36,975 --> 00:50:40,105 Item 15. This is also an item just for board discussion. 1083 00:50:40,705 --> 00:50:44,905 15.1 lab affordability, pilot reducing barriers to care 1084 00:50:46,005 --> 00:50:47,985 and, and Kim presenting. 1085 00:50:50,035 --> 00:50:52,455 Kim, actually it's Kim, 1086 00:50:54,605 --> 00:50:57,055 It's only 'cause Anna's been away and she's back. 1087 00:50:57,055 --> 00:50:58,415 And so we did this without her. 1088 00:50:58,475 --> 00:51:00,295 So you know, I take full responsibility. 1089 00:51:00,855 --> 00:51:02,895 Good evening, I'm Kim car, I'm the chief strategy officer. 1090 00:51:03,715 --> 00:51:05,495 We promised you last month 1091 00:51:05,495 --> 00:51:06,775 that we would come back this month 1092 00:51:06,775 --> 00:51:08,895 with a communications plan around 1093 00:51:10,355 --> 00:51:12,215 the lab affordability plan 1094 00:51:12,435 --> 00:51:15,055 and our financial support program. 1095 00:51:16,115 --> 00:51:18,415 You might notice that the agenda item is not called a 1096 00:51:18,775 --> 00:51:20,335 communications plan and there is a reason for that. 1097 00:51:20,755 --> 00:51:23,575 As we started to dive into the communications plan, 1098 00:51:24,075 --> 00:51:27,695 it became quickly obvious that this is the perfect example 1099 00:51:27,795 --> 00:51:32,255 of the kind of work that really requires navigation help, 1100 00:51:32,755 --> 00:51:34,615 not just around communication, 1101 00:51:34,615 --> 00:51:36,935 but how do we actually work directly with our patients 1102 00:51:37,395 --> 00:51:39,295 to make our system easier to navigate. 1103 00:51:39,675 --> 00:51:42,695 And you may recall that through the 5,000 voices we heard 1104 00:51:43,285 --> 00:51:45,535 time and time again, that navigation is an issue, 1105 00:51:45,535 --> 00:51:46,855 that our system is complicated, 1106 00:51:47,125 --> 00:51:48,855 that people don't necessarily know where to go. 1107 00:51:49,595 --> 00:51:52,095 And so as we started to develop this communication plan, 1108 00:51:52,115 --> 00:51:53,535 it really became an engagement plan. 1109 00:51:53,555 --> 00:51:55,375 It became more than just communication. 1110 00:51:56,055 --> 00:51:57,775 So I, I put together this sort of outline, 1111 00:51:57,775 --> 00:51:58,775 but I wanted to be clear 1112 00:51:59,375 --> 00:52:01,135 for my fellow communications professionals 1113 00:52:01,135 --> 00:52:02,455 that I realized this is not a 1114 00:52:02,455 --> 00:52:03,575 traditional communications plan. 1115 00:52:03,635 --> 00:52:05,615 So if you'll bear with me in that way, 1116 00:52:10,545 --> 00:52:11,285 is this gonna work? 1117 00:52:11,585 --> 00:52:12,605 It wasn't working girl. 1118 00:52:14,095 --> 00:52:15,445 Thank you for forwarding that. 1119 00:52:16,785 --> 00:52:20,835 So a little bit about, about what we're doing here. 1120 00:52:20,835 --> 00:52:23,235 There really are two things that we want that we need 1121 00:52:23,235 --> 00:52:24,675 to address through this process. 1122 00:52:25,015 --> 00:52:27,155 One of them is kind of an exciting thing, 1123 00:52:27,155 --> 00:52:28,795 and we talked about this through the budget process, 1124 00:52:29,015 --> 00:52:31,035 but we will be moving forward 1125 00:52:31,065 --> 00:52:35,035 with our lab affordability project, which means that 70% 1126 00:52:35,035 --> 00:52:39,435 of our lab tests will be 25% lower priced. 1127 00:52:40,145 --> 00:52:43,035 This is a benefit that's available to everybody. 1128 00:52:43,655 --> 00:52:47,115 As you may recall, our community health labs were a small 1129 00:52:47,115 --> 00:52:48,675 segment and people requested them, 1130 00:52:49,575 --> 00:52:51,555 but this is available across the board. 1131 00:52:51,555 --> 00:52:52,555 You don't have to request it. 1132 00:52:52,575 --> 00:52:54,155 You simply go in for your lab test 1133 00:52:54,175 --> 00:52:56,355 and if it's one of the 70% of the tests 1134 00:52:56,355 --> 00:53:00,115 that we give you will automatically see a 25% lower 1135 00:53:01,465 --> 00:53:02,635 cost for those labs. 1136 00:53:02,815 --> 00:53:05,875 So it really is, I think, as you all know, we talked about 1137 00:53:05,875 --> 00:53:07,235 through the, the budgeting process, 1138 00:53:07,375 --> 00:53:10,555 an investment on the part of the health district in terms 1139 00:53:10,575 --> 00:53:12,675 of revenue that will not be coming in 1140 00:53:12,675 --> 00:53:14,675 because we are committed to that affordability. 1141 00:53:14,675 --> 00:53:17,235 And we think as a public health district, that's part 1142 00:53:17,235 --> 00:53:19,715 of our obligation is, is to do that very thing. 1143 00:53:21,495 --> 00:53:24,875 The second piece is really around pathways to access. 1144 00:53:25,325 --> 00:53:28,085 And one of the things that we wanna make sure is that 1145 00:53:28,185 --> 00:53:29,405 as people who come to us 1146 00:53:30,785 --> 00:53:33,165 and need some sort of financial support, 1147 00:53:33,395 --> 00:53:34,965 that we have a door for that. 1148 00:53:35,035 --> 00:53:36,205 That we are making sure 1149 00:53:36,555 --> 00:53:39,125 that those people are not just getting an affordable lab 1150 00:53:39,125 --> 00:53:41,645 test, but they work, we're working with them 1151 00:53:41,665 --> 00:53:44,805 to figure out whether they actually qualify 1152 00:53:45,185 --> 00:53:47,005 for our financial support dollars. 1153 00:53:47,305 --> 00:53:50,245 And what we don't wanna have happen is somebody comes in 1154 00:53:50,245 --> 00:53:51,325 and they get a lab test 1155 00:53:51,425 --> 00:53:53,045 and then that lab test turns out 1156 00:53:53,045 --> 00:53:54,245 to be a result they don't want 1157 00:53:54,665 --> 00:53:56,685 and they have no medical support behind that. 1158 00:53:57,305 --> 00:54:00,685 So we, we feel the need to really make sure that 1159 00:54:00,685 --> 00:54:04,205 as people come into these labs, that we are qualifying them 1160 00:54:04,205 --> 00:54:07,325 for whatever financial support they might be eligible for, 1161 00:54:07,785 --> 00:54:09,165 and that we're then connecting them 1162 00:54:09,185 --> 00:54:11,325 to the down the road care that they need. 1163 00:54:11,385 --> 00:54:13,325 So they're just not kind of left hanging out there. 1164 00:54:14,145 --> 00:54:16,285 And part of this, I would love to say, 1165 00:54:16,285 --> 00:54:17,805 we're just doing this outta the goodness of our heart, 1166 00:54:17,805 --> 00:54:20,485 which we are, but it also makes us much more compliant 1167 00:54:20,485 --> 00:54:22,565 with some of the things that have changed in the past. 1168 00:54:22,925 --> 00:54:27,245 In 2024, California expanded eligibility 1169 00:54:27,665 --> 00:54:30,125 for financial support, the enforcement 1170 00:54:30,145 --> 00:54:31,965 of making financial support available, 1171 00:54:33,035 --> 00:54:35,965 some patient protections around lack of financial support 1172 00:54:36,745 --> 00:54:38,605 and some communications requirements, which is 1173 00:54:38,605 --> 00:54:41,325 what we're really here today to talk about this. 1174 00:54:41,495 --> 00:54:43,445 These requirements really say that we have 1175 00:54:43,445 --> 00:54:46,325 to make this financial support easily available 1176 00:54:46,505 --> 00:54:48,845 and easily understandable to our patients. 1177 00:54:48,945 --> 00:54:52,165 And so as we go through this plan tonight, you will see that 1178 00:54:52,165 --> 00:54:55,925 that is a very strong goal of ours as we, as we begin 1179 00:54:55,925 --> 00:54:59,485 to reach out to our, our community about these two programs. 1180 00:55:03,085 --> 00:55:05,545 So the first thing we wanna do is really make sure 1181 00:55:05,615 --> 00:55:07,665 that people understand their options. 1182 00:55:07,925 --> 00:55:10,025 So the focus is on the two things 1183 00:55:10,025 --> 00:55:11,265 we've already talked about. 1184 00:55:11,315 --> 00:55:13,025 We're we're taking a very broad look. 1185 00:55:13,025 --> 00:55:15,385 So when I I say that the communication will answer four 1186 00:55:15,665 --> 00:55:18,665 questions, we're taking a very broad look at 1187 00:55:18,665 --> 00:55:20,425 what communication me means. 1188 00:55:21,045 --> 00:55:24,225 So it's communication like we would do on a broad scale, 1189 00:55:24,225 --> 00:55:26,985 but it's also communication in terms of how we sit 1190 00:55:26,985 --> 00:55:29,585 and talk with our patients, how we guide them 1191 00:55:29,585 --> 00:55:31,385 through our system, how they get 1192 00:55:31,385 --> 00:55:32,625 information through our access center. 1193 00:55:32,625 --> 00:55:35,225 So we're really looking at communication from a 1194 00:55:35,255 --> 00:55:36,265 very broad perspective. 1195 00:55:36,565 --> 00:55:39,225 So as I, as I make my way through that, 1196 00:55:39,495 --> 00:55:40,545 kind of keep that in mind. 1197 00:55:41,115 --> 00:55:43,625 We're very much aware that particularly 1198 00:55:43,625 --> 00:55:45,905 where financial support and is concerned 1199 00:55:45,905 --> 00:55:48,905 and eligibility for financial support is concerned that 1200 00:55:48,905 --> 00:55:51,025 that is not something you, you don't get 1201 00:55:51,025 --> 00:55:52,705 that question answered through a brochure. 1202 00:55:53,135 --> 00:55:55,585 That is something that you discuss 1203 00:55:55,585 --> 00:55:56,665 with your doctor's office. 1204 00:55:56,665 --> 00:55:58,145 That is certainly something you discuss 1205 00:55:58,145 --> 00:55:59,465 with our financial navigators. 1206 00:56:00,175 --> 00:56:02,065 It's a, it, it can be a complicated process. 1207 00:56:02,205 --> 00:56:04,665 And so we wanna take people through that process 1208 00:56:04,815 --> 00:56:06,945 with the support that they need to truly understand 1209 00:56:07,175 --> 00:56:09,585 what is available to them and how they access it easily. 1210 00:56:11,835 --> 00:56:14,935 So next slide is really about 1211 00:56:16,085 --> 00:56:17,815 helping people understand. 1212 00:56:17,995 --> 00:56:20,575 So if you start at the top 1213 00:56:20,795 --> 00:56:21,815 and you go to the bottom, 1214 00:56:22,395 --> 00:56:25,165 the top is the most specific level of detail. 1215 00:56:25,225 --> 00:56:26,685 So through the community health team 1216 00:56:26,745 --> 00:56:28,365 and through staff at our primary care 1217 00:56:28,365 --> 00:56:30,165 and specialty clinics, that is 1218 00:56:30,165 --> 00:56:32,765 where you will have the ability to have conversation 1219 00:56:32,765 --> 00:56:34,365 with your providers where you'll be able 1220 00:56:34,365 --> 00:56:35,925 to get your own questions answered. 1221 00:56:36,175 --> 00:56:40,165 Where you'll be referred to our financial navigators 1222 00:56:40,165 --> 00:56:41,805 where you'll, where you'll understand 1223 00:56:42,115 --> 00:56:45,605 what phone number you call, what website you can go to, 1224 00:56:45,665 --> 00:56:48,885 but it, that's really about the patient specific information 1225 00:56:48,885 --> 00:56:52,685 where you can say to somebody, what do I need to do 1226 00:56:53,225 --> 00:56:54,685 and what do I get in return? 1227 00:56:55,825 --> 00:56:57,125 As you make your way down the list, 1228 00:56:57,315 --> 00:57:00,365 it's the information becomes more general 1229 00:57:00,465 --> 00:57:01,565 and less personalized. 1230 00:57:01,985 --> 00:57:03,965 So what you would find on social media 1231 00:57:04,065 --> 00:57:07,445 and local media is just a reminder that this is available 1232 00:57:07,585 --> 00:57:11,005 and to ask your provider or to call the access center 1233 00:57:11,025 --> 00:57:13,565 or to call the n the financial navigators and ask. 1234 00:57:14,225 --> 00:57:17,125 And then, you know, as we put printed information throughout 1235 00:57:17,125 --> 00:57:20,925 our facilities, that's really just a QR code that leads you 1236 00:57:20,925 --> 00:57:22,085 to more detailed information. 1237 00:57:22,225 --> 00:57:25,725 So, so we start with the availability for somebody 1238 00:57:25,725 --> 00:57:27,125 to get their individual questions answered 1239 00:57:27,145 --> 00:57:30,125 and then we work our way down to really broad sort 1240 00:57:30,125 --> 00:57:31,805 of understanding and, 1241 00:57:31,805 --> 00:57:33,365 and knowledge about the programs themselves. 1242 00:57:36,245 --> 00:57:37,745 So next slide if we would. 1243 00:57:38,685 --> 00:57:40,945 So this is a little bit about how this, 1244 00:57:41,005 --> 00:57:43,265 we want this patient, this journey to happen. 1245 00:57:44,125 --> 00:57:47,905 And I will say straight out, we are really relying on 1246 00:57:47,925 --> 00:57:50,905 and we are really putting in place the support that needs 1247 00:57:50,905 --> 00:57:53,785 to happen in order for our frontline staff to be ready 1248 00:57:53,805 --> 00:57:55,345 to talk about this with patients. 1249 00:57:55,695 --> 00:57:59,225 This is not something that just it that they know about. 1250 00:57:59,295 --> 00:58:01,465 This is something that we are working to arm them 1251 00:58:01,465 --> 00:58:02,505 with information on. 1252 00:58:03,205 --> 00:58:06,905 And so it is not our expectation that tomorrow every one 1253 00:58:06,905 --> 00:58:08,465 of our medical assistants will be able 1254 00:58:08,465 --> 00:58:10,745 to answer any questions about the affordable labs 1255 00:58:11,045 --> 00:58:13,625 nor about the financial support program. 1256 00:58:14,005 --> 00:58:15,865 We are working on a variety 1257 00:58:15,885 --> 00:58:18,985 of different communications tools, including talking points 1258 00:58:19,895 --> 00:58:22,865 federally or fin or frequently asked questions. 1259 00:58:23,605 --> 00:58:25,705 Any tool we can basically think of that arms them 1260 00:58:25,705 --> 00:58:27,825 with the information that we want. 1261 00:58:28,845 --> 00:58:31,825 It is really our goal long term that this, 1262 00:58:32,035 --> 00:58:33,185 these conversations 1263 00:58:33,365 --> 00:58:36,265 and this information be a routine part of patient care 1264 00:58:36,695 --> 00:58:38,025 that it not be a one-off, 1265 00:58:38,045 --> 00:58:41,345 but that it be, that it just be part of what happens. 1266 00:58:42,145 --> 00:58:46,185 Because once again, our entire goal is to renew, 1267 00:58:46,205 --> 00:58:49,065 remove any financial barriers from people accessing health. 1268 00:58:49,765 --> 00:58:52,465 We know people make decisions about whether 1269 00:58:52,465 --> 00:58:55,105 or not to get care based on their ability to afford it. 1270 00:58:55,525 --> 00:58:57,745 And, and our goal is to move away from that 1271 00:58:57,965 --> 00:59:00,185 and to make sure people get the care that they need. 1272 00:59:02,035 --> 00:59:03,175 So next slide. 1273 00:59:03,605 --> 00:59:06,575 This is really where we're talking about empowered staff, 1274 00:59:06,945 --> 00:59:09,655 staff that feel comfortable, staff that feel informed 1275 00:59:10,195 --> 00:59:12,655 and staff that feel like they're part of the solution. 1276 00:59:12,935 --> 00:59:15,375 I think we've said it tonight, we've said it over 1277 00:59:15,375 --> 00:59:16,895 and over again and all of us agree. 1278 00:59:16,915 --> 00:59:20,295 Our staff is amazing and they are dedicated 1279 00:59:20,295 --> 00:59:23,325 and passionate about helping our patients. 1280 00:59:23,345 --> 00:59:25,565 And so we just need to make sure that, you know, 1281 00:59:25,905 --> 00:59:29,045 as your favorite administrators, that they are armed 1282 00:59:29,075 --> 00:59:31,565 with the information they need to have those conversations. 1283 00:59:32,985 --> 00:59:36,165 We really wanna make sure that our patients are connected 1284 00:59:36,165 --> 00:59:37,685 to the right support, that they're not wondering, 1285 00:59:37,745 --> 00:59:40,485 but that, that there's a clear path and a direct path, 1286 00:59:40,865 --> 00:59:42,405 and then we wanna celebrate this, right? 1287 00:59:42,465 --> 00:59:45,925 So, so some of the metrics, the novel metrics that we came 1288 00:59:45,925 --> 00:59:48,605 to you with last month were around how many people are, 1289 00:59:48,945 --> 00:59:51,525 are inquiring about financial support 1290 00:59:51,545 --> 00:59:53,525 and how much financial support we're providing. 1291 00:59:53,865 --> 00:59:55,925 So we really wanna be able to celebrate the fact 1292 00:59:55,925 --> 00:59:57,645 that we have those resources available. 1293 00:59:58,345 --> 01:00:00,925 And then also really keeping an eye on what happens 1294 01:00:00,995 --> 01:00:04,285 with our, our, the number of labs we're providing. 1295 01:00:04,285 --> 01:00:07,685 Does the affordability pilot really, you know, 1296 01:00:08,795 --> 01:00:11,125 because community labs aren't available anymore, 1297 01:00:11,125 --> 01:00:13,085 we wanna make sure that those lab tests are not 1298 01:00:13,115 --> 01:00:14,285 migrating off the mountain. 1299 01:00:14,425 --> 01:00:16,885 And so we'll be keeping a close eye on that 1300 01:00:16,885 --> 01:00:19,285 and making sure that our affordability pilot is getting us 1301 01:00:19,285 --> 01:00:21,045 where we wanna be, where that is concerned. 1302 01:00:22,975 --> 01:00:26,155 And last but not least, so this is really where I wanted 1303 01:00:26,155 --> 01:00:27,635 to tie it back to communications 1304 01:00:27,635 --> 01:00:28,955 and what we're really trying to do from 1305 01:00:28,955 --> 01:00:30,075 a communications perspective. 1306 01:00:30,535 --> 01:00:34,315 So we will continue to look at all of these, all 1307 01:00:34,315 --> 01:00:36,915 of this information as we, as we go along. 1308 01:00:37,175 --> 01:00:39,435 So what kind of engagement are our social media posts 1309 01:00:39,435 --> 01:00:42,355 getting, you know, as we, you know, send out these emails, 1310 01:00:42,505 --> 01:00:43,955 what kind of open rates 1311 01:00:43,955 --> 01:00:45,315 and click through rates are we getting? 1312 01:00:45,695 --> 01:00:47,955 How many hits are we getting on our webpage? 1313 01:00:47,955 --> 01:00:50,635 And, and those are really broad engagement numbers. 1314 01:00:50,665 --> 01:00:52,955 They're not necessarily impactful, 1315 01:00:53,415 --> 01:00:55,115 but they allow us to sort of track 1316 01:00:55,575 --> 01:00:56,995 how people are seeing the information 1317 01:00:56,995 --> 01:00:58,075 and how they're acting on it. 1318 01:00:58,535 --> 01:01:01,355 But then really about, are people understanding it? 1319 01:01:01,355 --> 01:01:03,595 So not just are they clicking on a link in my email, 1320 01:01:03,855 --> 01:01:05,195 but are they picking up the phone 1321 01:01:05,215 --> 01:01:07,635 and are they calling our financial counselors? 1322 01:01:08,215 --> 01:01:10,115 You know, are patients asking questions? 1323 01:01:10,455 --> 01:01:12,835 You know, are our providers giving us feedback 1324 01:01:12,835 --> 01:01:14,075 that this is working or not? 1325 01:01:14,495 --> 01:01:17,715 So, so we will be continuing to track that as well. 1326 01:01:18,135 --> 01:01:19,555 And then we wanna continue to work 1327 01:01:19,555 --> 01:01:20,635 with our community partners. 1328 01:01:20,635 --> 01:01:24,075 Are they starting to see people show up who are, you know, 1329 01:01:24,615 --> 01:01:26,595 are having downstream implications from 1330 01:01:26,595 --> 01:01:27,635 this that we're not understanding? 1331 01:01:27,695 --> 01:01:30,075 So we just wanna keep the loop open. 1332 01:01:30,395 --> 01:01:32,555 I, you know, I say repeatedly that community input 1333 01:01:32,555 --> 01:01:34,395 and community engagement is not a onetime deal, 1334 01:01:35,015 --> 01:01:38,155 but that final column there on this slide is really about 1335 01:01:38,805 --> 01:01:40,955 continuing to engage in making sure that the work 1336 01:01:40,955 --> 01:01:43,035 that we do on the front end doesn't have unintended 1337 01:01:43,035 --> 01:01:44,315 consequences on the backend. 1338 01:01:45,535 --> 01:01:48,275 So with that, I will stop 1339 01:01:48,495 --> 01:01:50,955 and I'm hand it back to you Chairman. Gary, 1340 01:01:51,405 --> 01:01:52,405 Thank you very much. 1341 01:01:52,775 --> 01:01:55,035 Before we go into questions, I, this was really focusing 1342 01:01:55,035 --> 01:01:57,435 around awareness, engagement, communication. 1343 01:01:58,295 --> 01:02:00,395 Do we wanna limit questions to that topic? 1344 01:02:00,515 --> 01:02:03,155 I know we can go down a rabbit hole of like, the logistics 1345 01:02:03,155 --> 01:02:05,355 of the program and you know, why this, why that? 1346 01:02:05,355 --> 01:02:08,915 So I'm asking you first, do we wanna limit conversation to 1347 01:02:08,985 --> 01:02:10,155 Yeah, we're really here 1348 01:02:10,155 --> 01:02:11,995 to talk about the process for how we roll this out. 1349 01:02:12,055 --> 01:02:15,675 So, so yes, I think from an agenda perspective, that is the, 1350 01:02:15,675 --> 01:02:17,115 the crux of the conversation. Okay. 1351 01:02:17,115 --> 01:02:18,635 Yeah. Fantastic. With that in mind, 1352 01:02:19,755 --> 01:02:21,535 Any questions, comments from the board? 1353 01:02:21,595 --> 01:02:23,855 It would be great to have a pilot for future pilots, 1354 01:02:24,435 --> 01:02:28,335 you know, so we'll be, you know, we'll be watching this. 1355 01:02:29,065 --> 01:02:30,605 I'm looking at Crystal in the back of the room. 1356 01:02:33,565 --> 01:02:36,525 I will say to that, Mary, you know, listening 1357 01:02:36,525 --> 01:02:39,045 to Anna talk about the work streams that are part 1358 01:02:39,045 --> 01:02:41,285 of True North, the thing that is really the most exciting 1359 01:02:41,285 --> 01:02:43,725 to me is that we are putting systems in place 1360 01:02:43,725 --> 01:02:45,485 that really drive future work, right? 1361 01:02:45,555 --> 01:02:48,205 It's not just about these, these six work streams, 1362 01:02:48,205 --> 01:02:50,205 but it's about how do we take that model 1363 01:02:50,305 --> 01:02:51,765 and as our work streams evolve 1364 01:02:52,065 --> 01:02:54,845 and as our organizational needs evolve, how do we use 1365 01:02:54,845 --> 01:02:57,485 that model of, of management 1366 01:02:57,585 --> 01:03:00,325 and engagement to, you know, 1367 01:03:00,475 --> 01:03:02,405 address all kinds of things across the system? 1368 01:03:02,425 --> 01:03:04,005 And this is absolutely a case of that. 1369 01:03:07,695 --> 01:03:10,595 So then also, Kim, just this week 1370 01:03:10,695 --> 01:03:15,275 or just today, I received a message from World something 1371 01:03:15,295 --> 01:03:19,515 or other that be receiving 1372 01:03:19,605 --> 01:03:20,795 texts from Tower Forest. 1373 01:03:21,365 --> 01:03:25,715 Hello World is is that Hello world, hello world. Yeah, yeah. 1374 01:03:25,815 --> 01:03:28,155 Is that part of the communication? 1375 01:03:29,295 --> 01:03:31,275 So that's not specific to this, that's one 1376 01:03:31,275 --> 01:03:32,915 of the plugins available through MyChart, 1377 01:03:33,275 --> 01:03:36,115 but we are exploring across the system how we engage 1378 01:03:36,385 --> 01:03:38,515 with our community in every way we can. 1379 01:03:38,855 --> 01:03:40,515 You know, one of the things we've really realized 1380 01:03:40,515 --> 01:03:43,675 through this process is we do have a number of people, 1381 01:03:43,795 --> 01:03:44,915 a small number of people who, 1382 01:03:45,175 --> 01:03:47,355 who use the community labs on a regular basis. 1383 01:03:47,495 --> 01:03:50,275 And so we, we asked ourselves the question of, 1384 01:03:50,815 --> 01:03:52,795 we don't want them to have to rely on our website 1385 01:03:52,795 --> 01:03:54,475 to figure out how they get care. 1386 01:03:54,625 --> 01:03:56,515 Instead we wanna reach out to them directly. 1387 01:03:56,535 --> 01:03:59,195 So I was having a conversation earlier today with about, 1388 01:03:59,625 --> 01:04:01,675 okay, let's pull those people, 1389 01:04:01,685 --> 01:04:03,075 let's pull their email addresses 1390 01:04:03,075 --> 01:04:05,115 and let's figure out how they communicate with us 1391 01:04:05,495 --> 01:04:07,235 so we can push those messages out 1392 01:04:07,235 --> 01:04:08,555 through the channels that work for them. 1393 01:04:08,935 --> 01:04:10,435 And that is one of the new channels that we're, 1394 01:04:10,435 --> 01:04:11,595 that we're rolling out to make sure 1395 01:04:11,595 --> 01:04:12,875 that we have that conduit. 1396 01:04:14,015 --> 01:04:16,035 But we can still use MyChart, correct? 1397 01:04:16,225 --> 01:04:17,225 Yeah. Okay. Thank you. 1398 01:04:17,855 --> 01:04:20,515 And email, I mean, you Can use anything. Yeah, 1399 01:04:21,155 --> 01:04:22,355 A little off topic, but a number 1400 01:04:22,355 --> 01:04:24,835 of months ago when we had the TB exposure event, 1401 01:04:25,255 --> 01:04:26,995 and we really looked at how we were communicating, 1402 01:04:27,015 --> 01:04:28,955 we really did a tiered communication there as well. 1403 01:04:29,175 --> 01:04:32,475 So we did MyChart messages, and then we did did emails, 1404 01:04:32,615 --> 01:04:34,275 and then we did mailed letters, 1405 01:04:34,495 --> 01:04:36,875 and then we did a small number of phone calls for people 1406 01:04:36,875 --> 01:04:38,275 who we were most concerned about. 1407 01:04:38,735 --> 01:04:40,435 And so we, we want to make sure 1408 01:04:40,465 --> 01:04:42,155 that we have all those tools in place 1409 01:04:42,475 --> 01:04:44,435 whenever we need them, not just for special occasions. 1410 01:04:47,775 --> 01:04:50,345 Just in case, I'm asked in the Safeway checkout line 1411 01:04:52,185 --> 01:04:54,315 With which We've already identified as one 1412 01:04:54,315 --> 01:04:55,315 of our best communication 1413 01:04:55,555 --> 01:04:58,035 Vehicles, that'll be in lane three on 1414 01:04:58,035 --> 01:04:59,195 Tuesdays and Thursdays. 1415 01:05:01,545 --> 01:05:04,045 Is this assistance income qualified? 1416 01:05:04,905 --> 01:05:06,605 Yes. And I might look at Crystal 1417 01:05:06,785 --> 01:05:09,285 for a little more detail about the financial support piece. 1418 01:05:12,695 --> 01:05:15,995 So any person that could qualify for any kind 1419 01:05:15,995 --> 01:05:18,765 of financial assistance has to provide some sort 1420 01:05:18,765 --> 01:05:21,165 of financial documentation for us to review. 1421 01:05:21,905 --> 01:05:26,885 And then based upon family size, income levels allows us 1422 01:05:26,905 --> 01:05:30,485 to determine whether we can discount the pricing 1423 01:05:30,825 --> 01:05:35,205 or actually completely eliminate the cost to the patient, 1424 01:05:35,235 --> 01:05:37,325 depending on, on those criteria. 1425 01:05:37,505 --> 01:05:40,765 But our, our, our community needs to be willing 1426 01:05:40,905 --> 01:05:43,085 to trust in us and share that information 1427 01:05:43,105 --> 01:05:45,325 so we can help them and make that determination. 1428 01:05:45,425 --> 01:05:46,685 So that's no different than our, 1429 01:05:46,685 --> 01:05:48,685 what our charity care has been in the past. 1430 01:05:48,685 --> 01:05:49,685 Right? 1431 01:05:50,025 --> 01:05:52,125 So yes, over the years, 1432 01:05:53,385 --> 01:05:57,645 the fin financial assistance criteria has evolved. 1433 01:05:58,345 --> 01:06:02,945 And so historically you used to be able to look at, 1434 01:06:02,945 --> 01:06:04,625 like, do they own a home? 1435 01:06:04,725 --> 01:06:07,265 Do they have retirement? Do they, you know, a lot of assets. 1436 01:06:07,445 --> 01:06:10,985 And that has become very narrowed on what we can consider. 1437 01:06:12,565 --> 01:06:17,465 And also it's expanded from being like they, 1438 01:06:17,465 --> 01:06:20,105 they equated to the federal poverty level guidelines 1439 01:06:20,135 --> 01:06:21,945 that the federal government produces. 1440 01:06:22,645 --> 01:06:26,945 And it has been expanded to 400% of those levels, 1441 01:06:26,995 --> 01:06:29,505 where it used to be around two to 250%. 1442 01:06:29,605 --> 01:06:33,345 So over the years, the program has expanded to try 1443 01:06:33,345 --> 01:06:36,705 to assist more and more folks with financial assistance. 1444 01:06:37,845 --> 01:06:41,025 But it, it is the, the new iteration of charity care. 1445 01:06:41,205 --> 01:06:43,905 So, you know, as we did some research into how to do this, 1446 01:06:44,725 --> 01:06:46,385 we looked at some of the, you know, 1447 01:06:46,935 --> 01:06:48,825 most respected health systems in the country 1448 01:06:48,885 --> 01:06:50,665 and how they communicate about this and, 1449 01:06:51,005 --> 01:06:53,905 and the, the sort of financial support verbiage. 1450 01:06:53,905 --> 01:06:56,065 And, and the reason for really needing some 1451 01:06:56,665 --> 01:06:59,665 explicit talking points is the need to sort of move away, 1452 01:06:59,895 --> 01:07:01,665 away from talking about this in any way 1453 01:07:01,665 --> 01:07:03,585 that might cause people to not want to, 1454 01:07:04,965 --> 01:07:06,065 you know, ask for it. 1455 01:07:06,125 --> 01:07:08,825 And, and Charity Care, charity, the word charity has a bit 1456 01:07:08,825 --> 01:07:13,345 of a, a, a emotional component to it that we wanna avoid. 1457 01:07:13,435 --> 01:07:16,105 Thank you. I I was just about to make that same comment 1458 01:07:16,135 --> 01:07:20,225 that I, I really wanna move away from the term charity care, 1459 01:07:21,065 --> 01:07:22,865 because healthcare is expensive. 1460 01:07:23,925 --> 01:07:27,225 It, you don't have to be a charity case 1461 01:07:27,525 --> 01:07:29,185 to need financial assistance. 1462 01:07:29,385 --> 01:07:31,025 I mean, a family of four 1463 01:07:31,125 --> 01:07:33,185 who makes over a hundred thousand dollars a year 1464 01:07:33,245 --> 01:07:35,185 and has insurance and a high deductible 1465 01:07:35,185 --> 01:07:36,745 plan could probably qualify. 1466 01:07:37,205 --> 01:07:39,825 That's not charity. That's just financial assistance. 1467 01:07:39,825 --> 01:07:44,105 So I really wanna move away from the tagline of Charity care 1468 01:07:45,165 --> 01:07:48,465 to more of financial assistance discounting, 1469 01:07:49,925 --> 01:07:52,745 you know, that's, that is really what the program is. 1470 01:07:53,335 --> 01:07:55,185 Will it include digital imaging? 1471 01:07:56,875 --> 01:07:59,645 Digital imaging? This is labs. 1472 01:08:00,545 --> 01:08:04,045 So maybe This is strictly labs? No, at this point, 1473 01:08:04,505 --> 01:08:05,505 No. 1474 01:08:05,505 --> 01:08:07,725 The, I mean, we're addressing one aspect of 1475 01:08:07,725 --> 01:08:10,525 what the community told us about, you know, lab and imaging, 1476 01:08:11,025 --> 01:08:14,165 but our financial assistance applies to 1477 01:08:15,445 --> 01:08:18,045 anything within this health system that a, 1478 01:08:18,725 --> 01:08:22,445 a medical provider might deem medically necessary. Okay. 1479 01:08:22,515 --> 01:08:23,845 That answered my question. Thank you. 1480 01:08:25,085 --> 01:08:27,145 So just for my clarification, Denell, 1481 01:08:27,145 --> 01:08:29,465 you weren't asking specifically about the lab affordability 1482 01:08:29,515 --> 01:08:33,615 pilot, and is there a financial gate for that 1483 01:08:34,915 --> 01:08:37,175 you were asking more generic about, 1484 01:08:38,475 --> 01:08:41,165 because the, the lab affordability pilot is 1485 01:08:41,475 --> 01:08:42,885 available to everyone. To 1486 01:08:43,085 --> 01:08:43,685 Everyone. Yeah. It's 1487 01:08:43,685 --> 01:08:44,685 Across the board. 1488 01:08:44,685 --> 01:08:45,685 I wanna be really clear on that. Yeah, yeah. 1489 01:08:46,505 --> 01:08:48,765 So historically there was community health labs, 1490 01:08:48,815 --> 01:08:52,465 which did have a financial component to it. No, no, no. 1491 01:08:52,495 --> 01:08:54,185 Okay. No, that has, that's one 1492 01:08:54,185 --> 01:08:55,385 of the reasons why we had people coming 1493 01:08:55,385 --> 01:08:56,625 and using the community health labs 1494 01:08:56,645 --> 01:08:59,585 and not getting, potentially not getting follow-up care, is 1495 01:08:59,585 --> 01:09:02,225 because we weren't qualifying them for the financial support 1496 01:09:02,225 --> 01:09:03,825 that they were, they could potentially 1497 01:09:04,135 --> 01:09:05,145 have been eligible for. 1498 01:09:05,205 --> 01:09:07,185 So that's a piece that we're fixing. Okay. 1499 01:09:07,185 --> 01:09:09,905 Yeah. Okay. Fantastic. Thank you for clarifying. 1500 01:09:11,505 --> 01:09:15,735 Thank you. I'll try to make it quick data. 1501 01:09:16,175 --> 01:09:17,575 I, I think, you know, you mentioned briefly, 1502 01:09:17,715 --> 01:09:20,375 but I know that to get people to trust 1503 01:09:20,395 --> 01:09:23,255 and to understand seeing the data points that's working, 1504 01:09:23,315 --> 01:09:25,695 you know, how many people are getting it, et cetera, from 1505 01:09:25,695 --> 01:09:28,735 that as well, I think of the clinicians and Dr. 1506 01:09:29,305 --> 01:09:32,575 Being kindly spoke about how getting, hearing their ideas, 1507 01:09:32,675 --> 01:09:33,855 and this is going the opposite way, 1508 01:09:34,075 --> 01:09:36,495 you said it's coming from administrators to clinicians 1509 01:09:36,515 --> 01:09:38,295 to be the front lines, and I see front lines 1510 01:09:38,295 --> 01:09:39,375 and I think it's very important. 1511 01:09:40,115 --> 01:09:43,295 And so I, you know, having those, having that data, 1512 01:09:43,305 --> 01:09:47,615 those success stories, you know, the story as an ER doctor, 1513 01:09:47,655 --> 01:09:49,135 I see, and I'll just, my story is 1514 01:09:49,135 --> 01:09:51,175 that I see dental pain every day in the er, every day. 1515 01:09:51,365 --> 01:09:53,455 It's, it's a screw. It's an epidemic in the ER 1516 01:09:54,035 --> 01:09:57,895 and all the technology at renowned, my favorite is a nine, 1517 01:09:57,895 --> 01:10:00,135 eight and a half 11 sheet of dental referrals. 1518 01:10:00,715 --> 01:10:03,495 And every year I call the Salvation Army, I call them 1519 01:10:03,595 --> 01:10:04,735 and they say, oh yeah, 1520 01:10:04,735 --> 01:10:06,175 we still do dental extractions for free. 1521 01:10:06,405 --> 01:10:07,775 It's a three month waiting list. 1522 01:10:08,275 --> 01:10:10,415 And I kind of give the patient, I kill 'em, that story, 1523 01:10:10,675 --> 01:10:12,095 and I have no idea what happens. 1524 01:10:12,355 --> 01:10:14,735 Mm. You know, I never get, Hey, it worked, 1525 01:10:15,175 --> 01:10:16,575 I came back, I couldn't do it. 1526 01:10:16,685 --> 01:10:19,775 This is what's my, you know, none of that ever comes back. 1527 01:10:20,395 --> 01:10:23,295 And so I think to get buy-in, I think as clinicians, 1528 01:10:23,305 --> 01:10:26,815 front staff is having data or those stories, 1529 01:10:26,835 --> 01:10:29,575 and we'll hear it, you'll hear it in Safeway on aisle two, 1530 01:10:30,055 --> 01:10:31,535 Tuesdays and Thursdays, hopefully. 1531 01:10:31,555 --> 01:10:34,335 But I mean, that, that is the, that is the magic, right? 1532 01:10:34,365 --> 01:10:36,535 When, when someone says to a and 1533 01:10:36,595 --> 01:10:39,255 and Anna said it, so well, like, I mean, 1534 01:10:39,275 --> 01:10:40,295 may not have favorite administrator, 1535 01:10:40,295 --> 01:10:42,895 they have their favorite doctor saying, Hey, you know, I got 1536 01:10:42,895 --> 01:10:45,695 that piece of paper and yeah, it really worked. 1537 01:10:46,035 --> 01:10:48,735 You know, and that, that perpetuates the success. 1538 01:10:48,755 --> 01:10:49,815 So I, I don't know how that, 1539 01:10:49,955 --> 01:10:51,095 I'm glad that you said you'd study. 1540 01:10:51,095 --> 01:10:53,055 You're looking at best practices in nation. 1541 01:10:53,095 --> 01:10:54,815 I know that will will that data and that, 1542 01:10:54,815 --> 01:10:56,655 and having that available for us to share 1543 01:10:56,715 --> 01:10:59,215 and I think Will, will, will really be that great. 1544 01:10:59,395 --> 01:11:01,295 The reflection that I, I came from this is just 1545 01:11:01,295 --> 01:11:03,415 because that's where the magic happens when they just say, 1546 01:11:03,415 --> 01:11:04,975 yeah, it really did work for me. 1547 01:11:05,715 --> 01:11:07,415 And then, so good luck and thank you. 1548 01:11:07,855 --> 01:11:08,295 I love that. 1549 01:11:12,825 --> 01:11:14,005 Any other Comments, questions? Again, 1550 01:11:14,005 --> 01:11:15,165 this is just an item for discussion, 1551 01:11:15,165 --> 01:11:19,285 so no action will be taken if nothing else from the board. 1552 01:11:19,285 --> 01:11:21,365 Anyone from the audience? Comments, questions? 1553 01:11:29,565 --> 01:11:33,725 Drink? We 1554 01:11:33,725 --> 01:11:34,885 do it all around here, don't we? 1555 01:11:39,075 --> 01:11:40,655 Oh, crystal. Alright, 1556 01:11:40,925 --> 01:11:41,925 Well thank you. 1557 01:11:41,925 --> 01:11:44,815 And, and again, I know, I guess speaking on behalf 1558 01:11:44,835 --> 01:11:46,535 of the board, this is something we've been, 1559 01:11:46,535 --> 01:11:48,895 not specifically affordability, the lab affordability pilot, 1560 01:11:48,995 --> 01:11:52,135 but addressing these, these items for the community. 1561 01:11:52,135 --> 01:11:53,655 It's just, it's wonderful to see these coming to life 1562 01:11:54,355 --> 01:11:57,655 and recognizing the level of work, the complexity, 1563 01:11:57,835 --> 01:11:58,855 the amount of creativity 1564 01:11:58,855 --> 01:12:01,455 to bring these forward is remarkable. 1565 01:12:01,685 --> 01:12:03,335 It's just, it's, it's wonderful to see. 1566 01:12:05,295 --> 01:12:08,065 Item 16, this was an item for board action. 1567 01:12:08,405 --> 01:12:10,705 It is Crystal's favorite time of year. 1568 01:12:13,365 --> 01:12:14,615 It's our favorite time. Yes. 1569 01:12:16,095 --> 01:12:18,935 Resolution 2026 dash zero five. 1570 01:12:19,495 --> 01:12:23,335 I vote yes. Have we beaten 1571 01:12:23,335 --> 01:12:24,495 you down year over year? 1572 01:12:25,155 --> 01:12:28,895 And I give up you, gosh, 1573 01:12:29,015 --> 01:12:30,015 I don't have to say anything. 1574 01:12:31,285 --> 01:12:32,535 Yeah, I'm looking for a motion 1575 01:12:33,715 --> 01:12:34,715 Boy. 1576 01:12:34,715 --> 01:12:37,255 Aisle two. Wow. Wow. Get it. That's impressive. 1577 01:12:39,485 --> 01:12:40,535 I've done my job. 1578 01:12:41,925 --> 01:12:44,815 Beat me down. Will. You've got it. 1579 01:12:46,435 --> 01:12:47,895 So shall we just do some highlights 1580 01:12:47,895 --> 01:12:49,335 so the public understands what we're going 1581 01:12:49,605 --> 01:12:50,975 That that would be great. 1582 01:12:51,975 --> 01:12:54,675 All right. So it is that time of year where we have 1583 01:12:54,675 --> 01:12:58,115 to establish the rate per $100,000 1584 01:12:58,375 --> 01:13:01,115 of assessed value on properties to be able 1585 01:13:01,115 --> 01:13:02,915 to make our debt service payment on our 1586 01:13:02,915 --> 01:13:04,395 general obligation bonds. 1587 01:13:05,175 --> 01:13:08,355 The counties want us to report that rate by early August. 1588 01:13:08,615 --> 01:13:11,235 So that's why it appears in our July board meeting every 1589 01:13:11,235 --> 01:13:16,135 year we did receive the assessed values from 1590 01:13:16,135 --> 01:13:17,695 both Placer and Nevada County. 1591 01:13:17,915 --> 01:13:20,375 That's what is utilized to make our calculation. 1592 01:13:21,475 --> 01:13:25,615 We know per our, our general obligation bonds 1593 01:13:25,645 --> 01:13:27,015 what our debt schedule is. 1594 01:13:27,555 --> 01:13:30,935 So between getting the assessed values from the counties 1595 01:13:31,355 --> 01:13:35,455 and knowing what our next annual payments are going to be, 1596 01:13:35,995 --> 01:13:38,495 it becomes a mathematical equation. 1597 01:13:39,635 --> 01:13:42,615 The only caveat that comes into play is whether 1598 01:13:42,615 --> 01:13:44,455 or not we have dollars in reserve 1599 01:13:45,095 --> 01:13:47,695 because more might have come 1600 01:13:47,695 --> 01:13:51,135 through in the property tax roles than we expected creating 1601 01:13:51,135 --> 01:13:52,855 additional dollars available for 1602 01:13:52,855 --> 01:13:56,265 that payment background. 1603 01:13:57,665 --> 01:13:58,795 Over the last five years, 1604 01:13:58,895 --> 01:14:01,995 we have actually seen over a 6% growth in the 1605 01:14:02,195 --> 01:14:03,355 property values. 1606 01:14:04,515 --> 01:14:07,915 I will say 26 27 actually dropped below that. 1607 01:14:08,215 --> 01:14:12,405 So it was at 5.66% increase compared to the previous year. 1608 01:14:12,825 --> 01:14:14,805 So a little bit lower than we have seen 1609 01:14:14,805 --> 01:14:15,885 over the last five years. 1610 01:14:16,785 --> 01:14:19,605 Our total debt service requirement is 1611 01:14:20,265 --> 01:14:22,605 for the next payment cycle will be 1612 01:14:22,625 --> 01:14:26,965 $6,084,431 and 26 cents. 1613 01:14:27,865 --> 01:14:31,645 And if we were to just flat out 1614 01:14:32,275 --> 01:14:35,565 make the rate per 100,000 to fully cover that payment, 1615 01:14:36,225 --> 01:14:38,085 it would equate to $16 1616 01:14:38,145 --> 01:14:41,245 and 91 cents per a hundred thousand of assessed value. 1617 01:14:42,185 --> 01:14:43,845 But we do have reserves available 1618 01:14:44,525 --> 01:14:47,405 about $971,000. 1619 01:14:47,665 --> 01:14:48,685 I'm rounding this number 1620 01:14:49,705 --> 01:14:54,045 and the board can decide to use some, none. 1621 01:14:55,595 --> 01:14:59,035 A hundred percent of it. It's really at your discretion. 1622 01:14:59,575 --> 01:15:01,875 So if you were to use a hundred percent 1623 01:15:02,335 --> 01:15:06,115 of those reserve funds, the rate would drop to $14 1624 01:15:06,215 --> 01:15:08,675 and 22 cents per 100,000. 1625 01:15:09,335 --> 01:15:12,995 If you chose not to use any of the reserve, it's the $16 1626 01:15:13,095 --> 01:15:14,155 and 91 cents. 1627 01:15:14,945 --> 01:15:17,075 I've given you a few calculations in 1628 01:15:17,075 --> 01:15:20,195 between utilizing 25, 50, 75 1629 01:15:20,215 --> 01:15:23,555 and 85% of the reserve with what 1630 01:15:23,555 --> 01:15:28,195 that rate would be per 100,000 as I have done in the past. 1631 01:15:29,035 --> 01:15:31,795 I do believe some reserves should be retained 1632 01:15:31,975 --> 01:15:34,595 for future periods if we see any kind 1633 01:15:34,595 --> 01:15:36,475 of sharp declines in property values 1634 01:15:36,735 --> 01:15:37,955 or anything of that nature. 1635 01:15:39,335 --> 01:15:43,395 And so again, I'm coming forward with a recommendation 1636 01:15:43,455 --> 01:15:46,715 of 75% use of that reserve, 1637 01:15:47,125 --> 01:15:50,155 which would actually set the rate at $14 1638 01:15:50,255 --> 01:15:52,635 and 89 cents per 100,000. 1639 01:15:53,335 --> 01:15:55,075 Now that is just a recommendation. 1640 01:15:55,535 --> 01:15:58,395 You guys can have your own little argument over 1641 01:15:59,145 --> 01:16:02,475 what percentage, but that's what's before you right now. 1642 01:16:03,175 --> 01:16:06,155 Do you want to mention, what were they the years 1643 01:16:06,935 --> 01:16:10,315 2 20 10 to 2012 1644 01:16:11,685 --> 01:16:15,895 that we actually had to go into Yes. Operations. 1645 01:16:16,365 --> 01:16:20,935 Yeah. Yes. We actually saw a 4.64% decline in values 1646 01:16:21,755 --> 01:16:26,095 in 20 10, 20 11 as compared to 2009, 2010. 1647 01:16:26,995 --> 01:16:30,935 And then we saw another 1.92% decline the year after that. 1648 01:16:31,675 --> 01:16:35,975 And then in 20 12, 20 13 it only moved by 0.67% 1649 01:16:36,675 --> 01:16:38,495 in 20 10 11 1650 01:16:38,835 --> 01:16:43,775 and 1112 we did not have enough property 1651 01:16:43,795 --> 01:16:46,615 tax revenue collected to make the debt service payment 1652 01:16:46,715 --> 01:16:51,335 and was thus funded through operational revenue to fund 1653 01:16:51,335 --> 01:16:52,695 that debt service requirement. 1654 01:16:52,805 --> 01:16:56,175 Thus, why I strongly recommend always having some sort 1655 01:16:56,195 --> 01:17:00,135 of reserve when we get to the last required year 1656 01:17:00,355 --> 01:17:01,615 of the debt service payment, 1657 01:17:01,755 --> 01:17:03,975 we will fully utilize the reserve 1658 01:17:04,075 --> 01:17:05,495 and have nothing left over. 1659 01:17:07,135 --> 01:17:10,485 Will we be there For that? I'm gonna be retired. Yeah. 1660 01:17:12,205 --> 01:17:14,205 Although We'll see with the market right now. Right. 1661 01:17:16,095 --> 01:17:17,675 So you said for three years we paid, 1662 01:17:17,675 --> 01:17:19,835 it came outta operation. How many years? 1663 01:17:20,175 --> 01:17:23,315 We actually funded I think two years. Two years. 1664 01:17:24,055 --> 01:17:27,315 Let me see here. Yeah. 1665 01:17:27,315 --> 01:17:29,635 In 2011 1666 01:17:29,655 --> 01:17:33,475 and 2012 we actually paid out the operations 1667 01:17:33,505 --> 01:17:35,595 $540,000 one year 1668 01:17:35,935 --> 01:17:38,635 and 445,000 the next year. 1669 01:17:39,025 --> 01:17:40,275 Part of that was also 1670 01:17:40,275 --> 01:17:42,035 because the rate we had 1671 01:17:42,545 --> 01:17:46,195 told the public when we did our estimates long time ago, 1672 01:17:46,945 --> 01:17:49,795 back in before 2007, 1673 01:17:50,525 --> 01:17:53,595 where we were seeing double digit increases in our property 1674 01:17:53,695 --> 01:17:55,915 tax values and the average at 1675 01:17:55,915 --> 01:17:58,595 that time was an 8% increase year after year. 1676 01:17:59,175 --> 01:18:00,475 And then the market blew up. 1677 01:18:00,775 --> 01:18:04,795 So obviously we couldn't fully predict what was going 1678 01:18:04,795 --> 01:18:07,355 to happen with the market way back then. 1679 01:18:08,375 --> 01:18:11,635 And so when we said on average it would be $18 1680 01:18:11,735 --> 01:18:14,795 and 76 cents, that rate actually went higher 1681 01:18:15,135 --> 01:18:17,835 and the board at that time chose to also pay some 1682 01:18:17,835 --> 01:18:19,475 of those funds out of operations instead 1683 01:18:19,475 --> 01:18:22,275 of putting it on the backs of the property taxpayers. 1684 01:18:23,105 --> 01:18:27,585 Yeah. So, 1685 01:18:28,375 --> 01:18:31,115 So for years I used to advocate that we hold back 1686 01:18:31,705 --> 01:18:33,155 more in reserves and 1687 01:18:33,555 --> 01:18:38,035 because I, I was either on the border, 1688 01:18:38,315 --> 01:18:40,435 I think just after this occurred 1689 01:18:41,815 --> 01:18:44,355 and there was a lot of pushback from the community at the 1690 01:18:44,355 --> 01:18:45,875 time they were unhappy. 1691 01:18:47,215 --> 01:18:48,475 And so I unhappy 1692 01:18:48,475 --> 01:18:51,315 With what, With the fact that we, we holding 1693 01:18:51,315 --> 01:18:53,315 Reserves, holding reserves Were, yeah. 1694 01:18:53,575 --> 01:18:57,515 So I I would agree that holding back 1695 01:18:59,155 --> 01:19:03,685 75% or paying 75% of the reserves is the appropriate 1696 01:19:03,685 --> 01:19:05,445 Number retaining 25% retaining 1697 01:19:05,465 --> 01:19:06,485 In that 25%. 1698 01:19:06,785 --> 01:19:07,885 We what happens at the end? 1699 01:19:07,885 --> 01:19:09,165 And that goes into our general fund. 1700 01:19:09,165 --> 01:19:10,165 That just goes into No, no, 1701 01:19:10,165 --> 01:19:11,165 No, no, no. 1702 01:19:11,165 --> 01:19:13,525 Exactly. It is always a hundred percent dedicated 1703 01:19:13,625 --> 01:19:16,925 to the purpose of making the debt service requirement on the 1704 01:19:16,925 --> 01:19:17,925 general obligation bonds 1705 01:19:18,075 --> 01:19:19,525 Totally separate set of books. 1706 01:19:19,905 --> 01:19:23,445 So it, it is always restricted for that purpose. Okay. 1707 01:19:23,785 --> 01:19:26,965 And so when we finally get to that last payment 1708 01:19:27,625 --> 01:19:28,805 Of several million dollars 1709 01:19:29,785 --> 01:19:32,165 On these bonds, remember what the chart was, we'll have 1710 01:19:32,165 --> 01:19:35,205 to evaporate entirely that reserve account 1711 01:19:35,545 --> 01:19:38,765 and estimate what we think to make that payment. 1712 01:19:38,945 --> 01:19:42,365 We might want to, I mean this is a ways out 1713 01:19:42,385 --> 01:19:44,845 and somebody else will probably doing this calculation for 1714 01:19:44,845 --> 01:19:45,845 You. 1715 01:19:45,845 --> 01:19:46,965 That's okay. I I'll cut to that just for brevity time. 1716 01:19:47,045 --> 01:19:47,925 I just scored the, where, 1717 01:19:48,265 --> 01:19:49,405 how much money do we have right now? 1718 01:19:50,025 --> 01:19:51,925 So there's 909, 1719 01:19:52,705 --> 01:19:55,965 So last year we had 200 and that carries over, right? 1720 01:19:56,235 --> 01:19:57,525 Last year was a little bit 1721 01:19:57,935 --> 01:19:58,935 Where curves going? 1722 01:19:58,935 --> 01:19:59,965 Does it carry over or do we just 1723 01:19:59,965 --> 01:20:01,205 collect that so that carries over? 1724 01:20:01,345 --> 01:20:03,765 It carries over. It stays in a restricted account. Yeah. 1725 01:20:03,765 --> 01:20:05,285 In a restricted account. Perfect. Yeah. Okay. 1726 01:20:05,285 --> 01:20:06,845 And we cannot use that for anything else. Nothing 1727 01:20:06,845 --> 01:20:07,565 Else. Okay. We 1728 01:20:07,565 --> 01:20:08,485 Can't pay down other debts 1729 01:20:08,505 --> 01:20:09,645 or anything like that as well. Nope. 1730 01:20:09,825 --> 01:20:11,525 So like the 900 we have right now 1731 01:20:12,185 --> 01:20:14,045 is the reserve from last year, 1732 01:20:14,105 --> 01:20:16,445 the carryover from last year plus additional 1733 01:20:16,555 --> 01:20:18,165 reserve that came in? Yes. Yeah. 1734 01:20:18,165 --> 01:20:19,885 Okay. Yeah. Okay. I wanna be clear on that. 1735 01:20:20,225 --> 01:20:23,165 Yes. So we rolled over about 250,000 from last year. 1736 01:20:23,635 --> 01:20:25,205 Then the collections came in, 1737 01:20:25,205 --> 01:20:27,765 which gave us about another 700,000 1738 01:20:28,435 --> 01:20:30,565 that came in more than we expected. 1739 01:20:30,995 --> 01:20:33,885 That gave us about that $970,000 reserve. 1740 01:20:34,505 --> 01:20:38,465 If we use 75% of that, that other 200 1741 01:20:38,485 --> 01:20:40,905 to 7,000 we'll roll over again in a restricted 1742 01:20:40,905 --> 01:20:42,545 account only for this purpose. 1743 01:20:48,745 --> 01:20:50,735 Makes sense. Makes sense. Okay, thank you. 1744 01:20:50,805 --> 01:20:52,705 Yeah, no further questions. 1745 01:20:54,285 --> 01:20:55,285 I think, would you have done this 1746 01:20:56,015 --> 01:20:57,105 just once right? Last? Yeah, just 1747 01:20:57,725 --> 01:20:58,905 Oh Yeah. No, it's a little, 1748 01:20:59,825 --> 01:21:00,945 I remember that one very a little. 1749 01:21:01,335 --> 01:21:03,945 Yeah. I think takes a second to get Yeah. 1750 01:21:03,945 --> 01:21:06,105 I mean looking, you know, just like, yeah, no, I went 1751 01:21:06,105 --> 01:21:07,785 through some numbers back in the Hadn math 1752 01:21:07,785 --> 01:21:09,105 and I just, again, looking at, 1753 01:21:09,395 --> 01:21:11,065 let's say it's a million dollar home, you know, 1754 01:21:11,065 --> 01:21:14,945 you're looking at $169 versus 142 versus 148. 1755 01:21:15,415 --> 01:21:17,985 Yeah. I called a few people yesterday and today 1756 01:21:18,105 --> 01:21:19,465 'cause I was like, what does it mean to you? 1757 01:21:19,485 --> 01:21:22,435 And many people were kind of surprised like, oh, 1758 01:21:22,435 --> 01:21:23,635 I didn't even know that it changes. 1759 01:21:24,265 --> 01:21:27,155 Yeah. And then I said, well, you know, that's really kind 1760 01:21:27,155 --> 01:21:30,155 of your money, you know, what would you, would you want us 1761 01:21:30,155 --> 01:21:31,355 to all pay it down? 1762 01:21:31,495 --> 01:21:34,395 And many of them just as long as like, well, as long 1763 01:21:34,395 --> 01:21:35,475 as long, you know, they, 1764 01:21:35,545 --> 01:21:38,315 many people just didn't really have much of a say about it. 1765 01:21:38,335 --> 01:21:40,795 You know, $5 1 42 versus 1 48 1766 01:21:40,795 --> 01:21:42,515 for a million dollars home, $6. 1767 01:21:42,515 --> 01:21:43,835 They're like, yeah, fine. 1768 01:21:44,265 --> 01:21:46,715 Well unless they move out of the area it has, 1769 01:21:46,945 --> 01:21:50,915 it's still in their quote bank account for, 1770 01:21:50,935 --> 01:21:53,355 for use at a later date. So small portion. 1771 01:21:53,505 --> 01:21:54,505 Yeah. Yeah. 1772 01:21:54,505 --> 01:21:56,755 So I think the biggest question I get, 1773 01:21:56,755 --> 01:21:59,635 because my direct line is attached 1774 01:21:59,655 --> 01:22:01,955 to your property text statement if you notice it. 1775 01:22:02,535 --> 01:22:04,955 So the phone calls I get are, 1776 01:22:05,455 --> 01:22:06,795 do you have a senior exemption? 1777 01:22:07,315 --> 01:22:09,595 I mean, that's probably the biggest question that comes up. 1778 01:22:09,735 --> 01:22:12,355 And in this case we have no exemptions there. 1779 01:22:12,355 --> 01:22:14,795 There's no one exempt from being able, 1780 01:22:14,795 --> 01:22:17,955 like the school districts, you could be exempt from some 1781 01:22:17,955 --> 01:22:19,555 of their tax measures if you're a senior 1782 01:22:19,755 --> 01:22:20,955 'cause you don't have kids in school. 1783 01:22:21,815 --> 01:22:23,395 But we do not have exemptions. 1784 01:22:23,415 --> 01:22:26,275 So that's probably the biggest question the public asks me. 1785 01:22:28,585 --> 01:22:30,945 I just wanted to make sure that everybody understands 1786 01:22:30,965 --> 01:22:33,065 how seriously we really do take this. 1787 01:22:33,765 --> 01:22:37,145 And I know s we're, we're, we're, you know, kind of 1788 01:22:37,835 --> 01:22:39,825 being funny about it. 1789 01:22:39,825 --> 01:22:42,625 Right now it's because we've done this year after year 1790 01:22:42,625 --> 01:22:46,585 after year, and we've had these arguments between giving, 1791 01:22:46,855 --> 01:22:49,945 holding all of it and returning all of it. 1792 01:22:50,005 --> 01:22:52,865 And it's, you know, it's run the full breadth of all 1793 01:22:52,865 --> 01:22:55,185 of these different realms 1794 01:22:55,185 --> 01:22:57,305 of possibility year after year after year. 1795 01:22:57,325 --> 01:23:01,145 And that's why we're kind of being lighthearted about it. 1796 01:23:01,165 --> 01:23:02,945 But we do take it very seriously. 1797 01:23:03,645 --> 01:23:06,485 And toward that end, I would like to make the motion 1798 01:23:06,555 --> 01:23:08,645 that we retain 75% 1799 01:23:08,955 --> 01:23:11,245 Well, we're gonna go to, Of the reason we have to go 1800 01:23:11,245 --> 01:23:12,285 There, we're gonna go to the, 1801 01:23:12,665 --> 01:23:14,045 the people whose money we're gonna take 1802 01:23:14,465 --> 01:23:15,445 Yes. To retain, 1803 01:23:15,835 --> 01:23:19,525 Just to retain Before we, before we jump in there. No, 1804 01:23:19,525 --> 01:23:22,325 I'm sorry Mary, really important point 1805 01:23:22,435 --> 01:23:25,085 that not everyone benefits from the history that we do. 1806 01:23:25,585 --> 01:23:28,005 You know, crystallize, you said it, it, at the end 1807 01:23:28,005 --> 01:23:29,245 of the day, it does come down to just the 1808 01:23:29,245 --> 01:23:30,325 math equation, right? 1809 01:23:30,545 --> 01:23:31,565 And then what do you wanna do? 1810 01:23:31,625 --> 01:23:35,245 But it is, you know, I think the differences between, 1811 01:23:35,465 --> 01:23:36,525 you know, this percent and 1812 01:23:36,525 --> 01:23:38,005 that percent might yield maybe a 1813 01:23:38,005 --> 01:23:39,165 difference of $5 as you said. 1814 01:23:39,345 --> 01:23:41,525 But, but to some it's, you know, it's the, 1815 01:23:41,795 --> 01:23:43,405 Well people are calling people calling 1816 01:23:43,505 --> 01:23:44,505 Her. 1817 01:23:44,505 --> 01:23:46,685 Well, but the, the total $170 is real money, you know, 1818 01:23:46,825 --> 01:23:49,325 but the, the differences that, you know, when we argued 1819 01:23:49,325 --> 01:23:51,485 between, you know, this percent versus that percent, yeah. 1820 01:23:51,505 --> 01:23:53,445 The, the net difference was a dollar. 1821 01:23:53,985 --> 01:23:56,165 And let me clarify, it's like three phone calls. 1822 01:23:56,275 --> 01:23:58,085 It's not like I'm getting hundreds, 1823 01:23:58,305 --> 01:23:59,725 But if few people are calling, you know, they're like, 1824 01:23:59,835 --> 01:24:02,685 yeah, they are probably 30 to 300 looking at 1825 01:24:02,685 --> 01:24:05,445 that saying they're, what am I paying for that didn't call? 1826 01:24:05,545 --> 01:24:06,935 So it's, yeah. 1827 01:24:07,035 --> 01:24:08,735 And I think that's the key thing is that it's retaining, 1828 01:24:08,735 --> 01:24:10,975 this is not money that's coming into the general funds here 1829 01:24:11,075 --> 01:24:13,295 or the hospital using or anything we could pay down. 1830 01:24:13,295 --> 01:24:15,775 This is money that they'll be we'll be using back 1831 01:24:15,775 --> 01:24:19,535 to pay down again or general obligation to 1832 01:24:22,235 --> 01:24:24,215 Any other comments, questions from the board? 1833 01:24:25,855 --> 01:24:27,165 Again, I didn't come from this point. 1834 01:24:27,225 --> 01:24:29,445 My only comment is I keep, I keep struggling 1835 01:24:29,445 --> 01:24:30,565 with why not a hundred percent? 1836 01:24:30,755 --> 01:24:32,965 I'll be frankly honest. I again, and I'm a new guy. 1837 01:24:32,965 --> 01:24:33,965 That's right. Because of that, 1838 01:24:36,085 --> 01:24:40,745 That one time, that one time two times, if it happens, 1839 01:24:41,605 --> 01:24:43,585 if we have, if it happens again, they're 1840 01:24:43,585 --> 01:24:44,985 Gonna find you on aisle two basically. 1841 01:24:45,055 --> 01:24:46,185 Yeah. They're gonna find me here. 1842 01:24:46,185 --> 01:24:47,385 You're gonna tell 'em where you are. 1843 01:24:52,225 --> 01:24:53,195 That is my only comment. 1844 01:24:53,785 --> 01:24:57,815 Okay. Yeah, I, I think the, the the important point, 1845 01:24:58,075 --> 01:25:01,585 you know, Robert Trade, like we don't take the reserves 1846 01:25:01,585 --> 01:25:03,545 and go out the party, you know, that, 1847 01:25:03,545 --> 01:25:04,745 that they are dedicated. 1848 01:25:04,745 --> 01:25:07,425 It's just a matter of, you know, it's just, it's a, 1849 01:25:07,495 --> 01:25:09,065 it's a small layer of protection 1850 01:25:10,085 --> 01:25:13,065 in case things go south in the year ahead. 1851 01:25:14,855 --> 01:25:16,155 But it's money that's going to be paid 1852 01:25:16,155 --> 01:25:17,795 through tax dollars at some point. 1853 01:25:18,255 --> 01:25:21,395 Yep. A hundred percent of It. 1854 01:25:21,905 --> 01:25:23,755 Yeah, a hundred percent. A hundred percent. Yeah. Right. 1855 01:25:23,755 --> 01:25:24,955 Yeah, there's no slush fund, there's no, 1856 01:25:24,955 --> 01:25:26,355 I think we talked about these reserve accounts. 1857 01:25:26,355 --> 01:25:28,515 Yeah, that's, well the end, that's not code for slush fund. 1858 01:25:28,515 --> 01:25:30,635 Yeah. It's like every single dollar will go to pay, 1859 01:25:30,665 --> 01:25:33,715 it's just we'll pay this year that next year or the year 1860 01:25:33,855 --> 01:25:35,155 or the year, you know, or at the end. 1861 01:25:36,575 --> 01:25:37,575 So 1862 01:25:38,635 --> 01:25:42,645 Crystal, to clarify the resolution as presented was 1863 01:25:42,875 --> 01:25:47,085 with the 75% utilized 1864 01:25:47,515 --> 01:25:49,365 utilization of the reserve. Correct. 1865 01:25:50,075 --> 01:25:52,605 Retaining 25%, Correct? Correct. 1866 01:25:53,155 --> 01:25:55,005 Yeah. Which it was in the motion. 1867 01:25:55,315 --> 01:25:58,445 Yeah. The suggested motion that's in the agenda. 1868 01:25:58,825 --> 01:26:01,205 So that would be, yeah, the, the 1489 per a hundred 1869 01:26:01,485 --> 01:26:04,415 thousand and the 75% Yeah. 1870 01:26:04,835 --> 01:26:06,135 Use of the reserve. Yeah. Okay, 1871 01:26:06,905 --> 01:26:08,295 we'll get to that in just a second. 1872 01:26:10,675 --> 01:26:12,535 Any input from the audience? Comments, questions? 1873 01:26:18,065 --> 01:26:20,115 None. None From Lauren? She walks in. 1874 01:26:20,115 --> 01:26:24,155 Yeah, she's like what me? I'm assuming nothing online. 1875 01:26:24,155 --> 01:26:27,195 Okay, wonderful. With that Mary. 1876 01:26:27,815 --> 01:26:30,675 Yes, with that I would move that we 1877 01:26:31,825 --> 01:26:36,115 here it's retain 25% of the reserve account. 1878 01:26:36,215 --> 01:26:38,075 Oh, you've got it right there. Yeah. 1879 01:26:38,455 --> 01:26:43,075 Set the, set the 26 27 fiscal year general obligation bond 1880 01:26:43,175 --> 01:26:46,755 tax rate per 100,000 at 1589. 1881 01:26:46,975 --> 01:26:50,595 And utilize approximately 75% of the reserve 1882 01:26:51,015 --> 01:26:54,915 to fully cover the 26 27 debt reserve requirement. 1883 01:26:55,905 --> 01:26:58,595 This will leave 25% in 1884 01:26:58,595 --> 01:27:01,255 reserve. I'll second that 1885 01:27:01,755 --> 01:27:02,755 And a second. 1886 01:27:02,755 --> 01:27:03,255 All in favor? 1887 01:27:03,755 --> 01:27:05,015 Aye. Aye. Aye. 1888 01:27:05,525 --> 01:27:10,205 Opposed? Thank you very much. 1889 01:27:10,845 --> 01:27:12,005 Approved unanimously 1890 01:27:13,485 --> 01:27:15,345 And see you next year on this one. 1891 01:27:18,805 --> 01:27:19,505 So tempted. 1892 01:27:23,315 --> 01:27:24,845 Fantastic. Item 17, 1893 01:27:24,865 --> 01:27:28,645 we did have one item pulled from the consent calendar. 1894 01:27:28,875 --> 01:27:31,845 Item 14 six, town of Forest Home Health 1895 01:27:31,845 --> 01:27:35,565 and Hospice services Director Jar and Kevi pulled that. 1896 01:27:35,665 --> 01:27:37,085 So we'll let you lead the discussion 1897 01:27:39,425 --> 01:27:41,545 I want And Lauren, how long have you been here? 1898 01:27:42,325 --> 01:27:45,785 Hi, it's so nice to see you. So I'm Lauren Zara. 1899 01:27:46,345 --> 01:27:48,265 I am the director of Home Health, 1900 01:27:48,265 --> 01:27:49,385 hospice and Palliative Care. 1901 01:27:49,645 --> 01:27:53,025 And I started in February this time around, 1902 01:27:54,545 --> 01:27:58,985 I actually sat in this room about 20 years ago in a 1903 01:27:59,185 --> 01:28:02,025 CNA course that I took when I was working 1904 01:28:02,125 --> 01:28:05,905 as a cashier at the retail pharmacy across the street 1905 01:28:06,605 --> 01:28:09,225 and then worked in the inpatient pharmacy 1906 01:28:09,445 --> 01:28:11,585 and had the honor of working with Alice 1907 01:28:12,145 --> 01:28:14,785 upstairs on the floor as a CNA 1908 01:28:14,785 --> 01:28:15,905 before I went to nursing school. 1909 01:28:16,645 --> 01:28:21,105 So being back here full circle as a nurse practitioner now 1910 01:28:21,105 --> 01:28:22,265 and director of Home Health, 1911 01:28:22,265 --> 01:28:24,625 hospice palliative care in the thrift stores is 1912 01:28:25,725 --> 01:28:27,225 pretty amazing, honestly. So 1913 01:28:27,395 --> 01:28:28,395 Story. 1914 01:28:28,395 --> 01:28:28,855 Yeah. 1915 01:28:29,165 --> 01:28:32,305 And kudos to, to Child Forest for this is 1916 01:28:32,305 --> 01:28:33,545 where I always wanted to come back. 1917 01:28:33,805 --> 01:28:37,915 So excited to be here and happy to answer any questions. 1918 01:28:39,265 --> 01:28:41,155 Well, thank you. Thank you for your introduction 1919 01:28:41,215 --> 01:28:43,035 and thank you really for doing this. 1920 01:28:43,195 --> 01:28:45,595 I think the rea the reason I pulled this is I, 1921 01:28:45,715 --> 01:28:49,435 I really wanted the public to know how important this is, 1922 01:28:49,495 --> 01:28:50,755 how hospice is important. 1923 01:28:50,955 --> 01:28:53,715 I think you look around the room, I think we all are kind 1924 01:28:53,715 --> 01:28:56,515 of, you know, going through that with our family and, 1925 01:28:57,095 --> 01:28:59,475 and this is something that's you, I think 1926 01:28:59,735 --> 01:29:01,485 as a physician you find that the, the people, 1927 01:29:01,925 --> 01:29:04,685 families are at most vulnerable scared. 1928 01:29:05,305 --> 01:29:08,005 Yet it is most wonderful time that we can honor. 1929 01:29:08,305 --> 01:29:11,165 So I really wanna say just thank you for this great work. 1930 01:29:11,165 --> 01:29:13,925 Welcome. You know, looking at the data 1931 01:29:13,945 --> 01:29:16,845 and the quality there as always, you know, so, 1932 01:29:16,905 --> 01:29:18,445 so wonderful to he. 1933 01:29:18,625 --> 01:29:21,325 See. I'm just curious, is there anything 1934 01:29:21,325 --> 01:29:25,245 that you've noticed in your journey that you've seen 1935 01:29:25,265 --> 01:29:27,565 or uncovered or even that you have us now? 1936 01:29:27,765 --> 01:29:29,525 I pulled you up, I made you wait this long, 1937 01:29:30,185 --> 01:29:31,325 so now you have us. 1938 01:29:31,665 --> 01:29:33,165 So I guess my question is, you have us here, 1939 01:29:33,165 --> 01:29:34,765 is there anything that you wish to tell us more 1940 01:29:34,765 --> 01:29:36,525 besides this report or anything that 1941 01:29:37,145 --> 01:29:39,805 we should know more than, than the great work 1942 01:29:39,805 --> 01:29:41,365 that you're doing and the team is doing? 1943 01:29:42,085 --> 01:29:45,245 I think there's a lot I would say, 1944 01:29:45,265 --> 01:29:48,925 but to keep it brief, I really, I looked back at the last 1945 01:29:49,905 --> 01:29:52,765 few years and watched the recordings of board meetings 1946 01:29:53,545 --> 01:29:56,285 of the home health hospice quality presentation. 1947 01:29:56,585 --> 01:29:59,445 And with this, I really wanted to expand. 1948 01:29:59,925 --> 01:30:04,165 I think the last few quality plans had had 1949 01:30:04,915 --> 01:30:07,765 five or six measures for both for home health 1950 01:30:07,785 --> 01:30:09,165 and a few measures for hospice. 1951 01:30:09,705 --> 01:30:11,045 And so I really wanted to expand. 1952 01:30:11,145 --> 01:30:13,325 So I know you can't all see it right now, 1953 01:30:13,625 --> 01:30:17,165 but in home health there are, 1954 01:30:19,205 --> 01:30:23,145 Oh, if you go ahead, I'm not, keep going, keep going. 1955 01:30:23,495 --> 01:30:27,185 This one, go back one originally. So this is home health. 1956 01:30:27,365 --> 01:30:31,065 So often home health hospice gets lumped together into one 1957 01:30:31,155 --> 01:30:33,265 thing and it's, it's very unique. 1958 01:30:33,725 --> 01:30:38,025 And so there are very, there's very different criteria 1959 01:30:38,205 --> 01:30:40,625 for each program and each department. 1960 01:30:40,805 --> 01:30:42,585 And I think because we're out in the home 1961 01:30:43,325 --> 01:30:46,305 and we're often, it's a continuum in some ways. 1962 01:30:46,405 --> 01:30:48,225 You know, patients often go from home health 1963 01:30:48,245 --> 01:30:49,345 to palliative care to hospice. 1964 01:30:50,265 --> 01:30:51,265 We get lumped together. 1965 01:30:51,565 --> 01:30:55,905 And so I really wanted to put up here the quality measures 1966 01:30:55,905 --> 01:30:57,225 that CMS is looking at 1967 01:30:57,285 --> 01:31:00,145 and really align our quality program with 1968 01:31:01,435 --> 01:31:02,705 nationwide benchmarks. 1969 01:31:03,085 --> 01:31:04,185 And so for home health, 1970 01:31:04,235 --> 01:31:05,865 these are the measures that we look at. 1971 01:31:05,925 --> 01:31:09,025 So oasis based measures, those are measures 1972 01:31:09,025 --> 01:31:10,665 that we are self-reporting on, 1973 01:31:10,665 --> 01:31:13,025 how patients are doing at the beginning of care 1974 01:31:13,645 --> 01:31:16,865 at a recertification or after a readmission, 1975 01:31:16,925 --> 01:31:20,225 and then a discharge, claims-based measures. 1976 01:31:20,565 --> 01:31:23,385 And then our patient satisfaction scores. 1977 01:31:23,765 --> 01:31:26,385 So if you go to the next slide, 1978 01:31:28,375 --> 01:31:30,845 these actual next three slides are, 1979 01:31:31,185 --> 01:31:32,445 are all of those measures. 1980 01:31:32,445 --> 01:31:34,045 So this first one is the oasis, 1981 01:31:34,115 --> 01:31:36,085 then we have the claims-based 1982 01:31:36,185 --> 01:31:38,005 and then our patient satisfaction scores. 1983 01:31:38,385 --> 01:31:41,525 So I really wanted to put all of them in there 1984 01:31:41,665 --> 01:31:43,965 so we're not just looking at maybe the 1985 01:31:43,965 --> 01:31:45,125 ones we're doing really well on. 1986 01:31:45,285 --> 01:31:46,685 'cause I think for our quality plan, 1987 01:31:46,705 --> 01:31:48,165 we should really be looking at the things 1988 01:31:48,165 --> 01:31:49,565 we need to improve on. 1989 01:31:50,185 --> 01:31:53,805 So I wanted to include all of them 1990 01:31:53,985 --> 01:31:55,085 and then include all of 1991 01:31:55,085 --> 01:31:57,125 that in the discussions I'm having with staff. 1992 01:31:57,125 --> 01:31:59,925 Because these things really matter. 1993 01:31:59,985 --> 01:32:01,325 If we're looking at, you know, 1994 01:32:01,325 --> 01:32:04,885 improvement in bed transferring, that really matters 1995 01:32:05,065 --> 01:32:07,205 to somebody's life and quality of life 1996 01:32:07,225 --> 01:32:08,325 and how well we're doing. 1997 01:32:08,505 --> 01:32:11,365 If we can't, you know, roll out 1998 01:32:11,365 --> 01:32:12,525 of bed and that's the measure. 1999 01:32:12,525 --> 01:32:15,165 It's rolling from left to right and sitting up. 2000 01:32:16,055 --> 01:32:18,165 There are so many things that we can't do 2001 01:32:18,235 --> 01:32:19,925 that our quality is diminished. 2002 01:32:20,105 --> 01:32:23,925 So, you know, they, they really do matter in people's lives. 2003 01:32:24,065 --> 01:32:25,845 And so I wanted to incorporate all 2004 01:32:25,845 --> 01:32:27,685 of them into the quality plan 2005 01:32:27,745 --> 01:32:29,285 so we're not just looking at a few things 2006 01:32:29,285 --> 01:32:32,085 because they all are interrelated really. 2007 01:32:32,265 --> 01:32:36,455 So you can kind of scroll the claims base. 2008 01:32:36,565 --> 01:32:39,655 This is, you know, timely initiation of care. 2009 01:32:39,685 --> 01:32:41,655 This is a big one. We are required 2010 01:32:41,655 --> 01:32:44,135 to be out within 48 hours of a referral. 2011 01:32:44,275 --> 01:32:46,175 So how quickly are we getting out to patients 2012 01:32:46,175 --> 01:32:47,895 because that prevents readmissions. 2013 01:32:48,955 --> 01:32:52,175 The next one is our patient satisfaction scores. 2014 01:32:53,115 --> 01:32:55,295 I'm really looking at this 2015 01:32:56,755 --> 01:32:59,615 and looking at changing the system we're using right now. 2016 01:32:59,895 --> 01:33:02,535 'cause we use Press Ganey for home health, which is what 2017 01:33:03,295 --> 01:33:04,375 hospitals generally use, 2018 01:33:04,515 --> 01:33:07,895 but for the more majority 2019 01:33:07,895 --> 01:33:10,335 of agencies actually use this program, SHP. 2020 01:33:10,395 --> 01:33:13,375 So I'm looking at changing us over to that program 2021 01:33:13,455 --> 01:33:16,375 because it gives us real time data that we can look at 2022 01:33:16,375 --> 01:33:20,295 with every single patient as we submit data to CMS, 2023 01:33:20,295 --> 01:33:24,175 we also submit it to this program so we can make changes 2024 01:33:24,475 --> 01:33:27,615 as we see them and be more proactive instead of reactive. 2025 01:33:29,155 --> 01:33:30,575 And then with hospice, 2026 01:33:31,255 --> 01:33:33,135 I think is the next one you can actually 2027 01:33:33,135 --> 01:33:34,295 move on to the next one. 2028 01:33:36,415 --> 01:33:38,265 This I'm really excited about for hospice 2029 01:33:38,485 --> 01:33:39,945 and I wanted to include it 2030 01:33:39,945 --> 01:33:41,145 because CMS 2031 01:33:41,325 --> 01:33:45,025 for the first time has changed the hospice assessment. 2032 01:33:45,725 --> 01:33:48,545 So October 1st, last year, 2025, 2033 01:33:49,015 --> 01:33:51,545 they rolled out what's called the HOPE assessment. 2034 01:33:51,855 --> 01:33:54,465 It's the Hospice Outcomes and Patient evaluation. 2035 01:33:55,045 --> 01:33:58,665 And it is really going to change hospice quality measures 2036 01:33:58,855 --> 01:34:02,065 because previously we only looked at patient 2037 01:34:02,705 --> 01:34:04,985 satisfaction scores and those were sent out 2038 01:34:04,985 --> 01:34:06,225 after the patient was deceased. 2039 01:34:07,145 --> 01:34:09,465 So it's family members who are filling out this survey, 2040 01:34:10,005 --> 01:34:11,385 if they even get the survey, 2041 01:34:11,885 --> 01:34:14,305 if they return the survey in the midst 2042 01:34:14,445 --> 01:34:15,985 of everything they're dealing with. 2043 01:34:18,195 --> 01:34:22,445 This HOPE measure is, is pretty, I think, 2044 01:34:22,725 --> 01:34:25,565 revolutionary in hospice because it's gonna give us data, 2045 01:34:25,985 --> 01:34:28,165 it, it's something we do on admission 2046 01:34:28,345 --> 01:34:31,965 and then we have to do it within two weeks 2047 01:34:32,065 --> 01:34:33,125 of admitting the patient. 2048 01:34:33,625 --> 01:34:36,325 And then based on that assessment, if there's moderate 2049 01:34:36,465 --> 01:34:38,005 or severe symptoms, we have 2050 01:34:38,005 --> 01:34:40,165 to go back into a symptom follow-up visit. 2051 01:34:40,585 --> 01:34:43,485 And so it's gonna give us data on 2052 01:34:44,265 --> 01:34:45,925 our symptom management 2053 01:34:46,105 --> 01:34:49,045 and outcomes that for hospice, 2054 01:34:49,985 --> 01:34:51,325 you know, we really need. 2055 01:34:51,505 --> 01:34:55,725 And so I'm really excited CMS is doing this 2056 01:34:55,785 --> 01:34:59,245 and it aligns with home health, the Oasis evaluation. 2057 01:34:59,465 --> 01:35:02,165 So I just really wanted to include that 2058 01:35:02,165 --> 01:35:04,565 because it's gonna take a few years for it to happen. 2059 01:35:04,745 --> 01:35:08,045 But this is gonna change hospice quality hugely. 2060 01:35:08,935 --> 01:35:12,485 Which is happening right now in California. 2061 01:35:12,845 --> 01:35:14,565 I don't know many people know, 2062 01:35:14,565 --> 01:35:17,005 but there's a moratorium on hospices right now. 2063 01:35:17,105 --> 01:35:19,925 You cannot open a new hospice in California 2064 01:35:20,765 --> 01:35:25,685 because there's been so much hospice fraud and abuse in LA 2065 01:35:25,705 --> 01:35:26,725 and Riverside County. 2066 01:35:27,165 --> 01:35:30,485 I, the number, there was like a thousand percent increase in 2067 01:35:30,485 --> 01:35:32,765 the number of hospices where CDPH 2068 01:35:33,605 --> 01:35:38,045 actually in June just rolled out 194 pages 2069 01:35:38,145 --> 01:35:41,285 of new regulations for hospices because of this. 2070 01:35:41,285 --> 01:35:44,445 Because there were, when they looked at it, there were about 2071 01:35:46,065 --> 01:35:49,365 for, there were about one, there was one hospice agency 2072 01:35:49,385 --> 01:35:51,805 for every four people that had died in LA 2073 01:35:51,805 --> 01:35:52,885 and Riverside County. 2074 01:35:53,545 --> 01:35:55,605 So that math doesn't add up. 2075 01:35:56,385 --> 01:35:59,725 So they've rolled out all these new initiatives 2076 01:35:59,745 --> 01:36:02,165 and using Hope will give us a lot more data. 2077 01:36:02,825 --> 01:36:06,365 So I can go on for a long time about this. 2078 01:36:06,525 --> 01:36:09,005 I will. I, yeah, I, home health 2079 01:36:09,025 --> 01:36:11,605 and hospice is near and dear to my heart. 2080 01:36:11,725 --> 01:36:15,365 I love it. And you know, it's often you don't see 2081 01:36:15,395 --> 01:36:16,765 what we're doing out in the house 2082 01:36:17,145 --> 01:36:18,805 and what's happening in the home. 2083 01:36:18,905 --> 01:36:21,245 And so I really hope to be a champion for that 2084 01:36:21,345 --> 01:36:24,365 and really expand our program and access, 2085 01:36:24,365 --> 01:36:26,365 because when I'm talking about access to care, that's, 2086 01:36:26,745 --> 01:36:29,565 you know, most patients are going home from the hospital. 2087 01:36:29,675 --> 01:36:32,285 It's where they wanna be. It's, it's safer, it's, 2088 01:36:32,555 --> 01:36:34,085 it's the place where we get, 2089 01:36:36,545 --> 01:36:37,765 you know, where we live our lives. 2090 01:36:37,905 --> 01:36:41,085 So if we can get our care there and keep ourselves home 2091 01:36:41,145 --> 01:36:43,125 and out of the hospital, I think that's what we all want. 2092 01:36:45,425 --> 01:36:47,485 Lauren did I see, I can't find it. 2093 01:36:47,605 --> 01:36:50,765 I was trying to look back, did I see a data point in this 2094 01:36:50,795 --> 01:36:54,845 that showed that the average number of days in hospice 2095 01:36:55,515 --> 01:36:58,125 care had dropped precipitously? 2096 01:36:58,505 --> 01:37:00,645 If you go, I think it's the next, 2097 01:37:01,225 --> 01:37:03,365 or actually this one slide previous to that, 2098 01:37:04,265 --> 01:37:06,645 was it this one here? 2099 01:37:06,745 --> 01:37:11,125 So our Tahoe Forest average length of stay is 29 days, 2100 01:37:11,125 --> 01:37:14,405 whereas the Medicare average is 88.6. 2101 01:37:14,745 --> 01:37:16,045 Is that the number? That 2102 01:37:16,045 --> 01:37:17,045 Was the number I thought. 2103 01:37:17,555 --> 01:37:20,365 Yeah. So that's really something I'm gonna work on is 2104 01:37:20,365 --> 01:37:23,005 getting hospice referrals sooner. 2105 01:37:23,745 --> 01:37:26,285 The number one thing people say about hospice is they 2106 01:37:26,285 --> 01:37:27,525 wish they had it sooner. 2107 01:37:29,025 --> 01:37:33,725 So I think there's a lot of work I'm gonna do on that 2108 01:37:33,825 --> 01:37:35,045 and I hope that changes. 2109 01:37:35,365 --> 01:37:36,565 I think it's gonna take some time, 2110 01:37:36,785 --> 01:37:40,165 but that is something I really wanna work on. 2111 01:37:40,835 --> 01:37:42,175 And the other piece of 2112 01:37:42,175 --> 01:37:45,215 that though is we really wanna make sure our patients are 2113 01:37:45,215 --> 01:37:46,575 appropriate for hospice care. 2114 01:37:46,915 --> 01:37:50,695 So if we're looking at agencies that maybe have, you know, 2115 01:37:52,135 --> 01:37:54,295 numerous patients on that don't really qualify 2116 01:37:54,555 --> 01:37:58,965 or there is that fraud with hospice, you know, 2117 01:37:59,505 --> 01:38:02,245 we, I don't know if that number is exactly accurate of 2118 01:38:02,245 --> 01:38:05,405 what it should be, but Okay, sure. 2119 01:38:05,585 --> 01:38:06,645 You know, we'll look at that 2120 01:38:06,705 --> 01:38:09,405 and I really wanna expand it, so thank 2121 01:38:09,405 --> 01:38:10,405 You for what you do. 2122 01:38:10,505 --> 01:38:13,465 Of course. Thank you. And then Lauren, 2123 01:38:13,605 --> 01:38:17,705 can I ask the question, is the future of hospice quality 2124 01:38:17,845 --> 01:38:22,625 and the Hope Project or the Hope format, is 2125 01:38:22,625 --> 01:38:25,065 that gonna be something that you'll be able 2126 01:38:25,065 --> 01:38:29,265 to collect the data on your computer program 2127 01:38:30,005 --> 01:38:33,065 so that you'll be easy to pull up and present? 2128 01:38:33,785 --> 01:38:36,225 I hope so, yes. So right now for hospice, 2129 01:38:36,765 --> 01:38:40,345 we are not using SHP, that program 2130 01:38:40,375 --> 01:38:41,625 that we use for home health. 2131 01:38:41,805 --> 01:38:45,305 So I'm working with them on getting that or hospice 2132 01:38:45,575 --> 01:38:47,585 because that will pull that data 2133 01:38:48,045 --> 01:38:50,985 and as CMS gets more data, we'll be able to have 2134 01:38:51,725 --> 01:38:52,945 better numbers for that. 2135 01:38:53,245 --> 01:38:54,625 But that's my hope with it. Yeah. 2136 01:38:56,195 --> 01:39:00,575 And are you working in conjunction with the doulas 2137 01:39:00,675 --> 01:39:02,175 for end of life? 2138 01:39:03,085 --> 01:39:07,935 Yeah. Yes. I tele Forest actually had a course 2139 01:39:07,935 --> 01:39:11,215 through Sierra College with Kate, she's the end 2140 01:39:11,215 --> 01:39:13,615 of life doula that she caught on, taught on Death 2141 01:39:13,635 --> 01:39:15,215 and Dying, which I attended. 2142 01:39:15,355 --> 01:39:17,855 It was a a six class series 2143 01:39:18,615 --> 01:39:21,695 for healthcare providers on providing care at end of life. 2144 01:39:21,995 --> 01:39:23,855 And she is one of the death doulas. 2145 01:39:23,875 --> 01:39:25,615 So I spoke with her extensively 2146 01:39:25,675 --> 01:39:27,855 and we do work with her. Yeah, 2147 01:39:28,235 --> 01:39:29,235 That's great. 2148 01:39:29,555 --> 01:39:30,895 And thank you. Thank you for taking 2149 01:39:30,995 --> 01:39:32,175 on the position. Welcome. 2150 01:39:32,175 --> 01:39:34,135 Yeah, I'm so excited. Welcome. Yeah, thank you. 2151 01:39:39,665 --> 01:39:42,685 Any other comments, questions? No from the audience? 2152 01:39:42,705 --> 01:39:46,935 Any comments, questions? We do need a motion. 2153 01:39:46,935 --> 01:39:48,855 This was part of the consent calendar. Yeah, I'll 2154 01:39:48,855 --> 01:39:51,615 Go ahead and make a motion except 14.6 0.1. 2155 01:39:51,615 --> 01:39:54,175 The 2026 Health and Hospice quality 2156 01:39:54,355 --> 01:39:55,355 Report. 2157 01:39:55,355 --> 01:39:58,455 I'll second that Motion and a second. All in favor? 2158 01:39:58,715 --> 01:40:02,125 Aye. Aye. Opposed? All right. Approved unanimously. 2159 01:40:02,125 --> 01:40:06,795 Thank you very much. Item 18, 2160 01:40:07,615 --> 01:40:11,835 do we have any any board committee reports this month? 2161 01:40:16,075 --> 01:40:19,705 Looks like? No, that 2162 01:40:21,445 --> 01:40:22,535 gets us to the end of the meeting. 2163 01:40:23,525 --> 01:40:25,435 Great. Thank you very much. I'm getting adjourned. 2164 01:40:36,165 --> 01:40:37,725 I got mine. I figured you might, 2165 01:40:38,955 --> 01:40:42,485 Just before we had a advent 2166 01:40:42,785 --> 01:40:44,325 and board meeting.