Advancing the Financial Strength of Los Angeles County Clinics...• Launched in 1995, nonprofit,...

AFS 102 Training Program

December 5, 2019

Susan Petrie, MBA Chief Operating Officer, Capital Link

Advancing the Financial Strength of Los Angeles County Clinics: Monitoring and Improving Health Center Performance

• Launched in 1995, nonprofit, HRSA national cooperative agreement partner

• Offices in CA, CO, FL, MA, MO, and WV

• Over $1.2 billion in financing for over 234 capital projects

• Direct assistance to health centers and complementary nonprofit organizations in planning for and financing operational growth and capital needs

• Industry vision and leadership in the development of strategies for organizational, facilities, operational and financial improvements

• Metrics and analytical services for measuring health center impact, evaluating financial and operating trends and promoting performance improvement

2019 Capital Link www.caplink.org 2

Capital Link - Overview


Advancing Financial Strength (AFS) Program Overview

Program Developed with CCALAC • Tools, Trainings, Technical Assistance

Goal: Improve Health Center Financial Sustainability and Increase Readiness for Growth.

CEO/COO CMO/Clinical Team

CFO/Finance Team

Board Members


Goal: Financial Sustainability and Access to High Quality Care

Benchmarking/Dashboards


Performance Improvement


Benchmarking

A standard or point of reference against which things may be compared or assessed.


Benchmarking/Best Practices

What metrics should I track?

What to compare performance to?

What does it mean?


Capital Link’s Performance Benchmarking Toolkit

http://caplink.org/california-clinics


Data Sources for Benchmarking


CA FQHCs Performance Trends

http://caplink.org/ca-trends-2019

http://caplink.org/ca-trends-2019


Capital Link’s Benchmarking Toolkit

Performance Trends: Key Metrics

3.5%

5.9%

4.7%

5.7% 5.6%

6.3%

4.8% 4.5%

3.7%

4.3%

3.6% 3.1%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

2015 2016 2017 2018

CCALAC Operating Median CA FQHCs Median NATIONAL Median


Operating Margin


Bottom-Line Margin

5.5%

6.8%

4.9%

5.9%

6.8% 7.3%

5.3% 5.4% 5.1%

5.5%

4.4% 4.1%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

2015 2016 2017 2018

CCALAC CA FQHCs Median NATIONAL Median


Personnel-Related Expenses as a Percentage of Operating Expenses

72.0%

68.0%

72.1%

69.3%

70.8% 70.6%

72.5%

71.2% 70.9%

70.2%

71.8% 71.5%

65.0%

66.0%

67.0%

68.0%

69.0%

70.0%

71.0%

72.0%

73.0%

2015 2016 2017 2018



Days in Net Patients Receivables

54

48

43 40

44

38 37 38 41 41

39 38

0

10

20

30

40

50

60

2015 2016 2017 2018



Days Cash on Hand

43

59

81

97

71 79

92 94

53

63 67

71

0

20

40

60

80

100

120

2015 2016 2017 2018



Physician Visits per Physician FTE

2,500

2,600

2,700

2,800

2,900

3,000

3,100

3,200

3,300

3,400

2015 2016 2017 2018



Mid-Level Visits per Mid-Level FTE

2,000

2,200

2,400

2,600

2,800

3,000

3,200

3,400

3,600

2015 2016 2017 2018



Dental Visits per Dental Provider FTE

1,500

1,700

1,900

2,100

2,300

2,500

2,700

2015 2016 2017 2018



Median Growth Rates – Patients

1%

13%

7%

5%

3%

7%

4% 3% 3%

5% 5%

3%

0%

2%

4%

6%

8%

10%

12%

14%

2015 2016 2017 2018



Median Growth Rates – Visits

5%

14%

10% 9%

6%

9%

7% 7%

5%

7% 6%

5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

2015 2016 2017 2018



CCALAC Growth Rates by Service Line 2015-2018 Median Health Center

5% 5%

10% 12%

23%

12%

0%

5%

10%

15%

20%

25%

Medical

Patient

Growth Rate

Medical Visit

Growth Rate

Dental Patient

Growth Rate

Dental Visit

Growth Rate

Mental Health

Patient

Growth Rate

Mental Health

Visit Growth

Rate


CCALAC Median Health Center: Service Mix by Year

77% 79% 77% 75%

6% 8% 10% 13% 4% 4% 4% 5% 4% 3% 3% 4%

0%

20%

40%

60%

80%

100%

2015 2016 2017 2018

Enabling Visits as a Percentage of Total Visits

Mental Health Visits as a Percentage of Total Visits

Dental Visits as a Percentage of Total Visits

Medical Visits as a Percentage of Total Visits


CCALAC Patients per Payer as a Percent of Total Patients (Median Health Center)

47% 55% 60% 64% 64% 65%

82% 81%

87% 86% 86% 85%

0%

20%

40%

60%

80%

100%

120%

140%

160%

2013 2014 2015 2016 2017 2018

CCALAC Medi-Cal

Medicaid Collections as Percentage of Total Collections

Medicaid Patients as Percentage of Total Patients

45%

35% 29% 27% 24% 24%

5%

5%

3% 3%

3% 2%

0%

10%

20%

30%

40%

50%

60%

2013 2014 2015 2016 2017 2018

CCALAC Self-Pay/Uninsured

Self-Pay Collections as Percentage of Total Collections

Self-Pay Patients as Percentage of Total Patients

Evolving Business Models


Transition from FFS to Value-Based Reimbursement

*Capital Link Performance Benchmarking Toolkit


Transition from FFS to Value-Based Reimbursement


Medical Patients per Medical Provider FTE

750

800

850

900

950

1,000

2015 2016 2017 2018



Medical Team Productivity: Medical Patients per Medical Staff FTE

260

270

280

290

300

310

320

2015 2016 2017 2018



Cost per Patient

$851 $868 $875 $940

$887 $959

$1,049 $1,075

$801 $837 $873 $917

$0

$200

$400

$600

$800

$1,000

$1,200

2015 2016 2017 2018



Cost per Visit

$193 $204 $204

$219 $201

$220 $230 $239

$208 $218

$233 $242

$0

$50

$100

$150

$200

$250

$300

2015 2016 2017 2018



CCALAC Medical Support Staff by Medical Provider Median Health Center

How Does Your Health Center Compare?


Performance Evaluation Profile (PEP)


Resources



Benchmarking is an Ongoing Process!!


Questions? Contact Us

Tony Skapinsky—CA Office Project Consultant Tel: 805-544-2355 [email protected]

Jose Fonseca—CA Office Associate Project Consultant Tel: 805-819-8909 [email protected]

Susan Petrie Chief Operating Officer Tel: 617-988-2248 [email protected] Jonathan Chapman Chief Project Officer Tel: 225-241-6855 [email protected]

mailto:[email protected]




Advancing the Financial Strength of Los Angeles County Clinics...• Launched in 1995, nonprofit,...

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