PARTNERSHIP HEALTHPLAN OF CALIFORNIA PHYSICIAN ADVISORY COMMITTEE ~ MEETING NOTICE Members: Angela Brennan, D.O. Willard Hunter, M.D. Thomas Paukert, M.D. Jeffrey Gaborko, M.D. (Chair) Mills Matheson, M.D. Teresa Shinder, D.O. David Gorchoff, M.D. Douglas McMullin, M.D. Karen Sprague, MSN, CFNP Steve Gwiazdowski, M.D. Danielle Oryn, D.O. Matthew Symkowick, M.D. Michele Herman, M.D. Bessant Parker, M.D. Suzanne Eidson-Ton, M.D. Lisa Ward, M.D. PHC Staff: Liz Gibboney, Chief Executive Officer Robert Moore, MD, MPH, Chief Medical Officer Wendi West, Northern Executive Director Peggy Hoover, RN, Senior Director, Health Services Patti McFarland, Chief Financial Officer Mary Kerlin, Senior Dir., Provider Relations (PR) Dept. Marshall Kubota, MD, Regional Medical Director Mark Netherda, MD, Assoc. Medical Director of Quality Jeffrey Ribordy, MD, Regional Medical Director Colleen Townsend, MD, Regional Medical Director Stan Leung, Pharm.D., Director, Pharmacy Services Erika Robinson, Director, Quality & Performance Improvement (S) Debra McAllister, RN, Assoc. Dir. of UM Strategies Nancy Steffen, Director, Quality & Performance Improvement (N) David Glossbrenner, MD, N. Regional Medical Director Ad Hoc PHC Sonja Bjork, Chief Operating Officer Kevin Spencer, Director of Member Services Members: Kirt Kemp, Chief Information Officer James Cotter, MD, Associate Medical Director Lynn Scuri, Regional Director Bettina Spiller, MD, Associate Medical Director Chloe Secor-Schafer, Northern Regional Manager Mark Glickstein, MD, Associate Medical Director Tahereh Daliri Sherafat, N. Region Mbr Services & PR Dir. Margaret Kisliuk, Behavioral Health Administrator Sharon Hoffman-Spector, RN, N. UM Manager Rebecca Boyd Anderson, RN, Director, Population Health Ledra Guillory, Senior Prov. Relations Rep. Manager Katherine Barresi, RN, Director, Care Coordination Margarita Garcia-Hernandez, Assoc. Dir., Health Analytics Diane Wong, Pharm.D., Senior Clinical Pharmacist Vic Patel, Pharm.D., Clinical Pharmacy Manager Rachael French, Assoc. Dir., Quality & Performance Improvement Jeffrey DeVido, MD, Behavioral Health Clinical Director Amy McCune, Manager, Quality Incentive Programs Doreen Crume, RN, Northern Manager, Care Coordination Karl Santos, Director, Network Operations Kim Sivers, RN, Assoc. Director Utilization Management Lisa O’Connell, Sr. Mgr., Network Education & Credentialing cc: PHC Commission Chair Gabriel Samuel Chua, MD Kali Stanger, MD Voltaire Velarde, MD Richard Fogg Jerry Douglas, MD Amy Brom, Psy.D Karen Relucio, MD David Danzeisen, MD Jeremy Austin, MD Bela T. Matyas, MD Susan Foster, MSN, FNP-BC Francisco Trilla, MD FROM: Linda Largent DATE: April 7, 2021 SUBJECT: PHYSICIAN ADVISORY COMMITTEE MEETING The Physician Advisory Committee will meet as follows and will continue to meet the second Wednesday of every month (July and December are tentative.) Please review the Meeting Agenda and attached packet, as discussion time is limited. DATE: Wednesday, April 14, 2021 TIME: 7:30 a.m. – 9:00 a.m. LOCATIONS – DUE TO COVID-19 AND SOCIAL DISTANCING, ACCESS IS LIMITED See Agenda for Call-In Information: ________Via Video Conference________ Partnership HealthPlan of CA PHC – Sonoma Office PHC – Redding Office 4665 Business Center Drive 495 Tesconi Circle 2525 Airpark Drive (Please Park in Front of Bldg.) Santa Rosa Redding Fairfield, CA Please contact me at (707) 863-4228, or e-mail [email protected] if you are unable to attend. Blank Page 2 of 229 REGULAR MEETING OF PARTNERSHIP HEALTHPLAN OF CALIFORNIA’S PHYSICIAN ADVISORY COMMITTEE (PAC) - AGENDA Date: April 14, 2021 Time: 7:30 – 9:00 a.m. Location: PHC Per Governor Newsom’s Executive Order, N-25-20 that relates to social distancing measures being taken for COVID-19: The Executive Order authorizes public meetings with Brown Act requirements to be held via teleconference or telephone. It waives the Brown Act requirement for physical presence at the meeting for members, the clerk, and/or other personnel of the body as a condition of participation for a quorum. However, the Executive Order requires at least one public location consistent with ADA requirements to be made available for members of the public to attend the meeting, so all PHC offices will be available for members of the public to attend the meeting in-person. To Join by Telephone: 1-844-621-3956 Access code: 807 289 275 REMINDER – TO MUTE / UNMUTE YOUR TELEPHONE, PLEASE USE *6 w Speaker 2 minutes Speaker 2 minutes This Brown Act meeting may be recorded. Any audio or video tape record of this meeting, made by or at the direction of PHC, is subject to inspection under the Public Records Act and will be provided without charge, if requested. Welcome / Introductions I. Approval of Minutes – Chair 5 – 13 7:30 II. Standing Agenda Items Lead Pg # Time A. Status Update Administration Ms. Gibboney 7:40 Medical / Health Services Report Dr. Moore 7:50 Regional Medical Director Reports - Napa & Southeast Counties Dr. Townsend 7:55 - Southwest Counties Dr. Kubota 7:58 - Northwest Counties Dr. Ribordy 8:01 - Northeast Counties Dr. Glossbrenner 8:04 A.1. Committee Member Highlight Dr. Parker -- 8:07 B. Quality / Utilization Advisory Committee (Q/UAC) Activities Report with Dr. Moore 14 - 89 8:17 attachments – Consent Review Acceptance of Meeting Minutes: Activities & Minutes of the March 17, 2021 meeting - Minutes – Internal Quality Improvement meetings 02/09/21 - Quality Improvement Update – March 2021 Approval of Committee’s Action Items & Material Reviewed: Note – only pages with significant changes are included for policies Policies & Procedures: Policy Summary - See Pages 37 - 39 - Substance Use Disorder (SUD) Site & Medical Record Review (MCQP1025) - Treatment Auth. Request (TAR) Review Process (MCUP3041) Redline/Excerpt - Quarterly Grievance & Appeals – Inaugural Edition of the PULSE Report - Annual Evaluation of the 2020 UM Program (UM / Pharmacy) - Pharmacy Operations Update - Medical Equipment Dist. Services Program (presented to Committee in March) B.1. 2020-2021 QI Work Plan Update – Mid-Year Report Ms. Robinson 90 - 93 8:17 No Action Required – For Information Purposes Only B.2. Clinical Practice Guidelines for the Diagnosis & Management of Asthma Dr. Moore 94 – 8:17 (MPXG5001) Redline only Approval Required under Consent 104 B.3. Major Depression in Adults Clinical Practice Guidelines (MPXG5003) Dr. Moore 105 - 8:17 Redline only Approval Required under Consent 111 B.4. Clinical Practice Guidelines: Pain Management, Chronic Pain Dr. Moore 112 - 8:17 Management, and Safe Opioid Prescribing (MPXG5008) Redline only 116 Approval Required under Consent B.5. Utilization Management Program Description (MPUP3001) Ms. McAllister 117 - 8:17 Approval Required under Consent 182 Page 1 of 2 Continued REMINDER – TO MUTE / UNMUTE YOUR TELEPHONE, PLEASE USE *6 C. Pharmacy &Therapeutics (P&T) Committee / Consent Review Dr. Leung / -- -- Acceptance of Meeting Minutes: Dr. Moore Approval of Committee’s Action Items & Material Reviewed: No Meeting in March D. Provider Advisory Group (PAG) Report – Consent Review Ms. Sherafat / -- -- Ms. Kerlin “Due to the ongoing COVID-19 pandemic, Partnership HealthPlan of California (PHC) will not be conducting the Provider Advisory Group (PAG) meeting.” E. Credentialing Committee Meeting Summary (Committee Approved) Dr. Kubota 183 - 8:17 Acceptance of Meeting Minutes: 190 Approval of Committee’s Action Items & Material Reviewed Summary and Credentialed List for the February 10, 2021 meeting (attached) F. Pediatric Quality Subcommittee Dr. Ribordy -- -- Acceptance of Meeting Minutes: Approval of Committee’s Action Items & Material Reviewed Minutes & Recommendations from the February 3, 2021 meeting (deferred) G. Recommended Committee Appointments / Resignations for Approval: Dr. Moore -- -- III. Old Business Lead Pg # Time IV. New Business A. Pediatric TeleHealth Pilot (see attached – presentation) Ms. Bains 191 - 8:18 No Action Required 199 B. CalAIM: Enhanced Care Management (ECM) and In Lieu-of Services Ms. Barresi 200 – 8:30 (ILOS) (see attached – presentation) No Action Required 213 C. Video Interpretation Pilot (see attached – presentation) Mr. Spencer 214 - 8:45 No Action Required 229 V. Adjournment 8:55 This agenda contains a brief description of each item to be considered. Except as provided by law, no action shall be taken on any item not appearing on the agenda. Government Code §54957.5 requires that public records related to items on the open session agenda for a regular committee meeting be made available for public inspection. Records distributed less than 72 hours prior to the meeting are available for public inspection at the same time they are distributed to all members, or a majority of the members of the committee. The committee has designated the Administrative Assistant to the Chief Medical Officer as the contact for Partnership HealthPlan of California located at 4665 Business Center Drive, Fairfield, CA 94534, for the purpose of making those public records available for inspection. The Physician Advisory Committee Agenda and supporting documentation is available for review from 8:00 AM to 5:00 PM, Monday through Friday at all PHC regional offices (see locations under the Meeting Notice). It can also be found online at www.partnershiphp.org. In compliance with the Americans with Disabilities Act, PHC meeting rooms are accessible to people with disabilities. Individuals who need special assistance or a disability-related modification or accommodation (including auxiliary aids