REGULAR MEETING OF THE GOVERNING BOARD OF THE INLAND EMPIRE HEALTH PLAN
July 8, 2019 - 9:00 AM
Board Report #294
Riverside County Administrative Center First Floor, Board Chambers 4080 Lemon Street Riverside, CA 92501
If disability-related accommodations are needed to participate in this meeting, please contact Annette Taylor, Secretary to the IEHP Governing Board at (909) 296-3584 during regular business hours of IEHP (M-F 8:00 a.m. – 5:00 p.m.)
PUBLIC COMMENT AT INLAND EMPIRE HEALTH PLAN GOVERNING BOARD MEETINGS: The meeting of the Inland Empire Health Plan Governing Board is open to the public. A member of the public may address the Board on any item on the agenda and on any matter that is within the Board’s jurisdiction. Requests to address the Board must be submitted in person to the Secretary of the Governing Board prior to the start of the meeting and indicate any contributions in excess of $250.00 made by them or their organization in the past twelve (12) months to any IEHP Governing Board member as well as the name of the Governing Board member who received contribution. The Board may limit the public input on any item, based on the number of people requesting to speak and the business of the Board.
All public record documents for matters on the open session of this agenda can be viewed at the meeting location listed above, IEHP main offices at 10801 6th Street, Suite 120, Rancho Cucamonga, CA 91730 and online at http://www.iehp.org.
AGENDA
I. Call to Order
II. Special Presentation: In Recognition and Honor of Dr. Bradley P. Gilbert, MD, MPP, Chief Executive Officer, for his 23 years of Service and Unwavering Support to the Inland Empire Health Plan and its Members, Providers and Staff.
III. Changes to the Agenda: Board Secretary
IV. Public Comments on Matters on the Agenda
V. Conflict of Interest Disclosure:
VI. Adopt and Approve of the Meeting Minutes from the June 10, 2019 Regular Meeting of the Governing Board of the Inland Empire Health Plan and IEHP Health Access
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VII. IEHP
CONSENT AGENDA
ADMINISTRATION (Bradley P. Gilbert, M.D.) 1. Appointment of the Chief Executive Officer and Approval of the Employment Agreement with Jarrod McNaughton 2. Approve the Professional Services Agreement for Consulting Services with Dr. Bradley P. Gilbert, MD, MPP dba BGT Consulting
INFORMATION TECHNOLOGY DEPARTMENT (Michael Deering) 3. Approve The Increase In Spending Authority With Opentext Corporation
MARKETING DEPARTMENT (Susan Arcidiacono) 4. Approve the Fifth Amendment to the Professional Services Agreement with mPulse Mobile, Inc. 5. Approve the use of Selected Broadcast Media for Advertising Services 6. Approve the use of Selected Print Media Vendors for Advertising Services 7. Approve the use of Selected Outdoor Media Vendors for Advertising Services
OPERATIONS DEPARTMENT (Jarrod McNaughton) 8. Approve the First Amendment to the Professional Services Agreement with California Dining Services
PROVIDER NETWORK DEPARTMENT (Kurt Hubler) 9. Ratify and approve the Twenty Eighth Amendment to the Hospital Per Diem Agreement with Arrowhead Regional Medical Center 10. Ratify and approve the Twentieth Amendment to the Hospital Per Diem Agreement with Children’s Hospital at Mission 11. Ratify and approve the Twentieth Amendment to the Hospital Per Diem Agreement with Children’s Hospital of Orange County 12. Ratify and approve the First Amendment to the Urgent Care Provider Agreement with Inland Urgent Care of Sun City 13. Ratify and approve the Fifth Amendment to the Capitated Primary Care Provider Agreement with Pomona Community Health Center dba Parktree Community Health Center
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14. Ratify and approve the Fourth Amendment to the Inland Empire Health Plan Per Diem Hospital Agreement with Prime Healthcare Services III, LLC dba Montclair Hospital Medical Center 15. Approval of the Evergreen Contracts: Renewal under the Evergreen Clause of the following Agreements effective, August 1, 2019: 1. Ancillary Provider Agreement with Dynamics Orthotics and Prosthetics Inc. 2. Ancillary Provider Agreement with The Elizabeth Hospice Inc. 3. Behavioral Health Provider Agreement with Cross Cultural Marriage and Family Therapy Counselling Center Inc. 4. Behavioral Health Provider Agreement with Professional Family Counseling Inc. 5. Open Access Provider Agreement with Rory Dennis Goshorn 6. Capitated Primary Care Provider Agreement with GK Urgi Care Inc SJ Medical Clinic 7. Fee-For-Service Primary Care Provider Agreement with Housecall Doctors Medical Group Inc. 8. Residential Care for the Elderly Provider Agreement with Maria Puraci dba Holy Hill Home Care 9. Residential Care for the Elderly Provider Agreement with Nick Puraci dba Holy Hill Home Care East 10. Residential Care for the Elderly Provider Agreement with Rose Garden Residential Operator LLC dba Rose Garden Residential 11. Participating Provider Agreement with Alessandro Medical Professional Corporation dba Alessandro Clinica Medica Familiar 12. Participating Provider Agreement with Chang Li Lee dba Chang L Lee MD Inc. 13. Participating Provider Agreement with Dr Javier R Rios A Medical Corporation dba Lake Elsinore Clinica Medica Familiar and Mead Valley Clinica Medica Familiar 14. Participating Provider Agreement with Javier R Rios A Professional Corporation dba Magnolia Clinica Medica Familiar
POLICY AGENDA AND STATUS REPORT ON AGENCY OPERATIONS:
ADMINISTRATION (Bradley P. Gilbert, M.D.) 16. Monthly Membership Report 17. State of the Inland Empire Health Plan
FINANCE DEPARTMENT (Keenan Freeman) 18. Review of Monthly Financials
HEALTH SERVICES DEPARTMENT (Jennifer N. Sayles, M.D., MPH) 19. Overview of the 2019 Medicaid and Medicare Consumer Assessment of Health Providers & Systems Adult Member Satisfaction Survey Results
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VIII. IEHP HEALTH ACCESS
CONSENT AGENDA
PROVIDER NETWORK DEPARTMENT (Kurt Hubler) 20. Ratify and approve the Twenty Eighth Amendment to the Hospital Per Diem Agreement with Arrowhead Regional Medical Center 21. Ratify and approve the Twentieth Amendment to the Hospital Per Diem Agreement with Children’s Hospital at Mission 22. Ratify and approve the Twentieth Amendment to the Hospital Per Diem Agreement with Children’s Hospital of Orange County 23. Ratify and approve the First Amendment to the Urgent Care Provider Agreement with Inland Urgent Care of Sun City 24. Ratify and approve the Fourth Amendment to the Inland Empire Health Plan Per Diem Hospital Agreement with Prime Healthcare Services III, LLC dba Montclair Hospital Medical Center 25. Ratify and approve the Fifth Amendment to the Capitated Primary Care Provider Agreement with Pomona Community Health Center dba Parktree Community Health Center 26. Approval of the Evergreen Contracts Renewal under the Evergreen Clause of the following Agreements effective, August 1, 2019: 1. Ancillary Provider Agreement with Dynamics Orthotics and Prosthetics Inc. 2. Ancillary Provider Agreement with The Elizabeth Hospice Inc. 3. Behavioral Health Provider Agreement with Cross Cultural Marriage and Family Therapy Counselling Center Inc. 4. Behavioral Health Provider Agreement with Professional Family Counseling Inc. 5. Open Access Provider Agreement with Rory Dennis Goshorn 6. Capitated Primary Care Provider Agreement with GK Urgi Care Inc SJ Medical Clinic 7. Fee-For-Service Primary Care Provider Agreement with Housecall Doctors Medical Group Inc. 8. Residential Care for the Elderly Provider Agreement with Maria Puraci dba Holy Hill Home Care 9. Residential Care for the Elderly Provider Agreement with Nick Puraci dba Holy Hill Home Care East 10. Residential Care for the Elderly Provider Agreement with Rose Garden Residential Operator LLC dba Rose Garden Residential 11. Participating Provider Agreement with Alessandro Medical Professional Corporation dba Alessandro Clinica Medica Familiar 12. Participating Provider Agreement with Chang Li Lee dba Chang L Lee MD Inc. 13. Participating Provider Agreement with Dr Javier R Rios A Medical Corporation dba Lake Elsinore Clinica Medica Familiar and Mead Valley Clinica Medica Familiar 14. Participating Provider Agreement with Javier R Rios A Professional Corporation dba Magnolia Clinica Medica Familiar
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IX. MAIN OBJECTIVES FOR THE NEXT 90 DAYS AND SUMMARY COMMENTS (Bradley P. Gilbert, M.D.)
X. COMMENTS FROM THE PUBLIC ON MATTERS NOT ON THE AGENDA
XI. ADJOURNMENT
The next meeting of the IEHP Governing Board will be held on August 12, 2019 at the San Bernardino County Government Center.
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ADMINISTRATION
1. APPOINTMENT OF THE CHIEF EXECUTIVE OFFICER AND APPROVAL OF THE EMPLOYMENT AGREEMENT BETWEEN IEHP AND JARROD MCNAUGHTON
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) appoint the Chief Executive Officer and approve the Employment Agreement for Chief Executive Officer between IEHP and Jarrod McNaughton.
Contact: Janet Nix, Chief Organizational Officer
Background: The Chief Executive Officer (CEO) of IEHP is responsible for the direction and oversight of all IEHP activities. The CEO’s principal duties generally include: formulating policies for the IEHP Governing Board (Board) approval; providing a monthly operational report to the Board; developing annual financial plans and monthly financial statements; serving as the primary contact person for interactions with state and federal regulatory agencies; providing direction for the preparation of IEHP’s fiscal and other regulatory reports to appropriate regulatory agencies; monitoring and reporting on legislative and regulatory developments at the state and federal level on the Board’s behalf; developing and promoting working relationships with pertinent governmental, community and professional organizations; and facilitating and maintaining positive relationships with network providers.
Dr. Bradley Gilbert has been serving as IEHP’s CEO since October 1, 2008. During his tenure as CEO, he has been instrumental in making IEHP a major presence in the Inland Empire, striving to fulfill IEHP's mission in providing accessible health care. Dr. Gilbert has always remained focused on IEHP's mission about the health and well-being of members. Under his leadership, IEHP earned #1 and #2 rankings in California for America’s Best Health Plans in 2008 and 2009, respectively. In 2010, he led IEHP to become one of only five health plans across the country to achieve a 5-star rating for Medicare Part D Quality and Performance. In May 2012, IEHP received a 100 percent score on the Standards portion of its NCQA review, with an overall Commendable Accreditation Level. After his long, accomplished career with IEHP, which started in 1996 and spans over 2 decades, Dr. Gilbert has announced his retirement for July 19, 2019.
Discussion: Over the last few months, IEHP conducted a thorough recruitment in order to find the next CEO upon Dr. Gilbert’s retirement. The selection process was facilitated by IEHP’s outside recruiting firm, Witt Kiefer, during which the candidates went through a rigorous process including a Hogan personality/leadership survey, interviews with Governing Board Members and interviews with senior leadership at IEHP. Through this process, IEHP desires to nominate Jarrod McNaughton as the next CEO.
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Mr. McNaughton joined IEHP as the Chief Operating Officer (COO) in May 2018. Mr. McNaughton embodies IEHP’s mission, culture and values, and brings not only his experience with IEHP as COO, but also extensive experience in the provider space. His most recent job before IEHP was the President of Kettering Medical Center and Executive Vice President of Kettering Health Network. This large health system in Southwest Ohio included 8 hospitals, many outpatient clinics and over 11,000 employees. Previously, he was the Vice president at San Joaquin Community Hospital where he developed and implemented a new mission and service department, increasing patient satisfaction scores from the 40th percentile to the 85th percentile in less than a year. His nearly 20 years of experience in the healthcare industry where he utilized multi-tiered operational strategies and innovation, generating superior results and establishing a reputation for building dynamic teams, developing leaders, and fostering key relationships in the community, helps support IEHP’s position of strength in the ever-changing healthcare environment.
Mr. McNaughton is expected to continue IEHP’s core values, which has brought IEHP much success under Dr. Gilbert’s leadership, and to also innovate by introducing new methods and ideas that stem from his outside experience, all of which will make IEHP a stable and smarter organization.
An Employment Agreement with Mr. McNaughton for the position of CEO has been negotiated and is now presented to this Board for approval. The CEO Employment Agreement shall commence at 12:00 a.m. on July 20, 2019, at which time Mr. McNaughton will assume the position of CEO.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY19/20
Financial Review: V.Johnson, 6/28/19
Reviewed by Counsel: Yes
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ADMINISTRATION
2. APPROVE THE PROFESSIONAL SERVICES AGREEEMENT FOR CONSULTING SERVICES WITH DR. BRADLEY P. GILBERT, MD, MPP dba BGT CONSULTING
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Professional Services Agreement (Agreement) with Dr. Bradley P. Gilbert MD, MPP dba BGT Consulting for administrative consulting services.
Contact: Steve Sohn, General Counsel
Background: Dr. Gilbert has been with IEHP since 1996, serving as the Chief Executive Officer (CEO) since October 1, 2008. Since IEHP’s inception, Dr. Gilbert has played a pivotal role in guiding IEHP to its place as a nationally recognized leader in public healthcare and has been instrumental to IEHP's mission of providing accessible health care in the Inland Empire to those in need.
IEHP was the first Medi-Cal health plan in the state to earn National Committee for Quality Assurance (NCQA) Accreditation, the nation’s leading quality monitoring organization of health plans. Under his leadership, the organization also developed a multi-faceted and multi-disciplinary Wellness Program to encourage members to live healthy lives and prevent illness. These efforts earned IEHP a #1 and #2 ranking in California for America’s Best Health Plans in 2008 and 2009. In 2010, he led IEHP to become one of only five health plans across the country to achieve a 5-star rating for Medicare Part D Quality and Performance. In May 2012 IEHP received a 100 percent score on the Standards portion of its NCQA review, with an overall Commendable Accreditation Level.
After his long, accomplished career with IEHP, Dr. Gilbert is retiring on July 19, 2019. However, as part of transition planning and providing continuity for the organization, it is desirable and necessary for IEHP to support the transition of the next CEO by retaining Dr. Gilbert as a consultant advisor to assist the next CEO.
Discussion: Due to his deep and expansive knowledge of IEHP, retaining Dr. Gilbert as a consultant to the next CEO would greatly benefit IEHP. Based on his 23 years of service to IEHP, and leading IEHP as the CEO for a decade, Dr. Gilbert has a unique understanding of IEHP and its operations, as well as the state and federal requirements of public health plans. Dr. Gilbert has particular knowledge of the needs, goals and objectives of IEHP. As part of this engagement, Dr. Gilbert will support the next CEO with historical background/context, institutional knowledge sharing, leadership development and coaching on external stakeholder relationships. His services will include: advisement on direction and oversight of IEHP activities and/or strategies, advisement and assistance on regulatory requirements and helping to make connections with leaders of regulatory agencies and key stakeholders. His guidance will support IEHP in its transition to new leadership, and his extensive knowledge and expertise in directing a large Medi-Cal plan, such as IEHP, are
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value added elements to this engagement and to IEHP. Dr. Gilbert is best suited and uniquely qualified to fulfill the role of advisor to the next CEO of IEHP. He will serve as an independent contractor with expected hours at approximately two hours per week, he will not receive direction on his work product from the IEHP Governing Board or the CEO. His work will be offsite using his own materials.
This Consulting Agreement shall have an initial term of one (1) year beginning July 20, 2019. IEHP may extend the Agreement for up to one (1) additional year. The total compensation is not to exceed $69,600.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: New Expenditure
Fiscal Review: V. Johnson, 6/28/19
Reviewed by Counsel: Yes
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INFORMATION TECHNOLOGY DEPARTMENT
3. RATIFY AND APPROVE THE INCREASE IN SPENDING AUTHORITY WITH OPENTEXT CORPORATION
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the increase in spending authority with OpenText Corporation for cloud-based faxing services. The additional cost shall not exceed $196,000 for one (1) year, effective July 1, 2019. The total cost under this Agreement shall not exceed $2 million.
Contact: Michael Deering, Chief Information Officer
Background: In May 2014 under Minute Order 14-124, the Governing Board approved the Professional Services Agreement (Agreement) with EasyLink Services, formerly known as OpenText, for cloud-based faxing services at a cost not to exceed $360,000 for a period of three (3) years, effective January 31, 2014.
In October 2014 under Minute Order 14-248, the Governing Board approved the First Amendment to the Agreement, which replaced the Corporate Vendor, EasyLink Services, with its subsidiary, Xpedite Systems, LLC, and changed the Agreement type with the Xpedite Systems, LLC from a Professional Services Agreement to a Customer Services Agreement. The additional cost, which included tax and other fees, was not to exceed $500,000. The total costs under this Agreement increased to an amount not to exceed $860,000 for three (3) years, effective October 1, 2014.
In January 9, 2017 under Minute Order 17-00, the Governing Board approved an increase in spending authority with Xpedite System, LLC for cloud-based faxing services for an amount not to exceed $300,000 through October 1, 2017. The total costs under this Agreement increased to an amount not to exceed $1.16 million.
In September 2017 under Minute Order 17-156, the Governing Board approved an increase in spending authority and the renewed Agreement. The renewal was altered in structure from the Agreement’s initial composition through the transition from year-based terms to month-to-month auto-renewals. The total requested amount was $414,000 which included a 15% contingency for a period of one (1) year. The new total costs under this Agreement increased to an amount not to exceed $1.574 million.
In October 2018, under Minute Order 18-297. The Governing Board approved an increase in spending authority for $230,000. Since 2018, IEHP has been exploring new vendor options and possible in-house based solutions. As such, the $230,000 was to account for six (6) months of funding.
Discussion:
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The digitalization and linking of information systems has become a requirement of organizations that wish to compete in modern markets. As cloud-based server and telecommunication carrier systems have expanded their capabilities, so have the available forms of data transmission and delivery. In 2018, IEHP furthered the Plans alignment with these latest capabilities through a system-wide upgrade to its faxing system infrastructure.
The first step in this upgrade required the migration of all faxing communications to a RightFax system. This system utilizes virtualized servers to transmit inbound and outbound data across multiple formats such as: multifunction printers (MFPs), desktop applications, email applications, Office 365, and CRM systems. As of December 2018, IEHP completed the RightFax migration upgrade.
Building upon this upgrade, IEHP will be constructing a bridge between the RightFax virtualized servers and components of IEHP’s CORE system. Specifically, IEHP will be constructing an application programming interface (API) that will link existing fax connections (fax numbers) with MedHOK repositories, effectively populating the faxed data into MedHOK’s available pool of data.
As the API build requires contribution from multiple vendor sources, the timing of the Fax- MedHOK API completion is contingent upon the timelines of concurrent MedHOK project work. Once the API is built and tested, it is estimated that an additional four (4) to six (6) weeks will be required to fully transition each connected fax number to the upgraded carrier connection.
To begin this collaboration, an API project kick-off is scheduled for early July 2019. To allow the continuation of uninterrupted faxing services until the project completion is achieved, IEHP is requesting approval for an additional $196,000 for this four (4) to six (6) month period. The new total cost under the agreement shall not exceed $2 million.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence
Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Fiscal Review: T. Amin 6/20/19
Reviewed by Counsel: Yes
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MARKETING DEPARTMENT
4. APPROVE THE FIFTH AMENDMENT TO THE PROFESSIONAL SERVICES AGREEMENT WITH MPULSE MOBILE, INC.
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Fifth Amendment to the Professional Services Agreement (Agreement) with mPulse Mobile, Inc. for an additional amount not to exceed $1.164 million and extend the term for an additional three (3) years effective July 8, 2019 through December 31, 2022 for SMS/texting and email communication services. The total amount payable under this Agreement shall not exceed $4.364 million.
Contact: Susan Arcidiacono, Chief Marketing Officer
Background: In October 2014, IEHP released a Request for Proposal (RFP) for SMS/Texting and Email Communication Services. After a thorough RFP process MobileStorm was selected in December 2014, as the most qualified vendor for text and email communications to IEHP Members. In January 2015, under Minute Order 15-28, the Governing Board approved the original Agreement with MobileStorm for an amount not to exceed $200,000 per year effective January 12, 2015 through December 31, 2017.
In February 2015 under Minute Order 15-39, the Governing Board approved the First Amendment to the Agreement that changed the vendor name from Mobile Storm, Inc. to mPulse Mobile, Inc.
In July 2016 under Minute Order 16-115 the Governing Board approved the Second Amendment increasing the cost by an additional $250,000 per year for an annual cost not to exceed $450,000 effective July 1, 2016 through December 31, 2017. This was followed by a Third Amendment that changed the pricing structure, with no other changes to Agreement.
In December 2017 under Minute Order 17-233 the Governing Board approved the Fourth Amendment for an additional $1.0 million and extended the term for an additional two (2) years effective January 1, 2018 through December 31, 2019.
Discussion: mPulse Mobile Inc. will continue to provide the following services to IEHP for the next three (3) years: Assist IEHP with obtaining permission from our Members to receive these services from us Provide web-based platform that IEHP can use for SMS/texting and email services Send approved SMS/texting and emails to our Members Train IEHP Team Members on how to set up and use their platform Provide general account management to IEHP Recommend ways to improve after each campaign Expansion of texting services to other departments
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In addition to the above, this Fifth Amendment will also include: The Plan Licensing/State Requirements Addendum A provision section, Compliance with Legal and Regulatory requirements
The Fifth Amendment extends the Agreement for an additional three (3) years at a cost not to exceed $1.164 million, effective July 8, 2019 through December 31, 2022. The total amount payable under this Agreement shall not exceed $4.364 million.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY19/20 Budget
Financial Review: R. Mok, 6/24/19
Reviewed by Counsel: Yes
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MARKETING DEPARTMENT
5. APPROVE THE USE OF SELECTED BROADCAST MEDIA FOR ADVERTISING SERVICES
Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) authorize IEHP to use selected broadcast media including radio and cable TV in an amount not to exceed $2.2 million for FY19/20 advertising services.
Contact: Susan Arcidiacono, Chief Marketing Officer
Background: Broadcast advertising is generally used for branding and direct response to support key company objectives and initiatives. For example, IEHP uses radio and cable TV as advertising channels to promote key HEDIS/CAHPS measures, such as preventive care and customer satisfaction. The goal is to impact Members’ behavior to help them be healthier and to help improve HEDIS/ CAHPS scores. Broadcast advertising is also one of the critical media channels that has contributed to our current 90 percent Medi-Cal plan choice rate (highest among local public plans in California) and our 97 percent brand awareness rate in the Inland Empire.
Broadcast advertising will also help support the Strategic Focus Areas for a top employer brand within the Inland Empire and California.
Discussion: IEHP uses data from media ratings company, Nielsen, and our Member’s survey and focus groups to evaluate and select high performance radio stations and cable TV shows that will effectively reach their target audiences.
IEHP requests the approval to: 1. Confirm the approved IEHP FY 19/20 budget to the actual vendor spending authority; and 2. Purchase radio and cable TV advertising from all stations owned and/or affiliated with the following companies for FY 19/20: RADIO Alpha Media, LLC Inland Empire Broadcasting Corp. (KKUU/KPSI) (KOLA) Entercom Communications Liberman Broadcasting, Inc. Corp. (KFRG) (KRQB) El Dorado Broadcasting Pandora Media, LLC (KATJ/KZXY) Entravision Communications Gulf California Broadcast (KUNA) (KLYY/KLOB) RM Broadcasting, LLC iHeart Media Radio (KGGI) (KPLM)
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CABLE TV Spectrum Reach Univision Radio Stations Groups, Inc. Estrella TV Univision Palm Springs, KVER-TV KUNA TV Telemundo 15 NBC Palm Springs, KPSE-TV Palm Springs
IEHP will purchase advertising directly with the radio stations and cable providers instead of through a media placement agency. With this approach, IEHP will receive a discount rate that is only given to not-for-profit organizations, as well as some credits for their direct purchase. The total compensation payable under this Minute Order shall not exceed $2.2 million for FY 19/20.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY19/20
Financial Review: R. Mok, 06/19/19
Reviewed by Counsel: N/A
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MARKETING DEPARTMENT
6. APPROVE THE USE OF SELECTED PRINT MEDIA VENDORS FOR ADVERTISING SERVICES
Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) approve the use of selected print media vendors in an amount of $150,000 for FY 19/20 advertising services.
Contact: Susan Arcidiacono, Chief Marketing Officer
Background: Print advertising is generally used for branding and direct response purposes. For example, IEHP distributes flyers to promote Medi-Cal, Cal MediConnect program and Community Resource Centers. IEHP also runs print advertisements in the Riverside and San Bernardino Medical Society Associations’ publications to promote our partnership with Providers, organizational achievements, high Physician Satisfaction scores, etc.
Discussion: IEHP has been using print as a direct response vehicle to promote Medi-Cal and the Cal MediConnect program. This advertising channel has proven very effective for many years. In addition, IEHP promotes their brand and services to the provider community in selected publications such as the Riverside Medical Society Association, San Bernardino Medical Society Association, and the CAHP Annual Report.
IEHP requests approval to: 1. Conform the approved IEHP FY 19/20 budget to the actual vendor spending authority; and 2. Purchase advertising from all print publications owned and/or affiliated with the following entities for FY 19/20:
a. California Association of Health Plans (CAHP) b. Desert Mobile c. Inland Empire Magazine d. Riverside Medical Society Association e. San Bernardino Medical Society Association f. Valassis g. Valley Messengers/Teeters
The total compensation payable under this Minute Order shall not exceed $150,000 for FY 19/20.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
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Fiscal Impact: Included in FY 19/20
Financial Review: R. Mok, 06/19/19
Reviewed by Counsel:
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MARKETING DEPARTMENT
7. APPROVE THE USE OF SELECTED OUTDOOR MEDIA VENDORS FOR ADVERTISING SERVICES
Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) approve the use of selected outdoor media vendors for advertising services in an amount not to exceed $700,000 for the FY 19/20 advertising services.
Contact: Susan Arcidiacono, Chief Marketing Officer
Background: Outdoor advertising is generally used for branding and direct response to support key company objectives and initiatives. For example, IEHP uses outdoor advertising channels to promote key HEDIS/CAHPS measures such as preventive care, customer satisfaction and the Community Resource Centers (CRC). We support the CRC’s with freeway and interior billboards. The goal is to impact Members’ behavior to help them be healthier and to help improve HEDIS/CAHPS scores. Outdoor advertising is one of the critical media channels, which has contributed to IEHP’s 90 percent Medi-Cal plan choice rate (highest among local public plans in California) and our 97 percent brand awareness rate in the Inland Empire.
Discussion: For many years IEHP has used only high-performance billboards, bus sides and bus shelters in strategic marketing locations throughout the Inland Empire. IEHP uses the Traffic Impression report from Caltrans to determine which billboard locations will reach current and potential Members effectively. IEHP requests authority to conform the approved IEHP FY 19/20 budget to the actual vendor spending authority for FY 19/20 at a cost not to exceed $700,000.
Currently, IEHP advertises at the following billboard locations:
LOCATION SIZE ILLUMINATION 91 Freeway in Riverside 14’ x 48’ Yes Interstate 10 in Fontana 14’ x 48’ Yes Interstate 10 in Palms 10’6” x 36’ Yes Spring/Indio/Coachella Interstate 10 in Yucaipa 12’ x 40’ Yes Interstate 215 in Perris/Hemet 12’ x 40’ Yes Interstate 15 in Hesperia (1) 12’ x 40’ Yes Interstate 15 in Victorville (3 for CRC) 12’ x 40’ Yes
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LOCATION SIZE ILLUMINATION Interstate 15 in Lake Elsinore 14’ x 36’ Yes
IEHP also places advertisements on the sides of 30 buses and in the metro and west side areas of San Bernardino due to the high concentration of our membership. Bus side advertising does not exist in Riverside.
IEHP requests the authority to purchase advertising from the following companies that own the outdoor media channels listed above for FY 19/20:
1) Clear Channel Outdoor 2) The Lamar Companies
For the printing of the vinyl billboards (i.e. fabrication), IEHP solicits quotes from the following vendors.
1) Independent’s Service Company 2) Metromedia Technologies 3) The Garvey Group West
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY19/20
Financial Review: (R. Mok, 06/19/19)
Reviewed by Counsel: N/A
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OPERATIONS DEPARTMENT
8. APPROVE THE FIRST AMENDMENT TO THE PROFESSIONAL SERVICE AGREEMENT WITH CALIFORNIA DINING SERVICES
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the First Amendment with California Dining Services for food services. The term of this agreement will be on a month-to-month basis, not to exceed one (1) year.
Contact: Jarrod McNaughton, Chief Operating Officer
Background: In July 2014 Minute Order 14-162, the Governing Board the Professional Services Agreement with California Dining Services (CDS) to provide food services at the Atrium. CDS provides onsite café food services within IEHP’s Atrium building. CDS operates and provides food service management, food logistics, café systems, labor, and all material necessary to ensure a successful operation.
Discussion: IEHP is requesting a month-to-month renewal, that will not exceed one (1) year with California Dining Services (CDS). Until further notice CDS will continue to provide food services on behalf of IEHP within IEHP premises. During this time, IEHP will be actively exploring new and innovative options for its onsite food services within the Atrium building.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence
Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY19/20 budget
Financial Review: J. Taylor 04/9/2019
Reviewed by Counsel: Yes
20 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
9. RATIFY AND APPROVE THE TWENTY EIGHTH AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH ARROWHEAD REGIONAL MEDICAL CENTER
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twenty Eighth Amendment to the Hospital Per Diem Agreement with Arrowhead Regional Medical Center, effective July 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Arrowhead Regional Medical Center is a contracted Hospital in the IEHP Network since February 1, 2008. The Hospital has all product lines of business.
Discussion: The Twenty Eighth Amendment extends the term beginning July 1, 2019 through June 30, 2020.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
21 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
10. RATIFY AND APPROVE THE TWENTIETH AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH CHILDREN’S HOSPITAL AT MISSION
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twentieth Amendment to the Hospital Per Diem Agreement with Children’s Hospital at Mission, effective June 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Children’s Hospital at Mission is a contracted Hospital in the IEHP Network since January 1, 2004.
Discussion: The Twentieth Amendment extends the term beginning June 1, 2019 through May 31, 2021 and replaces the Attachment C, Compensation Rates.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
22 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
11. RATIFY AND APPROVE THE TWENTIETH AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH CHILDREN’S HOSPITAL OF ORANGE COUNTY
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twentieth Amendment to the Hospital Per Diem Agreement with Children’s Hospital of Orange County, effective June 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Children’s Hospital of Orange County is a contracted Hospital in the IEHP Network since January 1, 2004.
Discussion: The Twentieth Amendment extends the term beginning June 1, 2019 through May 31, 2021 and replaces the Attachment C, Compensation Rates.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
23 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
12. RATIFY AND APPROVE THE FIRST AMENDMENT TO THE URGENT CARE PROVIDER AGREEMENT WITH INLAND URGENT CARE OF SUN CITY
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the First Amendment to the Urgent Care Provider Agreement with Inland Urgent Care of Sun City, effective May 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Inland Urgent Care of Sun City is currently a contracted Provider in the IEHP Network since November 1, 2010.
Discussion: The First Amendment is to ratify the Attachment B, Compensation for all product lines of business to May 1, 2019.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
24 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
13. RATIFY AND APPROVE THE FIFTH AMENDMENT TO THE CAPITATED PRIMARY CARE PROVIDER AGREEMENT WITH POMONA COMMUNITY HEALTH CENTER DBA PARKTREE COMMUNITY HEALTH CENTER
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Fifth Amendment to the Capitated Primary Care Provider Agreement with Pomona Community Health Center dba Parktree Community Health Center, effective September 1, 2018.
Contact: Kurt Hubler, Chief Network Officer
Background: Pomona Community Health Center dba Parktree Community Health Center is currently a contracted Provider in the IEHP Network since December 1, 2012.
Discussion: The Fifth Amendment is to ratify the Attachment B, Compensation for all product lines of business to September 1, 2018.
Strategy Focus Areas:
Member Experience Network Team Members Operational Excellence
Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
25 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
14. RATIFY AND APPROVE THE FOURTH AMENDMENT TO THE INLAND EMPIRE HEALTH PLAN PER DIEM HOSPITAL AGREEMENT WITH PRIME HEALTHCARE SERVICES III, LLC DBA MONTCLAIR HOSPITAL MEDICAL CENTER
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Fourth Amendment to the Inland Empire Health Plan Per Diem Hospital Agreement with Prime Healthcare Services III, LLC dba Montclair Hospital Medical Center, effective July 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Prime Healthcare Services III, LLC dba Montclair Hospital Medical Center is currently a contracted Hospital in the IEHP Network since November 1, 2001. The Hospital has all product lines of business.
Discussion: The Fourth Amendment extends the term beginning July 1, 2019 through June 30, 2021; changes the name to Prime Healthcare Services, LLC dba Montclair Hospital Medical Center; replaces the following Attachments: C - Compensation Rates, C2 – Notes to Compensation Rates, C3 – Compensation Rates – Medicare Advantage Program, G – Medicare Advantage Program and H – Managed Care Medi-Cal Noncapitated or Carve Out Drugs.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
26 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
15. APPROVAL OF THE EVERGREEN CONTRACTS
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the listed Evergreen Contracts for an additional one (1) year to five (5) year term.
Contact: Kurt Hubler, Chief Network Officer
Background: An Evergreen Contract is a contract that automatically renews on the same terms and subject to the same conditions as the original agreement, unless sooner terminated in accordance with the terms and conditions.
Discussion: Renewal under the Evergreen Clause of the following Agreements effective, August 1, 2019: 1) Ancillary Provider Agreement with Dynamics Orthotics and Prosthetics Inc – Additional five (5) year term. 2) Ancillary Provider Agreement with The Elizabeth Hospice Inc – Additional five (5) year term. 3) Behavioral Health Provider Agreement with Cross Cultural Marriage and Family Therapy Counselling Center Inc – Additional five (5) year term. 4) Behavioral Health Provider Agreement with Professional Family Counseling Inc – Additional five (5) year term. 5) Open Access Provider Agreement with Rory Dennis Goshorn – Additional five (5) year term. 6) Capitated Primary Care Provider Agreement with GK Urgi Care Inc SJ Medical Clinic – Additional five (5) year term. 7) Fee-For-Service Primary Care Provider Agreement with Housecall Doctors Medical Group Inc – Additional two (2) year term. 8) Residential Care for the Elderly Provider Agreement with Maria Puraci dba Holy Hill Home Care – Additional one (1) year term. 9) Residential Care for the Elderly Provider Agreement with Nick Puraci dba Holy Hill Home Care East – Additional one (1) year term. 10) Residential Care for the Elderly Provider Agreement with Rose Garden Residential Operator LLC dba Rose Garden Residential – Additional one (1) year term. 11) Participating Provider Agreement with Alessandro Medical Professional Corporation dba Alessandro Clinica Medica Familiar – Additional five (5) year term. 12) Participating Provider Agreement with Chang Li Lee dba Chang L Lee MD Inc – Additional five (5) year term. 13) Participating Provider Agreement with Dr Javier R Rios A Medical Corporation dba Lake Elsinore Clinica Medica Familiar and Mead Valley Clinica Medica Familiar – Additional five (5) year term. 14) Participating Provider Agreement with Javier R Rios A Professional Corporation dba Magnolia Clinica Medica Familiar – Additional five (5) year term.
27 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: N/A
28 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
ADMINISTRATION
16. MONTHLY MEMBERSHIP REPORT
Recommended Action: Review and File
Contact: Bradley P. Gilbert, M.D., Chief Executive Officer
Background: This report reflects actual membership projections in the IEHP budget.
Discussion: Mild upward trend the last few months. We are one of only three Medi-Cal Managed Care Plans showing growth in Medi-Cal and have the largest growth of any plan for our CalMediConnect Plan.
Fiscal Forecast Actual + or – + or – Year Month Membership Membership Forecast Last Month
FY 18/19 November 2018 1,246,102 1,249,573 3,471 2,932 December 2018 1,246,094 1,247,464 1,370 (2,109) January 2019 1,246,112 1,244,442 (1,670) (3,022) February 2019 1,246,131 1,249,681 3,550 5,239 March 2019 1,246,150 1,250,585 4,435 904 April 2019 1,246,168 1,251,191 5,023 606 May 2019 1,246,187 1,252,184 5,997 993
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: None
Financial Review: N/A
Reviewed by Counsel: N/A
29 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
ADMINISTRATION
17. STATE OF THE INLAND EMPIRE HEALTH PLAN
Recommended Action: Review and File
Contact: Bradley P. Gilbert, M.D., Chief Executive Officer
Background: In order to showcase the accomplishments of the Inland Empire Health Plan, as well as to discuss opportunities for improvement, Dr. Gilbert, in collaboration with his executive team, created the following presentation.
Discussion: The attached presentation highlights the current state of the Inland Empire Health Plan.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence
Technology Financial Stewardship Not Applicable
Fiscal Impact: None
Fiscal Review: None
Reviewed by Counsel: N/A
30 of 77 State of IEHP Bradley P. Gilbert, MD, MPP
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31 of 77 2
32 of 77 Breast Cancer Screening (BCS) Cervical Cancer Screening (CCS)
70.00% 70.00% 62.04% 64.96% 67.07% 66.84% 58.59% 68.00% 60.00% 54.12% 66.00% 64.17% 50.00% 64.00% 62.00% 40.00% 60.00% RATES RATES 57.64% 30.00% 58.00% 20.00% 50th Percentile 56.00% 75th Percentile 54.00% 10.00% 52.00% 0.00% 2016 2017 2018 2019 2016 2017 2018 2019 Member HEDIS YEARS HEDIS YEARS Experience Comprehensive Diabetes Care (CDC): Controlling High Blood Pressure HbA1c Control (<8.0%) (CBP) 58.00% 57.42% 60.50% 60.34% 56.00% 60.00% 54.01% 54.00% 52.90% 59.50% 58.85% 58.85% 52.00% 51.04% 59.00% 58.64% RATES RATES 50.00% 58.50% 50th Percentile 48.00% 75th Percentile 58.00% 46.00% 57.50% 2016 2017 2018 2019 2016 2017 2018 2019 HEDIS YEARS HEDIS YEARS 3
33 of 77 Adolescent Well‐Care Visits (awc) Childhood Immunization Status (CIS): Combination #10 47.00% 46.06% 46.00% 45.50% 45.26% 35.00% 30.09% 31.14% 28.01% 45.00% 30.00% 25.79% 44.00% 25.00% 43.00% 20.00% 41.90% RATES 42.00%
RATES 15.00% 41.00% 10.00% 25th Percentile 40.00% <25th Percentile 5.00% 39.00% 0.00% 2016 2017 2018 2019 2016 2017 2018 2019 Member HEDIS YEARS HEDIS YEARS Experience Well‐Child Visits in the First 15 Well‐Child Visits in the Third, Fourth, Months of Life (w15): 6+ Visits Fifth and Sixth Years of Life (w34) 60.00% 78.00% 49.54% 51.58% 49.88% 75.43% 50.00% 76.00% 74.94% 40.97% 74.00% 73.15% 40.00% 72.00% 30.00% 70.00% 68.06% RATES 20.00% RATES 68.00% 66.00% 10.00% 50th Percentile <25th Percentile 64.00% 0.00% 62.00% 2016 2017 2018 2019 2016 2017 2018 2019 HEDIS YEARS HEDIS YEARS
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34 of 77 # of PCPs – 1,279 # of Specialists – 2,267 # of Behavioral Health – 1,263 # of Urgent Cares ‐ 76 Network # of Optometrists ‐ 285 # of Hospitals ‐ 32 # of Tertiary Hospitals out of county ‐ 9 # of SNFs ‐ 97
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35 of 77 CAHPS
Performance Year 2018 Measure Rate Percentile Getting Needed Care 83.43% 25th Getting Care Quickly 80.73% <25th Rating of Personal Doctor 76.9% 50th Network Rating of Specialist 85.06% 90th Network Expansion Fund
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36 of 77 Team Member
Engagement Overview
7
37 of 77 • Assessment, Evaluation, Oversight • Instructional Design/Development • Stays in each department/unit Centers of • Standards, Outcomes/Measurements (Kirkpatrick • Preceptors (designated SME) Excellence Level 4), Sustainability, Follow‐up • Coaches (usually Supervisor/Manager) • Quality Assurance Teams
Team Learning Tactical – & Department Academies Member Specific Innovation Center
• Leadership Academy • Career Academy (wellness, resilience, personal growth, • All Trainers across the organization under the Center Operational individual education plans) • Become business partners with units to work with • Organization Learning Academy (on‐ Preceptors and quality teams boarding, orientation, departmental, skill development – Levels ABC) 8
38 of 77 Conscious Leader Program • 33 Executive/Senior Directors/Directors successfully completed an intensive 12 month program • 220 Supervisors/Managers attended 3 half day sessions over a 12 month period IEHP Leadership Academy • 20 sessions offered LEADERSHIP • 331 Leaders attended DEVELOPMENT • Topics included: Engaging & Retaining Talent, Driving Change, FEHA & ADA, Creating Awareness, Establishing Trust, Communicating for 2018/2019 Leadership Success, Self‐Awareness, Understanding Biases and Conflict Styles Leadership 101 ‐ Onboarding • 5 sessions offered • 58 New Leaders attended 2018 Leader Harassment Prevention Training • 258 Leaders completed training
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39 of 77 Strategy – Deploy systems level thinking, end‐to‐end, and improvement across departments by embracing a “BE LEAN” strategy focused on results, behaviors, tools, and culture that connects all TMs to our mission, vision, and goals
16 Value Stream Analyses Operational 80 Rapid Improvement Events 832 Total Bronze TMs Trained Excellence 93% 255 of 274 leaders have graduated from Bronze Leadership Training 90% 1,922 of 2,135 Total Lean Participation by Team Members Optimize core processes 56 Teams launched using the Lean Fundamentals approach to deliver compliant, high quality, and efficient 140 Front line huddles under way services $41.1M Financial savings from recent Lean Activities Financial Examples: • UM Long Term Care ‐ The team tried an experiment which led to successfully diverting Members from admitting into an In‐Patient Facility by providing wrap around services to keep them home. The Team also discharged our members back into the community that have been institutionalized by providing services. ($10M) • Pharmacy – By applying A3 thinking, the team was able to drive improvements in areas such as formulary conversion changes and specialty rate re‐contracting ($20M+) 10
40 of 77 •99.99% up‐time for Web presence *Approximately 52.59 minutes of unscheduled outage for System FY1819 Uptime •99.9% up‐time for internal systems *Approximately 8.77 hours of unscheduled outage for FY1819 Technology
•Provider Portal Stats: Provider Portal ‐ 65,889,591 annual transactions for FY1819 and Member •Member Portal/App Stats: Portal/App ‐ 90,000 registered users for FY1819 Stats ‐ 1,599,609 annual transactions for FY1819
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41 of 77 HSP Statistics
• 11,510,932 claims processed with an 80% auto adjudication rate Technology • 34,000 Average claims received per processing day • 51 custom requests deployed to Production with 30 requests in queue and slated for future releases
• 2,194 active users in MediTrac
• 10,489,053 events generated in MediTrac to support interdepartmental workflows
• 1,658,780 Member Service Calls taken
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42 of 77 Roadmap Focus Areas
Encounter Plan Data External Data Operational Data Integration Connection Stability
Provider Provider Edifecs Portal Tool Kit Technology Enhanced Payor Provider Centralized Interoperability Provider Data Data Analytics dbMotion Ecosystem Expansion Enhancement
43 of 77 Encounter Data
Technology Plan Data Integration
External Data Collection
44 of 77 Finance Reserves 5 Year Trend
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45 of 77 Finance Reserves Comparison
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46 of 77 Fiscal Year 2019 -2020 PMPM Ratios Enrollment 15,037,317 Revenue $ 5,162,327,732 $ 343.30
Medical Expenses: Hospital 1,788,280,678 $ 118.92 34.5% IPA, Physicians 1,509,762,237 $ 100.40 29.1% Finance Pharmacy 791,726,804 $ 52.65 15.3% Pay For Performance 77,369,750 5.15$ 1.5% Budget Other Expense 738,636,404 $ 49.12 14.2% FY19/20 Medical Expenses $ 4,905,775,873 $ 326.24 94.5% Gross Margin $ 256,551,859 17.06$ 4.9%
G & A Expenses - Allocated $ 230,393,142 15.32$ 4.4% Non Operating Income $ 27,480,400 1.83$ 0.5% Net Surplus (Deficit) $ 53,639,117 3.57$ 1.0%
MCR 95.0% ACR 4.5% NCR 1.0% 17
47 of 77 Team Culture is Alive and Well
• Requires constant attention • New CEO embodies our Culture and Mission
Quality / Member Satisfaction
• Improving but still below what we want/our Summary members need Operations are Generally Solid
LEAN is Active and Expanding
Leadership is Strong and Learning
• Leadership programs impacting positively
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48 of 77 State Government
• New Governor’s Agenda •DHCS •DMHC
Federal Government
Challenges •ACA • Law Suits •Medicaid
Economy
•Local • State •County
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49 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
FINANCE DEPARTMENT
18. REVIEW OF MONTHLY FINANCIALS
Recommended Action Review and File
Contact Keenan Freeman, Chief Financial Officer
Background This report is presented monthly and is a summary of the financial statements.
Discussion Summary Income Statement for the month ended May 31, 2019.
Highlights:
Enrollment of approximately 1.25M members generated a deficit of $7.4M for the month.
The $28.3M positive variance in actual revenue compared to budget is due to higher enrollment in the LTC COA, SPD COA, MCE Non-dual COA, increased BHT cases, and the expansion of the Proposition 56 program. CMC was impacted by a $4M rate true up for CCI populations related to CY19 and offset by additional capitation expenses related to the Quality Withhold and a higher than expected Final Year Sweep for CY2018.
The negative medical cost variance of $29.9M is primarily due to the increase in Proposition 56 expense, $11.3M increase in specialist claims compared to budget, and $10M increase in facility costs.
Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable
Fiscal Impact Included in FY 18/19 Budget
Reviewed by Counsel N/A
50 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
Inland Empire Health Plan Summary Income Statement for the Month Ended May 31, 2019
Actual Budget Variance $ Operating Revenue Medi-Cal 376,191,819 346,672,219 29,519,599 Medicare 35,264,799 36,533,423 (1,268,624) Net Revenue 411,456,618 383,205,642 28,250,975
Medical Costs Total Medi-Cal Costs 356,905,771 334,961,533 (21,944,238) Total Medicare Costs 47,819,610 39,902,072 (7,917,537) Total Medical Costs 404,725,381 374,863,606 (29,861,775)
Gross Margin 6,731,237 8,342,037 (1,610,800)
Operating Expenses Total Operating Expenses 17,133,273 17,733,955 600,683
Operating Surplus (Deficit) (10,402,036) (9,391,919) (1,010,117)
Total AB85 2,043,039 2,047,762 (4,723) Total IHSS Total Sales Tax 18,738 - 18,738
Other Income (Expense) 849,110 565,203 283,907 Property Management Income (Expense) 70,159 59,786 10,373
Total Non Operating Income (Expense) 2,981,046 2,672,751 308,296
Net Surplus (Deficit) (7,420,989) (6,719,168) (701,821)
Note: Totals may be subject to immaterial rounding differences.
51 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
Discussion Summary Income Statement on a Year-To-Date basis for the period ended May 31, 2019.
Highlights:
Member months of approximately 13.7M generated a net surplus of $4M for the eleven months ended May 31, 2019:
The positive Medi-Cal revenue variance of $283.4M is due to Prop 56 rate change for FY18/19, GEMT revenue for FY18/19, $11.6M MCE Partial Dual rate adjustment to the SPD rate, $4M CCI rate true up for January 2019 to April 2019, $11.3M CCI risk corridor reserve adjustment, higher than expected Medi-Cal rates, and higher overall membership in SPD, LTC, MCE Non- Duals COAs, and BHT services.
The positive Medicare revenue variance of $14.1M is due to better than expected CMC mid-year and final year sweeps, an increase to premium revenue, additional accruals for CY15-18 risk adjustment and the quality withhold for the CY17 final settlement.
The negative medical cost variance is due to a Prop 56 rate change for FY18/19, GEMT accrued expenses for FY18/19, a settlement with Landmark Health, an increase in the MLTSS institutional enrollment impacting facility costs, increased specialist costs, and transportation benefits.
A $35M negative variance in Non-Operating Income & Expense is due to an adjustment to the IHSS reconciliation reserve for CY14-17.
The negative variance for Other Income is due to lower interest income (low cash balance YTD).
Summary Income Statement for the eleven months ended May 31, 2019 on the following page.
52 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
Inland Empire Health Plan Year-To-Date Summary Income Statement for the period ended May 31, 2019.
Actual Budget Variance $ Operating Revenue Medi-Cal 4,070,982,729 3,787,603,261 283,379,468 Medicare 403,016,933 388,875,018 14,141,915 Net Revenue 4,473,999,661 4,176,478,278 297,521,383
Medical Costs Total Medi-Cal Costs 3,804,390,780 3,579,186,087 (225,204,692) Total Medicare Costs 455,677,254 413,421,319 (42,255,935) Total Medical Costs 4,260,068,033 3,992,607,406 (267,460,627)
Gross Margin 213,931,628 183,870,872 30,060,756
Operating Expenses Total Operating Expenses 204,652,437 193,875,667 (10,776,771)
Operating Surplus (Deficit) 9,279,190 (10,004,795) 19,283,985
Total AB85 22,232,201 22,525,380 (293,178) Total ACA 273 - 273 Total IHSS (33,933,321) - (33,933,321) Total Sales Tax 352,582 - 352,582 Other Income (Expense) 4,924,453 6,217,233 (1,292,780) Property Management Income (Expense) 1,166,574 968,301 198,274 Total Non Operating Income (Expense) (5,257,237) 29,710,913 (34,968,151)
Net Surplus (Deficit) 4,021,953 19,706,119 (15,684,166)
Note: Totals may be subject to immaterial rounding differences.
53 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
Discussion Balance Sheet as of May 31, 2019.
Cash increased by $69M primarily due to receiving June’s CMC MCR funding in May and receiving CY18’s CMS final adjustment offset by the $33M Landmark Settlement payment.
Accrued Medical Expenses decreased by $17.7M primarily due to the $33M Landmark Settlement payout, offset by a $14M Prop 56 expense accrual.
The 60-day Operating Expense Liquidity reserve is an internal reserve requirement set by IEHP executive management and the Board of Supervisors to address potential concerns regarding the timelines of revenue payments from DHCS. At the end of May, the liquidity reserve is noncompliant at 80.63% of its target of 100%. However, IEHP’s Tangible Net Equity exceeds the DMHC statutory requirement. The following graph shows the trend line for the liquidity reserve.
105.00%
100.00%
95.00%
90.00%
85.00%
80.00%
Target 75.00% Actual 70.00% May-17 Jul-17 Sep-17 Nov-17 Jan-18 Mar-18May-18 Jul-18 Sep-18 Nov-18 Jan-19 Mar-19May-19
54 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
Inland Empire Health Plan Balance Sheet as of May 31, 2019
May Apr Jun FY1819 FY1819 FY1718
ASSETS CURRENT ASSETS Cash 679,336,547 610,305,117 575,207,829 Restricted Fund 300,000 300,000 303,467 DHCS Receivable 435,217,258 499,302,463 497,459,484 Other Receivables 116,125,152 129,653,076 133,847,056 Prepaid Expenses 10,286,269 11,599,683 11,631,151 TOTAL CURRENT ASSETS 1,241,265,226 1,251,160,339 1,218,448,987
FIXED ASSETS
Building, Office Furniture & Equipment 269,646,180 268,294,132 253,333,694 Accumulated Depreciation (61,936,329) (60,483,315) (46,091,645) NET FIXED ASSETS 207,709,851 207,810,817 207,242,049
DEFERRED OUTFLOWS OF RESOURCES 24,734,384 24,734,384 24,771,416 NET OTHER ASSETS - - - TOTAL ASSETS 1,473,709,460 1,483,705,540 1,450,462,452
Note: Totals may be subject to immaterial rounding differences.
55 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
May Apr Jun LIABILITIES AND NET ASSETS FY1819 FY1819 FY1718 CURRENT LIABILITIES MEDICAL Incurred But Not Reported (IBNR) 260,189,575 292,405,006 334,999,441 Accrued Medical Expenses 211,669,183 229,356,864 98,749,787 Capitation Payable 12,454,401 15,581,035 374,353 Deferred Revenue - - 35,510,891
OTHER Due to DHCS 14,395,877 15,590,270 33,143,707 Due to BOE 34,495,865 22,794,233 44,227,099 Due to CMS - - - Due to DOI - - -
ADMINISTRATIVE Accounts Payable 4,067,080 2,895,613 3,871,332 Accrued Operating Expenses 4,796,859 5,091,099 5,055,869 Accrued Salaries and Benefits 15,148,762 13,853,461 19,763,857 Tenant Deposits & Prepaids 686,472 681,285 752,383 Current Portion of LTD - - - TOTAL CURRENT LIABILITIES 557,904,075 598,248,866 576,448,719
LONG TERM LIABILITIES Lease Payable - - - Note Payable - - - Less Current Portion of LTD - - - Net Pension Liability 444,696 444,696 444,696 TOTAL LONG TERM LIABILITIES 444,696 444,696 444,696
DEFERRED INFLOWS OF RESOURCES 39,518,619 1,748,919 1,748,919
TOTAL LIABILITIES 597,867,390 600,442,481 578,642,335
Increase (Decrease) in Net Assets 4,021,953 11,442,942 53,617,136 TNE Requirement 153,168,092 151,454,313 147,350,529 Reserve for FQHC - - - Residual Fund Balance 718,652,025 720,365,804 670,852,451 NET ASSETS 875,842,070 883,263,059 871,820,117
TOTAL LIABILITIES AND NET ASSETS 1,473,709,460 1,483,705,540 1,450,462,452
Note: Totals may be subject to immaterial rounding differences.
56 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
HEALTH SERVICES DEPARTMENT
19. OVERVIEW OF 2019 MEDICAID AND MEDICARE CONSUMER ASSESSMENT OF HEALTH PROVIDERS & SYSTEMS ADULT MEMBER SATISFACTION SURVEY RESULTS
Recommended Action: Review and File
Contact: Jennifer N. Sayles, M.D., MPH, Chief Medical Officer
Background: The Consumer Assessment of Health Providers & Systems (CAHPS®) Adult Member Survey are National Committee for Quality Assurance (NCQA) required standardized member healthcare consumer satisfaction assessments. The survey identifies potential opportunities to improve members’ experiences for participating health plans.
The 2019 CAHPS® surveys used a mixed methodology approach (mail and telephone). 1. For the Medi-Cal adult survey, a systematic random sample of IEHP Members, age 18 years or older as of December 31, 2018, who were continuously enrolled in IEHP for at least six months. A total of 356 completed surveys were received to yield a 20.03% response rate.
Discussion: Medi-Cal 2019 Results
1. The following CAHPS® measures are used by NCQA Accreditation to score the Medi-Cal population:
a. Overall Ratings: i. All Health Care ii. Personal Doctor iii. Specialist (seen most often) iv. Health Plan b. Composites: i. Getting Needed Care (2 questions) ii. Getting Care Quickly (2 questions) iii. Customer Service (2 questions) iv. Coordination of Care c. HEDIS Measures: i. Flu Vaccinations for Adults ages 18-64 ii. Advising Smokers and Tobacco Users to Quit
57 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
2. Medi-Cal Overall Ratings: The CAHPS Survey uses a 0-10 rating (0 worst, 10 best) to assess Member’s Overall Ratings. The proportion of Members who scored 8, 9 or 10 is depicted in the chart below. The table provides a year to year comparison of ranking. Percentiles are based on 2019 Accreditation Benchmarks and Thresholds.
Overall Ratings: Percentile Ranking Comparison CAHPS CAHPS 2018 CAHPS CAHPS 2019 Percentile 2018 Percentile 2019 Percentile* Movement Rating of Personal Doctor 76.6% 25th 76.9% 50th ↑ Rating of Specialist 78.7% 75th 85.1% 90th ↑ Rating of Health Care 70.9% <25th 77.1% 50th ↑↑ Rating of Health Plan 77.1% 50th 81.0% 75th ↑ *based on currently available national benchmarks. Note: Yellow highlight indicates current rate at 50th percentile. Green highlight indicates current rate above 50th percentile.
3. Medi-Cal Overall Rating Results: Rating of All Health Care had the greatest percentile increase from <25th to the 50th percentile. The Rating of Specialist (seen most often) demonstrated a raw score increase and an increase from 75th to 90th percentile
58 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
4. Medi-Cal Composite Ratings: The CAHPS Survey uses an “Always”, “Usually”, “Sometimes” or “Never” scale for Composite responses. The “Usually” or “Always” rate percentage is graphed below. The table provides a year to year comparison of ranking for the four (4) composite measures.
Composite Results
91.2 91.7 89.6 83.4 80.7 80.1 77.2 78.2 74.6 73.7 76.1 69.7
GETTING NEEDED GETTING CARE QUICKLY CUSTOMER SERVICE COORDINATION OF CARE 2017 2018 2019
Composite Ratings: Percentile Ranking Comparison CAHPS CAHPS 2018 CAHPS CAHPS 2019 Percentile 2018 Percentile 2019 Percentile* Movement Getting Needed Care 80.1% <25th 83.4% 25th ↑ Getting Care Quickly 76.1% <25th 80.7% <25th ↔ Customer Service 91.7% 90th 89.6% 90th ↔ Coordination of Care 77.2% <25th 78.2% <25th ↔ *based on currently available national benchmarks. Note: Red highlight indicates current rate below 50th percentile. Green highlight indicates current rate above 50th percentile.
5. Medi-Cal Composite Ratings Results: All but one measure (Customer Service) demonstrated a raw score increase from the prior year. While Customer Service decreased in raw score, the measure still maintained the 90th percentile.
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6. HEDIS Measures: The results for the following CAHPS survey questions are used in accreditation scoring. Trend results for ‘Flu Vaccinations for Adults’ and ‘Advising Smokers and Tobacco Users to Quit’ are depicted below.
HEDIS Measures
68.7 61.4 57.7
37.7 38.7 40.5
FLU VACCINES FOR ADULTS ADVISING SMOKERS AND TOBACCO USERS TO QUIT 2017 2018 2019
HEDIS Measures: Percentile Ranking Comparison HEDIS HEDIS 2018 HEDIS HEDIS 2019 Percentile 2018 Percentile 2019 Percentile* Movement Flu Vaccinations for Adults th th Ages 18-64 38.7% 25 40.5% 50 ↑ Advising Smokers and th th Tobacco Users to Quit 61.4% <25 68.7% <25 ↔ *based on currently available national benchmarks. Note: Yellow highlight indicates current rate at 50th percentile. Red highlight indicates current rate below 50th percentile.
7. HEDIS Measures Results: Both HEDIS measures increased in percentile score, with the Flu vaccinations measure also displaying improvement in percentile ranking.
a. The IEHP CAHPS Action Plan will continue to be updated based on developing strategy activities. Below is a list of in-flight activities that support CAHPS performance:
Performance Transparency and Provider Incentives: i. PCP and IPA incentive program to reward Providers who improve Member satisfaction scores (Global Quality P4P) ii. Share Member Satisfaction survey results at the IPA and PCP level iii. Conduct quality improvement Provider education visits that focus on access-related CAHPS measures. iv. Conduct Provider trainings on IEHP Provider access standards.
60 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 POLICY AGENDA July 8, 2019
Improving Access to Care: i. Expanding eConsult solution to new provider groups ii. Expand TeleHealth solutions for Psychiatry iii. Network Expansion Fund iv. Enhanced Transportation Benefit v. Medication Management Programs: DTM / Preveon (previously known as WeCare) vi. Enhanced Monitoring of Network Adequacy by Region to drive Provider contracting outreach efforts vii. Improving auto-authorization rates
Improving Care Coordination: i. High Touch Member Programs: Charter / Health Homes ii. Provider Based Integration Teams iii. Care Management Pilot Program: Integrated Remote Care Teams iv. Internal Transitions of Care Programs in Utilization Management and Behavioral Health departments v. Integration of IEHP Care Management, Behavioral Health Teams, and Transition of Care Teams vi. Ongoing LEAN Transformation – Improve departmental processes to provide the best service to Members and Providers
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence
Technology Financial Stewardship Not Applicable
Fiscal Impact: N/A
Fiscal Review: N/A
Reviewed by Counsel: N/A
61 of 77 IEHP Governing Board 2019 CAHPS Results
July 8, 2019
Jennifer N. Sayles, MD, MPH Chief Medical Officer Inland Empire Health Plan
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62 of 77 What is CAHPS?
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) • A standardized survey of a random sample of adult IEHP members conducted by a third party vendor / CMS every year during the months of January to May (telephone and mail) • Asks members about their experiences with a range of health care services at multiple levels of the delivery system • Response rates range from 15‐30% (IEHP is 20%) • It is used in many quality ratings of health plans as a way to capture patient experience, including NCQA 2
63 of 77 IEHP’s Current Accreditation Status
CAHPS 13%
NCQA 50% HEDIS 37%
IEHP = 3.5 Star Health Plan
• Healthcare Effectiveness Data and Information Set (HEDIS) • National Committee for Quality Assurance (NCQA) • Consumer Assessment of Healthcare Providers and Systems (CAHPS)
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64 of 77 Medi‐Cal CAHPS Results Summary
Overall Ratings: Percentile Ranking Comparison CAHPS 2018 CAHPS CAHPS 2019 Percentile CAHPS 2018 Percentile 2019 Percentile* Movement
Rating of Personal Doctor 76.6% 25th 76.9% 50th ↑ Rating of Specialist 78.7% 75th 85.1% 90th ↑ Rating of Health Care 70.9% <25th 77.1% 50th ↑↑ Rating of Health Plan 77.1% 50th 81.0% 75th ↑ Composite Ratings: Percentile Ranking Comparison Getting Needed Care 80.1% <25th 83.4% 25th ↑ Getting Care Quickly 76.1% <25th 80.7% <25th ↔ Customer Service 91.7% 90th 89.6% 90th ↔ Coordination of Care 77.2% <25th 78.2% <25th ↔
*based on currently available national benchmarks 4
65 of 77 CAHPS Improvement Activities
Performance Transparency and Provider Incentives • PCP and IPA incentive program reward providers who improve member satisfaction scores • Share Member satisfaction survey results at the IPA and PCP level • Tailored provider education visits and practice transformation support to improve same day appointments, advanced access, overall office flow and use of technology • Provider trainings on IEHP Provider access standards.
Getting Needed Care / Getting Care Quickly • Expanding eConsult solution to new provider groups • Expand teleHealth solutions for psychiatry and other specialties • Network Expansion Fund (NEF) to recruit providers to the Inland Empire and IEHP network • Enhanced transportation benefit • Enhanced monitoring of network adequacy by region informs Provider contracting outreach • Improving auto‐authorization rates 5
66 of 77 CAHPS Improvement Activities Customer Service • Outbound call campaigns planned for Members – birthday calls • Member Services Value Stream Analysis to improve member experience when calling health plan • Provider customer service training program
Improving Care Coordination • Increase high touch Member programs: Health Homes Program (HHP), home visit programs, palliative care (My Path Program), pain centers of excellence • Integrated behavior health and physical health care teams in PCP Offices • IEHP integrated remote care teams (behavioral health, registered nurse, community health worker, coordinator, pharmacist) • Identify high risk patients for transitions of care programs from hospital to home • Care coordination VSA efforts across utilization management, behavioral health, care management, and pharmacy teams – to improve coordination of Member care 6
67 of 77 QuestionsQuestions
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68 of 77 Submittals to IEHP Health Access Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
20. RATIFY AND APPROVE THE TWENTY EIGHTH AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH ARROWHEAD REGIONAL MEDICAL CENTER
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twenty Eighth Amendment to the Hospital Per Diem Agreement with Arrowhead Regional Medical Center, effective July 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Arrowhead Regional Medical Center is a contracted Hospital in the IEHP Network since February 1, 2008. The Hospital has all product lines of business.
Discussion: The Twenty Eighth Amendment extends the term beginning July 1, 2019 through June 30, 2020.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
69 of 77 Submittals to IEHP Health Access Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
21. RATIFY AND APPROVE THE TWENTIETH AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH CHILDREN’S HOSPITAL AT MISSION
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twentieth Amendment to the Hospital Per Diem Agreement with Children’s Hospital at Mission, effective June 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Children’s Hospital at Mission is a contracted Hospital in the IEHP Network since January 1, 2004.
Discussion: The Twentieth Amendment extends the term beginning June 1, 2019 through May 31, 2021 and replaces the Attachment C, Compensation Rates.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
70 of 77 Submittals to IEHP Health Access Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
22. RATIFY AND APPROVE THE TWENTIETH AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH CHILDREN’S HOSPITAL OF ORANGE COUNTY
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twentieth Amendment to the Hospital Per Diem Agreement with Children’s Hospital of Orange County, effective June 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Children’s Hospital of Orange County is a contracted Hospital in the IEHP Network since January 1, 2004.
Discussion: The Twentieth Amendment extends the term beginning June 1, 2019 through May 31, 2021 and replaces the Attachment C, Compensation Rates.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
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PROVIDER NETWORK DEPARTMENT
23. RATIFY AND APPROVE THE FIRST AMENDMENT TO THE URGENT CARE PROVIDER AGREEMENT WITH INLAND URGENT CARE OF SUN CITY
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the First Amendment to the Urgent Care Provider Agreement with Inland Urgent Care of Sun City, effective May 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Inland Urgent Care of Sun City is currently a contracted Provider in the IEHP Network since November 1, 2010.
Discussion: The First Amendment is to ratify the Attachment B, Compensation for all product lines of business to May 1, 2019.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
72 of 77 Submittals to IEHP Health Access Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
24. RATIFY AND APPROVE THE FOURTH AMENDMENT TO THE INLAND EMPIRE HEALTH PLAN PER DIEM HOSPITAL AGREEMENT WITH PRIME HEALTHCARE SERVICES III, LLC DBA MONTCLAIR HOSPITAL MEDICAL CENTER
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Fourth Amendment to the Inland Empire Health Plan Per Diem Hospital Agreement with Prime Healthcare Services III, LLC dba Montclair Hospital Medical Center, effective July 1, 2019.
Contact: Kurt Hubler, Chief Network Officer
Background: Prime Healthcare Services III, LLC dba Montclair Hospital Medical Center is currently a contracted Hospital in the IEHP Network since November 1, 2001. The Hospital has all product lines of business.
Discussion: The Fourth Amendment extends the term beginning July 1, 2019 through June 30, 2021; changes the name to Prime Healthcare Services, LLC dba Montclair Hospital Medical Center; replaces the following Attachments: C - Compensation Rates, C2 – Notes to Compensation Rates, C3 – Compensation Rates – Medicare Advantage Program, G – Medicare Advantage Program and H – Managed Care Medi-Cal Noncapitated or Carve Out Drugs.
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
73 of 77 Submittals to IEHP Health Access Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
25. RATIFY AND APPROVE THE FIFTH AMENDMENT TO THE CAPITATED PRIMARY CARE PROVIDER AGREEMENT WITH POMONA COMMUNITY HEALTH CENTER DBA PARKTREE COMMUNITY HEALTH CENTER
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Fifth Amendment to the Capitated Primary Care Provider Agreement with Pomona Community Health Center dba Parktree Community Health Center, effective September 1, 2018.
Contact: Kurt Hubler, Chief Network Officer
Background: Pomona Community Health Center dba Parktree Community Health Center is currently a contracted Provider in the IEHP Network since December 1, 2012.
Discussion: The Fifth Amendment is to ratify the Attachment B, Compensation for all product lines of business to September 1, 2018.
Strategy Focus Areas:
Member Experience Network Team Members Operational Excellence
Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: Yes
74 of 77 Submittals to IEHP Health Access Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
PROVIDER NETWORK DEPARTMENT
26. APPROVAL OF THE EVERGREEN CONTRACTS
Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the listed Evergreen Contracts for an additional one (1) year to five (5) year term.
Contact: Kurt Hubler, Chief Network Officer
Background: An Evergreen Contract is a contract that automatically renews on the same terms and subject to the same conditions as the original agreement, unless sooner terminated in accordance with the terms and conditions.
Discussion: Renewal under the Evergreen Clause of the following Agreements effective, August 1, 2019: 1) Ancillary Provider Agreement with Dynamics Orthotics and Prosthetics Inc – Additional five (5) year term. 2) Ancillary Provider Agreement with The Elizabeth Hospice Inc – Additional five (5) year term. 3) Behavioral Health Provider Agreement with Cross Cultural Marriage and Family Therapy Counselling Center Inc – Additional five (5) year term. 4) Behavioral Health Provider Agreement with Professional Family Counseling Inc – Additional five (5) year term. 5) Open Access Provider Agreement with Rory Dennis Goshorn – Additional five (5) year term. 6) Capitated Primary Care Provider Agreement with GK Urgi Care Inc SJ Medical Clinic – Additional five (5) year term. 7) Fee-For-Service Primary Care Provider Agreement with Housecall Doctors Medical Group Inc – Additional two (2) year term. 8) Residential Care for the Elderly Provider Agreement with Maria Puraci dba Holy Hill Home Care – Additional one (1) year term. 9) Residential Care for the Elderly Provider Agreement with Nick Puraci dba Holy Hill Home Care East – Additional one (1) year term. 10) Residential Care for the Elderly Provider Agreement with Rose Garden Residential Operator LLC dba Rose Garden Residential – Additional one (1) year term. 11) Participating Provider Agreement with Alessandro Medical Professional Corporation dba Alessandro Clinica Medica Familiar – Additional five (5) year term. 12) Participating Provider Agreement with Chang Li Lee dba Chang L Lee MD Inc – Additional five (5) year term. 13) Participating Provider Agreement with Dr Javier R Rios A Medical Corporation dba Lake Elsinore Clinica Medica Familiar and Mead Valley Clinica Medica Familiar – Additional five (5) year term. 14) Participating Provider Agreement with Javier R Rios A Professional Corporation dba Magnolia Clinica Medica Familiar – Additional five (5) year term.
75 of 77 Submittals to IEHP Health Access Governing Board Staff Reports and Recommendations #294 CONSENT AGENDA July 8, 2019
Strategy Focus Areas: Member Experience Network Team Members Operational Excellence Technology Financial Stewardship Not Applicable
Fiscal Impact: Included in FY 18/19 Budget
Financial Review: N/A
Reviewed by Counsel: N/A
76 of 77 Submittals to Inland Empire Health Plan Governing Board Staff Reports and Recommendations #294 SUMMARY COMMENTS July 8, 2019
MAIN OBJECTIVES FOR THE NEXT 90 DAYS AND SUMMARY COMMENTS
1. Main Objectives for the Next 90 Days: a. No longer relevant.
2. Summary Comments: a. I have greatly enjoyed my relationship with all of the Governing Board members and my time working at IEHP. I will miss the connections and interactions as your CEO but know that IEHP is in good hands from the Board all the way through the organization.
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