ALAMEDA ALLIANCE FOR HEALTH
BOARD OF GOVERNORS MEETING/STRATEGIC PLANNING RETREAT
January 17, 2008, 9:30 a.m.
Sequoia Country Club
Oakland, CA

SUMMARY OF PROCEEDINGS
Present: Excused: Unexcused:
Ingrid Lamirault
Jane Garcia (Chair)
Michael Mahoney (Vice-Chair)
Ray Davis, Jr. MD
Pamela Gumbs
Wright Lassiter
Marty Lynch
John Norton
Linda Price
Gail Steele
Richard Thomason
  Pamela


Agenda Item (& Supporting Documents) Speaker Discussion Highlights Action Follow-Up Required
Call to Order Jane Garcia Meeting was called to order at 9:35 a.m. by Jane Garcia. A quorum of the members was present. None None
Approval of Agenda
Attachment
1.17.08 Agenda
Jane Garcia J. Garcia asked for a motion to accept this month's agenda. Motion: L. Price
Second: R. Davis
Vote: Unanimouss
None
Approval of November Meeting Minutes
Attachment
11.29.07 Meeting Minutes
Jane Garcia J. Garcia asked for a motion accepting the November meeting minutes. Motion: M. Lynch
Second: W. Lassiter
Vote: Unanimous
None
Chair’s Report Jane Garcia The Chair summarized the single action taken during the 11-29-07 Closed Session meeting/ Approval of PRCC recommendations for provider credentialing. None None
CEO’s Report
Six Attachment
o CEO Report
o 2007 HEDIS Rates
o IPs 2007 HEDIS
o Provider Bulletin August
o Provider Bulletin October
o Provider Bulletin November/December
I. Lamirault   None None
Finance Committee
Attachment
12.31.07 Financial Report
John Volkober Financial report for month ended December 31, 2007. J. Garcia asked for a motion accepting the December's financial statements. Motion: M. Lynch
Second: G. Steele
Vote: Unanimous
 
Overview of State Challenges Jim Gross
Peter Harbage
     
Adjourned for Break Jane Garcia A break was taken at 11:20 a.m. None None
Readjourned from Break Jane Garcia Meeting was resumed at 11:35 a.m. None None
Strategic Planning Meeting
Medi-Cal
I. Lamirault • Modest membership growth
• At best, we will see no increase premium revenue; more likely to receive a decrease in premiums
• Rising medical expense: prescription drugs; inpatient services
• Will break even this fiscal year
• Losses next year $5-$7 million range
• Last year, we were encouraged by the State’s implementation of the new premium setting methodology. Believed there was now rationality in the process and that we could make a case for a rate increase.
• Although State still kept latitude to set actuarially sound rates within a range, if we could show increased utilization and cost for our market, we could at least get the lower end of the range.
• We submitted our documentation in December – making a compelling case for 10% increase ($13.2 million given current member mix). If the State sticks to its stated process, we will be meeting with them in February to make a verbal case.
------ • Finance Committee review feasibility of obtaining a line of credit to ensure cash flow.
• Staff prepare a resolution for Board review and approval outlining a contract reimbursement policy to guide staff negotiations over the next 6-12 months.
• If we were in normal times and the State kept its commitment for actuarially sound rates based on utilization, the Medi-Cal fee schedule, and unique cost pressures associated with the Bay Area, I am convinced that we would get some type of modest rate increase.
• Page 7 summarizes our current and projected position for Medi-Cal only:
Fiscal 07-08Fiscal 08-09
Revenue$131.8$134.0
Medical Expense120.1128.4
Gross Margin11.75.7
Administrative Expense11.712.1
Net Income - Current0.0(6.5)
Prior Period Medical Expense1.50.0
Net Income/(Loss)$1.5($6.5)
• In addition to the Governor’s proposed rate cut, the Director of Medi-Cal Managed Care also informed us that we can expect delays in capitation payments in August because the State will be having cash flow problems. Some say that this type of delay may occur for longer than a month and/or may happen throughout the year.
Critical Issue
• We will not have enough cash to handle anticipated and anticipated delayed payments and provide provider rate increases for Medi-Cal. For providers, vendors, and payroll, we spend approximately $12-$13 million a month. We currently have $25 million in reserves.
• As a body we need to agree that increases for Medi-Cal services are impossible to give to providers over the next year, maybe two. We need to be clear about the implications of this decision (shrinkage of provider network, providers having to shut down to new patients to make their patient mix more profitable; access problems for members).
• Review current Board-approved policy that shapes our negotiations with providers and see if there is agreement for a temporary tightening of the parameters. If our discussion takes the shape of some type of consensus, we will prepare a Board resolution for our March meeting. Current Board-approved policy includes:
Hospitals: 100% CMAC levels; increases provided upon notice to plan once CMAC grants a hospital FFS rate increase
Directly Contracted PCPs: 110% Medi-Cal FFS rates
Specialists: Most at 100% Medi-Cal FFS or Medicare equivalent; harder to access specialists are paid at higher rates
Medical Groups: No Board policy
Chief Medical Officer’s Report
Attachment
Formulary Updates
A. Chen, MD J. Garcia asked for a vote to accept the proposed changes on the December 2007 Forumulary Changes. Motion: M. Lynch
Second: L. Price
Vote: Unanimous
 
Other Business J. Garcia None None None
Public Comments J. Garcia None None None
Set Next Meeting Date
The next meeting will be held pm Thursday, March 27, 2008. M. Lynch asked that members be polled regarding changing the date.

Adjournment
The meeting was adjourned at 12:04 p.m.

Respectfully Submitted By:
Ingrid Lamirault, Secretary/Treasurer of the Board and CEO