Ventura County Medi-Cal Managed Care Commission …...Sep 23, 2019 · 3.Chief Executive Officer...

Ventura County Medi-Cal Managed Care Commission (VCMMCC)

dba Gold Coast Health Plan (GCHP)

Regular Meeting

Monday, September 23, 2019, 2:00 p.m.

Gold Coast Health Plan, 711 East Daily Drive, Community Room, Camarillo, CA 93010

AGENDA

CALL TO ORDER

PLEDGE OF ALLEGIANCE

ROLL CALL

PUBLIC COMMENT

The public has the opportunity to address Ventura County MediCal Managed Care Commission (VCMMCC) doing business as Gold Coast Health Plan (GCHP) on the agenda. Persons wishing to address VCMMCC should complete and submit a Speaker Card.

Persons wishing to address VCMMCC are limited to three (3) minutes unless the Chair of the Commission extends time for good cause shown. Comments regarding items not on the agenda must be within the subject matter jurisdiction of the Commission.

CONSENT

1. Approval of Ventura County Medi-Cal Managed Care Commission Meeting

Regular Minutes of August 26, 2019.

Staff: Maddie Gutierrez, CMC – Clerk of the Commission RECOMMENDATION:

Approve the minutes.

2. Approval of Credentials / Peer Review Committee Member

Staff: Nancy Wharfield, M.D., Chief Medical Officer

RECOMMENDATION: Approve Nilesh Higarh, M.D., as an active member of the Credentials / Peer Review Committee.

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REPORTS

3. Chief Executive Officer (CEO) Update

Staff: Dale Villani, Chief Executive Officer

RECOMMENDATION: Receive and file the report.

FORMAL ACTION

4. Chief Diversity Officer Role

Staff: Ted Bagley, Chief Diversity Officer

RECOMMENDATION: Commission to provide direction to staff.

5. July Financials Report

Staff: Kashina Bishop, Chief Financial Officer

RECOMMENDATION: Receive, approve, and file July financials report.

REPORTS

6. Chief Medical Officer (CMO) Update


RECOMMENDATION: Receive and file the update.

7. Chief Diversity Officer (CDO) Update



CLOSED SESSION

8. PUBLIC EMPLOYEE PERFORMANCE EVALUATIONTitle: Chief Executive Officer.

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COMMENTS FROM COMMISSIONERS

ADJOURNMENT

Unless otherwise determined by the Commission, the next regular meeting will be held on October 28, 2019 at Gold Coast Health Plan at 711 E. Daily Drive, Suite 106, Community Room, Camarillo, CA 93010.

Administrative Reports relating to this agenda are available at 711 East Daily Drive, Suite #106, Camarillo, California, during normal business hours and on http://goldcoasthealthplan.org. Materials related to an agenda item submitted to the Commission after distribution of the agenda packet are available for public review during normal business hours at the office of the Clerk of the Board.

In compliance with the Americans with Disabilities Act, if you need assistance to participate in this meeting, please contact (805) 437-5512. Notification for accommodation must be made by the Monday prior to the meeting by 3 p.m. to enable the Clerk of the Board to make reasonable arrangements for accessibility to this meeting.

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AGENDA ITEM NO. 1

TO: Ventura County Medi-Cal Managed Care Commission

FROM: Maddie Gutierrez, Clerk to the Commission

DATE: September 23, 2019

SUBJECT: Meeting Minutes of August 26, 2019 Regular Commission Meeting

RECOMMENDATION:

Approve the minutes.

ATTACHMENTS:

Copy of the August 26, 2019 Regular Commission Meeting minutes.

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Ventura County Medi-Cal Managed Care Commission

(VCMMCC)

dba Gold Coast Health Plan (GCHP)

August 26, 2019 Regular Meeting Minutes

CALL TO ORDER

Commissioner Antonio Alatorre called the meeting to order at 6:03 p.m., in the Lower Plaza Conference Room at Ventura County Government Center, Administration Building, 800 South Victoria Ave., Ventura, California.

Commissioner Alatorre thanked the Gold Coast Health Plan staff for all the outreach that was done in preparation for this meeting.

PLEDGE OF ALLEGIANCE

Commissioner Alatorre led the Pledge of Allegiance.

ROLL CALL

Present: Commissioners Antonio Alatorre, Shawn Atin, Theresa Cho, M.D., Laura

Espinosa, Johnson Gill, Gagan Pawar, M.D., Dee Pupa and Supervisor

John Zaragoza.

Commissioner Jennifer Swenson was not present at Roll Call. She arrived at 6:24 p.m.

Absent: Commissioners Fred Ashworth and Lanyard Dial, M.D.

PUBLIC COMMENT

1. Sienna Lindsay, seventh grade student at DeAnza Middle School in Ventura spoke

about vaccines. Miss Lindsay stated she had a reaction from the T-DAP immunization

vaccine. This vaccine is mandatory for school admission and she doesn’t think it

should be. Commissioner Zaragoza stated this requirement might be a school policy

and her concern should be addressed at the school. Commissioner Alatorre also

suggested speaking with state and local representatives.

2. Monica Gray, Sienna Lindsay’s mother, appeared on behalf of young breast cancer

survivors. Ms. Gray stated she is concerned about proactive versus reactive health

care and the fiscal impact on individuals. Ms. Gray stated she has trust issues with

local health care. She believes there is waste and inefficiency in the hospital system.

She is not sure where to ask or who to go to for assistance on treatment. She is

requesting help for the people in Ventura County with restricted budgets.

Commissioner Zaragoza referred Ms. Gray to Jennifer Wortham, from the Health

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Care Agency, for assistance. Commissioner Cho stated she knows this patient and

will work with her to get assistance. Commissioner Espinosa thanked Ms. Gray and

her daughter for their courage in making a public comment and reassured that she

would get assistance from GCHP staff as well as County staff.

3. Sofia Rubalcava, Deputy Mayor, City of Ventura, thanked the Commission and staff

for rotating the location and time of the meetings in order for the public to have an

opportunity to attend. She also extended an invitation for a future meeting to be held

in West Ventura.

4. Rick Castaniero, LULAC District 17 Director, thanked the Commission for changing

the time of the meeting so the public could attend. He expressed concern about

GCHP’s deficit and whether members would be able to get the care that they need.

5. Sandra I. Aldana, MPH, PhD. stated she wanted to make a correction to the July

minutes. Her middle initial was listed incorrectly. The correction was noted and the

change will be made.

6. Kate English, Executive Director of One Step a La Vez, a teenage youth center in

Fillmore stated she was grateful for the meeting time change. Ms. English is an

advocate for youth in the Santa Clara Valley, many of whom are GCHP members.

Ms. English noted the Piru Clinic is now closed, and this a major setback. Due to this

closure, transportation to other clinics has become an issue. Ms. English also

advocates for the LGTBQ community and works with transgender youth. She is

worried about the future of Santa Paula West due to county layoffs.

7. Monty (no last name listed) stated he was a new GCHP member. The staff at VCMC

has been doing a good job. One of his major concerns is the protection of patient

data and the potential for data breaches. Melissa Scrymgeour, Chief Administrative

Officer, stated the Plan’s contract with DHCS imposes strict regulatory requirements

around member security that must be followed. There is also an ongoing focus and

training on information security for employees. Commissioner Espinosa stated the

speaker specifically referred to the Cal-Win system, which is the Human Services

Agency’s eligibility system, and how it interfaces with GCHP. CAO Scrymgeour

stated GCHP does not interface with this system.

CONSENT

1. Approval of Ventura County Medi-Cal Managed Care Commission Meeting

Regular Minutes of July 22, 2019.

Staff: Maddie Gutierrez, CMC, Clerk of the Commission.

RECOMMENDATION: Approve the minutes.

Commissioner Espinosa asked for a clarification on page 7, paragraph 3, second

sentence by adding the word “membership.” The change was noted and will be

inserted into the minutes.

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Commissioner Pupa motioned to approve the minutes with the clarification noted.

Commissioner Swenson seconded.

AYES: Commissioners Antonio Alatorre, Shawn Atin, Theresa Cho, M.D., Laura

Espinosa, Johnson Gill, Gagan Pawar, M.D., Dee Pupa and John

Zaragoza.

NOES: None.

ABSENT: Commissioners Fred Ashworth and Lanyard Dial, M.D.

Commissioner Alatorre declared the motion carried.

Commissioner Antonio Alatorre requested to move the order of Agenda Item 9 to Agenda

Item 4 and Agenda Item 3 to Agenda Item 2.

3. Beacon Health Presentation


RECOMMENDATION: Receive and file the presentation.

Chief Medical Officer, Nancy Wharfield, M.D., introduced Sarah Arnquist from

Beacon Health Options. Beacon provides behavioral health services for GCHP’s

members and works closely with GCHP’s clinical staff. Their function is to contract

providers, answer calls, manage utilization and pay claims. Beacon is building a

network of psychiatrists, which includes recruiting Spanish-speaking providers.

Providers must attest to having gone through cultural and linguistic competency

training. Commissioner Espinosa asked how many days members wait for an

appointment once a referral has been made. Commissioner Cho commented that

some members wait 2 to 3 months. Ms. Arnquist stated telehealth is making a

difference and 15 days is the goal. Commissioner Pawar asked if referrals are

tracked and how many are in the waiting cue and expressed concern about

patients falling through the cracks. CEO Villani explained that low reimbursement

affects the number of providers who accept Medi-Cal. Ms. Arnquist said that every

state has initiatives to ease shortages because of psychiatrists opting out of

accepting insurance. Beacon is partnering with GCHP and working on rates to add

more providers to the network. Clinicas is a good partner. Commissioner Espinosa

commented that the Latino population is not being served adequately. Ms. Arnquist

said changes could be made at the state level to allow certified peers.

Commissioner Alatorre stated he would like more data; Commissioner Pupa

requested a report on the referral process; Commissioner Pawar wanted more

information on how moderate-to-severe cases are being tracked. CMO Wharfield

commented that Beacon provides reports to GCHP and works closely with county

mental health and certified peer specialists to ensure members are receiving the

correct level of care.

PUBLIC COMMENT

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8. Sandra I. Aldana, MPH, PhD appeared on behalf of the State Council on

Developmental Disabilities. Dr. Aldana reviewed the data on Beacon’s improved

ABA services and noted that regional centers are no longer paying for behavioral

health services. She stated that there are not enough providers and more bilingual

providers are needed.

9. Miguel Rodriguez stated he had worked for the county in Santa Paula and it is

grossly underserved. He knows of members who have had to wait for services up

to 1½ years. When providers are outside of the member’s area – even if it’s within

a 20-mile radius - getting to an appointment can be a challenge. Some providers

have requested that members bring their own interpreter, showing a need for

culturally-competent providers.

REPORTS

2. CEO Update

Staff: Dale Villani, Chief Executive Officer

RECOMMENDATION: Receive and file the report.

CEO Villani began his report with a review of the fiscal year financial losses. He

stated that the significant losses were driven by three primary factors: membership

changes, health care costs, and accounting adjustments. The plan experienced a

decrease in overall membership in FY18-19. Members who are younger and

healthier, such as the adult expansion population, were falling off enrollment,

leaving a higher risk pool. While membership decline and member mix played a

factor in the losses, CEO Villani explained that the primary driver of the losses

were health care costs attributed to provider reimbursement rates. He also stated

that financial adjustments contributed to the losses, including a large payment to

the state that was required as part of the Adult Expansion program. CEO Villani

stressed that GCHP has adequate financial reserves but cannot go below a certain

level. The FY19-20 budget includes an estimated $1.5M surplus. Part of that is

driven by our rates from the state, which includes a 12% increase. However, staff

is evaluating strategies to contain medical and administrative costs, including

contracting strategies such as preferred networks, contract rate changes, and

increasing the number of delegated networks. So, rather than the risk being

delegated to the health plan it would be shifted to the delegated provider. CEO

Villani added that staff identified further savings opportunities in administrative

costs through organizational redesign. The plan is ensuring vendors are

performing at expected performance levels through increased oversight.

CEO Villani briefly reviewed the state’s audit report on OptumRx. The audit found

that reimbursements are reasonable. There were three key findings: 1) Comments

from the Commission about choosing OptumRx were missing, 2) Failures in

OptumRx’s performance should have been formally addressed sooner, and 3)

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Reimbursements were low compared to other plans but were reasonable. The

recommendations have been reviewed. CMO Wharfield stated that changes have

been made to policies and procedures.

The DHCS medical audit results were also reviewed. The state audit showed three

findings, which were limited. This continues a positive trend by the plan to

successfully meet the quality of care standards established by DHCS.

GCHP’s Director of Government Affairs and Community Relations, Marlen Torres,

gave an update on government affairs at both the national and local levels. Director

Torres introduced her new Community Relations team. She noted that GCHP

participated in the Salsa Festival and plans to participate in Fiestas Patrias and the

upcoming health fair in Santa Paula. She thanked her team and all who

participated in getting the word out in the community for this evening’s meeting,

including Commissioner Espinosa.

Executive Director of Human Resources, Jean Halsell, provided a human

resources update. She noted that staff is building an HR dashboard to share with

the Commission. Executive Director Halsell stated the Plan’s turnover rate on a

monthly basis is on target with the national average. She also stated there is a

hiring freeze as of August 12th that will be reviewed on a monthly basis. Executive

Director Halsell noted there have been layoffs, for a total of five positions, 3

occurring in August. These eliminated positions are part of our action plan to

contain administrative costs. She added that an employee survey is planned for

December. CEO Villani noted that the employee survey will establish a baseline

and the questions are questions asked by other Medi-Cal plans. Executive

Director Halsell explained that staff will also update Commissioners on our HR

policies, when they are completed and reviewed by legal. In addition, the

consultant who works with us on our compensation plan will provide

Commissioners an update on the market review process in progress at the October

Commission meeting. The review will ensure that pay is aligned with the industry

and market. Commissioner Espinosa asked about industry standards on the timing

of salary market reviews. Executive Director Halsell stated the standard is to

review them every 2 to 3 years. Commissioner Espinosa noted she had a concern

that the organization accommodates specific individuals. Executive Director

Halsell stated the established compensation plan and process is in place to ensure

decisions and actions are fair and equitable.

Commissioner Zaragoza noted at the last meeting there was a $40 million loss

projected, which has increased to $51.9 million. He requested more information.

CEO Villani stated that provider reimbursement rates are a key driver of the losses

and they need to be reviewed. GCHP also did not anticipate the level of

membership decline, which impacts revenue. Commissioner Zaragoza asked

about the Plan’s TNE levels. CEO Villani replied that TNE levels are at 245%, well

above the 100% required by the State. However, staff is taking action to rebuild

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reserves. He commented that a deeper dive of the losses would be covered in the

financial report.

Commissioner Alatorre stated that a number of Commissioners received a letter

from a couple of employees and wanted to know whether Ms. Halsell or Mr. Bagley

were investigating the allegations. CEO Villani replied that he did not have an

official copy of the document and asked what letter was being referenced.

Commissioner Alatorre said he would send it to him. Commissioner Espinosa said

she wanted to ensure confidentiality is maintained. CEO Villani suggested

redacting any names before sending the letter. Commissioner Atin commented

that he read the complaints and proposed that a third party conduct an employee

survey. He suggested that Commissioners review the surveys questions, as well

as the compensation studies. Commissioners Atin and Pupa volunteered to review

the survey questions. Commissioner Zaragoza stated he is concerned about the

allegations and supported the suggestion of an employee survey. Commissioner

Alatorre referenced Executive Director Halsell’s PowerPoint presentation, which

showed that the employee survey was scheduled for December. He added that it

would be great if it could be done quicker.

Commissioners Alatorre and Pawar recused themselves at 8:01 p.m. for the discussion

on the pilot with AmericasHealth Plan. Commissioner Jennifer Swenson took over Chair

duties.

FORMAL ACTION

9. AmericasHealth Plan (AHP) Pilot Changes

Staff: Brandy Armenta, Chief Compliance Officer

RECOMMENDATION: That Commissioners receive information about

Commissioner Zaragoza’s proposed amendments to the original 13-point

AmericasHealth Plan pilot program, including any impact on Gold Coast Health

Plan and the Department of Health Care Services comments on the revised plan,

and consider approval of the amendments to the 13-point program as outlined by

Commissioner Zaragoza’s motion at the July 22 Commission meeting.

General Counsel, Scott Campbell reviewed Commissioner Zaragoza’s comments

from the previous Commission meeting. Commissioner Zaragoza presented a

document to the Commission with six amendments listed as follows:

1. In order for the pilot to be fairly and accurately assessed he (Commissioner

Zaragoza) proposes that the period of the pilot be amended from five years to

three years.

2. That the pilot begin with 10,000, rather than 5,000 members who will have the

option to self-select from Clinicas’ existing GCHP assigned membership pool.

3. At the end of a two year period, in the event pre-agreed upon performance

measures are met or exceeded and at the discretion of the Commission the

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pilot will be continued with up to an additional 5,000 members who will have

the option to self-select from Clinicas’ existing GCHP assigned membership

pool for a total of 15,000 members.

4. Clinicas, the parent company of AHP, can provide the required Tangible Net

Equity for AHP as a prudent reserve during the course of this pilot program.

5. Item 12 of the program shall be amended to state: At the end of the three-year

pilot program in the event the program has been deemed to be successful by

the GCHP Commission, the Plan will enter into discussions with AHP regarding

the creation of a permanent option whereby Clinicas and other GCHP assigned

members will have the option to receive services by AHP.

6. And finally, I (Commissioner Zaragoza) propose the deletion of item 13 of the

program which stated: In no event will the total AHP membership exceed the

current percentage of eligible GCHP members assigned to Clinicas.

Commissioner Zaragoza noted that AHP is eager to work collaboratively with

GCHP on the pilot program.

Commissioner Zaragoza motioned to accept the six amendments as presented to the

Commission and present the amendments to the state. He requests implementation as

soon as possible. If the state modifies the terms, the Commission will hold a special

meeting to review and consider the modifications.

Rohan Reid, Chief Executive Officer of AmericasHealth Plan, was available to

answer questions. CEO Villani gave an update on the status of the pilot program.

Both proposals (the original 13-point proposal along with the six amendments)

have been sent to the state for review. There are two documents the state must

approve: 1) the boiler plate and 2) the contract template. AHP also must send the

two documents to its regulator for approval. The state has requested clarification

on the membership plan. Originally, guidance was that the membership plan would

be written by AHP, but the state wants GCHP to work with AHP on it and submit

it. The state requires that there be a clear approach to member choice.

Commissioner Zaragoza stated this is a pilot and nothing is changing until the pilot

is complete. AHP CEO Reid said that AHP is ready move forward if the state

approves the pilot. Commissioner Zaragoza stated if the state has any concerns

about the pilot, a special meeting should be held to review them.

Commissioner Swenson went over the amendments one-by-one to hear where

GCHP stands:

Item 1 – The Plan concurs.




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Item 5 – The Plan concurs but notes that the language is open ended.


PUBLIC COMMENT

10. Miguel Rodriguez stated it was important for people to have a choice and empower

them to select their own health care and make better decisions. Although 10,000

lives are low for the pilot, he said he understands the progression. Mr. Rodriguez

also noted that he appreciates LULAC’s advocacy for this pilot.

11. Rick Castaniero, District 17 LULAC Director, stated LULAC has been working on

bringing the parties together since January because inclusion and an opportunity

for choice is important to the community. The hope is that if this pilot moves

forward, more members will be allowed to choose AHP as their provider.

12. Raul Marquez stated he is a Medi-Cal recipient and wanted to thank all those

involved in the development of a plan-to-plan model and the opportunity to

consider options for health care.

13. Sandra I. Aldana, MPH, PhD, stated AHP will ensure equitable access. It is

important for members to have a choice.

Commissioner Zaragoza repeated the motion to accept the six amendments as presented

to the Commission and present the amendments to the state. He requested

implementation as soon as possible. If the state modifies the terms, the Commission will

hold a special meeting to review and consider the modifications. Commissioner Atin

seconded.


Espinosa, Johnson Gill, Gagan Pawar, M.D., Dee Pupa and John Zaragoza.

NOES: None.

ABSENT: Commissioners Fred Ashworth and Lanyard Dial, M.D.

Commissioner Swenson declared the motion carried.

Commissioners Alatorre and Pawar returned to the meeting at 8:24 p.m.

4. June Financials Report

Staff: Kashina Bishop, Chief Financial Officer

RECOMMENDATION: Receive, approve and file the June financial report.

Chief Financial Officer Kashina Bishop highlighted portions of the June financialstatements. CFO Bishop stated there was an $8.9 million loss in June. Financialstatements are currently being audited and there have been significant

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adjustments. The final audited statements will be presented to the Commission in October. CFO Bishop has found a lack of documentation and significant accounting errors, which will be reviewed and improved going forward. The 2018 rate development template was submitted to the state.

Discussion focused on money that was returned to the state for medical expenses falling below 85% in FY 16/17 for the adult expansion population. Commissioner Zaragoza asked why GCHP had to send the money back. CFO Bishop said it was a CMS (federal) requirement. CEO Villani stated the funds were for medical expenses back in 2016/17. The state didn’t know how to set the rate for the adult expansion population for the ACA, so it gave health plans more money in that first year. Commissioner Pupa commented that it happened across the state, not just Ventura County.

Regarding the accounting adjustments, Commissioner Atin commented that citing insufficient documentation and writing accounts receivables off as a reason for the adjustments goes against basic accounting practices and asked whether the issues have been fixed. CEO Villani replied that yes, the issues have been addressed. Commissioner Swenson asked staff to quantify the actual amount of the operational loss versus the adjustments that were made. CFO Bishop replied that the most significant adjustment was the accrual for the FY 16/17 AE MLR requirement. Staff estimated that $4M would be due back to the State and had accrued the amount last fiscal year. However, it was written off in error when the June 2018 audited financial statements were being finalized. Commissioner Alatorre reminded staff that the Commission asked for a detailed 3-5 year comparison of the budget to see trends. Commissioner Pawar asked for an explanation of why Prop 56 funds were considered a loss if they are a pass through. CFO Bishop stated it was budget neutral because the funds are documented as both revenue and an expense. Commissioner Atin asked why the budget was off so much. CFO Bishop stated the budget did not account for changes to provider contracts (increased rates). CEO Villani added that GCHP is paying too much for medical care. CFO Bishop also stated that it is important to make smaller incremental changes to provider rates rather than a big change in one year.

Commissioner Zaragoza asked if a yearly increase is anticipated in the budget for providers. CEO Villani stated that he now oversees Network Operations. Every provider group is renegotiating contracts and they want an increase in the fees they are paid. Commissioner Atin asked how GCHP’s TNE compares to other COHS. CFO Bishop replied that it is the lowest in the state and that the Plan is also the youngest of the COHS. Commissioner Atin stated that there is an urgent need for the Plan’s finances to stabilize. CEO Villani stated that GCHP is looking at incentive programs for providers because how they are paid is critical.

Commissioner Zaragoza asked if GCHP can advertise and promote the Plan, noting Clinicas does a good job on that. CEO Villani stated that GCHP cannot

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market, but can educate and inform. General Counsel Scott Campbell stated that GCHP can make people aware of the Plan’s benefits. Chief Compliance Officer Brandy Armenta stated that as a COHS, GCHP is prohibited from marketing. CAO Scrymgeour stated GCHP is sponsoring more community events to make the community aware of the Plan’s services.

General Counsel, Scott Campbell, noted the top two lines on the budget under Fiscal year to date (FYTD) show that GCHP spent $9 million more in the community than the Plan received from the state.

Commissioner Pawar left the meeting at 9:24 p.m.

Commissioner Espinosa motioned to receive, approve and file the June financials

report. Commissioner Gill seconded.


Espinosa, Johnson Gill, Dee Pupa and John Zaragoza.

NOES: None.

ABSENT: Commissioners Fred Ashworth, Lanyard Dial, M.D. and Gagan Pawar, M.D.


5. Contract Award Approval for Supplemental Security Income (SSI/SocialSecurity Disability (SSDI) services – Centauri Health Solutions, Inc. d/b/aHuman Arc

Staff: Melissa Scrymgeour, Chief Administrative OfficerKashina Bishop, Chief Financial Officer

RECOMMENDATION: Award a one-year agreement to the single responsive bidder, Centauri Health Solutions, Inc. d/b/a Human Arc, along with the approval of two, 12-month renewal options based on Human Arc’s performance during the initial one year term.

Chief Administrative Officer, Melissa Scrymgeour, stated that staff is seeking an outside vendor to assist in identifying members who may be eligible for SSI/SSDI benefits. This is one of the Plan’s fiscal year cost containment strategies. Staff issued a RFP in July. One response was received, and two vendors declined to submit a proposal. Human Arc, the responsive bidder, will identify GCHP members who are eligible for SSI/SSDI, and assist through the eligibility and approval process. This is a benefit to members who may be eligible for additional benefits and GCHP, who would receive increased revenue due to the change in aid category. There is no financial risk to the Plan as Human Arc would charge only for those members who obtain SSI/SSDI status.

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Commissioner Espinosa asked how clients are identified. CAO Scrymgeour replied that GCHP will provide claims data to Human Arc, who will use the information to identify potentially eligible members. Both CFO Bishop and CEO Villani stated that there is no risk to GCHP because Human Arc would do outreach. CFO Bishop added that the vendor has a proprietary process for identifying members. Commissioner Espinosa stated she was not convinced that GCHP staff could determine how much member information would have to be shared with the vendor to identify those who are eligible and expressed concern about potential risk. Commissioner Alatorre asked if the item should be tabled and have the vendor present at a future meeting. He asked if this was a conflict of interest for GCHP. CAO Scrymgeour replied that as a security measure for any RFPs requiring the use of personal health information, the vendor must sign a business associate agreement and go through a security risk assessment before sharing data. Commissioner Atin clarified that other County Organized Health Systems do this with similar vendors and stated that he did not require further details about the vendor’s process.

Commissioner Atin motioned to award a one-year agreement to Centauri Health Solutions d/b/a Human Arc, along with approval of two 12-month renewal options based on performance during the initial one-year term. Commissioner Zaragoza seconded.

AYES: Commissioners Antonio Alatorre, Shawn Atin, Theresa Cho, M.D., Johnson

Gill, Dee Pupa and John Zaragoza.

NOES: Commissioner Laura Espinosa.



6. Proposed creation of a Bylaws Subcommittee of the Commission to reviewBylaws and the Delineation of Authority Policy.

Staff: Scott Campbell, General Counsel

RECOMMENDATION: The Commission establish a Bylaws Ad HocSubcommittee to be tasked with making recommendations on any changes to thebylaws and Delegation Policy.

General Counsel Scott Campbell stated this subcommittee would review thebylaws and make recommendations on any amendments to the bylaws. Thissubcommittee would also review the Delineation of Authority Policy whichdelegates certain authority to the CEO and propose revisions, amendments andrestatements to the policy as necessary.

Commissioner Atin motioned that the same subcommittee who does the performance review for the CEO should comprise this sub-committee. Commissioner Cho seconded.

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NOES: None.



7. Proposed creation of an Ad Hoc Advisory Subcommittee of the Commissionto provide Guidelines for the Appointment Process of the CommunityAdvisory and Credentialing and Peer Review Committees.

Staff: Scott Campbell, General Counsel

RECOMMENDATION: That the Commission establish an AdvisorySubcommittee to propose guidelines, considerations, and factors, to theCommunity Advisory and Credentialing and Peer Review committees.

General Counsel Scott Campbell stated this will be the establishment of an Ad HocAdvisory subcommittee for the appointment of members to the CAC andCredentialing and Peer Review Committee.

Commissioner Espinosa motioned she agreed to this subcommittee and volunteered to participate, Commissioner Pawar was nominated and Commissioner Cho volunteered.

Commissioner Cho asked to be removed from the Bylaws and Delineation of Authority subcommittee and be moved to the CAC and Credentialing and Peer Review subcommittee.

Commissioner Cho modified the original motion to have herself removed from the Bylaws and Delineation of Authority subcommittee and in turn, establish and become part of the CAC and Credentialing and Peer Review subcommittee. Commissioner Atin seconded.

Commissioner Atin motioned to have Commissioners Espinosa, Cho and Pawar be the subcommittee for the CAC and Credentialing and Peer Review subcommittee. Commissioner Pupa seconded.



NOES: None.



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8. Proposed creation of a Strategic Planning Subcommittee of the Commissionto provide guidance and input for Strategic Plan updates and thedevelopment of supporting goals and objectives.

Staff: Melissa Scrymgeour, Chief Administrative Officer

RECOMMENDATION: The Commission establish an ad hoc StrategicPlanning Subcommittee of the Commission to provide guidance and input forStrategic Plan updates and the development of supporting goals and objectives.

CAO Scrymgeour stated this subcommittee will work with staff in developing goals

and objectives supporting GCHP’s strategic plan in preparation for the annual

strategic planning retreat in December 2019.

Commissioner Alatorre motioned that the Executive Finance committee members

become the Strategic Planning subcommittee. Seconded by Commissioner Swenson.



NOES: None.



REPORTS

10. Chief Medical Officer (CMO) Update



11. Chief Diversity Officer (CDO) Update



12. Chief Operating Officer (COO) Update

Staff: Ruth Watson, Chief Operating Officer


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Commissioner Atin motioned to receive and file the CMO, CDO and COO updates as

presented. Commissioner Zaragoza seconded.



NOES: None.



The Commission adjourned to Closed Session at 9:43 p.m. regarding the following items:

CLOSED SESSION

13. CONFERENCE WITH LEGAL COUNSEL – ANTICIPATED LITIGATIONInitiation of litigation pursuant to paragraph (4) of subdivision (d) of Section54956.0 One case.

14. PUBLIC EMPLOYEE PERFORMANCE EVALUATIONTitle: Chief Executive Officer

OPEN SESSION

The regular meeting reconvened at 10:05 p.m.

General Counsel Scott Campbell state there was no reportable action.

COMMENTS FROM COMMISSIONERS

None.

ADJOURNMENT

Commissioner Alatorre adjourned the meeting at 10:12 p.m.

Approved:

____________________________________________

Maddie Gutierrez, CMC

Clerk to the Commission

Page 18 of 90

AGENDA ITEM NO. 2


FROM: Nancy Wharfield, M.D., Chief Medical Officer


SUBJECT: Approval of Credentials / Peer Review Committee Member

Summary:

As directed in the Gold Coast Health Plan Provider Credentialing Policy, the Ventura County Medi-Cal Managed Care Commission is required to approve changes to the Credentials / Peer Review Committee membership.

Nilesh Hingarh, MD has been nominated to replace Patty Auchard, M.D., as an active member of the Credentials / Peer Review Committee. Dr. Hingarh began work as the Medical Director for Health Services at Gold Coast Health Plan on August 26, 2019.

Recommendation:

Approve Nilesh Hingarh, M.D., as an active member of the Credentials / Peer Review Committee.

Page 19 of 90

AGENDA ITEM NO. 3


FROM: Dale Villani, Chief Executive Officer


SUBJECT: Chief Executive Officer Update

CEO SUMMARY: Verbal Update.

GOVERNMENT RELATIONS UPDATE

Director of the Department of Health Care Services Announces Departure

Earlier this month, the Director of the Department of Health Care Services, Jennifer Kent, announced she was leaving the Department at the end of the month. As Director, Ms. Kent was in charge of overseeing California’s Medicaid expansion, the passage of two Managed Care Organization taxes, reorganizing several departments, and expanding Medi-Cal Managed Care. She leaves behind department deputies who will have very full plates. DHCS is in the midst of unveiling their plans for the next state Medicaid waiver, of carving pharmacy benefits out of managed care, and ramping up for a procurement of services with managed care plans. At this time, the Governor’s office has not announced Jennifer Kent’s replacement.

California Legislative and Policy Update

Legislative Update

On September 13, the Legislature adjourned for the year after its final month of hearing bills in fiscal committees and on the Assembly and Senate Floors. The Governor now has 30 days, until October 13, to sign or veto bills. Below is preliminary list of the legislative bills, pertaining to the Medi-Cal program, that moved out of the Legislature and are waiting to be reviewed by the Governor.

AB 318 (Chu) Translations and Readability – Passed, on Governor’s Desk. This bill

requires field-testing by a native speaker of specific Medi-Cal beneficiary informing

materials. This bill requires DHCS to implement field-testing beginning January 1,

Page 20 of 90

2020 and develop a community workgroup no later than January 1, 2021. Plans

argue that the current Medi-Cal managed care contract and DHCS All-Plan Letter

#18-016 contain robust requirements regarding the readability and suitability of

health education and information materials. Expanding these requirements to

mandate field-testing of translated beneficiary informing material is extensive.

Furthermore, the Department of Finance opposes AB 318 for the following reasons:

o It largely duplicates existing state requirements and protections for language

and readability standards;

o It results in General Fund costs not included in the Administration's fiscal

plan;

o This bill results in General Fund cost pressures to the extent the bill places

additional requirements on counties for programs in 2011 Realignment.

AB 1175 (Wood) Medi-Cal Mental Health Services– Passed, on Governor’s Desk.

This bill pertains to Medi-Cal mental health services and coordination between

county mental health plans and managed care plans. Plans are in support of AB

1175 as they believe it addresses the challenge of delivering coordinated care

across siloed systems by requiring that Medi-Cal managed care plans and county

mental health plans share information regarding their shared patients to improve

treatment and coordination. The Department of Finance is opposed to this bill

because it results in unknown, but potentially significant, General Fund costs, and

certain provisions may be duplicative to federal law under the Medicaid Managed

Care Final Rule.

AB 1642 (Wood) EPSDT Audit Findings & Managed Care Plan Sanctions – Passed,

on Governor’s Desk. This bill includes requirements for network adequacy reporting,

alternative access, and managed care plan sanctions. The Local Health Plans of

California removed its opposition after successfully advocating for language

requiring the DHCS, at the plan’s request, to meet and confer with a plan prior to

issuance of a final sanction (see WIC§14197.7(h)). The Department of Finance

opposes this bill because it imposes significant General Fund costs not included in

the 2019 Budget Act.

SB 66 (Atkins) FQHC Same Day Billing – Held, two-year bill. The author, with

support of the co-sponsors, decided to make SB 66 a two-year bill after it was

agreed that the author and clinics were not amenable to a compromise offered by

the Administration. The compromise would have used the bill as a vehicle for FQHC

participation in the Proposition 56 VBP Behavioral Health Integration program and

requiring that participating FQHCs undergo a scope change. The scope change was

a significant disincentive for FQHC participation in the VBP program. Discussions

Page 21 of 90

about SB 66 and FQHC same day billing will continue next year. Furthermore, the

Department of Finance opposed this bill for the following reasons:

o It undermines the comprehensive rate-setting process of the Prospective

Payment System by allowing for clinics to self-select the most beneficial

rates.

o It would create significant new General Fund costs not included in the

Administration's spending plan. This issue was considered by the Legislature

for inclusion in the 2018 Budget Act but was ultimately not adopted.

SB 361 (Mitchell) Health Homes Program– Held, two-year bill. This bill extends the

Health Homes Program by removing current restrictions limiting General Funds to

first eight quarters of the program. It also contains requirements around rates for

providers serving homeless beneficiaries. Discussions will continue in the coming

year.

SB 503 (Pan) Delegation Oversight – Passed, on Governor’s desk. This bill outlines

requirements for oversight of Medi-Cal managed care plan subcontractors, including

a definition of subcontractor and specific auditing requirements. The Department of

Finance opposes this bill because it imposes costs not included in the 2019 Budget

Act and could potentially require a rate increase for Medi-Cal managed care plans,

especially those with many subcontractors. Additionally, DHCS already has 221

positions dedicated to its anti-fraud efforts within the Medi-Cal program. These staff

receive fraud complaints and refer them to the Department of Justice when

appropriate, conduct annual audits of all Medi-Cal managed care plans, identify

fraudulent billing practices, investigate allegations of fraud, and perform financial

audits, which can uncover irregularities and potential abuse. Finance believes these

oversight mechanisms and anti-fraud efforts are more cost-effective than requiring

plans to conduct costly audits of all of their subcontractors.

A complete report of the legislative bills signed by Governor Newsom will be provided next month.

COMMUNITY RELATIONS UPDATE

In the last month, GCHP awarded sponsorships to the following organizations:

Boys & Girls Club of Santa Clara Valley: A sponsorship was awarded to the

“Happy Birthday at the Ranch” event. Proceeds go towards providing access to safe

and supervised activities for children in underprivileged communities.

Future Leaders of America: A sponsorship was awarded to the 6th Annual “El

Reencuentro” scholarship event. The event raises funds for a year-round youth

Page 22 of 90

empowerment program held in public schools and communities of Ventura County.

The event recognized students’ achievements in the community. Scholarships were

awarded to students pursuing a higher education.

Hip-Hop Help: In conjunction with the Chief Diversity Officer, a sponsorship was

awarded to Hip-Hop Help. The funds will be used to launch a workshop, which will

teach youth the art of breakdancing. Hip-Hop Help is a community-based

organization that offers opportunities for learning and personal development to youth

through music and language, movement, and the visual arts.

Brain Injury Center: A sponsorship was awarded to the “An Evening of Magical

Memories” 2019 gala. Proceeds go towards counseling services, support groups,

advocacy, and care coordination for brain injury survivors and their families.

Interface Children & Family Services: A sponsorship was awarded to the “Hope

and Light” 2019 gala. Proceeds go towards shelters and advocacy for homeless

youth, victims of human trafficking and domestic abuse, and for trauma counseling

services.

GCHP in the Community The Community Relations team participated in several events in September: Fiestas Patrias Oxnard 2019 Gold Coast Health Plan (GCHP) sponsored the September 15th Fiestas Patrias celebration held at Plaza Park in the City of Oxnard. Every year the event draws several thousand attendees. The GCHP Community Relations (CR) team engaged over 370 community members throughout the day. The team shared information on care management, transportation, member incentives, and member benefit information. GCHP staff also participated in the parade and distributed promotional items to community members watching the parade. Gratitude was expressed from many community members, including a parade goer who exclaimed, “Thank you Gold Coast Health Plan!”

Page 23 of 90

GCHP in the Community

The Oxnard College EXPO held in the City of Oxnard is an event for students to learn about campus and community resources. Over 60 college and high school students stopped by the booth. Ted Bagley, Chief Diversity Officer, also attended the event and shared information about GCHP.

Staff participated in the 4th Annual Preventing Suicide HELP & HOPE Conference held in the City of Moorpark. Various community partners and college students visited the booth and obtain information about GCHP.

Page 24 of 90

Back to School Night Throughout the month of September, the CR team has been participating in back to school nights held in 15 different schools in the City of Oxnard. Thus far, the team has engaged over 830 community members. Below is a summary of the schools the team has attended to-date: Harrington Elementary Back to School Night drew over 90 participants. Over half self-identified as GCHP members.

dss

Curren K-8 Back to School Night drew over 140 participants. This event also served as a resource fair for students and parents. Various community organizations participated in the event such as: Ventura County Behavioral Health, the Boys and Girls Club of Oxnard and Port Hueneme, and the Mixtecto Indigenous Community Organizing Project.

Page 25 of 90

Sierra Linda Elementary Back to School Night drew over 100 participants. Over 70 percent self-identified as GCHP members. Rita Duarte-Weaver, Chair of GCHP’s Community Advisory Committee, also participated at this event as a representative of Ventura County Public Health.

McKinna Elementary Back to School Night drew over 200 participants. Bryan Quijada, Community Relations Specialist, introduced himself to parents and school staff and gave a brief overview of GCHP at the event.

Driffill K-8 Back to School Night drew over 100 participants. Over half self-identified as GCHP members.

Page 26 of 90

Rose Avenue Elementary Back to School Night drew over 185 participants. Over 40 participants self-identified as being GCHP members.

The CR team provided event participants with an overview of who GCHP is, what benefits are available such as: transportation, care management, and member incentives. For those who self-identified as members, the team invited them to attend a Member Benefit Information meeting.

Remainder of page left blank.

Page 27 of 90

COMPLIANCE UPDATE

DHCS Annual Medical Audit:

Audits and Investigation (A&I) conducted the annual medical audit June 3, 2019 through June 7, 2019. Staff received the final report from A&I On September 13, 2019. GCHP is required to respond no later than October 14, 2019. The Plan is working on the CAP responses. The Plan’s goal is to resolve the findings timely.

The Joint Legislative Audit released the final audit report on August 15, 2019. The Audit report has two recommendations:

1) To ensure that the public clearly understands the commission’s decisions, the commissionshould report its reasoning for awarding contracts or the legal basis, if any, for choosing notto do so.

2) To ensure that it addresses any significant performance issues by its contractors in a timelymanner, Gold Coast should establish a process to immediately require contractors to takenecessary corrective action to resolve issues and ensure that they do not recur.

The Plan is required to respond in 60 days, 6 months and 1 year about the steps it took to implement the recommendations that are within statutory authority. The response will include timelines and who or whom is responsible party for implementing the recommendations.

DHCS Contract Amendments:

The draft DHCS contract amendment has included multiple revisions based on CMS review. The contract amendment is still pending approval by CMS and the Plan is pending the final amendment for signature. GCHP has received additional requirements from the Mega Reg via All Plan Letters and has had multiple deliverables due to DHCS to ensure compliance. GCHP is operating under the requirements of the draft amendment as required by DHCS and GCHP is audited by DHCS to those standards.

Page 28 of 90

Delegation Oversight:

Kaiser 2018 Annual Claims Open 9/23/2018 Under CAP

Pending Closure

N/A

Conduent 2018 Annual Claims *Open 6/20/2018 Under CAP Ongoing monitoring imposed

Beacon Health Options

2018 Annual Claims *Open 6/26/2018 Under CAP & Under

Financial Sanctions

Ongoing monitoring imposed


2018 6 month Claims (focused)

audit

*Open 11/21/2018 Under CAP & Under

Financial Sanctions

Ongoing monitoring imposed

Clinicas del Camino

Real, Inc.

2018 Annual Claims Audit

*Open 12/28/2018 Under CAP Ongoing monitoring imposed

Cedars 2019 Annual Credentialing

Open July 11, 2019 Under CAP

Children’s Hospital

2019 Annual Credentialing

Open July 16, 2019 Under CAP

City of Hope 2019 Annual Credentialing

Open June 10, 2019 Under CAP

Optum 2019 Annual Audit (C&L, FWA, HIPAA, UM, Credentialing)

Open March 4, 2019 Under CAP


Call Center Open May 23, 2019 Under CAP

VTS Call Center Open April 26, 2019 Under CAP

CDCR Concurrent UM Quarterly Audit

Closed August 29, 2019 N/A (CAP not issued )

Page 29 of 90

Gold Coast Health Plan (GCHP) is contractually required to perform oversight of all functions delegated through subcontracting arrangements. Oversight includes but is not limited to:

Monitoring/reviewing routine submissions from subcontractors

Conducting onsite audits

Issuing a Corrective Action Plan (CAP) when deficiencies are identified

*Ongoing monitoring denotes delegate is not making progress on a CAP issued and/oraudit results were unsatisfactory and GCHP is required to monitor the delegate closely as itis a risk to the Plan when delegates are unable to comply.

Compliance will continue to monitor all CAP(s) issued. GCHP goal is to ensure compliance is achieved and sustained by our delegates. It is a DHCS requirement for GCHP to hold all delegates accountable. The oversight activities conducted by GCHP is evaluated during the DHCS annual medical audit. DHCS auditors review GCHP’s policies and procedures, audit tools, audit methodology, and review audits conducted and corrective plans issued by GCHP during the audit period. DHCS continues to emphasize the high level of responsibility Plans have in oversight of delegates.

Remainder of page left blank.

Page 30 of 90

NETWORK OPERATIONS

Provider Contracting

Medical Cost Reduction Contract Strategy

-Initiated local market and tertiary hospital rate reduction initiatives and proposals

sent. Rate reductions focused on:

o Movement from 1st dollar to 2nd dollar stop loss payment inclusive of a

definitive per diem rate of payment as opposed to a percentage of billed

charges once the stop loss threshold is met.

o Modifications to reimbursement for high cost drugs.

o Changing percent of charge reimbursement to per diem rates and case rates

for inpatient services and a percentage of the Medi-Cal rate for outpatient

services as applicable.

o Achieving standardized rate structures for community and tertiary providers.

-Initiated local market specialty and specialty tertiary medical group rate reductioninitiatives and proposals sent. This strategy entailed:

o Modifications to standardize rate structures based on each individual

agreement.

- In process of finalizing a capitated outpatient laboratory services agreement with a major

laboratory.

- Development of a DME preferred network in process which will involve a capitated

payment methodology.

New Contracts

- Adventist Simi Valley Hospital

Better Doctor

The Plan continues to meet weekly with Quest Analytics as a touch base to ensure

that the process continues to move smoothly.

We also continue to verify the demographic information obtain from Better Doctor.The following reviews were performed:

Page 31 of 90

- 318 providers were completed and updated in Provider Network Database

(PNDB).

- 322 provider records were audited to ensure the providers were loaded

accurately in PNDB and IKA (GCHP Claims system).

- Below are the YTD updated numbers for the Better Doctor project:

Updated in PNDB: 2,307

Audited for Accuracy: 2,353

Provider Contract Review

- 12 files reviewed for accuracy and system updates.

Provider Contracting and Credentialing Management System (PCCM)

This major system initiative to replace both the Plan’s Network Operations and Credentialing’s legacy data base, was kicked off on April 8th. Regularly scheduled meetings are being held to maximize data conversion and efficiency. It is expected that the system implementation and integration will take 12 months from the date of the kick-off meeting.

PCCM Items Currently In Progress:

Onboarding of contractor resources to support the project. These are budgeted.

Iteration 3 conversion testing

Legacy Provider Database Clean-Up

IT evaluation of testing automation tools

Provider Additions:

August 2019 Provider Additions- 43 Total

Hospitalist 1

Midlevel 8

Primary Care Provider 1

Skilled Nursing Facility 1

Specialist 32

August 2019 Provider Terminations – 33 Total

Midlevel 1

Specialist 32

These provider terminations have no impact on member access and availability.

Page 32 of 90

HUMAN RESOURCES UPDATE

January to July 2019

Period Overall Turnover Total Terminations Average Headcount

Jan- 19 0.54% 1 186.13

Feb- 19 1.08% 2 185.39

Mar- 19 0.53% 1 187.84

Apr- 19 1,06% 2 189.40

May- 19 1.05% 2 190.10

Jun- 19 0.52% 1 193.47

July- 19 2.04% 4 196.06

Aug- 19 1.53% 3 197

Total Terms Reasons

5 Elimination of Position

1 Retirement

6 Resignation

1 Health

1 Misconduct

2 Performance

Work in Progress and Upcoming

Performance Reviews and Merit Reviews August through October 2019

Ongoing culture work and team building to include DiSC Communication Style

workshops

Employee Survey roll out November 2019 to be completed by year end

Benefit Open Enrollment November for January 2020 effective date

Salary Market review with Compensation Plan validation January 2020

RECOMMENDATION:

Accept and File

Page 33 of 90

AGENDA ITEM NO. 4


FROM: Ted Bagley, Interim Chief Diversity Officer


SUBJECT: Chief Diversity Officer Action Item(s)

Action Item for Commission: Decision on status of the CDO role. Any new arrangement will be effective January 2020.

1. Options to continually cover CDO position.

Option #1 – Fill the position with a full time resource. (Not recommended)-Position, at this juncture, does not require a full time resource.

Option #2 – Find another consulting resource to fill position if current arrangement not deemed effective. (Commission/Dale decision)

Option #3 - Continue with the current resource (two days per week with 1 day flex- time, as needed, for exceptional circumstances. My schedule does

allow me to continue based on the current schedule. (Recommended)

Option #4 – Do not backfill the position/have current resources handle any diversity concerns. A viable option for the future, not recommended at this time.

Page 34 of 90

AGENDA ITEM NO. 5


FROM: Kashina Bishop, Chief Financial Officer


SUBJECT: July 2019 Fiscal Year to Date Financials

SUMMARY:

Staff is presenting the attached July 2019 fiscal year-to-date (FYTD) financial statements of Gold Coast Health Plan (“Plan”) for the Commission to accept and file. The Executive / Finance Committee did not review these financials.

BACKGROUND/DISCUSSION:

The staff has prepared the unaudited July 2019 FYTD financial package, including statements of financial position, statement of revenues, expenses and changes in net assets, and statement of cash flows.

FISCAL IMPACT:

FYTD Financial Highlights

Net gain of $17,580; a $474,871 budget variance.

July FYTD net revenue is $67.2 million, $2.4 million higher than budget.

FYTD Cost of health care is $64.4 million, $3.8 million higher than budget.

The medical loss ratio is 95.1% of revenue, which is 2.4% higher than the budget.

The administrative cost ratio is 5.2%, 2.9% lower than budget.

Current membership for July is 195,483.

Tangible Net Equity was $80.2 million which represents approximately 38 days ofoperating expenses in reserve and 244% of the required amount by the State.

Page 35 of 90

Financial Report:

In the month of July 2019, Gold Coast Health Plan is reporting a net gain of $17,580. Impacting the medical expenses this month is 5 provider payment cycles, which historically inflates medical expenses for the month. The overall net results of this were mitigated by lower than budgeted administrative expenses and revenue that is higher than budget due to rate changes and supplemental payments. See income statement categories below for further explanation.

Revenue Base revenue is over budget by $2.4 million. The budget variance is being driven by revised draft capitation rates from the State, and higher than budgeted supplemental payments for Behavioral Health services.

Health Care Costs Health care costs for the month of July were $64.4 million; over budget by $3.8 million.

Notable variances in the month of July were a result of the following:

Approximately $2M of the expense is related to change in estimate for FY 18/19 expense.The service types with the most significant changes in estimate are behavioral and mentalhealth services, physician specialty, and inpatient. It is too early in the fiscal year todetermine if this will impact the projections for the upcoming year, or if the estimate is wasimpacted by the additional provider payment cycle.

Page 36 of 90

Behavioral and mental health utilization has increased significantly in the most recentmonths which could indicate a need to revise per member per month cost expectationsfor the current fiscal year. The budget is $8.16 per member per month and the most recentmonths are between $9-10 per member per month. The increased cost will be partiallyoffset by supplemental payments from the State for Behavioral Health treatment.

Total fee for service health care costs, considering date of service, are over budget by$3.67 pmpm (1.7%).

Note: Medical expenses are considered a significant estimate due to the delay between the time the medical service is provided and when the claim is paid. This is calculated through a

$-

$2.00

$4.00

$6.00

$8.00

$10.00

$12.00

PMPM: Behavorial and Mental Health Services

PAID THROUGH 201907 ESTIMATED COMPLETE

$-

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$150.00

$200.00

$250.00

PMPM: Paid vs Estimated CompleteExcluding capitation and pharmacy

PAID THROUGH 201907 ESTIMATED COMPLETE

Page 37 of 90

predictive model which is referred to as “Incurred But Not Paid” (IBNP), and is a liability on the balance sheet. On the balance sheet, this calculation is a combination of the Incurred But Not Reported and Claims Payable. The total liability is the difference between the estimated costs (the orange line above) and the paid amounts (in grey above).

Administrative Expenses – For the fiscal year to date through July, administrative costs were $3.6 million and $1.8 million below budget. As a percentage of revenue, the administrative cost ratio (or ACR) was 5.2% versus 8.1% for budget.

Cash and Short Term Investment Portfolio – At July 31st, the Plan had $128.9 million in cash and short-term investments. The investment portfolio included Ventura County Investment Pool $42.2 million; LAIF CA State 5.1 million; the portfolio yielded a rate of 2.2%.

Medi-Cal Receivable – At June 30th, the Plan had $70.8 million in Medi-Cal Receivables due from the DHCS.

RECOMMENDATION:

Staff requests that the Commission accept and file the July 2019 financial package.

Page 38 of 90

CONCURRENCE:

N/A

ATTACHMENT:

July 2019 Financial Package

Page 39 of 90

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Page 41 of 90

07/31/19 06/30/19 05/31/19

ASSETS

Current Assets:

Total Cash and Cash Equivalents $ 81,527,919 $ 108,964,312 $ 103,320,380 Total Short-Term Investments 47,389,953 46,961,600 46,833,185Medi-Cal Receivable 70,849,465 69,895,552 76,311,271Interest Receivable 94,905 412,797 445,602Provider Receivable 392,532 1,624,443 387,081Other Receivables 7,826,387 7,826,412 6,781,623Total Accounts Receivable 79,163,289 79,759,203 83,925,576

Total Prepaid Accounts 2,217,433 2,044,070 1,515,926Total Other Current Assets 153,789 153,789 153,789Total Current Assets 210,452,383 237,882,975 235,748,856

Total Fixed Assets 1,644,274 1,667,770 1,652,181

Total Assets 212,096,657$ 239,550,745$ 237,401,037$

LIABILITIES & NET ASSETS

Current Liabilities:

Incurred But Not Reported 54,343,710$ 51,757,912$ 45,779,614$ Claims Payable 12,017,584 19,991,095 28,719,797Capitation Payable 26,080,001 26,002,103 28,922,818Physician Payable 1,523,121 - 3,495,375DHCS - Reserve for Capitation Recoup 11,008,184 11,008,184 3,552,448Accounts Payable 2,578,068 4,257,785 3,700,813Accrued ACS 1,644,258 (1,192) 1,649,251Accrued Provider Reserve 1,700,000 1,995,681 1,995,681Accrued Pharmacy 17,932,152 17,719,988 6,358,316Accrued Expenses 589,744 572,319 7,963,936Accrued Premium Tax - 23,626,246 13,687,065Accrued Payroll Expense 1,336,018 1,291,500 1,316,998Total Current Liabilities 130,752,840 158,221,621 147,142,113

Long-Term Liabilities:Other Long-term Liability-Deferred Rent 1,118,265 1,121,152 1,128,400 Total Long-Term Liabilities 1,118,265 1,121,152 1,128,400

Total Liabilities 131,871,105 159,342,773 148,270,512

Net Assets:Beginning Net Assets 80,207,972 132,115,371 132,115,371Total Increase / (Decrease in Unrestricted Net Assets) 17,580 (51,907,399) (42,984,846)

Total Net Assets 80,225,552 80,207,972 89,130,525

Total Liabilities & Net Assets 212,096,657$ 239,550,745$ 237,401,037$

STATEMENT OF FINANCIAL POSITION

Page 42 of 90

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Page 44 of 90

STATEMENT OF CASH FLOWS July 2019 FYTD 19-20

Cash Flows Provided By Operating Activities

Net Income (Loss) 17,580$ 17,580$ Adjustments to reconciled net income to net cash

provided by operating activitiesDepreciation on fixed assets 23,495 23,495 Amortization of discounts and premium - -

Changes in Operating Assets and Liabilites - Accounts Receivable 595,915 595,915 Prepaid Expenses (173,363) (173,363) Accounts Payable (55,840) (55,840) Claims Payable 6,372,493 6,372,493 MCO Tax liablity (23,626,246) (23,626,246) IBNR 2,585,798 2,585,798

Net Cash Provided by (Used in) Operating Activities (14,260,168) (14,260,168)

Cash Flow Provided By Investing ActivitiesProceeds from Restricted Cash & Other AssetsProceeds from Investments - - Proceeds for Sales of Property, Plant and Equipment - Payments for Restricted Cash and Other Assets - Purchase of Investments plus Interest reinvested (395,712) (395,712) Purchase of Property and Equipment - -

Net Cash (Used In) Provided by Investing Activities (395,712) (395,712)

Increase/(Decrease) in Cash and Cash Equivalents (14,655,880) (14,655,880) Cash and Cash Equivalents, Beginning of Period 136,859,971 136,859,971 Cash and Cash Equivalents, End of Period 122,204,091$ 122,204,091$

Page 45 of 90

To:

From:

Date:

RE:

AGENDA ITEM NO. 6

Ventura County Medi-Cal Managed Care Commission

Nancy Wharfield, MD, Chief Medical Officer

September 23, 2019

Chief Medical Officer Update

Community Health Needs Assessment (CHNA) Implementation Planning Session

On September 13th, 2019, GCHP hosted a whole day strategic planning session for the

Community Health Needs Assessment (CHNA) Collaborative. Participants included the VC

Public Health Department (VCPH), area hospitals, healthcare providers, and health systems

from across the county to improve food insecurity and care coordination for social needs.

The CHNA continues to develop a fully integrated Community Health

Improvement/Implementation Plan (CHIP) that aligns with the identified health priorities of

the county, with an emphasis on achieving health equity. GCHP has been an active

participant and member of the CHNA leadership committee since August 2018. This

collaborative has provided an effective platform for GCHP to advocate for member needs,

identify shared goals, and support the work of our community partners.

On October 17, 2019, the collaborative will reconvene and continue discussions regarding

implementation strategy and data sharing opportunities to improve population health

outcomes.

Page 46 of 90

Influenza Vaccine 2019

The CDC recommends everyone 6 months of age and older should get a flu vaccine every

season. Vaccination is particularly important for people who are at high risk of serious

complications from influenza (young children, older adults, pregnant women, and those with

certain chronic diseases or immunocompromised).

Flu vaccination can reduce flu illnesses, doctors’ visits, and missed work and school due to

flu, as well as prevent flu-related hospitalizations. A 2017 study showed flu vaccine has been

shown to be life-saving in children.

It takes about two weeks after vaccination for antibodies that protect against flu to develop in

the body. CDC recommends that people get a flu vaccine by the end of October. Getting

vaccinated later, however, can still be beneficial and vaccination should continue to be

offered throughout the flu season, even into January or later. Children who need two doses

of vaccine to be protected should start the vaccination process sooner, because the two

doses must be given at least four weeks apart.

GCHP will use its communications channels to encourage our members to obtain flu shots

early in the season.

Behavioral Health Follow Up

Accessing Appointments

Behavioral health and medication management services under GCHP benefit structure do

not require prior authorization and all members can self-refer to counseling and medication

management services through FQHCs with integrated behavioral health services or other

Beacon Health Options providers. Members may call Beacon’s Call Center at 1-855-765-

9702 for assistance with finding a provider or getting an appointment. Beacon’s 24/7 staff

will screen for need and provide resources and/or make referrals to the local Beacon onsite

Care Managers, which are collocated with the GCHP Health Services staff. Both the Call

Center staff and local Care Management staff can assist with access concerns if requested.

Analysis of access and availability of emergent, urgent, and routine appointments is

performed quarterly. Results from Q1 and Q2 showed 100% compliance for urgent

appointments (48-hour target) and a 2 quarter average of 91% compliance for routine

appointments (10 business days). There were no requests for emergent appointments (6-

hour target).

Utilization

Beacon provides utilization reports at the quarterly GCHP Utilization Management

Committee (UMC). This report examines clinical utilization by age, race, language and

gender. Highlights of utilization data are shown below. While there are disparities in Spanish

Page 47 of 90

speaking services, there has been steady improvement over time. This is an area that we

will focus future efforts and reporting on.

Translation Services

Beacon will be educating providers about available translation services for members who

need language assistance. This communication scheduled to be delivered this month will

stress that providers should never request members bring their own interpreter.

Page 48 of 90

Key M

easu

res

Measu

re

1.

The p

erc

enta

ge o

f m

em

bers

requesting n

on-life-t

hre

ate

nin

g

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erg

ent behavio

ral health c

are

appoin

tment w

ho a

re a

ble

to s

ee a

pro

vid

er

within

6 h

ours

of

request

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D%

ND

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D%

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era

ll100%

00

0.0

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%

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rescriber

100%

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%

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scriber

100%

00

0.0

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%

2.T

he p

erc

enta

ge o

f m

em

bers

requesting U

rgent appoin

tment and

are

able

to s

ee a

pro

vid

er

within

48

hours

of

request

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era

ll100%

11

100.0

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2100.0

%

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rescriber

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11

100.0

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%

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scriber

100%

00

0.0

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1100.0

%

3.

The p

erc

enta

ge o

f m

em

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requesting R

outine a

ppoin

tment

and a

re a

ble

to s

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pro

vid

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within

10 b

usin

ess d

ays o

f re

quest.

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38

43

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71

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%

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%

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scriber

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00

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13

100.0

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Be

aco

n H

ea

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Pla

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Q2

20

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al:

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im

pro

ve

me

mb

er

acce

ssib

ility

to

me

dic

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avio

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are

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orm

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019

Q1

Q2

Q3

Q4

Page 49 of 90

9

Q1

2019

Pen

etra

tion

by L

angu

age

2.48

%

0.80

%

1.57

%

0.43

%

0.32

%

1.31

%

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%

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Pen

etra

tion

rate

Eng

lish

Span

ish

Taga

log

Viet

nam

ese

No

valid

dat

a re

porte

dO

ther

All L

angu

ages

Page 50 of 90

22

GC

HP

MH

Ser

vice

Util

izat

ion

Sum

mar

y by

Age

Ban

d, Q

1 20

19

Age

Ban

dU

niqu

e U

tiliz

ers

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trat

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%U

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Uni

ts/U

U

Ther

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0-5

108

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25.

11

6-17

1276

2.06

%66

645.

22

18-2

555

72.

20%

2866

5.15

25+

2184

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%11

611

5.32

ALL

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Psy

ch T

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LL

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Man

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ALL

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25+

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%13

794

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ALL

5243

2.48

%24

543

4.68

Page 51 of 90

23

GC

HP

MH

Ser

vice

Util

izat

ion

Sum

mar

y by

Gen

der –

Q1

2019

Gen

der

Uni

que

Util

izer

sPe

netr

atio

n%

Uni

tsU

nits

/UU

Ther

apy

Fem

ale

2694

2.40

%14

196

5.27

Mal

e14

311.

45%

7497

5.24

ALL

4125

1.96

%21

693

5.26

Psy

ch T

estin

gFe

mal

eM

ale

ALL

Med

Man

agem

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1.77

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1632

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%28

501.

75

ALL

Fem

ale

3349

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923

4.75

Mal

e18

941.

92%

8620

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ALL

5243

2.48

%24

543

4.68

Page 52 of 90

24

Q1

2019

MH

Util

izat

ion

by R

ace

Rac

eSe

rvic

eU

niqu

eU

tiliz

erPe

netr

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n %

Uni

tsU

nits

UU

Bla

ck

Ther

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671.

93%

322

4.81

Psy

ch T

estin

gM

ed M

anag

emen

t38

1.09

%67

1.76

All

Ser

vice

s90

2.59

%38

94.

32

Whi

te

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605.

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sych

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ting

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agem

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85A

ll S

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2011

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pani

c

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89A

ll S

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%31

714.

64

Page 53 of 90

25

Q1

2019

MH

Util

izat

ion

by L

angu

age

Lang

uage

Serv

ice

Uni

que

Util

izer

Pene

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nits

Uni

ts U

U

Eng

lish

Ther

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3253

2.46

%18

040

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08%

2560

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All

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s42

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20%

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5.68

Page 54 of 90

Hepatitis C Update

About 3 million people in the United States have hepatitis C and many do not even know they

have this blood born virus which can cause liver damage and liver failure. Gold Coast Health

Plan (GCHP) currently has about 35 members per month undergoing treatment for hepatitis

C. The number of cases in the United States has continued to rise since 2010 and is

commonly associated with intravenous drug use. There is no vaccine for hepatitis C.

Early attempts at anti-viral treatment with poor response rates in the 1990’s have evolved

into genotype specific therapies for hepatitis C treatments with excellent response rates since

2014 – 2015.

Since 2017, most GCHP members have been treated with Mavyret, an anti-viral agent that

is extremely effective against all hepatitis C genotypes and has a short duration of treatment

that is well tolerated. Mavyret is the most cost effective hepatitis C therapy available. On

August 28, 2019, the Food and Drug Administration released a warning that Mavyret and

other hepatitis C drugs may cause liver injury when prescribed to patients with moderate to

severe liver damage. These agents are still recommended for patients with normal liver

function or minimal liver damage. GCHP will reinforce appropriate prescribing protocols with

providers and will monitor effects on pharmacy costs.

Pharmacy Benefit Performance and Trends

SUMMARY: Pharmacy utilization data is compiled from multiple sources including the pharmacy benefits manager (PBM) monthly reports, GCHP’s ASO operational membership counts, and invoice data. The data shown is through the end of July 2019. Although minor changes may occur to the data going forward due to the potential of claim adjustments from audits and/or member reimbursement requests, the data is generally considered complete due to point of sale processing of pharmacy data.

Abbreviation Key: PMPM: Per member per month PUPM: Per utilizer per month GDR: Generic dispensing rate COHS: County Organized Health System KPI: Key Performance indicators RxPMPM: Prescriptions per member per month

Page 55 of 90

PHARMACY COST TRENDS:

0

10,000

20,000

30,000

40,000

50,000

60,000

$-

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

Dolla

rs in T

housands

Total Cost vs. Utilizing Members

Total Cost (in thousands) Utilizing Members

0%

5%

10%

15%

20%

25%

30%

$-

$10.00

$20.00

$30.00

$40.00

$50.00

$60.00

$70.00

PMPM vs. Utilizing Percent

PMPM Utilizing Percent

Page 56 of 90

*Claim totals prior to June 2017 are adjusted to reflect net claims.

PAID PER PRESCRIPTION:

70%

75%

80%

85%

90%

95%

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Total Claims vs. GDR

Net Claims GDR

$-

$100

$200

$300

$400

$500

$600

$700

Dollars Paid Per Prescriptions

Paid/Rx Paid/Generic Rx Paid/Brand Rx

Page 57 of 90

PRESCRIPTIONS PER MEMBER PER MONTH:

*Calculation reflects net claims.

PBM OVERSIGHT:

Pharmacy Monitoring:

Issue Type Number of Pharmacies

CA Board of Pharmacy Disciplinary Actions – Pending 0

CA Board of Pharmacy Disciplinary Actions – License Revoked 0

CA Board of Pharmacy Disciplinary Actions – Probation 3

OptumRx Audits – Ongoing 0

DEA Investigations 1

340B DRUG DISCOUNT PROGRAM

Clinicas del Camino Real (CDCR) and GCHP continue to have discussions regarding the proposed 340B compliance contract GCHP provided to CDCR in early 2018. This is affected by a pending release of a DHCS All Plan Letter (APL) regarding 340B program oversight requirements for managed care plans (MCPs).

0.60

0.64

0.68

0.72

0.76

0.80

June August October December February April

Prescriptions Per Member Per Month

2015-2016 2016-2017 2017-2018

2018-2019 2019-2020 Linear (2015-2016)

Linear (2016-2017) Linear (2017-2018) Linear (2018-2019)

Page 58 of 90

ONGOING PHARMACY INITIATIVES

Clinical Programs: Gold Coast Health Plan has selected the following clinical programs offered by OptumRx:

Programs Modules Start Date Notes Retrospective Drug Utilization Review (RDUR)

Safe and AppropriateUtilization

Gaps in Care

10/1/2018 Program will end on9/30/2019

Opioid Risk Management

Retrospective DrugUtilization Review (RDUR)

Intensive CaseManagement

10/1/2018 Program will end on9/30/2019

Adherence Antidepressant Drug Class Est. 1/1/2020 Aligns with new MCASmeasure

Provider Relations: Gold Coast Health Plan is reaching out to provider offices in the following mechanisms in order to facilitate more efficient PBM communications for provider offices:

Provider Survey on PBM Functions

GCHP Pharmacy Staff Provider Office Visitso Office visits continue for August and September

Page 59 of 90

AGENDA ITEM NO. 7


FROM: Ted Bagley, Interim Chief Diversity Officer


SUBJECT: Chief Diversity Officer Update

Monthly Actions:

Community Relations

1. Met with Thousand Oaks Chamber to review Diversity Videos for future Lunch and

Learn series.

2. Met with Diversity Council to review manager’s work guide and to discuss Adopt-A-

School Process.

3. Bi-weekly update meeting with Dale Vallini, CEO, to discuss items of

interest/concerns.

4. Attended two diversity symposiums in the area during the month.

5. Attended Boys’ and Girls’ Club event at Limoneira Ranch

Case Investigations - No new cases to date through the hot line or otherwise. Discussions held with several employees on career direction, coaching and mentoring subjects.

Employee behavior( supervisors/Managers) Career focus (Employee) Community involvement (Employee) Personal branding (Employee/Managers) Education (Employee) Appraisal delivery (Managers)

In lieu of training, conduct a one hour open discussion on diversity, direction and opportunity with the Commission. Discussion would focus around trends, statistics, and results. Discussion could take place at the end of the proceedings or after closed session.

Page 60 of 90

APPENDIX

Page 61 of 90

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nd

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st ..

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OF

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AR

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Sep

tem

ber

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etw

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up

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ces

DSS

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ldch

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rg

Page 62 of 90

Inp

atie

nt

Uti

lizat

ion

an

d C

ost

Page 63 of 90

Inp

atie

nt

Uti

lizat

ion

an

d C

ost

(co

nt’

d)

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gen

cy D

epar

tmen

t U

tiliz

atio

n a

nd

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st

Page 64 of 90

Elig

ible

Me

mb

ersh

ip

Page 65 of 90

Cal

l Cen

ter

KP

I Das

hb

oar

d

5,46

24,

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Page 66 of 90

Cla

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Inpa

tient

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8

Hom

e an

d Co

mm

unity

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ed S

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Hos

pice

Ser

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s

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9

Hom

e an

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mm

unity

Bas

ed S

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ces -

Oth

er

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- Sp

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Hom

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17-1

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18-1

9

FQHC

- Pr

imar

y Ca

re P

hysic

ian

17-1

8

18-1

9

Page 71 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

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18-1

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Oth

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Out

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Inpa

tient

17-1

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18-1

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Lab

and

Radi

olog

y

17-1

8

18-1

9

Page 72 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

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Uni

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Tran

spor

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17-1

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Spec

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Phy

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Phar

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Prim

ary

Care

Phy

sicia

n

17-1

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18-1

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Phar

mac

y

18-1

9

Page 73 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

203,

624

205,

465

205,

440

204,

966

203,

355

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200,

240

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ge >

10%

Paid

Thr

esho

ld >

200

K

Serv

icin

g Pr

ovid

er S

peci

alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

hang

e fr

om P

rior 1

2 M

onth

s

Uni

ts1

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Ambu

lato

ry su

rgic

al c

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r

17-1

8

Ambu

lanc

e se

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e su

pplie

r

17-1

8

18-1

9

All o

ther

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liers

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mun

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Mem

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17-1

8

18-1

9

Alte

rnat

ive

Med

icin

e

17-1

8

18-1

9

Page 74 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

203,

624

205,

465

205,

440

204,

966

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2,433,079

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2,372,162

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ge >

10%

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esho

ld >

200

K

Serv

icin

g Pr

ovid

er S

peci

alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

hang

e fr

om P

rior 1

2 M

onth

s

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hip

Addi

ctio

n m

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17-1

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Uni

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6.9%

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0.58

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2.92

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349

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Uni

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Uni

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$57

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$67

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$66

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3,55

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3,87

93,

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7,12

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3,75

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8,88

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7,91

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8,56

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0,28

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1.08

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1.58

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Uni

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Uni

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Card

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17-1

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18-1

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Cert

ified

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ical

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r

17-1

8

18-1

9

Anes

thes

iolo

gy

17-1

8

18-1

9

Page 75 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

203,

624

205,

465

205,

440

204,

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ge >

10%

Paid

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esho

ld >

200

K

Serv

icin

g Pr

ovid

er S

peci

alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

hang

e fr

om P

rior 1

2 M

onth

s

Mem

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hip

Addi

ctio

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Cert

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18-1

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Chiro

prac

tic

17-1

8

18-1

9

Page 76 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

203,

624

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465

205,

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Paid

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esho

ld >

200

K

Serv

icin

g Pr

ovid

er S

peci

alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

hang

e fr

om P

rior 1

2 M

onth

s

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Addi

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3.72

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3,87

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4,12

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2,33

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3,14

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0,09

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18-1

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Page 77 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

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Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

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% C

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17-1

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18-1

9

Page 78 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

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Jun

Jul

Aug

Sep

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Dec

Jan

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% C

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18-1

9

Page 79 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

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Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

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% C

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Inte

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ting

Faci

lity

(IDTF

)

17-1

8

18-1

9

Hosp

ice

18-1

9

Page 80 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

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Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

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Mar

Apr

May

% C

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e fr

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ith re

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tory

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apist

17-1

8

Med

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supp

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r DM

ERC

17-1

8

18-1

9

Med

ical

supp

ly c

ompa

ny w

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pros

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Med

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17-1

8

18-1

9

Lice

nsed

clin

ical

soci

al w

orke

r

17-1

8

18-1

9

Page 81 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

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K

Serv

icin

g Pr

ovid

er S

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alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

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e fr

om P

rior 1

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or g

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e

17-1

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18-1

9

Page 82 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

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ovid

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Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

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13,4

14.0

0$

11,2

68.0

0$

16,6

09.0

0$

13,0

28.0

0$

9,41

0.00

$9,

496.

00$

7,11

8.00

$13

,017

.00

$14

,731

.00

$14

,918

.00

$15

5,73

8.00

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id/M

embe

r0.

09$

0.08

$0.

07$

0.06

$0.

08$

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05$

0.05

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0.07

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-20.

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nits

/Mem

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0.00

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160.

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0.00

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126.

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id/U

nit

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49.9

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41.1

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41.4

3$

51.2

6$

56.8

9$

56.0

1$

51.8

9$

48.0

9$

77.0

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70.8

2$

78.9

3$

54.9

1$

-25.

8%

Occ

upat

iona

l the

rapi

st (i

ndep

ende

ntly

pra

ctic

ing)

17-1

8

18-1

9

Nur

sing

faci

lity,

oth

er

17-1

8

18-1

9

Obs

tetr

ics/

gyne

colo

gy

17-1

8

18-1

9

Nur

se p

ract

ition

er

17-1

8

18-1

9

Nur

se, N

on P

ract

ition

er

17-1

8

18-1

9

Neu

rosu

rger

y

18-1

9

Nuc

lear

med

icin

e

17-1

8

18-1

9

Page 83 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

203,

624

205,

465

205,

440

204,

966

203,

355

204,

140

200,

240

200,

870

200,

276

200,

166

200,

387

2,433,079

Chan

ge <

018

-19

199,

668

198,

662

198,

672

198,

222

197,

659

198,

207

197,

567

196,

859

196,

802

196,

046

196,

768

197,

030

2,372,162

Chan

ge >

10%

Paid

Thr

esho

ld >

200

K

Serv

icin

g Pr

ovid

er S

peci

alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

hang

e fr

om P

rior 1

2 M

onth

s

Mem

bers

hip

Addi

ctio

n m

edic

ine

17-1

8

Uni

ts2

1-

11

21

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Paid

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$31

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00$

Paid

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ber

0.01

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610.

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0$

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31.0

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nits

11

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15

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5.1%

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$30

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9.50

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$31

.00

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.00

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9.8%

Uni

ts2,

825

2,61

23,

157

2,61

52,

892

2,85

62,

222

2,93

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703

2,68

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795

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733

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719.

00$

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866.

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00$

267,

394.

00$

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00$

299,

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00$

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487.

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258,

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261,

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00$

281,

432.

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3,41

9,64

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id/M

embe

r1.

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1.44

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43$

1.30

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37$

1.47

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24$

1.68

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29$

1.31

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1.48

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41$

Uni

ts/M

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r0.

0138

0.01

280.

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/Uni

t10

4.68

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2.51

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4.77

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4.08

$11

4.81

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$97

.55

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0.69

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2.72

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nits

2,73

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795

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719

2,67

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751

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808

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42Pa

id28

6,50

5.00

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1,73

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8,26

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$29

7,87

6.00

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2,95

7.00

$32

9,60

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2,39

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7,15

8.00

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1.00

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7.00

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Paid

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1.43

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1.60

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1.53

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76$

1.65

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65$

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85$

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0.01

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380.

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2.4%

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4.64

$13

9.35

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0.43

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3.52

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4.82

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7.93

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4.13

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7.68

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1.14

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7.88

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9.81

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8.71

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Uni

ts25

325

724

225

533

219

028

844

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236

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1,60

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00$

1,60

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.00

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,271

.00

$16

,755

.00

$26

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.00

$17

,133

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,457

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8,52

3.00

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id/M

embe

r0.

01$

0.01

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01$

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01$

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06$

0.13

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08$

0.13

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09$

0.10

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05$

Uni

ts/M

embe

r0.

0012

0.00

130.

0012

0.00

120.

0016

0.00

090.

0014

0.00

220.

0016

0.00

210.

0018

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270.

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Paid

/Uni

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33$

5.95

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26$

8.34

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83$

4.91

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.03

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$63

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.20

$36

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nits

562

609

582

560

705

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547

544

514

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id18

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$13

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$28

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.00

$20

,120

.00

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.00

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1,34

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id/M

embe

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0.09

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12$

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09$

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84.6

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nits

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0.00

280.

0031

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2874

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Paid

/Uni

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$36

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0%U

nits

15

51

105

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31

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id-

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6.00

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389.

00$

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6,31

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772.

00$

4,49

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id/M

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r-

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id/U

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-$

107.

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1,07

7.80

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7.00

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1.60

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9.00

$75

4.40

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498.

00$

557.

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Uni

ts2

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82

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45

6-

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00$

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5,72

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8.00

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489.

00$

153,

886.

00$

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id/M

embe

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0.03

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10$

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nits

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0.00

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0028

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Paid

/Uni

t75

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$71

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63$

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0$

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00$

204.

50$

497.

80$

25,6

47.6

7$

-$

293.

17$

3,69

8.90

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3.2%

Uni

ts1,

338

1,39

61,

553

1,29

61,

581

1,62

31,

303

1,56

01,

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1,59

21,

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918

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Paid

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747.

00$

331,

040.

00$

237,

025.

00$

402,

182.

00$

409,

686.

00$

403,

916.

00$

321,

595.

00$

306,

018.

00$

354,

476.

00$

303,

764.

00$

652,

610.

00$

389,

874.

00$

4,51

6,93

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id/M

embe

r1.

98$

1.63

$1.

15$

1.96

$2.

00$

1.99

$1.

58$

1.53

$1.

76$

1.52

$3.

26$

1.95

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86$

Uni

ts/M

embe

r0.

0066

0.00

690.

0076

0.00

630.

0077

0.00

800.

0064

0.00

780.

0074

0.00

790.

0089

0.00

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0076

Paid

/Uni

t30

2.50

$23

7.13

$15

2.62

$31

0.33

$25

9.13

$24

8.87

$24

6.81

$19

6.17

$23

8.70

$19

0.81

$36

6.22

$20

3.17

$24

5.11

$U

nits

1,84

21,

852

2,00

41,

857

2,12

21,

979

1,64

92,

091

1,75

11,

873

1,94

91,

688

22,6

57Pa

id29

4,84

6.00

$62

2,49

5.00

$43

3,68

6.00

$30

2,41

7.00

$38

8,50

9.00

$38

4,16

0.00

$31

0,85

6.00

$44

1,91

3.00

$29

9,55

3.00

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9,45

3.00

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5,91

6.00

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979,

962.

00$

Paid

/Mem

ber

1.48

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13$

2.18

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53$

1.97

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94$

1.57

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24$

1.52

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70$

3.13

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81$

2.10

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Uni

ts/M

embe

r0.

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0.00

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0101

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0.00

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26.1

%Pa

id/U

nit

160.

07$

336.

12$

216.

41$

162.

85$

183.

09$

194.

12$

188.

51$

211.

34$

171.

08$

282.

68$

316.

14$

210.

85$

219.

80$

-10.

3%U

nits

155

4-

35

11

34

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5.00

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00$

-$

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0$

309.

00$

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0$

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0$

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6.00

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00$

0.00

$-

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00$

0.00

$-

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00$

0.00

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id/U

nit

7.00

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00$

-$

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11.3

3$

61.8

0$

-$

-$

5.67

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.25

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00$

12.0

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Uni

ts4

28

67

96

13

41

556

Paid

6.00

$20

.00

$26

5.00

$20

.00

$27

2.00

$40

5.00

$43

.00

$12

.00

$38

.00

$17

2.00

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$29

3.00

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546.

00$

Paid

/Mem

ber

0.00

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00$

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00$

0.00

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00$

0.00

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00$

-$

0.00

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00$

199.

8%U

nits

/Mem

ber

0.00

000.

0000

0.00

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0000

0.00

000.

0000

0.00

000.

0000

0.00

000.

0000

0.00

000.

0000

0.00

0030

.5%

Paid

/Uni

t1.

50$

10.0

0$

33.1

3$

3.33

$38

.86

$45

.00

$7.

17$

12.0

0$

12.6

7$

43.0

0$

-$

58.6

0$

27.6

1$

129.

6%U

nits

741

654

867

712

867

829

558

644

685

756

709

1,10

59,

127

Paid

296,

108.

00$

366,

679.

00$

234,

785.

00$

617,

648.

00$

227,

282.

00$

161,

525.

00$

85,4

97.0

0$

279,

382.

00$

229,

980.

00$

112,

624.

00$

219,

028.

00$

171,

648.

00$

3,00

2,18

6.00

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id/M

embe

r1.

45$

1.80

$1.

14$

3.01

$1.

11$

0.79

$0.

42$

1.40

$1.

14$

0.56

$1.

09$

0.86

$1.

23$

Ost

eopa

thic

man

ipul

ativ

e th

erap

y

17-1

8

18-1

9

Oto

lary

ngol

ogy

17-1

8

Ora

l Sur

gery

(den

tists

onl

y)

17-1

8

18-1

9

Ort

hope

dic

surg

ery

17-1

8

18-1

9

Oph

thal

mol

ogy

17-1

8

18-1

9

Opt

omet

rist

17-1

8

18-1

9

Ocu

laris

t

17-1

8

18-1

9

Page 84 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

203,

624

205,

465

205,

440

204,

966

203,

355

204,

140

200,

240

200,

870

200,

276

200,

166

200,

387

2,433,079

Chan

ge <

018

-19

199,

668

198,

662

198,

672

198,

222

197,

659

198,

207

197,

567

196,

859

196,

802

196,

046

196,

768

197,

030

2,372,162

Chan

ge >

10%

Paid

Thr

esho

ld >

200

K

Serv

icin

g Pr

ovid

er S

peci

alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

hang

e fr

om P

rior 1

2 M

onth

s

Mem

bers

hip

Addi

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Phys

ical

med

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d re

habi

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ion

17-1

8

18-1

9

Phys

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ther

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(ind

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ract

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17-1

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Pedi

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Pain

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Path

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17-1

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18-1

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Oto

lary

ngol

ogy

17-1

8

18-1

9

Page 85 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

203,

624

205,

465

205,

440

204,

966

203,

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140

200,

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200,

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200,

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166

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387

2,433,079

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199,

668

198,

662

198,

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198,

222

197,

659

198,

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Chan

ge >

10%

Paid

Thr

esho

ld >

200

K

Serv

icin

g Pr

ovid

er S

peci

alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

hang

e fr

om P

rior 1

2 M

onth

s

Mem

bers

hip

Addi

ctio

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208.

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179.

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125.

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Uni

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690.

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Paid

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1,48

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1,31

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Uni

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ts5

44

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Uni

ts17

1916

1221

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7834

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ts/M

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Prev

entiv

e m

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ine

17-1

8

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9

Psyc

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ty

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able

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ay su

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Phys

icia

n as

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nt

17-1

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Plas

tic a

nd re

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tive

surg

ery

17-1

8

18-1

9

Phys

ical

ther

apist

(ind

epen

dent

ly p

ract

icin

g)

18-1

9

Page 86 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

150

203,

624

205,

465

205,

440

204,

966

203,

355

204,

140

200,

240

200,

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200,

276

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166

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387

2,433,079

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ge <

018

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199,

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198,

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198,

672

198,

222

197,

659

198,

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196,

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2,372,162

Chan

ge >

10%

Paid

Thr

esho

ld >

200

K

Serv

icin

g Pr

ovid

er S

peci

alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

hang

e fr

om P

rior 1

2 M

onth

s

Mem

bers

hip

Addi

ctio

n m

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17-1

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2635

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3943

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Paid

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Reha

bilit

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n Ag

ency

17-1

8

Radi

atio

n on

colo

gy

17-1

8

18-1

9

Radi

atio

n Th

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y Ce

nter

17-1

8

18-1

9

Publ

ic h

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or w

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18-1

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pend

ently

)

17-1

8

18-1

9

Psyc

h/M

enta

l Hea

lth F

acili

ty

18-1

9

Page 87 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

:17

-18

204,

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624

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10%

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K

Serv

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g Pr

ovid

er S

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alty

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

% C

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e fr

om P

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2 M

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s

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17-1

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Spee

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Path

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18-1

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Reha

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atio

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nter

17-1

8

18-1

9

Page 88 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

ent c

ycle

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Jun

Jul

Aug

Sep

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Jan

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% C

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6,48

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1,13

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17-1

8

18-1

9

Page 89 of 90

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

TOTA

LIn

the

mos

t rec

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ycle

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Sep

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% C

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Uro

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17-1

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18-1

9

Page 90 of 90

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