Strategic Planning & Budget Retreat

1. Strategic Planning & Budget Retreat COMTREA Board and Leadership Council Thursday, June 13, 2019

2. AGENDA 8:00AM Meeting Opens Review of Mission Statement & Vision Stakeholder Feedback FY 2020 10 BIG ROCKS FY 2020 Strategic Plan & 3 Year Plan (2018-2020) Presentation of the FY 2020 Budget Meeting Closing

3. COMTREA Our Mission To lead in providing quality, comprehensive healthcare that is affordable and accessible, and to support the dedicated professionals who make caring for the individuals we serve their number one priority. Our Vision To be recognized as a leader in comprehensive healthcare, challenging and inspiring individuals, families, and employees to reach their full potential and purpose. Our Values C – COMPASSION AND COMMUNITY CENTERED CARE O – OUTREACH AND OPPORTUNITY M – MEANINFFUL AND MEASURED SERVICES T – TRAUMA INFORMED AND POSITIVITY FOCUSED R – RESPONSIVE, RESPECTFUL AND RESILIENT E – EXCELLENCE AND EVIDENCE BASED SERVICES A – AFFORDABLE AND ACCESSIBLE

4. OUR MISSION STATEMENT • Why is it important? • It determines the company’s direction • It focuses the company’s future • It provides a template for decision-making • It forms the basis for alignment • It welcomes helpful change • It shapes strategy • It facilitates evaluation and improvement

5. AWARENESS OF SERVICES (SLIDE 1)

6. AWARENESS OF SERVICES (SLIDE 2)

7. AWARENESS OF SERVICES (SLIDE 3)

8. PERFORMANCE RATING (SLIDE 1)

9. PERFORMANCE RATING (SLIDE 2)

10. PROPERTY OWNED • End of FY 2019

11. PROPERTY LEASED • End of FY 2019 Note: In 2018/2019 the Truman Boulevard location was added for the Welcome Center and Marketing relocated to 109 Mill

12. VEHICLES OWNED • End of FY 2019 Note: For FY2020, approximately 12 vehicles need to be replaced we will lease these vehicles through Enterprise Leasing at $412/mth per car. This will be approximately $60,000. (this is without fuel cost that is in the budget at current trend). *Includes MAP Trailer in count

13. COMMUNITY HEALTH NEEDS ADDRESSED BY COMTREA

14. COMMUNITY HEALTH NEEDS ADDRESSED BY COMTREA

15. COMMUNITY HEALTH NEEDS ADDRESSED BY COMTREA

16. COMMUNITY HEALTH NEEDS ADDRESSED BY COMTREA

17. COMMUNITY HEALTH NEEDS ADDRESSED BY COMTREA

18. COMMUNITY HEALTH NEEDS ADDRESSED BY COMTREA

19. EVALUATION OF IMPACT • Mental Health and Substance Use • COMTREA is a Certified Community Behavioral Health Center (CCBHC) and the Administrative Agent for Jefferson County as designated by Department of Mental Health. • There is a complete range of programs available to meet needs include the following: Community Support Specialists; Medication services for Opiate Use Disorder and Substance Use treatment/counseling services; EPICC (Engaging Patients in Care Coordination); Psychosocial Rehabilitation (PSR); Welcome Center for Behavioral Health needs triage and access to care; Certified Peer Recovery Specialists for mental health and substance use treatment support and Family Supports; collaborative partner with Jefferson County Treatment Courts; School liaison program that provides mental health professionals in each school in Jefferson County; Tails with Tails Canine Therapy Program (in the schools, hospitals, libraries); Outreach/Engagement Service Diversion via Emergency Department and Inpatient treatment units-face to face engagement and referral to treatment; and school based counseling/therapy services • Additional services include an assisted living facility (Keaton Center) for individuals with persistent and severe mental illness. Through a contractual relationship with the county, the Jefferson County Community Mental Health Fund Board (JCCMHFB) administers an RFP process with up to $250,000 distributed annually to agencies that serve individuals with mental illness in Jefferson County. • Access to Care(Insurance Coverage) • COMTREA Outreach & Enrollment program works to get everyone who qualifies enrolled in Medicaid and health insurance. • Access to Care (Availability of Services) • In addition to the 11 clinical sites for scheduled appointments and follow-up, COMTREA provides same day access for behavioral health needs at the Welcome Center located in Festus, same day/emergency oral health needs at Twin Cities Dental in Festus, and same day walk-in for primary care services at both Emerson and Hickory Plaza. • Housing COMTREA assists individuals and families impacted by behavioral health and other disorders with obtaining and sustaining stable housing. Services are provided utilizing state and federal resources and include case management, financial assistance for independent and residential care placement costs, and linkage to community housing supports.

20. EVALUATION OF IMPACT • Chronic Disease Monitoring/Management • COMTREA provides chronic care management for all individuals served with comprehensive care management including care transitions and coordination of home- and community-based services. COMTREA’s Primary Care Health Home (PCHH) and Behavioral Health Health Care Home (BH HCH) are models for Chronic Disease Management with a team approach consisting of the Nurse Care Manager (RN), Behavioral Health Consultant (LCSW), Patient Care Coordinator and a physician champion. • The PCHH is customized to meet the specific needs of low-income patients with chronic medical conditions such as diabetes, cardiovascular disease, obesity, chronic obstructive pulmonary disease, mental health condition, substance use disorder, asthma, and tobacco use. Clients enrolled in BH HCH have at least two chronic disease. The nurse care managers give basic health management information for specific disease processes and ways to improve overall health. We can also help with diabetes management (A1c, glucose monitoring and discussing diet changes), if that is something that the client needs help with. The nurse care managers will also give the clients names of possible referral doctors for specialty practices like endocrinologists or cardiologists. They ask that the clients take the names to their PCP for an actual referral since it needs to come from their PCP. • The Nurse Care Manger takes a lead role by the promotion of health services including increasing an individual’s health literacy, development of individualize treatment and or self-management plans, assisting with obtaining and adhering to medications and other prescribed treatments. • The Patient Care Coordinator assists with the individual’s barriers by finding an appropriate linkage for appointment scheduling, referrals, follow-up monitoring, and communicating with other providers and family members when needed.

21. EVALUATION OF IMPACT • Obesity/Poor Nutrition/Physical Inactivity • The management of obesity is a growing issue within Jefferson County. Food intake, eating disorders, sedentary lifestyle, physiological influences, and or prescription medication are some of the causes that the clinical team assess for reasons of obesity. Health promotions that are always a constant is encouraging exercise or diet alterations. An integrated approach with Primary Care and Behavioral Health is with individualized lifestyle counseling and motivational interviewing to try and achieve healthy changes in behaviors. • Social Determinants of Health Screenings are performed to help reduce barriers when it comes to poor nutrition and physical inactivity. COMTREA offers food portioned plates, FIT BITs, Health Cook Books and scales as tools to assist in weight loss. Community based staff (Community Health Workers, Community Support Specialists) work directly with individuals served including shopping for healthy food choices, healthy food preparation and food bank access. Prevention and education is key, so at every visit all individuals starting at the age of 3, who are evident of an above average body mass index, are counseled for nutrition and physical activity at the time of service. • We also use many of our community partners from the Jefferson County Health Department’s trained Dieticians, Local Hospitals, and the YMCA, who all offer a reduced cost for services for those individuals who could not otherwise afford services. Promotion of the use of local school gym tracks and parks are shared with individuals. For many who do not have easy access to some of these facilities, education on how to exercise around the home is given. • Violence • COMTREA provides crisis intervention, as appropriate, via phone and face to face. Our Crisis Intervention Team provides direct supports, referrals and crisis resolution. Our CMHL (Community Mental Health Liaison) provides support to law enforcement. Clinical staff also work with community partners to provide direct intervention and or referrals related to domestic violence and or intimate partner violence. • A Safe Place pamphlets are available in each office, along with other community resources. • Tobacco Use • COMTREA has staff trained, both nursing and clinical, in Tobacco Cessation. This is addressed in the full assessment from clinical staff and providers and this service is provided to clients throughout the year, individually and in group settings. Additional resources include use of the MO Quit Line. When individuals served present for oral health services, dentists and dental assistants discuss the importance of smoking cessation and pamphlets are available in each office

22. EVALUATION OF IMPACT • Dental/Oral Health • COMTREA provides comprehensive dental care as part of the FQHC. Additionally, COMTREA provides the following: mobile dental program that serves preschool, school based programs and residential facilities; MAP clinic (55-foot trailer with 3 operatories) that serves various locations through Jefferson County on a rotating schedule; and a Walk In Clinic for dental emergencies. • Accidents/Unintentional Injuries • Unintentional injuries can lead to lost lives, high health costs, and a decreased quality of life, and yet many can be preventable, which is why the entire health team at COMTREA promotes safety tips to individuals served and their family members as part of their everyday care received. Predictable and preventable educational promotions include wearing seat belts, bicycle safety, home fall prevention, swimming safety, gun lock safety, proper medication storage, and wearing sun screen. Outside the clinic, the Community Health Worker and the Community Support Specialist, who visit the individuals in their home environment assesses and address any safety concerns they may observe • The Primary Care Physician is usually the first step with x-rays and treatment as indicated. If the injury was severe and needed immediate treatment we would obviously send them to the ER.

23. COMTREA LEADERSHIP Involved at the state level and within the community

24. FY 2020 STRATEGIC PLANNING TIMEFRAME

25. 10 BIG ROCKS & • FULL STRATEGIC PLAN The full FY 2020 Strategic Plan, 10 Big Rocks and 3 yr plan are attached to your meeting packet for review. The Board will vote to approve these at the June 17th, 2019 Annual Meeting.

26. THREE YEAR STRATEGIC PLAN FY 2018-2020 Note: 3 year update FY2021-2023 we anticipate significant changes to parallel the healthcare transformation. The Big Rocks and Priorities will change to value based payment, digital technology (reduction in face to face clinician visits, addressing housing, transportation and food along with the inclusion of social determinants.

27. THREE YEAR STRATEGIC PLAN FY 2018-2020

28. BUDGET FY 2020

29. BUDGET FY 2020 REVENUE

30. BUDGET FY 2020 – PERSONNEL EXPENSES 74.4% OF TOTAL BUDGET Benefits = 19.47% of salaries

31. BUDGET FY 2020 – OPERATING EXPENSES OPERATING EXPENSES $ 31,062,065

32. BUDGET FY 2020 • OPERATING REVENUE $32,686,845 • OPERATING EXPENSES $ 31,062,065 • OPERATING PROFIT/LOSS$ 1,624,780 4.97% • Revenues • All projections reviewed and approved by program directors • Revenues are based on expectation of productivity factoring a 30% no show rate • Sales Tax / MIL Tax – no increase • Total Revenue 6.4% increase over current year end projections • Patient Revenues 9.3% increase over current year end projections

33. BUDGET FY 2020 • Expenses • 5 New Positions + Current positions = 435 Positions • Salary Adjustments include: • 1.5% COLA • 1% Performance increase (distribution to be determined) • Benefits at 10% increase overall • All expenses based on trends, norms and any specific increase due to need. *Equipment purchases will be made as cash flow is maintained and agency operations are stable. Approved purchases are subject to change.

34. PROJECTED CASH 6/30/2020 includes $696,455 restricted for MHOH includes line of credit includes approx. $280,221 for MHOH

35. MHOH BUDGET FY 2020

36. MHOH BUDGET FY 2020 OPER PROFIT/LOSS $773,766 93.68%

37. DON’T FORGET! COMTREA BOARD MEETING Monday, June 17th at 7:30 am, JCCMHFB Meeting follows immediately