L.A. CARE HEALTH PLAN BOARD OF GOVERNORS MEETING # 207
April 5, 2012 ● 2:00 PM – 5:00 PM
Vision
A healthy community in which all have access to the health care they need.
Mission
To provide access to quality health care for Los Angeles County’s vulnerable and low income communities and residents and to support the safety net required to achieve that purpose.
Values
We are committed to the promotion of accessible, high quality health care that:
• Is accountable and responsive to the communities we serve and focuses on making a difference;
• Fosters and honors strong relationships with our health care providers and the safety net;
• Is driven by continuous improvement and innovation and aims for excellence and integrity;
• Reflects a commitment to cultural diversity and the knowledge necessary to serve our members with respect and competence;
• Empowers our members, by providing health care choices and education and by encouraging their input as partners in improving their health;
• Demonstrates L.A. Care’s leadership by active engagement in community, statewide and national collaborations and initiatives aimed at improving the lives of vulnerable low income individuals and families; and
• Puts people first, recognizing the centrality of our members and the staff who serve them.
BOARD OF GOVERNORS Thursday, April 5, 2012 (Meeting No. 207) 2:00 - 5:00 PM, L.A. Care Health Plan 1055 W Seventh Street, 10th Floor, Los Angeles, CA 90017
All votes in a teleconferenced meeting shall be by roll call.
Teleconference Information Call (866) 528-2256 Access Code 7485299
Teleconference Sites Honorable Gloria Molina G. Michael Roybal, MD, MPH Los Angeles County Board of Supervisors 5240 Mimosa Lane 500 W. Temple Street #856 Las Cruces, NM 88001 Los Angeles, CA 90012
AGENDA I. Welcome Walter A. Zelman, PhD Chair
II. Approval of today’s meeting agenda Chair
III. Approval of March 1, 2012 Meeting Minutes Chair
IV. Chairperson’s Report Chair • Board and Committee Meeting Processes
V. Chief Executive Officer’s Report Howard A. Kahn • Board of Governors Retreat Chief Executive Officer
• Changing Marketplace • Operations Report • Second Quarter Organizational Performance Report
VI. Chief Medical Officer’s Report Elaine Batchlor, MD, MPH Chief Medical Officer
VII. Standing Committee Reports
A. Executive Committee Walter A. Zelman, PhD Chair
* - Proposed Consent Agenda items Last saved 4/2/2012, 9:10:52 AM Agenda - Board of Governors Meeting April 5, 2012 Page 2 of 4
1. Legislative Update/Actions Cherie Fields • State Issues Director of Government Affairs • Federal Issues • Local Health Plans of California Sponsored Legislation Concerning Quorum for Teleconferenced Meetings
2. Tranquada IV Grant Recommendations Elaine Batchlor, MD
Motion EXE 100.0412 To increase the budget for the Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative IV by $100,000 and approve seven grants for a total of $1,100,000 as outlined in the enclosed memo and Attachment A.
3. Community Health Councils – South LA Diabetes Initiative Elaine Batchlor, MD
Motion EXE 101.0412 To approve a $100,000 grant to the Community Health Councils to implement and evaluate the “Enhanced Diabetes Care Management Initiative” in South Los Angeles.
4. Community Health Investment Fund (CHIF) Annual Report Elaine Batchlor, MD
B. Finance & Budget Committee Philip L. Browning Chair
1. Annual Sponsorship Report Elena Stern Director, Communications & Marketing 2. Financial Report Tim Reilly Chief Financial Officer Motion FIN 100.0412 To accept the Financial Report for the five months ended February 29, 2012, as submitted.
3. Cornerstone Consulting Contract Amendment Gene Fernandez Chief Information Officer Motion FIN 101.0412 To authorize Howard A. Kahn, Chief Executive Officer, to execute a contract amendment with Cornerstone Data Strategies, Inc. to complete the new core system vendor negotiations process and provide project management resources in an amount not to exceed $1,585,000.
4. Language Select Contract Amendment Elaine Batchlor, MD
Motion FIN 102.0412 To authorize staff to amend the Language Select contract to add $410,000, extend the contract term to December 31, 2012 for a total amount not to exceed $685,000, and execute a contract for up to three years with equal or better terms for a total amount not to exceed $2,400,000.
* - Proposed Consent Agenda items Agenda - Board of Governors Meeting April 5, 2012 Page 3 of 4
VIII. Periodic Committee Reports
A. Governance Committee Mark Gamble, Chair
B. Services Agreement Committee Elected Chair
IX. Advisory Committee Reports
A. Executive Community Advisory Committee Mario Ramos/Maria Guerrero
X. Public Comments Chair
XI. ADJOURN TO CLOSED SESSION (Estimated time: 45 mins) Chair
A. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m) • DHCS Medi-Cal Rate • Provider Rates • Plan Partner Medi-Cal Rates
B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare & Institutions Code Section 14087.38(n) • Discussion concerning New Product Lines • Discussion concerning Core System Modernization Estimated date of public disclosure: March 2014 • Consideration of options to minimize managed care organization tax (AB 1422) Estimated date of public disclosure: April 2014 • Discussion concerning issues related to LA County Board of Supervisors’ motion on HMA Recommendations Estimated date of public disclosure: October 2013
C. CONFERENCE WITH REAL PROPERTY NEGOTIATORS Pursuant to Section 54956.8 of the Ralph M. Brown Act Property: 1055 West 7th Street, Los Angeles Agency Negotiator: Howard A. Kahn Negotiating Parties: Jamison Properties, 1055 West Seventh, LLC Under Negotiation: Price and Terms of Payment
D. PUBLIC EMPLOYEE APPOINTMENT Pursuant to Section 54957 of the Ralph M. Brown Act Title: Compliance Officer
E. CONFERENCE WITH LEGAL COUNSEL--ANTICIPATED LITIGATION Significant exposure to litigation pursuant to Section 54956.9 (b) of Ralph M. Brown Act: Three (3) Potential Cases
F. PUBLIC EMPLOYEE PERFORMANCE EVALUATION Pursuant to Section 54957 of the Ralph M. Brown Act Title: Chief Executive Officer
* - Proposed Consent Agenda items Agenda - Board of Governors Meeting April 5, 2012 Page 4 of 4
G. CONFERENCE WITH LEGAL COUNSEL – EXISTING LITIGATION Pursuant to subdivision (a) of Section 54956.9 of the Ralph M. Brown Act. Cedars-Sinai Health Systems v. L.A. Care Health Plan (Anthem Blue Cross) California Department of Health Services Office of Administrative Hearings and Appeals; Emergency Services Claim Dispute Nos. 859-06-RW, et seq. and 1599-06-RW, et seq.
XII. RECONVENE IN OPEN SESSION Chair
XIII. Adjournment Chair
The order of items appearing on the agenda may change during the meeting.
Please keep your comments to three minutes or less.
THE PUBLIC MAY ADDRESS THE BOARD OF GOVERNORS ON ALL MATTERS LISTED ON THE AGENDA BY FILLING OUT A “REQUEST TO ADDRESS” FORM AND SUBMITTING THE FORM TO L.A. CARE STAFF PRESENT AT THE MEETING BEFORE THE AGENDA ITEM IS ANNOUNCED. YOUR NAME WILL BE CALLED WHEN THE ITEM YOU ARE ADDRESSING IS DISCUSSED. THE PUBLIC MAY ALSO ADDRESS THE BOARD ON L.A. CARE MATTERS DURING PUBLIC COMMENT.
NOTE: THE BOARD OF GOVERNORS CURRENTLY MEETS ON THE FIRST THURSDAY OF MOST MONTHS AT 2:00 P.M. POSTED AGENDA and PRINTED MEETING MATERIALS ARE AVAILABLE FOR INSPECTION AT Board Services, 1055 W. 7th Street – 10th Floor, Los Angeles, California 90017
Any documents distributed to a majority of the Board Members regarding any agenda item for an open session after the agenda has been posted will be available for public inspection at Board Services, L.A. Care Health Plan, 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017, during regular business hours, 8:00 a.m. to 5:00 p.m., Monday – Friday.
Meetings are accessible to people with disabilities. Individuals who may require any accommodations (alternative formats – i.e., large print, audio, translation of meeting materials, interpretation, etc.) to participate in this meeting and wish to request an alternative format for the agenda, meeting notice, and meeting packet may contact L.A. Care’s Board Services Department at (213) 694-1250. Notification at least one (1) week before the meeting will enable us to try and make reasonable arrangements to ensure accessibility to the meetings and to the related materials.
* - Proposed Consent Agenda items Board of Governors General Meeting #206 Meeting Minutes – March 1, 2012 L.A. Care Health Plan Conference Room 29ABCD 555 W. Fifth Street, Los Angeles, CA 90013 All votes during a teleconferenced portion of the meeting were by roll call.
Members Management/Staff Walter A. Zelman, PhD, Chairperson* Jim Mangia, MPH* Howard A. Kahn, Chief Executive Officer Thomas Horowitz, DO, Vice Chairperson Louise McCarthy, MPP** Elaine Batchlor, MD, MPH, Chief Medical Officer Philip L. Browning Treasurer* Supervisor Gloria Molina** Barbara Cook, Chief, Human and Community Resources Mario A. Ramos, Secretary* Michael A. Rembis, FACHE Gene Fernandez, Chief Information Officer Mark Gamble G. Michael Roybal, MD, MPH Augustavia J. Haydel, Esq., General Counsel Maria Guerrero John F. Schunhoff, PhD Tim Reilly, Chief Financial Officer Thomas S. Klitzner, MD, PhD* John Wallace, Chief of Staff *absent; ** via telephone
AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN CALL TO ORDER Thomas Horowitz, D.O. Vice Chairperson, called the meeting to order at 2:03 p.m.
Thomas Horowitz, D.O. Vice-Chairperson
APPROVAL OF Vice-Chairperson Horowitz indicated that Item IX. C.4, consideration of Motion COM 103, Approved unanimously MEETING AGENDA was postponed to a future meeting at the request of the hospital association. Today’s agenda by roll call. 7 AYES was approved as amended. (Gamble, Guerrero, Thomas Horowitz, D.O. Horowitz, McCarthy,
Rembis, Roybal, Schunhoff). Member Molina did not vote. APPROVAL OF The Executive Committee approved six motions to be considered under the consent agenda. Motion to Approve the CONSENT AGENDA FIN 100 Increase in Expenditures to Black Box Consent Agenda and FIN 101 Amendment to AppleCare Insurance Services contract Motion to approve the Thomas Horowitz, D.O. COM 100 2012 Code of Conduct February minutes were COM 101 2012 Compliance Plans for Special Needs Plan and Non-Medicare Products simultaneously COM 102 Policies ISTS 020 and ISTS 029 considered and approved ECA 100 Approval of RCAC Members unanimously. 8 AYES
Page 1 of 10 DRAFT AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ACCEPTANCE OF The minutes of the February 2, 2012 meeting were approved as submitted. (Gamble, Guerrero, MEETING MINUTES Horowitz, McCarthy, Molina, Rembis, Roybal, Thomas Horowitz, D.O. Schunhoff) CHAIRPERSON’S There was no report from the Chairperson. REPORT
CHIEF EXECUTIVE Howard A. Kahn, Chief Executive Officer, referred members to the written report included in the OFFICER’S REPORT materials for this meeting (a copy of Mr. Kahn’s report may be obtained by contacting Board Services). Mr. Kahn introduced three new members of L.A. Care’s management team: Howard A. Kahn • Elena Stern – Director, Communications and Marketing • Maria Calleros – Director, Safety Net Initiatives • Lance MacLean – Senior Manager, Facilities Services
He also informed the Board that, after 13 years, Rayne Johnson has submitted his resignation as the Senior Director of Information Services at L.A. Care. Mr. Johnson has accepted the position of Chief Information Officer of Santa Clara Health Plan. Mr. Kahn expressed his regret that Mr. Johnson is leaving L.A. Care and he congratulated Mr. Johnson on his new position.
• Mr. Kahn reported that L.A. Care submitted a response to the duals pilot request for solutions on February 24, 2012. L.A. Care is applying in collaboration with Health Net, as required for two-plan counties. The proposal is substantially the same as the version previously reviewed by the Board of Governors. (A copy of the proposal is available by contacting Board Services.) A total of 22 applications were submitted from 10 counties in California. • The California Department of Health Care Services (DHCS) announced on Friday, February 17, 2012, that the elimination of the Adult Day Health Center (ADHC) program will be postponed until March 31. The one month delay is in response to a request from the Centers for Medicare and Medicaid Services (CMS) for more time to process the amendment. California’s replacement program, Community Based Adult Services (CBAS) is now scheduled to launch on April 1. • Richard Chambers, CEO of Cal Optima, the county organized health system in Orange County, will be leaving his position in April to become President of Molina Healthcare of California. His departure comes amid increased scrutiny of the Cal Optima Board by members of the Orange County Board of Supervisors.
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AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN • Yesterday, Mr. Kahn spoke at the UCLA Health Care Forum on California’s Health Benefit Exchange with Peter Lee, ED of the California Health Benefit Exchange, and Tom Epstein, VP, Public Affairs of Blue Shield of California. • Construction of L.A. Care’s expansion office space on the fourth floor should be completed in six weeks. Additional space is being researched to accommodate continued growth.
STRATEGIC John Wallace, Chief of Staff, introduced Laura Jaramillo, Director, Product Management. Mr. Wallace DISCUSSION: reported that Ms. Jaramillo has been spearheading efforts to design a new contracting program COMPENSATION AND for L.A. Care’s direct Medi-Cal line of business and authored the narrative that is included with CARE ALIGNMENT the presentation in the materials for this meeting (a copy of the presentation may be obtained by PLAN (C-CAP) FOR contacting Board Services). Since last June, staff has been carefully and methodically reviewing the HOSPITAL SERVICES new contracting model with input from impacted hospitals and independent physician associations (IPAs). The model attempts to align the hospitals, the plan and the IPAs so that John Wallace everybody is working together to eliminate shortfalls in today’s contracting methods, and to put all incentives in the right place to manage care and shorten hospital stays where appropriate. The model also is being designed to benefit all the parties.
Ms. Jaramillo discussed the feedback and adjustments made in response to the comments received from over 40 organizations, including hospitals, independent physician associations and their contracted managed service organizations, to which staff presented the C-CAP model. One of changes made to the C-CAP model in response to stakeholder feedback was the addition of pre-prepayment provisions in order to address cash flow concerns and a potential negative impact on disproportionate share hospital (DSH) revenue. Contracts including the pre- payment provisions would be offered to hospitals that qualify based on defined criteria.
The next steps will include setting up meetings with the hospital association and physician group representatives to present a final C-CAP model. During the Summer of 2012, L.A. Care will begin negotiating with providers that formerly had dual risk contracts with Community Health Plan. Several hospitals have asked L.A. Care to start testing the model as soon as possible this Spring.
In response to questions about the delegation of services in the agreement, particularly with regard to care management and utilization management services, Ms. Jaramillo noted that the division of financial responsibility among the parties will be the same as much as possible, but because of the differences in the services provided by hospitals, there may be variations.
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AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Mr. Kahn indicated that L.A. Care is also looking to build quality factors with financial incentives into the contract arrangements.
ECAC Chairperson Vice-Chairperson Horowitz introduced Hilda Perez, Chairperson of L.A. Care’s Executive Community Advisory Committee (ECAC).
Ms. Perez informed the Board that ECAC is working on changes to the RCAC operating rules and guidelines.
UPDATE ON STATUS Augustavia J. Haydel, Esq., General Counsel, provided an update concerning L.A. Care OF L.A. CARE Community Health, L.A. Care’s non-profit organization. L.A. Care staff is considering moving COMMUNITY non-Medi-Cal lines of business into the 501(c) 4 organization to avoid imposition by state HEALTH regulators of the 2.35% managed care organization premium tax. Further information and recommendations from staff will be presented at a future meeting of the Board of Governors. Augustavia J. Haydel, Esq.
STANDING COMMITTEE REPORTS EXECUTIVE The Executive Committee met on February 22, 2012. In closed session, the Committee COMMITTEE discussed Contract Rates and received a report involving Trade Secrets. There was no report from the closed session. Under authority delegated by the Board of Governors, the Committee Thomas Horowitz, D.O. also reviewed statistics from the 2010-11 Human Resources Annual Report presented by Barbara Cook. (A copy of the minutes of this meeting may be requested from Board Services.)
Legislative Update/ Cherie Fields, Director of Government Affairs, reported: Actions Federal
Cherie Fields • President Obama released a draft federal budget on February 13, 2012. It included the phase down of Medicaid provider taxes, increases to Medicare premiums, creates a blended rate for Medicaid and the Children’s Health Insurance Program, and revises Medicare drug payment policies. It proposes $365 billion in savings over ten years, with $270 billion of those savings from Medicare cuts and $252 billion in cuts to Medicaid programs. This draft is a beginning for negotiations on a final budget. • Seven California legislators have announced retirement because of the redrawing of district boundaries. There will be two races in Southern California with just two candidates. • Governor Brown was in Washington D.C. recently and met with Health and Human Services Secretary Kathleen Sebelius regarding his cost savings proposals for Medicaid. There are reports that he may achieve some flexibility for his proposed cuts.
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AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN • L.A. Care has been briefing Los Angeles congressional delegation on its application for the duals pilot and has received letters of support.
State • Senate Pro Tem Steinberg and Speaker Perez held a press conference on bills related to the duals long term care support services, sponsored by Service Employees International Union. L.A. Care staff is analyzing the bills and will continue to work with L.A. County on this issue. • The Senate Budget Committee held a hearing earlier in the week on long-term care integration and the duals demonstration pilots. The Assembly Budget Committee will hold a similar hearing on March 7. Key concerns expressed by Senate committee members at the hearing focused on the proposed increase in the number of pilots from four to ten, which seems to exceed the number authorized in the legislation which could be characterized as a pilot program. Another concern was DHCS’ lack of communication in the SPD transition with intended enrollees in advance, and with state’s inability to adequately process Medical Exemption Requests. • The budget proposal to move the Healthy Families program into Medi-Cal is being discussed throughout California. The budget includes a 26% rate cut regardless of the potential change. • Mr. Kahn added that the large population size exceeds what could be routinely characterized as a pilot in the counties being considered for the duals pilot whether the pilot is implemented in four or ten counties. Ms. Fields noted that current legislation allows four counties to participate. In response to a question, Ms. Fields reported that the concerns are being expressed by Budget Committee members Emmerson, Alquist, and several other members.
FINANCE & BUDGET The Finance & Budget Committee met on February 22. (A copy of the minutes of this meeting may be COMMITTEE requested from Board Services.) Topics discussed in closed session include Plan Partner Medi-Cal Rates, provider rates, new product lines, core system modernization project, and issues related Mike Rembis to LA County Board of Supervisors’ motion on HMA Recommendation.
There was a technical issue with approval of motions, so the Committee met again on February 28, 2012 by telephone to re-vote on four motions.
Per the Committee’s delegated authority from the Board to authorize expenditures related to property negotiations and construction, motion FIN-A approved a budget of $2,915,000 for
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AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN construction on the fourth and fifth floors. The Committee reviewed and approved motion FIN-B, to approve execution of a contract with The Lewin Group for a compliance assessment.
Financial Report Tim Reilly, Chief Financial Officer, presented the highlights of the Financial Report: • January performance resulted in surplus of $4 million or 2.7% on revenue of $147.2 million, Tim Reilly mainly due to retroactive maternity kick payment revenue. • Fiscal year-to-date results for L.A. Care’s directly contracted line of business (MCLA) shows a deficit of $2.8 million or -1.8% on revenue of $153 million. Performance was $1.3 million favorable to forecasts, driven by favorable cost of health care and lower administrative expenses. • MCLA’s SPD membership increased by 11,363 members to reach 56,556 in January.
In response to an inquiry about the timing of payments and adjustments to the revenues and Approved unanimously. 8 expenses. Mr. Reilly responded that accounting standards require that prior period revenues or AYES (Rembis, expenses be adjusted in current period statements. Horowitz, McCarthy,
Motion BOG 100.0312 Schunhoff, Roybal, To accept the Financial Report for the four months ended January 31, 2012, as Gamble, Guerrero and Molina) submitted. Black Box Contract Motion FIN 100.0312* Approved unanimously Extension To approve an increase in expenditures for services from Black Box to $1,257,000 for under the Consent Rayne Johnson fiscal year 2012. Agenda. 8 AYES
AppleCare Insurance Motion FIN 101.0312* Services Contract Approved unanimously To amend AppleCare Insurance Services contract for the term of March 1, 2012 to Amendment under the Consent December 31, 2012. The amendment amount is $448,062, bringing the contract total to Agenda. 8 AYES Elaine Batchlor, MD, MPH $645,062 through the amended contract term.
COMPLIANCE & Vice Chairperson Horowitz reported that the Committee met on February 16, 2012: QUALITY • Jim Mangia was unanimously re-elected Chairperson of the Compliance & Quality COMMITTEE Committee. • Howard Kahn reported on the December 13, 2011 California State Auditor’s Office Report Thomas Horowitz, D.O. on the Medi-Cal Managed Health Care Programs at eight local initiatives (LIs) in California. o The audit was commissioned by the Joint Legislative Committee, partly because of concerns with Kern County Health System. Board of Governors Meeting Page 6 of 10 March 1, 2011 DRAFT
AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN o The report was positive and there were no recommendations or corrective action plans (CAP) for L.A. Care. o The report focused on Tangible Net Equity (TNE) and administrative cost percentages, cash on hand (liquidity) and executive compensation. ¾ All LIs and commercial plans under the two-plan model have TNE actual balances above the minimum required by state regulators. ¾ Administrative expenses are in line with regulations and requirements. ¾ LIs use comparable methods to establish and approve executive compensation. The report noted that L.A. Care’s senior executive compensation level is higher than of other LIs due to L.A. Care’s large membership and size of its provider network. The report described executive compensation of the CEO as properly approved in accordance with policies, contracts and pay structure approved by L.A. Care’s Board of Governors. L.A. Care’s pattern of periodically conducting salary market surveys was specifically mentioned. • The Committee reviewed Motions COM 100, COM 101, COM 102 approved earlier today under the Consent Agenda. • The Committee reviewed and approved Motion COM 103 Financial Compliance Policy FC-004 (Minimum Requirements for Capital Hospitals), which was on today’s agenda but was postponed earlier in this meeting.
2012 Code of Conduct Approved unanimously Motion COM 100.0312* under the Consent André Acosta To approve the 2012 Code of Conduct document, as attached. Agenda. 8 AYES 2012 Medicare and Non- Motion COM 101.0312* Approved unanimously Medicare Compliance To approve the following 2012 Compliance Plans and Workplans, as submitted: under the Consent Plans • 2012 Special Needs Plan (SNP) Compliance Plan Agenda. 8 AYES
André Acosta • 2012 Non-Medicare Compliance Plan
Information Services Policies & Procedures ISTS-020 (Laptop and Motion COM 102.0312* Approved unanimously Mobile Devices) and To approve revisions to Information Services Policies & Procedures ISTS-020 (Laptop under the Consent ISTS-029 (Internet and Mobile Devices) and ISTS-029 (Internet Usage), as attached. Agenda. 8 AYES Board of Governors Meeting Page 7 of 10 March 1, 2011 DRAFT
AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Usage)
Gene Fernandez
Financial Compliance Policy FC-004 (Minimum Motion COM 103.0312 This item was postponed Requirements for To approve Financial Compliance Policy & Procedure FC-004 (Minimum Requirements for discussion at a future Capitated Hospitals) for Capitated Hospitals), as attached. meeting of the Board of Governors. Laura Jaramillo
PERIODIC COMMITTEE REPORTS GOVERNANCE Member Gamble reported that the Governance Committee met on February 16, 2012: COMMITTEE • The Committee approved the removal of Cynthia Jackson from RCAC 3 membership. The member has 60 days to appeal the decision to the Executive Committee. Mark Gamble • The Committee received a report on the status of RCAC membership since implementation of a new RCAC meeting structure in 2008. o RCACs have sustained a membership increase since 2008. o Based on member feedback, RCAC activities are more community focused. o The Executive Community Advisory Committee (ECAC) formed a workgroup to review RCAC membership rules and the application process. Recommendations were presented to ECAC in February and will also be presented to RCAC members for input and feedback at their meetings in March and April. • The Committee received a report on the timeline of the upcoming Consumer Member and Consumer Member Advocate Election. • Mr. Kahn provided an update on the status of expiring Board Member terms, the challenges with some nominating entities, and the possibility of creating a physician advisory committee. • The Committee postponed the election of a 2012 Committee Chair.
PUBLIC ADVISORY COMMITTEE REPORTS EXECUTIVE Member Guerrero reported that at the February ECAC meeting: COMMUNITY • ECAC members continue to discuss and develop recommendations to strengthen the ADVISORY guidelines and procedures that will support a more accountable regional community COMMITTEE advisory committee (RCAC) system. Recommendations will be reviewed and then
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AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN presented at the RCAC meetings for additional feedback. Mario Ramos/ • ECAC approved election procedures for the Consumer and Consumer Advocate seats. Maria Guerrero Health Promoters Program • Health Promoters have completed training on the 2012 program, “Access to Health and Health Care Reform.” • They have been studying at home, completing homework assignments and taking quizzes. • Eight health promoters were trained by L.A. Care health education staff to present a prenatal/postpartum curriculum “Healthy Mom, Healthy Baby," at RCAC meetings in February and March.
A RCAC Election Education Conference was held on Thursday, February 23, 2012 at the Los
Angeles Cathedral conference center. Board members Guerrero, Mangia, and Ramos
participated, along with former board members Carrie Broadus and Jim Lott, and staff members
Howard Kahn and Ellin Davtyan. RCAC members received information about the two
consumer board seats, and had time to ask questions. Staff from Board Services was also at the
event.
Motion ECA 100.0312* To approve the following candidate(s) to the Regional Community Advisory Committees (RCAC) as reviewed by the Executive Community Advisory Committee Approved unanimously (ECAC) during the February 08, 2012 ECAC meeting: under the Consent • Christina Vega, RCAC 2, Consumer Agenda. • Marilyn J. Harris, RCAC 6, Advocate, Los Angeles Unified School District – Food 8 AYES Services • Silvia Herrera de Andrade, RCAC 8, Consumer • James Padilla, RCAC 8, Consumer • Rosa Paz, RCAC 10, Consumer
PUBLIC COMMENT There was no public comment.
ADJOURN TO The Board adjourned to a closed session at 3:10 p.m. CLOSED SESSION A. CONTRACT RATES Walter A. Zelman, PhD Pursuant to Welfare and Institutions Code Section 14087.38(m) • DHCS Medi-Cal Rate
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AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN • Medi-Cal Managed Care Supplemental Payment (move to end)
B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare & Institutions Code Section 14087.38(n) • Discussion concerning Core System Modernization Project moved to end Estimated date of disclosure: March 2014 • Discussion concerning New Product Lines Estimated date of public disclosure: March 2014 • Discussion concerning issues related to LA County Board of Supervisors’ motion on HMA Recommendations Estimated date of public disclosure: October 2013 • Discussion concerning Core System Modernization Project moved from earlier Estimated date of disclosure: March 2014
C. CONFERENCE WITH LABOR NEGOTIATOR Pursuant to Section 54957 of the Ralph M. Brown Act Agency Negotiator: Howard A. Kahn Unrepresented Employee: All L.A. Care Employees
D. CONFERENCE WITH REAL PROPERTY NEGOTIATORS Pursuant to Section 54956.8 of the Ralph M. Brown Act Property: 1055 West 7th Street, Los Angeles Agency Negotiator: Howard A. Kahn Negotiating Parties: Jamison Properties, 1055 West Seventh, LLC Under Negotiation: Price and Terms of Payment
RECONVENE IN The Board reconvened in open session a 3:54 p.m. OPEN SESSION No reportable actions were taken during the closed session. Walter A. Zelman, PhD ADJOURNMENT The meeting was adjourned at 3:54 p.m.
Respectfully submitted by: Linda Merkens, Manager APPROVED BY: ______Malou Balones, Committee Liaison Mario Ramos Secretary Samantha Coins, Committee Liaison Date Signed ______
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March 18, 2012
To: L.A. Care Board of Governors From: Walter Zelman, Chair Subject: Meeting Processes
During the months of December, January and February I met with several board members, primarily the newer ones, to get their views on their roles as L.A. Care Board members and on our Board processes.
All board members stressed their respect for the way L.A. Care conducts its business. All had very positive views of L.A. Care leadership, staff, and processes. It is within this context that the following views were expressed.
Most of these views drew support and/or interest from more than one Board member. Some issues were only discussed with a few members.
Vision, Strategic Planning and the Future
1. Board and staff need to identify places where the board can be helpful in defining directions. The Board needs to focus some more on vision - on the big picture - and specifically, L.A. Care’s vision of an improved health care system, especially an improved delivery system, and the role we can play in getting there. Several Board members expressed a desire to see more time spent on the major issues, including more dialogue, including Board and senior staff, around those issues and options.
2. Retreat and strategic issues: There is a great awareness that L.A. Care is facing major new challenges and expansion issues. There is considerable interest in finding the best way for the Board to be of value in addressing these strategic challenges –both the policy and substance of them and the organizational and procedural attributes of the new challenges. Several members suggested that the Board spend a significant block of its retreat time reviewing its own role and processes and, if necessary, less time on the substantive issues, some of which can be addressed at regular board meetings. • Given the expansion of L.A. Care, the Board may need to rethink its role and processes. Is our committee system the best? What are the alternatives? If we are to have new members who should they represent? Are we making the best use of our Board meeting time?
Meeting Processes Page 2 of 4
3. Several Board members expressed interest in an overnight retreat –to allow for more personal interaction and more substantive discussion. Some suggested spouses be invited; social time is helpful. Alternatively, two one-day retreats – spring and fall, perhaps—might create the space for more strategic discussion without the challenges of an overnight retreat. • Last year’s retreat was seen as very successful, with good opportunity for Board dialogue and interaction.
4. Long-term Decision-making: There was some concern expressed that there are some times when the Board seems to be asked to make a decision too quickly; major decisions need to be vetted well in advance. Quick decisions or responses are not the best role for the Board.
Board Processes and Strategic Discussion
1. To address the interest in more strategic discussion, several suggestions were offered. • Topics selected for strategic discussion are usually the right ones and staff presentations are very good. But discussion with the Board might be improved if staff presentations are based on a 3-4 page summary of the issues in the Board packet. (Such reports are often included today). • Slides could be included in the packet; some could be part of a brief presentation • The 3-4 page summary might include discussion of: Why this issue is being presented to the Board? What are the toughest issues that need to be resolved? What are L.A. Care’s strengths and weaknesses in the issue area? What are some of the pros and cons of the key options? • Staff presentation needs to be short enough to allow for adequate Board discussion, based on the questions put to Board by the presenter and by the materials in the Board packet.
2. Board roles and participation: Time should be allotted for Board members to take a few minutes to outline their constituency’s views on key issues; it would help others to have the perspective of all. Perhaps one board member could do this each meeting.
3. Some staff reports may not require presentation before the Board. However, they may be necessary for accountability purposes or to keep people involved • Most staff reports should, where appropriate, highlight an issue or development on which Board input might be valued or needed. Such a process might move the staff report more towards an opening of a brief Board discussion on an issue as opposed to a straight report on which there might be some questions • If possible, consider having most staff reports on paper only. Time spent on them at committee or board meetings should be discussing the material, based on questions identified by staff presenter • Legislative reports are very helpful but might focus more on issues that have a unique LA perspective or impact rather than on overall health care-relevant news. • Note: Processes like those described above will not work if Board members do not review the material
Meeting Processes Page 3 of 4
4. Consent Calendar: There was wide agreement that the consent calendar could be expanded. However, such action may require some new emphasis on what is on the consent agenda, and some higher expectation that board members will review that list. • There was considerable confidence expressed in the committee system we have and some willingness of Board members to defer to decisions made in committees. • Committees should be able to recommend consent items to staff and/or the Executive Committee • Items ripe for consent: not controversial; were unanimously approved by a committee; item does not raise larger issues of which Board should be aware • As in the current process, any Board member may request an item be removed from consent • Consent items should be clearly displayed in Board papers
5. Committees: Several board members found committee discussions particularly interesting and productive. Reasons for this included: a smaller group; more time and a better setting for give and take amongst board and staff; more familiarity with the committee members as compared to the full board; greater informality. • These realities may be inevitable; Board meetings are going to be more formal. But there may be means of introducing more Board discussion into the Board meetings.
6. Committee membership: Chair needs to balance at least several considerations • With some exceptions, all Board members should serve on one of the regularly scheduled committees: Executive, Finance or Compliance and Quality • Service on a committee over more than a year builds expertise and is valuable • Some board members have particular knowledge that may make them particularly valuable on certain committees; e.g., physicians and C and Q. • However, there may be a value in encouraging members to sit different committees over time; this might apply in particular to long service on C and Q or Finance.
Other Matters
1. Focus on the delivery system: a number of Board members raised the central question of, how can L.A. Care become a catalyst for delivery system change?
2. L.A. Care may now be big enough to house a small research or think tank unit of its own. We need to think ahead about ways to maximize our capacity to positively influence the system. Staff space must be set aside for this. (NOTE: this suggestion did not come, as some might expect, from the Chair)
3. Pro forma discussion: There was some concern that some aspects of Board discussions seemed pro-forma or inadequate. The Board tends to focus on items on which they can engage; but then the rest of the meeting seems rushed. If the issues we rush through are not critical, they might be on consent; if they are, we should not rush through them. But, in any case, give pro-forma consideration to matters makes some Board members uneasy.
Meeting Processes Page 4 of 4
4. New board members: may need more individualized briefings to bring them up to speed. • A half or one-day retreat for new board members as a group might be worthwhile, at least if there are several new board members • A finance briefing for new (and some old) board members might also be of value.
5. Finance and budget: this committee may sometimes need more time.
March 29, 2012
TO: Board of Governors
FROM: Howard A. Kahn, Chief Executive Officer
SUBJECT: CEO Report – April 2012
Please find below an update on organizational activities that occurred in March 2012. Additional updates will be made during my CEO report at the April 5, 2012 Board meeting.
1. Board Retreat Planning At the March 2012 Executive Committee meeting, I reviewed with Committee members some preliminary thoughts on our initial planning of this year’s Board retreat. I have attached to my report an updated version of a memo describing possible discussion topics. In summary, the Chair and staff are proposing a one day Board retreat to be held on June 7 (the regular Board meeting day) at a central location, outside of L.A. Care’s offices. Proposed facilitated discussion topics include implications of provider market and health care reform changes on L.A. Care, our role in accelerating the transformation of the health care delivery system, current and future Board structure and processes, and L.A. Care’ mission in the changing environment. I will update Board members on the Executive Committee’s feedback at the April Board meeting.
2. California’s Dual Eligibles Demonstration Pilot On March 20, 2012, selected members of L.A. Care’s leadership team participated in a face to face interview, as part of the duals pilot competitive selection process, with several State agencies including the Department of Health Care Services (DHCS), the Department of Social Services, the Department of Rehabilitation, and others. Overall, we believe our interview went very well with no major surprises. DHCS will be announcing pilot counties in the first week of April, about one week later than the original timeline of late March. In anticipation of the announcement, L.A. Care is convening internal workgroups to begin planning, should LA County be selected as a pilot site.
Attached to my CEO report are two articles on recent changes in the provider marketplace in response to new opportunities to serve dual eligibles. Humana and CareSource, a non-profit Medicaid plan, have formed a strategic alliance in an effort to better serve dual eligible patients. Also, Aetna recently released a statement that they are ready and able to serve dual eligibles, despite not having a major stake in that market at this time. These issues, and their implications for L.A. Care and the health care delivery system in general, will be a discussion topic at the 2012 Board retreat. CEO Report – April 2012
3. Promotion of John Wallace to Chief Operating Officer I am excited to announce that John Wallace has accepted the position of Chief Operating Officer at L.A. Care. John joined L.A. Care in 2005 as Senior Director of Administration and two years later, moved into his most recent position as Chief of Staff. He joined the L.A. Care team following four years with the LA County Department of Health Services (DHS). John’s ability to handle many complex responsibilities simultaneously, form relationships on behalf of L.A. Care, lead internally and implement strategic programs has directly contributed to our continued growth and success. Please join me in congratulating John in his new role.
4. Healthy Families Community Provider Plan Designation In every county in California, one health plan that participates in the Healthy Families program is designated as the Community Provider Plan (CPP). This designation is given to plans that have the highest number/ratio of traditional and safety net providers in its network (Child Health and Disability Program providers, clinic providers, and hospitals) and allows the plan to offer a $3 per month discount to members. An audit is required in counties where there is a less than 15% difference between the highest scores or if there appears to be a change in the highest score from the year before. In Los Angeles County, the Community Health Plan (CHP) held the CPP designation since its inception. In previous years, in support of the County, L.A. Care did not compete for the designation. As part of the CHP transition, CHP agreed to release its CPP designation giving L.A. Care the opportunity to compete for it. In March, L.A. Care was informed that there would not be an audit for LA County as part of our application for the CPP designation. The official award announcement is scheduled at the MRMIB Board meeting on May 9, 2012. We are confident that L.A. Care’s recent expansion of the Healthy Families provider network to include the LA County DHS medical facilities has enhanced our safety net network and will enable us to achieve this designation.
5. Health Care Reform Supreme Court Hearing On March 26, 2012, the Supreme Court began a hearing in the case against health care reform. One of the central arguments being heard is the constitutionality of the individual mandate. According to Politico, there are several different possible outcomes in the case including: upholding the entire law, striking down the entire law, striking down specific aspects of the law, or deciding that an anti-injunction act prevents a ruling. Cherie Fields, Director of Government Affairs, will be providing additional information and updates at the Board meeting.
6. CalOptima Board Reappointment Delayed and Temporary CEO Appointed The Orange County Board of Supervisors voted to delay a normally routine reappointment of Ed Kacic as Chair of CalOptima’s Board of Directors. CalOptima is Orange County’s Medi-Cal managed care plan, under the county organized health system model. The organization is currently under investigation relating to allegations that Kacic used his position to obtain funds on behalf of the organization he works for, the Irvine Health Foundation. Additionally, the CalOptima Board of Directors appointed Michael Engelhard as its temporary CEO, in anticipation of the departure of Richard Chambers in April. As previously reported, Mr. Chambers announced last month that he would be assuming the role of President of Molina Healthcare of California. Mr. Engelhard is CalOptima’s current Chief Financial Officer.
CEO Report – April 2012
7. Payment Delays Reported at Gold Coast Health Plan Health care providers recently reported that Gold Coast Health Plan, Ventura County’s Medi-Cal managed care plan, is significantly behind in processing claims. This report comes on the heels of the resignation of Gold Coast’s CEO in mid-March and dismissal of the plan’s Human Resources Director and Interim Director of Operations the previous month. Gold Coast’s Chief Financial Officer also resigned in January 2012.
8. Cal eConnect Leadership Change On March 19, 2012, the Cal eConnect Board of Directors announced that Ted Kremer has decided to withdraw from his newly appointed role of President and CEO. Laura Landry, who has served as Interim CEO of Cal eConnect for the past six months, will assume the position. Mr. Kremer will remain as the lead of a local regional health information organization in Rochester, New York. The Cal eConnect Board, of which I am a member, is looking forward to making rapid progress in connecting California with a viable health information exchange in the coming months.
9. Health Plan Operations Report Please find attached to my report a quarterly update on health plan operations.
Effective immediately, Steve Krivit will take on the role of L.A. Care’s Interim Compliance Officer. Steve comes to us with over 30 years of Medi-Cal managed care experience and was one of the original staff members at California’s first County Organized Health System in Santa Barbara.
10. Quarterly Organizational Performance Report Please find attached to my report a quarterly update on organizational performance.
11. Meetings and Events of Interest L.A. Care provided downtown meeting space for several community activities and trainings this past month:
• March 2, 23, and 30 – Health Promoter Trainings • March 7 – CCALAC Member Meeting • March 13 – HITEC-LA Physician Advisory Council Meeting • March 27 – eConsult Pilot Physician Leadership Meeting • March 29 – Local Health Plans of California Marketing Staff Meeting
On March 9, I participated in a press event at the offices of the California Association of Provider Groups (CAPG) for Dr. Farzad Mostashari, National Coordinator for Health Information Technology (HIT) at the US Department of Health and Human Services. Dr. Mostashari and his team were promoting the Office of the National Coordinator’s strategic plan for advancing the exchange of health information (recently published in Health Affairs). Following the press event, L.A. Care hosted Dr. Mostashari and several HIT leaders and HIT early adopters at a collaborative meeting at our office.
CEO Report – April 2012
On March 19, L.A. Care hosted another Member Services job fair at our office. Out of the approximately 203 individuals who attended the job fair, 49 were tested and 25 were hired. We are very pleased with the turnout and results.
Attached to my report is a list of sponsorships and events of interest for March 2012.
Attachments: • March 2012 sponsorships and events of interest • Board retreat memo and marketplace changes articles • Health plan operations report • Second quarter organizational performance report CEO Report – April 2012
March 2012 Participation and Sponsorship List
Event Date Organization Event/Conference Location AltaMed Health Services Beverly Hilton Hotel, 3/9/2012 Annual Gala Corporations Beverly Hills, CA
Los Angeles County Commission Biltmore Hotel, 3/12/2012 Women of the Year Luncheon for Women Los Angeles, CA
Westin Hotel, 3/31/2012 Rancho los Amigos Foundation Amistad Gala Long Beach, CA
March 26, 2012
To: Executive Committee
From: Howard A. Kahn, Chief Executive Officer
Subject: Preliminary Thoughts on Board of Governors Retreat
The Board of Governors periodically holds day-long planning retreats to discuss high level strategic issues facing L.A. Care. These meetings have provided a team building opportunity for the Board to develop a unified vision for the organization and give guidance to senior management on where they want to see L.A. Care headed. The last Board retreat was held on June 2, 2011 at L.A. Care’s downtown offices.
At the direction of Dr. Zelman, L.A. Care staff is preparing for the upcoming Board of Governors retreat. Board members are being polled for dates in or around June 2012 that will maximize participation and representation of our stakeholders. At this time, June 7, 2012 appears to be the best option however, it is still being confirmed among Board members.
At past retreats, a significant portion of the day was dedicated to notable guests offering their perspectives on the health care environment and delivery system. This year’s retreat will stray from that agenda slightly by focusing more on interactive Board discussions on high level issues impacting L.A. Care today and in the future.
Below are some thoughts on agenda topics that we plan to discuss with the Executive Committee during my CEO Report. Dr. Zelman and staff would like to get a sense of which topics Board members are interested in discussing at the retreat. In an effort to make the retreat productive, staff will prepare brief white papers on selected issues to help prepare Board members for the day. Based on your feedback on the suggested topics below, staff will begin to formalize the agenda.
I. Introductory comments/Perspective from the Board Chair
II. External Speaker (TBD) A. A future look at the health care system and what it means to health plans
III. Facilitated Board Discussions/Breakout Sessions A. Discussion 1 - Impact of the changing health delivery system (health care reform, the Exchange, ACOs, duals pilot, primary care physician shortage) on: o The provider market - What are the implications of provider market and health care reform changes, and their resulting delivery system changes, on L.A. Care? o L.A. Care’s role in accelerating the transformation of the delivery system – What does L.A. Care want the future health care delivery system to look like? Can L.A. Care play an active part in moving it in the right direction?
B. Discussion 2 - Current and future Board structure and processes o Mission of the Board and representation of stakeholders o Standards for what agenda items come to the Board (vs. Committees) for review and approval o Board focus areas given new priorities and populations served (best ways the Board should use its time) o Implications for the Board and Board meetings for our higher profile organization
C. Discussion 3 - L.A. Care’s Mission o Does the changing health care system impact L.A. Care’s ability to achieve its core mission and values (e.g., protect the safety net, remain accountable to the community, etc)? o Does L.A. Care’s mission need to be revisited? o (An external speaker could be brought in for a brief overview of the role of a stakeholder Board.)
I have attached to this memo a few articles that were recently published on the changing health care market in response to the enrollment of dually eligible patients into managed care. We will be diving in depth into issues like these at the retreat but I welcome your preliminary thoughts on this issue and the retreat discussion topics during my CEO report at the Executive Committee meeting.
http://www.hcbd.biz/story.aspx?id=30934 Humana and CareSource Form Alliance to Serve Medicare and Medicaid Beneficiaries, Particularly ‘Dual-Eligible’ Population—Business Wire March 20, 2012
Humana Inc. (NYSE: HUM), one of the nation’s largest and most experienced Medicare companies, and CareSource, one of the most respected Medicaid companies in the U.S., are joining forces in a strategic alliance designed to enable both companies to more effectively serve Medicare and Medicaid beneficiaries – particularly people who qualify for both programs, the ‘dual-eligible’ population. Humana and CareSource anticipate working together in multiple states.
Humana, with more than 5 million members enrolled in Medicare plans (both Medicare Advantage medical plans and stand-alone prescription drug plans), brings more than 25 years of experience working with Medicare beneficiaries. CareSource, a community-based nonprofit with more than 900,000 Medicaid members (primarily in Ohio), has 23 years of experience in Medicaid.
Working together, the companies will benefit from each other’s respective strengths and expert knowledge of Medicare and Medicaid beneficiaries. Through the alliance, Humana and CareSource will deliver innovative solutions to federal and state governments looking to enhance care coordination and improve health outcomes for pregnant women, children, working-age adults, seniors, and individuals with disabilities, including the ‘dual-eligible’ population.
“As one of the nation’s leading Medicare companies, Humana sought a Medicaid partner with a corresponding level of experience and expertise, and we’re excited about what this new alliance with CareSource will mean for the members we’ll serve,” said Michael B. McCallister, Humana’s Chairman and Chief Executive Officer. “Without integration it is a challenge to manage and coordinate the care of beneficiaries enrolled in both Medicare and Medicaid. Humana looks forward to applying the expertise we’ve gained through the years to help Medicare-Medicaid enrollees get the care they need, when they need it, enabling them to remain in their homes and live healthier lives.”
“With all the changes in the health care industry, this alliance with Humana perfectly positions CareSource for strategic diversification and growth,” said Pamela Morris, CareSource President and Chief Executive Officer. “This alliance brings together the best of CareSource’s mission-based Medicaid expertise with Humana’s extensive network and experience with the senior population to offer full-service solutions to the state and federal governments.”
In states where Humana and CareSource work together, the relationship will be exclusive. The companies did not disclose financial terms of the alliance but acknowledged that there will be some level of risk-sharing.
Humana’s Medicare members live in all 50 states, Washington D.C. and Puerto Rico. The company has seen its Medicare membership grow from approximately 500,000 in 2005 to more than 5 million today. Humana has demonstrated its ability to help Medicare beneficiaries achieve better health outcomes than people enrolled in Original Medicare.
CareSource has more than 900,000 Medicaid members who reside in Ohio and Michigan, making CareSource Ohio’s largest Medicaid company and one of the larger Medicaid companies in the U.S. True to its mission to improve health care for the underserved, CareSource is known and well- respected for the outstanding work its associates do managing the care of Medicaid enrollees, especially in partnering with communities and social service organizations to provide the full range of services so many Medicaid enrollees need.
http://news.morningstar.com/all/ViewNews.aspx?article=/DJ/201203191654DOWJONESDJON LINE000439_univ.xml Aetna Ready For 'Dual Eligibles' Despite Commercial Focus – Dow Jones March 19, 2012
Aetna Inc. (AET) believes it can ably serve health-challenged patients covered by both Medicare and Medicaid, even though the company doesn't have a major stake in those markets.
Additionally, the commercially-focused health insurer doesn't need acquisitions to win business for "dual eligible" patients, according to Chief Financial Officer Joseph Zubretsky. Some of Aetna's big competitors have recently made deals with an eye on dual patients, and Aetna has faced questions about whether it has the right make-up for the market.
"I do believe we'll have the platforms built to be able to respond to this opportunity," Zubretsky said, speaking during an interview at Aetna's Hartford headquarters.
The market has significant potential, but will build over several years, giving Aetna time to grow its businesses from within, Zubretsky said. Meantime, Aetna has the capabilities within these businesses to address the kind of complex health problems dual patients often present, he said.
Dual patients, who represent a potential $300 billion market for health insurers, have become a hot topic as states and the federal government look for ways to better coordinate care and save money. These patients tend to rack up high costs due to their health challenges. A handful of states could have programs for covering dual patients up and running next year, and the market is expected to continue growing in subsequent years.
Managed-care companies could be big beneficiaries, but questions abound about which firms are best positioned to win state-by-state contracts. Analysts view Medicaid-focused insurers such as Molina Healthcare Inc. (MOH) and Centene Corp. (CNC) as potential winners, and bigger insurers such as UnitedHealth Group Inc. (UNH) and WellPoint Inc. (WLP) are also expected to compete based on their presence in both the Medicaid and Medicare markets.
Aetna has modest stakes in markets for government-based plans. At the end of last year, roughly 90% of Aetna's 18.5 million medical members were on commercial health plan, which are typically plans provided through employers.
Citigroup analyst Carl McDonald recently said Aetna's valuation has been hurt by "the company's lack of government exposure". Still, Aetna shares are up 33% over the last year, helped by patients keeping a lid on health costs after the recession.
Competitors including UnitedHealth, WellPoint and Cigna Inc. (CI) have all recently made Medicare-focused acquisitions that could improve their chances in the duals market. Aetna has been wary of paying too much, however, and feels there is time to build up its own businesses.
"The opportunity has been reflected in certain managed care valuations long before the revenue is ever going to show up," Zubretsky said. "This is not a cataclysmic event where $300 billion dollars is going to race into the market inside of 12 months. It's going to happen in a phased approach."
Aetna Chief Executive Mark Bertolini has talked about the company's ability to grow its Medicare business by keeping commercial members on Aetna plans when they switch over to Medicare. There are about 1.2 million Medicare-eligible members in the company's commercial membership. He also noted Aetna has more than doubled revenue in its Medicaid business since acquiring it in 2007.
-By Jon Kamp, Dow Jones Newswires; 617-654-6728; [email protected]
Health Plan Operations Report through March 2012 John Wallace, Chief Operating Officer
1 Claims • Volume has significantly increased since December 2011 due to SPD membership. Daily receipts increased over 150% in the past 6 months.
2 Claims • Claims inventory is arguably the most visible claims indicator for our providers. Inventory is the number of unprocessed claims at the end of each week. Controlling this inventory, especially during a period of heavy growth, is a major goal. • Days receipts on hand (DROH) is a standard measure of inventory relative to the volume of claims received. We have established an internal goal of keeping this less than 7 DROH. # = Days Receipt On Hand (DROH)
3 Claims • The cost of labor per claim is one indication of the overall efficiency of the claims payment process. To proactively mitigate potential inventory issues from the CHP transition, we hired ahead of anticipated volume, which is reflected in the December increase. The staffing strategy has generally resulted in modest efficiency gains.
4 Claims • Auto adjudication (AA) is claims processed without the intervention of a claims examiner and impacts accuracy, timeliness, and efficiency of the claims payment process. While the number of auto adjudicated claims has remained constant, the AA rate has declined due to the increased number of SPD claims, which are more complex and more costly. The rate will continue to decline as SPD volumes increases.
5 Member Services • Due to the transition of ~130,000 CHP members and ~40,000 IHSS members in January and February, call volume has more than doubled year over year. All transitioning CHP and IHSS members received a new L.A. Care ID and outbound welcome calls.
6 Member Services • Total LA Care membership as of February 2012 is 1,035,316, an increase of 3.53% members from the previous month. Overall membership, variance to budget, is positive at 0.86%.
% % Growth % % December January % Growth January February Growth % Growth December Variance Variance 2O11 2O12 FY 2O12 2O12 January‐ FY ‐January to Budget to Budget Segment February Plan Partners 758,457 641,049 ‐15.48% ‐16.21% 1.24% 641,049 638,440 ‐0.41% ‐16.55% 1.41% MCLA 187,134 326,019 74.22% 123.28% 1.02% 326,019 323,953 ‐0.63% 121.87% ‐0.81% Medicare Advantage (HMO SNP) 2,326 2,582 11.01% 32.00% 7.81% 2,582 2,866 11.00% 46.52% 16.03% Healthy Families (CHP) 6,753 6,717 ‐0.53% 56.06% ‐0.93% 6,717 6,488 ‐3.41% 50.74% ‐4.31% Healthy Families (L.A. Care) 10,770 10,713 ‐0.53% ‐3.08% ‐3.76% 10,713 10,615 ‐0.91% ‐3.97% ‐5.91% Healthy Kids (0‐5) 1,808 1,786 1.22% ‐11.28% 1.59% 1,786 1,695 ‐5.10% ‐15.80% ‐0.76% Healthy Kids (6‐18 11,186 11,142 ‐0.42% ‐4.13% 0.60% 11,142 10,959 ‐1.64% ‐5.70% 0.31% IHSS ‐‐‐‐‐40,300 100.00% 100.00% 8.21%
Total 978,437 1,000,008 2.20% 6.15% 1.10% 10,000,008 1,035,316 3.53% 9.90% 0.86%
7 Member Services • Overall membership growth has exceeded budget projections since the beginning of the fiscal year.
8 Member Services
• Centers for Medicare and Medicaid Services (CMS) selected L.A. Care for a financial audit of Medicare Advantage and Prescription Drug programs records and financial activity. Similar to past years, CMS will contract with several auditing firms. • Heffler, Radetich and Saitta, LLP, the CMS contractor who conducted L.A. Care’s 2008 financial audit in 2011, reported no findings in their final report. • Member Services and Human Resources hosted a call center job fair in January, attended by over 100 applicants and resulting in 13 new hires. Due to its initial success, a second job fair was hosted in March. Over 200 applicants attended and final candidates are participating in the hiring process.
9 Provider Network Operations
• Providers, primarily in the ancillary provider area (dialysis, home health, SNF, surgery centers), continue to added to serve the SPD members and the newly transitioned members in the IHSS program.
Added Ancillary Providers Total Ancillary Providers 7 350
• DHCS released the CBAS-certified facility list with member utilization data, which we are using to identify high-volume facilities and analyze geographic coverage. We are also drafting the CBAS facilities contract template and finalizing credentialing parameters and intend to have the necessary network prior to the July 1, 2012 start date. • In preparation for the duals pilot, we have engaged in preliminary contract discussions with several IPAs and health plans. As part of the duals pilot network strategy, we are finalizing IPA and health plan participation criteria to ensure we have objective, measureable criteria for assessing network capacity and experience in serving the duals. • PNO and Product Management staff completed the requested modifications to the C-CAP model and have begun to meet with hospitals and IPAs. Legal, Regulatory Affairs, and Finance are assisting in developing the required policies, auditing tools and contract language. We anticipate negotiations to begin with hospitals and high volume IPAs within the next several months.
10
April 1, 2012
TO: Board of Governors
THROUGH: John Wallace, Chief Operating Officer
FROM : Marella Umali, Special Projects Manager to the Chief Operating Officer
SUBJECT: Second Quarter FY 2011-2012 Organizational Performance Report
The organizational performance report summarizes the status of organizational goals and objectives outlined in the Board-approved FY 2011-2012 budget and other major projects undertaken during the fiscal year.
L.A. Care began enrolling Medi-Cal members in 1997 and has provided high quality healthcare for LA County’s most vulnerable people. On February 1, L.A. Care member enrollment surpassed one million members. This accomplishment is a critical step in meeting the health care needs of uninsured and underinsured County residents and was made possible by dedication and hard work in every part of the organization.
In February, L.A. Care was one of twenty-two plans in ten counties to submit a response to California’s Dual Eligible Demonstration Pilot Request for Solutions (Duals Pilot). If awarded the pilot, L.A. Care’s recent experience with the Seniors and People with Disabilities (SPD) transition will be immensely beneficial in meeting the Duals Pilot’s short planning and implementation timeframe, and providing services to the estimated 100,000-170,000 dually eligible who may enroll through the pilot.
The second quarter also marked a halfway point for the SPD transition. The enrollment rate is expected to slow from current levels of about 10,000 members monthly during the second half of the transition. L.A. Care will continue its efforts to ensure continuity of care for new members and will strive to resolve the program’s implementation issues.
As a follow up to the transition of CHP Medi-Cal members in January, L.A. Care successfully completed the planned transition of Community Health Plan’s Healthy Families and IHSS members on February 1.
As a public health plan, L.A. Care has a unique responsibility to support the safety net by transforming the way health care services are delivered. The remarkable one million members milestone has enabled us to fulfill that responsibility on a massive scale, and provides an even greater opportunity to change lives in a meaningful way. Organizational Performance Report FY 2011-2012: Strategic Plan Targets
Status Objective Target Q2 FY 2011-2012 Target Not on on Not On Target
Improving HEDIS results is a yearlong continuous effort that involves many areas of L.A. Care. Among the ongoing organization-wide interventions to improve HEDIS measures are: Community Health Improvement (1) Improve provider 1. Improve HEDIS performance (percent of Project (CHIP), Promotores programs, Health in Motion Classes and group health education appointments, systems & performance total available points) by 1-2 percentage X distribution of member friendly preventive health guidelines, member outreach reminder calls and mailings, to ensure timely access to points annually. LAP4P, and Physician P4P. The HEDIS project is currently in progress. The activities include medical record quality care retrieval, administrative data collection, and abstraction. Two NCQA audit firms will audit the process in March for DHCS and NCQA accreditation. The expected completion date is June 15, 2012.
1. Maintain a rating > 75% for each provider type in the "Overall Satisfaction with L.A. The project has been delayed due to previous contract delays and subsequent methodology changes. The Care" category as indicated in the annual estimated completion date is June 30, 2012. Provider Satisfaction survey. (2) Increase provider satisfaction 2. Maintain a rating > 80% for each provider type in the "Satisfaction with Utilization The project has been delayed due to previous contract delays and subsequent methodology changes. The Management" category as indicated in the estimated completion date is June 30, 2012. annual Provider Satisfaction survey.
The MCLA MCR for the four months ended January 31, 2012 was 90% excluding SPD members and 96% overall. MCLA administrative expenses have also fallen to 4.4% during the four-month reporting period. There 1. The MCR (medical cost ratio) for the was a significant improvement in the MCR from the prior two-month reporting period ending November 30, MCLA line of business shall fall in the range 2011 (99.6% MCR) largely attributed to substantial reductions in SPD pharmacy costs following a number of of 87% to 92% (not including SPD X pharmacy management protocols implemented for chronic care medications. The transition period for the members) or 87% to 96% (including SPD utilization of non-formulary medications was reduced from 90 days to 30 days. The rate of formulary medication members). adherence and generic medication utilization has also increased. Additionally, inpatient and outpatient costs have decreased with the transition of the Community Health Plan (CHP) membership due to CHP’s capitated facility agreements, which result in fixed CHP facility costs. (3) Optimize administrative and The Claims Department adopted a staffing strategy to proactively address anticipated growth and claims volume 2. Decrease the 12-month average claim operational performance ahead of the CHP transition, resulting in an increase in December 2011 and three month average claims processing cost to $3.50 across all direct X and ensure resources are processing costs. However, the 6-month average decreased to $3.42 and the most recent month of January 2012 product lines. available to fund critical is $3.00 per claim. activities Detailed project work plans to upgrade the MHC legacy information system and surrounding application dependencies were completed in mid-February. The source code evaluation process continued in anticipation of upgrading to an ICD-10 compliant version. MHC core system demonstrations to review key system upgrade features and identify customized source code for remediation began in March with DST consultants. The 3. Complete parallel system processing and X coordination of benefits (COB) enhancement module implementation commenced in December 2011, but the core system “go-live” by September 2012. completion date was extended to the end of June 2012 due to additional data and workflow requirements. Given the recent CMS announcement regarding ICD-10 delays, management is re-evaluating the business need and priorities for this MHC upgrade. Staff is completing preliminary risk analysis, cost-benefit analysis, and overall recommendations. Organizational Performance Report FY 2011-2012: Strategic Plan Targets
Status Objective Target Q2 FY 2011-2012 Target Not on on Not On Target
1. Maintain < 1.5% monthly MCLA Due to the decline in the volume of ADHC members opting out of managed care, second quarter results X voluntary disenrollment target. decreased favorably to 1% (fiscal year to date voluntary disenrollment rate is 1.2%).
As of February 1, 2012, second quarter Medicare voluntary disenrollment was 3.2%, comparable the previous quarter; however, February disenrollments are still being reviewed. During the second quarter, 34% of the 2. Maintain < 3% monthly Medicare X disenrollments occurred within the first 90 days of enrollment (compared to 32% for the previous quarter). voluntary disenrollment target. Member education regarding the impact of changing the pharmacy drug plan (PDP) at the point of service continues.
(4) Increase member Market Vibes completed the 2011 L.A. Care Image & Awareness in January 2012 using the same parameters as satisfaction and 3. Increase or maintain the rating in the the previous study. The survey results in the identified categories were: engagement following "key measures" categories as -Health Plan Preference (43%) indicated in the annual Awareness & Image -Ability to Meet Member Needs (52%) survey: X -Likelihood to Renew Health Plan (81%). -Health Plan Preference (>42%) However, the survey results also showed slight declines in other areas including perceived reputation and quality -Ability to Meet Member Needs (>51%) of care by consumers. These declines can be attributed to several factors, including the absence of L.A. Care -Likelihood to Renew Health Plan (>79%). advertising since June 2011. The data will inform future decisions about L.A. Care’s advertising and brand strategies in preparation for federal health care reform implementation.
4. Reduce disparities in health outcomes by X Efforts to reduce disparities continue. The RFP for an outreach vendor will be released in next few weeks. 5% for at least one HEDIS measure. Market share increased by 1.8% from 65.9% in January 2011 to 67.1% in February 2012. Total Los Angeles 1. Increase L.A. County Medi-Cal managed X County Medi-Cal membership increased to 1.4 million members. The SPD transition continues to account for care market share by 0.4% annually. the majority of growth in the MCLA line of business. As of January 2012, MCLA membership was 324,152 and includes the transition of CHP members. MCLA 2. Achieve an MCLA target membership of X remains on target to achieve the membership goal by 9/30/12 based on a market penetration rate above fifty 350,685 by 9/30/12. percent and the remaining SPD transition members. (5) Grow membership 3. Achieve a Medicare target membership of As of March 2012, Medicare SNP membership was 2,846. Due to the continued efforts of the Sales and Outreach X 2,995 by 9/30/12. and Member Retention Teams, L.A. Care’s Medicare membership is exceeding projections.
In February 2012, the annual choice enrollment rate was 69%. An enhanced provider network and greater brand 4. Achieve a 12-month average MCLA choice recognition are the driving forces behind this significant increase. According to the 2011 Awareness & Image X enrollment target rate > 33%. survey conducted on behalf of L.A. Care, brand recognition remains high at 85%, a one percentage point increase from 2010.
(6) Actively engage in community and be an TBD accountable & responsive partner Project Status Tracking Tool
Project Blue box indicates Expected Project Description FY 2011-2012 Target Second Quarter FY 2011-2012 Project Status project listed in Completion Date
Budget Book. On Target Not On Target
ADHC services were extended to March 31. Utilization The adult day health care (ADHC) benefit was eliminated Community Based Management has begun to create care plans for members from Medi-Cal as part of Governor Brown's State budget Adult Services ineligible for CBAS. The process has proven to be time package. Enrolling ADHC participants into managed care Implement and manage the CBAS (CBAS) formerly X consuming and laborious due to difficulties in 05/31/2012 plans is one solution the State is exploring to ensure program by July 1, 2012. Adult Day Health communicating with the members. Plan Partners have consumers have long term supports and services and avoid Care (ADHC) been provided with up to date information regarding their long term care (LTC) placement. CBAS-eligible membership.
Due to competing priorities, this project has been delayed. The call center business requirements will be defined and Call Recording The current system was purchased in 2006 and has Replace call recording system by June validated in the third quarter of FY 2011-2012. The vendor X 11/30/2012 System Replacement reached functional obsolescence due to call center growth. 30, 2012. RFP process and replacement project implementation activities are expected to commence by September 30, 2012.
The Product Management and Provider Network The Compensation and Care Alignment Plan (C-CAP) is Complete phased-in implementation of Operations Departments are finalizing requested L.A. Care’s new hospital reimbursement model for MCLA. the CCAP model by June 30, 2012, modifications to the C-CAP model and developing C-CAP The model is designed to financially align the plan, X 12/31/2012 with full implementation by December policies, auditing tools, and contract language. L.A. Care hospitals, and IPAs and maintain a medical cost ratio 31, 2012. plans to test the model with high volume IPAs and (MCR) between 89-92%. hospitals in the coming months.
Medi-Cal members transitioned smoothly on January 1, 2012. Transition agreement negotiations have been completed. Healthy Families and IHSS transition occurred Complete negotiations on a mutually on February 1, 2012 and L.A. Care began providing L.A. County DHS and L.A. Care are developing and beneficial relationship between LA administrative services for CHP Healthy Families CHP Transition utilizing a new integrated safety net delivery system and X 12/31/2011 County DHS and L.A. Care by membership. Several meetings have been held with SEIU transitioning CHP membership to L.A. Care. December 31, 2011. leadership to introduce L.A. Care and review the transition. The DHS agreement was amended to incorporate IHSS rates and the division of financial responsibility, while the DPSS agreement continues to be discussed.
4/2/2012 Project Status Tracking Tool
Project Blue box indicates Expected Project Description FY 2011-2012 Target Second Quarter FY 2011-2012 Project Status project listed in Completion Date
Budget Book. On Target Not On Target
The UDT project was completed and an additional UDT pipeline is being developed based on claims, UM, and provider contract priorities as part of regular IS configuration maintenance. The coordination of benefits The MHC system enhancement project is part of the core MHC System (COB) project began in January 2012 to configure, train, system modernization program. This project will Implement MHC utilization decision Enhancements X and "turn on" the MHC COB module. The project team 3/31/2012 implement MHC utilization decision tables (UDT) and tables and COB by March 31, 2012. Project and DST consultants concluded additional internal work COB Functionality. on interfaces and processes is needed to operationalize COB. The project team will initially test and implement Medicare SNP and then determine the sections and order of Medi-Cal and IHSS implementation.
Part of Core System Modernization Program. Due to current and future business drivers such as health care reform and upcoming pilot projects, L.A. Care continues to explore alternative technology platforms to replace MHC and is currently in negotiations with industry- Establish a long-term Core System Negotiations with core system selection vendor finalists are New Core System leading core system vendors. A phased approach over X 3/31/2012 Migration Strategy by March 2012. ongoing. several years from MHC to another platform is anticipated. This phased approach allows L.A. Care to be sensitive to the challenging economic environment, gives us time to control the pace of the changes, and allows us to better allocate staff time to current high-priority projects.
The Department of Health Care Services (DHCS) is In February, L.A. Care was among twenty-two applicants establishing a pilot program to improve the delivery system from ten counties to submit a response to the State’s duals for California’s dual eligible beneficiaries in an integrated, pilot request for solutions (RFS). L.A. Care participated in cost-effective, efficient, and quality-driven manner. an applicant interview conducted by representatives from Duals launch anticipated January 1, Duals Pilot Together, L.A. Care and Health Net of California are X the state Departments of Health Care Services, Social TBD 2013. collaborating in a joint proposal to leverage and expand our Services, Rehabilitation, and Aging. Pilot sites will be considerable and collective experience in the California notified in late March. L.A. Care continues to proactively marketplace and in the largest dual eligible county in the discuss implementation strategies and policy issues with country. Health Net and other local initiative health plans.
4/2/2012 Project Status Tracking Tool
Project Blue box indicates Expected Project Description FY 2011-2012 Target Second Quarter FY 2011-2012 Project Status project listed in Completion Date
Budget Book. On Target Not On Target
As part of the federal health care reform law, small employer groups and individuals will be required to L.A. Care continues to anticipate federal guidance from purchase health care coverage beginning in 2014. L.A. Care Health and Human Services on Basic Health Plan will need to determine its organizational exchange guidelines. Finance is developing enrollment, market share, preparedness as well as market share percentage in order to and revenue projections. Staff has participated in determine participation in Exchange/BHP. This project Complete readiness assessment by conference calls with various national and state trade will include the evaluating the necessary components of Exchange/ BHP September 30, 2012. X associations, weighed in on draft Exchange regulations, TBD successful participation in the Exchange. An assessment and attended and monitored the monthly California Health will be conducted to identify gaps in current operational Benefits Exchange meetings. An RFP for a strategy and and technical capabilities. If L.A. Care decides to implementation consultant will be finalized and distributed participate in the Exchange and/or Basic Health Plan, this in the third quarter of FY 2011-2012. project will be expanded to include implementation preparation, go-live preparation, and post-implementation follow-up.
L.A. Care is committed to supporting the Plan Partner structure and quality of care for both safety net and non- safety net providers. A contracted vendor will provide Perform an internal review of L.A. The Lewin Group contract was approved a the February MCLA Member Auto- consulting services for MCLA to demonstrate L.A. Care’s Care's member transfers and call center Finance & Budget Committee meeting. The contract is X 5/30/2012 Assignment Audit compliance with Plan Partner policies and contractual activities by the second quarter of FY being finalized and work is expected to commence in April agreements, member transfers, and call center activities. A 2011-2012. 2012. final audit findings report will be delivered by the contracted consultant with recommendations.
Due to our increasing membership, our member services Construction has begun. Relocating departments include department is being expanded and will occupy an additional The expansion will be completed by Space Expansion X Member Services (excluding call center), Family Resource 4/30/2012 floor in our new building. The expansion project includes April 30, 2012. Centers, Medicare Operations, and Product Management. construction and furnishings.
Under the State’s proposed 1115 Medicaid Waiver, SPD membership continues to increase by ~10,000 approximately 175,000 fee-for-service Medi-Cal SPD Continue to seamlessly support SPD members monthly. Care management has been transitioned beneficiaries in Los Angeles County would be transitioned transition to ensure appropriate to HealthWays. Advocates, DHCS and DMHC are SPD Transition into managed care beginning June 2011. There is no more X 05/31/2012 member assignment through June 1, increasingly contacting L.A. Care to seek expedited immediate issue for our organization than the 2012. resolution of member concerns and an internal process is establishment of a capable and effective SPD provider being developed to triage these inquiries. network and core operational capabilities.
4/2/2012
March 12, 2012
To: Board of Governors
From: Elaine Batchlor, MD, MPH, Chief Medical Officer
Subject: CMO Report for April 2012
1. Medical and Pharmacy Management
Since June 2011, nearly 75,000 seniors and people with disabilities (SPD) members have enrolled in L.A. Care’s directly-contracted network (MCLA). We continue to experience increases in medical and pharmacy utilization and service requests as these members transition into new provider arrangements. While authorizations continue to rise, we are seeing the prevalence of diabetes and complex medical conditions leveling off. Tables 1 through 5 illustrate these trends.
Table 1: Diabetes Prevalence for DLOB membership
4.80% 4.30% 3.80% 3.30% 2.80% 2.30% 1.80% 1.30% 0.80%
Diabetes Prevalence to Total Membership
Table 2: DLOB Enrollment in Diabetes Disease Management* 16,000 14,000 12,000 8,434 10,000 8,000 6,000 6,460 5,587 690 4,208 4,646 4,000 2,689 521 2,000 406 409 461 466 488 526 558 585 626 655 4,974 1,774 1,776 1,955 2,061 2,227 2,370 1,638 1,648 1,633 1,791 2,065 ‐
MCLA+HF+HKID SNP SPD
April CMO Report March 12, 2012 Page 2 of 7
* L.A. Care offers a diabetes disease management program for members with chronic diseases and complex medical conditions. The program provides enhanced health education for all members, and telephonic coaching from a nurse or health educator for members with greater needs.
Table 3: DLOB High Risk Cases
3.00%
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
Care Management Prevalence to Total Membership
Table 4: DLOB High Risk Case Management Cases 600 198 500 400 113 5 300 75 70 74 74 10 9 6 8 5 5 200 35 32 12 6 7 303 100 177 186 169 168 177 196 178 182 178 174 197 ‐
(MCLA+SPD+HF+HKID) SNP SPD
Table 5: Pharmacy Prior Authorizations 2000 1764
1424 1500 1181 1167 1188
1000 670 542 430 500 411
0 Jun‐11 Jul‐11 Aug‐11 Sep‐11 Oct‐11 Nov‐11 Dec‐11 Jan‐12 Feb‐12
total number of pharmacy prior authorizations
April CMO Report March 12, 2012 Page 3 of 7
Lanterman Developmental Center
The Lanterman Developmental Center, located in Pomona, is a residential facility that is the home for 300 people with profound developmental disabilities living in Los Angeles County (not to be confused with the Lanterman Regional Center, which provides services and support to people with intellectual and developmental disabilities in Metro Los Angeles). Lanterman Development Center residents live and receive all their healthcare and other services onsite, and most of them have lived there for 30 years or longer. The Center is in the process of closing and moving its residents into community housing. The Center is closing because of the expense of maintaining it and the change in attitudes and practices with regard to caring for people with developmental disabilities. The facility was built over 80 years ago and needs a significant amount of work in order to make it safe and compliant with health and safety codes. In addition, society has moved towards integrating people with developmental disabilities into communities instead of isolating them in institutions.
Over the next two years, families of the Center’s residents and staff at Regional Centers will work to find community-based housing for the Center’s residents. Plans will be developed to transition residents back to the communities they came from or near where their families live in the greater Southern California area. It may take many months to put together an individual transition plan as it involves finding suitable housing, making sure healthcare services are in place, and ensuring the client is ready to move. The Regional Centers are developing new group homes for former Lanterman residents. These group homes will have more staff and be better equipped to support people with complex medical and behavioral needs. All Lanterman residents will remain in the Center until their individual transition plans and preparations are completed.
Thirty percent of the Lanterman residents have Medi-Cal only and 70 percent are dual eligibles. The Medi-Cal only group will have to join a Medi-Cal health plan, either L.A. Care or Health Net. The dual eligible group will have the option of joining a health plan on a voluntary basis. L.A. Care, Health Net, and several other Southern California Medi-Cal health plans will be required to enroll former residents who choose to join Medi-Cal managed care once they leave the developmental center. To prepare for potential members, we are working with the seven L.A. County Regional Centers to determine residents’ healthcare and service needs and develop provider arrangements and care coordination programs to meet those needs. We are seeking physicians, specialists, dentists, mental health providers, and other healthcare providers who are sensitive to the needs of people with significant developmental disabilities. As we engage in this process, we are drawing on the experiences of health plans in northern California that recently went through a similar developmental center closure. The transition will likely begin in earnest in mid-to late 2012, at which time we will begin providing quarterly updates.
Community Based Adult Services (CBAS)
Adult Day Health Care is a Medi-Cal benefit for seniors and people with disabilities with complex healthcare needs, including people with Alzheimer’s, post-stroke complications, or serious mental illness. The program is designed to help people to remain in their own homes as they age, as opposed to moving into nursing homes which are more expensive and generally not where people would choose to live. Adult Day Health centers provide services including medication assistance, physical and speech therapy, meals, and supervision. The benefits are covered by regular Medi-Cal, not by Medi-Cal health plans.
April CMO Report March 12, 2012 Page 4 of 7
In the summer of 2011, the state decided to end the Adult Day Health Care program. It was originally scheduled to end in November 2011, but a court case kept it open through March 2012 to give the state time to start an alternate program to protect people’s health and independence. On April 1, 2012, the state plans to eliminate the program and replace it with a new program called Community Based Adult Services (CBAS). The state’s goal is to ensure that people who need Adult Day Health Care type services continue to receive them under the CBAS program. To achieve that goal, state nurses are assessing everyone going to an Adult Day Health Care center to decide who will be eligible for Community Based Adult Services and who will transition out of the program and receive alternative services through managed care. L.A. Care has close to 4,500 members who were getting Adult Day Health Care, and most of these members were determined to be eligible for Community Based Adult Services. To date, only 121 members were deemed ineligible. Medi-Cal health plans are required to provide enhanced case management for members who lose their Adult Day Health Care benefit. This enhanced case management will help members access alternative services in the community, such as meal delivery, social programs, and therapies, that will allow them to live independently in their own homes.
Fee-for-service Medi-Cal will cover Community Based Adult Services until July, at which time Medi-Cal health plans will begin covering and paying for them. Approximately 16,000 people in Los Angeles County will have to join a Medi-Cal managed care plan to continue to receive these services. Some will choose L.A. Care as their health plan, and if individuals do not make a health plan choice, they will be assigned one. They will have the option to return to Fee-for- service Medi-Cal, however without Community Based Adult Services. Most of the 16,000 individuals have both Medi-Cal and Medicare coverage, and only need to join L.A. Care’s Medi- Cal health plan in order to continue to receive the services. To prepare for this transition, L.A. Care will contract with more than 150 Community Based Adult Services sites around L.A. County. L.A. Care will be responsible for deciding which members need services, how often they receive them, and for periodic re-assessments of members receiving services to see if their needs have changed. Our provider network department is working on contracts with the CBAS sites, and our medical management department is developing a care team to coordinate the CBAS services.
Health Information Technology
HITEC-LA HITEC-LA has enrolled over 3,350 providers. Our service partners are on-site with over 2,700 providers, helping them select, implement and meaningfully use electronic health records. Over 1,600 providers are live on an EHR and 129 have achieved Meaningful Use.
On March 9th, Dr. Farzad Mostashari, the National Coordinator for Health Information Technology, visited Los Angeles with his staff to learn about local health information technology initiatives and how providers are attempting to achieve Meaningful Use.
Dr. Mostashari, along with Howard Kahn, participated on a panel about health information exchange at a media event hosted by the California Association of Physician Groups. The panel discussed the government’s proposal that providers should have the capability to exchange patient data by 2014. April CMO Report March 12, 2012 Page 5 of 7
Hospitals and doctors have received billions of dollars in government subsidies to upgrade electronic health records and the next step is to make those records accessible to other providers.
At L.A. Care, a panel of physicians from the County, community clinics, and small practices shared their experience with EHR adoption and Meaningful Use. Physicians talked about the challenges associated with their transition to an EHR and Meaningful Use and expressed gratitude for HITEC- LA’s support. L.A. Care’s Director of Health Information Technology, Sajid Ahmed, and a DHS physician spoke about the Safety Net eConsult project and the expected benefits that will derive from the health information exchange.
The ONC and CMS released the Meaningful Use Stage 2 Notice of Proposed Rule Making, which details the proposed standards that physicians and hospitals must meet to qualify for federal incentive payments for achieving Meaningful Use with EHRs. The proposed rule highlights the importance of connectivity and communication between providers, and states that 10% of provider referrals would have to be electronically exchanged. It recommends that patients be granted online access to their health information, and specifies payment adjustments under Medicare for physicians and hospitals failing to demonstrate meaningful use and other program participation requirements. The final rule is scheduled for release this summer, following a 60-day comment period.
As detailed in the February report, the ONC is in the process of reviewing progress of regional extension centers across the country toward achieving the goals of the Regional Extension Center (REC) program. The ONC is reviewing HITEC-LA as part of this process. We anticipate a positive outcome because of the progress HITEC-LA has made toward achieving its goals. We expect to receive notification of the outcome of the review in April.
Medicare and Medicaid EHR Incentive Programs The Medicare and Medicaid EHR incentive programs provide payments to hospitals and eligible professionals nationwide as they adopt, implement, upgrade and demonstrate Meaningful Use of EHRs. The Medicare incentive program is paying hospitals and eligible professionals. So far, it has paid out $181 million to California providers. The Medi-Cal incentive program has paid $62 million to California hospitals, with an additional $70 million to be paid by the end of March. The Medi-Cal incentive program for professionals will be ready to start payments in late April. Eighty five percent of the providers that have attested for the Medi-Cal incentive in Los Angeles County are HITEC-LA members.
Safety Net eConsult Program In June, the Board of Governors approved funding for an 18-month Safety Net eConsult project, to develop and implement a common eConsult system for use by providers at community clinics and the Los Angeles County Department of Health Services (DHS). The system will be used at 50 clinic sites.
The technology vendor for the project, Safety Net Connect, has completed a beta version of the application that is being tested by the eConsult physician and technical workgroup, L.A. Care staff, and DHS staff. In early April, we plan to roll out the beta version to ten clinic sites for approximately four to eight weeks of testing. After testing and any resulting modifications are completed, we will begin to roll out the final version of the eConsult application to the remaining 40 plus sites between June and September.
April CMO Report March 12, 2012 Page 6 of 7
We have selected four organizations, the Community Clinic Association of Los Angeles County, COPE Health Solutions, Object Health, and e2o Health Inc., to provide onsite training and support for the participating providers through the end of the year.
L.A. Care launched an informational website on the Safety Net eConsult project in mid-February. The website provides information on how to use eConsult, project updates, and answers to frequently asked questions. The website can be accessed at http://www.econsultla.com/.
2. Quality Improvement
Medicare Star Update
In 2010, the Centers for Medicare and Medicaid Services launched the Medicare Star program as a system for rating Medicare Advantage plans on clinical quality and service. Plans are rated on a scale of 1 to 5, with 5 being the highest rating, and ratings are publically available. Minimum performance is required to continue to offer a Medicare plan and high performance earns plans a higher rate of reimbursement. Plans are required to earn 3.0 stars to remain in the Medicare Advantage program and are given three years to get there. Medicare special needs plans are at a disadvantage because they are compared to Medicare only plans that do not include Medi-Cal populations and have broader provider networks. The Association for Community Affiliated Plans has requested the Centers for Medicare and Medicaid Services not to compare Medicare special needs plans to Medicare only plans unless it is with enrollees with matched health, functioning, and social and economic factors.
In 2012, L.A. Care’s Special Needs Medicare Plan received a rating for the first time, 2.5 stars. L.A. Care’s goal is to improve the rating to 3.0 stars.
Health Services is focused on improving performance on the clinical Star measures that are measured by HEDIS and member surveys. We have developed and activated a plan that includes encouraging providers and members to complete needed clinical services. For example, in December, we began intense efforts to reach out to members who were missing key Star services, such as influenza and pneumonia vaccines and colorectal cancer screening. We conducted a month-long program that provided home visits to almost 200 members who wouldn’t otherwise have received services. We mailed colorectal screening kits to members and received over 400 completed kits.
We recently completed a new member mailing, called the Passport to Good Health. The Passport includes a list of health screenings, immunizations, and lab assessments that members have received as well as those they need to receive. We encourage them to schedule an appointment to receive needed services and maintain a record of services they’ve received. We are doing outbound calls to members to encourage them to follow through on the Passport recommendations and Member Services and Medical Management team members have been trained to emphasize the same messages when members call us. The program received positive feedback from the Physician Quality Advisory Committee and members are beginning to call in response to the mailings. Staff is also developing a number of tools to help physicians improve their completion of Star services, including patient opportunity lists, clinical guidelines, and medical record forms. Staff will then take these tools to high volume provider offices.
We will continue to update you on our programs to improve our ratings and the impact.
April CMO Report March 12, 2012 Page 7 of 7
3. Community Benefit Programs
Budget Update The $3 million budget approved by the Board for fiscal year 2011-2012 includes $1 million for clinic infrastructure projects (Tranquada IV), $1 million for health information technology (HIT IV), $500,000 for ad hoc grants, $350,000 to support training a second cohort of patient centered medical homes, and $150,000 for a community advocacy and outreach initiative.
At the upcoming April meeting, Board members will be asked to consider seven Tranquada IV recommendations and an ad hoc grant to Community Health Councils for a diabetes initiative. Staff recently released a request for applications for a second patient center medical home initiative to over 275 medical practices. We received 15 applications, which will be reviewed in early April. Recommendations will be brought for Board consideration. The Community Outreach and Education department is the process of selecting an organization for the Community Advocacy and Outreach initiative. The selected organization will design, develop and implement a train-the trainer program to inform and educate consumers and community members most impacted by the changes brought about by California’s 1115 Waiver and federal health care reform. In late spring, staff plans to bring forth a health information technology initiative concept that will focus on telehealth, including telepsych, and a number of ad hoc proposals that meet CHIF criteria and priorities.
For updates on recently funded and completed grants, please review the Community Health Investment Fund Summary for fiscal year 2010-2011.
Board of Governors MOTION SUMMARY
Date: April 5, 2012 Motion No. EXE 100.0412 Committee: Executive Committee Chairperson: Walter A. Zelman, PhD
Issue: Approval of $1,100,000 to fund seven Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative IV awards.
Background: In 2005, L.A. Care’s Board established a grant program to honor founding Board member and past Chairman, Robert E. Tranquada, M.D. The purpose of the Tranquada Safety Net Infrastructure Initiative (Tranquada) is to provide grants to strengthen safety net provider infrastructure. To date, three cycles of grants have funded 32 projects for over $6.5 million.
This year’s Community Benefits budget includes $1,000,000 for Tranquada IV to help clinics meet the growing demand for services as a result of health care reform and the California 1115 Waiver. The initiative is designed to support clinics expand their capacity to serve an increasing number of adult patients with complex medical and social needs, including seniors and persons with disabilities. Due to the number of strong applications received, we recommend increasing the total amount for the initiative. We are seeking approval to fund the initiative at $1,100,000, which will fund seven projects for up to 24 months at amounts ranging from $150,000 to $200,000 per applicant. The seven projects will increase medical services, integrate behavioral health with primary health and renovate facilities to best serve the initiative’s target populations. Funds are available for renovation and development of facilities, clinical and telemedicine equipment, provider recruitment, and staff and consultants needed to implement the projects.
The Tranquada IV Initiative is consistent with L.A. Care’s organizational goal of strengthening the safety net and expanding access to health care services for Los Angeles County’s vulnerable and low-income communities and residents, including SPDs and adults with complex medical and social needs.
Budget Impact: If the entire request of $1,100,000 for Tranquada IV is approved, the community benefits budget will increase by $100,000 for a total of $3.1 million.
Motion: To increase the budget for the Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative IV by $100,000 and approve seven grants for a total of $1,100,000 as outlined in the enclosed memo and Attachment A.
March 29, 2012
To: Executive Committee
Through: Elaine Batchlor, MD, MPH, Chief Medical Officer
From: Roland Palencia, Consultant, Community Benefit Programs
Subject: Approval of seven Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative IV awards for a total of $1,000,000, and an additional allocation of $100,000.
Introduction This year’s Community Benefits budget includes $1,000,000 for the Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative IV (Tranquada IV) to help clinics meet the growing demand for services to adults and seniors and persons with disabilities (SPDs) with complex medical and social needs as a result of health care reform and the California 1115 Waiver. L.A. Care announced the availability of this funding to the Los Angeles safety net community via a request for proposals process and received 27 applications. These applications were reviewed by L.A. Care staff and community experts with a recommendation to fund seven Tranquada IV proposals for a total of $1,100,000. Staff is requesting an augmentation of $100,000 to the Community Health Invest Fund (CHIF) budget to be able to fund all seven projects, which range from $150,000 to $200,000 each and for up to 24 months. If the initiative is funded at the original $1,000,000 level, we will be able to support the first six projects noted in Attachment A.
Background In 2005, L.A. Care’s Board established a grant program to honor founding Board member and past Chairman, Robert E. Tranquada, M.D. The purpose of the Initiative is to provide grants to strengthen safety net provider infrastructure. To date, three cycles of grants have funded 32 projects for over $6.5 million.
In 2007, eleven clinics received $4.1 million in Tranquada I grants to expand access to new populations and provide new services such as pharmacy, mental health and specialty care. In 2009, twelve clinic projects received over $1.1 million through Tranquada II, an initiative designed to help small community clinics complete organizational assessments, develop plans, and implement projects to strengthen their long-term infrastructure.1 In 2011, through Tranquada III, nine clinics received almost $1.2 million to help them prepare for and meet the growing demand for patient services resulting from health care reform, California’s 1115 Waiver, and local expansion initiatives
1 For the purpose of Tranquada II, a small clinic is defined as having annual revenue of $5 million or less and an overall annual operating budget of no more than $7 million in FY 2008. March 29, 2012 Tranquada IV Initiative Recommendations Page 2 of 3 such as Los Angeles County’s Healthy Way LA. Tranquada III projects are expanding access to care for SPDs as well as integrating behavioral and mental health services for low-income, underserved patients of all ages.
Tranquada IV Initiative Tranquada IV is designed to support clinics expand their capacity to serve an increasing number of adult patients with complex medical and social needs, including SPDs.
The projects that qualify under this initiative include recruitment of adult medicine medical providers, expansion of clinical space, programs to integrate behavioral and mental health care, and programs to provide care coordination and specialty care. Funds are available for renovation and development of facilities, clinical and telemedicine equipment, provider recruitment, and staff and consultants needed to implement the projects.
Application Process and Recommendations Staff released a request for application in early February 2012 and two informational conference calls were held a few days later. All the 27 received proposals were evaluated in early March by a review committee composed of L.A. Care staff and community experts. Criteria considered by the reviewers included meeting the priorities of the initiative; demonstrable benefit and impact of the services for the patient population; organizational capacity; appropriate and allowable budget items; project sustainability; and potential benefit for L.A. Care members.
The committee recommended seven proposals. This included two proposals to increase medical services in the greater San Fernando Valley and the Westside; three to integrate behavioral health into primary care in the San Gabriel Valley and South Los Angeles; and two to renovate physical spaces such as adding exam rooms in Southeast Los Angeles County and Hollywood. Some of the selected projects will also implement new care coordination models for adults and SPDs.
The proposed projects are expected to be sustainable as L.A. Care is providing seed funding for medical personnel. Two proposals are one-time only renovation projects which do not require additional investment. Medical personnel services are reimbursable through third party payors such as Healthy Way LA and Medi-Cal.
Timeline If the enclosed recommendations are approved at the April Board meeting, L.A. Care will begin grant agreements in May 2012 for grant periods of up to 24 months.
Alignment with L.A. Care Goals The Tranquada IV Initiative is consistent with L.A. Care’s organizational goal of strengthening the safety net and expanding access to health care services for Los Angeles County’s vulnerable and low- income communities and residents, including SPDs and adults with complex medical and social needs.
Evaluation The program will be evaluated by L.A. Care staff to measure the overall impact of the initiative, as well as the accomplishments of the individual grantees. Individual grantees will be evaluated based
March 29, 2012 Tranquada IV Initiative Recommendations Page 3 of 3 on their specific project objectives and milestones. The overall initiative will be evaluated using measures of service expansion, patient visits and successful integration of behavioral health.
Recognition L.A. Care acknowledgement and recognition opportunities with selected grantees include press releases, the L.A. Care logo on program-related literature, decals on equipment, website acknowledgment, organizational annual reports, events, and strategically located plaques.
Attachment A - Tranquada IV Initiative Grantee Recommendations - FY 2011-2012 Board Meeting on April 5, 2012 Length of Name of Requested Recommended Grant Previous L.A. Organization Project Type Services to be Provided Amount Amount Agreement Care Awards RCAC Region 1 Family Health Care Renovations Renovate Bell Garden site to expand clinical and case Center of Greater L.A management space. Make it accessible to SPDs patients. Will serve current 1,100 patients, including 450 SPDs and to 7 increased number of new patients. Renovations funds for Bellflower dispensary, call center, repave parking lot, adjustable exam tables and weight scales. $200,000 $ 200,000 24 months$ 226,474 2 Garfield Health Center Integrate Mental Health Integration. Care and case management to 3 (GHC) behavioral health integrate behavioral health into primary care. Funds for nurse Alhambra, into primary care practitioner, psychologists and care coordinator. Will serve up to Pasadena, 600 SPDs. $199,916 $ 150,000 18 months$ 175,000 Foothill 3 L.A. Gay and Lesbian Renovations Renovate specialty care clinic to add four rooms, expand lab to Center meet growing demand. Will serve additional 1,680 patients, 4 including 420 SPDs, including lesbian, gay, bisexual and Downtown, transgender seniors. All funds will be used for renovations. Glendale, Hollywood $200,000 $ 150,000 24 months$ 19,918 4 Northeast Community Integrate Integrate behavioral health into primary care. Co-location at 3 Clinic behavioral health health center in Hawthorne. Funds for Psychiatrist and Alhambra, into primary care behavioral health coordinator, consultant. Will serve 600 SPDs. Pasadena, $200,000 $ 150,000 18 months$ 39,500 Foothill 5 Northeast Valley Increase medical Serve over 400 new adult and SPD patients, including high risk 2 Health Corporation access care coordination, expect to add over 1,600 new patient visits. San Fernando (NEVHC) Funds for nurse practitioner and internist sign-in bonus. Valley, West Valley, East $200,000 $ 150,000 18 months$ 2,054,291 Valley 6 Venice Family Clinic Increase medical Establish a medical team to serve 600 new SPDs and improve 5 access care coordination. Funds for physician, medical assistant and West Los care coordinator. $200,000 $ 150,000 18 months$ 906,084 Angeles 7 Central City Integrate Mental Health Integration. Transition patients with mental and Community Health behavioral health developmental disabilities into managed care who live in 6 Center into primary care residential care facilities and nursing homes. Serve 1,000 SPD South, patients. Funds for LCSW, Care manager, Patient Navigators. Compton, Inglewood $200,000 $ 150,000 18 months$ 506,400 Total $1,399,916 $ 1,100,000 L.A. Care Health Plan, Community Health Investment Fund Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative IV Review Committee Roster Review Committee Meeting held on March 9, 2012
Name Organization Title 1 Bridget Hogan Cole Community Partners Senior Program Director
2 Irene Dyer LAC Department of Health Services Director, Planning and Analysis Professor, School of Public Health & Principal Investigator at California Health 3 Richard Brown, Ph.D. UCLA School of Public Health Interview Survey Kaiser Permanente, Southern 4 Ryan Yamamoto California Region Manager, Community Benefit 5 Chris Hunt Community Partners Senior Program Associate
L.A. Care Staff 6 Elaine Batchlor, MD, MPH L.A. Care Health Plan Chief Medical Officer
7 Estela Martinez L.A. Care Health Plan Director, Provider Network Operations
Program Director, Services for Seniors 8 Lisa Kodmur L.A. Care Health Plan and Persons with Disabilities
9 Sarita Mohanty. MD, MPH L.A. Care Health Plan Medical Director, Medical Management Consultant, Community Benefit 10 Roland Palencia L.A. Care Health Plan Programs
11 Rosa Castillo L.A. Care Health Plan Community Benefit Programs Specialist
1
Board of Governors MOTION SUMMARY
Date: April 5, 2012 Motion No. EXE 101.0412 Committee: Executive Committee Chairperson: Walter A. Zelman, PhD
Issue: Approval of a $100,000 ad hoc grant to the Community Health Councils to implement and evaluate a diabetes care management initiative in South Los Angeles.
Background: Staff recommends a two-year ad hoc grant of $100,000 to the Community Health Councils to implement and evaluate the “Enhanced Diabetes Care Management Initiative”. This project is in partnership with eight South Los Angeles Federally Qualified Health Centers (FQHCs) and other community stakeholders. L.A. Care’s support will help improve the health outcomes of 3,000 adult patients whose diabetes is poorly controlled and who are at-risk for unnecessary emergency room visits and hospitalizations, and overall poor quality of life.
Community Health Councils is a non-profit health advocacy and policy organization committed to improve access to quality health care and to eliminate health disparities in underserved, uninsured and underinsured populations in Los Angeles County and statewide. All of the eight FQHC’s and some of the stakeholders participating in this project are either previous or current L.A. Care grantees.
A team of mid-level providers, with physicians and other support staff, will monitor a cohort of ten teams of 300 high risk diabetic patients per team for a period of up to nine months. Adult patients diagnosed with diabetes with higher than normal blood sugar and who had visited a participating FQHC within the past 12 months will be eligible to participate in this initiative. Mid-level providers will team up with the patient’s primary care physician. Patients will continue to be monitored after “program graduation” to make sure they stay within controlled thresholds.
This project aligns with L.A. Care’s goal of strengthening the safety net that serves Los Angeles County's vulnerable, low income communities and to improve community and public health. It implements innovative care methods, standardizing quality of care and seeks to reduce health disparities. This care management model has the potential for replication among similar low-income populations throughout Los Angeles County.
L.A. Care will provide $50,000 of project start-up funds and $50,000 to evaluate the initiative for a total of $100,000. These funds will help support a full-time mid-level care provider and an outside evaluator.
Community Health Councils has already secured over $2.7 million of an estimated $3.1 million two-year budget. This includes Kaiser Permanente ($500,000), The California Endowment ($150,000) and Good Hope Medical Foundation ($100,000) and over $2 million of in-kind funds from FQHC partners. To close the gap of $350,000, Community Health Councils has pending and planned requests, including UniHealth and Blue Shield Foundation.
The initiative is expected to be fully sustainable after its second year of operation as a number of the visits are reimbursable under the Los Angeles County’s Healthy Way LA matched and unmatched programs, Medi-Cal and other public third party payor programs.
Board of Governors MOTION SUMMARY
Budget Impact: This grant will be paid out of the $3 million FY 2011-2012 Community Health Investment Fund budget which includes a $500,000 allocation for responsive (ad hoc) grants. If this request is approved, the new balance will be $333,000.
Motion: To approve a $100,000 grant to the Community Health Councils to implement and evaluate the “Enhanced Diabetes Care Management Initiative” in South Los Angeles.
March 29, 2012
To: Executive Committee
Through: Elaine Batchlor, MD, MPH, Chief Medical Officer
From: Roland Palencia, Consultant, Community Benefit Programs
Subject: Approval of $100,000 ad hoc grant to Community Health Councils to implement and evaluate the “Enhanced Diabetes Care Management Initiative” in South Los Angeles
Introduction Staff recommends a two-year ad hoc grant of $100,000 to the Community Health Councils to implement and evaluate the “Enhanced Diabetes Care Management Initiative.” This project is in partnership with eight South Los Angeles Federally Qualified Health Centers (FQHCs) and other community stakeholders 1. L.A. Care’s support will help improve and evaluate the health outcomes of 3,000 adult patients whose diabetes is poorly controlled and who are at-risk for unnecessary emergency room visits and hospitalizations, and overall poor quality of life.
Background and Project Rationale Community Health Councils is a non-profit health advocacy and policy organization committed to improve access to quality health care and to eliminate health disparities in underserved, uninsured and underinsured populations locally and statewide. Over the past year, Community Health Councils has worked with members of the South LA Healthcare Leadership Roundtable to standardize primary care services within the safety-net in South Los Angeles. This advisory group convened in 2007 and is composed of clinic and hospital executives, academic and research institutions, physician groups and philanthropic organizations committed to improving the health of South LA residents.2
South Los Angeles has high rates of uninsured and publicly-insured patients with little access to high-quality, affordable health care. Thirty-nine percent of adults in that area reported having difficulty obtaining medical care.3 Diabetes, often considered a preventable condition, continues to be one of the fastest growing diseases in that community. While only 12.3% of South Los Angeles
1 The eight FQHCs are: Central City Community Health Center, Eisner Pediatric and Family Medical Center, South Bay Family Health Care, South Central Family Health Center, St. John’s Well Child and Family Center, T.H.E. Clinic, UMMA Community Clinic and Watts Healthcare Corporation. 2 Some members of the South LA Healthcare Leadership Roundtable include: California Hospital Medical Center, the Southside Coalition of community clinics, Kaiser Permanente West Los Angeles Medical Center, Martin Luther King, Jr. Multi-Service Ambulatory Care Center (DHS), Charles Drew University of Medicine and Science and MedPOINT Management among others. 3 LA County Health Survey, 2007. March 29, 2012 Community Health Councils – Enhanced Diabetes Care Management Initiative Page 2 of 4
adults are diagnosed with diabetes,4 it remains the fourth leading cause of death in that area with an age-adjusted death rate of 40 individuals per 100,000. This is nearly twice the rate of 23 individuals per 100,000 in Los Angeles County.5 Preventable hospitalizations for short-term complications and uncontrolled diabetes have steadily increased in South Los Angeles hospitals since 2003 from a rate of 82.3 hospitalizations per 100,000 individuals to 102.6 hospitalizations per 100,000 in 2008. This is more than double the rate for Los Angeles County of 45.7 individuals per 100,000.6
Proposed Project and Outcomes The “Enhanced Diabetes Care Management Initiative” will monitor up to 3,000 diabetic patients over a two-year period and provide them with intense care services and management to control their blood sugar levels, blood pressure and cholesterol to acceptable levels. This collaborative provides clinic partners and other stakeholders an opportunity to address disparities by improving how South Los Angeles clinics share consistent guidelines, standardized protocols and best practices, manage patient populations, prioritize sick patients and engage patients in their own care. This initiative will help the clinics implement a common approach to managing diabetes, allow them to learn from each other, and to make changes in their respective practices to benefit the initiative’s targeted populations and other at- risk patients.
A team of mid-level providers, with physicians and other support staff, will monitor a cohort of ten teams of 300 high risk diabetic patients per team for up to a period of nine months. Adult patients diagnosed with diabetes with higher than normal blood sugar and who have visited a participating FQHC within the past 12 months will be eligible for this initiative. Mid-level providers will team up with the patient’s primary care physician while patients go through this intensive diabetic care management program. Patients will continue to be monitored by the mid-levels and their primary care physician after “program graduation” to make sure they stay within controlled thresholds.
The program components include: • Up to nine months of intervention, in coordination with a primary care provider, to bring critical clinical indicators such as blood pressure, low-density lipoprotein (LDL) cholesterol and blood sugar levels into control as defined by the American Diabetes Association standards. • Up to ten mid-level (nurse practitioners and physician assistants) providers will follow standardized protocols to deliver intensive care and care management to a panel of enrolled patients with supervision by a dedicated physician and support from a medical assistant. • Providers will use disease registries, patient self-coaching, case management, health education, education of family members, telephonic visits, e-mails and text-messaging. • On-going integration of specialized monitoring with primary care services • Community Health Councils will convene the South Los Angeles Healthcare Leadership Roundtable and its Clinical Leadership Committee to provide program oversight, identify and share best practices, address challenges and advocate for adoption of public policy to facilitate the geographic expansion of care management models.
4 Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Key Indicators of Health; June 2009. 5 Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology, Mortality in Los Angeles County 2006: Leading causes of death and premature death with trends for 1997-2006. September 2009. 6 Office of Statewide Health Planning and Development, Preventable Hospitalizations in California: 1999-2008. 2010. March 29, 2012 Community Health Councils – Enhanced Diabetes Care Management Initiative Page 3 of 4
By the end of year one of enrollment, sixty percent of patients will demonstrate improvements to clinical outcomes and treatment compliance for at least two out of three measures of cholesterol, blood sugar or blood pressure levels.
Use of Funds L.A. Care will provide $50,000 of project start-up funds. These funds will help support a full-time mid-level care provider. An additional $50,000 will be provided for an outside evaluator, for a total contribution of $100,000. Additional details regarding the project funding can be found on page 4.
Alignment with L.A. Care Goals This project aligns with L.A. Care’s goal of strengthening the safety net that serves Los Angeles County's vulnerable, low income communities and to improve community and public health. It implements innovative care methods, standardizing quality of care, and seeks to reduce health disparities. This care management model has the potential for replication among similar low-income populations throughout Los Angeles County.
Challenges The two major challenges of this project are the complexities that arise in working with a large and diverse number of entities that are spread out over a large geographic area, as well as procuring the start-up financial resources necessary to sustain the initiative on a long-term basis.
Although many of the partners involved in this initiative have worked with each other in the past, it has been for shorter time frames, fewer multi-disciplinary engagements, standardized and specific clinical outcomes, and not as an entire group. This initiative will require a more structured, longer term commitment and a more standardized approach with a larger and more diverse number of stakeholders.
The core key partners in the initiative are eight FQHCs, a hospital, and a Los Angeles County multi- service ambulatory site. This challenge of managing multiple partners dedicated to a specific project is addressed by the long-standing relationships and partnerships already existing among the eight FQHCs and other involved stakeholders. Some of the FQHCs have collaborated for almost two decades in a number of clinical and patient advocacy efforts. All of the FQHCs are members of the Community Clinic Association of Los Angeles County, incorporated in 1996, and the Southside Coalition of Community Health Centers, which began its work in 2003.
Other involved stakeholders have long-standing working relationships with each of the clinics. All stakeholders will provide key resources to make this project a success. For example, the MLK Multi- Service Ambulatory Care Center will train mid-level clinicians on treatment protocols to ensure high clinical quality; Kaiser Permanente West Los Angeles will provide basic provider training and share best practices; Charles Drew University of Medicine and Science will provide care team protocols training; LA NET will provide practice facilitation trainings to ensure seamless integration of this initiative into daily clinic operations and for long-term impact; and the USC Center for Community Health Studies will evaluate the initiative, highlighting best practices and improvements.
Funding The second challenge is project start-up and long-term sustainability funds. Community Health Councils has already secured over $2.7 million of an estimated $3.1 million two-year budget. This March 29, 2012 Community Health Councils – Enhanced Diabetes Care Management Initiative Page 4 of 4
includes Kaiser Permanente ($500,000), The California Endowment ($150,000), Good Hope Medical Foundation ($100,000), and over $2 million of in-kind funds from FQHC partners. To close the gap of $350,000, Community Health Councils has pending and planned requests, including UniHealth, Blue Shield Foundation and L.A. Care.7
The initiative is expected to be fully sustainable after its second year of operation as a number of the visits are reimbursable under the Los Angeles County’s Healthy Way LA matched and unmatched programs, Medi-Cal and other third party payor public programs. Once established, each cohort of 300 patients is estimated to cost about $125,000 per year for a total of $1,250,000 for the ten cohorts. Almost half of the 3,000 patients are expected to be funded through the County’s unmatched program, with a reimbursement of $94 per visit. An average of six visits per year , per patient will generate over $800,000, covering about 64% of the on-going costs. The rest of the costs will be covered by patients who qualify for Medi-Cal and other government- sponsored programs, private fundraising and foundation grants. Community Health Councils estimates that over 10,000 patients could qualify for this program in the next three to four years. On a longer term, Community Health Councils also plans to advocate for policy adoptions to allow case management, care coordination, and innovative team approaches to be recognized as reimbursed services that are as critical as direct services.
Evaluation USC Center for Community Health Studies will lead the evaluation team and assess the frequency of screening, diagnostic, laboratory procedures, foot and retinal screening exams and cholesterol monitoring. USC will analyze referrals to specialists, appointment and referral patterns, successes and challenges in caring for patients and treatment decisions. Some of the specific metrics to evaluate include retinal exams in the past 12 months, foot exams, influenza vaccination, depression screening and additional measures of care such as date enrolled and exited the program, number of health education classes attended, number and nature of referrals for specialty care services and scheduled and missed appointments.
Community Health Councils plans to broadly disseminate the evaluation findings to change health care financing and reimbursement policies that support care management and team-based approaches, as well as potentially expanding the program to other safety-net providers throughout Los Angeles County.
Recognition and Acknowledgement Community Health Councils will recognize L.A. Care as the funder and key project partner through a detailed publicity plan, including joint press releases, featured speaking opportunities and distribution of literature at the initiative sites.
L.A. Care Budget Impact This grant will be paid out of the $3 million FY 2011-2012 Community Health Investment Fund budget which includes a $500,000 allocation for responsive (ad hoc) grants. The Board previously approved $67,000 for a clinic merging project. If this Community Health Councils request is approved, the new ad hoc balance will be $333,000.
7 The two-year $3.1 million budget includes start up costs such as evaluation, practice facilitation, training and operational overhead.
March 29, 2012
To: Executive Committee
Through: Elaine Batchlor, MD, MPH, Chief Medical Officer
From: Roland Palencia, Consultant, Community Benefit Programs
Subject: Community Health Investment Fund Summary for Fiscal Year 2010-2011
Introduction This document provides a review of Community Health Investment Fund (CHIF) grants made during the 2010-2011 fiscal year and an update on active grants. Since the community benefits program started in 2001, L.A. Care’s investment totals almost $40 million. When the Children’s Health Initiative and sponsorship contributions are included, L.A. Care’s community support surpasses $132 million, making L.A. Care one of the largest health care safety net funders in Los Angeles County.
CHIF grantmaking is guided by policies that outline funding priorities, procedures for grant review, grant approvals, and reporting. All grants go through a review process, including a formal application process, discussion with staff members, site visits and final review by staff, and sometimes by community experts. Each grant is brought to the Executive Committee for consideration and then to the Board of Governors for final approval.
Summary of Grants Made in Fiscal Year 2010-2011 Each year, the grantmaking budget is divided between funds for predetermined initiatives and for grants in response to external requests. In fiscal year 2010-2011, the Board approved a budget of $4 million for CHIF grantmaking. We ended the fiscal year within our $4 million budget, committing $3,790,000 to grants. We funded nine clinic programs to integrate behavioral health and coordinated care for diverse populations through the Tranquada III initiative ($1,150,000); two health information technology projects, including support to Los Angeles Network for Enhanced Services (LANES) to develop a health information exchange system between Los Angeles County Department of Health Services (LAC DHS) and community-based clinics and the development of a County-wide Safety Net eConsult platform through HIT III ($1,000,000); support for the executive director position at LANES ($300,000); sixteen preventative and therapeutic dental projects for adults who lost their Medi-Cal benefits in 2009 through the first phase of the oral health initiative V ($635,000); and three ad hoc grants that supported hospital readmissions reductions, health reform information and training for low-income safety net advocates, and platform development of a remote video project to train primary care providers on at least one clinical specialty ($705,000).
Community Health Investment Fund (CHIF) Grants - Summary 2010-2011 March 29, 2012 Page 2
We also funded 11 additional CHIF grants from other funding sources and previous allocated funds. From an original allocation of $3 million designed to support projects at Rancho Los Amigos National Rehabilitation Center, we funded the development of a financially sustainable care delivery model in alignment with health care reform and California’s 1115 Waiver. We reallocated unspent LAC DHS funds to support four new projects, including support for the Office of Nursing Affairs to purchase computerized mannequins to enhance and standardize nurse training; support for the Valley Care Network to implement a retinal telemedicine program to improve access and quality of eye care for diabetic patients; equipment and furnishings for the newly expanded South Valley Health Center pediatric clinic; and support for the replacement of an outdated specialty care referral system and the development of a safety net eConsult platform. First 5 LA, a long-time oral health initiative partner provided $500,000 to be re-granted to six OHI V, phase 2 grantees to support dental services for children ages 0 to five.
In summary, we funded 42 projects for over $5.5 million. Please refer to Attachment A: Grants Approved in fiscal year 2010-2011. We also monitored 26 active grants that were funded prior to the start of the fiscal year. Please refer to Attachment B: Previously Funded Grants – FY 2010-2011 for more details.
Areas of Impact As in previous years, CHIF grants were aligned with three key organizational goals: strengthening the safety net, improving community and public health, and expanding access to care for underserved communities. CHIF grants have helped public and private safety net providers expand their capacity and improve quality of care by preparing them to meet the growing demand for services resulting from health care reform and the California 1115 Waiver. Also, CHIF grants are helping increase health information technology capacity in Los Angeles County by funding a health information exchange initiative, the development of an eConsult platform, and a telehealth project.
Specific areas of impact are described below.
Health Reform, California 1115 Waiver and Medi-Cal Expansion L.A. Care has invested in projects that strengthen safety net infrastructure and expand capacity to serve adults with complex medical and social needs, including seniors and people with disabilities (SPDs). In 2014, under the federal Patient Protection and Affordable Care Act (ACA), an estimated 4.7 million previously uninsured Californians will be able to access health insurance benefits through Medi-Cal and the California Health Benefit Exchange.1 Already, California’s 1115 Waiver is expanding coverage to adults with incomes of up to 133% of the federal poverty level under local county initiatives. This is expected to benefit over 300,000 Los Angeles County uninsured and low- income residents.2,3 These changes present an opportunity to improve access and quality of care for these individuals, most of them adults with complex medical and social needs, including SPDs. Effective June 1, 2011, California’s 1115 Waiver required most SPDs in fee-for-service Medi-Cal to
1 Lavarreda SA and Cabezas L. Two-Thirds of California’s Seven Million Uninsured May Obtain Coverage Under Health Care Reform. Los Angeles, CA:UCLA Center for Health Policy Research, 2011. 2 "California Bridge to Reform: A Section 1115 Waiver Fact Sheet." Department of Health Care Services (2010). Available at: http://www.dhcs.ca.gov/Documents/1115%20Waiver%20Fact%20Sheet%2011.2.10.pdf Accessed March 2011. 3 Dyer, Irene, Director, Office of Planning and Analysis, LA County DHS, presentation slides, LA Health Action Collaborative Meeting, February 14, 2011. Community Health Investment Fund (CHIF) Grants - Summary 2010-2011 March 29, 2012 Page 3
join a managed care plan. This expansion prompted many community clinics and other safety net providers to plan for and implement projects to expand their service capacity and deliver more integrated, patient-centered models of care.
In September 2011, L.A. Care approved the Tranquada III initiative to help community-based safety net clinics meet the growing demand for services resulting from federal, state and local initiatives that seek to expand medical care. The Tranquada III initiative supported the expansion of clinical services and implementation of new care models. This included transitional care between a hospital and a primary care clinic, the creation of an SPD care coordination team, integration of behavioral health into primary care, a referral and patient navigation services center, and the redesign of space to add behavioral services. Nine grants were funded and all are in the implementation phase.
For example, Altamed Health Services Corporation, COPE Health Solutions and the White Memorial Medical Center are implementing a care transition and coordination program to transition patients from hospitals to a primary care medical home. Some of the expected outcomes include reducing hospital readmissions, enhancing patient medication compliance, and establishing a medical home for over 150 SPDs a year.
The JWCH Institute is developing a centralized appointment system. This new system will allow the clinic to better coordinate over 110,000 annual medical, health education, behavioral health and other visits to support the transition of homeless and SPD patients into a system of care.
The Valley Community Clinic is building a behavioral health suite, an education and training room, and remodeling a dispensary. The newly renovated behavioral health suite will have 19 offices and treatment rooms, a handicap accessible bathroom, a patient reception area and a training and staff meeting room. These renovations will allow the clinic to hire additional behavioral health staff and increase mental health visits. The training room will host community classes, patient wellness education groups, and medical staff trainings (such as CPR and First Aid). The dispensary and other waiting room renovations will allow patients to receive their prescriptions more promptly and facilitate clinic patient navigation. In 2012, the clinic expects to serve 5,000 new patients through its contract with Los Angeles County’s Healthy Way LA., which will increase their patient base by over 30%. L.A. Care’s support of these renovations will help the clinic to accommodate this increase in patient workload.
We also funded an ad hoc grant to address upcoming healthcare reform changes. In December, 2010 we supported the Hospital Association of Southern California to implement a hospital readmissions reduction project with the goal of reducing readmissions by 15% at ten hospitals by July 2012. This project is timely as healthcare reform will adversely impact hospitals with a high readmission rate. The project has recruited seven of ten target hospitals, held a webinar on the root causes of readmissions and hosted two in-person collaborative meetings to date.
Some of the biggest challenges faced by this project are the competing priorities within each hospital, many which are involved in a number of quality and patient safety initiatives. Accountability milestones are in place to address this challenge. Hospitals are also experiencing difficulties when working with qualified data (readmission type, diagnoses and trends) and resources to analyze that data. Working with each hospital separately has been an effective way to address this challenge. Community Health Investment Fund (CHIF) Grants - Summary 2010-2011 March 29, 2012 Page 4
Although hospital enrollment in this project is no longer open, HASC is in the process of negotiating an expanded scope of work with L.A. Care to direct unused funds. To accommodate program implementation delays, we will most likely provide a no-cost extension to allow for program completion.
Support for a Health Information Exchange Initiative and eConsult Project Through three health information technology (HIT) grant initiatives and a number of ad hoc grants, L.A. Care has provided over $6 million to help 29 organizations purchase HIT and implement 32 HIT projects. Our two primary objectives are to ensure that low-income communities have the tools and resources to benefit from the quality enhancements from the use of clinical HIT, and to strengthen community clinic safety-net provider infrastructure in support of quality and efficiency improvement. In this fiscal year, CHIF supported a health information exchange and an eConsult project to enhance the safety net’s ability to exchange clinical patient information and improve communication between providers.
Health Information Exchange Initiative We supported LANES with a grant of $250,000. LANES is a public-private collaboration network initiated by the County of Los Angeles to facilitate the exchange of health information between LAC DHS system and community-based safety net providers. Staff for the Los Angeles County Chief Executive Officer (CEO) convened a steering committee that is comprised of representatives from the CEO’s office, the LAC DHS, L.A. Care, Hospital Association of Southern California, the Community Clinic Association of Los Angeles County, and Health-e-LA.
LANES has initiated the Health Data Highway Project to enable safety net providers to exchange clinical information electronically. This includes lab and diagnostic test information, clinical notes, hospital admission and discharge information, and medication information. The project seeks to connect sixteen non-profit community clinics, with four hospitals, two multi-specialty ambulatory care centers, six comprehensive health centers, and 14 outpatient clinics in the LAC DHS system. LANES will connect a variety of systems including practice management systems, lab systems, electronic health record systems, disease registries, pharmacy systems, and referral and eConsult systems. LANES is expected to integrate data from Quest Laboratories and Providence Hospital in early April and data for over six million patients from LAC DHS facilities by July 2012.
Safety Net eConsult In this fiscal year, L.A. Care funded eConsult, a care management process that addresses gaps in communication and coordination of patient care between primary care physicians and specialists.
The Safety Net eConsult project, funded in mid 2011, will connect up to ten community-based clinics with 30 sites and an estimated 20 LAC DHS sites. Key partners in the project include HealthCare LA IPA (HCLA)-representing most community clinics in the county, MedPoint Management - the management services organization for HCLA, Los Angeles County’s Chief Executive Office, and LAC DHS.
L.A. Care is managing the project and has hired a vendor to build the eConsult platform, which is expected to “go-live” in June 2012. We will phase-in about an average of two specialties per month, for a total of 13 specialties by the end of September 2012. Some of the specialties include: Community Health Investment Fund (CHIF) Grants - Summary 2010-2011 March 29, 2012 Page 5 cardiology, dermatology, orthopedics/podiatry and gastroenterology. We selected four vendors to provide the participating clinics with training, technical support, and help with implementation: Community Clinic Association of Los Angeles County, COPE Health Solutions, Object Health and e2o Health.
Support for Delivery of Oral Health Services Since 2003, L.A. Care has provided funding to expand access and provide oral and dental health services, because of the strong connection between oral health and overall health and the lack of resources to cover dental services for low-income people, particularly adults. We have funded 91 projects that provide oral health education, prevention and treatment services. Having awarded over $9.1million, L.A. Care is one of the largest funders of oral health services for low-income communities in Los Angeles County. Investments in oral health have helped to develop a network of safety net oral health providers in L.A. County, most of them integrating physical and oral health.
Through the fifth oral health initiative, we supported 16 dental programs for a total of $635,000. This initiative targeted adults, including physically and developmentally disabled populations and Medi-Cal beneficiaries over the age of 21 who lost their dental benefits due to State of California cutbacks effective July 2009. We supported a variety of dental projects, including converting a mobile clinic to a full service clinic, dental preventative services and treatment such as full examinations, topical fluoride, fillings and extractions and partial dentures and the purchasing of dental equipment, including x-rays and dental software. Through our partnership with First 5 LA, we funded six projects that provided oral health education for parents and preventative and therapeutic dental services for children ages 0 to 5 for a total of $500,000.
These two OHI V programs are expected to provide over 66,000 procedures and visits to an estimated adult and children patient population of over 22,000. All 22 dental projects are still in the implementation phase.
Support for Los Angeles County Department of Health Services We funded seven LAC DHS projects in 2006 and 2007. As of this fiscal year, three projects remain outstanding: Endoscopy, Optometry and marketing and contracting for Rancho Los Amigos National Rehabilitation Center (RLA). All of these projects are scheduled to be completed by the end of 2012.
LAC DHS initially requested funds to build an endoscopy suite, which was not feasible due to fire and building code restrictions. The funds were reprogrammed to provide endoscopy services, decreasing wait times for colonoscopies in the LAC + USC Healthcare Network from six months to six weeks. About 1,152 endoscopy procedures, out of an expected 1,400, were provided prior to November 2010. No services have been provided since then as Hudson’s Gastroenterologist resigned and a replacement has not been hired yet.
In 2010, the optometry program provided almost 1,500 visits out of an expected 1,800, bringing the total to almost 3,400 since the grant started in July 2007. We have had significant challenges in getting accurate and timely reports for calendar year ending 2011. We continue to engage with staff assigned to this project.
Community Health Investment Fund (CHIF) Grants - Summary 2010-2011 March 29, 2012 Page 6
RLA has secured eight out of ten health plan service contracts, including L.A. Care’s. In 2011, these contracts generated over $4 million in revenues and over 1,700 inpatient visits and close to 1,400 outpatient visits. RLA continues to market its services to other health plan networks.
The Satellite Nursing campus project at Olive View Medical Center, one of the seven original LAC DHS projects, was never implemented. This resulted in unspent funds of $2.25 million. All these funds have been reallocated, including funding of the four LAC DHS projects noted below that are still in the initial phases of implementation.
One of the projects provided support for the Office of Nursing Affairs to purchase five computerized mannequins to train 50 nurses per year on emergency response skills. These computerized mannequins are equipped with several real-life clinical features such as a heart, pulse, respiratory and blood pressure rates, body sounds, blinking eyes and secretions. This type of training program will expand the nurses’ emergency knowledge through use of real-life simulation learning. The first mannequin is scheduled to arrive in early Summer 2012 and will be housed at Olive View- UCLA Medical Center. The rest of the mannequins will be arriving in the Fall of 2012.
The Valley Care Network project is implementing a retinal telemedicine program to improve access and quality of eye care for diabetic patients, scheduled to provide almost 3,000 retinal exams per year. The program is scheduled to open in early April and is expected to serve 50 patients per week by May 2012.
A third grant provided equipment and furnishings to the newly expanded South Valley Health Center pediatric clinic. The clinic is scheduled to open in June 2012.
A fourth grant for $750,000 supported the replacement of the County’s outdated specialty care referral processing system and the development of an eConsult platform. This platform will be developed and implemented by the same vendor working on the Safety Net eConsult platform highlighted in a previous section of this CHIF Summary document.
A grant made previous to this fiscal year, provided transitional funds of $572,000 to support the video medical interpreter program at four LAC DHS hospitals: RLA, LAC+USC, Harbor UCLA, and Olive View Medical Center. These additional funds have helped to generate over 46,000 calls in over 15 languages, including American Sign Language. LAC DHS is committed to continue this program and incorporate it into their overall budget. Total L.A. Care support for this project is over $1.5 million.
The implementation and reporting of progress of LAC DHS grants continues to be a challenge. In ensuing grantmaking decisions, L.A. Care staff has considered the complex operational structures, staff turnover and unclear delegation as factors to consider when making new grants to LAC DHS. Accordingly, the LAC DHS grants approved in the past two years are narrower in scope, and have more direct involvement from their project staff and more realistic timelines. These improvements are helping to ensure that projects are successfully implemented and completed in a timely manner.
Transforming Safety Net Providers into Patient-Centered Medical Homes In July 2010, L.A. Care launched a CHIF funded program to help private and non-profit primary care practices become patient-centered medical homes (PCMH). The PCMH model has the Community Health Investment Fund (CHIF) Grants - Summary 2010-2011 March 29, 2012 Page 7
potential to improve clinical quality, enhance patient satisfaction and reduce costs. The goal of this pilot project is to help these practices achieve PCMH designation as defined by the National Committee for Quality Assurance (NCQA).4 Transforming L.A. Care network clinics into PCMHs will help providers expand their services to SPDs as part of California’s 1115 Waiver process and prepare for Medicaid expansion through health care reform. Eleven practices, including community clinics, private practices and residency programs that serve over 85,000 patients, were recruited for the first cohort. They have received technical assistance focusing on items required for NCQA recognition including patient tracking and registry functions, care management, and performance reporting and improvement. This assistance is being provided by a consultant through group training sessions, conference calls, webinars, and individual consultations.
To date, all six PCMH workshops focusing on core areas of competency have been completed and all of the practices are on track to submit NCQA PCMH recognition applications by December 2012. Implementation of electronic medical records continues to be the biggest obstacle in achieving the must-pass elements for NCQA recognition. Recent staff turnover continues to impact the progress of practices, however, practices have made good progress and we provided additional funds to support care coordination, extended hours, development of health education materials and an enhanced call center.
L.A. Care recently released a request for applications for the second PCMH cohort. This was distributed to close to 275 practices that met specific criteria and 15 applications were received. Selections will be made by April 2012.
Acknowledgement and Recognition As a result of the activities and projects funded through the Community Benefit Programs, L.A. Care is increasingly recognized as an important safety net funder in Los Angeles County. In this past fiscal year, staff noted almost 20 specific acknowledgement activities by grantees, including official recognition awards. Other recognition activities included acknowledgement at grantee’s ribbon cutting ceremonies, grand openings, fundraising events; plaques; equipment decals; mentions in grantee websites and newsletters; and joint press releases.
To assess potential media exposure, L.A. Care’s Communications and Marketing department conducted a media hit analysis on all fiscal year 2010-2011 grants. As part of this analysis, they monitored newspaper circulation and website and television reports on the approximate number of viewers or readers. The audience was estimated at 5,537,220 million potential hits through 113 multilingual media outlets. L.A. Care’s Chief Executive Officer, Howard Kahn, Chief Medical Officer, Elaine Batchlor, MD, MPH, and Community Benefit Programs staff have been featured speakers at press conferences, radio interviews and events as a result of this media coverage.
4 Per NCQA: a medical home has the following basic features: Builds patient-provider relationships, Emphasizes care teams, Coordinates care across settings, Enables patient-centered visits, and Utilizes health information technology to improve patient outcomes.
Community Health Investment Fund (CHIF) Grants - Summary 2010-2011 March 29, 2012 Page 8
Lessons Learned and Grantmaking Improvements Staff submitted a CHIF Grants Summary report last March 2011 that included suggestions to improve project implementation delays, financial sustainability, evaluation activities and grantmaking efficiency. Below we describe progress made in these areas.
Delays in Project Completion In previous years, most CHIF grants were for a one-year time period. This short timeframe made it challenging for grantees to implement projects and evaluate sustainability and impact, particularly in the case of large infrastructure projects. To address this, infrastructure grants were extended to two years or more. The number of grants requiring no-cost extensions has decreased to less than 10% during the last fiscal year, from 25% the year before.
Staff has instituted more intensive due diligence efforts for each grant, including visiting the project site before a final recommendation is made and requesting more detailed work plans and progress reports. In addition, staff divides grant payments into smaller installments with more specific deliverables that prevent large outlays of funds without timely accountability.
Evaluation CHIF program staff identified evaluation as an area to be strengthened. In addition to documenting the progress, accomplishments and impact of each grant, staff engaged consultants to evaluate large grant programs like HIT, the PCMH initiative, and certain complex ad hoc grants like the Integrated Recovery Network project for dually and triply diagnosed individuals with housing provided as an anchor service. These evaluations are expected to be completed by the end of 2012 and will provide data and perspectives that will provide further insight about these projects and help shape future initiatives and individual grants.
Grantmaking Efficiency Since its inception in fiscal year 2001-2002, the CHIF program has awarded close to $40 million in grants to 140 organizations for 360 projects. To address the increasing size and date related to our grantmaking, L.A. Care purchased GIFTS online, a grants tracking program, in early 2011. This program helps the department to track grants, qualify applicants online, generate queries and reports, evaluate projects and provide access to key grant information for other L.A. Care departments. The program was scheduled to be in full operation late last year; however, there have been delays due to the release of three new versions in the past four months alone and readjustment to our forms and data. There have also been some challenges in receiving timely technical assistance. We expect full implementation within the next three months, including the ability for applicants to submit proposals online.
The Community Benefit Programs department has implemented a number of administrative improvements to streamline the grantmaking process. These improvements include revising grantee progress report templates, strengthening the ad hoc and initiative applications, creating and maintaining a mechanism to track active grants and grant-related forms, and reconfiguring electronic files to simplify retrieval and to eliminate repetitive and outdated information.
Community Health Investment Fund (CHIF) Grants - Summary 2010-2011 March 29, 2012 Page 9
Leveraging L.A. Care Funding Grants are increasingly leveraged by other funders, helping grantees to successfully implement or enhance their projects. The majority of projects are leveraged with additional 10% to 70% contributions from other funders.
This year we partnered with First 5 LA for supplemental oral health funds, which funded the children’s portion of our oral health initiative and doubled the funds available for this initiative from $500,000 to $1 million. Our investment of $562,968 to help Rancho Los Amigos to develop contracting and marketing expertise to diversify revenue sources and promote their services has resulted in over $4 million in patient revenue in its first full year of contract implementation, highly leveraging our initial investment.
Conclusion L.A. Care will continue its commitment to develop funding opportunities in areas closely aligned to its organizational goals. In the current fiscal year, Board Members will be asked to consider the Tranquada IV clinic infrastructure grants, the HIT IV telehealth medicine program, a grassroots community outreach and advocacy project to inform impacted communities about the challenges and benefits of California’s 1115 Waiver and health care reform, a second cohort of PCMH clinics, and a number of ad hoc proposals that meet CHIF criteria and priorities.
Attachment A Grants Approved in FY 2010-2011. From October 1, 2010 through September 30, 2011 Number of Grants: 42 Total: $5,586,000 April 5, 2012 Board Meeting Grant Start Grant End Name of Organization Grant Award Grant Purpose & Status Date Date Ad-Hocs - Three grants HASC will implement “Project BOOST” a hospital readmissions reduction project at Hospital Association of Southern 1 $450,000 1/15/11 7/1/12 ten L.A. Care contracted hospitals. HASC has recruited seven hospitals to date and California (HASC)- Readmissions already held a webinar and an in-person meeting.
To engage local safety net stakeholders in programs and initiatives aligned with federal health reform efforts. ITUP has held two LA Health Collaborative meetings 2 Insure the Uninsured Project $100,000 4/15/11 10/15/12 and seven Strategic Discussion meetings. The February statewide conference in Sacramento was attended by over 500, its largest to date. ITUP has posted seven health reform implementation documents on its website.
To train safety net primary care providers via video technology to effectively manage L.A. Net (fiscal agent Community pediatric patients in a primary care setting and improve access to specialty care 3 $155,000 9/30/11 9/30/13 Partners) through Project ECHO(Extension for Community Healthcare Outcomes). First report due April 2012. Total Ad Hocs: $705,000
Oral Health Initiative V, Phase 1 - Sixteen grants To purchase dental equipment such as radiography sensors and an endodontic 4 AltaMed Health Services Corp. $40,000 8/1/11 2/1/13 express rotary system to increase access to endodontic and pedodontic services. First report is due April 2012. To convert a second mobile clinic to a full service dental clinic. Conversion includes Antelope Valley Community 5 $40,000 8/1/11 2/1/13 the removal and replacement of cabinets, a larger water tank, and hand held digital Clinic x-ray systems. First report due in April 2012. To provide full examinations, x-rays, prophylaxis, periodontal scalings by quadrant, Children's Dental Health Center 6 $40,000 8/1/11 2/1/13 composite and amalgam surface fillings, and extractions. First report still pending of Greater L.A. for this recent grant. First report is due in April 2012. To convert a second mobile clinic to a full service dental clinic. Conversion includes Community Health Alliance of 7 $40,000 8/1/11 2/1/13 the removal and replacement of cabinets, a larger water tank, and hand held digital Pasadena (CHAP) x-ray systems. First report due April 2012. East Valley Community Health 8 $40,000 8/1/11 2/1/13 To provide the following services: prophylaxis, diagnostic Xrays, amalgams, Center, Inc. complete and partial dentures and topical floride. First report due in April 2012.
9 JWCH Institute, Inc. $40,000 8/1/11 2/1/13 To provide prophylaxis, sealants, fillings, scaling diagnostic x-rays, amalgams, complete and partial dentures and topical floride. First report is due in April 2012. Los Angeles Christian Health 10 $40,000 8/1/11 2/1/13 To provide full examinations, x-rays, prophylaxis, periodontal scalings by quadrant, Center composite and amalgam surface fillings. First report due in April 2012.
4/2/2012 Page 1 Grant Start Grant End Name of Organization Grant Award Grant Purpose & Status Date Date To provide the following services to the disabled and non-disabled populations: Northeast Valley Health 11 $40,000 8/1/11 2/1/13 prophylaxis, peridontal scaling and root planing, amalgam and composite surfaces Corporation and extractions. First report due in April 2012. To provide prophylaxis, diagnostic x-rays, amalgams, anterior resins, periodontal 12 QueensCare Family Clinic $40,000 8/1/11 2/1/13 scaling, root planing, complete and partial denture services. First report due in April 2012. South Bay Childrens Health To provide prophylaxis, sealants, fillings, extractions and root canals. First report 13 $40,000 8/1/11 2/1/13 Center- Dental Clinic due in April 2012. South Bay Family Health Care To purchase two digital x-ray systems and the related training for staff. First report 14 $40,000 8/1/11 2/1/13 Center due in April 2012. St. John’s Well Child and Family To purchase digital x-ray systems for three dental clinics to improve quality of care. 15 $40,000 8/1/11 2/1/13 Center First report due in April 2012. To provide the following services to a developmentally disabled population: The Frank D. Lanterman 16 $35,000 8/1/11 2/1/13 prophylaxis, periodontal maintenance , x-rays and examinations. First report is due Regional Center in April 2012. To provide comprehensive oral evaluations and diagnostic x-rays, panoramic University of Southern California- 17 $40,000 8/1/11 2/1/13 cleanings, restorative and surgical, endodontic and prosthodontic care. First report School of Dentistry due late April 2012.
18 Valley Community Clinic $40,000 8/1/11 2/1/13 To purchase and implementation of an electronic dental record system that will integrate with existing electronic health records. First report is due in April 2012. To purchase and implementation of an electronic dental record system and user 19 Watts Healthcare Corporation $40,000 8/1/11 2/1/13 license. First report is due in April 2012. Total OHI V, Phase 1: $635,000 Oral Health Initiative V, Phase 2 - Six grants (Regranted from First 5 LA grant) To provide preventative and therapeutic dental services for children ages 0-5 at the Eisner Pediatric & Family Medical 20 $100,000 12/1/2011 3/31/2013 clinic, a WIC center and at an elementary school. First report is due in mid-April Center 2012. To expand hours at the Sun Valley Health Center to provide dental care and funding Northeast Valley Health 21 $85,000 12/1/2011 3/31/2013 for a Consumer Relations Specialist to provide outreach and oral health education. Corporation First report is due in mid-April 2012. To fund expanding and enhancing pediatric dental care and staff training, and South Bay Children's Health 22 $100,000 12/1/2011 3/31/2013 providing prevention and oral health education services at WIC Centers. First report Center still pending for this recent grant. First report is due in mid-April 2012. To Provide six offsite oral health screening events to children ages 0-5 through the 23 South Bay Family Health Center $15,000 12/1/2011 3/31/2013 Healthy Kids Express Mobile Health. First report is due in mid-April 2012. To fund a Strategic partnership with USC School of Dentistry using their mobile van St. John's Well Child and Family 24 $100,000 12/1/2011 3/31/2013 to increase dental services for children ages 0-5, and training of dental students. Center First report is due in mid-April 2012. To fund the expansion of preventative and therapeutic dental services for children 25 The Saban Free Clinic $100,000 12/1/2011 3/31/2013 ages 0-5 at the clinic and those referred from WIC. First report is due in mid-April 2012. Total OHI V, Phase 2: $500,000 4/2/2012 Page 2 Grant Start Grant End Name of Organization Grant Award Grant Purpose & Status Date Date Robert E. Tranquada MD Safety Net Infrastructure III (Tranquada III) - Nine grants 26 AltaMed Health Services Corp. $100,000 9/30/2011 3/31/2013 To implement a hospital Care Transition & Coordination Program in collaboration with COPE Health Solutions and White Memorial Medical Center. First report is due 27 East Valley Community Health $125,000 9/30/2011 3/31/2013 To be used for Expansion of care coordination and integrated behavioral health Implement program for home-based primary care (HBPC) services for the SPD Eisner Pediatric and Family 28 $150,000 9/30/2011 3/31/2013 population through an integrated team approach, modeled after the approach Medical Center implemented by the VA. First report due April 2012. Expansion of current weekend-only integrated behavioral and primary care services 29 Harbor Community Clinic $150,000 9/30/2011 3/31/2013 to 5-days per week with staffing of one full time clinical psychologist and two licensed clinical social workers (LCSW). First report due April 2012. Enhanced care coordination and primary care service delivery through creation of a Centralized Patient Services Center capable of scheduling, referral coordination, 30 JWCH Institute, Inc. $100,000 9/30/2011 3/31/2013 patient navigation.Enhanced care coordination and primary care service delivery through creation of a Centralized Patient Services Center capable of scheduling, referral coordination, patient navigation. First report due April 2012.
UMMA-University Muslim Medical Expansion of case management, scheduling, and triage services to support an 31 $150,000 9/30/2011 3/31/2013 Association Community Clinic increased population of SPD patients. First report is due late April 2012. Expansion of hours at two clinics and redesign of space to incorporate care URDC Bill Moore Community 32 $150,000 9/30/2011 3/31/2013 coordination and increased services to SPD population. First report is due late April Clinics 2012. Expand services through renovation of existing space to add behavioral health 33 Valley Community Clinic $125,000 9/30/2011 3/31/2013 reatment services and office space, dispensary, and patient navigation center. First report due April 2012. 34 Venice Family Clinic $100,000 9/30/2011 3/31/2013 Expand services through renovation of existing space to add behavioral health Total Tranquada III: $1,150,000 Health Information Technology III Initiative (HIT III) - Two grants LANES (Los Angeles Network for Enhanced Services. Plans to bring new users 35 LANES $250,000 10/1/2011 10/1/2012 such as Providence Hospital, LAC DHS and Quest Laboratories with over six million patient database. Second report due June 2012. To develop a safety net eConsult platform that will connect community clinics and 36 $750,000 eConsult LAC DHS. Total HIT III: $1,000,000 37 LANES $300,000 8/31/2011 TBD Funding for LANES Executive Director position
4/2/2012 Page 3 Grant Start Grant End Name of Organization Grant Award Grant Purpose & Status Date Date Los Angeles County Department of Health Services. Reallocated Unspent Funds - Four grants The Valley Care Network will receive $115,000 for a Retinal Telemedicine program LAC-DHS to improve access and quality of eye care for diabetic patients. The program is 38 $115,000 5/1/2011 11/1/2012 Retinal Telemedicine scheduled to open in early April and is expected to serve 50 patients per week by May 2012. Fund to the Office of Nursing will purchase computerized mannequins within two LAC-DHS months to enhance and standardize the clinical training of nurses.The first 39 Metiman Manikins Education and $236,000 5/1/2011 11/1/2012 mannequin is scheduled to arrive in early summer 2012 and will be housed at Olive Training Project View-UCLA Medical Center. The rest of the mannequins will be arriving in fall 2012. LAC-DHS South Valley Health Center received funds to equip and furnish a newly LAC-DHS expanded pediatric clinic. The equipment, furniture, and computer items were 40 South Valley Health Center $75,000 5/1/2011 11/1/2012 ordered. The opening of the new clinic is scheduled for June 2012. Second report Pediatric Clinic Expansion due May 2012. Funds will replace outdated specialty care appointment system and develop an 41 LAC-DHS eConsult $750,000 5/25/2011 5/25/2013 eConsult platform to be connected to the Safety Net eConsult network. Total LAC DHS: $1,176,000 Rancho Los Amigos National Rehabilitation Center - One grant Rancho Los Amigos National To develop a financially sustainable care delivery model that aligns with California’s 42 Rehabilitation Center (SPD $120,000 9/30/11 3/31/13 1115 Waiver and federal health care reform changes. First report due April 2012. Managed Care) Total Rancho SPD MC: $120,000 All Approved Grants Total $5,586,000
4/2/2012 Page 4 Attachment B Previously Funded Grants FY 2010-2011, and still active during October 1, 2010 through September 30, 2011. Number of Grants: 26 Total: $5,837,738 April 5, 2012 Board Meeting Grant Start Grant End Name of Organization Grant Award Grant Purpose & Status Date Date Ad-Hocs To complete a strategic process to affiliate with another health care organization. American Indian HC has selected American Indian Healing 1 $55,000 10/15/10 4/15/12 the JWCH Institute as a merger partner. L.A. Care made a recent award for $67,000 to formalize the partnership Center merger. To provide train-the-trainer instruction on asthma prevention and management, and environmental health for 50 Esperanza Community L.A. Care Regional Community Advisory Committee (RCAC) health promoters. The 50 L.A. Care trained health 2 $50,000 10/15/10 4/15/12 Housing promotores have educated 408 people through educational presentations, health fairs, one-on-one presentations and home visits. To expand social services and linkages to medical care and benefits for homeless persons with dual diagnoses of Integrated Recovery Network mental illness and substance abuse in Los Angeles County. IRN has helped a total of 65 people get off the streets 3 $126,000 7/1/10 1/30/11 (includes $40k for evaluation) and into housing with linkages to comprehensive support services; thus already surpassing its target goal of 56 clients. Long Beach Network for To connect a minimum of ten Los Angeles County community clinics and over 30 sites to the existing WHIN health 4 Health dba Western Health $153,000 1/1/10 12/31/11 information exchange network. WHIN signed up 10 clinics with 40 sites. WHIN will evaluate the value of shared Information Network (WHIN) data in Spring of 2012. Northeast Valley Health To support the start-up and operating costs for the Santa Clarita Health Center to provide up to 3,765 patient visits. 5 $300,000 1/15/10 7/15/12 Corporation-Santa Clarita HC The clinic began operating full time in January 2011 and had already provided 3,355 visits by July 2011. Initiative to help practices achieve patient centered medical home (PCMH) designation as defined by the National Qualis Health Center - Committee for Quality Assurance (NCQA). Eleven non and for profit private practices, including two residency 6 $400,000 + Evaluation + Direct $600,000 8/15/10 12/15/12 programs participate in the program and serve over 85,000 patients. Baseline provider assessments have been support to community clinics. performed, an evaluator has been identified and most practices are on track to receive NCQA certification by the end of 2012. To support a new community dental clinic in Lawndale with four new operatories. The clinic opened in September South Bay Childrens Health 7 $210,000 7/15/10 1/15/12 2011 and has doubled its service capacity to 590 unduplicated clients and almost 1,100 visits. They have provided Center- Dental Clinic oral screenings to 6,178 children in 12 schools. Total: $1,494,000 Oral Health Initiative IV (OHI IV)
To support diagnostic, preventive and treatment services for Medi-Cal dental beneficiaries over the age of 21 who 8 The Saban Free Clinic $40,880 9/24/09 5/1/11 have lost their benefits due to State of California cutbacks as of July 1, 2009. Grantee provided 1,111 procedures, meeting the grant objectives. Total: $40,880 Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative I (Tranquada I) Provide for the expansion of the existing clinic facilities by adding five additional ADA compliant examination rooms and one additional mental health counseling office. The City of Los Angeles City Planning Community Redevelopment Committee became interested in preserving some of the key identifying architectural features of the 9 Harbor Community Clinic $250,000 11/1/07 6/30/11 building. This posed additional challenges and increased costs, since the project was mid-way through construction. The clinic worked with the Historical Society to reach a resolution, and the project should be completed by Summer of 2012. Total: $250,000
4/2/2012 Page 1 Grant Start Grant End Name of Organization Grant Award Grant Purpose & Status Date Date Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative II, Phase 2 (Tranquada II - Phase 2) To help purchase and implement a new practice management system with an electronic health records (EHR) Cleaver Family Wellness/Our 10 $105,000 5/15/2010 5/15/2012 module. The clinic implemented the system in July 2011. Scheduled daily visits are back at pre-implementation Saviour Center figures (45) and close to goal of 50 visits. To help the clinic with performing activities related to FQHC-Look-Alike research, clinical and administrative 11 Garfield Health Center $125,000 5/15/2010 5/15/2012 infrastructure development and the submission of an FQHC Look-Alike application. The clinic was asked to re- submit the Look-Alike application, and expects to hear about the current pending application any day. Help the clinic to move to a new site and renovate over 5,500 square feet of clinical and administrative space, Pomona Community Health 12 $200,000 5/15/2010 5/15/2012 including eight exam rooms. Construction has been completed and the license should be awarded soon. Staff Center recruitment has begun. To support expansion of adolescent and prenatal health services at the existing UMMA clinic site and establish a new school-based health center. LAUSD decided to select a new vendor for the modular building for the clinic. This 13 UMMA Community Clinic $200,000 5/15/2010 5/15/2012 change requires new construction approvals from the California Division of the State Architect. UMMA now expects the clinic facility to be completed by October 2012. UMMA has obtained occupancy permits, and selected equipment and furnishings. To help purchase and implement a new practice management system with an electronic health records (EHR) module. The clinic received the Practice Management System (PMS) training in May and and went "live" in June 14 URDC Bill Moore $165,000 5/15/2010 5/15/2012 2011. Data migration from their database into the eClinical Works EHR was completed, with all patient demographic and eligibility information successfully migrated. Total: $795,000 Health Information Technology II Initiative (HIT II) Asian Pacific Health Care To purchase and implement a new electronic health records (EHR) system and interfaces. The clinic revised the 16 $115,000 7/31/2010 7/31/2012 Venture, Inc. training schedule and is in the process of implementing NextGen EHR and PMS systems. Family Health Care Centers of To purchase and implement a new electronic health records (EHR) system and interfaces. The clinic revised the 17 $115,000 7/31/2010 7/31/2012 Greater Los Angeles training schedule and is in the process of implementing NextGen EHR and PMS systems. Northeast Valley Health To purchase and implement a new electronic health records (EHR) system. The NextGen EHR was implemented 18 $100,000 7/31/2010 7/31/2012 Corporation with two 25 workstation training rooms to accommodate staff. St. John’s Well Child and To purchase and implement a new electronic health records (EHR) system. The clinic selected the GE Centricity 19 $99,000 7/31/2010 7/31/2012 Family Center EHR and has provided in-depth EHR end-user training for medical staff, assistants, and support services staff To purchase and implement a new electronic health records (EHR) system. The clinic went "live" with the NextGen 20 Venice Family Clinic $100,000 7/31/2010 7/31/2012 EHR system in July 2011 and trained all staff. Total: $529,000 Los Angeles County-Department of Health Services To increase endoscopic capacity by renovating new endoscopy suites, installing state-of-the-art networked endoscopy equipment. The suite was not able to be built due to fire and building codes, thus funds were redirected 21 LAC-DHS - Endoscopy $499,161 1/1/07 6/30/11 to services. The backlog for colonoscopies in the LAC-USC Healthcare Network decreased from six months to six weeks. In November 2010, Hudson CHC's (Hudson) Gastroenterologist left, and no replacement has been found. As November 2010, 1,152 colonoscopies have been provided. Reports are late. Increase capacity at two existing ambulatory suites for optometry and to provide up to 1,800 visits per year. In 2010, 22 LAC-DHS - Optometry $199,729 1/1/07 6/30/11 1,481 new visits were provided, bringing the project total to 3,387. Over 91% of patients were uninsured. LAC-DHS - Contract & To allow Rancho to hire contracting and marketing experts to support assessment and implementation activities to 23 Marketing, Rancho Los $542,968 1/1/08 1/31/12 diversify its contracting and funding sources. To date, eight insurance contracts have been signed and have raised Amigos Foundation over $4 million in revenues. To provide funding to assist with the development of an outpatient Day Rehabilitation and Wellness Center at LAC-DHS Rancho Day Rehab - Rancho Los Amigos Hospital. Expanded its services by adding the Adult Brain Injury Program serving patients with 24 Rancho Los Amigos $915,000 11/1/08 10/31/11 stroke, spinal cord injury, brain injury and other neurological disorders. To date, 4,854 patients have received Foundation 57,312 therapy visits at the center. A no-cost extension has been requested to utilize remaining funds.
4/2/2012 Page 2 Grant Start Grant End Name of Organization Grant Award Grant Purpose & Status Date Date To sustain the video medical interpretation services for the Interpreter Call Center Program at four LAC DHS LAC DHS - Video medical hospitals. LAC-DHS has established a fully operational system for health care interpreter services at the four DHS 25 $100,000 7/15/2010 9/15/2010 interpretation hospitals (LAC-USC, Harbor-UCLA, Olive View-UCLA Medical Center, and Rancho Los Amigos). Interpreter services have provided15,516 calls using 15 languages and American Sign Language. Public Health Foundation To sustain the video medical interpretation services for the Interpreter Call Center Program at four LAC DHS Enterprises, Inc. (Fiscal Agent hospitals. LAC-DHS was able to continue providing a fully operational system for health care interpreter services at 26 $472,000 5/1/2011 11/1/2012 for LAC DHS - Video medical the four DHS hospitals and the medical ambulatory care center at MLK (MLK-MACC). To-date, 46,421 callers have interpretation) been assisted. Total: $2,728,858 Grant Total for Grants $5,837,738 Approved:
4/2/2012 Page 3
March 20, 2012
TO: Finance and Budget Committee
FROM: Elena Stern, Director, Communications and Marketing Jejuana Johnson, Communications and Marketing Coordinator
THROUGH: John Wallace, Chief Operating Officer
SUBJECT: Fiscal Year 2010/2011 Sponsorship Report
We are submitting for your review the annual Sponsorship Report required by L.A. Care Policy 603. Attached to this memo you will find a complete listing of all approved sponsorships and declined sponsorship requests logged during this fiscal year, and a copy of L.A. Care Policy 603.
All sponsorship requests were carefully assessed to determine if the organization and/or the event met the criteria set forth by Policy 603. Special consideration was given if the event offered considerable exposure for L.A. Care in a key market, honored an L.A. Care employee, or if another department indicated a specific interest in participating. A majority of approved sponsorships were supported in prior years and continue to be of mutual benefit to L.A. Care and the requesting organizations.
Highlights for this fiscal year: The Communications and Marketing department (C&M) sponsorship budget for FY 2010/2011 was $200,000. Many requests were forwarded to the C&M from other L.A. Care departments that were directly solicited by the requesting organizations.
C&M received and reviewed 99 sponsorship requests from various local and national organizations. Of those, 50 sponsorships were approved and 49 sponsorships were declined. C&M funded $203,570 (slightly over budget as is detailed below) and other departments co-funded events totaling $22,360, for a combined total of $225,930.
As in previous years, L.A. Care continues to support events that focus on increasing visibility among seniors and people with disabilities, and on safety net clinics and hospitals. L.A. Care was a major sponsor of events for the Community Clinic Association of Los Angeles County, the South Bay Fiscal Year 2010/11 Sponsorship Report March 20, 2012 Page 2 of 2
Family Health Center, and Partners in Care Foundation. L.A. Care participated in the Westside Center for Independent Living “Full of Life Festival” for the first time.
In an effort to stay within the budget, leadership approved the reallocation of the CareNow ($20,000) sponsorship and two ABC7 sponsorship campaigns ($10,000) to FY 2011/2012. Despite the reallocation we were slightly over budget by $3,570.
Comparison to the previous year: We received thirteen fewer requests this year, due in part to a decrease in the number of requests for non health-related events and organizations based outside our service area that have been repeatedly declined by us in the past. Three fewer sponsorships were awarded. Overall, expenditures were $26,180 less than in the prior year, because many repeat sponsorship requests were negotiated at lower funding levels.
Amount Topic/Grant Status Amount Event Date Category Organization Event/Conference Location Amount Other Category Funded Mrkting Dept.
9/24/2010 Event Chinatown Service Center 39th Anniversary Dinner San Gabriel Hilton Sponsorship YES $2,500 $2,500 $0 California 10/1/2010 Event Black Women for Wellness Annual Conference Sponsorship YES $6,250 $6,250 $0 Endowment 4716 Cesar Chavez 10/2/2010 Event Familia Unida Wheelchair Wash Sponsorship YES $7,500 $7,500 $0 Ave. 7th Annual Walk for the 10/2/2010 Event NAMI Walks Long Beach, CA Sponsorship YES $2,500 $2,500 $0 Mind of America International Center for 7th Annual Black Midwives 10/7/2010 Conference Long Beach, CA Sponsorship NO $0 $0 $0 Traditional Childbearing and Healers Conference 123 South Alvarado 10/9/2010 Event Clinico Romero Romero Health Walk Sponsorship YES $2,500 $2,500 $0 Street (kick-off) Asian Rehabilitation Fundraising Gala - Ha Ha 10/10/2010 Event The Queen Mary Sponsorship NO $0 $0 $0 Services Hollywood Antelope Valley Partners In John P. Eliopoulos 10/11/2010 Event 11th Anniversary Gala Sponsorship NO $0 $0 $0 Health Hellenic Hall
T.H.E. Clinic (To Help California African 10/14/2010 Event 36th Anniversary Gala Sponsorship YES $5,000 $5,000 $0 Everyone Clinic) American Museum East Los Angeles 10/17/2010 Event LAs Best Family Health Festival Sponsorship NO $0 $0 $0 College Minority AIDS Project - 10/18/2010 Organo Gold Los Angeles Sponsorship NO $0 $0 $0 Treatment Adherence USC-KECK and Charles Primary Care Week USC and Charles 10/18/2010 Conference Sponsorship YES $5,000 $5,000 $0 Drew University Conference Drew Campus 50th Anniversary The Dorothy 10/19/2010 Event JWCH Institute Sponsorship YES $7,500 $7,500 $0 Celebration Chandler Pavilion Anniversary Celebration and New Capital 10/20/2010 Event Asian Youth Center Sponsorship NO $0 $0 $0 Awards Dinner Seafood Restaurant 20th Anniversary Gala 10/21/2010 Event Community Coalition JW Marriott Hotel Sponsorship NO $0 $0 $0 Dinner Amount Topic/Grant Status Amount Event Date Category Organization Event/Conference Location Amount Other Category Funded Mrkting Dept. 24th Anniversary Millennium Biltmore 10/21/2010 Event KHEIR Fundraising Dinner and Sponsorship YES $5,000 $5,000 $0 Hotel Awards White Memorial Medical Beverly Wilshire 10/24/2010 Event Gala 2010 Sponsorship NO $0 $0 $0 Center Hotel LA Faith Conference, Strike Out AIDS Day, CHIVAS Various locations in 10/25/2010 Event The Wall Memorias Sponsorship NO $0 $0 $0 AIDS Awareness, Noche De Los Angeles Las Memorias
USC-School of Policy, USC Town and 10/26/2010 Event Guardian Awards dinner Sponsorship NO $0 $0 $0 Planning and Development Gown
Mercado La Paloma Esperanza Community 10/28/2010 Event Dancing Under the Stars 3655 S. Grand Sponsorship NO $0 $0 $0 Housing Ave., Los Angeles Annual Gala - Celebrate South Campus of 10/28/2010 Event L.A. Trade Tech College Education: A Pegasus Ad Buy YES $500 $500 $0 L.A. Trade Tech Experience South Bay Family Health Excellence In Health Care Manhattan Beach 10/28/2010 Event Sponsorship YES $25,000 $25,000 $0 Care Gala Marriott Asian and Pacific Islanders Self Determination 10/29/2010 Conference Westin Long Beach Sponsorship NO $0 $0 $0 with Disabilities of California Conference Pacific Palms 11/5/2010 Event COPE Health Solutions Awards Gala Resort, City of Sponsorship YES $2,000 $2,000 $0 Industry Millennium Biltmore 11/5/2010 Event National Health Foundation Hospital Hero Awards Sponsorship YES $2,500 $2,500 $0 Hotel Amount Topic/Grant Status Amount Event Date Category Organization Event/Conference Location Amount Other Category Funded Mrkting Dept. California Hispanic Health Marriott Marquis National Hispanic 11/9/2010 Event Professional student Hotel, San Sponsorship NO $0 $0 $0 Foundation Scholarship Gala Dinner Francisco Millennium Biltmore Southern California Visionaries Awards 11/9/2010 Event Hotel - Crystal Sponsorship YES $1,325 $1,325 $0 Leadership Network Luncheon Ballroom Los Angeles Economic 11/10/2010 Event Eddy Awards Beverly Hilton Sponsorship NO $0 $0 $0 Development Leadership 11/13/2010 Event Western University Tribute of Caring Disneyland Hotel Ad Buy YES $1,500 $1,500 $0 Olive View UCLA Medical 11/20/2010 Event Tree Planting Olive View Sponsorship YES $2,485 $2,485 $0 Center 11/22/2010 Event Saban Free Clinic 34th Annual Dinner Gala The Beverly Hilton Sponsorship NO $0 $0 $0 California Department of Living Well With Disabilities 11/29/2010 Conference Sacramento, CA Sponsorship YES $500 $0 $500 Public Health Conference 8th Annual Community Los Angeles Airport 12/3/2010 Conference Vision y Compromiso Sponsorship YES $3,500 $3,500 $0 Workers Conference Marriott Annual 5k/10k Holiday 12/5/2010 Event Say No to Drugs Universal Studios Sponsorship NO $0 $0 $0 Classic Grandparents Day 12/5/2010 Event Wiley Center Sheraton Gateway Sponsorship YES $300 $300 $0 Luncheon St. John's Well Child and Health and Human Rights Los Angeles 12/10/2010 Conference Sponsorship YES $5,000 $5,000 $0 Family Center Conference Convention Center Insure the Uninsured ITUP 15th Annual Sacramento 2/2/2011 Conference Sponsorship YES $3,000 $3,000 $0 Project Conference Convention Center UCLA School of Public Hyatt Regency 2/2/2011 Event Anniversary Gala Sponsorship YES $5,000 $5,000 $0 Health Century Plaza 2/8/2011 Event Saban Free Clinic Benefit Concert Wiltern Theatre Sponsorship NO $0 $0 Community Clinic Health Care Symposium and Hyatt Regency 2/11/2011 Conference Association of Los Angeles Community Health Star Sponsorship YES $20,000 $20,000 $0 Huntington Beach County Awards Community Clinic Westside Center for Hyatt Regency 2/11/2011 Conference Association LAC Health Star Sponsorship YES $5,000 $5,000 $0 Independent Living (WCIL) Huntington Beach Awards Amount Topic/Grant Status Amount Event Date Category Organization Event/Conference Location Amount Other Category Funded Mrkting Dept. Los Angeles County JFK Profiles in Courage 3/23/2011 Event Los Angeles Sponsorship NO $0 $0 $0 Democratic Party Awards
ABC7 - Volunteer Center of Kid Healthy Steps to a 3/1/2011 Event Los Angeles Sponsorship YES $10,000 $10,000 $0 Orange County Healthy Living
3/11/2011 Event AltaMed Annual Gala Beverly Hilton Sponsorship YES $0 $0 $0
Los Angeles County Women of the Year Awards 3/14/2011 Event Millennium Biltmore Sponsorship YES $340 $340 $0 Commission for Women Luncheon
UC Irvine School of Latino Medical Association 4/1/2011 Conference UC Irvine Sponsorship NO $0 $0 $0 Medicine National Conference Los Angeles 4/2/2011 Event KJLH Women's Health Forum Sponsorship YES $750 $0 $750 Convention Center 4/8/2011 Event LA Spring Fair Fair Ontario, CA Sponsorship NO $0 $0 $0 Ability First Marathon/Santa 4/9/2011 Event Ability First Santa Anita, CA Sponsorship NO $0 $0 $0 Anita Derby Day 4/9/2011 Event UMMA Clinic Annual Fundraising Gala Riviera Club Sponsorship YES $1,500 $1,500 $0 White Memorial Medical 4/11/2011 Event 2011 Golf Classic Palms Resort Sponsorship NO $0 $0 $0 Center Sony Pictures Los Angeles Universal Preschool Teacher of the 4/12/2011 Event Studio in Culver Sponsorship NO $0 $0 $0 Preschool (LAUP) Year City One-Day Training and 4/19/2011 Conference Westside Pregnancy Clinic Los Angeles, CA Sponsorship YES $1,500 $1,000 $500 Conference Amount Topic/Grant Status Amount Event Date Category Organization Event/Conference Location Amount Other Category Funded Mrkting Dept. Gilmore Adobe 4/29/2011 Event Para Los Ninos Cinco de Mayo Celebration Sponsorship YES $2,500 $2,500 $0 Farmers Market Fairmont Miramar Westside Family Health 4/30/2011 Event Annual Gala Hotel, Santa Sponsorship YES $400 $400 $0 Center Monica California Association of Annual Healthcare Huntington Beach, 5/4/2011 Conference Sponsorship YES $18,000 $6,250 $11,750 Physician Groups Conference CA
Institute for Healthcare Hyatt Regency 5/4/2011 Conference Health Literacy Conference Sponsorship YES $1,000 $1,000 $0 Advancement Hotel
5/5/2011 Event LAs BEST Annual Family Brunch Millennium Biltmore Sponsorship NO $0 $0 $0 Pandora on the Community Health Alliance 5/6/2011 Event Annual Gala Green, Pasadena, Sponsorship NO $0 $0 $0 of Pasadena CA
Westin Long Beach 5/7/2011 Event Rancho Los Amigos Amistad Gala Sponsorship YES $7,500 $7,500 $0 Hotel
Vision and Excellence in 5/9/2011 Event Partners in Care Foundation Healthcare Leadership Beverly Hills Hotel Sponsorship YES $25,000 $25,000 $0 Tribute dinner Amount Topic/Grant Status Amount Event Date Category Organization Event/Conference Location Amount Other Category Funded Mrkting Dept. Hospital Association of Regis resort, Dana 5/11/2011 Event 2011 Annual Meeting Sponsorship YES $5,000 $5,000 $0 Southern California Point UCLA Campus - Leaders of Today Leaders Grand Horizon 5/11/2011 Event UCLA - HSAA Sponsorship YES $920 $920 $0 of Tomorrow Dinner Ballroom of Covel Commons London Hotel, West 5/12/2011 Event UCLA School of Nursing Nurse 21 Award and Dinner Sponsorship NO $0 $0 $0 Hollywood St. John's Well Child and Los Angeles Union 5/15/2011 Event Movable Feast Sponsorship YES $5,000 $5,000 $0 Family Center Station Reception, Auction Dinner - Mulholland Tennis 5/21/2011 Event Children's Hospital Sponsorship NO $0 $0 $0 Garry Yates Tribute Club Annual Flavors of Los Loews Santa 5/22/2011 Event American Liver Association Sponsorship NO $0 $0 $0 Angeles Monica Westside Center for 5/24/2011 Event Full of Life Festival Los Angeles, CA Sponsorship YES $5,000 $5,000 $0 Independent Living Serra Project and Aid for 5/24/2011 Event A Faire of the Heart Beverly Hills Hotel Sponsorship NO $0 $0 $0 AIDS ABC7 - American Red 6/1/2011 Event ABCs of Safe Summer Los Angeles Sponsorship YES $2,000 $2,000 $0 Cross REACH-US California and 6/1/2011 Conference Statewide Conference Long Beach, CA Sponsorship NO $0 $0 $0 Beyond Coalition East Valley Community 6/10/2011 Event Annual Gala Pomona Fairplex Sponsorship NO $0 $0 $0 Health Center MEND (Meet Each Need MENDing Poverty MEND Center, 6/15/2011 Conference Sponsorship YES $500 $0 $500 with Dignity) Conference Pacoima, CA The Globe Theater Los Angeles 65th 6/15/2011 Event National Medical Fellows Universal Studios, Sponsorship YES $2,500 $2,500 $0 Anniversary Gala Universal City, CA Public Dialogues with Dr. Various locations in 7/1/2011 Meeting LA Health Action Sponsorship YES $1,000 $1,000 $0 Mitchell Katz Los Angeles
7/8/2011 Event AltaMed East L.A. Meets Napa Sponsorship YES $300 $300 $0 Amount Topic/Grant Status Amount Event Date Category Organization Event/Conference Location Amount Other Category Funded Mrkting Dept. Extravaganza for the Sunset Gower 7/16/2011 Event Saban Free Clinic Sponsorship YES $2,500 $2,500 $0 Senses Studios East Los Angeles 7/17/2011 Event Familia Unida Wheelchair Wash Sponsorship NO $0 $0 $0 Civic Center Jim Cleamons Books and 8/8/2011 Event The Brotherhood Crusade Expo Center Sponsorship NO $0 $0 $0 Basketball Los Angeles Police 8/30/2011 Event Eagle and Badge Gala JW Marriott Hotel Sponsorship NO $0 $0 $0 Protective League 9/3/2011 Event L.A. County Fair Fair Pomona Fairplex Sponsorship NO $0 $0 $0 Neighborhood Legal Annual Just Neighbors 9/10/2011 Event Services of Los Angeles Santa Anita Park Sponsorship NO $0 $0 $0 Celebration County 79th Anniversary and Children's Dental Health Santa Catalina 9/10/2011 Event Catalina Clinic Ribbon Sponsorship NO $0 $0 $0 Clinic Island Cutting CDU,KECK-USC, & 9/13/2011 Event CDU,KECK-USC, & UCLA Annual Primary Care Week Sponsorship NO $0 $0 $0 UCLA (campuses) El Proyecto del Barrio Sheraton Universal 9/15/2011 Event 40th Anniversary Gala Sponsorship NO $0 $0 $0 Foundation Hotel California Medical Ethnic Physician Leadership 9/17/2011 Conference Hilton/San Jose, CA Sponsorship NO $0 $0 $0 Association Summit Communities Actively Living Luminaries 9/21/2011 Event 10th Anniversary Sponsorship NO $0 $0 $0 Independently and Free Restaurant Hilton Los 9/23/2011 Event Chinatown Service Center 40th Anniversary Gala Angeles/San Sponsorship NO $0 $0 $0 Gabriel Hotel South Bay Children's Health Harlyne J. Norris 9/24/2011 Event Gala for Good Sponsorship YES $860 $0 $860 Center Pavilion California Partnership of Rancho 9/28/2011 Event CAA Conference Sponsorship YES $2,500 $0 $2,500 Health Care Advocates Cucamonga Amount Topic/Grant Status Amount Event Date Category Organization Event/Conference Location Amount Other Category Funded Mrkting Dept. Eagle and Badge 10th Anniversary Eagle and Hyatt Regency 9/30/2011 Event Sponsorship NO $0 $0 $0 Foundation Badge Gala Century Plaza Arroyo Vista Family Health Millennium Biltmore 9/30/2011 Event Anniversary Gala Sponsorship YES $5,000 $0 $5,000 Center Hotel ABC7 - MOMS of Orange 10/3/2011 Event Women's Health Month Los Angeles Sponsorship YES $3,000 $3,000 $0 County
Marketing - $203,570 Other Depts. - $22,360 Total - $225,930 Budgeted Amount $200,000
Board of Governors MOTION SUMMARY
Date: April 5, 2012 Motion No. FIN 100.0412
Committee: Finance & Budget Committee Chairperson: Philip L. Browning
Issue: Acceptance of the Financial Report for the five months ended February 29, 2012.
Background:
Budget Impact: None.
Motion: To accept the Financial Report for the five months ended February 29, 2012, as submitted.
Financial Performance February 2012
2/22/2012
Financial Performance Results Index
Description Page
Highlights (All Products) i Financial Statements (All Products) 1 Financial Statements (MediCal Plan Partners) 2 Financial Statements (DLOB) 3 Financial Statements (MCLA) 4 Financial Statements (MCLA - SPD) 4a Financial Statements (Medicare) 5 Financial Statements (HF-CHP) 6 Financial Statements (LAHF) 7 Financial Statements (IHSS) 8 Financial Statements (HK 0-5) 9 Financial Statements (HK 6-18) 10 Financial Statements (Community Programs) 11 Financial Statements (HITEC-LA) 12 Balance Sheet Statisitcs 13 Financial Performance Results Highlights February 2012
Overall Highlights February performance was a surplus of $190,000 or 0.1% on revenue of $159.8 million. Performance declined by $3.8 million from a surplus of $4.0 million in January. The decline was driven by a fiscal year to date adjustment for MCLA cost of health care related to the CHP transition, higher pharmacy and administrative expenses. February membership increased by 44,511 members to reach 1,035,233. In February 40,300 IHSS members transitioned to LA Care.
Fiscal year-to-date performance was a surplus of $2.7 million or 0.4% on revenue of $713.4 million and was $7.8 million favorable to plan. The favorable variance was driven by timing of administrative expenses related to advertising and professional fees and labor savings.
Plan Partners February performance was a surplus of $2.2 million or 2.5% on revenue of $87.4 million. Performance improved by $131,000 compared to January driven by lower provider incentive expenses. February membership increased by 4,848 to 638,440 members.
Fiscal year-to-date performance was a surplus $11.3 million or 2.4% on revenue of $469.3 million. Performance was $8.1 million favorable to plan driven by timing of administrative expenses related to advertising and professional fees and labor savings.
MCLA Highlights MCLA’s performance for February was a deficit of $599,000 or -1.0% on revenue of $57.2 million. Performance deteriorated by $3.3 million as compared to January, driven by a fiscal year-to-date cost of health care adjustment related to the CHP transition as well as higher pharmacy and outpatient expense. February membership decreased by 199 to 323,953 members.
Fiscal year to date performance was a deficit of $3.4 million or -1.6% on revenue of $210.9 million. Although a deficit, performance was $1.8 million favorable to plan driven by favorable cost of health care and lower administrative expenses due to timing of advertising and professional fees as well as labor savings.
MediCal Direct SPD membership increased by 4,011 members to reach 60,567 in February. The operating margin declined by $2.5 million compared to January driven by higher cost of healthcare expense. Fiscal year to date operating margin shows a loss of $8.9 million and was $10.4 million unfavorable to the budget driven by higher than expected cost of health care.
Medicare Highlights Medicare performance resulted in a deficit of $199,000 or -7.9% on revenue of $2.5 million. Performance declined by $100,000 from a deficit of $99,000 in January driven by a reduction in Part D revenue and higher pharmacy expense. Membership grew by 132 to reach 2,666 members in February.
Fiscal year to date results show a deficit of $563,000 or -4.8% on revenue of $11.8 million which was $149,000 favorable to plan driven by additional revenue associated with higher membership and administrative savings.
i Financial Performance Results Highlights February 2012
Healthy Families Highlights HFP CHP performance was a surplus of $13,000 and improved by $89,000 compared to January driven by lower inpatient expense. Fiscal year-to- date performance was a surplus of $38,000 which was $299,000 favorable to budget driven by lower than expected cost of health care.
HFP LAC performance was a surplus of $31,000 which improved by $79,000 from a deficit of $47,000 in January driven by lower cost of health care. Fiscal year to date results show a surplus of $30,000 which was $432,000 favorable to plan with lower than expected cost of health care.
IHSS Highlights The IHSS transition from CHP took place in February with 40,300 members which was 3,057 more members than expected. Year-to-date results, which include ramp-up expenses, show a surplus of $16,000 which is favorable to plan by $212,000 driven by additional revenue related to higher than expected membership.
Healthy Kids Highlights Healthy Kids 0-5 performance resulted in a surplus at $29,000 and improved by $17,000 compared to January. Fiscal year-to-date performance was a surplus of $163,000 and was $58,000 favorable to plan.
Healthy Kids 6-18 results show a deficit of $708,000 which declined by $442,000 compared to January which had $350,000 in grant money from Good Hope. Fiscal year to date performance was a deficit of $3.0 million and was $15,000 favorable to plan.
Community Programs Highlights
Fiscal year-to-date performance was a deficit of $1.3 million which was $1.4 million favorable to the budget driven by timing of grants.
HITEC-LA
Grant revenue is drawn-down based upon expenses incurred. Fiscal year-to-date there is a deficit of $278,000 which is $21,000 favorable to plan.
i Combined Operations Financial Statements ($ in thousands) February 2012
Current Prior Increase Total Budget Variance Actual Actual (Decrease) Year Fav (Unfav)
1,035,233 990,722 44,511 Current Membership 1,035,233 1,026,534 8,699 1,043,495 1,000,008 43,487 Member Months 4,978,985 4,959,186 19,799 Revenue $149,563 $136,361 $13,202 Capitation $669,114 $673,919 ($4,805) 9,591 10,152 (561) Maternity Kick 41,381 39,194 2,187 684 705 (21) Grants 2,856 2,690 166 159,838 147,218 12,620 Total Revenue 713,350 715,802 (2,452)
Cost of Health Care 108,129 97,065 11,064 Capitation 494,966 503,289 8,323 0 0 0 Quality Improvement Fee 0 0 0 5,770 6,112 (342) Maternity Kick 29,832 29,836 4 2,048 2,663 (615) Provider Incentives 14,200 17,200 3,000 310 303 8 Shared Risk 1,268 1,408 140 12,539 12,199 340 Inpatient Claims 51,758 39,438 (12,320) 8,620 7,907 713 Outpatient Claims 33,331 32,496 (835) 10,886 9,232 1,654 Pharmacy 41,202 42,461 1,259 4,045 1,789 2,256 Medical Administrative Expenses 12,690 16,998 4,307 152,347 137,269 15,078 Total Cost of Health Care 679,248 683,125 3,878 95.3% 93.2% 2.1% Medical Cost Ratio 95.2% 95.4% 0.2%
7,491 9,949 (2,458) Operating Margin 34,103 32,677 1,426
7,140 6,226 914 Total Operating Expenses 31,883 37,147 5,263 4.5% 4.2% 0.2% Admin Ratio (%) 4.5% 5.2% 0.7%
351 3,723 (3,372) Income from Operations 2,220 (4,470) 6,689 (161) 304 (465) Total Non-Operating Income (Expense) 501 (580) 1,081
$190 $4,027 ($3,837) Net Surplus (Deficit) $2,721 ($5,050) $7,770 0.1% 2.7% -2.6% Margin (%) 0.4% -0.7% 1.1%
Page 1 MediCal Plan Partners Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
638,440 633,592 4,848 Current Membership 638,440 629,542 8,898 644,874 641,049 3,825 Member Months 3,589,908 3,572,335 17,573
Revenue $81,081 $125.73 $79,818 $124.51 $1,264 $1.22 Capitation $436,570 $121.61 $435,604 $121.94 $966 ($0.33) 6,337 9.83 6,717 10.48 (380) (0.65) Maternity Kick 32,779 9.13 32,787 9.18 (8) (0.05) 87,418 135.56 86,534 134.99 884 0.57 Total Revenue 469,348 130.74 468,391 131.12 958 (0.38)
Healthcare Expenses 74,228 115.10 73,068 113.98 1,160 1.12 Capitation 398,409 110.98 396,017 110.86 (2,392) (0.12) - - - - - Quality Improvement Fee - - - 5,770 8.95 6,112 9.53 (342) (0.59) Maternity Kick 29,832 8.31 29,836 8.35 4 0.04 1,870 2.90 2,088 3.26 (217) (0.36) Provider Incentives 12,114 3.37 13,828 3.87 1,714 0.50 - - - - - Shared Risk - - - 1 0.00 - 1 0.00 Inpatient Claims 6 0.00 - (6) (0.00) () (0.00) 1,845.00 0.00 (2) (0.00) Outpatient Claims 2 0.00 - (2) (0.00) ------Pharmacy - - - 1,193 1.85 1,149 1.79 44 0.06 Medical Administrative Expenses 6,096 1.70 6,204 1.74 107 0.04 83,062 128.80 82,418 128.57 644 0.24 Total Healthcare Expenses 446,459 124.37 445,884 124.82 (575) 0.45 95.0% 95.2% -0.2% Medical Cost Ratio 95.1% 95.2% 0.1%
4,356 6.75 4,116 6.42 240 0.33 Operating Margin 22,889 6.38 22,507 6.30 383 0.08
2,174 3.37 2,065 3.22 109 0.15 Total Operating Expenses 11,616 3.24 19,339 5.41 7,723 2.18 2.5% 2.4% 0.1% Admin Ratio (%) 2.5% 4.1% 1.7%
2,181 3.38 2,051 3.20 131 0.18 Income from Operations 11,274 3.14 3,167 0.89 8,106 2.25
$2,181 $3.38 $2,051 $3.20 $131 $0.18 Net Surplus (Deficit) $11,274 $3.14 $3,167 $0.89 $8,106 $2.25 2.5% 2.4% 0.1% Margin (%) 2.4% 0.7% 1.7%
Page 2 Direct Lines Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
385,834 345,852 39,982 Current Membership 385,834 386,067 (233) 387,667 347,817 39,850 Member Months 1,332,400 1,330,608 1,792
Revenue $68,321 $176.24 $56,380 $162.10 $11,941 $14.14 Capitation $231,718 $173.91 $237,489 $178.48 ($5,771) ($4.57) 3,255 8.40 3,436 9.88 (181) (1.48) Maternity Kick 8,602 6.46 6,407 4.82 2,195 1.64 71,575 184.63 59,816 171.97 11,760 12.66 Total Revenue 240,321 180.37 243,896 183.30 (3,576) (2.93)
Healthcare Expenses 33,570 86.60 23,644 67.98 9,926 18.62 Capitation 94,843 71.18 105,574 79.34 10,731 8.16 - - - - - Quality Improvement Fee - - - 170 0.44 567 1.63 (397) (1.19) Provider Incentives 2,048 1.54 3,372 2.53 1,324 1.00 303 0.78 295 0.85 8 (0.07) Shared Risk 1,230 0.92 1,376 1.03 146 0.11 12,405 32.00 12,172 34.99 234 (2.99) Inpatient Claims 51,335 38.53 39,236 29.49 (12,099) (9.04) 8,511 21.96 7,739 22.25 773 (0.29) Outpatient Claims 32,458 24.36 31,758 23.87 (700) (0.49) 10,826 27.93 9,180 26.39 1,646 1.53 Pharmacy 40,954 30.74 42,210 31.72 1,256 0.99 2,809 7.25 610 1.75 2,200 5.49 Medical Administrative Expenses 6,338 4.76 10,436 7.84 4,098 3.09 68,595 176.94 54,206 155.85 14,389 21.10 Total Healthcare Expenses 229,208 172.03 233,964 175.83 4,756 3.81 95.8% 90.6% 5.2% Medical Cost Ratio 95.4% 95.9% 0.6%
2,980 7.69 5,610 16.13 (2,630) (8.44) Operating Margin 11,113 8.34 9,933 7.46 1,180 0.88
3,545 9.14 3,259 9.37 287 (0.22) Total Operating Expenses 15,078 11.32 16,559 12.44 1,480 1.13 5.0% 5.4% -0.5% Admin Ratio (%) 6.3% 6.8% 0.5%
(565) (1.46) 2,351 6.76 (2,916) (8.22) Income from Operations (3,965) (2.98) (6,626) (4.98) 2,661 2.00
($565) ($1.46) $2,351 $6.76 ($2,916) ($8.22) Net Surplus (Deficit) ($3,965) ($2.98) ($6,626) ($4.98) $2,661 $2.00 -0.8% 3.9% -4.7% Margin (%) -1.6% -2.7% 1.1%
Footnotes: Direct Lines of Business include: MCLA, Medicare, Healthy Families, IHSS, and Healthy Kids 0-5.
Page 3 MCLA Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
323,953 324,152 (199) Current Membership 323,953 326,584 (2,631) 325,955 326,019 (64) Member Months 1,183,853 1,183,803 50
Revenue $53,994 $165.65 $52,373 $160.64 $1,621 $5.00 Capitation $202,265 $170.85 $208,850 $176.42 ($6,585) ($5.57) 3,255 9.99 3,436 10.54 (181) (0.55) Maternity Kick 8,602 7.27 6,407 5.41 2,195 1.85 57,249 175.63 55,809 171.18 1,440 4.45 Total Revenue 210,868 178.12 215,258 181.84 (4,390) (3.72)
Healthcare Expenses 22,707 69.66 22,210 68.13 497 1.54 Capitation 78,688 66.47 90,032 76.05 11,344 9.59 - - - - - Quality Improvement Fee - - - - 124 0.38 525 1.61 (400) (1.23) Provider Incentives 1,890 1.60 3,122 2.64 1,232 1.04 202 0.62 202 0.62 () (0.00) Shared Risk 790 0.67 838 0.71 48 0.04 11,444 35.11 11,078 33.98 366 1.13 Inpatient Claims 47,065 39.76 35,295 29.81 (11,770) (9.94) 8,121 24.92 7,209 22.11 912 2.80 Outpatient Claims 30,224 25.53 28,989 24.49 (1,235) (1.04) 10,250 31.44 8,931 27.39 1,318 4.05 Pharmacy 39,149 33.07 40,554 34.26 1,405 1.19 2,518 7.72 496 1.52 2,022 6.20 Medical Administrative Expenses 5,426 4.58 8,517 7.20 3,091 2.61 55,366 169.86 50,652 155.36 4,714 14.49 Total Healthcare Expenses 203,233 171.67 207,348 175.15 4,115 3.48 96.7% 90.8% 6.0% Medical Cost Ratio 96.4% 96.3% -0.1%
1,883 5.78 5,157 15.82 (3,274) (10.04) Operating Margin 7,635 6.45 7,910 6.68 (275) (0.23)
2,481 7.61 2,451 7.52 30 0.09 Total Operating Expenses 11,030 9.32 13,071 11.04 2,041 1.72 4.3% 4.4% -0.1% Admin Ratio (%) 5.2% 6.1% 0.8%
(599) (1.84) 2,705 8.30 (3,304) (10.13) Income from Operations (3,395) (2.87) (5,161) (4.36) 1,766 1.49
($599) ($1.84) $2,705 $8.30 ($3,304) ($10.13) Net Surplus (Deficit) ($3,395) ($2.87) ($5,161) ($4.36) $1,766 $1.49 -1.0% 4.8% -5.9% Margin (%) -1.6% -2.4% 0.8%
Page 4 Exhibit for information purposes only. Not a financial Statement MCLA SPD excluding Duals Exhibit ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
60,567 56,556 4,011 Current Membership 60,567 60,883 (316) 58,997 56,378 2,619 Member Months 233,110 234,590 (1,480)
Revenue $27,641 $468.51 $26,433 $468.86 $1,208 ($0.34) Capitation $109,331 $469.01 $110,088 $469.28 ($758) ($0.27)
27,641 468.51 26,433 468.86 1,208 (0.34) Total Revenue 109,331 469.01 110,088 469.28 (758) (0.27)
Healthcare Expenses 8,740 148.15 9,309 165.12 (569) (16.98) Capitation 37,438 160.60 45,238 192.84 7,800 32.24 62 1.04 81 1.43 (19) (0.39) Provider Incentives 387 1.66 1,380 5.88 994 4.23 80 1.36 80 1.42 - (0.06) Shared Risk 401 1.72 401 1.71 - (0.01) 7,340 124.42 6,353 112.68 988 11.74 Inpatient Claims 27,539 118.14 17,375 74.07 (10,164) (44.07) 5,035 85.35 3,539 62.78 1,496 22.57 Outpatient Claims 15,589 66.88 12,104 51.60 (3,485) (15.28) 7,203 122.10 6,116 108.48 1,088 13.62 Pharmacy 28,827 123.66 29,800 127.03 973 3.37 1,123 19.04 106 1.88 1,017 17.15 Medical Administrative Expenses 2,332 10.00 2,217 9.45 (115) (0.55) 29,584 501.45 25,584 453.80 4,000 47.65 Total Healthcare Expenses 112,513 482.66 108,517 462.58 (3,997) (20.08) 107.0% 96.8% 10.2% Medical Cost Ratio 102.9% 98.6% -4.3%
(1,943) (32.94) 849 15.06 (2,792) (48.00) Operating Margin (3,183) (13.65) 1,572 6.70 (4,755) (20.35)
Page 4a Medicare Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
2,666 2,534 132 Current Membership 2,666 2,470 196 2,668 2,582 86 Member Months 11,866 11,431 435
Revenue $2,350 $880.69 $2,332 $903.29 $17 ($22.60) Part C $10,802 $910.33 176 65.89 229 88.68 (53) (22.79) Part D 1,005 84.70 2,525 946.58 2,561 991.97 (36) (45.39) Total Revenue 11,807 995.02 11,645 1,018.76 162 (23.73)
Healthcare Expenses 918 344.18 925 358.11 (6) (13.93) Capitation 4,158 350.40 4,319 377.80 161 27.40 40 15.00 32 12.51 8 2.49 Provider Incentives 110 9.25 250 21.87 140 12.62 77 28.95 68 26.49 9 2.45 Shared Risk 326 27.45 365 31.95 40 4.50 890 333.54 876 339.31 14 (5.77) Inpatient Claims 3,701 311.91 3,347 292.82 (354) (19.08) 142 53.30 181 69.93 (38) (16.64) Outpatient Claims 791 66.66 971 84.93 180 18.26 203 76.00 130 50.23 73 25.77 Pharmacy 1,043 87.89 877 76.73 (166) (11.16) 119 44.55 64 24.66 55 19.89 Medical Administrative Expenses 523 44.12 537 46.96 13 2.84 2,389 895.52 2,275 881.24 114 14.28 Total Healthcare Expenses 10,652 897.67 10,666 933.06 14 35.39 94.6% 88.8% 5.8% Medical Cost Ratio 90.2% 91.6% 1.4%
136 51.07 286 110.73 (150) (59.66) Operating Margin 1,155 97.35 980 85.70 176 11.66
336 125.80 385 149.19 (50) (23.39) Total Operating Expenses 1,719 144.83 1,692 147.99 (27) 3.16 13.3% 15.0% -1.8% Admin Ratio (%) 14.6% 14.5% 0.0%
(199) (74.73) (99) (38.46) (100) (36.27) Income from Operations (563) (47.48) (712) (62.30) 149 14.81
($199) ($74.73) ($99) ($38.46) ($100) ($36.27) Net Surplus (Deficit) ($563) ($47.48) ($712) ($62.30) $149 $14.81 -7.9% -3.9% -4.0% Margin (%) -4.8% -6.1% 1.3%
Page 5 Healthy Families CHP Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
6,516 6,672 (156) Current Membership 6,516 6,780 (264) 6,366 6,717 (351) Member Months 33,439 33,978 (539)
Revenue $431 $67.76 $455 $67.68 ($23) $0.08 Capitation $2,263 $67.68 $2,301 $67.71 ($38) ($0.03) 431 67.76 455 67.68 (23) 0.08 Total Revenue 2,263 67.68 2,301 67.71 (38) (0.03)
Healthcare Expenses 167 26.17 176 26.15 (9) 0.02 Capitation 874 26.14 891 26.23 17 0.10 1 0.16 1 0.15 0.01 Provider Incentives 5 0.14 - (5) (0.14) 12 1.82 12 1.82 (1) (0.00) Shared Risk 58 1.75 68 2.00 9 0.25 28 4.36 118 17.60 (90) (13.24) Inpatient Claims 249 7.46 186 5.46 (64) (2.00) 71 11.21 97 14.38 (25) (3.18) Outpatient Claims 393 11.77 563 16.58 170 4.81 25 3.98 22 3.29 3 0.69 Pharmacy 118 3.54 129 3.80 11 0.27 22 3.46 17 2.53 5 0.94 Medical Administrative Expenses 94 2.82 378 11.12 283 8.30 326 51.15 443 65.92 (117) (14.77) Total Healthcare Expenses 1,792 53.60 2,215 65.19 423 11.59 75.5% 97.4% -21.9% Medical Cost Ratio 79.2% 96.3% 17.1%
106 16.61 12 1.76 94 14.85 Operating Margin 471 14.07 86 2.52 385 11.56
92 14.52 87 13.00 5 1.52 Total Operating Expenses 432 12.93 346 10.19 (86) (2.74) 21.4% 19.2% 2.2% Admin Ratio (%) 19.1% 15.1% -4.0%
13 2.09 (75) (11.24) 89 13.32 Income from Operations 38 1.15 (261) (7.68) 299 8.82
$13 $2.09 ($75) ($11.24) $89 $13.32 Net Surplus (Deficit) $38 $1.15 ($261) ($7.68) $299 $8.82 3.1% -16.6% 19.7% Margin (%) 1.7% -11.3% 13.0%
Page 6 L.A. Care Healthy Families Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
10,704 10,707 (3) Current Membership 10,704 11,282 (578) 10,707 10,713 (6) Member Months 53,817 55,022 (1,205)
Revenue $777 $72.57 $778 $72.59 ($1) ($0.02) Capitation $3,902 $72.50 $4,005 $72.78 ($103) ($0.29) 777 72.57 778 72.59 (1) (0.02) Total Revenue 3,902 72.50 4,005 72.78 (103) (0.29)
Healthcare Expenses 278 26.01 279 26.01 () (0.00) Capitation 1,399 25.99 1,462 26.57 63 0.58 3 0.30 8 0.72 (5) (0.43) Provider Incentives 36 0.66 - (36) (0.66) 12 1.15 12 1.15 () 0.00 Shared Risk 58 1.07 98 1.79 41 0.72 37 3.50 76 7.12 (39) (3.62) Inpatient Claims 247 4.58 335 6.09 88 1.51 153 14.28 214 19.93 (61) (5.65) Outpatient Claims 940 17.46 1,066 19.38 126 1.92 60 5.58 57 5.35 2 0.22 Pharmacy 267 4.97 273 4.95 5 (0.02) 39 3.65 28 2.61 11 1.03 Medical Administrative Expenses 161 2.99 492 8.94 331 5.95 583 54.46 674 62.90 (91) (8.44) Total Healthcare Expenses 3,106 57.72 3,726 67.72 620 10.00 75.0% 86.6% -11.6% Medical Cost Ratio 79.6% 93.0% 13.4%
194 18.11 104 9.69 90 8.42 Operating Margin 795 14.78 278 5.06 517 9.71
163 15.20 151 14.12 11 1.08 Total Operating Expenses 765 14.21 680 12.36 (85) (1.85) 20.9% 19.5% 1.5% Admin Ratio (%) 19.6% 17.0% -2.6%
31 2.91 (47) (4.43) 79 7.34 Income from Operations 30 0.56 (401) (7.30) 432 7.86
$31 $2.91 ($47) ($4.43) $79 $7.34 Net Surplus (Deficit) $30 $0.56 ($401) ($7.30) $432 $7.86 4.0% -6.1% 10.1% Margin (%) 0.8% -10.0% 10.8%
Page 7 IHSS Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
40,300 40,300 Current Membership 40,300 37,243 3,057 40,300 40,300 Member Months 40,300 37,243 3,057
Revenue $10,393 $257.89 $10,393 Capitation $10,393 $257.89 $9,603 $257.84 $790 $0.05 10,393 257.89 10,393 Total Revenue 10,393 257.89 9,603 257.84 790 0.05
Healthcare Expenses 9,449 234.47 9,449 Capitation 9,449 234.47 8,594 230.77 (855) (3.70) - Provider Incentives - - - - Shared Risk - - - - Inpatient Claims - - - - Outpatient Claims - - - 282 7.00 30 252 Pharmacy 312 7.75 345 9.26 33 1.51 104 2.59 104 Medical Administrative Expenses 104 2.59 343 9.21 238 6.62 9,836 244.06 30 9,806 Total Healthcare Expenses 9,866 244.81 9,282 249.23 (584) 4.43 94.6% #DIV/0! #DIV/0! Medical Cost Ratio 94.9% 96.7% 1.7%
557 13.83 (30) 587 Operating Margin 527 13.08 321 8.61 207 4.48
397 9.86 114 284 Total Operating Expenses 511 12.68 516 13.87 6 1.19 3.8% #DIV/0! #DIV/0! Admin Ratio (%) 4.9% 5.4% 0.5%
160 3.97 (144) 304 Income from Operations 16 0.41 (196) (5.26) 212 5.67
$160 $3.97 ($144) $304 Net Surplus (Deficit) $16 $0.41 ($196) ($5.26) $212 $5.67 1.5% #DIV/0! #DIV/0! Margin (%) 0.2% -2.0% 2.2%
Page 8 Healthy Kids 0-5 Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
1,695 1,787 (92) Current Membership 1,695 1,708 (13) 1,671 1,786 (115) Member Months 9,125 9,131 (6)
Revenue $200 $119.51 $213 $119.46 ($14) $0.06 Capitation $1,088 $119.27 $1,085 $118.87 $3 $0.40 200 119.51 213 119.46 (14) 0.06 Total Revenue 1,088 119.27 1,085 118.87 3 0.40
Healthcare Expenses 50 30.20 55 30.57 (4) (0.37) Capitation 276 30.22 276 30.19 () (0.03) 2 0.94 2 0.90 () 0.03 Provider Incentives 8 0.83 - (8) (0.83) () (0.12) () (0.12) 0.00 Shared Risk (1) (0.16) 7 0.73 8 0.89 6 3.75 23 12.93 (17) (9.18) Inpatient Claims 73 8.04 74 8.09 0.05 23 14.03 39 21.72 (15) (7.69) Outpatient Claims 110 12.03 169 18.46 59 6.43 7 4.07 9 5.31 (3) (1.25) Pharmacy 65 7.10 32 3.55 (32) (3.55) 7 4.20 5 2.62 2 1.58 Medical Administrative Expenses 29 3.16 169 18.55 140 15.38 95 57.06 132 73.94 (37) (16.88) Total Healthcare Expenses 559 61.22 726 79.56 168 18.34 47.7% 61.9% -14.2% Medical Cost Ratio 51.3% 66.9% 15.6%
104 62.45 81 45.52 23 16.93 Operating Margin 530 58.05 359 39.31 171 18.74
76 45.37 70 39.05 6 6.32 Total Operating Expenses 367 40.19 254 27.77 (113) (12.43) 38.0% 32.7% 5.3% Admin Ratio (%) 33.7% 23.4% -10.3%
29 17.08 12 6.47 17 10.61 Income from Operations 163 17.85 105 11.54 58 6.31
$29 $17.08 $12 $6.47 $17 $10.61 Net Surplus (Deficit) $163 $17.85 $105 $11.54 $58 $6.31 14.3% 5.4% 8.9% Margin (%) 15.0% 9.7% 5.3%
Page 9 Healthy Kids 6-18 Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
10,959 11,278 (319) Current Membership 10,959 10,925 34 10,954 11,142 (188) Member Months 56,677 56,243 434
Revenue $161 $14.65 $163 $14.62 ($2) $0.04 Premiums* $826 $14.58 $826 $14.68 $ ($0.10) - 350 31.41 (350) (31.41) CHI Grants 350 31.95 - 350 31.95 161 14.65 513 46.03 (352) (31.38) Total Revenue 1,176 46.53 826 14.68 350 31.85
Healthcare Expenses 331 30.22 353 31.72 (22) (1.50) Capitation 1,713 30.23 1,698 30.19 (15) (0.04) 8 0.70 8 0.70 () (0.00) Provider Incentives 39 0.68 - (39) (0.68) 8 0.70 8 0.70 () 0.00 Shared Risk 38 0.67 32 0.58 (5) (0.09) 133 12.10 27 2.44 105 9.66 Inpatient Claims 417 7.35 201 3.58 (215) (3.77) 109 9.93 166 14.93 (58) (5.00) Outpatient Claims 871 15.37 738 13.11 (133) (2.25) 59 5.41 52 4.65 7 0.76 Pharmacy 248 4.37 251 4.46 3 0.09 42 3.86 31 2.75 12 1.10 Medical Administrative Expenses 175 3.09 358 6.36 182 3.27 689 62.92 645 57.90 44 5.02 Total Healthcare Expenses 3,501 61.77 3,278 58.28 (223) (3.49) 429.4% 125.8% 303.6% Medical Cost Ratio 297.6% 397.0% 99.34%
(529) (48.26) (132) (11.87) (396) (36.40) Operating Margin (2,325) (15.24) (2,452) (43.60) 127 28.36
180 16.40 135 12.08 45 4.32 Total Operating Expenses 702 12.39 590 10.49 (112) (1.90) 111.9% 26.2% 85.7% Admin Ratio (%) 59.7% 71.5% 11.8%
(708) (64.67) (267) (23.95) (442) (40.72) Income from Operations (3,027) (27.63) (3,042) (54.09) 15 26.46
- - - Provision for Community Grant - - -
($708) (64.67) ($267) (23.95) ($442) (40.72) Net Surplus (Deficit) ($3,027) (27.63) ($3,042) (54.09) $15 26.46 -441.3% -52.0% -389.3% Margin (%) -257.3% -257.3%
* Member premiums at $15 were effective July 1, 2010.
Page 10 Community Programs Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
Current Membership Member Months
Revenue $ $ - Pay for Performance $ $ $ - Total Revenue
Healthcare Expenses Medical Administrative Expenses * 80 (80) Total Healthcare Expenses 80 (80) Medical Cost Ratio 0.00%
Operating Margin (80) (80)
334 228 106 Total Operating Expenses 1,173 1,357 184 0.0% Admin Ratio (%) 0.0%
(334) (228) (106) Income from Operations (1,253) (1,357) 104
Provision for Community Grant * (1,250) 1,250
($334) ($228) ($106) Net Surplus (Deficit) ($1,253) ($2,607) $1,354 0.0% Margin (%) 0.0%
* Certain expenses are offset in the budget by provision for community grant.
Page 11 HITEC-LA Financial Statements ($ in thousands) February 2012 Current Prior Increase YTD YTD Fav
Current Membership Member Months
Revenue $684 $355 $329 Grants* $2,506 $2,690 ($184) 684 355 329 Total Revenue 2,506 2,690 (184)
Healthcare Expenses Medical Administrative Expenses Total Healthcare Expenses Medical Cost Ratio 0.00%
684 355 329 Operating Margin 2,506 2,690 (184)
759 394 365 Total Operating Expenses 2,784 2,989 205 111.1% 111.1% 0.0% Admin Ratio (%) 111.1% -111.1%
(76) (39) (37) Income from Operations (278) (299) 21
Provision for Community Grant
($76) ($39) ($37) Net Surplus (Deficit) ($278) ($299) $21 -11.1% -11.1% 0.0% Margin (%) -11.1% -11.1%
* Grant revenue accrued at 90% of qualifying expenses, expected from the Federal government and 10% is an L.A. Care match.
Page 12 Comparative Balance Sheet (Quarterly & Unaudited) February 2012
(dollars in thousands) Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Jan-12 Feb-12 ASSETS Total Current Assets $272,310 $293,674 $349,134 $306,199 $338,276 $357,464 $362,908 $358,903 $346,416 $384,942 Capitalized Assets - net 1,513 1,569 1,581 1,377 2,340 6,688 9,232 9,927 9,827 10,171 Restricted Assets 975 972 969 966 969 582 588 329 327 324 TOTAL ASSETS $274,797 $296,215 $351,684 $308,542 $341,585 $364,734 $372,727 $369,160 $356,569 $395,437
LIABILITIES & NET WORTH Accounts Payable & Accrued Liabilities $9,857 $16,619 $12,666 $11,666 $25,667 $18,819 $19,803 $21,475 $25,140 $31,295 Capitation Payable 88,848 101,917 154,240 104,746 124,962 145,024 131,769 117,078 89,725 116,343 Accrued Medical Expenses 18,223 16,810 20,560 20,460 22,623 24,153 35,634 43,465 49,172 52,851 Other 26,275 24,201 18,539 25,575 26,893 32,454 35,766 36,824 38,153 40,380 Long term liabilities 257 219 182 144 106 38 622 1,099 1,134 1,132 TOTAL LIABILITIES $143,459 $159,766 $206,186 $162,591 $200,251 $220,489 $223,593 $219,941 $203,324 $242,002
FUND EQUITY Invested in Capital Assets - net pf related debt 1,513 1,569 1,581 1,377 2,340 6,688 9,232 9,927 9,827 10,171 Restricted 951 951 1,735 1,367 1,395 616 935 499 438 345 Minimum TNE Requirement* 16,880 16,880 16,880 16,880 17,762 18,345 19,370 20,538 20,538 20,538 Designated 12,950 32,529 29,991 27,970 66,279 67,575 69,166 86,341 86,341 111,793 Undesignated 99,045 84,521 95,311 98,358 53,558 51,020 50,432 31,914 36,102 11,589 TOTAL FUND EQUITY $131,338 $136,449 $145,498 $145,951 $141,335 $144,245 $149,134 $149,218 $153,246 $154,435
TOTAL LIABILITIES & FUND EQUITY $274,797 $296,215 $351,684 $308,542 $341,585 $364,734 $372,727 $369,160 $356,569 $396,437
Solvency Ratios
Working Capital 129,108 134,128 143,130 143,753 138,131 137,013 139,937 140,062 144,226 144,072 Working Capital Ratio 1.9 1.8 1.7 1.9 1.7 1.6 1.6 1.6 1.7 1.6 Average Days Cash on Hand ** 33.4 34.9 0.0 30.1 2.1 31.5 25.5 26.1 27.8 0.0
* TNE is updated quarterly based on DMHC filing. ** Payment was delayed from the state in September 2010, March 2011, and February 2012.
Page 13
Board of Governors MOTION SUMMARY
Date: April 5, 2011 Motion No. FIN 101.0412
Committee: Finance & Budget Committee Chairperson: Philip L. Browning
Issue: Amendment to Cornerstone Data Strategies, Inc. Contract in support of New Core System Implementation Project
Background: Cornerstone is a California-based leader in Information Technology (IT) consulting services with expertise in IT strategic planning, IT project management implementation services, IT architecture design and IT related operations consulting services. Cornerstone has been under contract in the past by L.A. Care to perform an IT assessment and provide interim CIO leadership (2007); assist with development of a data warehouse strategy (2009); and data center design and computer systems relocation project (2011) with positive results and completion of high quality work products.
In March 2012, the Board approved a motion (BOG 101.0312-CS) that authorized L.A. Care to enter into a contract with TriZetto Group, Inc. for the purposes of implementing a new core information system. Use of this authority was subject to final contract terms and conditions with TriZetto and contingent upon final review of these terms by the Finance & Budget Committee. As previously endorsed by the Committee, budgetary estimates for additional consulting resources and implementation support services are approximately in the range of $3-$5 million over a two year implementation period for all Lines of Business.
Cornerstone consulting services has been identified and engaged to support L.A. Care in the complex negotiations process. Furthermore, Cornerstone project management resources will provide L.A. Care with necessary expertise to implement the new system. This contract amendment serves two primary objectives:
1. Expedite core systems vendor contract negotiations with TriZetto Group, Inc. by providing IT industry and vendor management expertise. ($60,000) 2. Provide supplemental IT program and project management resources in support of the core system implementation planned for 2012, which supports the L.A. Care Duals pilot first, and other lines of business to migrate over thereafter ($1.475 million)
In support of critical and time-sensitive vendor negotiations, the first phase of this amendment was executed due to time constraints and fell within the current dollar approval threshold policy. The level of estimate for completion of vendor contract negotiations is $60,000. Cornerstone has provided on-site consulting to L.A. Care that includes:
1. Assist L.A. Care with the development of a high level core system program and systems implementation governance plan. 2. Review and advise L.A. Care on industry best practices relative to software and hosting contracts,
Page 1 of 2
Board of Governors MOTION SUMMARY including vendor Statements of Work (SOW’s) with software vendor expertise. 3. Advise executive management on risks, timeframes and effort levels for the implementation of the new core system software product.
This amendment with Cornerstone for $1.475 million will support the program and project management of a multi-phased core system project beginning with the duals implementation. The following is a high level summary of the key deliverables and roles that Cornerstone resources will perform under this consulting agreement in conjunction with L.A. Care staff resources and the system vendor:
1. Program and Project Management including overall direction, project coordination, administration and tracking (contract provisions will include termination for convenience clauses in the event that key Cornerstone resources are no longer available). 2. Coordination between system vendor and L.A. Care to ensure necessary L.A. Care requirements for key vendor deliverables are provided in a timely and accurate manner. 3. Definition of system requirements in order to ensure appropriate system configuration to meet L.A. Care business needs. 4. Assurance that system vendor deliverables are satisfactorily completed and meet L.A Care requirements. 5. Management of the technical hosting implementation coordination and setup with the hosting vendor.
In an effort to ensure continuity in the overall new core system selection process, L.A. Care management requests approval to execute an amendment to the contract for Consulting and Project Management Services in the amount not to exceed $1,585,000. These cost projections will support project management, interim staffing and consulting resources (projected at 7250 hours) through early 2013 at pre-negotiated, discounted rates (blended rate of approximately $200/hr) with Cornerstone.
This is a sole source contract based upon the fact that Cornerstone resources have extensive knowledge of L.A. Care, a successful performance track record with us, and time is of the essence. L.A. Care staff has concluded that Cornerstone project management and consulting resource rate sheets are competitive compared to other negotiated, publicly available, government rates for similar project management skill sets from IBM, and Booze-Allen-Hamilton (i.e., federal government Mission Oriented Business Integrated Services (MOBIS) - Schedule 874, which are federal government contract negotiated rates for IT management and consulting services). In addition, Cornerstone consultants have consistently performed above expectations and produced high quality deliverables for L.A. Care.
Budget Impact: $ 60,000 (Core Systems Vendor Negotiations - Phase 1) $1,475,000 (Core Systems Project Implementation Services - Phase 2) $ 50,000 (Estimated Travel - Phase 2 ) $1,585,000
Note: Funds allocated in the FY2012 IS operations budget are sufficient to cover expected costs during this fiscal year. The FY2013 budget submission will also incorporate expected costs under this contract.
Motion: To authorize Howard A. Kahn, Chief Executive Officer, to execute a contract amendment with Cornerstone Data Strategies, Inc. to complete the new core system vendor negotiations process and provide project management resources in an amount not to exceed $1,585,000.
Page 2 of 2
Board of Governors MOTION SUMMARY
Date: April 5, 2012 Motion No: FIN 102.0412
Committee: Finance & Budget Committee Chairperson: Philip L. Browning
Issue: Approval to amend the existing Language Select telephonic interpretation contract to add funds due to increases in utilization due to SPD member enrollment and the transition of CHP Medi- Cal and IHSS members to L.A. Care, and to extend the contract term.
Background: Approximately 60 percent of L.A. Care members report a primary spoken language other than English. L.A. Care provides telephonic interpretation to members as required by state and federal regulations. These services are used by Member Services, Medical Management, Pharmacy, network physicians, and our after-hours vendor to communicate with members who speak languages other than English. Utilization of service is driven by membership.
In April, 2011, the Board approved a $275,000 contract with Language Select from October 1, 2011 to September 30, 2012. Language Select was the lowest-cost bidder in a competitive request for proposal process. The contract with Language Select has a current balance of $90,000. Staff expects that the funds will be depleted in April 2012 due to a higher than anticipated utilization of services and the acquisition of CHP Medi-Cal and IHSS members. The rate of utilization has increased from an average of 73 minutes per 1000 members prior to June, to a rate of 147 minutes per 1000 members after June. This may be due to longer call time as a result of increased complexity of calls from SPD enrollees, ADHC members who are new to managed care, and inquiries about CHP. When the contract was initially presented to the Board, the CHP transition was uncertain, the closure of the ADHC program was unknown, and data was unavailable to project an average call time to assist these new member categories. Due to these reasons, we did not include these costs in the original contract amount.
To ensure adequate funds through the contract term, staff is requesting an amendment to the contract for an additional $410,000, bringing the total amount to $685,000. We are also requesting an extension of the contract term to December 31, 2012.
The Finance & Budget Committee included in their approved motion that staff should pursue a contract arrangement with Language Select for up to three years in order to obtain the most favorable contract terms, including the existing 90-day termination clause.
Budget Impact: In February, the Board approved an increased budget amount of $1,113,000 for translation and interpretation services. The budget amount is sufficient for this proposed amendment request.
Motion: To authorize staff to amend the Language Select contract to add $410,000, extend the contract term to December 31, 2012 for a total amount not to exceed $685,000, and execute a contract for up to three years with equal or better terms for a total amount not to exceed $2,400,000.
DATE: March 28, 2012
TO: Finance and Budget Committee
THROUGH: Elaine Batchlor, MD, MPH, Chief Medical Officer
FROM: Nai Kasick, MPH, Director, Health Education, Cultural & Linguistic Services
SUBJECT: Telephonic Interpretation Vendor Contract Amendment
Staff is seeking approval to amend the existing Language Select telephonic interpretation contract to add funds due to increases in utilization due to SPD member enrollment and the transition of CHP Medi-Cal and IHSS members to L.A. Care, and to extend the contract term.
Background Approximately 60 percent of L.A. Care members report a primary spoken language other than English. L.A. Care provides telephonic interpretation to members as required by state and federal regulatory agencies. These services are used by Member Services, Medical Management, Pharmacy, network physicians, and our after-hours vendor to communicate with members who speak languages other than English. Utilization of services is driven by membership.
In April 2011, the Board approved a contract with Language Select for $275,000 for telephonic interpretation services. Language Select was the lowest-cost bidder in a competitive request for proposal process. Since executing a one year contract with Language Select in October 2011, staff has been satisfied with their quality of services. The contract has a current balance of $90,000 and we expect funds will be depleted by April 2012 due to increased utilization of services and the acquisition of CHP Medi-Cal and IHSS members. We are requesting a contract amendment to add $410,000, bringing the total amount to $685,000. We are also requesting an extension of the contract term to December 31, 2012.
Utilization and Expenditure Trend Telephonic interpretation is billed on a per-minute basis. L.A. Care pays a per-minute rate of $0.92, a 14% savings over our previous vendor’s rate of $1.07. Prior to June 2011, the average monthly cost was approximately $10,000. With the transition of SPD beneficiaries, the monthly costs rose to an average of $25,000 between June and September 2011. The cost further increased from October to December to $31,000 per month due to the transition of ADHC members into L.A. Care. January’s monthly cost was $41,650 due to the CHP member transition. In February, CHP IHSS enrollees transferred into L.A Care, and the monthly cost increased to $44,021. The cost trend is depicted in the graph below.
Telephonic Interpretation Vendor Contract Amendment March 28, 2012 Page 2 of 3
Telephonic Interpreting Monthly Expenditures
$50,000.00 Jan 2012 $45,000.00 CHP Transition $41,650 Feb 2012 $40,000.00 IHSS Transition $35,000.00 Jun-Sep 2011 $44,021 $30,000.00 SPD Transition $25,136 avg $25,000.00 Oct-Dec 2011 ADHC $20,000.00 Jan-Apr 2011 $31,000 avg $15,000.00 $9,800 avg May 2011 $10,000.00 $15,375 $5,000.00 $-
Prior to June, the average call time with an interpreter was 9.9 minutes. After June, the average call time increased to 12.5 minutes. The rate of utilization also increased from an average of 73 minutes per 1000 members prior to June, to a rate of 147 minutes per 1000 members after June. This may be due to longer call time as a result of increased complexity of calls from SPD enrollees, ADHC members who are new to managed care, and inquiries about CHP. When the contract was initially presented to the Board in April, 2011, the CHP transition was uncertain, the closure of the ADHC program was unknown, and data was unavailable to project an average call time to assist these new member categories. Due to these reasons, we did not include these costs in the original contract amount.
Contract Amendment Request We anticipate monthly costs will remain at $44,000 until June. In July and thereafter, we anticipate that it will increase to $54,000 due to the CBAS/enhanced case management program, the transition of CHP Healthy Families members, and the CCS pilot implementation. We expect these new programs to increase utilization in a similar way as the SPD transition. The table below outlines the amendment request.
Total current contract amount $275,000 Current amount remaining $90,000 Amount necessary for March – December $500,000 (four months @ $44,000 per month and six months @ $54,000 per month) Funding gap/Additional funds requested $410,000 Total contract amount to December 2012 $685,000
Contract Cost and Term Although Language Select was the lowest-cost bidder, we attempted to negotiate a lower rate earlier this year. However, the vendor could not reduce their rates any further. Staff is requesting approval to amend the Language Select contract to add $410,000, bringing the total to $685,000, and to extend the contract term to December 31, 2012. Staff will then determine new contract needs for 2013 based on whether or not we are participating in the duals pilot.
The Finance & Budget Committee included in their approved motion that staff should pursue a contract arrangement with Language Select for up to three years in order to obtain the most favorable contract terms, including the existing 90-day termination clause. Telephonic Interpretation Vendor Contract Amendment March 28, 2012 Page 3 of 3
Budget Impact In February, the Board approved an increased budget amount of $1,113,000 for translation and interpretation services. The budget amount is sufficient for this proposed amendment request.
Press clippings were provided to Board Members
To request a copy, please contact Board Services at [email protected] Schedule of Meetings April 2012
Monday Tuesday Wednesday Thursday Friday Saturday Sunday 1
2 3 4 5 6 7 8 Services Agreement Committee 12:45 – 2 pm Board of Governors 2 – 5 pm
9 10 11 12 13 14 15 Executive Community Advisory Committee 10 am –1 pm
16 17 18 19 20 21 22 Compliance & Quality 3 – 5 pm
23 24 25 26 27 28 29 Finance & Budget 1:00 – 2:30 pm Executive 2:30 – 4:30 pm
30
For information on the current month’s meetings, call L.A. Care’s Meetings Information Line at Tel. (213) 438-5408 or check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. Prepared by mhbalones/printed on 04/02/12 Board of Governors & Public Advisory Committees 2012 Meeting Schedule / Member Listing 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017 Tel. (213) 694-1250 / Fax (213) 694-1246
MEETING DAY, TIME, MEETING & LOCATION DATES MEMBERS Board of 1st Thursday April 5 Walter A. Zelman, PhD, Chairperson Governors 2:00 – 5:00 PM May 3 Thomas Horowitz, DO, Vice Chairperson 1055 W. 7th Street, June 7 Philip L. Browning, Treasurer General Meeting 10th Floor, Los Angeles, July 12 * Mario Ramos, MA, Secretary CA 90017 No meeting in Mark Gamble August Maria Guerrero *moved due to holiday September 6 Thomas S. Klitzner, MD, PhD October 4 Jim Mangia, MPH November 1 Louise McCarthy December 6 Honorable Gloria Molina Michael Rembis, FACHE G. Michael Roybal, MD, MPH John Schunhoff, PhD
Staff Contact: Howard A. Kahn, Chief Executive Officer, x4102 Linda Merkens, Manager, Board Services, x4050
Board of Governors - Standing Committees
MEETING DAY, TIME, MEETING & LOCATION DATES 2012 MEMBERS Executive Committee 4th Wednesday of the month April 25 Walter A. Zelman, PhD, Chairperson 2:30 - 4:30 PM May 23 Thomas Horowitz, DO 1055 W. 7th Street, June 27 Philip L. Browning 10th Floor, Los Angeles, July 18 * Mario Ramos, MA CA 90017 No meeting in Mark Gamble August Jim Mangia, MPH
September 27** *moved due to summer October 24 holidays November 28 Staff Contact: **moved due to holiday No meeting in Linda Merkens, Manager, Board Services, December x4050
For information on the current month’s meetings, call L.A. Care’s Meetings Information Line at Tel. (213) 438-5408 or check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. \\Barstow\board administration\BoGovernors\Meeting Files\Schedule of Meetings\2012 BoG-PACs-RCACs Mtg Schedule-0412.doc, Prepared by Malou Balones\Printed on 04/02/12, Page 1 of 6
BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2012 MEETING SCHEDULE / MEMBER LISTING
MEETING DAY, TIME, MEETING & LOCATION DATES 2012 MEMBERS Compliance & 3rd Thursday April 19 Jim Mangia, MPH, Chairperson Quality Committee 3:00 PM to5:00 PM May 17 Thomas Horowitz, DO 1055 W. 7th Street, June 21 Thomas S. Klitzner, MD, PhD 10th Floor, Los Angeles, July 19 Louise McCarthy CA 90017 No meeting in Honorable Gloria Molina August G. Michael Roybal, MD, MPH September 20 October 18 Staff Contact: November 15 Malou Balones No meeting in Committee Liaison, Board Services, x 4183
December
Finance & Budget 4th Wednesday of the month April 25 Philip Browning, Chairperson Committee 1:00 PM to 2:30 PM May 23 Mark Gamble 1055 W. 7th Street, June 27 Michael A. Rembis, FACHE 10th Floor, Los Angeles, July 18 * John F. Schunhoff, PhD CA 90017 No meeting in Walter A. Zelman, PhD
August September 27** Staff Contact: *moved due to summer October 24 Samantha Coins holidays November 28 Committee Liaison, Board Services/x 4184 **moved due to holiday No meeting in December
Governance MEETS AS NEEDED Mark Gamble, Chairperson Committee 1055 W. 7th Street, Thomas S. Klitzner, MD, PhD 10th Floor, Los Angeles, Maria Guerrero CA 90017 Louise McCarthy Mario Ramos G. Michael Roybal, MD, MPH
Staff Contact: Malou Balones Committee Liaison, Board Services/x 4183
Service Agreement MEETS AS NEEDED April 5 Chairperson to be elected Committee 1055 W. 7th Street, 12:45 – 2 pm Philip L. Browning 10th Floor, Los Angeles, Mark Gamble CA 90017 Louise McCarthy Honorable Gloria Molina Mario Ramos, MA John F. Schunhoff, PhD
Staff Contact Malou Balones Committee Liaison, Board Services/x 4183
For information on the current month’s meetings, call L.A. Care’s Meetings Information Line at Tel. (213) 438-5408 or check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. \\Barstow\board administration\BoGovernors\Meeting Files\Schedule of Meetings\2012 BoG-PACs-RCACs Mtg Schedule-0412.doc, Prepared by Malou Balones\Printed on 04/02/12, Page 2 of 6
BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2012 MEETING SCHEDULE / MEMBER LISTING
MEETING DAY, TIME, MEETING & LOCATION DATES 2012 MEMBERS Audit Committee MEETS AS NEEDED Jim Mangia, MPH Chairperson 1055 W. 7th Street, Maria Guerrero 10th Floor, Los Angeles, John Schunhoff, PhD CA 90017 Staff Contact
Samantha Coins Committee Liaison, Board Services/x 4184
MEETING DAY, TIME, MEETING & LOCATION DATES MEMBERS L.A. Care Meets Annually or as needed Walter A. Zelman, PhD, Chairperson Community 1055 W. 7th Street, Thomas Horowitz, DO, Vice Chairperson 10th Floor, Los Angeles, Philip L. Browning, Treasurer Health CA 90017 Mario Ramos, MA, Secretary Mark Gamble Maria Guerrero Thomas S. Klitzner, MD, PhD Jim Mangia, MPH Louise McCarthy Honorable Gloria Molina Michael Rembis, FACHE G. Michael Roybal, MD, MPH John Schunhoff, PhD
Staff Contact: Howard A. Kahn, Chief Executive Officer, x4102 Linda Merkens, Manager, Board Services, x4050
For information on the current month’s meetings, call L.A. Care’s Meetings Information Line at Tel. (213) 438-5408 or check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. \\Barstow\board administration\BoGovernors\Meeting Files\Schedule of Meetings\2012 BoG-PACs-RCACs Mtg Schedule-0412.doc, Prepared by Malou Balones\Printed on 04/02/12, Page 3 of 6
BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2012 MEETING SCHEDULE / MEMBER LISTING
Public Advisory Committees MEETING DAY, TIME, MEETING & LOCATION DATES STAFF CONTACT Children’s Health 3rd Tuesday of every other May 15 Kimberly Uyeda, MD, Chairperson Consultant Advisory month July 17 Committee 8:30 am – 10:00 am September 18 General Meeting 1055 W. 7th Street, November 20 Staff Contact: 10th Floor, Los Angeles, Samantha Coins CA 90017 Committee Liaison, Board Services/x 4184
Executive 2nd Wednesday of the month April 11 Hilda Perez, Chairperson Community Advisory 10:00 A.M. - 12:00 Noon May 9 Committee 1055 W. 7th Street, June 13 10th Floor, Los Angeles, July 11 CA 90017 No meeting in Staff Contact: August Idalia Chitica, Community Outreach & September 12 Education, Ext. 4420 October 10 November 14 December 12
Technical Advisory 4th Thursdays every other May 24 Elaine Batchlor, MD, MPH, Chairperson Committee month July 26 9:00 – 11:00 A.M. September 28 Staff Contact: 1055 W. 7th Street, November 29 Malou Balones 10th Floor, Los Angeles, Committee Liaison, Board Services/x 4183 CA 90017
For information on the current month’s meetings, call L.A. Care’s Meetings Information Line at Tel. (213) 438-5408 or check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. \\Barstow\board administration\BoGovernors\Meeting Files\Schedule of Meetings\2012 BoG-PACs-RCACs Mtg Schedule-0412.doc, Prepared by Malou Balones\Printed on 04/02/12, Page 4 of 6
BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2012 MEETING SCHEDULE / MEMBER LISTING
REGIONAL COMMUNITY ADVISORY COMMITTEES
MEETING DAY, TIME, REGION & LOCATION MEETING DATE STAFF CONTACT Region 1 3rd Friday of every other April 27* Griselda Jimenez, Chairperson Antelope Valley month June 15 10:00 AM – 12:30 PM August 17 Chimbole Cultural Center October 19 Staff Contact: 38350 N. Sierra Highway December 21 Frank Meza, Community Outreach & Palmdale, CA 93550 *will meet 4th Friday Education, Ext. 4239 Tel (661) 267-5656 this month Region 2 3rd Monday of every other April 16 Carlos Aguirre, Chairperson San Fernando Valley month June 18 10:00 AM – 12:30 PM August 20* Francis Polytechnic Senior High October 15 School December 17 Staff Contact: 12431 Roscoe Blvd. *Will meet the 4th Frank Meza, Community Outreach & Sun Valley, CA 91352 Monday of the month* Education, Ext. 4239 Region 3 3rd Tuesday of every other April 17 Cynthia Conteas-Wood, Chairperson Alhambra, Pasadena month June 19 and Foothill 9:30 AM – 12:00 noon August 21 STARS Program October 16 Staff Contact: 500 E. Villa Street December 18 Judy Hsieh, Community Outreach & Education, Pasadena, CA 91101 Ext. 4199 Tel. (626) 683-8733
Region 4 3rd Tuesday of every other May 15 Minerva Lopez, Chairperson Hollywood-Wilshire, month July 17 Central and Glendale 9:00 – 11:30 AM September 18 St. Vincent Medical Center November 20 Gymnasium Staff Contact: 2131 W. 3rd Street Judy Hsieh, Community Outreach & Education, Los Angeles, CA 90017 Ext. 4199 Tel. (213) 484-7766 Region 5 3rd Monday of every other April 16 Maria Guadalupe Mendez, Chairperson West month June 18 2:00 – 4:30 P.M August 20 Mar Vista Housing Dev. October 15 Multipurpose Room December 17 Staff Contact: 4909 Marionwood Street Culver Martin Vicente City, CA 90230 Community Outreach & Education, x 4423 Tel. (310) 915-9006
Region 6 3rd Thursday of every other April 19 Mary Romero, Chairperson South, Compton, month June 21 Inglewood 3:00 – 5:30 P.M. August 16 Saint John’s Well Child & Family Center October 18 Staff Contact: 5701 S. Hoover Street, Los December 20 Hilda Stuart Angeles, CA 90037 Community Outreach & Education, x 4421 Tel. (323) 541-1660
For information on the current month’s meetings, call L.A. Care’s Meetings Information Line at Tel. (213) 438-5408 or check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. \\Barstow\board administration\BoGovernors\Meeting Files\Schedule of Meetings\2012 BoG-PACs-RCACs Mtg Schedule-0412.doc, Prepared by Malou Balones\Printed on 04/02/12, Page 5 of 6
BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2012 MEETING SCHEDULE / MEMBER LISTING
MEETING DAY, TIME, REGION & LOCATION MEETING DATE STAFF CONTACT Region 7 3rd Thursday of every other May 17 Hilda Perez, Chairperson San Antonio and month July 19 Bellflower 4:30 – 7:00 P.M. September 27* Middleton Elementary School November 15 Staff Contact: Gymnasium *will meet the 4th Frank Meza 6537 Malabar Street Thursday this month Community Outreach & Education, x 4239 Huntington Park, CA 90255 Tel. (323) 582-6387
Region 8 3rd Friday of every other May 18 Maria Montes – Chairperson Torrance and Harbor month July 20 10:30 A.M. – 1:00 PM September 21 John Mendez Community Center November 16 Staff Contact: 707 W. C Street Hilda Stuart Wilmington, CA 90748 Community Outreach & Education, x 4421 Tel. (310) 549-0052
Region 9 3rd Monday of every other May 21 Maria Cruz, Chairperson Long Beach month July 16 9:00 – 11:30 A.M. September 17 Miller Family Health Education Center November 19 Staff Contact: 3820 Cherry Avenue Hilda Stuart Long Beach, CA 90807 Community Outreach & Education, x 4421 Tel. (562) 570-7987
Region 10 3rd Thursday of every other April 19 Aida Aguilar, Chairperson East Los Angeles, month June 21 Whittier and North- 4:00 – 6:30 P.M. August 16 East Boyle Heights Technology Youth Center October 18 Staff Contact: th 1600 East 4 Street December 20 Martin Vicente, Community Outreach & Los Angeles, CA 90033 Education, Ext. 4423 Tel. (323) 526-0145
Region 11 3rd Wednesday of every May 17 Alejandra Martinez, Chairperson Pomona and El other Month July 19 Monte 9:00 AM – 11:30 AM September 27* First Christian Church November 15 Staff Contact: 1751 North Park Avenue *will meet the 4th Martin Vicente, Community Outreach & Pomona, CA 91768 Thursday this month Education, Ext. 4423 Tel. (909) 622-1144
For information on the current month’s meetings, call L.A. Care’s Meetings Information Line at Tel. (213) 438-5408 or check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. \\Barstow\board administration\BoGovernors\Meeting Files\Schedule of Meetings\2012 BoG-PACs-RCACs Mtg Schedule-0412.doc, Prepared by Malou Balones\Printed on 04/02/12, Page 6 of 6