What did UPC face in 2005?

Gail Speedy Mayeaux: In 2005, we were a struggling public health organization facing a sort of confluence of things. The first was that in 2005 and 2006, the two counties we served — Cattaraugus and Alleghany – were fully transitioning to the Managed Care Organization (MCO) model for Medicaid. This meant that clinic rates organizations like ours had initially relied on had now gone away. In our case, the average reimbursement rate for a Medicaid visit went down from about $70 to about $32, even though it was costing us about $68 to take care of that patient. So, in 2006 when I took over, we were about a $3 million organization and we were in an incredible amount of debt. Where is UPC today?

Gail Speedy Mayeaux: Today, UPC – thanks to an incredible Leadership staff – is going to end 2017 at about $9.5 million in the black. We have been in the black as per our audit in 2007, and now are very well positioned. We’ve got solid assets. We’ve won the National Quality Award for the three years it’s been in existence. This award is typically given to the top performing health centers across the country. We are the only one in New York State – outside of Charles B. Wang — which is a health center outside of New York City, that has won it all three years.

We’ve also almost tripled in size. We’re at about 90 staff now, and we were about 40; and I have been UPC’s second CEO since I arrived in Feb. 2006.

I left the organization at the end of November for a different career opportunity which is very bittersweet. UPC has been such a huge part of me and I love this place. But it’s an importunity to slow down and have a little different life style. When did things start to turn the corner for UPC, leading you to where you are today?

Gail Speedy Mayeaux: I think there were actually three key pivot years.

In 2008, we were able to almost make it pay to be an Article 28 Diagnostic and Treatment Center (DTC).

Being an Article 28 DTC means that you are licensed by the New York State Department of Health to operate a clinic required to accept all persons without regard to ability to pay.

So, our model is such that we are the largest Medicaid provider and uninsured provider, as well as one of the largest primary care providers in Cattaraugus and Orleans Counties. We have always accepted everyone. We take particular pride in that our sliding fee scale slides all the way to “zero” so a patient would not have to pay anything if they were truly indigent.

In 2008, we were also able to expense manage ourselves down to where we were almost able to break even.

Then in 2009, we became an FQHC “look-alike” and that allowed us to access a cost-per-visit payment, so in that scenario where it cost us $70 to do the visit, and we were only getting paid $35; when we were able to get the Medicaid wrap around payments as an FQHC “look alike”, we were able to recoup that $35.

In 2009, when our first cost per visit and wrap around rate were set, (the cost per visit was actually $102 per visit), that allowed us the model to become financially sustainable, but we had such a back log.

The other way you expense manage yourself is of course you do late payment to vendors. That’s what all struggling business do, that’s what we did.

At that point, when you have a sustainable model, now you have to start managing cash flow and managing cleaning up this vendor ledger. What makes you an FQHC “look alike” vs. being a Federal grantee?

Gail Speedy Mayeaux: An FQHC “look-alike” means you meet all of the standards for Section 330 federal grant funding; but you don’t get any Section 330 federal grant funding. So why would you do that? Why would you meet all of these standards and 19 federal grant requirements?

From a business perspective, there’s no way to make that pay.

But from a humanitarian and community perspective, it’s the right thing to do for the people you’re serving; and you’re serving the most vulnerable population, but there’s always that battle: there’s no romance without finance.…”

The inducement to become a “look alike” is that it opens up a couple of benefits for you. Primarily, the biggest benefit is that it allows you to get cost-based reimbursement. So in the age of managed Medicaid, you are not always reimbursed the full cost of seeing the vulnerable patient; plus you are seeing at that time 10 to 15 percent uninsured. It allowed you to access cost based reimbursement for these folks who used Medicaid, while also allowing you to be financially stable. And that was the biggest benefit.

Adding Chief Financial Officer Michael Malick to the UPC team in 2012 accelerated the organization’s “infrastructure build” strategy and enabled Gail Speedy Mayeaux to focus on “wearing one hat” as CEO. Were there any other important developments?

Gail Speedy Mayeaux: The final pivot point was June 20, 2012 when we became an FQHC grantee and Mike (Chief Financial Officer Michael Malick) came shortly after, we were still cleaning up the vendor ledger. That’s how long it took. What did Mike as new Chief Financial Officer bring to UPC?

Gail Speedy Mayeaux: Mike implemented the strategy beyond ledger clean up. He began asking: “How do we start to use our resources to build out the infrastructure?” That was really what we tasked Mike with: “What do we look like when we finally don’t have all this debt?”



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