Working together to strengthen the health of our communities.

AGENDA

9:30 am – 9:45 am Welcome and General Business – Matthew Rees, Acting Chair / CEO, Mayers Memorial Hospital District

March 14, 2013 General Membership Minutes (motion to recommend) Financial Update (Approved by Advisory Board at April 9, 2013 Meeting) – Steve Hubbard, CFO,

CCAHN / Jennifer Newman, CFO, CHA 9:45 am – 10:00 am New Advisory Board Members – Carolyn Bruce, Executive Director, CCAHN 10:00 am – 10:30 am Fate of the State, From Pillar to Post – C. Duane Dauner, President and CEO, CHA 10:30 am – 11:00 am How CCAHN Programs Bring in Revenue –Scot Mitchell, VP, CCAHN 11:00 am – 11:20 am Member Roundtable – Matthew Rees

Utilizing Focus & Execute to Assist Rural Hospitals to Stay in Business 11:20 am – 11:30 am Next Steps – Matthew Rees 2013 Meeting Schedule: General Membership (GM), Advisory Board (AB)

Meeting Date Time Venue

AB 6/18/2013 Click Here to RSVP 12:00 pm – 2:00 pm WebEx

GM 7/17/2013 Click Here to RSVP 10:30 am – 4:00 pm In-Person TBD

AB 8/6/2013 Click Here to RSVP 12:00 pm – 2:00 pm WebEx

GM 9/12/2013 Click Here to RSVP 2:00 pm – 4:00 pm WebEx

AB 10/15/2013 Click Here to RSVP 12:00 pm – 2:00 pm WebEx

GM 11/7/2013 Click Here to RSVP 2:00 pm – 4:00 pm WebEx

CCAHN CALIFORNIA CRITICAL

ACCESS HOSPITAL NETWORK General Membership Meeting

Tuesday, May 7, 2013 9:30 am – 11:30 am

Via WebEx – Details on Page 2

Working together to strengthen the health of our communities.

WebEx Access Information To join the WebEx, please follow the following easy-to-use steps below. If at any time you need technical assistance, please contact Stephen Day at 970-315-2329 or Stephen.Day@wha1.org or Bobbie Orchard at Bobbie.Orchard@wha1.org. Step 1: Click on the link below to join the meeting: https://ccahn.webex.com/ccahn/j.php?ED=194669452&UID=1344532532&RT=MiM2 Step 2: Enter your name and email address as directed on the screen. Step 3: A pop-up window will appear with Audio Conference option. Utilizing the pull-down menu for Use Phone, choose one of the options below:

Option 1: Call me: This feature allows you to enter a phone number and WebEx will call you directly at this number. Please make sure it is a direct number into your office or a cell number as it cannot be transferred to you. Option 2: I will call in: This feature allows you to dial in utilizing either of the numbers listed on the screen. The pop-up on your screen will walk you through this option and you will be prompted on the phone to enter the Access Code and Attendee ID (the Attendee ID is important as it connects your audio login to your online login) provided on your screen.

Step 4: Webcam: If you have a webcam on your device, simply click on the grey camera icon to the right of your name, the camera icon will turn green and other participants will be able to see you. Assistance: If at any time you need technical assistance, please contact Stephen Day at 970-315-2329 or Stephen.Day@wha1.org or Bobbie Orchard at Bobbie.Orchard@wha1.org.

Tips for a great

WebEx experience!

Calling in via your phone and not your computer mitigates static.

Please mute your phone when not speaking.

California Critical Access Hospital Network (CCAHN)

March 14, 2013 Meeting Minutes General Membership Meeting

Hyatt Regency Sacramento

Members in Attendance

Bob Edwards – Banner Lassen Medical Center

Wade Sturgeon – Biggs-Gridley Memorial Hospital

John Friel – Catalina Island Medical Center

Jonathan Andrus – Fairchild Medical Center

Harry Jasper – Jerold Phelps Community Hospital

David Hill – John C. Fremont Healthcare District

Tim McGlew – Kern Valley Healthcare District

Melanie Van Winkle – Mammoth Hospital

Craig Marks – Mark Twain St. Joseph’s Hospital

Matthew Rees – Mayers Memorial Hospital District

Ken Platou – Mercy Medical Center, Mount Shasta

Morris Eagelman – Mercy Medical Center, Mount Shasta

James Suver – Ridgecrest Regional Hospital

Charles Harrison – San Bernardino Mountains Community Hospital District

Lee Barron – Southern Inyo Hospital

Kelley Gentry – Surprise Valley Healthcare District

Siri Nelson – Sutter Lakeside Hospital

Anne Platt – Sutter Lakeside Hospital

Brenda DeRamus – Sutter Lakeside Hospital

Tamara Harris – Trinity Hospital

Jennifer Van Matre – Trinity Hospital

Others in Attendance

Carolyn Bruce – CCAHN, ED

Scot Mitchell – CCAHN, VP

Tom Northey – CCAHN, Director, IT Collaboration

Tom Lake – CCAHN, Director, Group Purchasing

Craig Deehring – CCAHN, Director, Network Services

Peggy Broussard Wheeler – CHA

Jennifer Newman – CHA

Rochelle Spinarski – Rural Health Solutions

Angelica Perez – CA State Office of Rural Health

Raymond Hino – Bear Valley Community Hospital

Barbara Willey – Bear Valley Community Hospital

Bruce Garlinghouse – Quorum Health Resources

John Kaszuba – Quorum Health Resources

Haady Lashkari – Ojai Valley Community Hospital

Call to Order Siri Nelson called the meeting to order at 7:15 pm. Minutes A motion was made to accept the minutes from the January 17, 2013 General Membership meeting as presented. Motion by: Harry Jasper, second by: Ken Platou. All General Membership members present voted – motion carried.

Financials Jennifer Newman gave a brief update on the current financial statements. A motion was made to approve the financial statements as presented. Motion by: Kelley Gentry, second by: Charles Harrison. All General Membership members present voted – motion carried.

Special Presentation Peggy presented Raymond Hino, former Board Chair for CCAHN with a plaque and thanked him for his years of dedicated service to the network. She also gave special thanks to all of the Advisory Board members for their service. The 2012 – 2013 CCAHN Story Scot Mitchell thanked Peggy for her support and the support of CHFT and CHA with the network. He then gave a presentation that highlighted the network’s activities for the last year and what is on the horizon for the coming year. Highlights included:

Major accomplishments over the last year: The TRUSTED Colleague Program iVantage Hospital Strength Index HRET HCAHPS Program Ridgecrest Regional Hospital Joined CCAHN New Association Membership Category Formed First CCAHN CFO Meeting Held Rolled Out New Benchmarking Program

Staff is working with members on ways to assist with: Healthcare Reform Monitoring Value Based Purchasing ACOs Meaningful Use OIG AB97,Coordinating with CHA HIPAA ICD-10 Bundled Payments

CCAHN is proactively working on providing value to its members and helping them transform their costs to be able to better adjust to all the changes coming their way.

Members are encouraged to let their individual boards know about CCAHN and how it can help their hospitals.

CCAHN Revenue Cycle Programs

CCAHN Business Development Committee has been reconvened. Current projects under research include: ICD-10 Preparedness Plans Revised HIPAA Regulations Health Benefits Through a Preferred Broker Arrangement Financial and Operational Benchmarking Utilization of FLEX Funds for Operational and Revenue Cycle Assessments

New CCAHN staff reading to assist members: Craig Deehring, Director, Network Services (Revenue Cycle products) Tom Northey, Director, IT Collaboration (IT Projects)

Carolyn Bruce gave a brief overview of how successful CCAHN can be by collaborating with other similar organizations. Highlights included:

Through the affiliation with Western Healthcare Alliance and other networks, we have the ability to develop and negotiate contracts on behalf of over 483 healthcare organizations. Staff can improve the network value proposition through the power of volume.

States of affiliation include:

Colorado, New Mexico, Oregon, Montana, Nevada, Utah, Idaho, Texas, Illinois, Wisconsin, Missouri, Minnesota, and Iowa.

Future Meetings

Meeting Date Time Venue

AB 4/9/2013 12:00 pm – 2:00 pm WebEx

GM 5/9/2013 2:00 pm – 4:00 pm WebEx

AB 6/18/2013 12:00 pm – 2:00 pm WebEx

GM 7/17/2013 10:30 am – 4:00 pm TBD

AB 8/6/2013 12:00 pm – 2:00 pm WebEx

GM 9/12/2013 2:00 pm – 4:00 pm WebEx

AB 10/15/2013 12:00 pm – 2:00 pm WebEx

GM 11/7/2013 2:00 pm – 4:00 pm WebEx

Meeting adjourned at 8:45 pm.

Two Months YTD 20132/28/2013 Budget Variance Budget

RevenuesMember dues $ 30,938 $ 25,938 $ 5,000 $ 155,625 Program administrative fees - 11,250 (11,250) 67,500 Travel Reimbursement- CRQAR 2,646 2,166 480 13,000 CRQAR Revenue 15,950 7,500 8,450 45,000 FLEX Operations program 834 (834) 5,000 Total revenues 49,534 47,688 1,846 286,125

Expenses Network management 21,000 21,000 - 126,000

Admin assistant 3,166 3,166 - 19,000 HIT Grant Mgt- WHA - - - - Peers Networks - 2,500 2,500 15,000

Consulting - 3,334 3,334 20,000 Consulting- CRQAR 14,500 7,126 (7,374) 42,750 Business Development - 1,666 1,666 10,000

Legal - 834 834 5,000 Telephone, webex 188 666 478 4,000

Website management - 166 166 1,000 Memberships 1,000 666 (334) 4,000

Travel - 1,250 1,250 7,500 Travel- CRQAR 2,646 2,166 (480) 13,000

Supplies, marketing material 558 334 (224) 2,000 Meetings - 666 666 4,000 Miscellaneous - - - - Total expenses 43,058 45,540 2,482 273,250

Increase in net assets 6,476$ 2,148$ 4,328$ 12,875$

California Critical Access Hospital Network Statement of Activities

For the Two months ended February 28, 2013

2013ASSETS

Cash 74,541$ Accounts receivable- Dues 65,627 Accounts receivable- Other 26,223

Total Assets 166,391$

LIABILITIES AND NET ASSETS

Accounts payable 12,736$ Deferred Revenue 129,688

Total liabilities 142,424

NET ASSETSUnrestricted net assets 17,491 Profit/Loss Current Year 6,476 Total net assets 23,967

Total liabilities and net assets 166,391$

California Critical Access Hospital Network Statement of Financial Position

February 28, 2013

Executive Director Report

April 2013

Summary The second quarter of 2013 has proven to be very busy for CCAHN. With more than 15 programs now implemented, members continue to enjoy significant savings. Newly developed programs and affiliations with networks across the country have enhanced our contracting and negotiating footprint, while initiating relationships to further enhance our product offering. Highlights:

CCAHN officially rolled out the new Hospital Financial and Operational Benchmarking program to members. Through a partnership with Health Data Solutions, this program is economical for members at only $2,450 per member, per year and CCAHN staff handles all of the data entry for members. Members simply submit their raw data to staff and staff enters the data into Health Data Solutions’ online system. This program allows members to compare against hospitals of similar size and demographics. Three (3) CCAHN members have officially signed up to participate in this new program.

The Premier group purchasing program continues to grow for the CCAHN membership. We now have 15 active members on the program, and one (1) more member is in process.

On April 30th, Eric Hirschberg, SVP with Lockton Companies led a WebEx on Self-Funded Employee Health Benefits for Hospitals. Another WebEx is scheduled for May 10th.

Staff has been completing due diligence on a program to assist members in complying with ICD-10.

NETWORK ACTIVITES PERTAINING TO: VALUE THROUGH COLLABORATION

Supporting and Sustaining Members Work continues with Epiphany Cardio so that a single server may be shared amongst multiple CCAHN members

allowing their physicians to cost-effectively digitally read cardiac tests. Evaluate New Technologies

Staff is in the final stages of evaluating a full shared services IT solutions vendor (including Disaster Recovery) for members. Tom Northey, Director of IT Collaboration, is leading this initiative that will bring additional value to CCAHN members.

Great opportunity exists across the network for fostering synchronized decision making (vs. unilateral), collaborative thinking, and standardized approaches which will generate greater discounts, increased purchasing power, and maintenance/SLA/licensing economies of scale.

Enhanced Communication

Member Meetings April 9, 2013 Advisory Board Meeting April 30, 2013 Resort Hospital Consortium Meeting

Staff continues to maintain the CCAHN website. Member meetings, minutes, reports, WebEx details, program information and other information are available for all members to view.

NETWORK ACTIVITES PERTAINING TO: NETWORK COLLABORATION Programs and Services

Healthcare Management partnered with Eide Bailly to begin offering Hospital Operations and Revenue Cycle Assessments to business offices. This service is available to any CCHAN member hospital. Discussions are underway for a possible project with FLEX funds being used to help one (1) CCAHN member pay for part of an assessment.

Group Purchasing Fifteen CCAHN hospitals have moved over to the program. One (1) additional member is in process.

CAH Annual Survey Five (5) Quality and Medical Staff Reviews and four (4) Mock Surveys have been completed, as well as one (1)

Clinical Policy and Procedure Review and one (1) State Correction Plan Follow-up. In addition, one (1) Quality and Medical Staff Review is being scheduled.

Peer Review One (1) CCAHN member is now utilizing the WHA/CCAHN Peer Review program.

Revenue Cycle Services Several members have shown interest in Healthcare Management for bad debt collections and self-pay services.

New Partners Medefis for healthcare staffing services. Employer Representatives, Inc. for an unemployment cost management program. AGL Hospital Consulting for an automated pharmacy solutions program.

New Program Implementation Work continues with Epiphany Cardio so that a single server may be shared amongst multiple CCAHN members

allowing their physicians to cost-effectively digitally read cardiac tests. Staff rolled out the new Hospital Financial and Operational Benchmarking program to members. Please contact

Scot Mitchell at scot.mitchell@wha1.org or 877-683-5227 for more information on this great new program. Determine Feasibility of the Following New Programs and Services

Credentialing and QA Service: Staff has been researching this program and has negotiated a corporate partner agreement with an NCQA certified CVO to offer primary source verification services to the members. Since this CVO is NCQA certified some payers will grant them delegated authority that could ease the credentialing process for your medical staff. Due to the recent flurry of business development activity, action on this program has been delayed until a future date.

Insurance Products Employee Benefits (Business Development Committee is working on this program) Property and Casualty Insurance Programs Cyber Insurance (Lockton Insurance)

Exploring vendors for the following services: hazardous waste, lab billing, and internet-based lab testing for uninsured.

Networking to Enhance the Network

Conferences/meetings attended: National Cooperative of Health Care Networks Annual Conference, National Healthcare Collection Association Conference, and Healthcare Financial Management Conference.

Carolyn Bruce continues conversations with the National Rural Health Resource Center on potential areas for collaboration.

Work continues with Peggy Broussard Wheeler, CHA/CHFT on the following: 2013 FLEX program initiatives. CAReHIN governance and evaluation. CCAHN future activities and agendas.

NETWORK ACTIVITIES PERTAINING TO: PERFORMANCE AND QUALITY IMPROVEMENT Facilitate Strategic Conversations

Conversations with Carolyn Bruce, Peggy Broussard Wheeler, Corinne Chavez, Angelica Perez, and Scot Mitchell regarding potential areas for collaboration with the FLEX dollars have continued. Focuses on QHi, HCAHPS, ICD-10 coding education, and technical assistance for revenue cycle performance

improvement. Conversations about ongoing state programs for CAHs.

Clinical Integration New consulting services available to CCAHN member laboratories include pathology outreach

marketing consulting, and Mock CAP laboratory surveys. Due diligence continues for the development of new lab network programs including laboratory data

benchmarking, lab outreach billing audits as well as several new group purchasing opportunities in the areas of lab equipment, hazardous waste, and lab/physician connectivity.

Cedaron, a scheduling and documentation software for physical therapy, continues to be evaluated by staff as a potential new program.

Assist Members to Obtain Financial Strength

YTD staff has collected $106,000 in member dues. Obtain and Utilize Data

Collaboration continues with iVantage on the Hospital Strength Index. Staff rolled out the new Hospital Financial and Operational Benchmarking program to members.

Healthcare Management partnered with Eide Bailly to begin offering Hospital Operations and Revenue Cycle Assessments to business offices. This service is available to any CCHAN member hospital. Discussions are underway for a possible project with FLEX funds being used to help one (1) CCAHN member pay for part of an assessment.