CH 3 21 Quotes on Outcome Metrics (new) edited (PDF)

Dr. Guadalupe Zamora to Cynthia Valadez:
“You can pull that item off the consent agenda, but we are just not going to be able to have this robust discussion that you are
asking for. We won’t have the answers that you’re asking Mike [Geeslin] to bring to you.”
Cynthia Valadez:
“That’s right. And I think that’s a consideration. ​How can we be voting on any amount of money if we don’t have those
answers?​”
Quotes from 3/21/18 Central Health Budget and Finance Committee meeting regarding Outcome Metrics
“Cost Savings Perspective” (FOR proposal)

“Healthcare Services Perspective” (AGAINST proposal)

Jeff Knodel:
“There are some similarities [to DSRIP], you’re paying for
outcomes. The biggest difference, at least from my
perspective, is on the DSRIP side you have specific
outcomes, generally clinical outcomes, that you’re achieving.
This [ECHO Project] is more predicated on implementing a
project and ​performing a project to achieve savings. You
have savings targets that you meet and once those
savings targets are met​, then that’s the trigger for payment.”

Maram Museitif:
“I want us to do it right and ​be good steward of tax dollars by
providing [the homeless] as many health services that we
can.​ I understand they are high-utilizers [...] a person without a
home is a person without anything. I would definitely support
similar initiatives, but I just want us to be very cognitive of the
funding we have and how we can better approach this strategy as
a collaborative initiative across all our stakeholders and our
partners.”

Shannon Jones:
“250 people may not seem like a lot of people, for the pilot,
we know ​those 250 individuals are drivers of significant
cost to our community.​”
“I would encourage us to consider, as a step of faith and
vesting in the future of our community as taxpayers, that we
look at measures that we can cut down those [emergency
room] costs​ holistically. Because the taxpayers are paying
not only us, but they are also paying for criminal justice
systems.”

Maram Museitif:
“We don’t have a position in place as a group: how are we going to
approach addressing social determinants of health? I understand
the goal of Paying For Success, and all the other entities in the
County and the City have a public health budget within them. ​This
is something that we would have to allocate and take away
clinical services [from] our community members. So I am not
in favor of taking away clinical services that we have
committed to.”

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Dr. Mark Hernandez:
“No amount of us clinically delivering services to those
individuals seems to blunt their utilization.”

Maram Museitif:
“I am definitely a firm believer of housing, but I just want to look at
this in terms of Central Health. If housing is our goal within our
framework of addressing Social Determinants of Health, if that’s
the only thing that we want to fund and support, I’m for it. But also
we have to look at: ​are we also going to be able to fund other
initiatives?​ That’s my question in addressing Social
Determinants of Health. ​Within the capacity that we have,
would we be able to?​”

Sherri Greenberg:
“We only pay if the negotiated outcomes [...] are met and that
those are specific healthcare ​outcomes that would lower
the health care costs that we’re paying​ for the homeless
individuals who [Dr. Hernandez] has ​not been able to find
any intervention to lower those costs.​”

Cynthia Valadez:
“I’m a firm believer in us taking care of what our statute requires us
to do as a taxing entity, and that is to ​provide healthcare
services delivery system for the most vulnerable population​,
which I know does include the homeless. With respect to that, I
would ​support making sure we have provided them with
access to healthcare​. I would even consider [taking] them off the
MAP rolls and [giving] them fully-funded comprehensive insurance
through Sendero. I would do something like that because I would
know that those people, at least those 250 people [...] would be
our clients and ​they would have access to comprehensive
insurance and comprehensive healthcare services.​ [...] We
would not be outside the realm of what our statute requires of us to
do.”

Ann Howard (ECHO):
“​It is significant the savings and cost avoidance that this
project promises to deliver, that connects to your
mission.​”

Cynthia Valadez:
“I’m not against this particular project, I’m just saying that we need
to comply with what our mission requires of us and the statute, our
law, requires us to do, and that is to ​address the healthcare
access issues that they have had a hard time navigating. So
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“​The lion’s share of the cost avoidance from this program
is healthcare costs.​”

if we are going to give them money for healthcare, let’s give
them money for healthcare. But right now, let the housing
entities provide housing for them [...] and we will fill the
healthcare gap for those people.”

Nirav Shah (VP, Social Finance):
“​The metric that we’ve talked about​, again it’s not been
finalized, is the reduction in [Emergency
Department]/hospitalization ​for unnecessary costs that are
avoidable​ based on permanent supportive housing. So
diabetes was cited, some individuals coming in for sobriety
reasons, ​those are examples of unnecessary costs that
would be part of the healthcare metric.​”

Cynthia Valadez:
“I have worked for decades as an advocate for our children and
our families that are homeless, that get services through the
schools and through other resources. [...] I’m not pleased to say I
wouldn’t support funding them right now. That’s not it. [But] it
needs to be done with a discussion of all entities at the table, with
the development of a comprehensive plan. [...] I think that all of us
should be supportive of that, and as we are at the table, we look at
what it is that we can realistically fund to ​make sure we are
impacting the closing of [health] disparities gaps.​”

Dr. Guadalupe Zamora:
“​As someone who practices in East Austin and frequently
finds someone under our overhang in the morning when
it’s cold and it’s wet and I have to chase them away
because patients are going to be showing up pretty soon,
I understand the homeless issue.​”

Julie Oliver:
“​I don’t see in this proposal that we have wrap-around
services. There are some [healthcare] gaps we need to fill.
I’m still not comfortable with the private investor’s profit
component.”

Dr. Charles Bell:
“​It is taken from a line item for New Initiatives. That line
item has a half-million dollars in it.​ I’m a little
uncomfortable with $400,000 in the fact that we could
probably learn just as much from $250,000 and allow
ourselves another $250,000 if we need it in the future.”

“Health care services, that’s one thing. ​We can absolutely and
we should be providing health care services.​ When we
venture outside of that scope and there are too many questions on
the table, I think I’m far less likely to move in that direction.
Especially when I see ​the very first thing under New Initiatives
is cancer. That a hard one for me to ignore. And women’s
health.​”

Section 281 Health & Safety Code: “to furnish medical aid and hospital care to indigent and needy persons residing in the district.”
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