[This transcript was generated automatically from audio using AI and hasn't been reviewed by a person -- it can contain mistakes, including plausible-sounding sentences that were never actually said. Treat it as a starting point, not a verbatim record.]

[18:13] 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.
[18:34] We are taking up a agenda item. One, consider and take further action on appointment to the Strategic Housing Finance Corporation Board of Directors.
[18:43] And this item may be taken into executive session under government code, personal matters, exception and government code,
[18:49] a second consultation with attorney exception.
[18:52] And commissioner, I don't know if there's any, I'm going to check on any public comment or any caller.
[18:58] Is there anybody here for public comment or any callers?
[19:02] We have no comment just permission.
[19:03] Thanks, Leo.
[19:05] And I think Judge Brown will be joining us shortly, but we're going to go ahead and get started with the layout.
[19:08] So we're closing down there.
[19:10] Do we need to close the public comment since there's nobody here for public comment, or it will close
[19:17] All right, well good afternoon everyone. I'm Julie Wheeler, Intergovernmental Relations Officer for the county
[19:26] Today we're going to do interviews for Shriheetit Housing and its Corporation. There are a total of five candidates
[19:32] Just to remind you. So there are five
[19:34] One of those candidates was previously interviewed in a different round to
[19:38] Court directed not to bring him back, but he's still under consideration.
[19:43] There are going to be two interviews today with two additional interviews at a later date.
[19:48] So those two members or those two candidates were not available.
[19:50] So we're going to be splitting the interview process.
[19:53] Because of that, I am recommending that we go into closed session for those interviews.
[19:58] That way it's fair to everybody, and there's not advance notice of the questions.
[20:02] So that would be the recommendation.
[20:03] and it is devying, again, from the norm,
[20:06] but because we have slightly different circumstances.
[20:09] The first thing that we need to do, though,
[20:12] is discuss the questions.
[20:14] So, I made it very confusing.
[20:15] I sent you all an initial draft of questions.
[20:18] I received some feedback and made edits.
[20:21] You then have, so you've received that via email.
[20:24] There's also a clean copy to make it easier.
[20:27] So the clean copy of questions,
[20:29] and you all have those in the packet in front of you.
[20:31] there would be a total of six questions. So we want from eight to six, did a little bit of
[20:36] combining and a little bit of reordering. If you would like to discuss those in greater detail,
[20:42] we can go into executive session to do that. Otherwise, if you all are happy with the clean copy
[20:47] as is, you could make a motion and that will be the set up interview questions.
[20:52] Mr. Shae, it's very briefly. I believe I wanted to make a note for the record when you open the meeting.
[20:57] It is a special voting session today.
[21:00] We only have a work session.
[21:01] You're right after noon.
[21:02] You're right.
[21:02] But today we're having a special session.
[21:03] Today is a special voting session.
[21:05] Thank you.
[21:06] Perfection.
[21:07] I do have a question on the combined questions.
[21:14] So today we should take it to the...
[21:16] So we'll turn briefly to the executive session
[21:18] and discuss the questions and the number of it.
[21:20] In the exception, this will be on agenda item 1 and the exceptions.
[21:24] First and no matter exception and consultation with the turning exception.
[21:28] Good.
[21:29] Thank you.
[21:33] In recess.
[38:16] session where we discussed interview questions, Julie.
[38:21] I would need a motion to approve the questions as discussed.
[38:26] Thank you.
[38:28] Motion from Commissioner Shea, second from Commissioner Morales.
[38:32] Any discussion?
[38:34] It was a tie.
[38:37] My brother from another brother.
[38:39] And we have no colors, all those in favor please, and that passes unanimously.
[38:47] Perfect.
[38:48] So next step, we'll be going back to executive session to conduct the first interview,
[38:53] and that is going to be with Evan Void.
[38:56] Judge, before we head back, could we have a moment of silence for our retired,
[39:02] Constable Mercer, who passed earlier this week.
[39:28] Thank you.
[39:29] He started off as a deputy Constable to die in Nespi.
[39:36] It was the first African American Constable in Travis County.
[39:40] And he was a gentleman and a giant.
[39:43] And served as a deacon and chair of the deacon board
[39:47] and Mount Zion for years.
[39:49] and was just the person that took it upon himself
[39:55] to train all of the new constable employees coming in
[40:00] and was to stay an incredible community presence
[40:05] and served all of his days and he was born in the St. John,
[40:13] born in the St. John tradition and served well there.
[40:17] I'll just remember him and ask for prayers for his family.
[40:23] Thank you.
[40:24] Thank you.
[40:26] All right, so we will now go to executive session to do the interviews and we're going
[40:31] under the personal matters exception.
[40:34] Yes.
[40:34] I believe.
[40:36] And there will be two interviews.
[40:39] So as soon as you guys conclude that one, I will bring back the second candidate and the second
[40:44] candidate is Patrick Russell.
[40:46] All right.
[40:46] What was the first candidate's name? Did you say that already?
[40:48] Evan Voint.
[40:50] And then, is it just, was there one other exception there's?
[40:53] There is personnel in a, you also posted for a turning consultation.
[40:57] Attorney constitution and something of an appointed body.
[41:01] This one will just be personnel, and not the,
[41:03] yes, not the personnel exception for an advisory body,
[41:06] just the, just the shorter one.
[41:08] Okay. All right. Sounds good. So we're going to go in there.
[41:11] Do those interviews. We'll come back here before we're taking action.
[41:14] Thanks.
[1:00:00] .
[1:15:00] .
[1:26:41] 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.
[1:26:53] 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.
[1:27:05] implementation of performance review recommendations and draft proposal of the fiscal year
[1:27:10] of 2027 budget.
[1:27:26] Commissioner Shea is in charge. I'll be right back, but y'all can go ahead.
[1:27:34] Does it want you to ask any additional questions?
[1:27:37] Not I'll restrain myself.
[1:27:46] Everyone, whenever you're ready, I'll go ahead and get started.
[1:27:48] Thank you. All right. Yes. Good afternoon, commissioners. Thank you very much for having
[1:27:59] us here today to provide our central health quarter-four update. My name is Beth Lecavassos
[1:28:06] and I'm the Chief Governance and Government Affairs Officer at Central Health. Today we're
[1:28:13] providing the quarter-four update as required by the amended financial order adopted by Travis
[1:28:18] County Commissioners in March of 2025. I want to introduce our speakers and then run through
[1:28:25] agenda for the presentation. So first, to my right, I want to introduce our Vice Chair,
[1:28:33] Elisa May, Vice Chair of our Central Health Board. I also want to introduce Dr. Pat Lee,
[1:28:39] President and CEO of Central Health. Dr. Nick Yagoda, the CEO of Community Care Health Centers.
[1:28:47] Dr. Lisa Dogget, the Chief Medical Officer of Cendero Health Plans.
[1:28:52] General Health Chief Financial Officer, Monica Crowley, our Chief Strategy and Planning
[1:28:59] Officer and Senior Council, and I also want to introduce and thank Alicia Ramirez
[1:29:04] our Government Relations Manager who keeps us organized.
[1:29:09] As for our quarter-four update, today we'll be presenting an update from our Board of
[1:29:17] we will also be giving an update on the Mazars Review
[1:29:23] Recommendation Implementation and where we're at with those recommendations
[1:29:27] We'll provide an overview of our June 2026 budget to actual financial statements
[1:29:33] and we'll be providing some highlights but the detailed financials are in the appendix of your presentation
[1:29:38] In addition we'll give an update on our year of access and this will be
[1:29:45] updates from Central Health Community Care and Sendero Health Plans. Lastly, because we will
[1:29:52] be back here on September 15th requesting action on our fiscal year 27 budget, we thought we would also
[1:30:00] 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.
[1:30:13] 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.
[1:30:28] 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.
[1:30:46] 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.
[1:30:58] So with that, I want to hand it over to our Vice Chair, Alyssa May.
[1:31:02] Thank you.
[1:31:02] Good afternoon, commissioners.
[1:31:04] Judge Brown, I know he's not the diocese, but is also welcome for him as well.
[1:31:09] My name is Alyssa May, and I serve as a Vice Chair for the Central Health Board of
[1:31:14] Managers on behalf of our Board and the entire Board as well as our Board Chair.
[1:31:21] I want to express our gratitude for the opportunity to brief you.
[1:31:24] We continue to focus on board-value transparency, accountability, responsibility, and treating
[1:31:33] every individual with dignity and respect.
[1:31:36] In the last quarter, the board focused on budget development while continuing to work on board
[1:31:42] governance excellence, creation of the central health foundation, discussions on updating
[1:31:48] the central health strategic plan, and creation of a comprehensive facilities plan together
[1:31:54] with ongoing work on the coal applicant agreement with community care health care centers.
[1:32:00] In conversations with you, we have heard your requests for us to prioritize mental health crisis
[1:32:07] center. I am here today to express that the center that the crisis center is a priority for the
[1:32:14] central board of managers. We are well positioned to make this happen with all our partners who are
[1:32:20] involved. The county city, central health,
[1:32:25] and local care as well as del medical school have
[1:32:28] had productive conversations about the development of a local
[1:32:31] mental health crisis center. And next week, our board will
[1:32:36] receive a public presentation at our regularly scheduled board
[1:32:40] meeting on the proposed mental health crisis center. Together with
[1:32:45] our partners, we recognize that there is an unmet need in
[1:32:48] County for the emergency health centers. We understand the purpose of the
[1:32:55] mental health crisis center and we understand that it is to intervene and the
[1:32:59] cycle and provide those in need with the right care at the right time in the
[1:33:04] right place addressing the root causes of illness reducing the burden of our
[1:33:08] system and our community. Together the partners are evaluating several
[1:33:13] potential locations. The research indicates that an ideal site would be near both a hospital
[1:33:20] and a central booking, allowing for effective deflection from unnecessary justice involvement
[1:33:26] or emergency room visits, jail diversion or individuals with low-level charges and ready to
[1:33:33] access hospital-based care when needed. We commit to working closely with the county,
[1:33:39] integral care in the city of Austin, Dell Medical School, Mental Health Experts, as well
[1:33:45] as experts in the Crisis Center operators to ensure a coordinated and thoughtful planning process.
[1:33:52] The Central Health Board has been briefed on the opportunity and has directed the Central
[1:33:57] Health CEO to explore further with partners, including assuring stable funding commitments from
[1:34:03] Travis County and the city of Austin required for long-term sustainability for mental health
[1:34:09] Center. We look forward to follow up presentations next week at our board meeting, and we welcome
[1:34:16] further conversations and guidance from the court. Today, you will hear a presentation on our
[1:34:22] draft budget for fiscal year 2027, and we have added information about mental health services,
[1:34:28] as well as the crisis care services that are funded under fiscal year 2027 budget.
[1:34:33] We are encouraged by the progress to date, much of our work, including some of the services
[1:34:39] funded in the fiscal year, 20, 27 budget and past budgets, have prepared us for this path
[1:34:46] that we are moving forward.
[1:34:48] We look forward to ongoing conversations in the weeks to come, and again, let me stress,
[1:34:54] we do want your guidance, absolutely we can't do this without your guidance.
[1:34:58] Now, you will be hearing from Monica Crawley, who will provide an update on implementation
[1:35:04] of the Mezzars Review recommendations.
[1:35:06] Thank you.
[1:35:07] Thank you.
[1:35:09] Monica Crawley, and I'm going to give just a quick update on our progress on implementation
[1:35:15] of the Mezzars review.
[1:35:17] I'd like to note that you have heart copies of the full Mezzars report printed out for you
[1:35:26] on the dias, and we are still making good progress
[1:35:30] on continuing to implement the best practice recommendations
[1:35:34] that were identified in the Mazar's report.
[1:35:38] We have completed 80% of all of the recommended items.
[1:35:45] Notice that we've got 83 out of 103 total in the green.
[1:35:50] Our compliance program continues to make good progress
[1:35:53] Under Nikes Smith's leadership is our Chief Compliance Officer, and since the last time we spoke,
[1:36:00] we've completed our first annual internal risk assessment under the new Chief Compliance
[1:36:06] Officer, have initiated an internal audit program and our developing vendor compliance training,
[1:36:13] which we're all recommendations from Mazar's, the joint affiliation committee recommendations
[1:36:20] are still underway, and if you remember, this is the committee that includes representatives
[1:36:26] from Central Health, UT Austin, and Decension, and we've met twice since the last time we were here.
[1:36:36] And we are developing a shared clinical quality framework to guide care and outcome achievement
[1:36:42] among the shared patient populations. And we are continuing to work towards a deeper expense
[1:36:50] reconciliation for seizures and also for the court's request, the joint, the joint affiliation
[1:36:57] committee meeting minutes are now posted on central health's website and you should see
[1:37:03] the minutes on central health's website from the last two meetings that we had. We had one
[1:37:08] in June and another again on August 3rd. So we're continuing in this work.
[1:37:18] Thank you. So, good to see all the commissioners this afternoon. I'm Jeff Knottle, Chief Financial Officer.
[1:37:28] So I'm going to briefly go over.
[1:37:30] Our central health financial statements, somewhat abbreviated form, as Pearl had mentioned, the
[1:37:37] detailed financials are in the backside of the packet that we provided. These financials are as
[1:37:45] of June 30th, 2026, so nine months into the fiscal year. Some of the highlights related around
[1:37:55] financials, $373.1 million related around property tax. We typically track the prior year
[1:38:04] and the current year collections versus levy and they're right on track based on previous
[1:38:12] years experience. $5.7 million of events on the Cendero high risk claims for the current
[1:38:22] period. Total balance is $19.1 million. $324.6 million. That's that 59% of our FY2026 budget. We
[1:38:38] don't have a proportional spend during the year. So one of the things that will happen
[1:38:46] in the next month's financials would be the payment of the U.T. affiliation payment, which is
[1:38:53] just a one-time lump sum of $35 billion. $137,000 of purchase health care services, then
[1:39:03] includes community care, that's at 65% of the budget. Behavioral health is another one of the
[1:39:10] is that it doesn't have that proportion of even spend as some of our providers, particularly
[1:39:16] integral care.
[1:39:17] They use other funding sources towards the beginning of our fiscal year, and as those
[1:39:24] are used, they tend to have a more weighted spend at the end of our fiscal year.
[1:39:33] $40.9 million of our direct clinical practice, that is at 50% of the budget, and just as
[1:39:43] a note, we have a large cohort of providers that we expect to start over the next few
[1:39:52] months that will start that span towards the latter part of the year into fiscal year 2027.
[1:40:01] And then 27.2 million dollars related around administrative expenses, which is 50% of the budget.
[1:40:11] Next slide, please.
[1:40:15] So this is more of a graphical representation of our expenses.
[1:40:22] There are two charts here.
[1:40:24] Again, we're nine months into the fiscal year.
[1:40:27] The bar chart on the left is nine months of expenses as compared to our budget.
[1:40:37] So for example, purchase healthcare services for nine months ended June 30th, we're at
[1:40:44] 38 million of a $211 million budget, which is 65%.
[1:40:51] And then on the right-hand side is a bar chart that shows June 30th year today for
[1:40:59] 2026 and June 30th from the prior year of 2025 and so you see the darker colored bars
[1:41:10] are our spend as of the nine months and again they're comparing it's a year over year comparison
[1:41:18] those healthcare services.
[1:41:23] We happen to answer any questions or that concludes the brief presentation.
[1:41:29] I guess if I summed up those two charts, the one on the left shows were a little bit under budget,
[1:41:35] but the one on the right shows that we've spent more than we spent last year.
[1:41:40] That's cool.
[1:41:40] So we're probably doing pretty good.
[1:41:44] That's correct.
[1:41:45] I have a couple questions, so do you want this to go section by section where we ask questions?
[1:41:53] I do want to do that.
[1:41:54] I can do it.
[1:41:55] Okay.
[1:41:56] That works for you.
[1:41:58] The 19 million, I think it was, for Sendero, 19 million in change.
[1:42:03] Does that get true to, does that get reimbursed from the federal government?
[1:42:07] I don't even know how to describe it, but I know it's sort of, we have to put up money
[1:42:10] events for the risk, but then does it get somehow, do we need to get made?
[1:42:16] Yeah, it's a financing of claims. Those claims, central health, finances, those claims.
[1:42:25] And in the subsequent period, once CMS goes through all the risk adjustment stuff, they make
[1:42:31] a risk adjustment payment and presumably that amount would be enough to repay the
[1:42:38] events that we might.
[1:42:40] Is that generally been the case?
[1:42:44] Yes, yes.
[1:42:45] So you're expecting that this will likely be in some way,
[1:42:50] the inverse to whatever the right term is for.
[1:42:52] Our expectation is that it would be, but insurance has risk.
[1:42:57] And there are all sorts of, for example, in previous years,
[1:43:01] there's been a case where a few large insurance companies owed money
[1:43:06] into the risk pool, and they didn't make the payment.
[1:43:10] They instead declared bankruptcy.
[1:43:13] And so there's a lot of external risk related around that.
[1:43:19] But we've been doing this for a number of years.
[1:43:24] We try not to get out of our skis on it and take a real
[1:43:27] moth article approach to it.
[1:43:30] This question you may not be able to answer, but is there a status update
[1:43:34] on the litigation?
[1:43:35] I've understood that it's winding down, but I don't know if you're able to talk about it.
[1:43:41] Which legislation?
[1:43:42] Well, the litigation with ascension or seatten over map numbers,
[1:43:51] which is what I'd understood was the gist of illegal disagreement.
[1:43:56] Maybe that's not an accurate way to describe it, but is it not getting resolved?
[1:44:00] Or are you not able to talk about it?
[1:44:02] the litigations currently in the papers as we work together with our
[1:44:07] ascension colleagues to try to resolve this, and we continue to be an act of
[1:44:13] discussion with them.
[1:44:18] That's next.
[1:44:19] All right.
[1:44:21] So, Judge Brown Commissioner, Dr. Bill Lake, Mr. Shay,
[1:44:24] Mr. Howard, Commissioner Morales, it's a pleasure to be here with all of you.
[1:44:29] At the beginning of fiscal year 2026, we made a series of commitments to this court and
[1:44:35] our community. We said we would improve access to care, bring more services close to the people
[1:44:41] who need them. Strengthen our response to behavior health needs an amount of accountable for the
[1:44:47] public resources entrusted to us by Travis County taxpayers, and while we still have and
[1:44:53] will likely always have plenty of work ahead of us. We have made meaningful progress on all of
[1:44:59] those promises.
[1:45:00] Now, your access. Thank you all for your support. As you've shown up milestone after milestone,
[1:45:05] challenged to go further and helped move the work forward. So, Commissioner Trevillian, thank
[1:45:11] you for keeping the needs of Eastern Travis County at the forefront of our work, the new
[1:45:16] Colony Park Health and Wellness Center, which you've brought ground on this year and will open
[1:45:20] next summer as a tangible example of one key promise becoming reality. Thanks to your advocacy,
[1:45:26] we have also worked to remove practical barriers to care after medication delivery, providing
[1:45:32] language assistance, offering evening and Saturday hours and some clinics, and this year we
[1:45:37] also launched our first internally managed patient transportation program which provides safe
[1:45:42] reliable transportation to appointments and essential destinations. I also want to thank you and
[1:45:49] your personnel for providing our back to school kids, our physicals, that was something that
[1:45:56] with that was really important and I really helped parents in the neighborhood. So thank you for
[1:46:02] providing those services as well. Thank you, Commissioner. I'm sure you're going to get a call from
[1:46:07] Commissioner Morales.
[1:46:10] We wait for your calls, sir. Commissioner Shay, you have consistently emphasized
[1:46:15] the importance of connecting what can too often feel like separate islands of care from primary care,
[1:46:21] the specialty care, behavioral health, the hospital, and back again, so that our
[1:46:26] pitious experience coordinated and connected care.
[1:46:29] And thank you for joining us, the opening of our walking clinic and the David Powell clinic
[1:46:34] at our future largest multi-specialties care site and handcock.
[1:46:39] That phase one opening offered a future look at what that site will make possible as our future
[1:46:45] system headquarters, bringing all of our parts that system together around the needs of the
[1:46:50] under one roof.
[1:46:52] And that's really your vision to knit together those islands of care, just repeating your vision.
[1:46:58] Thank you, Commissioner Schae.
[1:46:59] Commissioner Howard, thank you for your leadership and working closely with Travis County,
[1:47:04] the City of Austin, and it will care and other partners to advance a stronger
[1:47:07] mental health crisis response for our community.
[1:47:11] You've been a powerful supporter of a medical rest program,
[1:47:14] rest of the program, which officially marked its first full year of operation in
[1:47:18] As people experiencing homelessness, it previously not available safe place to recover after
[1:47:24] acute care leave in the hospital, connecting them with ongoing medical care on the support.
[1:47:30] This year we had 93 participants in this program nearly half of them successfully completed
[1:47:36] the program and made their way to permanent or transitional housing, shelter with friends
[1:47:42] or family depending on their preference, rather than going back to the street and continuing
[1:47:46] on the carousel death.
[1:47:49] Commissioner Morales, although you are new to this court, your collaboration has set
[1:47:53] for a health to support precinct four goes back much further, because of your leadership
[1:47:57] while constable, together, we delivered hundreds of thousands of COVID-19 vaccines in East
[1:48:02] Austin during the pandemic, saving countless lives, and we are thrilled to work with you
[1:48:08] to continue spending acts to high quality care in Southeast Travis County.
[1:48:12] And Judge Brown, your focused and determined leadership over the years has helped bring
[1:48:18] community leaders together around one of the most difficult challenges facing our community,
[1:48:22] the mental health crisis Travis County.
[1:48:25] And although we still have a lot of work ahead of us, our level of coordination and alignment
[1:48:29] today is stronger because you have led us to work together to clarify our roles to remain
[1:48:34] solution focused. And we are on the cost of something potentially transformational as you work
[1:48:40] together to develop them in a health crisis center together.
[1:48:44] So that is sure more about how we've expanded access to care dramatically this year.
[1:48:48] It's my own turn on Dr. Nick Goda, CEO of Community Care and Executive Vice President
[1:48:53] for Ammitoy's Services at Central Health.
[1:48:55] It will be unique.
[1:48:56] Good afternoon, commissioners.
[1:48:58] Judge Brown, Commissioner Travillian, Commissioner Shay, Commissioner Howard, Commissioner
[1:49:01] Modales.
[1:49:02] Thank you for the opportunity to be here today, especially thank you to Commissioner Modales
[1:49:06] in Pilar Sanchez for your support and partnership leading the lead testing event we had earlier
[1:49:12] in July.
[1:49:13] As Dr. Lee has mentioned to the 2026 has been our year of access for patients regardless
[1:49:19] of their ability to pay.
[1:49:21] Community care continues to conduct more visits year after year, expanding access to
[1:49:26] high-quality high-value care.
[1:49:29] We are the largest provider of primary care for the un- and undone-sured in Travis County.
[1:49:34] We expect to serve 150,000 unique patients this year.
[1:49:39] 54% of whom are uninsured versus the national average of 17%.
[1:49:46] Among those who report income, 98% were below 200% of the federal poverty line,
[1:49:53] which is about $66,000 a year for a family of four.
[1:49:56] We serve patients regardless of whether they have coverage ensuring they have access
[1:50:00] to preventative and specialty care without this access to community care, those patients
[1:50:05] would end up in the emergency room or the hospital later and sicker.
[1:50:11] We set out to improve access this year and we delivered measurable progress without giving
[1:50:16] up quality or volume.
[1:50:19] Through June, we cut new patient wait times by nearly 37% across all primary care and our
[1:50:30] 50%, and we're now under 14 days for new patient appointments and hospital visits, hospital
[1:50:35] follow-up visits.
[1:50:37] And despite financial headwinds, we've seen record-breaking numbers of patients, encounters
[1:50:42] are up 6% through June, that's an additional 22,000 visit encounters for our community
[1:50:48] this year.
[1:50:49] And we did it without giving up on quality, federal health resources and services and
[1:50:55] branch community care among the top 20% of health centers for quality control. Among, within
[1:51:02] that, we are actually among the highest rates of diabetes control, breast and cervical
[1:51:06] cancer screening, immunizations, cardiovascular disease prevention and HIV screening. This
[1:51:12] year also recognized as for high value care and exceptional, that is a unique measure
[1:51:19] that recognizes exceptional quality matched with cost control, a recognition given to only
[1:51:24] 15% of health centers in this country.
[1:51:27] Our fiscal year 2027 priorities strengthen this foundation
[1:51:31] of an integrated public health care system.
[1:51:34] You see, there was priorities listed below
[1:51:36] further decreasing wait times for new patients,
[1:51:39] recruiting and retaining providers in a highly competitive
[1:51:42] national, national environment, continuing to improve
[1:51:46] on quality and mitigating the burden
[1:51:48] on taxpayers created by policy changes.
[1:51:51] This last one matters,
[1:51:53] because we face real financial headwinds.
[1:51:56] Changes to 340B, policy and activity
[1:51:58] have substantially reduced pharmacy revenue.
[1:52:02] Our annual Medicaid reimbursement gap has grown
[1:52:04] from $10 million in fiscal year 2024
[1:52:08] to a projected $24 million in fiscal year 2027.
[1:52:14] I build a strong ambulatory system,
[1:52:16] community care and central health
[1:52:18] are minimizing avoidable disease
[1:52:20] and suffering for our patients.
[1:52:21] We are also reducing what the system pays for avoidable emergency care and leaving hospital capacity across the community.
[1:52:30] Those patients who need it most. Thank you very much for your time.
[1:52:33] Thank you.
[1:52:36] You've also expanded health coverage for residents across the county.
[1:52:40] And to share more about that, progress on the highlights from Cinderella.
[1:52:43] I'm delighted to turn over Dr. Lisa Doggett, Chief Medical Officer.
[1:52:46] It's in there health plans.
[1:52:48] Thank you, Dr. Lee.
[1:52:49] So this is my first time presenting before you.
[1:52:52] I am still pretty new as Chief Medical Officer at Cinderella,
[1:52:55] but I'm really excited to be here.
[1:52:57] 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.
[1:53:05] So, at Central Health and Cendero, providing coverage for healthcare as a top priority.
[1:53:10] Having health coverage is linked to better outcomes and improved quality of life.
[1:53:14] That is the reason I took this job.
[1:53:16] I feel so passionately about coverage and my values align with Central Health.
[1:53:22] Across the central health system, we continue to see strong growth
[1:53:25] and the number of Travis County residents receiving health coverage through both Cindero Health
[1:53:29] Plans and through central health medical access program and map basic.
[1:53:35] As illustrated on the slide before you, through the beginning of July and more than 56,000
[1:53:39] uninsured Travis County residents had received coverage through map during the fiscal year 2026
[1:53:45] and nearly 90,000 received coverage through map basic.
[1:53:50] That represents substantial growth over the past several years
[1:53:53] And more importantly, thousands more Travis County residents have access to their prescriptions,
[1:53:58] to their doctor, to addressing a health concern before it becomes a crisis.
[1:54:05] We've also seen significant growth at Sendero this year,
[1:54:08] but as you know, the health insurance landscape is changing and is unpredictable.
[1:54:14] Enrollment is affected by many factors beyond local control, including federal policy changes.
[1:54:19] So when the enhanced tax credits under the Affordable Care Act were not extended,
[1:54:25] Cendero did see a modest decline in enrollment, consistent with broader national trends.
[1:54:30] We're also seeing some adverse selection, meaning that people who are healthier may decide to go
[1:54:36] without coverage, whereas those who have more complex health needs are retaining coverage,
[1:54:41] and that balance has changed within our patient population.
[1:54:47] Regardless of the changes our commitment remains the same, though, helping people in our community
[1:54:51] find coverage they can afford, and ensuring that cost is not a reason that someone
[1:54:56] delays care or goes without it.
[1:54:59] Next slide.
[1:55:02] One of the benefits of having a health plan like Cinderow within the Central Health Enterprise
[1:55:07] is that we bring new resources and innovation, and I wanted to just share one of the initiatives
[1:55:12] that we've worked on this year to address ER visits, particularly avoidable ER visits
[1:55:17] that could have concerns that could be addressed in a better setting.
[1:55:21] So in 2025, there were 650 ER visits that were deemed avoidable by 533 Cendero members.
[1:55:28] These are for conditions like an upper respiratory infection or a minor injury.
[1:55:34] To reduce those numbers, we've created materials to send to our members that focus on how
[1:55:38] to seek care in the best setting.
[1:55:41] So it talks about when to go to the emergency room versus primary care versus urgent
[1:55:46] care versus Norman MD.
[1:55:48] If you're not familiar with Norman MD, it is a program through Austin Regional Clinic,
[1:55:53] where they have access to care 24-7 with a physician or other health care provider.
[1:55:59] It's free of charge to sendero members and offers a great way to access care.
[1:56:04] And often can offset a need for an emergency room visit.
[1:56:08] So we've created magnets that have the Norman MD phone number and we've included those magnets
[1:56:13] with the letter about best places to seek care that we're sending to our members who have
[1:56:17] unavoidable ER visit. We're then tracking our ER visits and Norman MD usage to assess our impact.
[1:56:25] We have several other initiatives underway that include an effort to reduce 30-day
[1:56:29] readmissions for people that are just getting out of the hospital. We have a thrive program to focus on
[1:56:35] mental health access. I'm glad to hear that that's continuing to be a big priority for you. It certainly
[1:56:39] for us and we also are working on increasing prenatal care and postpartum care as well as improving
[1:56:47] our transportation options. So that's it for me back to you, Dr. Lee.
[1:56:51] All right, thank you, Dr. Dougett. That's a quick look back at FY26.
[1:56:55] Now let's look forward at FY27. In the coming year, our focus will be on translating our FY27 budget
[1:57:03] investment into measurable improvements for Travis County residents. More people connected to
[1:57:09] care and coverage shorter wait times fewer gaps in critical services and a public health
[1:57:14] system that uses taxpayer dollars as effectively as possible. So these on the screen here
[1:57:20] are our top board-directed goals for fiscal year 27. How do a few of them? First and foremost,
[1:57:28] we will remain laser-focused on the goal of reducing appointment wait times to two weeks or less
[1:57:34] across our system.
[1:57:35] People can access care sooner, getting into care early,
[1:57:39] help prevent more expensive, and perhaps more advanced disease
[1:57:43] later in the ER as Dr. Goethe covered.
[1:57:47] Second, we want to continue to expand access to care and coverage.
[1:57:51] And this is in a year where there are substantial headwins
[1:57:54] that Dr. Dogged mentioned.
[1:57:56] Both on the ACA marketplace side, on the Medicaid side,
[1:58:00] and with increasing work requirements
[1:58:02] coming during this next year, we anticipate downward pressure on both those sorts of coverage.
[1:58:09] And we'll have to lean in to the medical access program as we've been doing this year to ensure
[1:58:14] that the overall number of residents engaged in health care and coverage increases if we're successful
[1:58:20] by 5%. That's about 10,000 more people in Travis County having access to care and coverage
[1:58:27] despite those headwinds.
[1:58:30] Third, we will improve our care and cancer in heart disease.
[1:58:34] These are the top causes of death in our community.
[1:58:37] In particular, timely diagnosis, treatment and follow-up
[1:58:40] can have a big impact on health outcomes in these areas.
[1:58:45] Fourth, we are going to extend our goal from F-20 second
[1:58:48] around increasing non-tax revenue from 2% to 5%
[1:58:53] toward the long range goal to reduce long-term burden
[1:58:57] on local taxpayers.
[1:58:59] Fifth, we will continue integrating our central health,
[1:59:02] community care and cinderous system.
[1:59:04] For patients, that means a more seamless path
[1:59:07] from coverage to primary care,
[1:59:09] especially care and back again.
[1:59:11] For taxpayers, it means we're using our resources more effectively
[1:59:14] and getting as much value as possible
[1:59:17] from every dollar invested across the system.
[1:59:20] And finally, in FY27, we will continue to advance and open
[1:59:23] several major new areas of care across our community, including fully opening our handcock
[1:59:31] multi-specialty site care clinic, which will be the largest multi-specialty site in the system
[1:59:37] at 90,000 square feet of clinical care, and the side of our future joint system headquarters.
[1:59:43] We should open the colony park, health and wellness center, in the summer of next year bringing
[1:59:48] primary care, specialty care, dental care, pharmacy services, and even the first public
[1:59:53] library to the area. And we will make substantial progress on Cameron Road, which is a new
[2:00:00] Sildee, that will build on the lessons we have learned in the medical rest of the program at the Clinical Education Center
[2:00:06] and expand access to that vital service line. Together, these facilities and more are creating the care infrastructure,
[2:00:15] the footprint of care that our community simply has not had particularly for the poor and vulnerable members of our community.
[2:00:23] bringing care closer to what we will live, bringing capacity for the right care and the right place at the right time.
[2:00:32] Now, before I turn things over to Jeff to dive in the budget details, we want to provide a brief snapshot
[2:00:37] of some of the care across the central system today.
[2:00:40] I won't duplicate what Dr. Ygot has said.
[2:00:43] But I do want to just double down next slide, please.
[2:00:46] And describe the importance of the prevention focus primary care system.
[2:00:51] next slide, please.
[2:00:55] This is a version of the Delta report from
[2:00:57] Shrivelian to show the year over year growth in primary care visits.
[2:01:02] You can see here 2018 through 2025. During that eight year period, we have grown by 88%
[2:01:10] reaching 670,000 visits in 2025. This year's numbers are still to be counted and increasing
[2:01:16] even further in 2027.
[2:01:20] This is a time when community health centers across the country are facing structural pressures
[2:01:26] from declining Medicaid, revenue declining 340B revenue.
[2:01:30] There are many, many health centers that have had to close services, lay off staff where
[2:01:36] even close their doors because of the support of the court and the people of Travis County.
[2:01:40] We are expanding services in the midst of those headwins.
[2:01:45] Next slide please, while primary care is the backbone of our system, special to care is an area
[2:01:51] of great need where we heard from our community several years ago that they wanted us to directly
[2:01:56] provide special care services, wait times, for gas and arology, for example, we're far too
[2:02:01] long, 12 to 18 months to get a colonoscopy to check if you have colon cancer, it simply wasn't
[2:02:08] happening. Over the past several years, we have gone from no direct care services to more than
[2:02:15] 30, especially care service lines available to our patients. In FY26, we will likely
[2:02:20] eclipse 40,000 direct, especially care appointments. And going back to that gastroenterology
[2:02:27] I service line, we learned that when we first made the care access, the lines increased actually
[2:02:33] because many folks realize I can get care.
[2:02:35] We continue to hire and expand and I'm delighted to share
[2:02:39] that from a wait list of well over a thousand patients,
[2:02:42] we are now well under a hundred
[2:02:44] and you can get the colon cancer detection services that you need.
[2:02:48] I've no doubt that we will be finding and
[2:02:50] care and colon cancer in a much higher rate
[2:02:52] in our population as a result.
[2:02:56] Next slide, please.
[2:02:57] And as we look at how access to specialty care,
[2:03:00] and actually, I believe this is where we go to a handout
[2:03:02] that you have. The handout that shows the five-year trend in mental health. I believe
[2:03:10] a commissioner should help that up a moment ago. So I want to give a highlight on mental
[2:03:15] health as the court is well aware for too many of our most vulnerable patients. The gap
[2:03:21] in critical mental health services remains and it means that patients cycle between the
[2:03:26] Department, the hospital, the jail, homelessness, and back again, receiving some of the most expensive
[2:03:33] services in our community without necessarily receiving the court into care they need to be stable
[2:03:39] and healthy. And we see that every day. Roughly 70% of our medical respite patients are experiencing
[2:03:46] serious mental health challenges. And we see the same generations of complex mental health needs
[2:03:52] among patients in our bridge,
[2:03:54] which are such as the care services,
[2:03:56] and our jail, telehealth services,
[2:03:58] according to the Meadows Institute report,
[2:04:01] a relatively small number of high-justice utilizing patients,
[2:04:05] roughly 950 people, cost our community
[2:04:09] about $137 million per year.
[2:04:13] We know that part of that problem is ours to solve.
[2:04:17] And that is why we have dramatically increased
[2:04:20] Central Health Investment and Behavioral Health over the past three years.
[2:04:25] By the approach of joining Central Health three years ago.
[2:04:28] And since that time, we have substantially increased our investment
[2:04:30] behavioral health from about $12 million to a proposed $49 million
[2:04:36] in this next fiscal year, as you see on the handout.
[2:04:40] In front of you, this includes investments with key partners like
[2:04:44] care, and the Silvering Center, as well as investments in our own direct behavior health services,
[2:04:50] including jail health, addiction medicine, and other critical services.
[2:04:56] There's also been significant discussion this year about a future mental health crisis
[2:04:59] center.
[2:05:00] That work remains in development, but I want to emphasize that we are not waiting for a future
[2:05:05] facility to begin building the system of care our community needs.
[2:05:10] Our FY27 budget already includes over $14 million for key components of that broader mental health
[2:05:18] crisis response, including investments in patients like the Atrick Care, Psychiatric
[2:05:23] Emergency Care, and other services that Jeff Knotall will detail in a moment.
[2:05:28] And finally, I want to sincerely thank this court for your leadership.
[2:05:31] We would not be in a position to make these investments with that your support and the support
[2:05:36] the people Travis County. We are proud of the progress we've made and we know this much more
[2:05:40] like a head. And so with that I will turn things over to Jeff to walk us through these investments
[2:05:45] in the broader proposed FY27 budget. Thank you Pat. So I'm going to talk here this slide and there
[2:05:53] is a lot of detail on it that I'm not going to go into. These are budget or contractual or
[2:06:02] amounts that were in contractual negotiations with a number of providers, but I want to give
[2:06:08] you a little sense of what our budget looks like. So generally speaking, as Pat mentioned,
[2:06:16] we have a budget of about $49.49.2 million. There's two areas of it. The direct health care
[2:06:25] services, we've listed out three of our service lines that we're including, including
[2:06:32] direct behavioral health psychiatry and direct addiction care that pulls out to about
[2:06:38] six and a half million dollars.
[2:06:41] Then in addition on our network and behavioral health contracts, the total of that amount
[2:06:49] is about $42.6 million. A large part of that is integral care. It's in fiscal year 2027.
[2:07:00] It's 31.3 million dollars. And on the narrative there on the left where it just says FY27,
[2:07:13] in integral care highlights. Again, just some of the major areas related around that contract
[2:07:21] is 11.1 million dollars related around the crisis care. 3.1, related around what's called
[2:07:29] PES or the...
[2:07:30] The psychiatric emergency services. 14.3 million dollars related around outpatient, clinical
[2:07:38] base services, including psychiatry counseling and case management, and then a million dollars
[2:07:44] related around permanent supportive housing, mental health services. One of the questions
[2:07:51] that is not, or one of the answers that is not on here, my apologies, but was related
[2:07:59] around over the past five years, four or five years, what has been the investment in
[2:08:05] integral character, I'm just going to quickly run through some numbers.
[2:08:12] I think the key is, you know, if you looked at the average increase, it's averaging about
[2:08:18] an increase of about $7 million a year.
[2:08:21] So beginning in fiscal year 20, 23, our budget was $9.1 million.
[2:08:27] 20 in fiscal year 2024, 16.2 million, 2025 is 21.7, 2026, 30.9, and then again in fiscal year
[2:08:41] 27, 31.3 million dollars, this has been a significant investment. That central house
[2:08:48] making in behavioral health and it's been a very rapid increase of mental health investment
[2:08:57] in our community.
[2:09:00] I'm going to keep going through slides here related around the strategic
[2:09:08] budget initiatives.
[2:09:12] So I could interrupt a minute to just point out, remind my colleagues on those interval
[2:09:17] care highlights on that page. We're all looking at the 3.1 million to the psychiatric emergency
[2:09:23] services. That's complementing the investment in our preliminary budget for the crisis care
[2:09:32] pilot, the diversion pilot, where we're picking up the ongoing expense at the TDP, the therapeutic
[2:09:41] diversion program on 15th Street and Central Health is picking up the added expense there
[2:09:49] at PES. And so together those make up the pilot that we've been we've funded with
[2:09:56] ARPA dollars in the beginning and with Central Health and now we're continuing it since the
[2:10:02] ARPA money is gone. So there's there's an addition to the six million or so that we put into
[2:10:08] these other pilots.
[2:10:09] Right.
[2:10:13] Thank you.
[2:10:13] Okay.
[2:10:14] Thank you.
[2:10:15] And a permanent support of housing mental health services.
[2:10:17] That's what we referred to when we talked about that matmalica from ECHO, talked
[2:10:22] about the health care collaborative, where they're going to have a mobile outreach, mobile
[2:10:27] doctors going to all the different apartment complexes that we built with the ship money.
[2:10:33] That funding is in addition then to the PSH services that make up your three-legged school.
[2:10:40] And now those included in here, there's a million dollars the last item.
[2:10:49] Thank you.
[2:10:50] Thank you.
[2:10:52] So, focusing on our strategic 2020-27 budget initiatives, our budget is focused on continued
[2:11:03] implementation of our board approved health equity plan and system goals.
[2:11:08] is Dr. Lee mentioned earlier, and will result in more access to care, more providers, and
[2:11:14] care teams, shorter wait times, new services, and facilities, and stronger support for patients
[2:11:20] with most complex needs.
[2:11:23] You'll see a couple of upcoming slides that there are three budget scenarios that we prepared
[2:11:30] For today, 8% over the non-New Revenue rate, a 6% rate over the non-New Revenue rate,
[2:11:39] and then the non-New Revenue rate, which is a Travis County Commissioner's Court
[2:11:44] Financial Order mandates that we bring that.
[2:11:48] Our $20-27 budget includes $27.3 million in strategic investments to continue the implementation
[2:11:58] of that plan, a holiday to a few key investments we did provide, it seems like a long
[2:12:05] time ago but probably three weeks ago a fairly detailed budget memo that has a lot
[2:12:10] of detail in it, but I'll highlight a few of those first related to the creating seamless
[2:12:20] care journeys that $18 million that includes specialties like general surgery, podiatry, cardiology,
[2:12:28] the mental health substance use services and care navigation.
[2:12:33] This includes new providers and expanded clinical teams to improve access and reduce
[2:12:39] weight times.
[2:12:40] In addition to staff assisting patients, navigate the healthcare system and stay connected
[2:12:47] to care.
[2:12:49] It also includes patients with complex medical needs, cancer patients, persons leaving the
[2:12:55] emergency departments, patients in skilled nursing facilities, and people who need help securing
[2:13:02] housing.
[2:13:05] As was mentioned earlier, our Hancock facilities opening in early 2027, these initiatives
[2:13:15] support patients that are services related around convenient location and investment to support
[2:13:23] operations, especially services at that facility. We're also strengthening care coordination,
[2:13:31] navigation, and eligibility support. The health patients move seamlessly across care
[2:13:37] settings, including inpatient oncology, skilled nursing facilities, host emergency department,
[2:13:45] discharge, permanent supportive housing, placement support, and field-based eligibility
[2:13:51] support at shelters. We're also expanding our medical
[2:13:56] respite program at the old children's hospital from 30
[2:14:01] beds to 50 beds, which would be more or less at full capacity.
[2:14:08] In addition, adding complex primary care providers for
[2:14:12] justice involved health, central health will provide a
[2:14:16] complex primary care provider at the Travis County
[2:14:21] Also working to stand up a re-entry program for patients
[2:14:25] exing the justice involved system.
[2:14:28] Today, in FY26, central health has provided approximately 250
[2:14:34] specialty care visits.
[2:14:36] Our specialty care practices open to see inmates.
[2:14:43] Our staff works with the sheriff's office to schedule those.
[2:14:46] It's been a very collaborative process.
[2:14:50] In addition, staff and equipment establish a new rapid access clinic supporting emergency department diversion and providing.
[2:15:00] I'm Lee Access and Connection to ongoing care from patients living in the hospital. The breakdown
[2:15:07] of the $18 million, $5.6 million is expanding directly. Our direct, especially practice,
[2:15:16] including General Surgery, Pediatry, Nefrology, Cardiology, Registered Dietitians, Occupational Therapy,
[2:15:25] and physical therapy teams.
[2:15:28] In addition, $3.1 million of our budget
[2:15:31] strictness, care coordination, and navigation
[2:15:33] centers, including inpatient oncology,
[2:15:38] complex case management, permanent support of housing,
[2:15:42] and, again, post-emergency department
[2:15:44] discharge, skilled nursing facilities,
[2:15:47] and, again, housing placement.
[2:15:49] $2.3 million supports are hand-cock operations,
[2:15:53] staff with staffing to support that facility, clinical administration, pharmacy, what's called
[2:16:02] PAP patient assistance program, which is a program that central health applies for low-cost
[2:16:13] medications through the pharmaceutical entities.
[2:16:18] In additional contracted certified medical interpretation,
[2:16:24] 1.6 million dollars expanding mental health and substance abuse services,
[2:16:29] including addiction medicine, substance abuse,
[2:16:33] counseling, a program manager and integrated social workers.
[2:16:38] $1.4 million around new specialty service lines, including neurology, oral surgery, and a clinical
[2:16:47] float coverage, which is a team that floats, there are some shortages in areas so that
[2:16:53] we can provide more constant and consistent coverage.
[2:16:57] Can I just interrupt real quick?
[2:16:58] Is there a page that you're referencing?
[2:17:00] I'm trying to figure out where these are.
[2:17:01] 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
[2:17:11] No, no, I just wondered what you were referencing because some of the numbers seemed larger than the numbers that were in the
[2:17:17] Yeah, I'm referencing the column on the left
[2:17:20] 18 18
[2:17:21] Okay, so breakdown of the 18
[2:17:22] Yes, ma'am. I'm a commissioner. We would be happy to share that detail with you view would like it in writing
[2:17:29] I think that's a pleasure, doesn't sure.
[2:17:31] I'll tell your reference.
[2:17:32] Thank you.
[2:17:33] And I promise I'm talking as fast as I can.
[2:17:36] Thank you for your patience.
[2:17:39] $1.2 million to expand the justice involved in unhouse patients.
[2:17:45] The justice involved health program will pursue three core aims
[2:17:50] of developing comprehensive reentry,
[2:17:53] care model, establishing a clinic infrastructure tailored to justice, involve patients in enhancing
[2:18:01] medical services within the gel study.
[2:18:04] Care team will consist of a team delivering complex care of four members of that team.
[2:18:13] $1.1 million to launch the rapid access clinic and $400,000 to expand field-based eligibility
[2:18:22] support at shelters, including enrollment in SSDI or disability insurance. Beyond
[2:18:32] direct patient care, the budget includes $2.6 million of workforce investment to
[2:18:38] help us with. And train the teams and providers needed to deliver these services.
[2:18:44] These funds will strengthen clinical education, emerging leadership development, and
[2:18:50] systems to improve workforce and operational efficiency.
[2:18:54] It also includes a $1.3 million investment and community support, including the start-up
[2:19:02] of the recently board approved central health foundation of approximately $913,000 and additional
[2:19:11] resources to strengthen revenue, cycle, reimbursement, and compliance functions.
[2:19:16] And then lastly, on the right-hand side, a 5.4 million dollar system investment that
[2:19:23] strengthens our infrastructure behind patient care, including new technology data systems
[2:19:29] and expanded facility, and supply chain needed at our Hancock facility, and we'll be
[2:19:37] needed for biomed functions across the system.
[2:19:40] A significant portion of the 5.4 million dollar investment is the hardened and strengthened
[2:19:46] our cybersecurity data system environment.
[2:19:50] Next slide, please.
[2:20:00] Over the past year, we've made significant progress, building a more integrated central health
[2:20:05] system across central health community care in Zendaro.
[2:20:09] That's included bringing key function and teams together across the system.
[2:20:13] for example, unifying leadership for health care for the homeless, integrating our data system
[2:20:19] teams, so we can better track care and outcomes across the system, and aligning pharmacy
[2:20:26] uh, eligibility screening supply chain and facility operations. Each of these changes is helping
[2:20:32] us operate more as one coordinated system, reducing duplication, making it easier for patients
[2:20:38] to move between services and using tax resources more efficiently.
[2:20:45] Over fiscal year 2020, our 2020 7 budget builds on that progress, we've worked to line
[2:20:52] overlapping investments across the system to ensure our patients can maintain health coverage
[2:20:57] and expanded access to primary care.
[2:21:01] For community care, that means a continued investment in expanding primary care capacity
[2:21:06] and other critical services, including dental care, and women's health, while also planning
[2:21:13] for in-house laboratory services that can better support patient care across the system,
[2:21:20] and deliver these services more effectively and efficiently, rather than third-party
[2:21:25] labral lines.
[2:21:29] For Sanderer, the focus is on maintaining the financial strength required of a community-based
[2:21:34] 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.
[2:21:58] The budget also reflects updated projections for affordable care, at premium assistance, allowing
[2:22:07] some therapists to slightly increase its current programs and membership levels despite changes
[2:22:13] in the broader coverage environment.
[2:22:15] In those coverage programs include ham, which has been a long-term partner, Austin, the
[2:22:23] Austin Restaurant Association, Good Works Austin, in addition to our high risk chat.
[2:22:30] At what we call a chop program related around enrolling mat patients that have more, more big conditions.
[2:22:44] Together these investments all contribute to our work building one integrated system of care that can expand access while operating more efficiently.
[2:22:54] Next slide.
[2:22:59] So this slide provides a high level comparison of our fiscal year 26 budget with a three
[2:23:04] proposal, fiscal year 27 scenarios.
[2:23:09] Importantly showing what each scenario means for health care services in our community.
[2:23:13] Under the eight and six percent scenarios, health care delivery, representatives of the largest
[2:23:17] area of investment growth, increasing by approximately $79 million over fiscal year 26.
[2:23:25] These dollars primarily support services from map members who are 200% below the
[2:23:33] at 200% and below the federal poverty level, as well as patients covered by affordable
[2:23:40] care act plans and Medicaid.
[2:23:43] The known new revenue scenario looks substantially different because it requires reductions
[2:23:47] and plant services and investments. First, approximately $12 million in strategic investments
[2:23:55] would not move forward. That would mean scaling back or eliminating planning expansion in
[2:24:00] areas such as patient navigation and care coordination, mental health, substance use,
[2:24:07] and addiction care, plant care services for the unhousing inmates at the Travis County gel,
[2:24:12] the new rapid access clinic for patients who need follow-up after discharge and expanded
[2:24:19] neurology and oral surgery, surgery, and surgery services.
[2:24:24] In addition to approximately $23 million in plan healthcare operations would need to be
[2:24:29] reduced under the no-new revenue, right?
[2:24:34] That could include funding reductions to community care and other FQHC partners, as well
[2:24:40] especially mental health and residential addiction, treatment services,
[2:24:44] inpatient rehab services, skilled nursing facility expansion,
[2:24:49] respite beds, a tomatry and dental services.
[2:24:54] The known revenue scenario would also include a $4.4 million amount
[2:25:00] in reductions for ongoing employee salary increases for all employees
[2:25:06] including providers.
[2:25:09] But simply the 8% and 6% scenarios preserve and expand the plan patient care while the
[2:25:16] no new revenue would require reductions across direct services, community partnerships and
[2:25:22] workforce investments.
[2:25:25] On the revenue side growth across all three scenarios is driven primarily by property
[2:25:30] In fact, revenue, along with more modest increases from tobacco settlement funds and patient
[2:25:36] service revenue, we expect patient service revenue to grow as Central Health has begun
[2:25:43] offering services to Sendero members.
[2:25:46] In addition, Central Health was recently approved for Medicaid, creating an additional
[2:25:51] revenue stream in FY2027.
[2:25:55] And then finally, all three scenarios did include the $30 million capital investment in
[2:26:00] and Darrow that we discussed, and then there's also a $91 million other funding sources that
[2:26:09] is the reimbursement from debt that we issued to reimburse us related around the cash funded
[2:26:15] capital projects.
[2:26:17] Next slide.
[2:26:23] So now we're getting into a subset or attachment B. It's a more detail related to our services.
[2:26:33] This slide looks more closely at investments in health services for patients provided directly
[2:26:40] by central health and community to care, along with other partners in our network.
[2:26:48] Patient services would continue to expand, including increased support for services in our network.
[2:26:54] community care is increasing from $98.6 million in FY26 to $117.5 million.
[2:27:06] Other FQHCs offering primary care, totaling in totaling approximately $21.5 million.
[2:27:16] And then we talked a lot about integral care and then also just adding the investment in
[2:27:23] delivering center, which is 600,000 to support their first floor operations and second floor
[2:27:30] operations, which provide a safe short term environment for individuals to remain as they
[2:27:36] are making decisions about whether or not to receive treatment.
[2:27:42] Much of the projected growth in direct health services for 2027 support, especially care and
[2:27:49] coordination. Again, including our Hancock campus, our clinical,
[2:27:55] respite, 20 new beds, and then expansion to addiction care teams.
[2:28:03] All of these investments are intended to reduce
[2:28:05] appointment, wait times, improve coordination, and help patients
[2:28:09] receive care earlier before four needs become more serious
[2:28:13] and costly. Next slide, please.
[2:28:20] So, this is a deeper look at four years worth of our direct clinical specialty practice.
[2:28:29] It's grown over four years from roughly $30 million to nearly $100 million proposed in FY27.
[2:28:38] Historically, specialty care has been one of the biggest gaps in our system with patients often waiting too long
[2:28:45] or struggling to find providers who could see them.
[2:28:48] So, over the past year, central health is increasingly built, our own clinical practice
[2:28:55] to meet these needs directly, at any more than a dozen specialty areas, including all
[2:29:00] the services you see listed on the slide.
[2:29:03] As part of the strategy each year, we have added, but capacity and new capabilities as we
[2:29:09] fill the gaps related around the continuum of care.
[2:29:16] One major area focuses care for patients following discharge from the hospital and as a result
[2:29:23] we're expanding our transitions of care teams.
[2:29:27] These teams connect with patients while they are still in the hospital and make sure
[2:29:31] they have a clear path back into the appropriate care even after they leave helping them to
[2:29:36] have better recovery outcomes.
[2:29:39] We're also adding more complex case management in our transition care program also for patients
[2:29:45] with significant medical and social needs so that the highest risk patients have coordinated
[2:29:51] support and don't have to navigate the system on their own. We also are continued in
[2:29:57] the best in areas like psychiatry and addiction.
[2:30:00] Care, further strengthening our ability to address behavioral and physical health needs.
[2:30:08] Next law.
[2:30:11] And so this is the second half of attachment B. Again, moving on from direct health services.
[2:30:21] This slide highlights our plan, investments, and operation support, and administration need to support our growing health system.
[2:30:28] The largest increases in this portion of attachment being includes the $30 million capital investment in
[2:30:38] 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
[2:30:55] facilities, long-term facilities that will result in long-term savings from ownership, and mitigate unpredictable cost and least-term renewals associated from leasing.
[2:31:10] We are also investing $5.2 million in information technology, cyber security, data infrastructure,
[2:31:17] or cleaning work to responsibly standardize and implement artificial intelligence tools that
[2:31:25] can improve efficiency and support better decision-making.
[2:31:29] The majority of the investment is for enhanced cybersecurity system systems and applications
[2:31:36] to protect our patient health records and reduce the risk of service or billing disruptions.
[2:31:43] 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.
[2:32:03] Next slide, please.
[2:32:10] So, we've shown this every other past few years.
[2:32:15] This is our days of reserve slide, three tax scenarios that we're proposing on the slide.
[2:32:25] And just as a reminder, and I alluded to the health equity plan that the board adopted,
[2:32:31] it's a seven-year plan, it was adopted in August of 2023.
[2:32:36] 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.
[2:32:50] 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.
[2:32:59] And again, our targeted days of reserve that we target over our forecast period is a band between
[2:33:09] 120 and 150 days.
[2:33:14] The eight percent scenario in that forecast period ends at 146 days, which is on the upper portion
[2:33:23] of the band. The 6% is at 122 days and the no-new revenue rate scenario is at 89 days.
[2:33:36] I need to pause for a second and just mention so we have different scenarios in FY 2027 for
[2:33:45] subsequent years, fiscal year 28 through fiscal year 31, all the scenarios are at 8%.
[2:33:54] So I just want to mention that.
[2:33:59] Central Health is the backbone of financial support for community care in Cendero.
[2:34:04] And our reserves provide protection against risk and uncertainty.
[2:34:09] Community care typically carries 30 to 45 days of cash on hand.
[2:34:15] Incendero may need further future capital funding and additional financing levels to maintain
[2:34:20] adequate cash levels for claim payments.
[2:34:24] We have seen some of these events already unfold and Dr. Yugoda beat me to the punch and
[2:34:32] so that the erosion of the 340B program that allows FQHC's to purchase drugs at significantly
[2:34:39] discounted prices or the diminishing Medicaid enrollment across the state that puts pressure
[2:34:45] on federally qualified health centers to provide care under a sliding scale payment model
[2:34:52] rather than a much higher Medicaid with called a PPS rate amount or maintaining adequate
[2:34:59] capital for the ACA was stricter enrollment and reduced subsidies. Reserves are also
[2:35:06] Circle in the fast-moving and volatile federal and state regulatory environment that can have significant impacts to long-term health care financing.
[2:35:18] Staff recommends maintaining a hundred and between 120 and 150 days on hand to support central health long-term fiscal health.
[2:35:35] So our tax payer impact shows the impact of each scenario for the median value and I'm going to go over this quickly.
[2:35:46] 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.
[2:35:57] the associated M&O and debt service rate. Under the no-new revenue rate, the median home value
[2:36:07] would increase by $10 from 20 to 26. At 6%, it would be $36 and at 8%, it would be $44.
[2:36:23] Over time, the debt service portion of the tax rate has increased, as I mentioned,
[2:36:29] did it that that issuance just want to point that out as you see that increase from 2026 to 2027.
[2:36:37] And just as a reminder, and then I'll turn it back over, we did send a budget memo with
[2:36:44] a lot of detail, there was a lot of tax information on it.
[2:36:48] We did get updated numbers from the Praisal District.
[2:36:53] These are the numbers, so I just didn't want there to be confusion if someone's referencing
[2:36:58] the budget memo and they see different rights or different amounts. So thank you for your
[2:37:06] all of patience on that and I'll turn it back over to Dr. Lee.
[2:37:10] All right, so thank you Jeff. I could take us home. The bottom line is that this preliminary
[2:37:16] budget is designed to execute the strategic direction of our boards that there are seven year
[2:37:21] strategic health care equity plan. Building a stronger, more accessible and more integrated
[2:37:27] health care system for Travis County.
[2:37:30] 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,
[2:37:42] 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.
[2:37:52] At a time when changes in the broader healthcare environment are creating additional pressures across the county,
[2:37:56] We are continuing to lean in to caring for our most vulnerable patients in building that
[2:38:02] core infrastructure in partnership with the county and the city and local care and others.
[2:38:07] We will also keep integrating central health, community care and syndrome more effectively.
[2:38:12] They can care and coverage easier for our patients, creating greater efficiencies and positioning
[2:38:17] the central health system for long-term cost savings.
[2:38:21] Importantly, this 8% proposed budget preserves the financial capacity and flexibility.
[2:38:28] We believe we will need in the years ahead, particularly as we navigate rising costs, growing
[2:38:34] demand, mental health needs, and the real risk of policy changes outside of our control.
[2:38:42] But the median Travis County Homestead, the recommended scenario, presents an increase
[2:38:46] approximately $44 per year or a little less than $4 per month. We believe that investment
[2:38:52] allows us to make meaningful progress today while maintaining strong reserves, preparing for emerging
[2:38:57] community needs, and protecting the long-term value of China's county dollars. Next slide, please.
[2:39:04] Next up in our budget process is August 26th when our board will vote on the proposed tax rate.
[2:39:09] The board will then, uh, it's scheduled to vote on the FY27 budget as September 9th,
[2:39:14] It will be bringing a final budget for the court's consideration around September 15th between now and then we will continue creating
[2:39:22] opportunities for public input, including a special budget-focused community conversation with Judge Brown on August 31st and a public hearing at our
[2:39:31] September 2nd Board meeting next slide please. And with that as always, it has been a pleasure to present to the court today.
[2:39:38] Thank you so much for your support and your leadership. We're happy to take any questions.
[2:39:43] I think it's again. Thanks.
[2:39:46] Thank you.
[2:39:47] Mr. Shea any thoughts or questions?
[2:39:49] I have a number of questions, but I'm happy to let my colleagues go first.
[2:39:55] Could you have any of the questions?
[2:39:56] I have a quick question that's on my mind.
[2:39:58] Are y'all able to consider a cost of living increase
[2:40:02] or adjustment for your staff?
[2:40:09] We typically do not, but we are considering a cost of living raise this year of two and a half percent.
[2:40:22] The county has been doing that since I've been here.
[2:40:26] So, whatever we can.
[2:40:28] We have just historically, we've done performance-based reviews with a maximum of a 3% amount.
[2:40:39] Okay.
[2:40:40] All right.
[2:40:41] Thank you.
[2:40:44] That 8% increased.
[2:40:45] Does that include the mental health crisis center?
[2:40:50] I know you said earlier, you're already starting the process of already taking action on a lot of that stuff.
[2:40:55] But there's that included if it's not, I'd like to see what that looks like.
[2:41:01] As we tried to break out, Commissioner Wallace.
[2:41:04] There's about 14 million, a little north of 14 million in the amount of health crisis services
[2:41:09] that you don't go care and silvering center.
[2:41:12] And others provide today that we believe would be core to the Envision amount of health crisis care center.
[2:41:18] If that were to come into being that that building would come online perhaps in four or more years.
[2:41:24] so it's not in the FSK-27 budget, but the crisis care services made of them are in the
[2:41:31] budget.
[2:41:32] And we would be more than happy to visit with you to break down with that multi-year investment
[2:41:38] of look like at your convenience.
[2:41:41] Thank you.
[2:41:44] Thank you all for the presentation.
[2:41:46] This is extremely helpful and thorough.
[2:41:49] 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.
[2:42:04] So that I don't know how easy it is to tease that out.
[2:42:07] But if I understood the description correct, is that part of why the risk-based capital for Cendero went from 8 million last year.
[2:42:19] 30 million this year because of anyone I want to see anything more about that. I'm trying to understand
[2:42:25] that. I'll start off. Yes, as Dr. Boggett alluded to, there was kind of a different mix
[2:42:33] of members across the, I guess, really across the country. But in Texas, you have a group that
[2:42:46] If it continued to purchase insurance, they needed insurance.
[2:42:51] Most of the healthy members don't like it, you know, when the enhanced tax credits
[2:42:58] left, they elected not to enroll in insurance.
[2:43:03] And so what that ended up doing from a kind of a risk pool standpoint, it's all about
[2:43:08] math, right.
[2:43:09] And so you just had a risk pool statewide that was a lot thicker than it had been before.
[2:43:16] And that kind of, that's the basis of how the risk adjustment payment is made, so you had this,
[2:43:22] it's based on statewide averages.
[2:43:25] Senderra has always enrolled a steady amount of chronically ill patients.
[2:43:33] And so the risk adjustment score didn't move a lot on Senderra, so it resulted in less of a risk adjustment payment.
[2:43:41] And anticipated, and then the second piece of it is just as, as those sicker patients are
[2:43:47] enrolling just the medical costs related to providing services to them is much greater.
[2:43:54] And the actual way is to say that caught out with all of these trends that are changing, but
[2:43:59] that's generally what I think Sundara is seeing is much, much more substantial cost per patient
[2:44:05] because the cohort of patients are a lot sick or that of a main intruder.
[2:44:12] And part of that is related to the either cuts or changes in the Affordable Care Act
[2:44:19] at the federal level and it's essentially causing the healthier patients who normally
[2:44:24] help balance out the finances and the insurance to leave not continue to pay insurance.
[2:44:32] 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.
[2:44:39] 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.
[2:44:50] So I don't know how we quantify that, but I just think that's an important thing for people to understand.
[2:44:55] It's that and just to mention the enrollment period.
[2:45:00] It's getting shorter and shorter every year, and that's another challenge of coming challenge that
[2:45:05] will have starting this year.
[2:45:07] And I presume some communities that don't have this kind of robust support for insurance
[2:45:15] for people are just simply seeing sicker people and they're ending up in the emergency room,
[2:45:21] right? Or dying.
[2:45:23] I just think we need to really need to make that clear because I don't think a lot of these
[2:45:28] impacts are less visible for the general public.
[2:45:33] So it wasn't immediately clear to me when I was looking at this, but I think it's an important
[2:45:38] story to tell because we are stepping up and providing medical care to people in a way
[2:45:46] that ultimately works better, because we're not waiting till their death store and coming
[2:45:51] to the emergency room, we're providing care for them earlier, which should be reducing
[2:45:58] over a medical course?
[2:46:01] In that also, sorry, if I could just add a little bit, and that also relates to community
[2:46:07] to care, some of the things we talked about, the 340B program, you know, some of the even
[2:46:13] some things that sound like they don't impact, like the most favored nation medicare and
[2:46:20] negotiations, those things like that impact the 340B program depending on the mix of pharmaceutical
[2:46:27] So there's not a lot of external factors, there's at some point a rebate program that will be
[2:46:35] instituted, which means you actually have to get through a validation program in order to
[2:46:41] get some of the rebates associated with the 340B program instead of kind of a seamless process.
[2:46:48] So there's a lot of real detailed things that happen in these programs that has a whole become meaningful.
[2:46:56] So the promise to reduce medical, pharmaceutical costs is not, we're not seeing it.
[2:47:01] To your point, Commissioner, there was a slider earlier in the presentation that shows
[2:47:05] the steady upward growth in primary care access and in people in coverage.
[2:47:11] But if we did not decisively intervene at the central health level what you would see, what
[2:47:17] you see across the country is rather than going up, those numbers are going down.
[2:47:21] So the difference between the national trends and what we're projecting, you know, of increasing by 5% in coverage and care,
[2:47:30] that's the difference that the public taxpayer funding is making.
[2:47:33] We know that if we allow people to not be covered and not in care, they don't disappear.
[2:47:39] We're going to see them on the streets and the arrest rate and the incarceration and in the ER and hospital.
[2:47:45] It's that Meadows Institute report, the 9 or 50 folks who cost the community 137 million a year.
[2:47:52] That's where we'll see them. Even though we are investing more, we believe in the end.
[2:47:58] The public is a lot more value for that investment and people stay healthier.
[2:48:03] And out of those crisis care settings.
[2:48:06] So that's the net at a high level that we are proposing in the 8% budget.
[2:48:11] And I think that's such a powerful story to tell.
[2:48:13] I realize these are complicated numbers and data.
[2:48:18] But what we've just discussed here, I think, helps convey that.
[2:48:22] And when you said the increase in coverage,
[2:48:25] you're talking about the map and map basic and the people
[2:48:27] that are covered, because starting in 24,
[2:48:30] it was a total of 116,700 and change.
[2:48:34] And now it's at 133,000.
[2:48:37] A lot of folks there who, if policy has had
[2:48:40] change, they might be in a marketplace plan or they might be unmedicated, but because those
[2:48:46] are harder to access, we are seeing them shift over substantially into map.
[2:48:53] Thank goodness we have map and we're willing to invest because we believe that that coverage
[2:48:58] dollar is much more value than waiting for someone to show up in crisis downstream.
[2:49:04] This is not really an assignment for you, but I think it is helpful for us to be able to understand
[2:49:11] how other communities are grappling with this.
[2:49:15] Who did the study on the 950 people costing 137 million was that?
[2:49:20] There is a Meadows Institute report.
[2:49:22] Those are the Austin numbers, but I believe there are statewide numbers, and we'd be happy
[2:49:29] to ensure you have a copy of that.
[2:49:30] 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
[2:50:00] restaurant workers. Do you know for also providing information to the restaurant workers, for instance,
[2:50:06] about the Raising Travis County, the healthcare, the child care initiative that Travis County is administering?
[2:50:15] Because I've run into a lot of restaurant workers who'd be very interested in assistance with child care,
[2:50:22] 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
[2:50:28] think up some additional support for people who are in the lower end of a
[2:50:32] past scale. We will bring it up to them. They are the tremendous outreach process.
[2:50:40] Thank you. Thank you for bringing that out. And I know they're very
[2:50:43] interested and they've been involved in it. I'm really glad to see the increase in
[2:50:47] the carrot jail. And is it one something million I was looking for the numbers
[2:50:55] that you were breaking down on that.
[2:50:57] That's 1.2 million.
[2:50:58] 1.2 million.
[2:51:00] And is that either specialist of primary care physicians
[2:51:03] that you're bringing to the jail to provide care?
[2:51:06] Yes.
[2:51:07] And that's a complex primary care.
[2:51:08] And that's in addition to people who are already
[2:51:11] going to appointments outside the jail for care.
[2:51:15] So this is new care at the jail.
[2:51:18] That's great.
[2:51:18] That's great.
[2:51:19] I'm really glad to hear that.
[2:51:20] Because I know we have a sicker population.
[2:51:24] I'll stop there.
[2:51:24] but thank you all so much for working
[2:51:26] to end the information you provided.
[2:51:29] Do I have a question about one of the sort of accomplishments
[2:51:33] in 2026 is still a goal in 2027 to continue to work
[2:51:38] on the wait time and are you fine?
[2:51:42] What are you finding is helping with that?
[2:51:45] I mean, I assume just adding more slots
[2:51:48] if you will pick appointments.
[2:51:50] But what else helps with that?
[2:51:54] Thanks, Commissioner, for the question.
[2:51:57] We actually have been able to make most of these increases
[2:51:59] without adding most lots.
[2:52:00] It's just by being more thoughtful about how we use our time.
[2:52:06] It took a substantial amount of work on the part of a couple of pilot groups
[2:52:10] to work a very long backlog down.
[2:52:13] But through just more sophisticated operational workflows,
[2:52:16] we've been able to cut them substantially.
[2:52:18] really. The next year looks forward to spreading those learnings. We have to be very thoughtful
[2:52:25] about how we spread that fit by bit to not over one more team, but they've been very
[2:52:30] All right,
[2:52:34] thank you so much. All right. I think that concludes our business for today. And we will adjourn at 415 PM.