Partnership HealthPlan of California Provider Advisory Group

Lunch: 12:00 Meeting 12:30

Mission Statement: The Provider Advisory Group of the Partnership HealthPlan of California will act as a liaison between the Health Care Services providers and the HealthPlan. The Group will make recommendations and provide a forum for providers to have ongoing input into the activities of the HealthPlan.

March 20th, 2015 Meeting Agenda

1. Standing Agenda Items 1.1. Welcome and Introductions – Chairman Bill Byrnes, Clinic Manager, Community Medical Centers 1.2. Approval of Minutes 1.3. Review of Agenda

2. Presentations 2.1. Jennifer Henn, PhD, Epidemiologist for the Napa County Department of Health & Human Services, will be presenting on the recent measles outbreak and the importance of immunization in the prevention of measles and other diseases.

3. Old Business 3.1 None

4. New Business 4.1. PHC Update/Report from PAC: Robert Moore, MD, MPH, Chief Medical Director 4.2. Report from the Claims Department – Tamarra Haywood, Claims Resolution Coordinator 4.3. Report from Member Services – Consumer Advisory Committee Update - Maria Cabrera, Member Services Supervisor 4.4. Report from Provider Relations – Reminder: ICD-10 Testing - Jill Tarap, Senior PR Representative 4.5. Report from QI: IHA/SHA Presentation – Nadine Harris, Quality Improvement Compliance Manager 4.6. Provider Topics of Interest: All Attendees 4.7. Upcoming Events, Health Fairs and Trainings: All Attendees

Next PAG Meeting: Friday, May 15 in Napa County

Meeting Adjourned

PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEETING MINUTES

Committee: Provider Advisory Group (PAG)

Date/Time: January 16, 2015 12:30 p.m. – 1:30p.m.

Members Santa Rosa: Gary Green, MD, Lynea Seiberlich, Francisco Soto, Diana Grimaldos, Claudia Nola, Jennifer Adams, Louveta Jones, Laura Thorson, Cathi Present: Charlberg, Cheryl Coulter, Teri Ortiz, Odessa Danesi, Suellen Eschenbach, Heidi Hawkins, Barbara Scherre, Dan Bogle, Zao Fen Hauf, MD, Barbara Neiman, Astrid Molina, Amanda Navarro, Michele, Julie Griffith Fairfield: Grace Salud. Denise Fitch, Sheila Allen, Cora Lucina, Tara Sharifzadeh, Kelli Fields, Stephanie DeLaRosa, Andrea Badillo, Vicki Fields- Johnson

PHC Staff Fairfield: Debra McAllister, Carol Parker, Jean Levato, Joan Russell, Heather Brandeburg, Sara Enwright, Tamarra Haywood Present: Santa Rosa: Marshall Kubota, Judy Paul, Lynn Scuri, Susan Gale, Melissa Perez, Stephanie Phipps, Gloria Turner, Michelle Arya, Michelle LeBaron

Attendees at Redding (via video): Elaine Fiores, Tammy Grove, Heather Esget, Fang Chen, Elaine Zook, Jessica Espinoza, Becky Dutro, Caprice Gillespie, Shelly Other Offices: McLain, Janeen Newsome, Moriah Padilla, Geoffrey Jensen PHC Staff: Ray Phillips, Tami Spliethof, Tara Brumley, Sharon McFarlin, Jane Lyon, Megan Shelton, Jennifer Meyer Eureka (via video): Nadine Parris, Lisa Barker PHC Staff: Kelley Sewell, Andy Jensen, Jeff Ribordy, MD, Jennifer Chancellor

AGENDA ITEM DISCUSSION/CONCLUSIONS RECOMMENDATIONS / DATE ACTION RESOLVED

1. Standing Agenda 1. None. 1. 1/16/2015 Items 1.1. Welcome and 1.1. Meeting called to order by Chairperson Lynea Seiberlich., Senior Clinic Manager at 1.1 Introductions Santa Rosa Community Health Center. Lynea welcomed participants from Fairfield, Redding, and Eureka via video conference. 1.2. Approval of Minutes 1.2. Minutes from 1/16/2015 reviewed and approved. 1.2. Approved

1.3. Review of 1.3. Approved. Agenda 1.3. Agenda was reviewed and approved.

2. Presentation 2. Gary Green, MD – Infectious Disease at Kaiser Permanente gave an informative 2. Presented as information 1/16/2015 presentation on the 2014 Ebola outbreak. only . The Ebola virus is a hemorrhagic fever virus characterized by fever, headache pain and bleeding. The largest outbreak began in March of 2014 in West Africa, where it has a mortality rate of up to 90 percent. So far there have been over 22,000 cases, with nearly 10,000 reported deaths. . The virus is believed to have been spread to humans though consumption of wild game ("bush meat"), with fruit bats believed to be the main carrier in nature. . Ebola quickly weakens the immune system and replicates rapidly, spreading into the bloodstream, liver, lymph nodes and other lymphoid tissue. . Humanitarian aid to Africa has been somewhat restricted due to panic about spreading the Ebola virus outside of Africa. It is important to note that the virus is not airborne, and is only transmitted between humans through direct contact with body fluids, making it somewhat difficult to flourish in a clean, healthy environment. The level or poverty, corruption, and the remote and rural locations with limited transportation and access to any kind of healthcare enabled the disease to reach epidemic proportions in Africa. Other contributing elements include the fact that villagers are suspicious of official attempts to combat the disease, as well as common burial practices that involve touching the dead. . There have been fewer than 20 cases of Ebola outside of Africa; in the US there are currently no reported cases of Ebola virus.

3. Old Business 3.1. None. 3. Presented as information 1/16/2015 only.

4. New Business 4.1. Marshall Kubota, MD, Regional Medical Director at Partnership HealthPlan of 4. Presented as information 1/16/2015 4.1. PHC Updates California presented updates on recent activities at PHC. only. . PHC is working with communities on the Managing Pain Safely Project to reduce the use of opioids in non-terminal patients with chronic pain. . Providers are encouraged to complete testing for the ICD-10 electronic claims submission prior to the October 2015 ICD-10. . The PartnershipAdvantage program ended on December 31, 2014. Funding in Marin County for the Healthy Kids Program will probably end June 2015; we anticipate membership to decrease from 1,200 to about 500.

4.2. Report from 4.2. Tamarra Haywood updated the group on current events from the Claims Claims Department

. Providers need to contact our EDI Department to begin testing prior to the transition

from ICD-9 to ICD-10 indicator.

. The 6 month claims billing limit has been extended to 12 months effective for dates

of service after July 1, 2014.

4.3. Report from 4.3. Gloria Turner, Provider Relations Representative, Lake County, presented Provider Relations information from the Provider Relations Department. . The Physician Satisfaction Survey is coming in February. We ask that providers please take a few minutes to complete and return it. Also check their spam mail as

it will be coming from Morpace again this year. This is providers' opportunity to let us know how we’re doing.

4.4. Report from the 4.4. Joan Russell, Manager of Provider Education, presented information from the Provider Education Provider Education Team. Team . We are continuing to encourage providers to contact the EDI Testing & Support Group at PHC and to test early for the upcoming ICD-10 implementation in order to minimize any delays in Claims payment. . Podiatry as well as vision benefits have been reinstated for PHC members effective February 1, 2015. A TAR is not required for most referrals to Podiatry. Vision benefits are accessed through VSP.

5. Provider Topics None. 1/16/2015 of Interest,

Announcements, and Upcoming Events

Meeting Adjourned Next Scheduled meeting: March 20, 2015 in Sonoma County. 3/20/2015

PHC – Provider Advisory Group – March 20, 2015 in Solano County Minutes prepared and submitted by: Carol Parker

Lynea Seiberlich 1/18/2015 Chairperson Lynea Seiberlich., Santa Rosa Community Health Center Date Attachment A Public Health Response to Measles: 2015 Outbreak

Jennifer Henn, PhD Epidemiologist Napa County Public Health Objectives

• Measles 101 – – Clinical basics – Testing • Epidemiology • MMR Vaccine • Public Health Messaging Measles Clinical Features • Prodrome: –fever 101 ‐104oF

–The 3 C’s • Cough, coryza, conjunctivitis

–Koplik spots Measles Clinical Features

• Rash – Maculopapular • becomes confluent – Begins on face and head – Moves head to toe – Persists 5‐6 days – Fades in order of appearance – Turns orange/pink colored during retreat Measles Pathogenesis

• Replicates in lymph nodes • Respiratory airborne & droplet transmission • Airborne 1‐2 hours • 90% attack rate • > 95% coverage for herd immunity Measles Follow Up of Exposed

Exposure Vaccine Rash onset w/in 72h

07 14 21 shortest Time in days longest Incubation periods

IG w/in 6 days Exclusion from work/school d7‐21 post exposure Measles Complications

% Diarrhea 8 Otitis media 7 Pneumonia 6 Encephalitis 0.1 (CFR 15%) Seizures 0.6‐0.7 Death 0.2 Based on 1985‐1992 U.S. data Measles Laboratory Diagnosis

• Isolation of measles virus from clinical specimen (PCR) – Nasopharynx or throat – Urine • Serology – Significant rise in measles IgG – Positive measles IgM Measles Epidemiology

Measles—United States, 1950-2005

Endemic 2nd dose transmission 900 1989 interrupted 1997 800 Vaccine 30000 Measles licensed 25000 declared 1963 eliminated 700 20000 2000 15000 600 Cases 10000 500 5000 0 400 1980 1985 1990 1995 2000 2005 300 200

Cases (thousands) Cases 100 0 1950 1960 1970 1980 1990 2000

Disneyland Measles Outbreak

Since December, 2014: Health No Known Link to Total Dept Epi‐link Disney

California 3 130 133

Updated 3/13/15 Confirmed cases by County Outbreak Case Statistics

• 19% of cases hospitalized

• 57 of 77 (74%) with known history unvaccinated

• 44% of cases in children and teens; 11% in children <1 year of age

ACIP MMR Recommendations

• 2 doses for Children 1‐18 years: – Additional dose for infants 6‐12 months prior to international travel

• 2 doses for adults born after 1956 (19‐58 years of age) who: – Work in a healthcare facility (also: if born before 1957 and no evidence of immunity) or – Plan to travel internationally or – Are postsecondary students or – Received inactivated (killed) measles vaccine or measles vaccine of unknown type during 1963–1967

• 1 dose for other adults born after 1956 Evaluating Immunity in Healthcare Workers

• 2 doses of MMR (documented)

• +IgG (trust documented vaccine record over serological result)

• Born before 1957

• Documented history of measles Measles Vaccine

• Live virus composition • 95% efficacy –1 dose • 97‐99% 2nd dose • Lifelong immunity • Combination vaccines – With mumps and rubella – With mumps, rubella, and varicella Vaccine Failure

• 2 –5 % do not respond to first dose • Most people with vaccine failure will respond to second dose • Caused by antibody, damaged vaccine, or record errors • 1963‐1967 – killed vaccine Public Health Messaging Requested Actions for Clinicians

• SUSPECT in patient with fever and rash • ISOLATE – – Airborne precautions – 4 days after rash onset • REPORT – Infection control practitioner – Local public health department • TEST – Throat/NP swab – Urine – Serology • VACCINATE • CHECK YOUR OWN/YOUR STAFF IMMUNITY Kindergartners with Immunization Exemptions: 2011 to 2014 (Type of Exemption: Personal Belief Exemption)

Definition: Percentage of children in kindergarten who have immunization exemptions, by type of exemption (e.g., in 2014, 3.2% of California kindergartners had Personal Belief Exemptions).

Data Source: As cited on kidsdata.org, California Department of Public Health, Immunization Branch, Kindergarten Assessment Results (May 2014). Clustering of Personal Belief Exemptions

CITY SCHOOL NAME UTD % PBE% MMR%

NAPA STONE BRIDGE 46 51 46

PACIFIC UNION COLLEGE 81 13 81 ANGWIN ELEMENTARY

ST. JOHN'S LUTHERAN 85 12 85 NAPA ELEMENTARY ST. HELENA ST. HELENA MONTESSORI 80 10 85

86 10 88 NAPA MT. GEORGE INTERNATIONAL

UTD% = percent of children up‐to‐date (UTD) on vaccines PBE% = percent of children with personal belief exemption (PBE) MMR% = percent of children with measles, mumps, rubella vaccine Marin County: Personal Belief Exemption (PBE) Study

Children get too many vaccines at the same time

I'm uneasy with newer vaccines

Vaccines contain unsafe toxins

Vaccines can cause autism

Vaccines can cause the diseases they are supposed to protect against Vaccinating isn't necessary as the diseases they protect against aren't common…

12345 Strongly Not Sure Strongly Courtesy Marin County Public Health Disagree Average Score Agree Countering Anti‐Vaccine Messaging Message: Too Many Vaccines

A common belief among parents who request PBEs is that children get too many vaccines at one time (100% agreed).

• Vaccines are a small drop in the bucket compared to what an infant's immune systems face every day. • In addition, vaccines have been refined over time and are now more effective while containing fewer antigens.

Courtesy Marin County Public Health Message: Vaccine Additives

One reason parents cited for requesting PBEs is that vaccines contain unsafe toxins (64% agreed).

• Everything that’s in a vaccine is there for a very good reason, is in a minute amount, and is not harmful. • Aluminum enhances our immune response to the vaccine. Aluminum is also found in formula and breast milk. • Thimerosal was removed from pediatric vaccines in 2001.

Courtesy Marin County Public Health Message: Autism

One‐third of parents with PBEs (34%) believe vaccines can cause autism.

• Over 20 scientific studies have researched hundreds of thousands of children and found no connection between vaccines and autism. • Autism rates are the same in vaccinated and unvaccinated children. • The study that first suggested the link in 1998 was retracted by the journal and 10 of its authors.

Courtesy Marin County Public Health Message: Low Perceived Risk

A reason for refusing or delaying vaccines is the perception of low risk of some vaccine‐preventable diseases.

• In the age of globalization, even diseases that are rare in the U.S., like measles, Hepatitis B and Polio, are just a plane ride away.

• U.S. rates of many vaccine‐preventable diseases are low because immunization rates are high.

Courtesy Marin County Public Health Message: Alternative Schedule

We see that most Marin parents with PBEs are not refusing all vaccines but rather choosing an alternative vaccine schedule (84%).

• 32% of parents with PBEs are delaying MMR, while we have seen measles outbreaks in California in the past decade.

• The recommended schedule is fully supported by research. However, alternative vaccine schedules are not rigorously tested and may unnecessarily leave children susceptible to vaccine‐preventable diseases.

Courtesy Marin County Public Health Questions?

Contact: [email protected] 707‐299‐2160 Attachment B

Attachment C

Healthy Nation, Healthy Solano!

2015 Public Health Fair

Thursday, April 9th

11:30 AM – 1:30 PM

2101 Courage Drive, Fairfield

 Front Parking Lot

JOIN US! Learn more about living healthier and preventing chronic diseases.

 Fun activities and demonstrations

 Snacks and spa water  Health screenings

 Healthy produce

 Zumba classes