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Senior Management Presentation to the Board

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HISTORY OF THE FAMILY HEALTH NETWORK EXECUTIVE DIRECTOR

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19?? 1986

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Rumor has it, Dr. Hurley told the Board of Directors

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Dr. Hurley is still here. BOBwell, he was.

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FIRED!!!

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1986 1990

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FIRED!!!

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1991 1998

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Officially, Thom was allowed to resign

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FIRED!!!

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1999-2008

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NOT FIRED! WOOHOO!!! Saw the organization through financial hardship, going concern, and being an exceptional grantee Saw the organization through a mass exodus of providers due to J-1 Visas; leaving Dr. Hurley as our sole provider Recipient of the Rotarian Pride of Workmanship Award 2005 President of the United Way 2005-2007 Member of multiple boards SVHC, CNYAHEC, United Way, CHCANYS Recipient of the Jeffrey T. Latman Award Did I mention.NOT FIRED

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The Not Fired Executive Directors Report

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006Progress to Date: 4/23/08 1. Improve facilities by relocating the Cortland and Moravia sites. Define needs for each site by 6/1/2006. Develop alternatives for BOD consideration by 10/1/2006. Develop business plan for building and funding by 1/1/ 2007. Present to Finance Committee and Board in the first quarter of 2007. Note: All things being equal, Cortland will be the first priority. A HEAL 6 grant will be submitted to the State on May 1 to fund both the Moravia and Cortland sites (leasehold improvements). As a result of the grant, the following has been accomplished: Needs have been defined; Preliminary clinic schematics have been developed; A budget has been developed for both the development and the ongoing operations; All will be presented to the respective Board committees and the full Board in April 2008.

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 2. Recruit broader representation and increase leadership on the Board. Create a plan for leadership development of new officers by 3/2007. Ensure that new members select a committee on which to participate by 7/1/2007. Two new members were elected in March; two will be elected in April. Three of the four are users of services and represent a diversity of backgrounds: political science, human resources, business management, and education. Committee choices have been made or are in the process of being selected. Brian Moore will be attending board training in Binghamton in May.

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 3. Improve orientation and training of Board members. Implement the board orientation and training plan as outlined in the board calendar (in process). Evaluate the need for additional board training by 10/2006. The board evaluation and education/training needs assessments have been completed and analyzed. The Board President and Executive Director will present a revised calendar and plan for training and education at the June Board meeting.

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 4. Investigate the potential for federal funds to support a School Health Program in Moravia. Dependent on funding, implement the dental screening program at Parker and Randall Elementary Schools in Cortland. FHN received funding to expand our School Health Programs dental program to Parker and Randall Elementary Schools. A Change of Scope was approved.

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 5. Implement a billing redesign with the long range goal of new technology. Set new goals including the following: Decrease technical denials by 10%. Develop a methodology and baseline for measuring the accuracy of coding. Develop a plan for improved coding by the end of 2006, including dedicated staff, audits, and training. In process. Losses due to technical denials have been cut by 50 60%. Tools to report and analyze coding have been developed for both medical and dental providers. These include comparisons to other FHN providers and other community health center providers. A certified coding expert completed working with two FHN providers who were the greatest outliers. Both report that the assistance was appreciated.

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 5. Implement a billing redesign with the long range goal of new technology. Actively seek a new practice management and EHR system. Develop criteria for a new system. Select and evaluate options. Present plan, including funding, to the Finance Committee. In the past quarter, the following have been completed: The GE Centricity system is the one now being considered. A contract with Alliance, the network in Chicago which would host the server and manage the implementation and training, is now having legal review. To date, FHN has received a $200,000 legislative grant which was applied to this project, including project management, travel to review different systems, and purchase of most of the needed hardware. Other funding commitments have also been made.

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 6. Recruit a family practice physician who will do OB. Reassess current recruitment strategies and seek out more effective approaches. Recruit a FP physician 5/ 2007. Evaluate possible role of midwife in relieving stress on two OB providers by the end of 2006. Kathy Keating was hired and began January 2, working two days a week in Moravia and two days in Marathon. This increased access and relieved the OB stress on the other two providers.

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 7.Continue to implement the Health Disparities Care Model. Develop user-friendly manual. Select clinical measures for evaluating success. Fully implement the program in Moravia by the end of 2006. The manual has been developed. The diabetes program in Moravia and DeRuyter has been fully implemented: a care manager is on site; patients have been identified and registered into the tracking system; two diabetes health fairs have been held; diabetic education classes have been held. A grant from New York State Health Foundation to fund expansion of the diabetes program to all five clinical sites was approved. We received $251,000 for a two year period!

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 8. Strive for a competitive salary and benefit program (based on the agencys financial status) that will attract quality staff. Review current benefits. Compare against other similar agencies. Recommend changes by 12/1/2006. As part of the 2008 operating budget development, all these steps were completed by January 9, 2008 and presented to the board at that time. A 401 K plan was implemented with a 2% employer contribution made in the first quarter of 2008.

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STRATEGIC ACTION PLAN: REVISED - 2006 Progress Report: April 2008 StrategyAction Steps -2006 Progress to Date: 4/23/08 9. Advance critical operational activities. Implement the Corporate Compliance Program (in process). Implement the 340 B Program by 9/30/2006. Implement the Emergency Preparedness Program by 8/2006. All departments have reviewed the critical compliance checklist and have developed policies and procedures as appropriate. Walt Priest made a presentation to the board in early 2008. The 340B Program was implemented in MV, CFP, MR, Marathon SHP, and Dental in 2006. DR began in 2007 (delivery program). CN by early 2008. To date, monthly net revenue has met or exceeded goals. Walt Priest and Jean Shields developed an exemplary Emergency Preparedness Program which was completed in the first quarter of 2008.

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Doug Rahner, MD Medical Directors Report

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Performance Improvement Plan Peer Review Process Alignment of Clinical Indicators with External Standards Patient satisfaction Surveys now administered by CRAN Clinical measures aligned with either Federal (Healthy People 2010,Office of Performance Review) or state (QARR) standards

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Gradual increase in Physicians National picture: 2007 saw increase in recruiting family physicians #1 search request for recruiting firms Cortland County has a significant need for additional OB providers especially for Medicaid patients Cathy Keating, MD, a family physician who does OB began on 1/2/08 Plan to hire an additional FP with OB in Summer 2009

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Focus on Diabetes Diabetes Collaborative begun in Spring 2006 at Moravia Expanded to DeRuyter - Spring 2007 Plan expansion to Marathon and Cincinnatus Fall, 2007, FHN awarded $250,000 Setting the Standard grant for diabetes care by New York State Health Foundation Currently recruiting for an additional care manager and a nutritionist Take the Plunge weight loss contest Words of encouragement from NYSDOH Plan: Present at CDC diabetes conference May 2009 Plan: Attain NCQA Diabetes Recognition

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Electronic Health Record 2007 finished initial presentations by 7 vendors September, 2007 Site visits to CHCs using two top products (eClinical Works, Centricity) November, 2007 Super Demo Day. The winner: Centricity Finding a network January/February, 2008 Visits with Alliance Reviewing Contract -Going on now The Future: Implement practice management Do pre-implementation for EHR Implement Return on Investment? Quality Money

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Lynn Bond Director of Finance Report

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Shes tall, shes slender, and she loves to stay late and work all night Lynns Highlight of 2007 Say hello to Lynns newest assistant, BRIDGET Okay, so her real name is Bridge-It And its not a she, its a computer program that crunches numbers But still.A Finance Directors dream come true!

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Annual Expenses

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Future Challenges: REVENUE 340B Medicaid offsite payments Decrease in state payments to SHP

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Walt Priest Director of Operations

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2007 OPERATIONAL EFFORTS AND CHALLENGES

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Dentist Recruitment Difficulties Dental covering expenses, but. Dental bonus system put in place Dentists are unique BUT, we currently have 4 candidates and are in the process of scheduling interviews

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Limited Data Management and Reporting Capability What happened? Lets research! Wait we cant unless we spend a lot of time and a lot of person power. TBS, its a start Flow and cycle time, in minutes (or sadly in hours) Bridge-It where have you been all of Lynns life?

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Limited Discretionary Spending for Project Development Thank the Good Lord and Barbara Lifton HEAL NY Were in!, YAHOO!... no wait, were not Thank you NYS Health Foundation 340B one-site, one pharmacy, no sliding seen

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Space and process challenges in Cortland and Moravia Limitation of growth No room at the Inn for people or records Have you heard about the studies on Rats?

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Grant Preparation Timeline Challenges, Recruitment Problems and Payment Delays 2007/2008 Relax, the 330 Grant is due in August Just kidding its due in April Wrong again, its due in May Innovative Childcare Just find the darn provider Mental Health, 330 Grant and HEAL 6 (squeeze everything else in) Fidelis will help, Total Care will help, no weaseling out allowed

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Insurance contracts and reimbursements all over the place 93 cents isnt bad is it? Who do we bill? Multi-Plan buys PHCS, PHCS contracts with Cigna, Cigna goes to MVP (but just in this county and just for some products). Going on strike from Workers Comp Quality incentives and the rule of interpretation.

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The Sites Must Go On! Groton Get up to speed, retain the staff, deal with the internal dynamics, recruit for the dentist, fix the no-shows, cancelations and re- schedules. Marathon Hire the New Manager, fire the new manager.. put in the cameras, take out the cameras..transfer the providers, repopulate the providers. interview the staff, stabilize the staff.keep it going, keep it going. DeRuyter- 340B and the new site delivery program, rebuilding from a misstep, ants, snakes, and toilets. Cincinnatus- Busy, busy, busy. Waltwe need to talk to you. School Health Program-Cut $20,000 of the base grant, get involved in a scandal in DeRuyter, putting the nose on the grindstone, and becoming part of the BIG TEAM. Moravia and Cortland Get us the heck out of here! (and all the stuff that goes with it).

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Policies, Procedures, and Protocols Making progress (better, but not good enough) Emergency Preparedness Corporate Compliance OSHA All Article 28 P&P&Ps Credentialing Etcetera, etcetera, etcetera One More Little Surprise! Waste not, want not.

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(just kidding)

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2007 OPERATIONS Looking Ahead

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The 340B Solution The Alternative Methods Demonstration Project Site Deliveries Sliding Fees Win-Win

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HPSA/MUA the Suggestions Continue What it means What they think What impact it might have

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The PMS/EHR Connection (The 6 Ps) The Potential The Process The Pain The Partners The Price The Payoff

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The Operational Necessity The Site and Programmatic Imperatives The Building Projects Teams, Committees, Trainings, Meetings and Maintaining Momentum Being as gentle as doves and as wise as serpents! The challenge of working not just smarter, but better.

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Laurie Sperger Director of Personnel

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Employee Picnic In 2007 the agency celebrated its 35 th anniversary, and the employees celebrated at a company picnic at Little York Park. It was a huge success and was attended by 95% of our employees and lots of family members. We even had a Sr. Management member that came incognito as a thug.

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Holiday Party The staff also celebrated at our annual holiday party. Again it was one of the biggest turnouts ever. We had several celebrity singers who should try out for the next American Idol contest.

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And then there are our next Dancing with the Stars contenders.

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Showcases, health fairs, etc NEW DISPLAY WALL (everyone say ooohh) Moravia Health Fair Diabetes focus Cazenovia College 90 Blood Glucose Screenings Business Showcase Blood Glucose & Blood Pressure Screenings Childrens Health Fair (part of MICAH, Cover the Uninsured)

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Challenges In 2007 we lost 3 very good Nurse Practitioners to other practices due to salaries. In 2008 we will need to be addressing this salary issue. I have started an in depth survey and will be bringing recommendations to the Personnel and Finance Committees. Midlevel providers have been proving to be very hard to recruit at this time. We currently have two openings and I have not received any applications from the ads that I have placed. And just this past year we had received a child care grant to place a midlevel provider in the 4 local child care settings and had to give the grant back due to the inability to hire an applicant.

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New Addition Dr. Catherine Keating started in January 2008, and she has been very well received in both Marathon and Moravia.

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Recruitment We have started recruitment for a 6 th Family practice physician who will do OB. Its not what you know, its not who you knowits where you go! Dr. Keating, Dr. Hurley, and Dr. Whites OB portion of their care is continuing to grow and overwhelm them. Currently, for certain months we have no new OB patient openings.

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And on a final note I will be very sorry to see Julie leave. She is the third and I might add BEST Executive Director I have worked with (of course seeing that the other two were fired) Im not sure there is a comparison. She brought both knowledge and a sense of fairness to this organization that was desperately needed. She has been a teacher, a mother (when certain employees leave dirty dishes in the sink) and most of all an inspiration to several employees to pull together and make this organization what is it today. I wish her the best of luck and I hope she knows how much she will be missed.

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Nancy Rongo Presentation: Oh Yeah, and BOB after talking with a few staff members to track it downhis real name is Robert (Bob) CLARK!