Cook Children s Health Plan

Transcription

1 Cook Children s Health Plan Fort Worth, Texas POSITION SPECIFICATION PRESIDENT/CHIEF OPERATING OFFICER Prepared by Witt/Kieffer February 2011 This Position Specification is intended to provide information about Cook Children s Health Plan and the position of President/Chief Operating Officer It is designed to assist qualified individuals in assessing their interest in this position.

2 TABLE OF CONTENTS Page I. The Organizational Overview 2 II. Cook Children s Health Plan 7 III. Position Summary 8 IV. Goals and Objectives 9 V. Candidate Qualifications 10 VI. Community Profile 12 VII. Procedure for Candidacy 14 VIII. Appendix 15 X. Job Description 16 XI. Cook Children s Financials 20 2

3 ORGANIZATIONAL OVERVIEW COOK CHILDREN S HEALTH CARE SYSTEM Cook Children s Health Care System (CCHCS) was created in December 1995 by Cook Children s Medical Center and Cook Children s Health Foundation to improve the health status of the community s children and to prepare for the era of managed care. Located in Fort Worth, Texas, and serving 130 counties in north and west Texas, CCHCS builds on an 85-year history of pediatric care by expanding the historical hospital vision of excellence in inpatient care to include the entire continuum of preventive primary care, specialty outpatient services, home care after hospitalization, and health insurance for uninsured and underinsured children. Nationally recognized services include cardiology and cardiothoracic surgery, hematology and oncology, critical care, neuroscience center and pulmonary medicine. The System consists of Cook Children s Medical Center (CCMC), Cook Children s Physician Network (CCPN) which employs 270 pediatricians and pediatric subspecialists, Cook Children s Health Plan (CCHP), Cook Children s Home Health (CCHH), Cook Children s Indemnity Company (CCIC) an offshore insurance captive, and Cook Children s Health Foundation. CCHCS is a diversified pediatric care system, not affiliated with a medical school. The System provides administrative and support functions to the Medical Center, the Physician Network, Home Health, the Health Plan, and the Foundation. These functions include government relations, case management, managed care contracting services, quality management, education, internal audit, finance, payroll, telecommunications, insurance, information services, human resources, employee benefits, occupational health, legal, grants and research administration, credentialing, and marketing. These services are allocated and charged back to the other members of the Integrated Delivery System based on their usage of these services. Cook Children s Health Foundation 3

4 Cook Children s Health Care System Cook Children s Physician Network Cook Children s Medical Center Cook Children s Health Plan Cook Children s Home Health Cook Children s Indemnity Hurst Children s Center Plano Ambulatory Surgery Center The System has a net operating revenue of $1 billion with a profit margin of 11 percent. Net assets are approximately $1.3 billion. The current endowment is $750 million with expectations to increase to $1 billion by As one of the most integrated pediatric health network, Child Health Corporation of America has consistently ranked the System in the top five to seven children s hospitals in all indicators, except debt, and has ranked it as one of the top two children s hospitals in ratio of cost to charges, a great value to payors and the State of Texas. The System has employed Athena Health, a web based system, to support interconnectivity between the 270 physicians and all of the System s operating entities and billing systems. Financial Statements: Consolidated balance sheets for W.I. Cook Foundation, Inc., and its subsidiaries d/b/a Cook Children s Health Foundation and Subsidiaries are located on the following pages: 20 and 21. For additional information on Cook Children s Health Plan, Health Foundation, Home Health Care, and Physician Network please see the Appendix. COOK CHILDREN S MEDICAL CENTER Cook Children s Medical Center (CCMC) is a 282-bed regional pediatric medical center that 4

5 offers state-of-the-art equipment, surgical suites, specialty clinics, rehabilitation facilities, behavioral health services, and ancillary and diagnostic services designed to meet the special needs of children. Specialty Clinics at the Medical Center offer treatment by 27 pediatric subspecialties. Treatment for children with chronic conditions is available through regional specialty clinics within the 130 counties in north central and west Texas served by the Medical Center. Major services located at the Medical Center include pediatric endocrinology, pediatric infectious disease, genetics, pediatric hematology/oncology and bone marrow/stem cell transplantation, pediatric gastroenterology, pediatric cardiology and open-heart surgery, pediatric surgery, pediatric ophthalmology, pediatric orthopedics, pediatric pulmonology, pediatric neurology and neurosurgery, plastic surgery, and rehabilitation services. The Medical Staff of Cook Children s Medical Center ranks highly their hospital-based services in neonatology, pediatric anesthesiology, pediatric intensive care, emergency medicine, inpatient pediatrics, pediatric radiology, and pediatric pathology. Cook Children s has Tarrant County s only designated pediatric trauma center, which is part of the Emergency Department that includes emergent care, trauma services, urgent care, and child sexual abuse services. The Emergency Department, staffed 24 hours per day with pediatric emergency medicine physicians, treated more than 104,000 children in Fiscal Year Another key element of the medical center is the medical transport service, Teddy Bear Transport, providing a link with distant suburban and rural areas. Teddy Bear Transport services include ambulances with special adaptations for children, helicopter transport, and a turboprop King Air B200 fixed-wing aircraft, fully equipped as a flying intensive care unit for children. This service transports approximately 2,000 patients annually 1,304 by ground, 266 by fixedwing airplane, and 430 by helicopter. CCHCS has currently $250 million of facilities expansion adding 580,000 square feet of outpatient and inpatient space, a forty percent increase in space funded by a capital campaign and $150 million in AA rated tax exempt bonds. Completed in 2000 was an urgent care & surgery center in Hurst and a child-care center for 214 children on the southwest side of the hospital's Fort Worth campus. Six new surgery suites and support spaces were completed in 2001, and a 5-story North Pavilion housing 84 new beds was completed in October History of Cook Children s Health Care System Cook Children s Medical Center resulted from the merger in 1985 of the former Cook Children s Hospital and Fort Worth Children s Hospital. Community leaders had dreamed of this combination since the 1950s and the new facility opened in 1989 as a realization of their goal. The former Fort Worth Children s Hospital began with the organization of the Fort Worth Free Baby Hospital in March 1918, under the leadership of Mrs. Ida L. Turner, a former postmistress. In 1961, under the leadership of Mrs. Nenetta Burton Carter and the Woman s Board of the Fort Worth Children s Hospital, a new facility was completed adjacent to Harris Methodist Hospital. This facility continued to operate independently until the merger in The roots of the former Cook Children s Hospital go back to January 1929 when the W.I. Cook 5

6 Memorial Hospital opened in Fort Worth. When the polio epidemic was spreading in the United States in 1952, the board of trustees of the W.I. Cook Memorial Hospital studied the special needs of children, voted to expand the facility to 72 beds with a special grant from the Tom B. Owens Trust, and changed its mission to care exclusively for the needs of children. Thus, the trustees renamed the facility Cook Children s Hospital, which continued to operate independently until the merger. In 1980, under the leadership of Mr. I. Jon Brumley, the two children s hospitals in Fort Worth formed the Children s Hospitals Coordinating Board and began negotiations to merge their facilities. In April 1982, the Children s Hospital s Coordinating Board hired Russell K. Tolman to administer the hospitals jointly and plan for their ultimate combination. Mr. Tolman was experienced in building pediatric medical programs and facilities. Physicians led the way and began the merger process in September 1982 when Hinton H. Hamilton, III, M.D., elected President of the Fort Worth Children s Hospital, and A. Stanley Elliott, M.D., elected President of the Cook Children s Hospital Medical Staff, jointly requested permission to combine their members into a single medical staff. The newly combined entity was named Cook-Fort Worth Children s Medical Center, and the new 183-bed facility was begun in 1987 and completed in May The Campaign for Children raised over $30 million toward the $58 million project, and sixteen gifts of $1 million or more were pledged to the campaign. The Future The 1995 Strategic Plan created Cook Children s Health Care System and focused on integrating business functions, computer systems, managed care contracting, involving physicians in system governance, and rapidly expanding specialty services in the north and west Texas regions. With the integration completed thus far, the System is now poised to work upstream from the hospital in the preventative realm of primary care and further expand regional specialty care. Every Child: 2020 Every Child: 2020 is an ambitious vision for Cook Children s Health Care System, requiring significant efforts at every level of the organization to achieve its goals and objectives. Over the next 15 years, the CCHCS will aggressively pursue the integration and alignment of the culture, strategy and communications of the organization, for Tarrant County and the five surrounding counties, toward achieving this vision for the future. The organizing principle for this plan is to deliver patient-centered clinical care to children through CCHCS pediatric integrated delivery system. Mission: To improve the health status of every child in our region through the prevention and treatment of illness, disease and injury. Vision: To be known nationally for how we organize community-wide pediatric health services and deliver patient-centered clinical care through our pediatric integrated delivery system. Values: Safety, Caring, Integrity, Collaboration, Innovation, Giving 6

7 Within the Every Child: 2020 plan are operating imperatives that must be executed at a consistently high level in order to accomplish this vision. These operating imperatives are associated with organizing community-wide health services and delivering patient-centered clinical care. Organizing Community-Wide Health Services includes insurance for every child, access to services and medication for every child, preventative care and health education for every child, and coordination of all community health resources and health information for every child. Delivering Patient-Centered Clinical Care includes providing the highest quality healthcare, great physicians, integration of process, services and companies, dedication to innovation, clinical and health services research for every child. COOK CHILDREN S HEALTH PLAN 7

8 Cook Children s Health Plan (the Company ) was incorporated on October 27, 1998 in the State of Texas as a not-for-profit corporation for the purpose of providing comprehensive health care services on a prepaid basis to enrolled children in various counties throughout North Texas. The Company is a controlled affiliate of Cook Children s Health Care System ( CCHCS ). The Company received funding and initial capitalization on November 19, 1998, was certified as a Health Maintenance Organization ( HMO ) under the Texas Health Maintenance Organization Act (the Texas HMO Act ) on February 25, 1999, and commenced subscriber enrollment on April 1, The Company has contracted with Texas Health and Human Services to arrange to provide health benefits for enrolled children in the Children s Health Insurance Program ( CHIP ). The Health Plan and its staff possess distinctive credentials and experience to manage both the CHIP and Medicaid Star populations. CHIP is a state program to provide insurance at a very low premium for children of families who do not qualify for Medicaid and could not otherwise afford insurance coverage. Medicaid Star is a federal program in which Medicaid recipients within certain counties receive their care through state awarded HMO programs. Together, CHIP and STAR will represent over one-quarter of the Medical Center s annual revenue. The Health Plan built the infrastructure to competently administer and manage this care through the recruitment and retention of highly skilled executive managers and staff from both for profit and not for profit HMOs experienced in managed care operations. CCHP currently provides services as a licensed health maintenance organization to 95,000 covered lives representing a 40% market share. CCHP s scope of work encompasses arranging for the delivery of comprehensive health care services to children 0-18 years of age, who are enrolled in CHIP and reside in the counties of Tarrant, Denton, Hood, Johnson, Parker and Wise, through a comprehensive network of contracted hospitals, physicians, and ancillary providers. Covered services provided by CCHP include hospital services, physician services including Local Health Department and Rural Health Clinic primary care (there are no FQHCs in the service area) and specialty care clinics in outlying areas, behavioral health care, home care services, durable medical equipment, radiology and laboratory services, and other services. CCHP is one of three organizations that were awarded the opportunity to enroll Medicaid STAR members in CCHP s service area. Both CHIP and Medicaid STAR members will re-enroll in July CCHP provided behavioral health services to the CHIP population through a behavioral health carve-out contract with MHNet from May 2000 through August 2003 when the state eliminated the benefit. Early in 2004, the benefits were partially restored and CCHP implemented an agreement with Corphealth, Inc. to provide behavioral health services to CHIP Members. Corphealth will also provide behavioral health services to STAR Members in the future. CCHP enjoys a unique position in providing comprehensive behavioral health care to its Members through its direct affiliation with its sister organizations, Cook Children s Medical Center and Cook Children s Physician Network. These organizations own and operate pediatric behavioral health programs, including inpatient, partial hospitalization and outpatient psychology, neuropsychology and family therapy services. 8

9 The health plan currently has a revenue of $200 million, 40% of the System s revenue, experiencing an average of 20% growth the last two years. POSITION SUMMARY The President and Chief Operating Officer of Cook Children s Health Plan (CCHP), has primary responsibility for profit and loss and for overall operations of the Health Plan. This position reports directly to the CCHCS Chief Financial Officer. The incumbent, working with the Board, System executives and CCHP staff, devises and gains consensus for the strategic direction of the plan and approval of the Board, oversees the execution of strategies and tactics outlined in the business plan. The President works with community leaders, government officials, payors and other regional health care executives to achieve the mission, vision and quality imperatives of the Health Plan. The incumbent collaborates with other health care organizations and managed care plans to create new opportunities for growth. The President ensures that the mission, vision, strategies and tactics of the Health Plan support the achievement of the mission and vision of the parent organization, the Cook Children s Health Care System. 9

10 GOALS AND OBJECTIVES Gain the confidence and trust of the Board, System leaders, physicians, senior management team, payors, and the community, ensuring that the President is perceived by all parties as serving the needs of the organization and the community. Effectively manage the current patient population, carving out the CHIP population into an accountable care model. Work with the current pilot cohort study on the pediatric Medicaid population on obesity and asthma and expand that study across the health plan. Develop and implement an effective audit process to ensure against potential compliance issues in the health plan. Effectively integrate into the business and social community and with the teams of the system and the health plan. Accomplish the re-procurement of the state Medicaid contract. Effectively manage the transition to a new claims payment system. Procure and implement a new care management system. Solidify the health plan staff and engage in staff development and mentoring, establishing a reputation of a high performing and high integrity team. Develop an effective methodology of contract negotiation. Over a three-year period, define best practices in the health plan industry and implement a process to meet or exceed those best practices. CANDIDATE QUALIFICATIONS 10

11 Should possess a minimum of a bachelor s degree from an accredited college or university. An advanced degree and/or clinical training is preferred. Should possess at least eight years of executive level management experience in a healthcare organization. Must possess a strong background in managed care operations with an in-depth knowledge of risk sharing, medical management, care management, risk management, product diversification, and network development. Must possess strong Board relations skills and demonstrated experience successfully working with a diverse Board. Experience working with a Medicaid population is highly preferred. Should understand the regulatory environment of Medicaid and CHIP with regard to compliance, audit, etc. Should understand how a health plan fits in an integrated healthcare system and have demonstrated experience as a team player in that environment capable of participating in a strategic capacity in that environment. Should understand how to work effectively with a state department of insurance, as well as all regulatory agencies. Should be experienced in and sensitive to market trends and competition, and the healthcare industry. Should have an understanding of accountable care organizations. Provider based health plan experience is highly preferred. Should be strong operator who is detail oriented, hands on, accountable, consistent and credible. Should understand population management and how to achieve success in disease management. Should understand preventative care. Should possess strong infomatics experience a data driven, factual leader. Should have highly effective physician relations skills. Should possess a strong professional image - a credible leader with strong business acumen and presentation skills. 11

12 Should be a strong manager who can develop and lead a credible, trusted, accountable staff evenhanded, fair and consistent. Should possess conservative values and a strong work ethic a mission oriented leader of high integrity. Should ideally have experience working in the mid-west or south and espouse the values and work ethic of that population. Should be one whose ego is in check, confident yet humble, with a good sense of humor. Should be open and transparent one who is not afraid to ask for help if necessary. Should be a positive, can-do person who always strives for excellent results. Should be politically savvy one who anticipates the needs of others. COMMUNITY PROFILE Fort Worth, Tarrant County, Texas 12

13 Fort Worth, Texas is the county seat of Tarrant County, which is an urban county located in the north central part of Texas. The DFW Metroplex includes 12 counties and a population of 5.5 million. The region is made up of the two major cities of Dallas and Fort Worth and many adjacent suburban communities running for 50 miles continuously from east of Dallas to west of Fort Worth. Two major economic drivers are the DFW Airport and the new Alliance Airport north of Fort Worth with its adjacent business development. The communities surrounding Fort Worth have experienced unprecedented business growth and population expansion during the last ten years. Fort Worth is the corporate headquarters for American Airlines, Lockheed Martin Aircraft, Bell Helicopter, Burlington Northern Santa Fe Railroad, Radio Shack, Pier One Imports, XTO Energy, AmeriCredit, Alcon Laboratories, and Cash America. Recent natural gas exploration and extensive drilling in the Barnett Shale has become the region s third largest employer and pumps billions of dollars into the Tarrant County Region. All of this business growth has created rapid development of new homes in every community. Many beautiful suburbs in and around Fort Worth have helped Cook Children s attract and retain key physicians and administrators who typically value the family-oriented lifestyle there. The vibrant local community, part of the growing Texas economy, is both a driving force for institutional growth and a recruiting plus for Cook Children s Health Care System. New professional sports arenas in Arlington, just east of Fort Worth, house the Texas Rangers baseball team and soon will house the Dallas Cowboys football franchise. The DFW Metroplex attracts major entertainers. The Metroplex is one of only a few areas to have team in six major professional team sports: the Dallas Cowboys (NFL), the Texas Rangers (MLB), the Dallas Mavericks (NBA), the Dallas Stars (NHL) and professional soccer s Dallas Burn and Dallas Sidekicks. Additional sporting events include the Texas Stampede Rodeo, Mesquite Rodeo, Texas Motor Speedway, and NCAA Division I athletics in more than a dozen sports. Fort Worth also hosts many national equestrian cutting horse competitions and a major annual rodeo, the Southwestern Exposition and Stock Show. This rich western agricultural heritage is complemented by a sophisticated dedication to the arts. The 2,056-seat Bass Performance Hall is home to the Van Cliburn International Piano Competition, the Fort Worth Symphony, the Fort Worth Dallas Ballet, the Fort Worth Opera, and special productions of Casa Manana musicals. Fort Worth s art museums are nationally respected the Fort Worth Museum of Modern Art, the Amon Carter Museum of Western Art, the Kimball Art Museum, and the Fort Worth Museum of Science and History. Fort Worth and Tarrant County are home to high quality public and private schools serving the needs of a growing family-oriented lifestyle. Prestigious private and public colleges and universities such as Texas Christian University, University of Texas at Arlington, Texas Wesleyan University, University of North Texas, and Southwestern Baptist Theological Seminary represent only a few of the many institutions meeting the educational needs of the area. The University of North Texas Health Science Center and the University of Texas Southwestern Health Science Center provide training for osteopathic and allopathic physicians. Located in the Sunbelt region of the United States, Fort Worth enjoys favorable weather throughout the year. Bright sunshine and wide blue skies make up the average 249-day, warm season. Rainfall throughout the year mainly occurs mostly in the spring, and snowfall is rare. In summary, Fort Worth and north Texas enjoy a robust economy and a rare mix of western 13

14 culture and fine arts. It has been the experience of Cook Children s leadership that physicians and key management staff are very favorably impressed with the city and the region in term so lifestyle and opportunity. For additional information, please visit PROCEDURE FOR CANDIDACY Send resume or nominations (with preference for communication) to CCHP@witkieffer.com: Marvene M. Eastham Witt/Kieffer 14

15 10375 Richmond, Suite 1625 Houston, Texas Phone: 713/ Fax: 713/ or Shirley Cox Harty Witt/Kieffer 3414 Peachtree Road, Suite 452 Atlanta, GA Phone: 404/ Fax: 404/ APPENDIX COOK CHILDREN S HOSPITAL FOUNDATION Cook Children s Health Foundation is a 501(c)3 charitable organization dedicated to bringing an environment of health, hope, and happiness to children and their families by raising funds to support Cook Children s Medical Center. These generous donations help fulfill many needs. Cook Children s is currently conduct a $60 million expansion project toward adding crucial 15

16 patient rooms for critically ill and injured children, premature and ill newborns, and children recovering from surgery, illness or injuries. COOK CHILDREN S HOME HEALTH CARE Cook Children s Home Health Care is an alternative to hospital care for patients whose diseases or conditions allow them to continue recovery or rehabilitation at home. Mission: Cook Children s Home Health Care is dedicated to providing a unified system of care and rehabilitation for recovering or chronically ill children and their families in the comfort of the child s home when it is appropriate and clinically prudent. COOK CHILDREN S PHYSICIAN NETWORK Cook Children s Physician Network employs 224 physicians and provides more than 30 pediatric specialties and services, including nationally-recognized programs for critical care, hematology/oncology, Pulmonology, cardiology, and cardiovascular surgery, and neurology/neurosurgery. With 15 specialty clinics and 33 primary care clinics, pediatric specialists and community physicians care for children in the Fort Worth, Dallas, and the rural ranch lands of North and West Texas in Tarrant, Denton, Hood, Wise, Parker and Johnson counties. In fiscal year 2003, patients in more than one-hundred Texas counties, 35 states, and several foreign countries were treated. COOK CHILDREN S INDEMNITY COMPANY This off-shore captive insurance company provides insurance coverage for the medical center and Cook Children s Physician Network. For additional information, please visit 16

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21 Organization Name FY09 FY10 Cook Children s Health Care System Financial Data Gross Patient Revenues 1,288,800,248 Net Patient Revenues 663,123, ,545,000 Non-Patient Revenues 158,571, ,262,000 Total Revenues 821,694, ,807,000 Salary & Benefit Costs 412,354, ,849,000 Supplies & Other Expenses 319,800, ,697,000 Total Expenses 732,154, ,546,000 Net Income on Operations 89,540,000 84,261,000 Operating Data Licensed Beds Operating Beds Average Daily Census Admissions 11,933 11,771 Patient Days 75,013 71,735 ALOS Hospital Wide ALOS Medicare N/A N/A Births N/A N/A Total FTEs Total Employees Open Hearts Surgeries Total Catheterizations Annually 18,223 27,334 Annual Inpatient Surgeries 4,175 4,019 Total Outpatient Visits 194, ,204 Total ER Visits 79, ,010 Other Data Percentage IP Business Percentage OP Business Active Medical Staff Population Primary Svs Area 2,757,275 2,800,000 Population Secondary Svs Area Payer Mix (%Net Revenue) Medicare 0.3% Similar Mix Medicaid & Medicaid Managed Care 36.8% Tricare Managed Care 58.3% Commercial/BCBS/Indemnity Ins/SEHP 1.6% Private/Other 3.0% % % 21

22 Organization Name FY09 FY10 Cook Children s Health Plan Financial Data Gross Patient Revenues Net Patient Revenues Non-Patient Revenues $125,509,724 $161,681,473 Total Revenues $125,509,724 $161,681,473 Salary & Benefit Costs $6,005,030 $7,321,958 Supplies & Other Expenses $123,762,616 $156,920,208 Total Expenses $129,767,646 $164,242,166 Net Income on Operations $(4,257,922) $(2,560,693) Operating Data Licensed Beds Operating Beds Average Daily Census Admissions Patient Days ALOS Hospital Wide ALOS Medicare Births Total FTEs Total Employees Open Hearts Surgeries Total Catheterizations Annually Annual Inpatient Surgeries Total Outpatient Visits Total ER Visits Other Data Percentage IP Business Percentage OP Business Active Medical Staff Population Primary Svs Area Population Secondary Svs Area Payer Mix Medicare Medicaid Tricare Managed Care Commercial/BCBS/Indemnity Ins/SEHP Private/Other % % 22