[0:20] Hey everybody.
[0:27] We do appreciate everyone showing us.
[0:29] It's long way, just us. Yeah.
[0:34] We are gonna go into open session.
[0:36] I can ask counsel to report on actions taken in
[0:39] session. Yep.
[0:40] We had four actions in closed session.
[0:42] The first action, 5.1 0.1,
[0:46] and 5.1 0.2 passed five to zero.
[0:52] Those were the closed session meeting minutes
[0:55] 5.2 hearing on the service recovery report.
[0:59] Motion passed five to zero.
[1:02] Item 5.3, the complaints and grievance report.
[1:05] Motion passed five to zero,
[1:08] and then we had item number 5.4,
[1:12] the medical staff credentials also passed.
[1:14] Five to zero. Thanks.
[1:16] Thank,
[1:21] Do you have any deletions
[1:23] or corrections to the posted open session agenda?
[1:30] No. Moving on. Item 10.
[1:32] Do we have any input from audience this evening?
[1:34] Again, this would be for items not on the posted agenda.
[1:40] I have a whole spiel about public comment,
[1:42] but since no one's moving, I'll spare us that time.
[1:47] Or do we have any, any online? Nope. Thank you.
[1:51] That's a, that's a new one for us. Thank you, Sarah.
[1:55] Employee associations. Item 11.
[1:57] Any input from employee associations let's anyone here
[2:00] moving on to what's become the highlight of the show
[2:04] president and CEO monthly
[2:07] Highlights. Good evening, Anna.
[2:12] Good evening chair members of the board.
[2:14] It, it is very nice to be with you tonight.
[2:16] I wanna thank members of the audience
[2:19] and people joining both from our staff
[2:21] and our community who are doing this virtually.
[2:24] This is actually gonna be a fun
[2:27] and much quicker than last month report,
[2:30] but I am gonna bring a couple highlights to you.
[2:33] We've been talking a lot about the true north
[2:37] and we've talked to you a lot about what it is.
[2:39] Tonight we're gonna talk a little bit about
[2:41] how we're gonna do it, how we're gonna actually get there.
[2:45] And so we're gonna, we're gonna go over just a quick
[2:48] overview of the Structure
[2:52] that we're putting in place, sort
[2:54] of lead this portfolio of work.
[2:57] As a reminder, true North has three priority areas.
[3:01] It is our single strategic plan.
[3:05] There is no other strategic plan. It is the true north.
[3:08] And so you will find sort of everything kind
[3:10] of making its way and being connected to that plan
[3:13] or that plan being connected to everything,
[3:15] which is maybe a more accurate way to say that.
[3:19] The other thing I wanna say
[3:20] before I lay out this
[3:23] leadership structure is do not get out a chisel
[3:26] or a piece of marble and like carve this in stone
[3:28] because this will, like most things, this is a,
[3:32] a new process.
[3:34] And so it will be, I anticipate,
[3:37] and I almost predict that this will for sure transform
[3:42] as we go and be refined as we go
[3:44] and maybe look a little bit different months,
[3:49] for sure years from now, but even maybe months from now.
[3:52] So one of the things that really, that
[3:55] we have empowered the teams to do is be a learning,
[3:59] learning organization.
[4:00] And that means you're allowed to, we,
[4:02] you have permission to improve.
[4:04] We kind of, we start where we think we start at a point we
[4:07] feel good about,
[4:09] but we also wanna make sure people understand you have the
[4:12] power to like actually outdo this and do
[4:15] and even improve it.
[4:16] So it, I would anticipate this will change.
[4:19] But without further ado, let me just introduce you to some
[4:22] of the teams and some
[4:24] of those team leads are in the room tonight.
[4:26] And we will start with, let shoot my,
[4:30] where do I shoot my laser?
[4:33] Oh, shoot it there. Okay.
[4:35] How about somebody advance this slide for me? Great. Okay.
[4:38] So we'll start with, we'll start with health within reach.
[4:42] And as you recall, we have two key areas kind of
[4:45] that we're working on there that is really sort of access
[4:48] and operations.
[4:50] And so we are going to, we have Debbie Stanley.
[4:53] This is gonna be no small task for Debbie.
[4:56] She is actually gonna be the work stream lead
[4:58] and that's gonna be really around improving
[5:00] access to primary care.
[5:02] That's around sort of the work that's gonna be happening
[5:04] around the scheduling, navigation,
[5:06] virtual care, extended care hours.
[5:09] And then also in within that scope,
[5:13] there is actually gonna be the improvement
[5:15] of financial navigation.
[5:16] Dylan will be the executive sponsor of that.
[5:20] And again, they're, they're here.
[5:22] So you could ask them questions if you
[5:24] have questions about that.
[5:26] And within this, I just wanna
[5:28] say they're not the only people.
[5:29] There will be whole teams underneath them.
[5:32] So the, the next, the next area is operations.
[5:35] And we know kind of that there's a lot
[5:37] of downstream operational
[5:41] performance work that has to happen.
[5:43] And actually Lauren Ard,
[5:44] because we haven't piled her plate high enough yet.
[5:48] I don't How long have you been here, Lauren? Five months.
[5:51] So I mean, yeah, she's got a few months
[5:53] before it's like, yeah.
[5:55] So, but she, she will be working, the executive sponsor
[5:59] of this will be Louie Ward, our Chief operating officer,
[6:02] and she'll be working around that sort
[6:04] of downstream operational performance.
[6:06] Again, this is, you're gonna see a lot of overlap
[6:09] because you can actually really improve access
[6:12] and your, your scheduling system
[6:16] and, you know, access
[6:17] to financial navigation without also improving
[6:21] operational performance
[6:22] and really thinking about the ancillaries.
[6:26] And actually also, as you know, when we talked about
[6:29] our measurement strategy, we talked about those
[6:33] balancing measures.
[6:34] And you can see that Lauren has one of those in there
[6:36] that maintaining the highest level of patient satisfaction.
[6:38] We, we know that we're gonna be doing a lot of changes
[6:41] and we wanna make sure that those don't come at the cost
[6:43] of things that are really, really important to our system.
[6:47] Next slide. So people in
[6:52] leadership, this is, again, we, we have kind of,
[6:55] this is really under that community guided.
[6:58] And this is really about amplifying the voice
[7:02] of both the people who work here
[7:03] and the people who use our, our system
[7:06] and rely on our system to live their healthiest life.
[7:10] Again, the work stream lead for the people
[7:12] and leadership piece will be Lauren Caprio
[7:15] to her executive sponsor.
[7:17] And the executive sponsor of this entire
[7:20] work stream will be Lisa Faust, who again, she's also,
[7:24] she's also gonna be starting actually next week.
[7:26] So we can still pile a bunch of stuff on her plate.
[7:29] Just kidding. I'm kidding.
[7:31] I'm, I, I feel confident she's actually watching tonight.
[7:34] So Lisa, I'm definitely kidding.
[7:38] But this is really to work on, you know, advance, enhancing
[7:42] that engagement, the culture work.
[7:45] I mean there's a lot of this is already going on.
[7:47] I mean this, this will feel very familiar to us,
[7:50] but also this is also going to include
[7:54] probably a little more solid scope
[7:56] around leadership development as well
[7:58] as succession planning.
[8:00] Because we, we just, there's so much talent here,
[8:03] but we wanna kind of line that talent up in a,
[8:05] on a bench here so that when people leave,
[8:08] because we have so much talent
[8:10] and we're kind of a, you know, a, a very,
[8:13] a right sized organization, we are, we're,
[8:16] we don't have thousands and thousands of people to draw on.
[8:19] We have 1500.
[8:22] And so sometimes when a key leader leaves,
[8:25] it's a pretty big, it's a pretty big thing.
[8:27] And as you all know, and I think that
[8:29] a great example will be the,
[8:30] the chief human resources officer that, that took a year
[8:35] to hire into that position.
[8:36] So we really want to have a very formal scope
[8:39] of succession planning happening.
[8:42] And then again, just kind of making sure that we align kind
[8:45] of that all of our performance management
[8:47] and our recognition with the things that we were told
[8:51] by the community and by our workforce that really matter.
[8:54] The second piece of
[8:56] that community guided is actually governance.
[8:59] That should feel, that should feel very familiar
[9:01] to our governing board,
[9:03] but I also really want to make sure
[9:06] that the community's able to follow along with that.
[9:09] And that is really gonna be your, your board clerk.
[9:12] Sarah Jackson is the, is the work stream lead for that.
[9:15] And Kim Mcar, our chief strategy officer,
[9:17] will be the executive overseeing that portfolio of work.
[9:22] There's a lot of work, a lot
[9:23] of this work is gonna be working directly with our board,
[9:26] but it's not just gonna be working with the board.
[9:28] It's also about looking at policies,
[9:30] it's about looking at charters.
[9:32] I mean that's the really exciting stuff, right, Sarah?
[9:35] And, but you know, there's a lot
[9:37] of structural things I think we have like, that are,
[9:40] we have a lot of opportunity I think to strengthen.
[9:43] But, and it's also, I anticipate again
[9:47] that this will start to transform what shape it takes
[9:51] as we think about how we,
[9:56] I wouldn't say the word succession plan
[9:58] because our board is an elected board,
[10:00] but how we create a bench and,
[10:02] and really tap how our board is positioned to be able
[10:05] to tap into the deep well of knowledge within this region
[10:08] as we have just an abundance of, of skill
[10:12] and knowledge in this region.
[10:14] And we're very lucky to have such an amazing community who,
[10:19] who by the way, I think this has come up many times,
[10:22] but is always been rooting for
[10:26] and always very generous to with Tahoe Forest,
[10:28] with their time, their skill, their spirit,
[10:31] and really even, you know,
[10:33] we have really benefited in our foundations from,
[10:35] from their active engagement as well.
[10:39] The next slide is the, we talked a little bit
[10:42] that's about the transformation.
[10:44] And again, this is, this is really, there's like a couple
[10:49] of scopes of work here that are very specific
[10:51] and I, I do wanna say we have scoped this to specific pieces
[10:55] of a portfolio, not the whole portfolio.
[10:58] So this is an all transformation,
[10:59] but we realize that really strengthening the partnership
[11:03] with the medical staff is a major
[11:06] priority for the organization.
[11:07] And I think that's not, you know, it's not a secret
[11:10] that Anna Roth, you know, discovered.
[11:12] I think when I was even interviewing for this job.
[11:14] I think the board was very clear, we would like to see this
[11:17] strengthened and we, and I think we have made many gains
[11:20] this in this last year,
[11:21] but we would like to institutionalize
[11:24] that and formalize that.
[11:25] The, this is a really critical stakeholder group.
[11:28] And so we're, we're, Sam Smith is going
[11:31] to be leading up this work stream
[11:33] and it, Dr. Evans will be the executive sponsor.
[11:38] I would anticipate that you'll see
[11:40] the med staff president somewhere in
[11:42] this, in this mix as well.
[11:43] I mean certainly the med staff president has been extremely
[11:47] involved this last year and we're very
[11:49] grateful for her leadership.
[11:51] But this will really be, again, around, again,
[11:54] around improving medical staff engagement,
[11:57] modernizing those care delivery models,
[11:59] but making sure those modernizations, those introductions
[12:02] of any changes are really in the vision of
[12:05] what the medical staff say, this is it, it needs
[12:08] to be an improvement that meets their standards.
[12:12] I mean they are the standard setters for care in our,
[12:15] in our system and in this region.
[12:17] And then again, aligning incentives,
[12:20] access, quality outcomes.
[12:23] Again, I would say that this will be go far beyond kind of a
[12:30] Press Ganey survey engagement survey or something.
[12:33] This is this, this will be about having meaningful
[12:37] engagement and meaningful participation
[12:40] and you know, not even just participation
[12:42] but partnership with the med staff.
[12:44] And I think, again, I think we, we recognize
[12:47] that we'll be much better for it if we are able to really,
[12:52] really lean into that.
[12:54] And then finally, finance, this is Crystal's
[12:56] favorite category.
[12:58] She is the executive sponsor and for hod,
[13:01] because we haven't piled his plate on enough too
[13:04] for hod will be leading that work stream.
[13:07] And this is really, again, I think you're gonna see
[13:09] as we've seen this last year,
[13:11] and I just wanna really acknowledge both finance
[13:14] 'cause Crystal really like kind
[13:15] of weaving finance into the strategy.
[13:18] And then also all of the gains
[13:20] with really business intelligence, which has really again,
[13:23] been a big for HOD
[13:26] and Crystal have really been thought leaders
[13:29] for our organization in this area.
[13:31] We've actually moved business intelligence under crystal,
[13:35] under finance and there will be a lot,
[13:38] I think you're gonna see as much change this coming year
[13:41] as we saw this last year with financial modeling,
[13:45] with modeling.
[13:46] And, and I think somebody floated a question to us tonight
[13:49] and even I think Dylan's
[13:52] or Sam is gonna come back with some modeling.
[13:55] We have the answer for you on one
[13:56] of your questions around access.
[13:58] But I think you're gonna see another quantum sort
[14:02] of gained this year around kind of finance
[14:04] and how finance really dovetails with the strategy.
[14:07] The affordability pilots is a really big deal.
[14:09] We're gonna talk about that tonight,
[14:11] but we're not gonna talk about like the pricing, we're going
[14:14] to talk about the communication piece of that tonight
[14:17] because as you know, we're rolling that out August 1st,
[14:19] which is very exciting.
[14:22] But it's also, you know, understandably nerve wracking
[14:26] for the staff, for our community.
[14:28] And we really want to make sure we do the work
[14:30] around communicating and we also want people to know
[14:34] that there are redundancy sort of there
[14:36] and we have sort of other pathways
[14:39] so that, that we're building.
[14:41] And so anyway, more on that so that
[14:45] if we can go to the next slide.
[14:47] I, I will just say that is our, before we, maybe
[14:49] before we go to that, sorry, if we can go back,
[14:51] that is our teams that are gonna be kind of,
[14:54] those people are carrying the balls down the
[14:56] field this, this year.
[14:59] So I don't know if anybody has any questions about that,
[15:02] but we'll be happy to answer those.
[15:04] I have many of them here in the audience,
[15:06] but I, I wanna just recognize Kim McCall who kind
[15:10] of has been working with the steering
[15:12] committee to put this together.
[15:14] 'cause it, it's a, it's a lot of moving parts to figure out
[15:17] how, as you'll see, and I, I think we talked about this.
[15:21] Again, these are one of these things, I'm,
[15:23] I'm making a point to put a pin in a deliverable
[15:27] and that is, when I first came to talk to you,
[15:29] I talked about not a like kind of viewing the organization
[15:33] and the leadership team as a team, but as a system.
[15:36] And as you can see, this is more of a leadership system
[15:40] and there's a lot of overlap.
[15:41] And most of these leaders, like Dylan
[15:45] and Crystal were joking today.
[15:47] Like they've already kind of melded their teams together.
[15:50] Like they're not crystal's,
[15:52] like we're not making any decisions without each other
[15:53] because they're so intertwined and,
[15:56] and really it, this really does recognize
[16:01] and acknowledge the hard work of what it is
[16:04] to be the difference between being kind of a hospital
[16:07] with some clinics to being an integrated health system.
[16:11] And I, I, you know, it, it sounds really easy to say,
[16:14] but it's actually a big change.
[16:16] So I just wanna acknowledge all of the people
[16:19] who have signed up for this, we, nobody got a raise
[16:21] nor they even get a parking place for doing this.
[16:23] But what, but we really are gonna work on making sure
[16:27] that if, you know, for those who are stepping forward
[16:29] to both lead these teams
[16:31] and beyond these teams, we wanna make sure
[16:34] that they get the tools that they need
[16:35] and the support from the, from the, the leadership team
[16:38] as well as the board because we are asking them
[16:40] to lead change.
[16:42] And it's, even if it's a great thing, it's,
[16:45] it's hard to lead change.
[16:46] So I just wanna thank them all for, for doing
[16:49] that and for being with us.
[16:52] And now let's get to the happy stuff.
[16:55] There's those big scissors and I talked about that.
[16:58] So see the date, August 21st, we are opening,
[17:02] we are doing the ribbon cutting ceremony for an open house
[17:05] for the North Shore clinic over in
[17:10] Dollar Hill or Tahoe City or Fabian Way.
[17:14] It depends on who you are and how you reference it,
[17:16] but it's all the same place.
[17:17] That's what I've learned.
[17:20] But we'll be, we'll be we'll be doing that 2:00 PM
[17:24] and we hope that all of you as well
[17:28] as our community can join us that day.
[17:30] The care team will be on site, we'll be doing clinics.
[17:33] There will, there truly will be a big pair of scissors
[17:36] and somebody's gonna be doing those.
[17:37] And I think that there was a question about that
[17:41] and I wanna just pause for a second
[17:43] and ask if Dale, you wanted us to talk about
[17:48] the access, what this might mean to access,
[17:51] because we are prepared to answer that
[17:55] and so we can stop here
[17:56] or we can do it at the end of the talk.
[17:58] Well, I, I, I was gonna pull 14.3 0.1 from the agenda,
[18:02] but this is appropriate time too.
[18:04] If you think I, I would like to raise the question. We
[18:07] Can do it at 14, then we'll do it at 14. Okay.
[18:10] Consent. Oh, you, or talk about it. I mean,
[18:14] What do you prefer, Dale or Anybody?
[18:16] You tell me what if, if this is appropriate, Dylan, you,
[18:21] it's on topic, you can talk about it now,
[18:22] but if it's Yeah, it's on topic.
[18:25] Yeah, yeah. It's about this one topic.
[18:27] It's just timing. It was, yeah.
[18:29] Okay. So we could talk about it
[18:30] either place, but we could talk about there.
[18:31] So why don't you ask your question.
[18:32] So the question I, Sam, I, the question I raised actually
[18:36] for Brian Evans, our chief medical officer was, you know,
[18:41] it's one thing to open up new space for
[18:45] doctor's offices, but the question is how,
[18:48] how do we man them and how are we manning them?
[18:53] And Dylan wrote me back, he said,
[18:56] we have four new physicians coming in or,
[18:59] and some advanced
[19:02] practice providers.
[19:04] Is that, what am I saying that correctly? Yeah.
[19:08] And so the, the question I had was what kind
[19:12] of luck are we having?
[19:15] It's a two part question. What kinda luck are we having in
[19:18] getting people who want to work full time?
[19:21] Is there a new trend coming?
[19:23] Are we make it part of our, our our efforts to recruit?
[19:28] And also, are we going
[19:33] to improve our access significantly as a result
[19:36] of the opening of this office?
[19:37] Is there any estimate
[19:39] of much our access is gonna improve as a result?
[19:43] And those were the questions I had, so Great.
[19:45] I'm happy to answer that. Okay.
[19:46] And I'm Sam Smith, administrative medical director.
[19:49] So that's a great question.
[19:51] We actually have five new providers coming on board.
[19:54] So we have two advanced practice providers,
[19:57] they're nurse practitioners and three physicians
[20:00] and four out of five of those hires are full-time.
[20:04] So we are really excited for that.
[20:06] We feel like it's a very promising short-term trend.
[20:10] I don't know that we have enough information
[20:12] to project a long-term trend in terms of hiring,
[20:14] but it is our intent to open full-time positions
[20:17] because that's what we need.
[20:18] That's what our community needs.
[20:21] And so that's our intent as far as expanding access.
[20:25] We know that with those clinicians coming on board,
[20:28] we anticipate a 13% increase in volume for this fiscal year.
[20:32] And then an improvement in our third next available in
[20:35] primary care by 8% with those new providers coming on, which
[20:40] with projections thanks to Dylan
[20:42] and for ho taking a look at this,
[20:43] we're looking at about 3.2 days impact
[20:46] on our third next available.
[20:48] And so our current third next available
[20:51] for primary care is 41 days.
[20:52] That would bring us down to 37.8.
[20:55] So again, successful short term trend,
[20:58] I'm not sure we have enough information
[20:59] to project long term,
[21:01] but we're really excited about some of our moves in terms
[21:03] of opening up space
[21:04] and we're ready to keep the momentum going.
[21:07] A lot of interest in coming
[21:08] to this community that is not a problem. Yeah.
[21:11] And so during the interview process,
[21:14] I assume then you kind of say we're looking for full-time.
[21:17] Absolutely, yeah. And the, the positions
[21:18] are posted as full-time.
[21:20] This one position
[21:21] that was part-time was actually just a replacement position
[21:25] for me actually because ica, I came out
[21:28] of a part-time clinical practice.
[21:29] Okay. So that's why that one wasn't part-time. Yeah,
[21:32] Thank you.
[21:33] Yeah, Sam, these new positions, the ones
[21:36] that are gonna fill the space, it's their,
[21:39] The new space a gateway actually those are just gonna
[21:41] fill our current space.
[21:42] So most of those, four out of five
[21:45] of those clinicians are coming on in the next few months.
[21:49] And we'll be here in Truckee
[21:50] and then one of those positions,
[21:52] we're still looking at space planning,
[21:54] but potentially at the new North Shore clinic,
[22:00] How many positions are we looking for in total right now?
[22:04] I mean for the new clinic. And
[22:07] We're just starting to look at, we're not just starting,
[22:10] we are in the process of looking at, it's not as simple as
[22:14] how many FTE do we need?
[22:15] Because sometimes if you shift schedule slightly
[22:18] or time slightly, you actually open up a lot more space.
[22:22] And so we are in the process
[22:23] of really looking at that for Gateway.
[22:27] Do you wanna add something Dylan?
[22:32] Yeah, if I could just comment on the FTE projection.
[22:35] So in line with our investments that have been approved
[22:39] for this fiscal year with our mobile clinic,
[22:41] our telehealth services weekend after hours,
[22:45] and then in addition to the North Shore clinic,
[22:47] we'll also be realizing some capacities with the first phase
[22:51] of gateway scheduled
[22:52] to open at the later part of this fiscal year.
[22:55] So we are rebalancing,
[22:57] obviously there's been a high priority on access as well
[23:00] as visit volume for both of those.
[23:02] And we're complimenting both.
[23:04] So we do have FTE projections for both of those.
[23:07] We appreciate the board goals and incentives put on those.
[23:11] So we are trying to maximize the space
[23:14] and realize those gains
[23:15] and access capacities as soon as possible.
[23:18] And we're actually considering some additional
[23:21] and changing some strategic plans
[23:24] to realize those as quick as possible.
[23:29] And as a reminder, I was gonna say, don't,
[23:32] don't go too far away, Dylan, as a reminder, not all,
[23:35] you know, not it won't, it not everything is going
[23:38] to be an FTE, you know, some of it's going to be,
[23:42] we're going to bring in more vir virtual providers.
[23:44] I think that was really, you know, that really speaks
[23:48] to kind of the importance around the credentialing
[23:51] and that sort of, you know, the cycle times around that.
[23:54] But also we are looking at considering
[23:59] either our partner
[24:01] or even our own, our own staff around extending hours too.
[24:05] So it's not just gonna be a kind of a one for one.
[24:07] We're kind of looking at all of it.
[24:09] So just as a reminder. Yeah. Can
[24:12] I add one thing?
[24:13] Yeah. I would say too, to build on that,
[24:15] it's also about the care delivery model.
[24:17] So sometimes you have two FTEs
[24:21] and you can actually, based on changing some efficiencies
[24:24] that make it easier for patients
[24:26] and our clinicians, we can actually make them
[24:30] be a lot more efficient just if they work together
[24:32] in a specific kind of way.
[24:33] So we're starting to explore those care delivery models.
[24:40] Yeah, thank you. It's a good question.
[24:45] So, so we'll see you on August 21st
[24:49] and I think there, there will be some more, you know,
[24:53] social media and that sort of thing, inviting the,
[24:56] the local community.
[24:58] I think that there also is gonna be some stuff
[25:00] out in Tahoe City.
[25:02] So we will, we'll look forward to seeing everybody.
[25:04] Then if we go to the next slide,
[25:06] I wanna talk a little bit about community guided
[25:08] and we actually, I'm gonna invite Lauren to come up
[25:12] and I just wanted to talk a little bit about,
[25:14] I'll talk about, I'll talk from the right
[25:17] side to, and we'll go left.
[25:19] But I do, I just wanna say that we had a great
[25:24] presence at the Truckee 4th of July parade.
[25:27] We had thousands of residents and visitors visit our table.
[25:31] I I just wanna really acknowledge Lauren
[25:34] and team that was there.
[25:35] It was, it was, it was a very busy table.
[25:39] And I know when our intern was there,
[25:41] we had an intern there, we had some of our HR was there,
[25:44] we had community health there.
[25:46] So it was, I saw our t-shirts on people
[25:50] like all over the parade.
[25:51] So again, I think we
[25:53] provided, you know, you know, a lot of information,
[25:56] but also just presence in the, in these community events.
[25:59] It, it's really important.
[26:00] So I just wanna acknowledge our team for, while many
[26:03] of us were at barbecues
[26:04] and stuff, they were out working that table
[26:06] and it was pretty hot that day.
[26:09] You know, the navigation center.
[26:10] I wanna just remind the board
[26:14] or just thank the board, acknowledge the board
[26:16] for the navigation center supporting that navigation center.
[26:19] That navigation center has stayed at 94% capacity
[26:24] throughout the year.
[26:26] It has been, as you recall, this is a 16 bed facility,
[26:30] six beds of them are, are interim housing
[26:33] and 10 of them are emergency.
[26:39] We don't call it shelter anymore,
[26:40] but the emergency, the short term emergency bed beds.
[26:44] And it's one of the things that I think that I, I know that,
[26:48] and I know that Alice is your representative on the, the TAC
[26:52] and, and Ted Owens, of course has been on that also.
[26:56] And he's, he's actually at a different, he has a different
[27:00] conflict tonight that, so he couldn't be here.
[27:01] But this has been such a critical
[27:07] asset to add to the, the, this region.
[27:10] And it's sometimes these numbers at the 94% bed occupancy.
[27:14] It doesn't, what we don't have now though,
[27:17] because our volumes were never super high, is like how
[27:21] to measure what didn't happen.
[27:23] But there was so many, you know,
[27:26] our emergency room didn't, you know, have people
[27:29] spending the night throughout the, the winter,
[27:31] through the winter, once this, once this
[27:35] navigation center opened.
[27:36] And that allows
[27:38] for throughput within the emergency department is just,
[27:41] our emergency department is designed
[27:42] to provide emergency care, not provide shelter.
[27:45] So it's very disruptive.
[27:46] It's, even though it may feel like
[27:48] to people like, what's the big deal?
[27:50] Like it's, they're just sitting there.
[27:51] It is, it's very, it's it's just not designed for that.
[27:54] So it's really hard to put words to how much it has meant.
[27:58] But you know, I, I know that Dr.
[28:01] Gladman has been a, a staun champion of this
[28:04] and has been really a, you know, advocating leader
[28:09] around kind of the importance of this navigation center.
[28:11] And I just wanna recognize and thank the board.
[28:13] And I also wanna remind you that in October we're going to,
[28:16] we're planning to, we're trying to work on our schedules
[28:19] and have a joint meeting with the town of Truckee
[28:22] to talk about kind of
[28:23] what happened in those first six months.
[28:24] So we'll have a lot more data.
[28:25] So this is just giving you a snapshot.
[28:27] There'll be a lot more data, we'll hear from the te cac,
[28:30] you know, in person and probably
[28:32] and from Volunteers of America
[28:34] and the other people who are kind of in, you know,
[28:36] much closer to that work.
[28:37] And then finally, I wanted to invite Lauren up
[28:40] to talk a little bit about the next two items and,
[28:43] and so Lauren, without further ado, I'll just hand to you.
[28:47] Thank you so much for being pleasure.
[28:49] My name's Lauren, I'm director of community health
[28:52] and I have a distinct honor
[28:54] and humbly to present the Tower Forest. I'm sorry.
[28:58] Nope. Just gonna keep talking on my own. There we go.
[29:02] Should I repeat myself or are we good? Okay, excellent.
[29:06] Sorry you guys, the distinct honor
[29:08] to present the Tower Forest Community Partnership Award
[29:11] to the Sierra Community House.
[29:13] And this award is really to honor the incredible dedication
[29:17] that Sierra Community House provides
[29:19] to community partners from incline
[29:22] all the way throughout our entire hospital district.
[29:24] And what this award is, is it's $150,000
[29:27] and I just wanna read real quick what it is.
[29:29] I'm happy to answer questions
[29:30] and then also present it to anal Cordova Sosa,
[29:34] who is the deputy Executive director
[29:36] of the Sierra Community House.
[29:38] So the community partnership award provides,
[29:40] will provide flexible food access for, and that's $100,000.
[29:44] And then the second $50,000 is to support
[29:47] and design the implementation
[29:48] of a collaborative pilot initiative led in partnership
[29:52] with the Tahoe Forest Hospital District
[29:54] and the, the Sierra Community House
[29:56] to develop a coordinated community informed project
[29:59] to explore an innovative approach
[30:00] to food insecurity in our region.
[30:03] So just wanna be able to,
[30:05] Same thing.
[30:10] Thank you very much. We we're so grateful
[30:13] for our partnership
[30:15] and our collaboration for so many, so many years.
[30:19] I can, I can say that literally thousands
[30:24] of of community members in the last
[30:29] 10 plus years of our collaboration have had the chance
[30:34] to access services and supports that
[30:37] otherwise would've not had the chance of accessing.
[30:42] So thank you very much for your support,
[30:45] your continued support.
[30:47] And we are so excited in particular about this, this topic.
[30:50] Food security, we serve around 60,
[30:56] I'm sorry, 600 families households
[31:00] every week in the,
[31:02] in the entire North Tahoe Track region.
[31:06] So this is critical support for the community
[31:11] and we are so grateful that, that we have your,
[31:14] we're support, continued support to, to be able to continue
[31:19] supporting our community members with, with the type of
[31:23] of need they, they have.
[31:25] So thank you very much again. Thank you. Yeah.
[31:30] And I just wanna say that this award really emerged
[31:32] to help honor the incredible financial pressure
[31:35] that is on the CER community house distinctly right now
[31:38] with the changing financial security of families
[31:41] and also the cost of resources.
[31:43] So for the hospital district to be able
[31:45] to step in at this critical point and give that flexibility
[31:48] and provision of services is, is huge.
[31:50] So thank you for the incredible support across the community
[31:54] and the board and we're excited about the pilot all
[31:57] as well. Any questions or?
[32:00] Yeah, I would hope please. Thank you.
[32:06] I'd be curious when you, when you figure out that
[32:08] that second $50,000 and,
[32:11] and the creative ways that we can expand the,
[32:14] the food accessibility
[32:16] and the like, would you come back and let us know?
[32:18] Oh yes, Mary, I'll always come back and talk about it.
[32:23] This is, this exciting pilot is actually, the goal of it is
[32:26] to really produce a program
[32:28] that will have pilot data evaluation
[32:31] and be ready for a full proposal to pitch either
[32:33] to the foundation or to a federal or state grant.
[32:35] So the real key is to get work with partners to understand
[32:39] what barriers are and try something new, flexible,
[32:41] innovative that they might
[32:42] otherwise not have been able to do, maybe with a little bit
[32:45] of risk and evaluate it
[32:46] and then be able to dial in for a project that goes
[32:48] to a bigger grant source.
[32:50] So we will absolutely report out.
[32:53] Thank you. Thank
[32:56] You.
[32:57] Thank you. Don't sit down yet, Lauren.
[33:02] Yeah, so it, you know,
[33:04] and I just, I too wanna just say how,
[33:09] How critical Sierra Community House is for our community
[33:12] and really we're just so pleased to be able to have
[33:17] such a rich resource in this region
[33:20] and with such deep connections and,
[33:21] and frankly we look to,
[33:24] to organizations like Sierra Community House
[33:27] to really understand
[33:28] how did you create those deep connections.
[33:30] 'cause we really aspire to follow you in
[33:34] that path deep into the community.
[33:37] And on that note, it's a, it's a little bit unusual for us,
[33:40] but actually Tahoe Forest got an award this last month
[33:44] and that was really, we were recognized, we were selected
[33:48] as the, as the community partnership award recipient
[33:53] from Angel Flight West.
[33:54] This is a network of volunteer pilots
[33:57] that provide medical transportation to people in need.
[34:01] And they have been working with us since 2012 and have
[34:05] provided more than 150 flights transports.
[34:10] And so Lauren accepted that
[34:14] award on behalf of our system along with me,
[34:17] and they actually flew out here to, to give us this award.
[34:20] And it was a, it was a, it was lovely.
[34:22] They, we tried, we could not get them lined up
[34:25] with a board meeting because
[34:27] apparently they have to fly to a lot of places.
[34:29] But again, I think this is is just another
[34:34] example of work that we've been doing in the community
[34:38] that I think to some degree we're pretty,
[34:40] we're we're pretty modest and quiet about,
[34:42] but actually we really wanna start sort
[34:45] of lifting this a little bit so that the board,
[34:47] not only the board, but our community really understands
[34:49] kind of the, the, the role
[34:51] that we're playing in this region.
[34:54] And it isn't always that we are the provider,
[34:56] maybe we are the bridge to the, to a to a provider
[34:59] that's better suited and,
[35:00] and it's really an honor to be able to work with
[35:04] community organizations like Sierra Community House
[35:07] and Angel Flight West and, and many others.
[35:10] So just wanted to acknowledge that.
[35:12] And Lauren is is out there
[35:15] because as you know, she's working on the mobile clinic,
[35:18] she's out there, she's meeting
[35:19] and greeting everybody now she's got our
[35:20] clinics guy going everywhere.
[35:23] So I just wanna again, recognize Lauren in the, in the work
[35:27] that she's doing on that and just express gratitude
[35:31] For that.
[35:32] Thank you. And just real quick note,
[35:33] this is the first time they've ever given a community
[35:35] partnership award, angel Flight West,
[35:37] and they serve 12 states
[35:38] and we're the first healthcare system they chose.
[35:41] So it's, it was really exciting. So thank you so much.
[35:44] Yeah. And finally,
[35:49] I'm gonna end on a high note, a really high note.
[35:52] So this is really another safe date.
[35:57] This is September 25th.
[35:58] We are doing our, what we were calling
[36:01] before the fall forum.
[36:02] We're now calling it beyond possible.
[36:05] This is, you know, we'll also feature
[36:08] the Thomas Hobb Day medical lectureship, our keynote,
[36:11] we have two keynotes.
[36:13] Dr. Dal will be the Thomas Hobb Hobday medical
[36:16] lectureship speaker.
[36:18] And he is an expert on AI
[36:21] and its impact on medical care.
[36:25] He's a very dynamic speaker.
[36:27] I'm very grateful to Dr. Evans for booking him
[36:30] before he was featured in the Atlantic because, but
[36:34] because then everybody wanted to book him.
[36:36] But also I think just really, really exciting, I mean is
[36:40] that we are also gonna have Jim Morrison, who,
[36:46] as some of you may know, who is the first person to
[36:51] ski down the north side of Mount Everest.
[36:54] And not, and not only that, he was the sixth person
[36:58] because only five people had ever ha had ever
[37:01] summited on the north side.
[37:03] So he's like part of the team of, it's really six
[37:06] through, there was 12 people with him.
[37:08] But he will be coming to, to provide us
[37:12] with some inspiration
[37:14] and really talk about kind of how one even sets out to do,
[37:20] do you know, to think outside of the boundaries.
[37:23] The other, the other group that isn't on here.
[37:25] But, we'll, you know, this is sort of,
[37:27] you'll be getting now regular, I think regular updates
[37:30] and advertising invites to come to this, to the forum.
[37:34] And that will be, we are also going to have a panel
[37:38] of medical experts, our, of our medical staff.
[37:41] And Sam, do you know who those they are? I know it's Dr.
[37:45] Rad and I know, say Dr. Cooper. Oh, Dr.
[37:50] Bey knows we,
[37:55] we'll have a, a group of lo inter local,
[37:58] our own medical experts.
[38:00] So your care providers will be there on stage
[38:03] and you know, if you are a member of the community,
[38:06] you can come and you can ask them anything.
[38:08] And that will be facilitated.
[38:10] And then we also are gonna have the north,
[38:16] the, the search and rescue, the North Lake Tahoe search
[38:19] and rescue team, is that what they're called?
[38:22] The North Lake Tahoe Search and Rescue team.
[38:24] And they're gonna, and then we,
[38:26] and so that we have some exciting facilitation happening
[38:30] and so, you know, come bring your tennis shoes.
[38:33] I don't know what's gonna happen, but it sounds like it's
[38:35] gonna be a really exciting day.
[38:36] But, you know, I think what, what, what the purpose of the
[38:40] really, this is partly to create a space for our own staff
[38:44] to really see the abundance in this region
[38:48] and really tap into kind of the thinking that some
[38:52] of these people who kind
[38:53] of have thought in totally different ways,
[38:55] but also also highlight some
[38:59] of our staff because they're incredible.
[39:01] And so I think we wanted to kind of both give them a day
[39:04] for kind of learning and inspiration,
[39:08] but also we, we were so impressed with our own staff
[39:11] that we also wanted to feature them too.
[39:13] So I think we're kind of, we're,
[39:15] we're trying to balance that.
[39:16] So we don't put 'em to work too much that day,
[39:18] but I think it's gonna be a really,
[39:20] a really interesting day.
[39:23] And I think what we are hoping to come out of this is that,
[39:26] you know, a deeper partnership
[39:28] and ideas around how we can collaborate with our community
[39:32] to kind of achieve and move beyond kind of what,
[39:35] what we're all, what everyone else is doing.
[39:37] And kind of think about things that feel like they're,
[39:41] you know, because of all the change and technology
[39:44] and stuff, it just kind of changes the adjacent possible.
[39:48] And so I think, again, these are people who kind of
[39:51] went like, okay, well that's what everybody,
[39:53] most everybody does, but we're gonna go do this.
[39:55] And so I think again, it, which is I think really aligned
[39:59] with the Tahoe Forest spirit.
[40:00] So I think it's gonna be a great day.
[40:02] And those are my highlights.
[40:04] I'm happy to answer any questions.
[40:05] I think we kind of talk through most of it as it went,
[40:09] but happy to answer any questions or hand back to the chair.
[40:14] Wonderful highlights as always.
[40:15] Yes, we did have questions throughout,
[40:16] but any additional comments, questions from the board?
[40:19] I've got one. Wonderful. If I could back to this
[40:24] med staff engagement all,
[40:26] I think we've called it alignment too.
[40:29] Are those words used interchangeably, engagement, alignment?
[40:36] The experts over there are, yeah. Si come on up.
[40:40] You know, I, I think we've called it lots of things. Yeah.
[40:43] And I think that's that, you know,
[40:45] and I think that, I think we're all, we're, we're trying
[40:48] to aim in a certain direction,
[40:49] but we're trying to really now institutionalize kind
[40:52] of amplifying the voice
[40:54] and the position of the med staff in decision making. And,
[40:58] Okay, well here, here's my question.
[41:00] You know, fortunately in case of Crystal's work,
[41:03] I mean we know when our finances are made
[41:06] or they're not made, you set a goal,
[41:08] you either make it or you don't make it.
[41:10] Same with the patient satisfaction scores, et cetera.
[41:14] But physician alignment in the past years has been a,
[41:19] an issue with this hospital
[41:21] and ultimately led to us hiring you
[41:26] as you well know, because of the issues that we were having
[41:30] with, with physicians not being as aligned
[41:34] or engaged with the operation at
[41:36] His.
[41:37] I just wanna make sure this is tied to agenda item. Is it
[41:42] Right here?
[41:43] Medical staff? Yeah,
[41:44] Medical staff. Which
[41:45] He is, I think he's referring to the team. Yeah,
[41:47] The teams.
[41:48] So the medical staff partnership on transformation.
[41:51] Yeah, it was on there.
[41:53] So, so the question I'm I'm getting to is
[41:57] how are we going about measuring, how will we know
[42:00] when we are finally aligned, engaged?
[42:05] Is there some magic
[42:10] You can take it and then I'm happy to jump in after.
[42:12] Yeah, yeah. This is,
[42:14] So in answering your question, alignment
[42:16] and engagement are slightly different.
[42:18] They're not interchangeable. As was mentioned earlier.
[42:22] I think the scope of this work stream is gonna go on. You
[42:25] Turn the microphone What red
[42:27] Now is it on?
[42:28] Oh, it was on before we left it on.
[42:31] So to answer your question, alignment
[42:32] and engagement are slightly different.
[42:35] The scope of this project I think will be broad.
[42:38] It hasn't been completely defined
[42:40] because really what we wanna do is work
[42:42] with the medical staff to look at some of our direction
[42:46] that's on here and really look at
[42:48] opportunities for how to improve.
[42:49] So what we, it's beyond just a Press Ganey survey, right?
[42:53] It's like how much is the medical staff rowing in the same
[42:57] direction as the board
[42:58] and our strategic direction and the community.
[43:01] Like we wanna make sure that we're all all aligned
[43:03] and working together and we often have a very highly
[43:08] engaged medical staff with the community
[43:11] and with clinical practice,
[43:14] but sometimes that can put them at risk
[43:17] for burnout if they're not always aligned with everyone.
[43:20] And so they are two slightly different things.
[43:23] I think this project will really dig into that
[43:25] and really understand from the medical staff
[43:27] what our opportunities are and how to improve.
[43:30] And, and I just wanna comment on one, you said
[43:33] how will we know when we arrive?
[43:35] I think this is gonna be lifelong project.
[43:37] Like, just like anything process improvement,
[43:39] you don't ever arrive, right?
[43:40] You're always building and learning
[43:43] and looking for opportunities,
[43:45] but I think this will be a huge start for our medical staff.
[43:50] This reminded me of two things, so I apologize
[43:53] to chair one.
[43:54] One is, I think I absolutely everything Sam said,
[43:57] and I would just say this, I also, I think I didn't mean to
[44:00] misspeak, it's not
[44:02] that we aren't gonna measure engagement like we have,
[44:05] you know, we'll, we'll still do the physician engagement,
[44:08] although we are talking about merging that kind
[44:11] of into one survey because we don't
[44:13] wanna have survey fatigue.
[44:15] But, so we're still gonna measure it,
[44:16] but it's also to indicate that's not enough.
[44:18] Because I will just say last year
[44:21] we actually had the single highest jump press ganeys ever
[44:25] seen in med staff engagement.
[44:26] Yeah. But, you know, we could pat ourselves on the back for
[44:29] that, but also we were really, really low before.
[44:32] And, and I think the other thing is that's, you know,
[44:35] that's not, that's, that's important,
[44:38] but it won't be sufficient.
[44:39] And so I think, you know what, how will we know,
[44:42] you know, we might not know.
[44:44] I think what we, what this really isn't a knowing
[44:47] or not, I mean, this is a commitment that we are going
[44:50] to share power with the medical staff
[44:52] and we want, well we want to, and I,
[44:55] and I don't mean share power in that way.
[44:56] We wanna empower the medical staff
[44:58] and we wanna also lean in to kind of amplify the voice
[45:01] of the medical staff because those, you know, that kind of,
[45:06] I don't know, for lack of a better word,
[45:08] but patient satisfaction, loyalty,
[45:11] passion around this system.
[45:13] It's not because everybody loves their administrators.
[45:15] I mean, they love their doctors.
[45:17] Do you know, I mean, I just wanna be, no offense to any
[45:21] of the administrators, I'll take responsibility,
[45:23] but I'm just saying that, you know, the doctors, you know,
[45:28] you know, really set the, you know, they, they are,
[45:31] you know, in the truest sense, you know, they
[45:34] are the guardians of clinical quality and care, you know,
[45:39] and so, you know, the, we need to create formal space for
[45:43] that beyond sort of the quality committee
[45:46] and a, and a survey.
[45:47] And so that actually has to be embedded into every
[45:51] how we make our decisions.
[45:52] And I just wanna add onto that to say,
[45:54] earlier when I talked about operations and, and Louie
[45:59] and Lauren Lessard, I will just say, you know,
[46:02] to the nurses, you're, you're not forgotten.
[46:05] I'm, I'm a nurse and actually I did, I I did stop by today
[46:09] and talk to Jan and actually Lauren
[46:12] and Trent had already gotten together this morning.
[46:15] And so there's going to be something similar
[46:18] for the nursing staff,
[46:19] but not just not quite, maybe not, not
[46:21] to quite take this shape and it's still taking shape.
[46:23] So I just didn't wanna get in front of Jan and Lauren
[46:28] and Tran to who are thinking about this.
[46:30] And so again, that, you know, fair warning,
[46:32] this will transform a little bit.
[46:34] But again, I think it's a great question
[46:36] and the answer is we probably won't know,
[46:39] but I can tell you this, you'll know if they're not aligned.
[46:42] Yeah, yeah. And we have in the past. Yeah.
[46:46] So it's really more of a commitment. You
[46:48] Have one thing to that as well.
[46:50] I would just say that I think as you continue
[46:52] to have these meetings and you get reports back from Sam on
[46:54] our medical staff advisory committee,
[46:56] which we're all really excited about being developed,
[46:58] which is essentially a group of physicians
[47:00] and other medical staff members that are going
[47:02] to evaluate all of the projects that we as medical directors
[47:06] and department chairs bring up as big things
[47:09] that we wanna work on or initiatives within our department
[47:11] that we wanna do that will directly impact either physician
[47:15] satisfaction in their workflows or patient care.
[47:17] We all have a ton of ideas
[47:18] and one of our biggest frustrations has been
[47:20] that we haven't had a pathway
[47:21] to put these ideas into practice
[47:23] and have them evaluated from an administrative level
[47:26] and said, this is a priority, this isn't a priority.
[47:29] And we were waiting for our strategic plan now.
[47:30] So it was just amazing that we have this guidance to sort
[47:33] of a foundation to guide us in those decisions
[47:35] and prioritization of those projects.
[47:37] But what you would see back is a report from Anna that says,
[47:40] these are the things that came out
[47:41] of our medical staff advisory committee.
[47:42] These are the projects that were physician initiated
[47:45] and driven from their clinics and from their departments.
[47:49] So that would be one way that you would know.
[47:51] And you know, that those projects
[47:52] were kind of coming from us.
[47:54] Additionally, we have engagement hours, which is part
[47:56] of most of our compensation plans.
[47:57] And this is where physicians elect
[47:59] to spend additional time working on specific projects
[48:01] that their department chairs kind of review and approve
[48:03] and say, this is a, you know, a good project to work on.
[48:06] And so that's another sort of more tangible thing
[48:08] that could be tracked to say that we, I don't know
[48:10] what our physician engagement hour utilization is at this
[48:13] point, but that could be
[48:13] something that could be tracked as well.
[48:15] So, didn't wanna take up time, but just
[48:16] wanna say, you'll know.
[48:18] Yeah, we'll know. I i
[48:20] I, I do want, we do have some items
[48:22] for board action tonight.
[48:24] So this is obviously just for discussion and purpose.
[48:26] So I am gonna step in and encourage us to move on.
[48:35] I'm 13 medical staff executive committee.
[48:37] There is no consent agenda for tonight,
[48:40] so we'll skip that. Oh, real
[48:42] Fast.
[48:43] Just because it was itemized as an an action.
[48:45] Let's ask for public comment. You
[48:47] Okay?
[48:48] I'm not sure what we would comment on. Item 13.
[48:53] Yeah. Isn't a just if
[48:54] Anyone had a, But there is, there's no item,
[48:57] there's no consent agenda to approve.
[49:00] Okay. No. Oh,
[49:01] Sorry.
[49:02] I just see an action item here,
[49:03] so I just wanted to make sure that consent.
[49:04] Yeah, typically consent didn't thinking they could
[49:06] Consent agenda that we, we, they, they present
[49:08] and then okay, but there's nothing to, yeah.
[49:11] So perfect. Item 14
[49:14] is the consent calendar.
[49:16] And again, just a reminder, these are items
[49:17] that are expected to be routine, non-controversial.
[49:20] The board will take action on them without discussion.
[49:23] However, there's an opportunity to pull items if needed.
[49:27] Dale, you had mentioned one, but I think we
[49:28] covered that. Yeah,
[49:29] 14.3 0.1.
[49:31] We're fine. Okay. Any other items
[49:34] to be pulled or discussed?
[49:38] I'd like to pull 14.6 0.1.
[49:41] How many on health and hospice?
[49:44] Okay.
[49:50] Yeah, she is Actually, we're gonna pull,
[49:54] we won't discuss it until later in the meeting though,
[49:58] So You just, you just stay close there,
[50:02] Baby. She worked on,
[50:04] All right, so then nursing Assistant,
[50:08] We would be looking for approval
[50:10] To move approval to approve the consent calendar.
[50:15] Calendar, right calendar without,
[50:19] with 14.6 0.1 removed. I a second the motion.
[50:25] Motion in a second. All in favor? Aye. Aye. Opposed?
[50:29] Alright, we will discuss item 14
[50:33] six at the back end of the meeting.
[50:36] Item 15. This is also an item just for board discussion.
[50:40] 15.1 lab affordability, pilot reducing barriers to care
[50:46] and, and Kim presenting.
[50:50] Kim, actually it's Kim,
[50:54] It's only 'cause Anna's been away and she's back.
[50:57] And so we did this without her.
[50:58] So you know, I take full responsibility.
[51:00] Good evening, I'm Kim car, I'm the chief strategy officer.
[51:03] We promised you last month
[51:05] that we would come back this month
[51:06] with a communications plan around
[51:10] the lab affordability plan
[51:12] and our financial support program.
[51:16] You might notice that the agenda item is not called a
[51:18] communications plan and there is a reason for that.
[51:20] As we started to dive into the communications plan,
[51:24] it became quickly obvious that this is the perfect example
[51:27] of the kind of work that really requires navigation help,
[51:32] not just around communication,
[51:34] but how do we actually work directly with our patients
[51:37] to make our system easier to navigate.
[51:39] And you may recall that through the 5,000 voices we heard
[51:43] time and time again, that navigation is an issue,
[51:45] that our system is complicated,
[51:47] that people don't necessarily know where to go.
[51:49] And so as we started to develop this communication plan,
[51:52] it really became an engagement plan.
[51:53] It became more than just communication.
[51:56] So I, I put together this sort of outline,
[51:57] but I wanted to be clear
[51:59] for my fellow communications professionals
[52:01] that I realized this is not a
[52:02] traditional communications plan.
[52:03] So if you'll bear with me in that way,
[52:10] is this gonna work?
[52:11] It wasn't working girl.
[52:14] Thank you for forwarding that.
[52:16] So a little bit about, about what we're doing here.
[52:20] There really are two things that we want that we need
[52:23] to address through this process.
[52:25] One of them is kind of an exciting thing,
[52:27] and we talked about this through the budget process,
[52:29] but we will be moving forward
[52:31] with our lab affordability project, which means that 70%
[52:35] of our lab tests will be 25% lower priced.
[52:40] This is a benefit that's available to everybody.
[52:43] As you may recall, our community health labs were a small
[52:47] segment and people requested them,
[52:49] but this is available across the board.
[52:51] You don't have to request it.
[52:52] You simply go in for your lab test
[52:54] and if it's one of the 70% of the tests
[52:56] that we give you will automatically see a 25% lower
[53:01] cost for those labs.
[53:02] So it really is, I think, as you all know, we talked about
[53:05] through the, the budgeting process,
[53:07] an investment on the part of the health district in terms
[53:10] of revenue that will not be coming in
[53:12] because we are committed to that affordability.
[53:14] And we think as a public health district, that's part
[53:17] of our obligation is, is to do that very thing.
[53:21] The second piece is really around pathways to access.
[53:25] And one of the things that we wanna make sure is that
[53:28] as people who come to us
[53:30] and need some sort of financial support,
[53:33] that we have a door for that.
[53:35] That we are making sure
[53:36] that those people are not just getting an affordable lab
[53:39] test, but they work, we're working with them
[53:41] to figure out whether they actually qualify
[53:45] for our financial support dollars.
[53:47] And what we don't wanna have happen is somebody comes in
[53:50] and they get a lab test
[53:51] and then that lab test turns out
[53:53] to be a result they don't want
[53:54] and they have no medical support behind that.
[53:57] So we, we feel the need to really make sure that
[54:00] as people come into these labs, that we are qualifying them
[54:04] for whatever financial support they might be eligible for,
[54:07] and that we're then connecting them
[54:09] to the down the road care that they need.
[54:11] So they're just not kind of left hanging out there.
[54:14] And part of this, I would love to say,
[54:16] we're just doing this outta the goodness of our heart,
[54:17] which we are, but it also makes us much more compliant
[54:20] with some of the things that have changed in the past.
[54:22] In 2024, California expanded eligibility
[54:27] for financial support, the enforcement
[54:30] of making financial support available,
[54:33] some patient protections around lack of financial support
[54:36] and some communications requirements, which is
[54:38] what we're really here today to talk about this.
[54:41] These requirements really say that we have
[54:43] to make this financial support easily available
[54:46] and easily understandable to our patients.
[54:48] And so as we go through this plan tonight, you will see that
[54:52] that is a very strong goal of ours as we, as we begin
[54:55] to reach out to our, our community about these two programs.
[55:03] So the first thing we wanna do is really make sure
[55:05] that people understand their options.
[55:07] So the focus is on the two things
[55:10] we've already talked about.
[55:11] We're we're taking a very broad look.
[55:13] So when I I say that the communication will answer four
[55:15] questions, we're taking a very broad look at
[55:18] what communication me means.
[55:21] So it's communication like we would do on a broad scale,
[55:24] but it's also communication in terms of how we sit
[55:26] and talk with our patients, how we guide them
[55:29] through our system, how they get
[55:31] information through our access center.
[55:32] So we're really looking at communication from a
[55:35] very broad perspective.
[55:36] So as I, as I make my way through that,
[55:39] kind of keep that in mind.
[55:41] We're very much aware that particularly
[55:43] where financial support and is concerned
[55:45] and eligibility for financial support is concerned that
[55:48] that is not something you, you don't get
[55:51] that question answered through a brochure.
[55:53] That is something that you discuss
[55:55] with your doctor's office.
[55:56] That is certainly something you discuss
[55:58] with our financial navigators.
[56:00] It's a, it, it can be a complicated process.
[56:02] And so we wanna take people through that process
[56:04] with the support that they need to truly understand
[56:07] what is available to them and how they access it easily.
[56:11] So next slide is really about
[56:16] helping people understand.
[56:17] So if you start at the top
[56:20] and you go to the bottom,
[56:22] the top is the most specific level of detail.
[56:25] So through the community health team
[56:26] and through staff at our primary care
[56:28] and specialty clinics, that is
[56:30] where you will have the ability to have conversation
[56:32] with your providers where you'll be able
[56:34] to get your own questions answered.
[56:36] Where you'll be referred to our financial navigators
[56:40] where you'll, where you'll understand
[56:42] what phone number you call, what website you can go to,
[56:45] but it, that's really about the patient specific information
[56:48] where you can say to somebody, what do I need to do
[56:53] and what do I get in return?
[56:55] As you make your way down the list,
[56:57] it's the information becomes more general
[57:00] and less personalized.
[57:01] So what you would find on social media
[57:04] and local media is just a reminder that this is available
[57:07] and to ask your provider or to call the access center
[57:11] or to call the n the financial navigators and ask.
[57:14] And then, you know, as we put printed information throughout
[57:17] our facilities, that's really just a QR code that leads you
[57:20] to more detailed information.
[57:22] So, so we start with the availability for somebody
[57:25] to get their individual questions answered
[57:27] and then we work our way down to really broad sort
[57:30] of understanding and,
[57:31] and knowledge about the programs themselves.
[57:36] So next slide if we would.
[57:38] So this is a little bit about how this,
[57:41] we want this patient, this journey to happen.
[57:44] And I will say straight out, we are really relying on
[57:47] and we are really putting in place the support that needs
[57:50] to happen in order for our frontline staff to be ready
[57:53] to talk about this with patients.
[57:55] This is not something that just it that they know about.
[57:59] This is something that we are working to arm them
[58:01] with information on.
[58:03] And so it is not our expectation that tomorrow every one
[58:06] of our medical assistants will be able
[58:08] to answer any questions about the affordable labs
[58:11] nor about the financial support program.
[58:14] We are working on a variety
[58:15] of different communications tools, including talking points
[58:19] federally or fin or frequently asked questions.
[58:23] Any tool we can basically think of that arms them
[58:25] with the information that we want.
[58:28] It is really our goal long term that this,
[58:32] these conversations
[58:33] and this information be a routine part of patient care
[58:36] that it not be a one-off,
[58:38] but that it be, that it just be part of what happens.
[58:42] Because once again, our entire goal is to renew,
[58:46] remove any financial barriers from people accessing health.
[58:49] We know people make decisions about whether
[58:52] or not to get care based on their ability to afford it.
[58:55] And, and our goal is to move away from that
[58:57] and to make sure people get the care that they need.
[59:02] So next slide.
[59:03] This is really where we're talking about empowered staff,
[59:06] staff that feel comfortable, staff that feel informed
[59:10] and staff that feel like they're part of the solution.
[59:12] I think we've said it tonight, we've said it over
[59:15] and over again and all of us agree.
[59:16] Our staff is amazing and they are dedicated
[59:20] and passionate about helping our patients.
[59:23] And so we just need to make sure that, you know,
[59:25] as your favorite administrators, that they are armed
[59:29] with the information they need to have those conversations.
[59:32] We really wanna make sure that our patients are connected
[59:36] to the right support, that they're not wondering,
[59:37] but that, that there's a clear path and a direct path,
[59:40] and then we wanna celebrate this, right?
[59:42] So, so some of the metrics, the novel metrics that we came
[59:45] to you with last month were around how many people are,
[59:48] are inquiring about financial support
[59:51] and how much financial support we're providing.
[59:53] So we really wanna be able to celebrate the fact
[59:55] that we have those resources available.
[59:58] And then also really keeping an eye on what happens
[1:00:00] with our, our, the number of labs we're providing.
[1:00:04] Does the affordability pilot really, you know,
[1:00:08] because community labs aren't available anymore,
[1:00:11] we wanna make sure that those lab tests are not
[1:00:13] migrating off the mountain.
[1:00:14] And so we'll be keeping a close eye on that
[1:00:16] and making sure that our affordability pilot is getting us
[1:00:19] where we wanna be, where that is concerned.
[1:00:22] And last but not least, so this is really where I wanted
[1:00:26] to tie it back to communications
[1:00:27] and what we're really trying to do from
[1:00:28] a communications perspective.
[1:00:30] So we will continue to look at all of these, all
[1:00:34] of this information as we, as we go along.
[1:00:37] So what kind of engagement are our social media posts
[1:00:39] getting, you know, as we, you know, send out these emails,
[1:00:42] what kind of open rates
[1:00:43] and click through rates are we getting?
[1:00:45] How many hits are we getting on our webpage?
[1:00:47] And, and those are really broad engagement numbers.
[1:00:50] They're not necessarily impactful,
[1:00:53] but they allow us to sort of track
[1:00:55] how people are seeing the information
[1:00:56] and how they're acting on it.
[1:00:58] But then really about, are people understanding it?
[1:01:01] So not just are they clicking on a link in my email,
[1:01:03] but are they picking up the phone
[1:01:05] and are they calling our financial counselors?
[1:01:08] You know, are patients asking questions?
[1:01:10] You know, are our providers giving us feedback
[1:01:12] that this is working or not?
[1:01:14] So, so we will be continuing to track that as well.
[1:01:18] And then we wanna continue to work
[1:01:19] with our community partners.
[1:01:20] Are they starting to see people show up who are, you know,
[1:01:24] are having downstream implications from
[1:01:26] this that we're not understanding?
[1:01:27] So we just wanna keep the loop open.
[1:01:30] I, you know, I say repeatedly that community input
[1:01:32] and community engagement is not a onetime deal,
[1:01:35] but that final column there on this slide is really about
[1:01:38] continuing to engage in making sure that the work
[1:01:40] that we do on the front end doesn't have unintended
[1:01:43] consequences on the backend.
[1:01:45] So with that, I will stop
[1:01:48] and I'm hand it back to you Chairman. Gary,
[1:01:51] Thank you very much.
[1:01:52] Before we go into questions, I, this was really focusing
[1:01:55] around awareness, engagement, communication.
[1:01:58] Do we wanna limit questions to that topic?
[1:02:00] I know we can go down a rabbit hole of like, the logistics
[1:02:03] of the program and you know, why this, why that?
[1:02:05] So I'm asking you first, do we wanna limit conversation to
[1:02:08] Yeah, we're really here
[1:02:10] to talk about the process for how we roll this out.
[1:02:12] So, so yes, I think from an agenda perspective, that is the,
[1:02:15] the crux of the conversation. Okay.
[1:02:17] Yeah. Fantastic. With that in mind,
[1:02:19] Any questions, comments from the board?
[1:02:21] It would be great to have a pilot for future pilots,
[1:02:24] you know, so we'll be, you know, we'll be watching this.
[1:02:29] I'm looking at Crystal in the back of the room.
[1:02:33] I will say to that, Mary, you know, listening
[1:02:36] to Anna talk about the work streams that are part
[1:02:39] of True North, the thing that is really the most exciting
[1:02:41] to me is that we are putting systems in place
[1:02:43] that really drive future work, right?
[1:02:45] It's not just about these, these six work streams,
[1:02:48] but it's about how do we take that model
[1:02:50] and as our work streams evolve
[1:02:52] and as our organizational needs evolve, how do we use
[1:02:54] that model of, of management
[1:02:57] and engagement to, you know,
[1:03:00] address all kinds of things across the system?
[1:03:02] And this is absolutely a case of that.
[1:03:07] So then also, Kim, just this week
[1:03:10] or just today, I received a message from World something
[1:03:15] or other that be receiving
[1:03:19] texts from Tower Forest.
[1:03:21] Hello World is is that Hello world, hello world. Yeah, yeah.
[1:03:25] Is that part of the communication?
[1:03:29] So that's not specific to this, that's one
[1:03:31] of the plugins available through MyChart,
[1:03:33] but we are exploring across the system how we engage
[1:03:36] with our community in every way we can.
[1:03:38] You know, one of the things we've really realized
[1:03:40] through this process is we do have a number of people,
[1:03:43] a small number of people who,
[1:03:45] who use the community labs on a regular basis.
[1:03:47] And so we, we asked ourselves the question of,
[1:03:50] we don't want them to have to rely on our website
[1:03:52] to figure out how they get care.
[1:03:54] Instead we wanna reach out to them directly.
[1:03:56] So I was having a conversation earlier today with about,
[1:03:59] okay, let's pull those people,
[1:04:01] let's pull their email addresses
[1:04:03] and let's figure out how they communicate with us
[1:04:05] so we can push those messages out
[1:04:07] through the channels that work for them.
[1:04:08] And that is one of the new channels that we're,
[1:04:10] that we're rolling out to make sure
[1:04:11] that we have that conduit.
[1:04:14] But we can still use MyChart, correct?
[1:04:16] Yeah. Okay. Thank you.
[1:04:17] And email, I mean, you Can use anything. Yeah,
[1:04:21] A little off topic, but a number
[1:04:22] of months ago when we had the TB exposure event,
[1:04:25] and we really looked at how we were communicating,
[1:04:27] we really did a tiered communication there as well.
[1:04:29] So we did MyChart messages, and then we did did emails,
[1:04:32] and then we did mailed letters,
[1:04:34] and then we did a small number of phone calls for people
[1:04:36] who we were most concerned about.
[1:04:38] And so we, we want to make sure
[1:04:40] that we have all those tools in place
[1:04:42] whenever we need them, not just for special occasions.
[1:04:47] Just in case, I'm asked in the Safeway checkout line
[1:04:52] With which We've already identified as one
[1:04:54] of our best communication
[1:04:55] Vehicles, that'll be in lane three on
[1:04:58] Tuesdays and Thursdays.
[1:05:01] Is this assistance income qualified?
[1:05:04] Yes. And I might look at Crystal
[1:05:06] for a little more detail about the financial support piece.
[1:05:12] So any person that could qualify for any kind
[1:05:15] of financial assistance has to provide some sort
[1:05:18] of financial documentation for us to review.
[1:05:21] And then based upon family size, income levels allows us
[1:05:26] to determine whether we can discount the pricing
[1:05:30] or actually completely eliminate the cost to the patient,
[1:05:35] depending on, on those criteria.
[1:05:37] But our, our, our community needs to be willing
[1:05:40] to trust in us and share that information
[1:05:43] so we can help them and make that determination.
[1:05:45] So that's no different than our,
[1:05:46] what our charity care has been in the past.
[1:05:48] Right?
[1:05:50] So yes, over the years,
[1:05:53] the fin financial assistance criteria has evolved.
[1:05:58] And so historically you used to be able to look at,
[1:06:02] like, do they own a home?
[1:06:04] Do they have retirement? Do they, you know, a lot of assets.
[1:06:07] And that has become very narrowed on what we can consider.
[1:06:12] And also it's expanded from being like they,
[1:06:17] they equated to the federal poverty level guidelines
[1:06:20] that the federal government produces.
[1:06:22] And it has been expanded to 400% of those levels,
[1:06:26] where it used to be around two to 250%.
[1:06:29] So over the years, the program has expanded to try
[1:06:33] to assist more and more folks with financial assistance.
[1:06:37] But it, it is the, the new iteration of charity care.
[1:06:41] So, you know, as we did some research into how to do this,
[1:06:44] we looked at some of the, you know,
[1:06:46] most respected health systems in the country
[1:06:48] and how they communicate about this and,
[1:06:51] and the, the sort of financial support verbiage.
[1:06:53] And, and the reason for really needing some
[1:06:56] explicit talking points is the need to sort of move away,
[1:06:59] away from talking about this in any way
[1:07:01] that might cause people to not want to,
[1:07:04] you know, ask for it.
[1:07:06] And, and Charity Care, charity, the word charity has a bit
[1:07:08] of a, a, a emotional component to it that we wanna avoid.
[1:07:13] Thank you. I I was just about to make that same comment
[1:07:16] that I, I really wanna move away from the term charity care,
[1:07:21] because healthcare is expensive.
[1:07:23] It, you don't have to be a charity case
[1:07:27] to need financial assistance.
[1:07:29] I mean, a family of four
[1:07:31] who makes over a hundred thousand dollars a year
[1:07:33] and has insurance and a high deductible
[1:07:35] plan could probably qualify.
[1:07:37] That's not charity. That's just financial assistance.
[1:07:39] So I really wanna move away from the tagline of Charity care
[1:07:45] to more of financial assistance discounting,
[1:07:49] you know, that's, that is really what the program is.
[1:07:53] Will it include digital imaging?
[1:07:56] Digital imaging? This is labs.
[1:08:00] So maybe This is strictly labs? No, at this point,
[1:08:04] No.
[1:08:05] The, I mean, we're addressing one aspect of
[1:08:07] what the community told us about, you know, lab and imaging,
[1:08:11] but our financial assistance applies to
[1:08:15] anything within this health system that a,
[1:08:18] a medical provider might deem medically necessary. Okay.
[1:08:22] That answered my question. Thank you.
[1:08:25] So just for my clarification, Denell,
[1:08:27] you weren't asking specifically about the lab affordability
[1:08:29] pilot, and is there a financial gate for that
[1:08:34] you were asking more generic about,
[1:08:38] because the, the lab affordability pilot is
[1:08:41] available to everyone. To
[1:08:43] Everyone. Yeah. It's
[1:08:43] Across the board.
[1:08:44] I wanna be really clear on that. Yeah, yeah.
[1:08:46] So historically there was community health labs,
[1:08:48] which did have a financial component to it. No, no, no.
[1:08:52] Okay. No, that has, that's one
[1:08:54] of the reasons why we had people coming
[1:08:55] and using the community health labs
[1:08:56] and not getting, potentially not getting follow-up care, is
[1:08:59] because we weren't qualifying them for the financial support
[1:09:02] that they were, they could potentially
[1:09:04] have been eligible for.
[1:09:05] So that's a piece that we're fixing. Okay.
[1:09:07] Yeah. Okay. Fantastic. Thank you for clarifying.
[1:09:11] Thank you. I'll try to make it quick data.
[1:09:16] I, I think, you know, you mentioned briefly,
[1:09:17] but I know that to get people to trust
[1:09:20] and to understand seeing the data points that's working,
[1:09:23] you know, how many people are getting it, et cetera, from
[1:09:25] that as well, I think of the clinicians and Dr.
[1:09:29] Being kindly spoke about how getting, hearing their ideas,
[1:09:32] and this is going the opposite way,
[1:09:34] you said it's coming from administrators to clinicians
[1:09:36] to be the front lines, and I see front lines
[1:09:38] and I think it's very important.
[1:09:40] And so I, you know, having those, having that data,
[1:09:43] those success stories, you know, the story as an ER doctor,
[1:09:47] I see, and I'll just, my story is
[1:09:49] that I see dental pain every day in the er, every day.
[1:09:51] It's, it's a screw. It's an epidemic in the ER
[1:09:54] and all the technology at renowned, my favorite is a nine,
[1:09:57] eight and a half 11 sheet of dental referrals.
[1:10:00] And every year I call the Salvation Army, I call them
[1:10:03] and they say, oh yeah,
[1:10:04] we still do dental extractions for free.
[1:10:06] It's a three month waiting list.
[1:10:08] And I kind of give the patient, I kill 'em, that story,
[1:10:10] and I have no idea what happens.
[1:10:12] Mm. You know, I never get, Hey, it worked,
[1:10:15] I came back, I couldn't do it.
[1:10:16] This is what's my, you know, none of that ever comes back.
[1:10:20] And so I think to get buy-in, I think as clinicians,
[1:10:23] front staff is having data or those stories,
[1:10:26] and we'll hear it, you'll hear it in Safeway on aisle two,
[1:10:30] Tuesdays and Thursdays, hopefully.
[1:10:31] But I mean, that, that is the, that is the magic, right?
[1:10:34] When, when someone says to a and
[1:10:36] and Anna said it, so well, like, I mean,
[1:10:39] may not have favorite administrator,
[1:10:40] they have their favorite doctor saying, Hey, you know, I got
[1:10:42] that piece of paper and yeah, it really worked.
[1:10:46] You know, and that, that perpetuates the success.
[1:10:48] So I, I don't know how that,
[1:10:49] I'm glad that you said you'd study.
[1:10:51] You're looking at best practices in nation.
[1:10:53] I know that will will that data and that,
[1:10:54] and having that available for us to share
[1:10:56] and I think Will, will, will really be that great.
[1:10:59] The reflection that I, I came from this is just
[1:11:01] because that's where the magic happens when they just say,
[1:11:03] yeah, it really did work for me.
[1:11:05] And then, so good luck and thank you.
[1:11:07] I love that.
[1:11:12] Any other Comments, questions? Again,
[1:11:14] this is just an item for discussion,
[1:11:15] so no action will be taken if nothing else from the board.
[1:11:19] Anyone from the audience? Comments, questions?
[1:11:29] Drink? We
[1:11:33] do it all around here, don't we?
[1:11:39] Oh, crystal. Alright,
[1:11:40] Well thank you.
[1:11:41] And, and again, I know, I guess speaking on behalf
[1:11:44] of the board, this is something we've been,
[1:11:46] not specifically affordability, the lab affordability pilot,
[1:11:48] but addressing these, these items for the community.
[1:11:52] It's just, it's wonderful to see these coming to life
[1:11:54] and recognizing the level of work, the complexity,
[1:11:57] the amount of creativity
[1:11:58] to bring these forward is remarkable.
[1:12:01] It's just, it's, it's wonderful to see.
[1:12:05] Item 16, this was an item for board action.
[1:12:08] It is Crystal's favorite time of year.
[1:12:13] It's our favorite time. Yes.
[1:12:16] Resolution 2026 dash zero five.
[1:12:19] I vote yes. Have we beaten
[1:12:23] you down year over year?
[1:12:25] And I give up you, gosh,
[1:12:29] I don't have to say anything.
[1:12:31] Yeah, I'm looking for a motion
[1:12:33] Boy.
[1:12:34] Aisle two. Wow. Wow. Get it. That's impressive.
[1:12:39] I've done my job.
[1:12:41] Beat me down. Will. You've got it.
[1:12:46] So shall we just do some highlights
[1:12:47] so the public understands what we're going
[1:12:49] That that would be great.
[1:12:51] All right. So it is that time of year where we have
[1:12:54] to establish the rate per $100,000
[1:12:58] of assessed value on properties to be able
[1:13:01] to make our debt service payment on our
[1:13:02] general obligation bonds.
[1:13:05] The counties want us to report that rate by early August.
[1:13:08] So that's why it appears in our July board meeting every
[1:13:11] year we did receive the assessed values from
[1:13:16] both Placer and Nevada County.
[1:13:17] That's what is utilized to make our calculation.
[1:13:21] We know per our, our general obligation bonds
[1:13:25] what our debt schedule is.
[1:13:27] So between getting the assessed values from the counties
[1:13:31] and knowing what our next annual payments are going to be,
[1:13:35] it becomes a mathematical equation.
[1:13:39] The only caveat that comes into play is whether
[1:13:42] or not we have dollars in reserve
[1:13:45] because more might have come
[1:13:47] through in the property tax roles than we expected creating
[1:13:51] additional dollars available for
[1:13:52] that payment background.
[1:13:57] Over the last five years,
[1:13:58] we have actually seen over a 6% growth in the
[1:14:02] property values.
[1:14:04] I will say 26 27 actually dropped below that.
[1:14:08] So it was at 5.66% increase compared to the previous year.
[1:14:12] So a little bit lower than we have seen
[1:14:14] over the last five years.
[1:14:16] Our total debt service requirement is
[1:14:20] for the next payment cycle will be
[1:14:22] $6,084,431 and 26 cents.
[1:14:27] And if we were to just flat out
[1:14:32] make the rate per 100,000 to fully cover that payment,
[1:14:36] it would equate to $16
[1:14:38] and 91 cents per a hundred thousand of assessed value.
[1:14:42] But we do have reserves available
[1:14:44] about $971,000.
[1:14:47] I'm rounding this number
[1:14:49] and the board can decide to use some, none.
[1:14:55] A hundred percent of it. It's really at your discretion.
[1:14:59] So if you were to use a hundred percent
[1:15:02] of those reserve funds, the rate would drop to $14
[1:15:06] and 22 cents per 100,000.
[1:15:09] If you chose not to use any of the reserve, it's the $16
[1:15:13] and 91 cents.
[1:15:14] I've given you a few calculations in
[1:15:17] between utilizing 25, 50, 75
[1:15:20] and 85% of the reserve with what
[1:15:23] that rate would be per 100,000 as I have done in the past.
[1:15:29] I do believe some reserves should be retained
[1:15:31] for future periods if we see any kind
[1:15:34] of sharp declines in property values
[1:15:36] or anything of that nature.
[1:15:39] And so again, I'm coming forward with a recommendation
[1:15:43] of 75% use of that reserve,
[1:15:47] which would actually set the rate at $14
[1:15:50] and 89 cents per 100,000.
[1:15:53] Now that is just a recommendation.
[1:15:55] You guys can have your own little argument over
[1:15:59] what percentage, but that's what's before you right now.
[1:16:03] Do you want to mention, what were they the years
[1:16:06] 2 20 10 to 2012
[1:16:11] that we actually had to go into Yes. Operations.
[1:16:16] Yeah. Yes. We actually saw a 4.64% decline in values
[1:16:21] in 20 10, 20 11 as compared to 2009, 2010.
[1:16:26] And then we saw another 1.92% decline the year after that.
[1:16:31] And then in 20 12, 20 13 it only moved by 0.67%
[1:16:36] in 20 10 11
[1:16:38] and 1112 we did not have enough property
[1:16:43] tax revenue collected to make the debt service payment
[1:16:46] and was thus funded through operational revenue to fund
[1:16:51] that debt service requirement.
[1:16:52] Thus, why I strongly recommend always having some sort
[1:16:56] of reserve when we get to the last required year
[1:17:00] of the debt service payment,
[1:17:01] we will fully utilize the reserve
[1:17:04] and have nothing left over.
[1:17:07] Will we be there For that? I'm gonna be retired. Yeah.
[1:17:12] Although We'll see with the market right now. Right.
[1:17:16] So you said for three years we paid,
[1:17:17] it came outta operation. How many years?
[1:17:20] We actually funded I think two years. Two years.
[1:17:24] Let me see here. Yeah.
[1:17:27] In 2011
[1:17:29] and 2012 we actually paid out the operations
[1:17:33] $540,000 one year
[1:17:35] and 445,000 the next year.
[1:17:39] Part of that was also
[1:17:40] because the rate we had
[1:17:42] told the public when we did our estimates long time ago,
[1:17:46] back in before 2007,
[1:17:50] where we were seeing double digit increases in our property
[1:17:53] tax values and the average at
[1:17:55] that time was an 8% increase year after year.
[1:17:59] And then the market blew up.
[1:18:00] So obviously we couldn't fully predict what was going
[1:18:04] to happen with the market way back then.
[1:18:08] And so when we said on average it would be $18
[1:18:11] and 76 cents, that rate actually went higher
[1:18:15] and the board at that time chose to also pay some
[1:18:17] of those funds out of operations instead
[1:18:19] of putting it on the backs of the property taxpayers.
[1:18:23] Yeah. So,
[1:18:28] So for years I used to advocate that we hold back
[1:18:31] more in reserves and
[1:18:33] because I, I was either on the border,
[1:18:38] I think just after this occurred
[1:18:41] and there was a lot of pushback from the community at the
[1:18:44] time they were unhappy.
[1:18:47] And so I unhappy
[1:18:48] With what, With the fact that we, we holding
[1:18:51] Reserves, holding reserves Were, yeah.
[1:18:53] So I I would agree that holding back
[1:18:59] 75% or paying 75% of the reserves is the appropriate
[1:19:03] Number retaining 25% retaining
[1:19:05] In that 25%.
[1:19:06] We what happens at the end?
[1:19:07] And that goes into our general fund.
[1:19:09] That just goes into No, no,
[1:19:10] No, no, no.
[1:19:11] Exactly. It is always a hundred percent dedicated
[1:19:13] to the purpose of making the debt service requirement on the
[1:19:16] general obligation bonds
[1:19:18] Totally separate set of books.
[1:19:19] So it, it is always restricted for that purpose. Okay.
[1:19:23] And so when we finally get to that last payment
[1:19:27] Of several million dollars
[1:19:29] On these bonds, remember what the chart was, we'll have
[1:19:32] to evaporate entirely that reserve account
[1:19:35] and estimate what we think to make that payment.
[1:19:38] We might want to, I mean this is a ways out
[1:19:42] and somebody else will probably doing this calculation for
[1:19:44] You.
[1:19:45] That's okay. I I'll cut to that just for brevity time.
[1:19:47] I just scored the, where,
[1:19:48] how much money do we have right now?
[1:19:50] So there's 909,
[1:19:52] So last year we had 200 and that carries over, right?
[1:19:56] Last year was a little bit
[1:19:57] Where curves going?
[1:19:58] Does it carry over or do we just
[1:19:59] collect that so that carries over?
[1:20:01] It carries over. It stays in a restricted account. Yeah.
[1:20:03] In a restricted account. Perfect. Yeah. Okay.
[1:20:05] And we cannot use that for anything else. Nothing
[1:20:06] Else. Okay. We
[1:20:07] Can't pay down other debts
[1:20:08] or anything like that as well. Nope.
[1:20:09] So like the 900 we have right now
[1:20:12] is the reserve from last year,
[1:20:14] the carryover from last year plus additional
[1:20:16] reserve that came in? Yes. Yeah.
[1:20:18] Okay. Yeah. Okay. I wanna be clear on that.
[1:20:20] Yes. So we rolled over about 250,000 from last year.
[1:20:23] Then the collections came in,
[1:20:25] which gave us about another 700,000
[1:20:28] that came in more than we expected.
[1:20:30] That gave us about that $970,000 reserve.
[1:20:34] If we use 75% of that, that other 200
[1:20:38] to 7,000 we'll roll over again in a restricted
[1:20:40] account only for this purpose.
[1:20:48] Makes sense. Makes sense. Okay, thank you.
[1:20:50] Yeah, no further questions.
[1:20:54] I think, would you have done this
[1:20:56] just once right? Last? Yeah, just
[1:20:57] Oh Yeah. No, it's a little,
[1:20:59] I remember that one very a little.
[1:21:01] Yeah. I think takes a second to get Yeah.
[1:21:03] I mean looking, you know, just like, yeah, no, I went
[1:21:06] through some numbers back in the Hadn math
[1:21:07] and I just, again, looking at,
[1:21:09] let's say it's a million dollar home, you know,
[1:21:11] you're looking at $169 versus 142 versus 148.
[1:21:15] Yeah. I called a few people yesterday and today
[1:21:18] 'cause I was like, what does it mean to you?
[1:21:19] And many people were kind of surprised like, oh,
[1:21:22] I didn't even know that it changes.
[1:21:24] Yeah. And then I said, well, you know, that's really kind
[1:21:27] of your money, you know, what would you, would you want us
[1:21:30] to all pay it down?
[1:21:31] And many of them just as long as like, well, as long
[1:21:34] as long, you know, they,
[1:21:35] many people just didn't really have much of a say about it.
[1:21:38] You know, $5 1 42 versus 1 48
[1:21:40] for a million dollars home, $6.
[1:21:42] They're like, yeah, fine.
[1:21:44] Well unless they move out of the area it has,
[1:21:46] it's still in their quote bank account for,
[1:21:50] for use at a later date. So small portion.
[1:21:53] Yeah. Yeah.
[1:21:54] So I think the biggest question I get,
[1:21:56] because my direct line is attached
[1:21:59] to your property text statement if you notice it.
[1:22:02] So the phone calls I get are,
[1:22:05] do you have a senior exemption?
[1:22:07] I mean, that's probably the biggest question that comes up.
[1:22:09] And in this case we have no exemptions there.
[1:22:12] There's no one exempt from being able,
[1:22:14] like the school districts, you could be exempt from some
[1:22:17] of their tax measures if you're a senior
[1:22:19] 'cause you don't have kids in school.
[1:22:21] But we do not have exemptions.
[1:22:23] So that's probably the biggest question the public asks me.
[1:22:28] I just wanted to make sure that everybody understands
[1:22:30] how seriously we really do take this.
[1:22:33] And I know s we're, we're, we're, you know, kind of
[1:22:37] being funny about it.
[1:22:39] Right now it's because we've done this year after year
[1:22:42] after year, and we've had these arguments between giving,
[1:22:46] holding all of it and returning all of it.
[1:22:50] And it's, you know, it's run the full breadth of all
[1:22:52] of these different realms
[1:22:55] of possibility year after year after year.
[1:22:57] And that's why we're kind of being lighthearted about it.
[1:23:01] But we do take it very seriously.
[1:23:03] And toward that end, I would like to make the motion
[1:23:06] that we retain 75%
[1:23:08] Well, we're gonna go to, Of the reason we have to go
[1:23:11] There, we're gonna go to the,
[1:23:12] the people whose money we're gonna take
[1:23:14] Yes. To retain,
[1:23:15] Just to retain Before we, before we jump in there. No,
[1:23:19] I'm sorry Mary, really important point
[1:23:22] that not everyone benefits from the history that we do.
[1:23:25] You know, crystallize, you said it, it, at the end
[1:23:28] of the day, it does come down to just the
[1:23:29] math equation, right?
[1:23:30] And then what do you wanna do?
[1:23:31] But it is, you know, I think the differences between,
[1:23:35] you know, this percent and
[1:23:36] that percent might yield maybe a
[1:23:38] difference of $5 as you said.
[1:23:39] But, but to some it's, you know, it's the,
[1:23:41] Well people are calling people calling
[1:23:43] Her.
[1:23:44] Well, but the, the total $170 is real money, you know,
[1:23:46] but the, the differences that, you know, when we argued
[1:23:49] between, you know, this percent versus that percent, yeah.
[1:23:51] The, the net difference was a dollar.
[1:23:53] And let me clarify, it's like three phone calls.
[1:23:56] It's not like I'm getting hundreds,
[1:23:58] But if few people are calling, you know, they're like,
[1:23:59] yeah, they are probably 30 to 300 looking at
[1:24:02] that saying they're, what am I paying for that didn't call?
[1:24:05] So it's, yeah.
[1:24:07] And I think that's the key thing is that it's retaining,
[1:24:08] this is not money that's coming into the general funds here
[1:24:11] or the hospital using or anything we could pay down.
[1:24:13] This is money that they'll be we'll be using back
[1:24:15] to pay down again or general obligation to
[1:24:22] Any other comments, questions from the board?
[1:24:25] Again, I didn't come from this point.
[1:24:27] My only comment is I keep, I keep struggling
[1:24:29] with why not a hundred percent?
[1:24:30] I'll be frankly honest. I again, and I'm a new guy.
[1:24:32] That's right. Because of that,
[1:24:36] That one time, that one time two times, if it happens,
[1:24:41] if we have, if it happens again, they're
[1:24:43] Gonna find you on aisle two basically.
[1:24:45] Yeah. They're gonna find me here.
[1:24:46] You're gonna tell 'em where you are.
[1:24:52] That is my only comment.
[1:24:53] Okay. Yeah, I, I think the, the the important point,
[1:24:58] you know, Robert Trade, like we don't take the reserves
[1:25:01] and go out the party, you know, that,
[1:25:03] that they are dedicated.
[1:25:04] It's just a matter of, you know, it's just, it's a,
[1:25:07] it's a small layer of protection
[1:25:10] in case things go south in the year ahead.
[1:25:14] But it's money that's going to be paid
[1:25:16] through tax dollars at some point.
[1:25:18] Yep. A hundred percent of It.
[1:25:21] Yeah, a hundred percent. A hundred percent. Yeah. Right.
[1:25:23] Yeah, there's no slush fund, there's no,
[1:25:24] I think we talked about these reserve accounts.
[1:25:26] Yeah, that's, well the end, that's not code for slush fund.
[1:25:28] Yeah. It's like every single dollar will go to pay,
[1:25:30] it's just we'll pay this year that next year or the year
[1:25:33] or the year, you know, or at the end.
[1:25:36] So
[1:25:38] Crystal, to clarify the resolution as presented was
[1:25:42] with the 75% utilized
[1:25:47] utilization of the reserve. Correct.
[1:25:50] Retaining 25%, Correct? Correct.
[1:25:53] Yeah. Which it was in the motion.
[1:25:55] Yeah. The suggested motion that's in the agenda.
[1:25:58] So that would be, yeah, the, the 1489 per a hundred
[1:26:01] thousand and the 75% Yeah.
[1:26:04] Use of the reserve. Yeah. Okay,
[1:26:06] we'll get to that in just a second.
[1:26:10] Any input from the audience? Comments, questions?
[1:26:18] None. None From Lauren? She walks in.
[1:26:20] Yeah, she's like what me? I'm assuming nothing online.
[1:26:24] Okay, wonderful. With that Mary.
[1:26:27] Yes, with that I would move that we
[1:26:31] here it's retain 25% of the reserve account.
[1:26:36] Oh, you've got it right there. Yeah.
[1:26:38] Set the, set the 26 27 fiscal year general obligation bond
[1:26:43] tax rate per 100,000 at 1589.
[1:26:46] And utilize approximately 75% of the reserve
[1:26:51] to fully cover the 26 27 debt reserve requirement.
[1:26:55] This will leave 25% in
[1:26:58] reserve. I'll second that
[1:27:01] And a second.
[1:27:02] All in favor?
[1:27:03] Aye. Aye. Aye.
[1:27:05] Opposed? Thank you very much.
[1:27:10] Approved unanimously
[1:27:13] And see you next year on this one.
[1:27:18] So tempted.
[1:27:23] Fantastic. Item 17,
[1:27:24] we did have one item pulled from the consent calendar.
[1:27:28] Item 14 six, town of Forest Home Health
[1:27:31] and Hospice services Director Jar and Kevi pulled that.
[1:27:35] So we'll let you lead the discussion
[1:27:39] I want And Lauren, how long have you been here?
[1:27:42] Hi, it's so nice to see you. So I'm Lauren Zara.
[1:27:46] I am the director of Home Health,
[1:27:48] hospice and Palliative Care.
[1:27:49] And I started in February this time around,
[1:27:54] I actually sat in this room about 20 years ago in a
[1:27:59] CNA course that I took when I was working
[1:28:02] as a cashier at the retail pharmacy across the street
[1:28:06] and then worked in the inpatient pharmacy
[1:28:09] and had the honor of working with Alice
[1:28:12] upstairs on the floor as a CNA
[1:28:14] before I went to nursing school.
[1:28:16] So being back here full circle as a nurse practitioner now
[1:28:21] and director of Home Health,
[1:28:22] hospice palliative care in the thrift stores is
[1:28:25] pretty amazing, honestly. So
[1:28:27] Story.
[1:28:28] Yeah.
[1:28:29] And kudos to, to Child Forest for this is
[1:28:32] where I always wanted to come back.
[1:28:33] So excited to be here and happy to answer any questions.
[1:28:39] Well, thank you. Thank you for your introduction
[1:28:41] and thank you really for doing this.
[1:28:43] I think the rea the reason I pulled this is I,
[1:28:45] I really wanted the public to know how important this is,
[1:28:49] how hospice is important.
[1:28:50] I think you look around the room, I think we all are kind
[1:28:53] of, you know, going through that with our family and,
[1:28:57] and this is something that's you, I think
[1:28:59] as a physician you find that the, the people,
[1:29:01] families are at most vulnerable scared.
[1:29:05] Yet it is most wonderful time that we can honor.
[1:29:08] So I really wanna say just thank you for this great work.
[1:29:11] Welcome. You know, looking at the data
[1:29:13] and the quality there as always, you know, so,
[1:29:16] so wonderful to he.
[1:29:18] See. I'm just curious, is there anything
[1:29:21] that you've noticed in your journey that you've seen
[1:29:25] or uncovered or even that you have us now?
[1:29:27] I pulled you up, I made you wait this long,
[1:29:30] so now you have us.
[1:29:31] So I guess my question is, you have us here,
[1:29:33] is there anything that you wish to tell us more
[1:29:34] besides this report or anything that
[1:29:37] we should know more than, than the great work
[1:29:39] that you're doing and the team is doing?
[1:29:42] I think there's a lot I would say,
[1:29:45] but to keep it brief, I really, I looked back at the last
[1:29:49] few years and watched the recordings of board meetings
[1:29:53] of the home health hospice quality presentation.
[1:29:56] And with this, I really wanted to expand.
[1:29:59] I think the last few quality plans had had
[1:30:04] five or six measures for both for home health
[1:30:07] and a few measures for hospice.
[1:30:09] And so I really wanted to expand.
[1:30:11] So I know you can't all see it right now,
[1:30:13] but in home health there are,
[1:30:19] Oh, if you go ahead, I'm not, keep going, keep going.
[1:30:23] This one, go back one originally. So this is home health.
[1:30:27] So often home health hospice gets lumped together into one
[1:30:31] thing and it's, it's very unique.
[1:30:33] And so there are very, there's very different criteria
[1:30:38] for each program and each department.
[1:30:40] And I think because we're out in the home
[1:30:43] and we're often, it's a continuum in some ways.
[1:30:46] You know, patients often go from home health
[1:30:48] to palliative care to hospice.
[1:30:50] We get lumped together.
[1:30:51] And so I really wanted to put up here the quality measures
[1:30:55] that CMS is looking at
[1:30:57] and really align our quality program with
[1:31:01] nationwide benchmarks.
[1:31:03] And so for home health,
[1:31:04] these are the measures that we look at.
[1:31:05] So oasis based measures, those are measures
[1:31:09] that we are self-reporting on,
[1:31:10] how patients are doing at the beginning of care
[1:31:13] at a recertification or after a readmission,
[1:31:16] and then a discharge, claims-based measures.
[1:31:20] And then our patient satisfaction scores.
[1:31:23] So if you go to the next slide,
[1:31:28] these actual next three slides are,
[1:31:31] are all of those measures.
[1:31:32] So this first one is the oasis,
[1:31:34] then we have the claims-based
[1:31:36] and then our patient satisfaction scores.
[1:31:38] So I really wanted to put all of them in there
[1:31:41] so we're not just looking at maybe the
[1:31:43] ones we're doing really well on.
[1:31:45] 'cause I think for our quality plan,
[1:31:46] we should really be looking at the things
[1:31:48] we need to improve on.
[1:31:50] So I wanted to include all of them
[1:31:53] and then include all of
[1:31:55] that in the discussions I'm having with staff.
[1:31:57] Because these things really matter.
[1:31:59] If we're looking at, you know,
[1:32:01] improvement in bed transferring, that really matters
[1:32:05] to somebody's life and quality of life
[1:32:07] and how well we're doing.
[1:32:08] If we can't, you know, roll out
[1:32:11] of bed and that's the measure.
[1:32:12] It's rolling from left to right and sitting up.
[1:32:16] There are so many things that we can't do
[1:32:18] that our quality is diminished.
[1:32:20] So, you know, they, they really do matter in people's lives.
[1:32:24] And so I wanted to incorporate all
[1:32:25] of them into the quality plan
[1:32:27] so we're not just looking at a few things
[1:32:29] because they all are interrelated really.
[1:32:32] So you can kind of scroll the claims base.
[1:32:36] This is, you know, timely initiation of care.
[1:32:39] This is a big one. We are required
[1:32:41] to be out within 48 hours of a referral.
[1:32:44] So how quickly are we getting out to patients
[1:32:46] because that prevents readmissions.
[1:32:48] The next one is our patient satisfaction scores.
[1:32:53] I'm really looking at this
[1:32:56] and looking at changing the system we're using right now.
[1:32:59] 'cause we use Press Ganey for home health, which is what
[1:33:03] hospitals generally use,
[1:33:04] but for the more majority
[1:33:07] of agencies actually use this program, SHP.
[1:33:10] So I'm looking at changing us over to that program
[1:33:13] because it gives us real time data that we can look at
[1:33:16] with every single patient as we submit data to CMS,
[1:33:20] we also submit it to this program so we can make changes
[1:33:24] as we see them and be more proactive instead of reactive.
[1:33:29] And then with hospice,
[1:33:31] I think is the next one you can actually
[1:33:33] move on to the next one.
[1:33:36] This I'm really excited about for hospice
[1:33:38] and I wanted to include it
[1:33:39] because CMS
[1:33:41] for the first time has changed the hospice assessment.
[1:33:45] So October 1st, last year, 2025,
[1:33:49] they rolled out what's called the HOPE assessment.
[1:33:51] It's the Hospice Outcomes and Patient evaluation.
[1:33:55] And it is really going to change hospice quality measures
[1:33:58] because previously we only looked at patient
[1:34:02] satisfaction scores and those were sent out
[1:34:04] after the patient was deceased.
[1:34:07] So it's family members who are filling out this survey,
[1:34:10] if they even get the survey,
[1:34:11] if they return the survey in the midst
[1:34:14] of everything they're dealing with.
[1:34:18] This HOPE measure is, is pretty, I think,
[1:34:22] revolutionary in hospice because it's gonna give us data,
[1:34:25] it, it's something we do on admission
[1:34:28] and then we have to do it within two weeks
[1:34:32] of admitting the patient.
[1:34:33] And then based on that assessment, if there's moderate
[1:34:36] or severe symptoms, we have
[1:34:38] to go back into a symptom follow-up visit.
[1:34:40] And so it's gonna give us data on
[1:34:44] our symptom management
[1:34:46] and outcomes that for hospice,
[1:34:49] you know, we really need.
[1:34:51] And so I'm really excited CMS is doing this
[1:34:55] and it aligns with home health, the Oasis evaluation.
[1:34:59] So I just really wanted to include that
[1:35:02] because it's gonna take a few years for it to happen.
[1:35:04] But this is gonna change hospice quality hugely.
[1:35:08] Which is happening right now in California.
[1:35:12] I don't know many people know,
[1:35:14] but there's a moratorium on hospices right now.
[1:35:17] You cannot open a new hospice in California
[1:35:20] because there's been so much hospice fraud and abuse in LA
[1:35:25] and Riverside County.
[1:35:27] I, the number, there was like a thousand percent increase in
[1:35:30] the number of hospices where CDPH
[1:35:33] actually in June just rolled out 194 pages
[1:35:38] of new regulations for hospices because of this.
[1:35:41] Because there were, when they looked at it, there were about
[1:35:46] for, there were about one, there was one hospice agency
[1:35:49] for every four people that had died in LA
[1:35:51] and Riverside County.
[1:35:53] So that math doesn't add up.
[1:35:56] So they've rolled out all these new initiatives
[1:35:59] and using Hope will give us a lot more data.
[1:36:02] So I can go on for a long time about this.
[1:36:06] I will. I, yeah, I, home health
[1:36:09] and hospice is near and dear to my heart.
[1:36:11] I love it. And you know, it's often you don't see
[1:36:15] what we're doing out in the house
[1:36:17] and what's happening in the home.
[1:36:18] And so I really hope to be a champion for that
[1:36:21] and really expand our program and access,
[1:36:24] because when I'm talking about access to care, that's,
[1:36:26] you know, most patients are going home from the hospital.
[1:36:29] It's where they wanna be. It's, it's safer, it's,
[1:36:32] it's the place where we get,
[1:36:36] you know, where we live our lives.
[1:36:37] So if we can get our care there and keep ourselves home
[1:36:41] and out of the hospital, I think that's what we all want.
[1:36:45] Lauren did I see, I can't find it.
[1:36:47] I was trying to look back, did I see a data point in this
[1:36:50] that showed that the average number of days in hospice
[1:36:55] care had dropped precipitously?
[1:36:58] If you go, I think it's the next,
[1:37:01] or actually this one slide previous to that,
[1:37:04] was it this one here?
[1:37:06] So our Tahoe Forest average length of stay is 29 days,
[1:37:11] whereas the Medicare average is 88.6.
[1:37:14] Is that the number? That
[1:37:16] Was the number I thought.
[1:37:17] Yeah. So that's really something I'm gonna work on is
[1:37:20] getting hospice referrals sooner.
[1:37:23] The number one thing people say about hospice is they
[1:37:26] wish they had it sooner.
[1:37:29] So I think there's a lot of work I'm gonna do on that
[1:37:33] and I hope that changes.
[1:37:35] I think it's gonna take some time,
[1:37:36] but that is something I really wanna work on.
[1:37:40] And the other piece of
[1:37:42] that though is we really wanna make sure our patients are
[1:37:45] appropriate for hospice care.
[1:37:46] So if we're looking at agencies that maybe have, you know,
[1:37:52] numerous patients on that don't really qualify
[1:37:54] or there is that fraud with hospice, you know,
[1:37:59] we, I don't know if that number is exactly accurate of
[1:38:02] what it should be, but Okay, sure.
[1:38:05] You know, we'll look at that
[1:38:06] and I really wanna expand it, so thank
[1:38:09] You for what you do.
[1:38:10] Of course. Thank you. And then Lauren,
[1:38:13] can I ask the question, is the future of hospice quality
[1:38:17] and the Hope Project or the Hope format, is
[1:38:22] that gonna be something that you'll be able
[1:38:25] to collect the data on your computer program
[1:38:30] so that you'll be easy to pull up and present?
[1:38:33] I hope so, yes. So right now for hospice,
[1:38:36] we are not using SHP, that program
[1:38:40] that we use for home health.
[1:38:41] So I'm working with them on getting that or hospice
[1:38:45] because that will pull that data
[1:38:48] and as CMS gets more data, we'll be able to have
[1:38:51] better numbers for that.
[1:38:53] But that's my hope with it. Yeah.
[1:38:56] And are you working in conjunction with the doulas
[1:39:00] for end of life?
[1:39:03] Yeah. Yes. I tele Forest actually had a course
[1:39:07] through Sierra College with Kate, she's the end
[1:39:11] of life doula that she caught on, taught on Death
[1:39:13] and Dying, which I attended.
[1:39:15] It was a a six class series
[1:39:18] for healthcare providers on providing care at end of life.
[1:39:21] And she is one of the death doulas.
[1:39:23] So I spoke with her extensively
[1:39:25] and we do work with her. Yeah,
[1:39:28] That's great.
[1:39:29] And thank you. Thank you for taking
[1:39:30] on the position. Welcome.
[1:39:32] Yeah, I'm so excited. Welcome. Yeah, thank you.
[1:39:39] Any other comments, questions? No from the audience?
[1:39:42] Any comments, questions? We do need a motion.
[1:39:46] This was part of the consent calendar. Yeah, I'll
[1:39:48] Go ahead and make a motion except 14.6 0.1.
[1:39:51] The 2026 Health and Hospice quality
[1:39:54] Report.
[1:39:55] I'll second that Motion and a second. All in favor?
[1:39:58] Aye. Aye. Opposed? All right. Approved unanimously.
[1:40:02] Thank you very much. Item 18,
[1:40:07] do we have any any board committee reports this month?
[1:40:16] Looks like? No, that
[1:40:21] gets us to the end of the meeting.
[1:40:23] Great. Thank you very much. I'm getting adjourned.
[1:40:36] I got mine. I figured you might,
[1:40:38] Just before we had a advent
[1:40:42] and board meeting.