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Thank you. Good afternoon. We are convening the work session of the Travis County Commissioners Court on Thursday, August 20th at 141 p.m. I am presiding Commissioner Bridges-A, and with me, our Commissioner Travillian, Commissioner Howard, Commissioner Morales.

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We are taking up a agenda item. One, consider and take further action on appointment to the Strategic Housing Finance Corporation Board of Directors.

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And this item may be taken into executive session under government code, personal matters, exception and government code,

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a second consultation with attorney exception.

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And commissioner, I don't know if there's any, I'm going to check on any public comment or any caller.

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Is there anybody here for public comment or any callers?

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We have no comment just permission.

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Thanks, Leo.

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And I think Judge Brown will be joining us shortly, but we're going to go ahead and get started with the layout.

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So we're closing down there.

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Do we need to close the public comment since there's nobody here for public comment, or it will close

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All right, well good afternoon everyone. I'm Julie Wheeler, Intergovernmental Relations Officer for the county

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Today we're going to do interviews for Shriheetit Housing and its Corporation. There are a total of five candidates

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Just to remind you. So there are five

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One of those candidates was previously interviewed in a different round to

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Court directed not to bring him back, but he's still under consideration.

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There are going to be two interviews today with two additional interviews at a later date.

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So those two members or those two candidates were not available.

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So we're going to be splitting the interview process.

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Because of that, I am recommending that we go into closed session for those interviews.

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That way it's fair to everybody, and there's not advance notice of the questions.

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So that would be the recommendation.

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and it is devying, again, from the norm,

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but because we have slightly different circumstances.

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The first thing that we need to do, though,

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is discuss the questions.

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So, I made it very confusing.

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I sent you all an initial draft of questions.

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I received some feedback and made edits.

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You then have, so you've received that via email.

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There's also a clean copy to make it easier.

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So the clean copy of questions,

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and you all have those in the packet in front of you.

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there would be a total of six questions. So we want from eight to six, did a little bit of

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combining and a little bit of reordering. If you would like to discuss those in greater detail,

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we can go into executive session to do that. Otherwise, if you all are happy with the clean copy

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as is, you could make a motion and that will be the set up interview questions.

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Mr. Shae, it's very briefly. I believe I wanted to make a note for the record when you open the meeting.

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It is a special voting session today.

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We only have a work session.

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You're right after noon.

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You're right.

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But today we're having a special session.

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Today is a special voting session.

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Thank you.

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Perfection.

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I do have a question on the combined questions.

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So today we should take it to the...

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So we'll turn briefly to the executive session

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and discuss the questions and the number of it.

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In the exception, this will be on agenda item 1 and the exceptions.

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First and no matter exception and consultation with the turning exception.

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Good.

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Thank you.

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In recess.

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session where we discussed interview questions, Julie.

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I would need a motion to approve the questions as discussed.

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Thank you.

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Motion from Commissioner Shea, second from Commissioner Morales.

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Any discussion?

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It was a tie.

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My brother from another brother.

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And we have no colors, all those in favor please, and that passes unanimously.

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Perfect.

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So next step, we'll be going back to executive session to conduct the first interview,

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and that is going to be with Evan Void.

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Judge, before we head back, could we have a moment of silence for our retired,

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Constable Mercer, who passed earlier this week.

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Thank you.

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He started off as a deputy Constable to die in Nespi.

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It was the first African American Constable in Travis County.

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And he was a gentleman and a giant.

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And served as a deacon and chair of the deacon board

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and Mount Zion for years.

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and was just the person that took it upon himself

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to train all of the new constable employees coming in

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and was to stay an incredible community presence

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and served all of his days and he was born in the St. John,

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born in the St. John tradition and served well there.

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I'll just remember him and ask for prayers for his family.

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Thank you.

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Thank you.

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All right, so we will now go to executive session to do the interviews and we're going

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under the personal matters exception.

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Yes.

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I believe.

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And there will be two interviews.

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So as soon as you guys conclude that one, I will bring back the second candidate and the second

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candidate is Patrick Russell.

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All right.

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What was the first candidate's name? Did you say that already?

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Evan Voint.

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And then, is it just, was there one other exception there's?

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There is personnel in a, you also posted for a turning consultation.

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Attorney constitution and something of an appointed body.

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This one will just be personnel, and not the,

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yes, not the personnel exception for an advisory body,

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just the, just the shorter one.

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Okay. All right. Sounds good. So we're going to go in there.

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Do those interviews. We'll come back here before we're taking action.

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Thanks.

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.

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.

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Welcome back to my next question. We discussed item 1, and we're not going to take any further action on that today, relating to the strategic housing finance corporation board of directors.

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We'll take that up again at a future court session. And then item we're here for item 2, receive a quarterly briefing and updates from central health on budget actuals to date.

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implementation of performance review recommendations and draft proposal of the fiscal year

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of 2027 budget.

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Commissioner Shea is in charge. I'll be right back, but y'all can go ahead.

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Does it want you to ask any additional questions?

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Not I'll restrain myself.

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Everyone, whenever you're ready, I'll go ahead and get started.

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Thank you. All right. Yes. Good afternoon, commissioners. Thank you very much for having

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us here today to provide our central health quarter-four update. My name is Beth Lecavassos

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and I'm the Chief Governance and Government Affairs Officer at Central Health. Today we're

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providing the quarter-four update as required by the amended financial order adopted by Travis

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County Commissioners in March of 2025. I want to introduce our speakers and then run through

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agenda for the presentation. So first, to my right, I want to introduce our Vice Chair,

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Elisa May, Vice Chair of our Central Health Board. I also want to introduce Dr. Pat Lee,

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President and CEO of Central Health. Dr. Nick Yagoda, the CEO of Community Care Health Centers.

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Dr. Lisa Dogget, the Chief Medical Officer of Cendero Health Plans.

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General Health Chief Financial Officer, Monica Crowley, our Chief Strategy and Planning

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Officer and Senior Council, and I also want to introduce and thank Alicia Ramirez

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our Government Relations Manager who keeps us organized.

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As for our quarter-four update, today we'll be presenting an update from our Board of

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we will also be giving an update on the Mazars Review

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Recommendation Implementation and where we're at with those recommendations

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We'll provide an overview of our June 2026 budget to actual financial statements

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and we'll be providing some highlights but the detailed financials are in the appendix of your presentation

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In addition we'll give an update on our year of access and this will be

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updates from Central Health Community Care and Sendero Health Plans. Lastly, because we will

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be back here on September 15th requesting action on our fiscal year 27 budget, we thought we would also

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Provide our proposed budget for fiscal year 27. Just as a preview, it's likely to change, but we wanted to let you know where we're at and what's included at this point in time.

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And then just also, based on some conversations that we had with commissioners, over the past few days, we did create a couple of additional slides that we want to hand out.

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Okay, they're already at your desk, so we've given you some bat, we've given you a hard copy of the presentation and some other requirements from the financial order, but just know that we are providing two additional slides that we believe answers some questions around mental health funding.

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And then Pat and Jeff, Dr. Lee and Jeff Knotl will speak to those slides and we'll let you know when we're talking about them.

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So with that, I want to hand it over to our Vice Chair, Alyssa May.

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Thank you.

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Good afternoon, commissioners.

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Judge Brown, I know he's not the diocese, but is also welcome for him as well.

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My name is Alyssa May, and I serve as a Vice Chair for the Central Health Board of

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Managers on behalf of our Board and the entire Board as well as our Board Chair.

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I want to express our gratitude for the opportunity to brief you.

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We continue to focus on board-value transparency, accountability, responsibility, and treating

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every individual with dignity and respect.

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In the last quarter, the board focused on budget development while continuing to work on board

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governance excellence, creation of the central health foundation, discussions on updating

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the central health strategic plan, and creation of a comprehensive facilities plan together

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with ongoing work on the coal applicant agreement with community care health care centers.

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In conversations with you, we have heard your requests for us to prioritize mental health crisis

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center. I am here today to express that the center that the crisis center is a priority for the

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central board of managers. We are well positioned to make this happen with all our partners who are

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involved. The county city, central health,

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and local care as well as del medical school have

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had productive conversations about the development of a local

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mental health crisis center. And next week, our board will

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receive a public presentation at our regularly scheduled board

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meeting on the proposed mental health crisis center. Together with

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our partners, we recognize that there is an unmet need in

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County for the emergency health centers. We understand the purpose of the

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mental health crisis center and we understand that it is to intervene and the

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cycle and provide those in need with the right care at the right time in the

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right place addressing the root causes of illness reducing the burden of our

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system and our community. Together the partners are evaluating several

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potential locations. The research indicates that an ideal site would be near both a hospital

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and a central booking, allowing for effective deflection from unnecessary justice involvement

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or emergency room visits, jail diversion or individuals with low-level charges and ready to

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access hospital-based care when needed. We commit to working closely with the county,

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integral care in the city of Austin, Dell Medical School, Mental Health Experts, as well

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as experts in the Crisis Center operators to ensure a coordinated and thoughtful planning process.

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The Central Health Board has been briefed on the opportunity and has directed the Central

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Health CEO to explore further with partners, including assuring stable funding commitments from

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Travis County and the city of Austin required for long-term sustainability for mental health

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Center. We look forward to follow up presentations next week at our board meeting, and we welcome

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further conversations and guidance from the court. Today, you will hear a presentation on our

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draft budget for fiscal year 2027, and we have added information about mental health services,

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as well as the crisis care services that are funded under fiscal year 2027 budget.

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We are encouraged by the progress to date, much of our work, including some of the services

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funded in the fiscal year, 20, 27 budget and past budgets, have prepared us for this path

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that we are moving forward.

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We look forward to ongoing conversations in the weeks to come, and again, let me stress,

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we do want your guidance, absolutely we can't do this without your guidance.

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Now, you will be hearing from Monica Crawley, who will provide an update on implementation

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of the Mezzars Review recommendations.

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Thank you.

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Thank you.

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Monica Crawley, and I'm going to give just a quick update on our progress on implementation

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of the Mezzars review.

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I'd like to note that you have heart copies of the full Mezzars report printed out for you

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on the dias, and we are still making good progress

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on continuing to implement the best practice recommendations

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that were identified in the Mazar's report.

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We have completed 80% of all of the recommended items.

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Notice that we've got 83 out of 103 total in the green.

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Our compliance program continues to make good progress

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Under Nikes Smith's leadership is our Chief Compliance Officer, and since the last time we spoke,

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we've completed our first annual internal risk assessment under the new Chief Compliance

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Officer, have initiated an internal audit program and our developing vendor compliance training,

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which we're all recommendations from Mazar's, the joint affiliation committee recommendations

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are still underway, and if you remember, this is the committee that includes representatives

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from Central Health, UT Austin, and Decension, and we've met twice since the last time we were here.

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And we are developing a shared clinical quality framework to guide care and outcome achievement

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among the shared patient populations. And we are continuing to work towards a deeper expense

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reconciliation for seizures and also for the court's request, the joint, the joint affiliation

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committee meeting minutes are now posted on central health's website and you should see

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the minutes on central health's website from the last two meetings that we had. We had one

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in June and another again on August 3rd. So we're continuing in this work.

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Thank you. So, good to see all the commissioners this afternoon. I'm Jeff Knottle, Chief Financial Officer.

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So I'm going to briefly go over.

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Our central health financial statements, somewhat abbreviated form, as Pearl had mentioned, the

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detailed financials are in the backside of the packet that we provided. These financials are as

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of June 30th, 2026, so nine months into the fiscal year. Some of the highlights related around

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financials, $373.1 million related around property tax. We typically track the prior year

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and the current year collections versus levy and they're right on track based on previous

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years experience. $5.7 million of events on the Cendero high risk claims for the current

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period. Total balance is $19.1 million. $324.6 million. That's that 59% of our FY2026 budget. We

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don't have a proportional spend during the year. So one of the things that will happen

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in the next month's financials would be the payment of the U.T. affiliation payment, which is

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just a one-time lump sum of $35 billion. $137,000 of purchase health care services, then

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includes community care, that's at 65% of the budget. Behavioral health is another one of the

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is that it doesn't have that proportion of even spend as some of our providers, particularly

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integral care.

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They use other funding sources towards the beginning of our fiscal year, and as those

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are used, they tend to have a more weighted spend at the end of our fiscal year.

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$40.9 million of our direct clinical practice, that is at 50% of the budget, and just as

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a note, we have a large cohort of providers that we expect to start over the next few

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months that will start that span towards the latter part of the year into fiscal year 2027.

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And then 27.2 million dollars related around administrative expenses, which is 50% of the budget.

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Next slide, please.

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01:40:15,460 --> 01:40:20,620
So this is more of a graphical representation of our expenses.

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There are two charts here.

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Again, we're nine months into the fiscal year.

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The bar chart on the left is nine months of expenses as compared to our budget.

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01:40:37,900 --> 01:40:44,860
So for example, purchase healthcare services for nine months ended June 30th, we're at

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38 million of a $211 million budget, which is 65%.

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And then on the right-hand side is a bar chart that shows June 30th year today for

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01:40:59,280 --> 01:41:10,100
2026 and June 30th from the prior year of 2025 and so you see the darker colored bars

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01:41:10,100 --> 01:41:17,420
are our spend as of the nine months and again they're comparing it's a year over year comparison

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those healthcare services.

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01:41:23,870 --> 01:41:28,990
We happen to answer any questions or that concludes the brief presentation.

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I guess if I summed up those two charts, the one on the left shows were a little bit under budget,

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01:41:35,690 --> 01:41:40,170
but the one on the right shows that we've spent more than we spent last year.

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That's cool.

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01:41:40,610 --> 01:41:43,530
So we're probably doing pretty good.

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01:41:44,410 --> 01:41:45,370
That's correct.

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I have a couple questions, so do you want this to go section by section where we ask questions?

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01:41:53,570 --> 01:41:54,730
I do want to do that.

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01:41:54,730 --> 01:41:55,390
I can do it.

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01:41:55,570 --> 01:41:55,750
Okay.

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01:41:56,370 --> 01:41:57,030
That works for you.

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01:41:58,970 --> 01:42:03,210
The 19 million, I think it was, for Sendero, 19 million in change.

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01:42:03,630 --> 01:42:06,930
Does that get true to, does that get reimbursed from the federal government?

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01:42:07,110 --> 01:42:10,770
I don't even know how to describe it, but I know it's sort of, we have to put up money

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01:42:10,770 --> 01:42:16,130
events for the risk, but then does it get somehow, do we need to get made?

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01:42:16,410 --> 01:42:24,630
Yeah, it's a financing of claims. Those claims, central health, finances, those claims.

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01:42:25,930 --> 01:42:31,750
And in the subsequent period, once CMS goes through all the risk adjustment stuff, they make

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01:42:31,750 --> 01:42:38,930
a risk adjustment payment and presumably that amount would be enough to repay the

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events that we might.

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01:42:40,870 --> 01:42:43,890
Is that generally been the case?

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01:42:44,310 --> 01:42:44,970
Yes, yes.

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01:42:45,310 --> 01:42:50,070
So you're expecting that this will likely be in some way,

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01:42:50,070 --> 01:42:51,990
the inverse to whatever the right term is for.

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01:42:52,030 --> 01:42:56,650
Our expectation is that it would be, but insurance has risk.

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01:42:57,130 --> 01:43:01,190
And there are all sorts of, for example, in previous years,

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01:43:01,390 --> 01:43:06,870
there's been a case where a few large insurance companies owed money

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01:43:06,870 --> 01:43:09,950
into the risk pool, and they didn't make the payment.

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They instead declared bankruptcy.

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01:43:13,130 --> 01:43:19,970
And so there's a lot of external risk related around that.

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01:43:19,970 --> 01:43:23,150
But we've been doing this for a number of years.

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01:43:24,150 --> 01:43:27,750
We try not to get out of our skis on it and take a real

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01:43:27,750 --> 01:43:29,770
moth article approach to it.

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This question you may not be able to answer, but is there a status update

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01:43:34,530 --> 01:43:35,310
on the litigation?

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01:43:35,310 --> 01:43:40,310
I've understood that it's winding down, but I don't know if you're able to talk about it.

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01:43:41,510 --> 01:43:42,130
Which legislation?

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01:43:42,850 --> 01:43:50,810
Well, the litigation with ascension or seatten over map numbers,

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01:43:51,570 --> 01:43:55,130
which is what I'd understood was the gist of illegal disagreement.

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01:43:56,290 --> 01:44:00,150
Maybe that's not an accurate way to describe it, but is it not getting resolved?

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01:44:00,330 --> 01:44:02,730
Or are you not able to talk about it?

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01:44:02,730 --> 01:44:07,910
the litigations currently in the papers as we work together with our

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01:44:07,910 --> 01:44:13,130
ascension colleagues to try to resolve this, and we continue to be an act of

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01:44:13,130 --> 01:44:13,840
discussion with them.

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That's next.

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01:44:19,730 --> 01:44:19,910
All right.

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01:44:21,890 --> 01:44:24,310
So, Judge Brown Commissioner, Dr. Bill Lake, Mr. Shay,

285
01:44:24,410 --> 01:44:29,090
Mr. Howard, Commissioner Morales, it's a pleasure to be here with all of you.

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01:44:29,870 --> 01:44:35,650
At the beginning of fiscal year 2026, we made a series of commitments to this court and

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01:44:35,650 --> 01:44:41,950
our community. We said we would improve access to care, bring more services close to the people

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01:44:41,950 --> 01:44:47,510
who need them. Strengthen our response to behavior health needs an amount of accountable for the

289
01:44:47,510 --> 01:44:53,390
public resources entrusted to us by Travis County taxpayers, and while we still have and

290
01:44:53,390 --> 01:44:59,130
will likely always have plenty of work ahead of us. We have made meaningful progress on all of

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01:44:59,130 --> 01:44:59,750
those promises.

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01:45:00,000 --> 01:45:05,020
Now, your access. Thank you all for your support. As you've shown up milestone after milestone,

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01:45:05,960 --> 01:45:11,800
challenged to go further and helped move the work forward. So, Commissioner Trevillian, thank

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01:45:11,800 --> 01:45:16,460
you for keeping the needs of Eastern Travis County at the forefront of our work, the new

295
01:45:16,460 --> 01:45:20,400
Colony Park Health and Wellness Center, which you've brought ground on this year and will open

296
01:45:20,400 --> 01:45:26,380
next summer as a tangible example of one key promise becoming reality. Thanks to your advocacy,

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01:45:26,380 --> 01:45:32,000
we have also worked to remove practical barriers to care after medication delivery, providing

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01:45:32,000 --> 01:45:37,120
language assistance, offering evening and Saturday hours and some clinics, and this year we

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01:45:37,120 --> 01:45:42,760
also launched our first internally managed patient transportation program which provides safe

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01:45:42,760 --> 01:45:49,040
reliable transportation to appointments and essential destinations. I also want to thank you and

301
01:45:49,040 --> 01:45:56,360
your personnel for providing our back to school kids, our physicals, that was something that

302
01:45:56,360 --> 01:46:02,100
with that was really important and I really helped parents in the neighborhood. So thank you for

303
01:46:02,640 --> 01:46:07,280
providing those services as well. Thank you, Commissioner. I'm sure you're going to get a call from

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01:46:07,280 --> 01:46:08,280
Commissioner Morales.

305
01:46:10,340 --> 01:46:15,060
We wait for your calls, sir. Commissioner Shay, you have consistently emphasized

306
01:46:15,060 --> 01:46:21,240
the importance of connecting what can too often feel like separate islands of care from primary care,

307
01:46:21,240 --> 01:46:26,140
the specialty care, behavioral health, the hospital, and back again, so that our

308
01:46:26,140 --> 01:46:28,860
pitious experience coordinated and connected care.

309
01:46:29,380 --> 01:46:34,220
And thank you for joining us, the opening of our walking clinic and the David Powell clinic

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01:46:34,220 --> 01:46:38,760
at our future largest multi-specialties care site and handcock.

311
01:46:39,440 --> 01:46:45,080
That phase one opening offered a future look at what that site will make possible as our future

312
01:46:45,080 --> 01:46:50,360
system headquarters, bringing all of our parts that system together around the needs of the

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01:46:50,360 --> 01:46:51,800
under one roof.

314
01:46:52,160 --> 01:46:57,800
And that's really your vision to knit together those islands of care, just repeating your vision.

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01:46:58,060 --> 01:46:59,000
Thank you, Commissioner Schae.

316
01:46:59,840 --> 01:47:03,860
Commissioner Howard, thank you for your leadership and working closely with Travis County,

317
01:47:04,060 --> 01:47:07,900
the City of Austin, and it will care and other partners to advance a stronger

318
01:47:07,900 --> 01:47:10,400
mental health crisis response for our community.

319
01:47:11,160 --> 01:47:13,780
You've been a powerful supporter of a medical rest program,

320
01:47:14,120 --> 01:47:18,340
rest of the program, which officially marked its first full year of operation in

321
01:47:18,340 --> 01:47:24,940
As people experiencing homelessness, it previously not available safe place to recover after

322
01:47:24,940 --> 01:47:29,640
acute care leave in the hospital, connecting them with ongoing medical care on the support.

323
01:47:30,160 --> 01:47:36,400
This year we had 93 participants in this program nearly half of them successfully completed

324
01:47:36,400 --> 01:47:42,440
the program and made their way to permanent or transitional housing, shelter with friends

325
01:47:42,440 --> 01:47:46,920
or family depending on their preference, rather than going back to the street and continuing

326
01:47:46,920 --> 01:47:48,760
on the carousel death.

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01:47:49,760 --> 01:47:53,300
Commissioner Morales, although you are new to this court, your collaboration has set

328
01:47:53,300 --> 01:47:57,500
for a health to support precinct four goes back much further, because of your leadership

329
01:47:57,500 --> 01:48:02,860
while constable, together, we delivered hundreds of thousands of COVID-19 vaccines in East

330
01:48:02,860 --> 01:48:08,420
Austin during the pandemic, saving countless lives, and we are thrilled to work with you

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01:48:08,420 --> 01:48:12,280
to continue spending acts to high quality care in Southeast Travis County.

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01:48:12,280 --> 01:48:18,100
And Judge Brown, your focused and determined leadership over the years has helped bring

333
01:48:18,100 --> 01:48:22,360
community leaders together around one of the most difficult challenges facing our community,

334
01:48:22,900 --> 01:48:24,540
the mental health crisis Travis County.

335
01:48:25,140 --> 01:48:29,280
And although we still have a lot of work ahead of us, our level of coordination and alignment

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01:48:29,280 --> 01:48:34,860
today is stronger because you have led us to work together to clarify our roles to remain

337
01:48:34,860 --> 01:48:40,220
solution focused. And we are on the cost of something potentially transformational as you work

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01:48:40,220 --> 01:48:43,340
together to develop them in a health crisis center together.

339
01:48:44,140 --> 01:48:48,040
So that is sure more about how we've expanded access to care dramatically this year.

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01:48:48,280 --> 01:48:53,120
It's my own turn on Dr. Nick Goda, CEO of Community Care and Executive Vice President

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01:48:53,120 --> 01:48:55,720
for Ammitoy's Services at Central Health.

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01:48:55,740 --> 01:48:56,320
It will be unique.

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01:48:56,520 --> 01:48:57,940
Good afternoon, commissioners.

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01:48:58,220 --> 01:49:01,880
Judge Brown, Commissioner Travillian, Commissioner Shay, Commissioner Howard, Commissioner

345
01:49:01,880 --> 01:49:02,240
Modales.

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01:49:02,400 --> 01:49:06,600
Thank you for the opportunity to be here today, especially thank you to Commissioner Modales

347
01:49:06,600 --> 01:49:12,220
in Pilar Sanchez for your support and partnership leading the lead testing event we had earlier

348
01:49:12,220 --> 01:49:12,780
in July.

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01:49:13,940 --> 01:49:19,420
As Dr. Lee has mentioned to the 2026 has been our year of access for patients regardless

350
01:49:19,420 --> 01:49:21,020
of their ability to pay.

351
01:49:21,340 --> 01:49:26,600
Community care continues to conduct more visits year after year, expanding access to

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01:49:26,600 --> 01:49:28,700
high-quality high-value care.

353
01:49:29,140 --> 01:49:34,880
We are the largest provider of primary care for the un- and undone-sured in Travis County.

354
01:49:34,880 --> 01:49:39,220
We expect to serve 150,000 unique patients this year.

355
01:49:39,940 --> 01:49:46,060
54% of whom are uninsured versus the national average of 17%.

356
01:49:46,060 --> 01:49:52,960
Among those who report income, 98% were below 200% of the federal poverty line,

357
01:49:53,140 --> 01:49:55,880
which is about $66,000 a year for a family of four.

358
01:49:56,660 --> 01:50:00,380
We serve patients regardless of whether they have coverage ensuring they have access

359
01:50:00,380 --> 01:50:05,700
to preventative and specialty care without this access to community care, those patients

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01:50:05,700 --> 01:50:10,200
would end up in the emergency room or the hospital later and sicker.

361
01:50:11,280 --> 01:50:16,280
We set out to improve access this year and we delivered measurable progress without giving

362
01:50:16,280 --> 01:50:18,380
up quality or volume.

363
01:50:19,020 --> 01:50:29,040
Through June, we cut new patient wait times by nearly 37% across all primary care and our

364
01:50:30,040 --> 01:50:35,460
50%, and we're now under 14 days for new patient appointments and hospital visits, hospital

365
01:50:35,460 --> 01:50:36,640
follow-up visits.

366
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And despite financial headwinds, we've seen record-breaking numbers of patients, encounters

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01:50:42,340 --> 01:50:48,820
are up 6% through June, that's an additional 22,000 visit encounters for our community

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this year.

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And we did it without giving up on quality, federal health resources and services and

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branch community care among the top 20% of health centers for quality control. Among, within

371
01:51:02,340 --> 01:51:06,320
that, we are actually among the highest rates of diabetes control, breast and cervical

372
01:51:06,320 --> 01:51:12,400
cancer screening, immunizations, cardiovascular disease prevention and HIV screening. This

373
01:51:12,400 --> 01:51:19,260
year also recognized as for high value care and exceptional, that is a unique measure

374
01:51:19,260 --> 01:51:24,580
that recognizes exceptional quality matched with cost control, a recognition given to only

375
01:51:24,580 --> 01:51:26,780
15% of health centers in this country.

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01:51:27,840 --> 01:51:31,000
Our fiscal year 2027 priorities strengthen this foundation

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01:51:31,000 --> 01:51:33,140
of an integrated public health care system.

378
01:51:34,720 --> 01:51:36,900
You see, there was priorities listed below

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01:51:36,900 --> 01:51:39,300
further decreasing wait times for new patients,

380
01:51:39,420 --> 01:51:42,780
recruiting and retaining providers in a highly competitive

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01:51:42,780 --> 01:51:46,400
national, national environment, continuing to improve

382
01:51:46,400 --> 01:51:48,880
on quality and mitigating the burden

383
01:51:48,880 --> 01:51:51,360
on taxpayers created by policy changes.

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01:51:51,980 --> 01:51:53,080
This last one matters,

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01:51:53,080 --> 01:51:56,380
because we face real financial headwinds.

386
01:51:56,440 --> 01:51:58,960
Changes to 340B, policy and activity

387
01:51:58,960 --> 01:52:01,240
have substantially reduced pharmacy revenue.

388
01:52:02,380 --> 01:52:04,940
Our annual Medicaid reimbursement gap has grown

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01:52:04,940 --> 01:52:07,720
from $10 million in fiscal year 2024

390
01:52:08,260 --> 01:52:12,820
to a projected $24 million in fiscal year 2027.

391
01:52:14,320 --> 01:52:16,380
I build a strong ambulatory system,

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01:52:16,780 --> 01:52:18,580
community care and central health

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01:52:18,580 --> 01:52:20,340
are minimizing avoidable disease

394
01:52:20,340 --> 01:52:21,560
and suffering for our patients.

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01:52:21,560 --> 01:52:29,280
We are also reducing what the system pays for avoidable emergency care and leaving hospital capacity across the community.

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01:52:30,000 --> 01:52:33,600
Those patients who need it most. Thank you very much for your time.

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01:52:33,940 --> 01:52:34,960
Thank you.

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01:52:36,100 --> 01:52:40,060
You've also expanded health coverage for residents across the county.

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01:52:40,540 --> 01:52:43,080
And to share more about that, progress on the highlights from Cinderella.

400
01:52:43,480 --> 01:52:46,580
I'm delighted to turn over Dr. Lisa Doggett, Chief Medical Officer.

401
01:52:46,780 --> 01:52:47,660
It's in there health plans.

402
01:52:48,580 --> 01:52:49,420
Thank you, Dr. Lee.

403
01:52:49,960 --> 01:52:52,580
So this is my first time presenting before you.

404
01:52:52,720 --> 01:52:55,640
I am still pretty new as Chief Medical Officer at Cinderella,

405
01:52:55,760 --> 01:52:57,120
but I'm really excited to be here.

406
01:52:57,120 --> 01:53:04,160
Sharon, all of us are CEO since her greetings and her apologies and not being here, but I'm glad to be here in her place.

407
01:53:05,460 --> 01:53:09,660
So, at Central Health and Cendero, providing coverage for healthcare as a top priority.

408
01:53:10,880 --> 01:53:14,780
Having health coverage is linked to better outcomes and improved quality of life.

409
01:53:14,940 --> 01:53:16,720
That is the reason I took this job.

410
01:53:16,940 --> 01:53:20,960
I feel so passionately about coverage and my values align with Central Health.

411
01:53:22,160 --> 01:53:25,420
Across the central health system, we continue to see strong growth

412
01:53:25,420 --> 01:53:29,560
and the number of Travis County residents receiving health coverage through both Cindero Health

413
01:53:29,560 --> 01:53:34,080
Plans and through central health medical access program and map basic.

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01:53:35,100 --> 01:53:39,840
As illustrated on the slide before you, through the beginning of July and more than 56,000

415
01:53:39,840 --> 01:53:45,140
uninsured Travis County residents had received coverage through map during the fiscal year 2026

416
01:53:45,740 --> 01:53:49,400
and nearly 90,000 received coverage through map basic.

417
01:53:50,320 --> 01:53:53,660
That represents substantial growth over the past several years

418
01:53:53,660 --> 01:53:58,760
And more importantly, thousands more Travis County residents have access to their prescriptions,

419
01:53:58,960 --> 01:54:04,200
to their doctor, to addressing a health concern before it becomes a crisis.

420
01:54:05,300 --> 01:54:08,500
We've also seen significant growth at Sendero this year,

421
01:54:08,780 --> 01:54:13,280
but as you know, the health insurance landscape is changing and is unpredictable.

422
01:54:14,120 --> 01:54:19,580
Enrollment is affected by many factors beyond local control, including federal policy changes.

423
01:54:19,580 --> 01:54:24,700
So when the enhanced tax credits under the Affordable Care Act were not extended,

424
01:54:25,020 --> 01:54:30,040
Cendero did see a modest decline in enrollment, consistent with broader national trends.

425
01:54:30,580 --> 01:54:36,260
We're also seeing some adverse selection, meaning that people who are healthier may decide to go

426
01:54:36,260 --> 01:54:41,060
without coverage, whereas those who have more complex health needs are retaining coverage,

427
01:54:41,180 --> 01:54:45,660
and that balance has changed within our patient population.

428
01:54:47,080 --> 01:54:51,820
Regardless of the changes our commitment remains the same, though, helping people in our community

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01:54:51,820 --> 01:54:56,480
find coverage they can afford, and ensuring that cost is not a reason that someone

430
01:54:56,480 --> 01:54:59,180
delays care or goes without it.

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01:54:59,520 --> 01:55:00,040
Next slide.

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01:55:02,820 --> 01:55:07,180
One of the benefits of having a health plan like Cinderow within the Central Health Enterprise

433
01:55:07,180 --> 01:55:12,640
is that we bring new resources and innovation, and I wanted to just share one of the initiatives

434
01:55:12,640 --> 01:55:17,760
that we've worked on this year to address ER visits, particularly avoidable ER visits

435
01:55:17,760 --> 01:55:21,020
that could have concerns that could be addressed in a better setting.

436
01:55:21,800 --> 01:55:28,560
So in 2025, there were 650 ER visits that were deemed avoidable by 533 Cendero members.

437
01:55:28,920 --> 01:55:33,220
These are for conditions like an upper respiratory infection or a minor injury.

438
01:55:34,300 --> 01:55:38,980
To reduce those numbers, we've created materials to send to our members that focus on how

439
01:55:38,980 --> 01:55:41,040
to seek care in the best setting.

440
01:55:41,320 --> 01:55:46,160
So it talks about when to go to the emergency room versus primary care versus urgent

441
01:55:46,160 --> 01:55:48,140
care versus Norman MD.

442
01:55:48,700 --> 01:55:52,880
If you're not familiar with Norman MD, it is a program through Austin Regional Clinic,

443
01:55:53,200 --> 01:55:58,520
where they have access to care 24-7 with a physician or other health care provider.

444
01:55:59,120 --> 01:56:03,600
It's free of charge to sendero members and offers a great way to access care.

445
01:56:04,340 --> 01:56:07,920
And often can offset a need for an emergency room visit.

446
01:56:08,400 --> 01:56:13,180
So we've created magnets that have the Norman MD phone number and we've included those magnets

447
01:56:13,180 --> 01:56:17,860
with the letter about best places to seek care that we're sending to our members who have

448
01:56:17,860 --> 01:56:24,200
unavoidable ER visit. We're then tracking our ER visits and Norman MD usage to assess our impact.

449
01:56:25,540 --> 01:56:29,680
We have several other initiatives underway that include an effort to reduce 30-day

450
01:56:29,680 --> 01:56:35,100
readmissions for people that are just getting out of the hospital. We have a thrive program to focus on

451
01:56:35,100 --> 01:56:39,380
mental health access. I'm glad to hear that that's continuing to be a big priority for you. It certainly

452
01:56:39,380 --> 01:56:47,320
for us and we also are working on increasing prenatal care and postpartum care as well as improving

453
01:56:47,320 --> 01:56:51,540
our transportation options. So that's it for me back to you, Dr. Lee.

454
01:56:51,800 --> 01:56:55,140
All right, thank you, Dr. Dougett. That's a quick look back at FY26.

455
01:56:55,720 --> 01:57:03,400
Now let's look forward at FY27. In the coming year, our focus will be on translating our FY27 budget

456
01:57:03,400 --> 01:57:09,140
investment into measurable improvements for Travis County residents. More people connected to

457
01:57:09,140 --> 01:57:14,600
care and coverage shorter wait times fewer gaps in critical services and a public health

458
01:57:14,600 --> 01:57:20,860
system that uses taxpayer dollars as effectively as possible. So these on the screen here

459
01:57:20,860 --> 01:57:28,180
are our top board-directed goals for fiscal year 27. How do a few of them? First and foremost,

460
01:57:28,400 --> 01:57:34,260
we will remain laser-focused on the goal of reducing appointment wait times to two weeks or less

461
01:57:34,260 --> 01:57:35,620
across our system.

462
01:57:35,920 --> 01:57:39,420
People can access care sooner, getting into care early,

463
01:57:39,760 --> 01:57:43,900
help prevent more expensive, and perhaps more advanced disease

464
01:57:43,900 --> 01:57:46,160
later in the ER as Dr. Goethe covered.

465
01:57:47,380 --> 01:57:51,320
Second, we want to continue to expand access to care and coverage.

466
01:57:51,440 --> 01:57:54,680
And this is in a year where there are substantial headwins

467
01:57:54,680 --> 01:57:56,380
that Dr. Dogged mentioned.

468
01:57:56,540 --> 01:58:00,620
Both on the ACA marketplace side, on the Medicaid side,

469
01:58:00,740 --> 01:58:02,800
and with increasing work requirements

470
01:58:02,800 --> 01:58:08,920
coming during this next year, we anticipate downward pressure on both those sorts of coverage.

471
01:58:09,120 --> 01:58:14,320
And we'll have to lean in to the medical access program as we've been doing this year to ensure

472
01:58:14,320 --> 01:58:20,960
that the overall number of residents engaged in health care and coverage increases if we're successful

473
01:58:20,960 --> 01:58:27,520
by 5%. That's about 10,000 more people in Travis County having access to care and coverage

474
01:58:27,520 --> 01:58:30,000
despite those headwinds.

475
01:58:30,360 --> 01:58:33,880
Third, we will improve our care and cancer in heart disease.

476
01:58:34,180 --> 01:58:37,060
These are the top causes of death in our community.

477
01:58:37,880 --> 01:58:40,580
In particular, timely diagnosis, treatment and follow-up

478
01:58:40,580 --> 01:58:44,020
can have a big impact on health outcomes in these areas.

479
01:58:45,120 --> 01:58:48,240
Fourth, we are going to extend our goal from F-20 second

480
01:58:48,240 --> 01:58:53,960
around increasing non-tax revenue from 2% to 5%

481
01:58:53,960 --> 01:58:57,220
toward the long range goal to reduce long-term burden

482
01:58:57,220 --> 01:58:58,200
on local taxpayers.

483
01:58:59,160 --> 01:59:02,580
Fifth, we will continue integrating our central health,

484
01:59:02,740 --> 01:59:04,340
community care and cinderous system.

485
01:59:04,980 --> 01:59:07,440
For patients, that means a more seamless path

486
01:59:07,440 --> 01:59:09,340
from coverage to primary care,

487
01:59:09,740 --> 01:59:11,040
especially care and back again.

488
01:59:11,480 --> 01:59:14,840
For taxpayers, it means we're using our resources more effectively

489
01:59:14,840 --> 01:59:17,160
and getting as much value as possible

490
01:59:17,160 --> 01:59:19,720
from every dollar invested across the system.

491
01:59:20,360 --> 01:59:23,820
And finally, in FY27, we will continue to advance and open

492
01:59:23,820 --> 01:59:31,620
several major new areas of care across our community, including fully opening our handcock

493
01:59:31,620 --> 01:59:37,020
multi-specialty site care clinic, which will be the largest multi-specialty site in the system

494
01:59:37,020 --> 01:59:43,100
at 90,000 square feet of clinical care, and the side of our future joint system headquarters.

495
01:59:43,620 --> 01:59:48,460
We should open the colony park, health and wellness center, in the summer of next year bringing

496
01:59:48,460 --> 01:59:53,780
primary care, specialty care, dental care, pharmacy services, and even the first public

497
01:59:53,780 --> 01:59:59,960
library to the area. And we will make substantial progress on Cameron Road, which is a new

498
02:00:00,000 --> 02:00:06,860
Sildee, that will build on the lessons we have learned in the medical rest of the program at the Clinical Education Center

499
02:00:06,860 --> 02:00:14,980
and expand access to that vital service line. Together, these facilities and more are creating the care infrastructure,

500
02:00:15,380 --> 02:00:23,500
the footprint of care that our community simply has not had particularly for the poor and vulnerable members of our community.

501
02:00:23,500 --> 02:00:30,980
bringing care closer to what we will live, bringing capacity for the right care and the right place at the right time.

502
02:00:32,220 --> 02:00:37,320
Now, before I turn things over to Jeff to dive in the budget details, we want to provide a brief snapshot

503
02:00:37,320 --> 02:00:39,820
of some of the care across the central system today.

504
02:00:40,100 --> 02:00:42,740
I won't duplicate what Dr. Ygot has said.

505
02:00:43,080 --> 02:00:45,800
But I do want to just double down next slide, please.

506
02:00:46,800 --> 02:00:51,540
And describe the importance of the prevention focus primary care system.

507
02:00:51,540 --> 02:00:52,760
next slide, please.

508
02:00:55,100 --> 02:00:57,820
This is a version of the Delta report from

509
02:00:57,820 --> 02:01:02,160
Shrivelian to show the year over year growth in primary care visits.

510
02:01:02,160 --> 02:01:09,940
You can see here 2018 through 2025. During that eight year period, we have grown by 88%

511
02:01:10,620 --> 02:01:16,860
reaching 670,000 visits in 2025. This year's numbers are still to be counted and increasing

512
02:01:16,860 --> 02:01:18,740
even further in 2027.

513
02:01:20,940 --> 02:01:26,600
This is a time when community health centers across the country are facing structural pressures

514
02:01:26,600 --> 02:01:30,460
from declining Medicaid, revenue declining 340B revenue.

515
02:01:30,880 --> 02:01:36,000
There are many, many health centers that have had to close services, lay off staff where

516
02:01:36,000 --> 02:01:40,600
even close their doors because of the support of the court and the people of Travis County.

517
02:01:40,800 --> 02:01:43,760
We are expanding services in the midst of those headwins.

518
02:01:45,180 --> 02:01:51,000
Next slide please, while primary care is the backbone of our system, special to care is an area

519
02:01:51,000 --> 02:01:56,640
of great need where we heard from our community several years ago that they wanted us to directly

520
02:01:56,640 --> 02:02:01,900
provide special care services, wait times, for gas and arology, for example, we're far too

521
02:02:01,900 --> 02:02:08,500
long, 12 to 18 months to get a colonoscopy to check if you have colon cancer, it simply wasn't

522
02:02:08,500 --> 02:02:15,520
happening. Over the past several years, we have gone from no direct care services to more than

523
02:02:15,520 --> 02:02:20,920
30, especially care service lines available to our patients. In FY26, we will likely

524
02:02:20,920 --> 02:02:27,440
eclipse 40,000 direct, especially care appointments. And going back to that gastroenterology

525
02:02:27,440 --> 02:02:33,140
I service line, we learned that when we first made the care access, the lines increased actually

526
02:02:33,140 --> 02:02:35,500
because many folks realize I can get care.

527
02:02:35,860 --> 02:02:39,340
We continue to hire and expand and I'm delighted to share

528
02:02:39,340 --> 02:02:42,360
that from a wait list of well over a thousand patients,

529
02:02:42,760 --> 02:02:44,220
we are now well under a hundred

530
02:02:44,220 --> 02:02:48,000
and you can get the colon cancer detection services that you need.

531
02:02:48,000 --> 02:02:50,820
I've no doubt that we will be finding and

532
02:02:50,820 --> 02:02:52,920
care and colon cancer in a much higher rate

533
02:02:52,920 --> 02:02:54,480
in our population as a result.

534
02:02:56,300 --> 02:02:57,220
Next slide, please.

535
02:02:57,700 --> 02:03:00,220
And as we look at how access to specialty care,

536
02:03:00,240 --> 02:03:02,760
and actually, I believe this is where we go to a handout

537
02:03:02,760 --> 02:03:10,660
that you have. The handout that shows the five-year trend in mental health. I believe

538
02:03:10,660 --> 02:03:15,420
a commissioner should help that up a moment ago. So I want to give a highlight on mental

539
02:03:15,420 --> 02:03:21,220
health as the court is well aware for too many of our most vulnerable patients. The gap

540
02:03:21,220 --> 02:03:26,080
in critical mental health services remains and it means that patients cycle between the

541
02:03:26,080 --> 02:03:33,340
Department, the hospital, the jail, homelessness, and back again, receiving some of the most expensive

542
02:03:33,340 --> 02:03:39,400
services in our community without necessarily receiving the court into care they need to be stable

543
02:03:39,400 --> 02:03:46,540
and healthy. And we see that every day. Roughly 70% of our medical respite patients are experiencing

544
02:03:46,540 --> 02:03:52,280
serious mental health challenges. And we see the same generations of complex mental health needs

545
02:03:52,280 --> 02:03:54,020
among patients in our bridge,

546
02:03:54,180 --> 02:03:55,800
which are such as the care services,

547
02:03:56,000 --> 02:03:58,000
and our jail, telehealth services,

548
02:03:58,920 --> 02:04:00,700
according to the Meadows Institute report,

549
02:04:01,440 --> 02:04:04,980
a relatively small number of high-justice utilizing patients,

550
02:04:05,460 --> 02:04:09,120
roughly 950 people, cost our community

551
02:04:09,120 --> 02:04:12,720
about $137 million per year.

552
02:04:13,280 --> 02:04:16,860
We know that part of that problem is ours to solve.

553
02:04:17,320 --> 02:04:20,400
And that is why we have dramatically increased

554
02:04:20,400 --> 02:04:24,560
Central Health Investment and Behavioral Health over the past three years.

555
02:04:25,000 --> 02:04:27,520
By the approach of joining Central Health three years ago.

556
02:04:28,020 --> 02:04:30,960
And since that time, we have substantially increased our investment

557
02:04:30,960 --> 02:04:36,560
behavioral health from about $12 million to a proposed $49 million

558
02:04:36,560 --> 02:04:40,220
in this next fiscal year, as you see on the handout.

559
02:04:40,820 --> 02:04:44,400
In front of you, this includes investments with key partners like

560
02:04:44,400 --> 02:04:50,060
care, and the Silvering Center, as well as investments in our own direct behavior health services,

561
02:04:50,660 --> 02:04:54,860
including jail health, addiction medicine, and other critical services.

562
02:04:56,560 --> 02:04:59,920
There's also been significant discussion this year about a future mental health crisis

563
02:04:59,920 --> 02:05:00,460
center.

564
02:05:00,980 --> 02:05:05,740
That work remains in development, but I want to emphasize that we are not waiting for a future

565
02:05:05,740 --> 02:05:10,380
facility to begin building the system of care our community needs.

566
02:05:10,380 --> 02:05:18,500
Our FY27 budget already includes over $14 million for key components of that broader mental health

567
02:05:18,500 --> 02:05:23,940
crisis response, including investments in patients like the Atrick Care, Psychiatric

568
02:05:23,940 --> 02:05:27,760
Emergency Care, and other services that Jeff Knotall will detail in a moment.

569
02:05:28,580 --> 02:05:31,380
And finally, I want to sincerely thank this court for your leadership.

570
02:05:31,620 --> 02:05:36,380
We would not be in a position to make these investments with that your support and the support

571
02:05:36,380 --> 02:05:40,960
the people Travis County. We are proud of the progress we've made and we know this much more

572
02:05:40,960 --> 02:05:45,600
like a head. And so with that I will turn things over to Jeff to walk us through these investments

573
02:05:45,600 --> 02:05:53,840
in the broader proposed FY27 budget. Thank you Pat. So I'm going to talk here this slide and there

574
02:05:53,840 --> 02:06:02,780
is a lot of detail on it that I'm not going to go into. These are budget or contractual or

575
02:06:02,780 --> 02:06:08,960
amounts that were in contractual negotiations with a number of providers, but I want to give

576
02:06:08,960 --> 02:06:15,740
you a little sense of what our budget looks like. So generally speaking, as Pat mentioned,

577
02:06:16,740 --> 02:06:25,980
we have a budget of about $49.49.2 million. There's two areas of it. The direct health care

578
02:06:25,980 --> 02:06:32,460
services, we've listed out three of our service lines that we're including, including

579
02:06:32,460 --> 02:06:38,260
direct behavioral health psychiatry and direct addiction care that pulls out to about

580
02:06:38,260 --> 02:06:40,880
six and a half million dollars.

581
02:06:41,320 --> 02:06:49,160
Then in addition on our network and behavioral health contracts, the total of that amount

582
02:06:49,160 --> 02:06:59,760
is about $42.6 million. A large part of that is integral care. It's in fiscal year 2027.

583
02:07:00,400 --> 02:07:13,400
It's 31.3 million dollars. And on the narrative there on the left where it just says FY27,

584
02:07:13,400 --> 02:07:21,060
in integral care highlights. Again, just some of the major areas related around that contract

585
02:07:21,060 --> 02:07:29,300
is 11.1 million dollars related around the crisis care. 3.1, related around what's called

586
02:07:29,300 --> 02:07:29,980
PES or the...

587
02:07:30,000 --> 02:07:38,280
The psychiatric emergency services. 14.3 million dollars related around outpatient, clinical

588
02:07:38,280 --> 02:07:44,240
base services, including psychiatry counseling and case management, and then a million dollars

589
02:07:44,240 --> 02:07:50,940
related around permanent supportive housing, mental health services. One of the questions

590
02:07:51,880 --> 02:07:59,660
that is not, or one of the answers that is not on here, my apologies, but was related

591
02:07:59,660 --> 02:08:05,540
around over the past five years, four or five years, what has been the investment in

592
02:08:05,540 --> 02:08:12,320
integral character, I'm just going to quickly run through some numbers.

593
02:08:12,540 --> 02:08:18,380
I think the key is, you know, if you looked at the average increase, it's averaging about

594
02:08:18,380 --> 02:08:21,100
an increase of about $7 million a year.

595
02:08:21,700 --> 02:08:27,380
So beginning in fiscal year 20, 23, our budget was $9.1 million.

596
02:08:27,380 --> 02:08:41,080
20 in fiscal year 2024, 16.2 million, 2025 is 21.7, 2026, 30.9, and then again in fiscal year

597
02:08:41,080 --> 02:08:48,820
27, 31.3 million dollars, this has been a significant investment. That central house

598
02:08:48,820 --> 02:08:57,060
making in behavioral health and it's been a very rapid increase of mental health investment

599
02:08:57,060 --> 02:08:58,120
in our community.

600
02:09:00,630 --> 02:09:08,650
I'm going to keep going through slides here related around the strategic

601
02:09:08,650 --> 02:09:09,910
budget initiatives.

602
02:09:12,070 --> 02:09:17,510
So I could interrupt a minute to just point out, remind my colleagues on those interval

603
02:09:17,510 --> 02:09:23,690
care highlights on that page. We're all looking at the 3.1 million to the psychiatric emergency

604
02:09:23,690 --> 02:09:32,090
services. That's complementing the investment in our preliminary budget for the crisis care

605
02:09:32,090 --> 02:09:41,270
pilot, the diversion pilot, where we're picking up the ongoing expense at the TDP, the therapeutic

606
02:09:41,270 --> 02:09:49,210
diversion program on 15th Street and Central Health is picking up the added expense there

607
02:09:49,210 --> 02:09:56,070
at PES. And so together those make up the pilot that we've been we've funded with

608
02:09:56,070 --> 02:10:02,830
ARPA dollars in the beginning and with Central Health and now we're continuing it since the

609
02:10:02,830 --> 02:10:08,550
ARPA money is gone. So there's there's an addition to the six million or so that we put into

610
02:10:08,550 --> 02:10:09,330
these other pilots.

611
02:10:09,550 --> 02:10:09,710
Right.

612
02:10:13,270 --> 02:10:13,850
Thank you.

613
02:10:13,990 --> 02:10:14,150
Okay.

614
02:10:14,290 --> 02:10:14,810
Thank you.

615
02:10:15,030 --> 02:10:17,270
And a permanent support of housing mental health services.

616
02:10:17,390 --> 02:10:22,370
That's what we referred to when we talked about that matmalica from ECHO, talked

617
02:10:22,370 --> 02:10:27,370
about the health care collaborative, where they're going to have a mobile outreach, mobile

618
02:10:27,370 --> 02:10:33,230
doctors going to all the different apartment complexes that we built with the ship money.

619
02:10:33,950 --> 02:10:40,830
That funding is in addition then to the PSH services that make up your three-legged school.

620
02:10:40,830 --> 02:10:45,890
And now those included in here, there's a million dollars the last item.

621
02:10:49,670 --> 02:10:50,210
Thank you.

622
02:10:50,250 --> 02:10:51,090
Thank you.

623
02:10:52,290 --> 02:11:03,610
So, focusing on our strategic 2020-27 budget initiatives, our budget is focused on continued

624
02:11:03,610 --> 02:11:08,530
implementation of our board approved health equity plan and system goals.

625
02:11:08,530 --> 02:11:14,730
is Dr. Lee mentioned earlier, and will result in more access to care, more providers, and

626
02:11:14,730 --> 02:11:20,630
care teams, shorter wait times, new services, and facilities, and stronger support for patients

627
02:11:20,630 --> 02:11:22,990
with most complex needs.

628
02:11:23,950 --> 02:11:30,170
You'll see a couple of upcoming slides that there are three budget scenarios that we prepared

629
02:11:30,170 --> 02:11:39,150
For today, 8% over the non-New Revenue rate, a 6% rate over the non-New Revenue rate,

630
02:11:39,170 --> 02:11:44,070
and then the non-New Revenue rate, which is a Travis County Commissioner's Court

631
02:11:44,070 --> 02:11:47,490
Financial Order mandates that we bring that.

632
02:11:48,170 --> 02:11:58,330
Our $20-27 budget includes $27.3 million in strategic investments to continue the implementation

633
02:11:58,330 --> 02:12:05,070
of that plan, a holiday to a few key investments we did provide, it seems like a long

634
02:12:05,070 --> 02:12:10,690
time ago but probably three weeks ago a fairly detailed budget memo that has a lot

635
02:12:10,690 --> 02:12:20,790
of detail in it, but I'll highlight a few of those first related to the creating seamless

636
02:12:20,790 --> 02:12:28,250
care journeys that $18 million that includes specialties like general surgery, podiatry, cardiology,

637
02:12:28,250 --> 02:12:32,570
the mental health substance use services and care navigation.

638
02:12:33,790 --> 02:12:39,310
This includes new providers and expanded clinical teams to improve access and reduce

639
02:12:39,310 --> 02:12:40,510
weight times.

640
02:12:40,830 --> 02:12:47,470
In addition to staff assisting patients, navigate the healthcare system and stay connected

641
02:12:47,470 --> 02:12:48,110
to care.

642
02:12:49,690 --> 02:12:55,510
It also includes patients with complex medical needs, cancer patients, persons leaving the

643
02:12:55,510 --> 02:13:02,510
emergency departments, patients in skilled nursing facilities, and people who need help securing

644
02:13:02,510 --> 02:13:03,150
housing.

645
02:13:05,790 --> 02:13:15,950
As was mentioned earlier, our Hancock facilities opening in early 2027, these initiatives

646
02:13:15,950 --> 02:13:23,750
support patients that are services related around convenient location and investment to support

647
02:13:23,750 --> 02:13:30,990
operations, especially services at that facility. We're also strengthening care coordination,

648
02:13:31,330 --> 02:13:37,430
navigation, and eligibility support. The health patients move seamlessly across care

649
02:13:37,430 --> 02:13:45,010
settings, including inpatient oncology, skilled nursing facilities, host emergency department,

650
02:13:45,850 --> 02:13:51,750
discharge, permanent supportive housing, placement support, and field-based eligibility

651
02:13:51,750 --> 02:13:56,310
support at shelters. We're also expanding our medical

652
02:13:56,310 --> 02:14:01,490
respite program at the old children's hospital from 30

653
02:14:01,490 --> 02:14:06,990
beds to 50 beds, which would be more or less at full capacity.

654
02:14:08,790 --> 02:14:12,830
In addition, adding complex primary care providers for

655
02:14:12,830 --> 02:14:16,330
justice involved health, central health will provide a

656
02:14:16,330 --> 02:14:20,790
complex primary care provider at the Travis County

657
02:14:21,670 --> 02:14:25,570
Also working to stand up a re-entry program for patients

658
02:14:25,570 --> 02:14:28,150
exing the justice involved system.

659
02:14:28,750 --> 02:14:33,790
Today, in FY26, central health has provided approximately 250

660
02:14:34,330 --> 02:14:35,870
specialty care visits.

661
02:14:36,810 --> 02:14:42,230
Our specialty care practices open to see inmates.

662
02:14:43,330 --> 02:14:46,630
Our staff works with the sheriff's office to schedule those.

663
02:14:46,810 --> 02:14:49,210
It's been a very collaborative process.

664
02:14:50,850 --> 02:14:59,750
In addition, staff and equipment establish a new rapid access clinic supporting emergency department diversion and providing.

665
02:15:00,000 --> 02:15:07,660
I'm Lee Access and Connection to ongoing care from patients living in the hospital. The breakdown

666
02:15:07,660 --> 02:15:16,360
of the $18 million, $5.6 million is expanding directly. Our direct, especially practice,

667
02:15:16,880 --> 02:15:25,400
including General Surgery, Pediatry, Nefrology, Cardiology, Registered Dietitians, Occupational Therapy,

668
02:15:25,400 --> 02:15:27,260
and physical therapy teams.

669
02:15:28,240 --> 02:15:31,440
In addition, $3.1 million of our budget

670
02:15:31,440 --> 02:15:33,500
strictness, care coordination, and navigation

671
02:15:33,500 --> 02:15:37,360
centers, including inpatient oncology,

672
02:15:38,640 --> 02:15:41,400
complex case management, permanent support of housing,

673
02:15:42,620 --> 02:15:44,480
and, again, post-emergency department

674
02:15:44,480 --> 02:15:46,580
discharge, skilled nursing facilities,

675
02:15:47,240 --> 02:15:48,440
and, again, housing placement.

676
02:15:49,760 --> 02:15:53,600
$2.3 million supports are hand-cock operations,

677
02:15:53,600 --> 02:16:02,560
staff with staffing to support that facility, clinical administration, pharmacy, what's called

678
02:16:02,560 --> 02:16:13,900
PAP patient assistance program, which is a program that central health applies for low-cost

679
02:16:13,900 --> 02:16:18,020
medications through the pharmaceutical entities.

680
02:16:18,020 --> 02:16:22,680
In additional contracted certified medical interpretation,

681
02:16:24,140 --> 02:16:29,240
1.6 million dollars expanding mental health and substance abuse services,

682
02:16:29,600 --> 02:16:32,720
including addiction medicine, substance abuse,

683
02:16:33,040 --> 02:16:37,300
counseling, a program manager and integrated social workers.

684
02:16:38,260 --> 02:16:47,700
$1.4 million around new specialty service lines, including neurology, oral surgery, and a clinical

685
02:16:47,700 --> 02:16:53,760
float coverage, which is a team that floats, there are some shortages in areas so that

686
02:16:53,760 --> 02:16:56,740
we can provide more constant and consistent coverage.

687
02:16:57,300 --> 02:16:58,340
Can I just interrupt real quick?

688
02:16:58,500 --> 02:16:59,920
Is there a page that you're referencing?

689
02:17:00,420 --> 02:17:01,400
I'm trying to figure out where these are.

690
02:17:01,940 --> 02:17:11,160
I'm really just walking through a lot of detail on this strategic budget initiatives. All of this details in in a memo, but be glad

691
02:17:11,160 --> 02:17:17,420
No, no, I just wondered what you were referencing because some of the numbers seemed larger than the numbers that were in the

692
02:17:17,420 --> 02:17:19,880
Yeah, I'm referencing the column on the left

693
02:17:20,380 --> 02:17:21,220
18 18

694
02:17:21,220 --> 02:17:22,580
Okay, so breakdown of the 18

695
02:17:22,580 --> 02:17:29,300
Yes, ma'am. I'm a commissioner. We would be happy to share that detail with you view would like it in writing

696
02:17:29,300 --> 02:17:31,100
I think that's a pleasure, doesn't sure.

697
02:17:31,100 --> 02:17:31,840
I'll tell your reference.

698
02:17:32,280 --> 02:17:33,280
Thank you.

699
02:17:33,800 --> 02:17:35,840
And I promise I'm talking as fast as I can.

700
02:17:36,840 --> 02:17:38,260
Thank you for your patience.

701
02:17:39,260 --> 02:17:44,200
$1.2 million to expand the justice involved in unhouse patients.

702
02:17:45,960 --> 02:17:50,500
The justice involved health program will pursue three core aims

703
02:17:50,500 --> 02:17:53,540
of developing comprehensive reentry,

704
02:17:53,540 --> 02:18:01,220
care model, establishing a clinic infrastructure tailored to justice, involve patients in enhancing

705
02:18:01,220 --> 02:18:03,480
medical services within the gel study.

706
02:18:04,440 --> 02:18:12,920
Care team will consist of a team delivering complex care of four members of that team.

707
02:18:13,500 --> 02:18:22,120
$1.1 million to launch the rapid access clinic and $400,000 to expand field-based eligibility

708
02:18:22,960 --> 02:18:32,760
support at shelters, including enrollment in SSDI or disability insurance. Beyond

709
02:18:32,760 --> 02:18:38,120
direct patient care, the budget includes $2.6 million of workforce investment to

710
02:18:38,120 --> 02:18:43,360
help us with. And train the teams and providers needed to deliver these services.

711
02:18:44,900 --> 02:18:50,220
These funds will strengthen clinical education, emerging leadership development, and

712
02:18:50,220 --> 02:18:53,360
systems to improve workforce and operational efficiency.

713
02:18:54,940 --> 02:19:02,380
It also includes a $1.3 million investment and community support, including the start-up

714
02:19:02,380 --> 02:19:11,480
of the recently board approved central health foundation of approximately $913,000 and additional

715
02:19:11,480 --> 02:19:16,260
resources to strengthen revenue, cycle, reimbursement, and compliance functions.

716
02:19:16,260 --> 02:19:23,760
And then lastly, on the right-hand side, a 5.4 million dollar system investment that

717
02:19:23,760 --> 02:19:29,700
strengthens our infrastructure behind patient care, including new technology data systems

718
02:19:29,700 --> 02:19:37,460
and expanded facility, and supply chain needed at our Hancock facility, and we'll be

719
02:19:37,460 --> 02:19:40,140
needed for biomed functions across the system.

720
02:19:40,140 --> 02:19:46,300
A significant portion of the 5.4 million dollar investment is the hardened and strengthened

721
02:19:46,300 --> 02:19:49,860
our cybersecurity data system environment.

722
02:19:50,540 --> 02:19:51,480
Next slide, please.

723
02:20:00,020 --> 02:20:05,940
Over the past year, we've made significant progress, building a more integrated central health

724
02:20:05,940 --> 02:20:08,660
system across central health community care in Zendaro.

725
02:20:09,500 --> 02:20:13,800
That's included bringing key function and teams together across the system.

726
02:20:13,800 --> 02:20:19,860
for example, unifying leadership for health care for the homeless, integrating our data system

727
02:20:19,860 --> 02:20:26,260
teams, so we can better track care and outcomes across the system, and aligning pharmacy

728
02:20:26,260 --> 02:20:32,180
uh, eligibility screening supply chain and facility operations. Each of these changes is helping

729
02:20:32,180 --> 02:20:38,880
us operate more as one coordinated system, reducing duplication, making it easier for patients

730
02:20:38,880 --> 02:20:44,040
to move between services and using tax resources more efficiently.

731
02:20:45,860 --> 02:20:52,260
Over fiscal year 2020, our 2020 7 budget builds on that progress, we've worked to line

732
02:20:52,260 --> 02:20:57,800
overlapping investments across the system to ensure our patients can maintain health coverage

733
02:20:57,800 --> 02:21:00,560
and expanded access to primary care.

734
02:21:01,280 --> 02:21:06,580
For community care, that means a continued investment in expanding primary care capacity

735
02:21:06,580 --> 02:21:13,420
and other critical services, including dental care, and women's health, while also planning

736
02:21:13,420 --> 02:21:19,800
for in-house laboratory services that can better support patient care across the system,

737
02:21:20,240 --> 02:21:25,980
and deliver these services more effectively and efficiently, rather than third-party

738
02:21:25,980 --> 02:21:26,860
labral lines.

739
02:21:29,810 --> 02:21:34,390
For Sanderer, the focus is on maintaining the financial strength required of a community-based

740
02:21:34,390 --> 02:21:58,050
Health Plan based on Sendera's projected 2025 and 2026 financial results, Central Health is budgeting a $30 million capital investment in FY 2027 to maintain capital levels required by the Texas Department of Insurance and Support the Plan's continued financial stability.

741
02:21:58,050 --> 02:22:07,330
The budget also reflects updated projections for affordable care, at premium assistance, allowing

742
02:22:07,330 --> 02:22:13,430
some therapists to slightly increase its current programs and membership levels despite changes

743
02:22:13,430 --> 02:22:15,150
in the broader coverage environment.

744
02:22:15,690 --> 02:22:23,730
In those coverage programs include ham, which has been a long-term partner, Austin, the

745
02:22:23,730 --> 02:22:29,970
Austin Restaurant Association, Good Works Austin, in addition to our high risk chat.

746
02:22:30,000 --> 02:22:43,440
At what we call a chop program related around enrolling mat patients that have more, more big conditions.

747
02:22:44,960 --> 02:22:53,120
Together these investments all contribute to our work building one integrated system of care that can expand access while operating more efficiently.

748
02:22:54,260 --> 02:22:55,460
Next slide.

749
02:22:59,270 --> 02:23:04,650
So this slide provides a high level comparison of our fiscal year 26 budget with a three

750
02:23:04,650 --> 02:23:08,090
proposal, fiscal year 27 scenarios.

751
02:23:09,230 --> 02:23:13,010
Importantly showing what each scenario means for health care services in our community.

752
02:23:13,750 --> 02:23:17,770
Under the eight and six percent scenarios, health care delivery, representatives of the largest

753
02:23:17,770 --> 02:23:24,550
area of investment growth, increasing by approximately $79 million over fiscal year 26.

754
02:23:25,550 --> 02:23:33,910
These dollars primarily support services from map members who are 200% below the

755
02:23:33,910 --> 02:23:40,110
at 200% and below the federal poverty level, as well as patients covered by affordable

756
02:23:40,110 --> 02:23:41,990
care act plans and Medicaid.

757
02:23:43,190 --> 02:23:47,950
The known new revenue scenario looks substantially different because it requires reductions

758
02:23:47,950 --> 02:23:55,130
and plant services and investments. First, approximately $12 million in strategic investments

759
02:23:55,130 --> 02:24:00,750
would not move forward. That would mean scaling back or eliminating planning expansion in

760
02:24:00,750 --> 02:24:07,070
areas such as patient navigation and care coordination, mental health, substance use,

761
02:24:07,290 --> 02:24:12,730
and addiction care, plant care services for the unhousing inmates at the Travis County gel,

762
02:24:12,730 --> 02:24:19,130
the new rapid access clinic for patients who need follow-up after discharge and expanded

763
02:24:19,130 --> 02:24:23,450
neurology and oral surgery, surgery, and surgery services.

764
02:24:24,490 --> 02:24:29,850
In addition to approximately $23 million in plan healthcare operations would need to be

765
02:24:29,850 --> 02:24:32,730
reduced under the no-new revenue, right?

766
02:24:34,550 --> 02:24:40,070
That could include funding reductions to community care and other FQHC partners, as well

767
02:24:40,070 --> 02:24:43,850
especially mental health and residential addiction, treatment services,

768
02:24:44,290 --> 02:24:48,710
inpatient rehab services, skilled nursing facility expansion,

769
02:24:49,630 --> 02:24:51,930
respite beds, a tomatry and dental services.

770
02:24:54,070 --> 02:25:00,090
The known revenue scenario would also include a $4.4 million amount

771
02:25:00,090 --> 02:25:06,350
in reductions for ongoing employee salary increases for all employees

772
02:25:06,350 --> 02:25:07,890
including providers.

773
02:25:09,910 --> 02:25:16,150
But simply the 8% and 6% scenarios preserve and expand the plan patient care while the

774
02:25:16,150 --> 02:25:22,990
no new revenue would require reductions across direct services, community partnerships and

775
02:25:22,990 --> 02:25:24,070
workforce investments.

776
02:25:25,750 --> 02:25:30,910
On the revenue side growth across all three scenarios is driven primarily by property

777
02:25:30,910 --> 02:25:36,990
In fact, revenue, along with more modest increases from tobacco settlement funds and patient

778
02:25:36,990 --> 02:25:43,050
service revenue, we expect patient service revenue to grow as Central Health has begun

779
02:25:43,050 --> 02:25:46,050
offering services to Sendero members.

780
02:25:46,930 --> 02:25:51,350
In addition, Central Health was recently approved for Medicaid, creating an additional

781
02:25:51,350 --> 02:25:54,830
revenue stream in FY2027.

782
02:25:55,710 --> 02:26:00,410
And then finally, all three scenarios did include the $30 million capital investment in

783
02:26:00,410 --> 02:26:09,210
and Darrow that we discussed, and then there's also a $91 million other funding sources that

784
02:26:09,210 --> 02:26:15,610
is the reimbursement from debt that we issued to reimburse us related around the cash funded

785
02:26:15,610 --> 02:26:16,610
capital projects.

786
02:26:17,970 --> 02:26:18,730
Next slide.

787
02:26:23,620 --> 02:26:33,000
So now we're getting into a subset or attachment B. It's a more detail related to our services.

788
02:26:33,000 --> 02:26:40,440
This slide looks more closely at investments in health services for patients provided directly

789
02:26:40,880 --> 02:26:46,220
by central health and community to care, along with other partners in our network.

790
02:26:48,120 --> 02:26:54,380
Patient services would continue to expand, including increased support for services in our network.

791
02:26:54,380 --> 02:27:06,580
community care is increasing from $98.6 million in FY26 to $117.5 million.

792
02:27:06,580 --> 02:27:14,740
Other FQHCs offering primary care, totaling in totaling approximately $21.5 million.

793
02:27:16,400 --> 02:27:23,230
And then we talked a lot about integral care and then also just adding the investment in

794
02:27:23,230 --> 02:27:30,030
delivering center, which is 600,000 to support their first floor operations and second floor

795
02:27:30,030 --> 02:27:36,690
operations, which provide a safe short term environment for individuals to remain as they

796
02:27:36,690 --> 02:27:40,550
are making decisions about whether or not to receive treatment.

797
02:27:42,920 --> 02:27:49,250
Much of the projected growth in direct health services for 2027 support, especially care and

798
02:27:49,250 --> 02:27:55,210
coordination. Again, including our Hancock campus, our clinical,

799
02:27:55,730 --> 02:28:02,590
respite, 20 new beds, and then expansion to addiction care teams.

800
02:28:03,590 --> 02:28:05,550
All of these investments are intended to reduce

801
02:28:05,550 --> 02:28:09,230
appointment, wait times, improve coordination, and help patients

802
02:28:09,230 --> 02:28:13,390
receive care earlier before four needs become more serious

803
02:28:13,390 --> 02:28:16,730
and costly. Next slide, please.

804
02:28:20,280 --> 02:28:27,580
So, this is a deeper look at four years worth of our direct clinical specialty practice.

805
02:28:29,120 --> 02:28:37,560
It's grown over four years from roughly $30 million to nearly $100 million proposed in FY27.

806
02:28:38,600 --> 02:28:45,240
Historically, specialty care has been one of the biggest gaps in our system with patients often waiting too long

807
02:28:45,240 --> 02:28:48,620
or struggling to find providers who could see them.

808
02:28:48,620 --> 02:28:55,020
So, over the past year, central health is increasingly built, our own clinical practice

809
02:28:55,020 --> 02:29:00,480
to meet these needs directly, at any more than a dozen specialty areas, including all

810
02:29:00,480 --> 02:29:02,440
the services you see listed on the slide.

811
02:29:03,580 --> 02:29:09,300
As part of the strategy each year, we have added, but capacity and new capabilities as we

812
02:29:09,300 --> 02:29:14,280
fill the gaps related around the continuum of care.

813
02:29:16,720 --> 02:29:23,260
One major area focuses care for patients following discharge from the hospital and as a result

814
02:29:23,260 --> 02:29:26,380
we're expanding our transitions of care teams.

815
02:29:27,140 --> 02:29:31,180
These teams connect with patients while they are still in the hospital and make sure

816
02:29:31,180 --> 02:29:36,900
they have a clear path back into the appropriate care even after they leave helping them to

817
02:29:36,900 --> 02:29:38,520
have better recovery outcomes.

818
02:29:39,420 --> 02:29:45,140
We're also adding more complex case management in our transition care program also for patients

819
02:29:45,140 --> 02:29:51,920
with significant medical and social needs so that the highest risk patients have coordinated

820
02:29:51,920 --> 02:29:57,300
support and don't have to navigate the system on their own. We also are continued in

821
02:29:57,300 --> 02:29:59,540
the best in areas like psychiatry and addiction.

822
02:30:00,020 --> 02:30:05,760
Care, further strengthening our ability to address behavioral and physical health needs.

823
02:30:08,610 --> 02:30:08,970
Next law.

824
02:30:11,660 --> 02:30:20,540
And so this is the second half of attachment B. Again, moving on from direct health services.

825
02:30:21,120 --> 02:30:28,660
This slide highlights our plan, investments, and operation support, and administration need to support our growing health system.

826
02:30:28,660 --> 02:30:38,320
The largest increases in this portion of attachment being includes the $30 million capital investment in

827
02:30:38,320 --> 02:30:55,760
Cendero and approximately $15 million increase in our annual debt service tied to our recent debt issuance and those debt issuance were those debt proceeds were used to purchase

828
02:30:55,760 --> 02:31:08,980
facilities, long-term facilities that will result in long-term savings from ownership, and mitigate unpredictable cost and least-term renewals associated from leasing.

829
02:31:10,800 --> 02:31:17,960
We are also investing $5.2 million in information technology, cyber security, data infrastructure,

830
02:31:17,960 --> 02:31:25,820
or cleaning work to responsibly standardize and implement artificial intelligence tools that

831
02:31:25,820 --> 02:31:29,100
can improve efficiency and support better decision-making.

832
02:31:29,780 --> 02:31:35,740
The majority of the investment is for enhanced cybersecurity system systems and applications

833
02:31:36,840 --> 02:31:43,380
to protect our patient health records and reduce the risk of service or billing disruptions.

834
02:31:43,380 --> 02:32:02,480
At this time, relate to our FY 2020-27 budget administrative costs remain relatively flat, and then together with these investments provide the operational foundation that we need to build a more integrated health system.

835
02:32:03,620 --> 02:32:04,580
Next slide, please.

836
02:32:10,100 --> 02:32:15,020
So, we've shown this every other past few years.

837
02:32:15,100 --> 02:32:24,660
This is our days of reserve slide, three tax scenarios that we're proposing on the slide.

838
02:32:25,700 --> 02:32:31,420
And just as a reminder, and I alluded to the health equity plan that the board adopted,

839
02:32:31,540 --> 02:32:36,080
it's a seven-year plan, it was adopted in August of 2023.

840
02:32:36,080 --> 02:32:48,300
In that plan contemplated the use of reserves over the seven-year period to invest in the implementation of the plan and the clothes, the health care gaps in our community.

841
02:32:50,180 --> 02:32:59,620
As I outlined earlier, the six and the eight percent scenarios both include the same strategic investments, the eight percent scenario provides more reserve margin.

842
02:32:59,620 --> 02:33:09,900
And again, our targeted days of reserve that we target over our forecast period is a band between

843
02:33:09,900 --> 02:33:12,920
120 and 150 days.

844
02:33:14,760 --> 02:33:23,700
The eight percent scenario in that forecast period ends at 146 days, which is on the upper portion

845
02:33:23,700 --> 02:33:35,400
of the band. The 6% is at 122 days and the no-new revenue rate scenario is at 89 days.

846
02:33:36,140 --> 02:33:45,120
I need to pause for a second and just mention so we have different scenarios in FY 2027 for

847
02:33:45,120 --> 02:33:54,440
subsequent years, fiscal year 28 through fiscal year 31, all the scenarios are at 8%.

848
02:33:54,440 --> 02:33:56,320
So I just want to mention that.

849
02:33:59,160 --> 02:34:04,140
Central Health is the backbone of financial support for community care in Cendero.

850
02:34:04,340 --> 02:34:08,580
And our reserves provide protection against risk and uncertainty.

851
02:34:09,660 --> 02:34:14,240
Community care typically carries 30 to 45 days of cash on hand.

852
02:34:15,060 --> 02:34:20,660
Incendero may need further future capital funding and additional financing levels to maintain

853
02:34:20,660 --> 02:34:23,700
adequate cash levels for claim payments.

854
02:34:24,460 --> 02:34:32,760
We have seen some of these events already unfold and Dr. Yugoda beat me to the punch and

855
02:34:32,760 --> 02:34:39,860
so that the erosion of the 340B program that allows FQHC's to purchase drugs at significantly

856
02:34:39,860 --> 02:34:45,740
discounted prices or the diminishing Medicaid enrollment across the state that puts pressure

857
02:34:45,740 --> 02:34:52,360
on federally qualified health centers to provide care under a sliding scale payment model

858
02:34:52,360 --> 02:34:59,620
rather than a much higher Medicaid with called a PPS rate amount or maintaining adequate

859
02:34:59,620 --> 02:35:06,920
capital for the ACA was stricter enrollment and reduced subsidies. Reserves are also

860
02:35:06,920 --> 02:35:17,380
Circle in the fast-moving and volatile federal and state regulatory environment that can have significant impacts to long-term health care financing.

861
02:35:18,420 --> 02:35:30,320
Staff recommends maintaining a hundred and between 120 and 150 days on hand to support central health long-term fiscal health.

862
02:35:35,510 --> 02:35:46,190
So our tax payer impact shows the impact of each scenario for the median value and I'm going to go over this quickly.

863
02:35:46,550 --> 02:35:57,350
It's so you see at the top you see the approved budget for 2026 and then you see the three tax scenarios the new revenue rate six and eight percent.

864
02:35:57,350 --> 02:36:07,650
the associated M&O and debt service rate. Under the no-new revenue rate, the median home value

865
02:36:07,650 --> 02:36:18,170
would increase by $10 from 20 to 26. At 6%, it would be $36 and at 8%, it would be $44.

866
02:36:23,770 --> 02:36:29,270
Over time, the debt service portion of the tax rate has increased, as I mentioned,

867
02:36:29,270 --> 02:36:36,290
did it that that issuance just want to point that out as you see that increase from 2026 to 2027.

868
02:36:37,970 --> 02:36:44,590
And just as a reminder, and then I'll turn it back over, we did send a budget memo with

869
02:36:44,590 --> 02:36:48,530
a lot of detail, there was a lot of tax information on it.

870
02:36:48,770 --> 02:36:52,350
We did get updated numbers from the Praisal District.

871
02:36:53,130 --> 02:36:58,350
These are the numbers, so I just didn't want there to be confusion if someone's referencing

872
02:36:58,350 --> 02:37:06,010
the budget memo and they see different rights or different amounts. So thank you for your

873
02:37:06,010 --> 02:37:10,190
all of patience on that and I'll turn it back over to Dr. Lee.

874
02:37:10,690 --> 02:37:16,070
All right, so thank you Jeff. I could take us home. The bottom line is that this preliminary

875
02:37:16,070 --> 02:37:21,610
budget is designed to execute the strategic direction of our boards that there are seven year

876
02:37:21,610 --> 02:37:27,350
strategic health care equity plan. Building a stronger, more accessible and more integrated

877
02:37:27,350 --> 02:37:29,170
health care system for Travis County.

878
02:37:30,000 --> 02:37:42,340
Under the recommended 8% scenario, we will continue expanding access to affordable high-quality care, despite the headwinds, helping more people get care sooner and closer to home,

879
02:37:42,860 --> 02:37:51,320
while advancing clinical programs and services need to improve health outcomes across our community. And that includes continuing to deepen our commitment to mental health.

880
02:37:52,100 --> 02:37:56,780
At a time when changes in the broader healthcare environment are creating additional pressures across the county,

881
02:37:56,780 --> 02:38:02,020
We are continuing to lean in to caring for our most vulnerable patients in building that

882
02:38:02,020 --> 02:38:06,500
core infrastructure in partnership with the county and the city and local care and others.

883
02:38:07,680 --> 02:38:11,580
We will also keep integrating central health, community care and syndrome more effectively.

884
02:38:12,360 --> 02:38:17,940
They can care and coverage easier for our patients, creating greater efficiencies and positioning

885
02:38:17,940 --> 02:38:21,060
the central health system for long-term cost savings.

886
02:38:21,860 --> 02:38:27,660
Importantly, this 8% proposed budget preserves the financial capacity and flexibility.

887
02:38:28,500 --> 02:38:34,440
We believe we will need in the years ahead, particularly as we navigate rising costs, growing

888
02:38:34,440 --> 02:38:40,680
demand, mental health needs, and the real risk of policy changes outside of our control.

889
02:38:42,280 --> 02:38:46,460
But the median Travis County Homestead, the recommended scenario, presents an increase

890
02:38:46,460 --> 02:38:52,180
approximately $44 per year or a little less than $4 per month. We believe that investment

891
02:38:52,180 --> 02:38:57,360
allows us to make meaningful progress today while maintaining strong reserves, preparing for emerging

892
02:38:57,360 --> 02:39:03,340
community needs, and protecting the long-term value of China's county dollars. Next slide, please.

893
02:39:04,100 --> 02:39:09,520
Next up in our budget process is August 26th when our board will vote on the proposed tax rate.

894
02:39:09,940 --> 02:39:14,460
The board will then, uh, it's scheduled to vote on the FY27 budget as September 9th,

895
02:39:14,460 --> 02:39:22,500
It will be bringing a final budget for the court's consideration around September 15th between now and then we will continue creating

896
02:39:22,500 --> 02:39:31,640
opportunities for public input, including a special budget-focused community conversation with Judge Brown on August 31st and a public hearing at our

897
02:39:31,640 --> 02:39:38,340
September 2nd Board meeting next slide please. And with that as always, it has been a pleasure to present to the court today.

898
02:39:38,780 --> 02:39:43,400
Thank you so much for your support and your leadership. We're happy to take any questions.

899
02:39:43,400 --> 02:39:45,740
I think it's again. Thanks.

900
02:39:46,800 --> 02:39:47,260
Thank you.

901
02:39:47,340 --> 02:39:48,760
Mr. Shea any thoughts or questions?

902
02:39:49,220 --> 02:39:53,420
I have a number of questions, but I'm happy to let my colleagues go first.

903
02:39:55,630 --> 02:39:56,350
Could you have any of the questions?

904
02:39:56,350 --> 02:39:58,410
I have a quick question that's on my mind.

905
02:39:58,830 --> 02:40:02,930
Are y'all able to consider a cost of living increase

906
02:40:02,930 --> 02:40:05,550
or adjustment for your staff?

907
02:40:09,190 --> 02:40:18,610
We typically do not, but we are considering a cost of living raise this year of two and a half percent.

908
02:40:22,100 --> 02:40:25,380
The county has been doing that since I've been here.

909
02:40:26,860 --> 02:40:28,640
So, whatever we can.

910
02:40:28,640 --> 02:40:39,480
We have just historically, we've done performance-based reviews with a maximum of a 3% amount.

911
02:40:39,480 --> 02:40:39,900
Okay.

912
02:40:40,940 --> 02:40:41,360
All right.

913
02:40:41,620 --> 02:40:42,380
Thank you.

914
02:40:44,410 --> 02:40:45,470
That 8% increased.

915
02:40:45,630 --> 02:40:49,330
Does that include the mental health crisis center?

916
02:40:50,050 --> 02:40:54,970
I know you said earlier, you're already starting the process of already taking action on a lot of that stuff.

917
02:40:55,850 --> 02:41:00,470
But there's that included if it's not, I'd like to see what that looks like.

918
02:41:01,850 --> 02:41:04,010
As we tried to break out, Commissioner Wallace.

919
02:41:04,190 --> 02:41:09,150
There's about 14 million, a little north of 14 million in the amount of health crisis services

920
02:41:09,150 --> 02:41:12,370
that you don't go care and silvering center.

921
02:41:12,650 --> 02:41:18,570
And others provide today that we believe would be core to the Envision amount of health crisis care center.

922
02:41:18,890 --> 02:41:24,950
If that were to come into being that that building would come online perhaps in four or more years.

923
02:41:24,950 --> 02:41:31,750
so it's not in the FSK-27 budget, but the crisis care services made of them are in the

924
02:41:31,750 --> 02:41:32,070
budget.

925
02:41:32,650 --> 02:41:38,510
And we would be more than happy to visit with you to break down with that multi-year investment

926
02:41:38,510 --> 02:41:40,770
of look like at your convenience.

927
02:41:41,690 --> 02:41:42,130
Thank you.

928
02:41:44,050 --> 02:41:45,550
Thank you all for the presentation.

929
02:41:46,130 --> 02:41:49,090
This is extremely helpful and thorough.

930
02:41:49,090 --> 02:42:02,810
I think it's valuable for the public to understand where they are basically having to pick up the tab because of cuts at the federal or the state level.

931
02:42:04,130 --> 02:42:06,870
So that I don't know how easy it is to tease that out.

932
02:42:07,610 --> 02:42:19,070
But if I understood the description correct, is that part of why the risk-based capital for Cendero went from 8 million last year.

933
02:42:19,070 --> 02:42:25,490
30 million this year because of anyone I want to see anything more about that. I'm trying to understand

934
02:42:25,490 --> 02:42:33,930
that. I'll start off. Yes, as Dr. Boggett alluded to, there was kind of a different mix

935
02:42:33,930 --> 02:42:46,430
of members across the, I guess, really across the country. But in Texas, you have a group that

936
02:42:46,430 --> 02:42:51,210
If it continued to purchase insurance, they needed insurance.

937
02:42:51,510 --> 02:42:58,810
Most of the healthy members don't like it, you know, when the enhanced tax credits

938
02:42:58,810 --> 02:43:02,490
left, they elected not to enroll in insurance.

939
02:43:03,090 --> 02:43:08,290
And so what that ended up doing from a kind of a risk pool standpoint, it's all about

940
02:43:08,290 --> 02:43:09,090
math, right.

941
02:43:09,590 --> 02:43:16,410
And so you just had a risk pool statewide that was a lot thicker than it had been before.

942
02:43:16,410 --> 02:43:22,550
And that kind of, that's the basis of how the risk adjustment payment is made, so you had this,

943
02:43:22,730 --> 02:43:24,790
it's based on statewide averages.

944
02:43:25,710 --> 02:43:32,790
Senderra has always enrolled a steady amount of chronically ill patients.

945
02:43:33,710 --> 02:43:41,170
And so the risk adjustment score didn't move a lot on Senderra, so it resulted in less of a risk adjustment payment.

946
02:43:41,170 --> 02:43:47,510
And anticipated, and then the second piece of it is just as, as those sicker patients are

947
02:43:47,510 --> 02:43:53,990
enrolling just the medical costs related to providing services to them is much greater.

948
02:43:54,850 --> 02:43:59,750
And the actual way is to say that caught out with all of these trends that are changing, but

949
02:43:59,750 --> 02:44:05,710
that's generally what I think Sundara is seeing is much, much more substantial cost per patient

950
02:44:05,710 --> 02:44:11,430
because the cohort of patients are a lot sick or that of a main intruder.

951
02:44:12,150 --> 02:44:19,050
And part of that is related to the either cuts or changes in the Affordable Care Act

952
02:44:19,050 --> 02:44:24,550
at the federal level and it's essentially causing the healthier patients who normally

953
02:44:24,550 --> 02:44:32,590
help balance out the finances and the insurance to leave not continue to pay insurance.

954
02:44:32,590 --> 02:44:39,450
It's now more costly because the federal government is cutting back on the ACA, so it's affecting the pace of mix and driving up the cost.

955
02:44:39,910 --> 02:44:48,690
That's absolutely correct and specifically the enhanced tax credits to the X-bar are exactly what we feel like the cost of a lot of that is.

956
02:44:50,650 --> 02:44:55,130
So I don't know how we quantify that, but I just think that's an important thing for people to understand.

957
02:44:55,470 --> 02:44:59,970
It's that and just to mention the enrollment period.

958
02:45:00,000 --> 02:45:05,600
It's getting shorter and shorter every year, and that's another challenge of coming challenge that

959
02:45:05,600 --> 02:45:07,240
will have starting this year.

960
02:45:07,660 --> 02:45:15,520
And I presume some communities that don't have this kind of robust support for insurance

961
02:45:15,520 --> 02:45:21,140
for people are just simply seeing sicker people and they're ending up in the emergency room,

962
02:45:21,340 --> 02:45:22,420
right? Or dying.

963
02:45:23,820 --> 02:45:28,900
I just think we need to really need to make that clear because I don't think a lot of these

964
02:45:28,900 --> 02:45:32,300
impacts are less visible for the general public.

965
02:45:33,320 --> 02:45:38,500
So it wasn't immediately clear to me when I was looking at this, but I think it's an important

966
02:45:38,500 --> 02:45:46,220
story to tell because we are stepping up and providing medical care to people in a way

967
02:45:46,220 --> 02:45:51,320
that ultimately works better, because we're not waiting till their death store and coming

968
02:45:51,320 --> 02:45:58,200
to the emergency room, we're providing care for them earlier, which should be reducing

969
02:45:58,200 --> 02:45:59,720
over a medical course?

970
02:46:01,560 --> 02:46:07,560
In that also, sorry, if I could just add a little bit, and that also relates to community

971
02:46:07,560 --> 02:46:13,660
to care, some of the things we talked about, the 340B program, you know, some of the even

972
02:46:13,660 --> 02:46:20,340
some things that sound like they don't impact, like the most favored nation medicare and

973
02:46:20,340 --> 02:46:27,060
negotiations, those things like that impact the 340B program depending on the mix of pharmaceutical

974
02:46:27,060 --> 02:46:35,400
So there's not a lot of external factors, there's at some point a rebate program that will be

975
02:46:35,940 --> 02:46:41,820
instituted, which means you actually have to get through a validation program in order to

976
02:46:41,820 --> 02:46:47,220
get some of the rebates associated with the 340B program instead of kind of a seamless process.

977
02:46:48,240 --> 02:46:56,060
So there's a lot of real detailed things that happen in these programs that has a whole become meaningful.

978
02:46:56,060 --> 02:47:01,680
So the promise to reduce medical, pharmaceutical costs is not, we're not seeing it.

979
02:47:01,900 --> 02:47:05,380
To your point, Commissioner, there was a slider earlier in the presentation that shows

980
02:47:05,380 --> 02:47:10,740
the steady upward growth in primary care access and in people in coverage.

981
02:47:11,540 --> 02:47:17,120
But if we did not decisively intervene at the central health level what you would see, what

982
02:47:17,120 --> 02:47:21,160
you see across the country is rather than going up, those numbers are going down.

983
02:47:21,160 --> 02:47:30,280
So the difference between the national trends and what we're projecting, you know, of increasing by 5% in coverage and care,

984
02:47:30,340 --> 02:47:33,580
that's the difference that the public taxpayer funding is making.

985
02:47:33,980 --> 02:47:38,760
We know that if we allow people to not be covered and not in care, they don't disappear.

986
02:47:39,580 --> 02:47:45,640
We're going to see them on the streets and the arrest rate and the incarceration and in the ER and hospital.

987
02:47:45,640 --> 02:47:52,500
It's that Meadows Institute report, the 9 or 50 folks who cost the community 137 million a year.

988
02:47:52,680 --> 02:47:58,020
That's where we'll see them. Even though we are investing more, we believe in the end.

989
02:47:58,720 --> 02:48:02,660
The public is a lot more value for that investment and people stay healthier.

990
02:48:03,420 --> 02:48:05,320
And out of those crisis care settings.

991
02:48:06,260 --> 02:48:11,380
So that's the net at a high level that we are proposing in the 8% budget.

992
02:48:11,380 --> 02:48:13,760
And I think that's such a powerful story to tell.

993
02:48:13,960 --> 02:48:18,040
I realize these are complicated numbers and data.

994
02:48:18,300 --> 02:48:21,960
But what we've just discussed here, I think, helps convey that.

995
02:48:22,440 --> 02:48:25,160
And when you said the increase in coverage,

996
02:48:25,360 --> 02:48:27,660
you're talking about the map and map basic and the people

997
02:48:27,660 --> 02:48:30,140
that are covered, because starting in 24,

998
02:48:30,320 --> 02:48:34,380
it was a total of 116,700 and change.

999
02:48:34,400 --> 02:48:37,380
And now it's at 133,000.

1000
02:48:37,780 --> 02:48:40,940
A lot of folks there who, if policy has had

1001
02:48:40,940 --> 02:48:46,720
change, they might be in a marketplace plan or they might be unmedicated, but because those

1002
02:48:46,720 --> 02:48:53,000
are harder to access, we are seeing them shift over substantially into map.

1003
02:48:53,020 --> 02:48:58,540
Thank goodness we have map and we're willing to invest because we believe that that coverage

1004
02:48:58,540 --> 02:49:04,800
dollar is much more value than waiting for someone to show up in crisis downstream.

1005
02:49:04,800 --> 02:49:11,880
This is not really an assignment for you, but I think it is helpful for us to be able to understand

1006
02:49:11,880 --> 02:49:14,580
how other communities are grappling with this.

1007
02:49:15,240 --> 02:49:20,060
Who did the study on the 950 people costing 137 million was that?

1008
02:49:20,560 --> 02:49:22,240
There is a Meadows Institute report.

1009
02:49:22,720 --> 02:49:29,060
Those are the Austin numbers, but I believe there are statewide numbers, and we'd be happy

1010
02:49:29,060 --> 02:49:30,880
to ensure you have a copy of that.

1011
02:49:30,880 --> 02:50:00,860
I'm assuming other places are not, are doing worse because this seems to me like we've got a really meaningful and important investment in public health, but I, I don't know how other communities are managing it, except the hospitals, I guess people are showing up at the emergency room, a quick question on the, the Cendero coverage with him and good work Austin, particularly the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the

1012
02:50:00,860 --> 02:50:06,580
restaurant workers. Do you know for also providing information to the restaurant workers, for instance,

1013
02:50:06,740 --> 02:50:15,600
about the Raising Travis County, the healthcare, the child care initiative that Travis County is administering?

1014
02:50:15,600 --> 02:50:21,300
Because I've run into a lot of restaurant workers who'd be very interested in assistance with child care,

1015
02:50:22,000 --> 02:50:27,980
and I don't know that they would all qualify it for the income qualifications, but it seems like they'd be a great way to

1016
02:50:28,460 --> 02:50:32,440
think up some additional support for people who are in the lower end of a

1017
02:50:32,440 --> 02:50:38,880
past scale. We will bring it up to them. They are the tremendous outreach process.

1018
02:50:40,340 --> 02:50:43,460
Thank you. Thank you for bringing that out. And I know they're very

1019
02:50:43,460 --> 02:50:47,980
interested and they've been involved in it. I'm really glad to see the increase in

1020
02:50:47,980 --> 02:50:55,540
the carrot jail. And is it one something million I was looking for the numbers

1021
02:50:55,540 --> 02:50:57,720
that you were breaking down on that.

1022
02:50:57,720 --> 02:50:58,680
That's 1.2 million.

1023
02:50:58,740 --> 02:50:59,660
1.2 million.

1024
02:51:00,020 --> 02:51:03,540
And is that either specialist of primary care physicians

1025
02:51:03,540 --> 02:51:06,720
that you're bringing to the jail to provide care?

1026
02:51:06,720 --> 02:51:06,920
Yes.

1027
02:51:07,180 --> 02:51:08,680
And that's a complex primary care.

1028
02:51:08,720 --> 02:51:11,520
And that's in addition to people who are already

1029
02:51:11,520 --> 02:51:15,820
going to appointments outside the jail for care.

1030
02:51:15,820 --> 02:51:17,860
So this is new care at the jail.

1031
02:51:18,120 --> 02:51:18,760
That's great.

1032
02:51:18,760 --> 02:51:19,060
That's great.

1033
02:51:19,060 --> 02:51:20,280
I'm really glad to hear that.

1034
02:51:20,280 --> 02:51:22,420
Because I know we have a sicker population.

1035
02:51:24,040 --> 02:51:24,440
I'll stop there.

1036
02:51:24,440 --> 02:51:26,760
but thank you all so much for working

1037
02:51:26,760 --> 02:51:28,420
to end the information you provided.

1038
02:51:29,380 --> 02:51:33,100
Do I have a question about one of the sort of accomplishments

1039
02:51:33,100 --> 02:51:38,600
in 2026 is still a goal in 2027 to continue to work

1040
02:51:38,600 --> 02:51:42,400
on the wait time and are you fine?

1041
02:51:42,460 --> 02:51:45,000
What are you finding is helping with that?

1042
02:51:45,120 --> 02:51:48,460
I mean, I assume just adding more slots

1043
02:51:48,460 --> 02:51:50,440
if you will pick appointments.

1044
02:51:50,440 --> 02:51:54,460
But what else helps with that?

1045
02:51:54,520 --> 02:51:56,100
Thanks, Commissioner, for the question.

1046
02:51:57,060 --> 02:51:59,440
We actually have been able to make most of these increases

1047
02:51:59,440 --> 02:52:00,640
without adding most lots.

1048
02:52:00,640 --> 02:52:05,980
It's just by being more thoughtful about how we use our time.

1049
02:52:06,080 --> 02:52:09,580
It took a substantial amount of work on the part of a couple of pilot groups

1050
02:52:10,080 --> 02:52:12,620
to work a very long backlog down.

1051
02:52:13,080 --> 02:52:16,400
But through just more sophisticated operational workflows,

1052
02:52:16,920 --> 02:52:18,520
we've been able to cut them substantially.

1053
02:52:18,520 --> 02:52:25,840
really. The next year looks forward to spreading those learnings. We have to be very thoughtful

1054
02:52:25,840 --> 02:52:29,980
about how we spread that fit by bit to not over one more team, but they've been very

1055
02:52:30,000 --> 02:52:31,340
All right,

1056
02:52:34,360 --> 02:52:47,140
thank you so much. All right. I think that concludes our business for today. And we will adjourn at 415 PM.