The gist
The audit, conducted by Mazars USA, highlighted issues with insufficient documentation and inconsistent reporting methods.
The report specifically lists concerns with the fundamental agreements made by Central Health with the Dell Medical School at The University of Texas at Austin, or Dell Med.
Since 2014, Dell Med has received $35 million of taxpayer dollars annually paid by Central Health with the intent to support increased capacity for greater care of the area’s poorest residents.
A lawsuit filed in 2017 spurred some of the initial unease from community members regarding the hospital district’s handling of tax dollars. County commissioners officially authorized a $845,000 contract in 2022 with Mazars USA to conduct an independent performance audit of Central Health.
Per the report, a little more than 80% of that funding is used to pay staff salaries; however, Mazars was unable to link the salaries paid to a direct number of outcomes or number of patients served due to a lack of consistent documentation by Dell Med and Central Health.
Mazars USA representative Steve Herbst previously told commissioners there are different understandings of the affiliation agreement between Central Health and Dell Med.
The update
Central Health officials informed commissioners that, of the 115 Mazars recommendations, the agency has implemented 34 and is actively working on addressing 63 more.
Among the 63 policies currently being addressed, Central Health has plans for:
- Providing greater language accessibility for both clinical care and written materials
- Offering a “provider directory” resource for Medical Access Program, or MAP, members
- Incorporating periodic internal audit reviews
- Ensuring public material and agendas are made available in timely manner, in accordance Texas Government Code
- Reviewing and creating policy for third-party contracts
The hospital district has brought in a team dedicated to the creation and review of procedures, Monica Crowley, Central Health’s chief strategy and planning officer, said.
There are six remaining recommendations marked as unresolved and another 12 that are not applicable, as they all pertain to the affiliation agreement with Dell Med, Crowley added.
“This recommendation would require renegotiation of the affiliation agreement, which [Dell Med] indicated in its letter to Mazars they are not open to renegotiation,” Central Health documents state.
Central Health’s response further indicated that the agency is working with Dell Med to obtain more information on salaries funded by Central Health dollars—in line with proposed third-party contract policy recommendations from the Marzars report.
Crowley said the hospital district is able to renegotiate the terms of their affiliation agreement when their contract with Dell Med comes to term; however, the initial affiliation agreement signed in 2014 expresses a 25-year term ending in 2039.
Quote of note
“We are in close contact with our UT colleagues. On the UT side, not to speak for them, but I understand there are quite a lot of uncertainties at the federal level that they're managing,” Central Health CEO Dr. Patrick Lee said. “We have not made as much progress as we would have liked to make, but we will diligently focus on that. We have a mutual agreement to really work, especially on the problem of communicating the value of the work that [Dell Med] provides—that I know they provide to our community.”
Diving deeper
Though Dell Med has been a key component in direct clinical care for Central Health over the yeasr, the organization has more recently shifted its goals and structure to support more direct care from within.
In 2021, the district launched its seven-year Healthcare Equity Plan—a nearly $700 million initiative to invest in more direct care methods and clinics.
Since then, in partnership with CommUnityCare Health Centers, Central Health has launched several new care clinics as well as a dozen new lines of specialty care.
The newest clinic to launch, Del Valle Health and Wellness Center, saw its first patients March 10, offering primary care—both adult and pediatric—dental care, mental health care and a drive-through pharmacy.
Additionally, the hospital district expanded its Bridge program this year, adding a mobile component in partnership with Travis County EMS.
The Bridge program works to close gaps in care by tackling environmental factors such as housing, access to medications and wound care. The program also helps reduce hospitalization and jail visits by meeting patients where they are medically and physically.
Central Health has also substantially increased enrollment in its Medical Access Program, which provides insurance for the county’s low-income and uninsured population, Lee said.
He highlighted the "meteoric growth” of memberships, which have more than quadrupled in recent years:
- 2023: 6,000 MAP members
- 2024: 14,000 MAP members
- 2025: 29,000 MAP members
He explained the agency employed the “innovative” use of an AI call agent to keep up with the demand of new MAP members.
Something to note
Central Health leaders outlined a new emphasis on collective engagement as the agency reevaluates its relationship with the district’s clinical service partner CommUnityCare.
Tension between Central Health and CommUnityCare arose after Lee placed Jason Fournier, the former CEO of CommUnityCare, on administrative leave without releasing additional information or formal allegations.
Fournier was officially dismissed in November.
“[We want] a very deliberative discussion and acknowledgement that we're stronger together,” Central Health board chair Ann Kitchen said. “We have to figure out how we're working together and that we have to respect each other's roles... We need to double down on collaboration.”
