[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.

Tahoe Forest Health System Board meeting July 23, 2026

Agenda

Transcript