| AGENDA ITEM |
SPEAKER |
DISCUSSION HIGHLIGHTS |
ACTION |
FOLLOW UP |
| 3. CHAIRS'S REPORT |
|
Report on January 25, 2007 Closed Session
|
M. Mahoney
|
Chair's Report on the Thursday, January 25, 2007 Closed Session:
- Dr. Art Chen provided an overview of the recommendations of the Peer Review and Credentialing Committee (PRCC) from the January 16, 2007 PRCC meeting. The Board unanimously approved PRCC's recommendations for Initial Credentialing and Recredentialing.
- Ingrid Lamirault and Mark Roche, Sr. Director of HR & Facilities, described the current status of pay and benefits that Alliance employees receive. Scott Anderson, Charles Sterling, and John Zervakos of Mercer Human Resource Consulting gave a presentation titled "Update on Pay and Benefits: Toward Total Compensation." The presentation summarized Mercer's work to change compensation and develop a sustainable benefits package. The Board discussed employee benefits and asked for more information about the current and proposed packages.
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None
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None
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| 4. CEO'S REPORT |
March 2007 CEO's Report
Resolution to Increase Member Advisory Committee Compensation
|
I. Lamirault |
Discussion of potential satellite office locations.
Medicare SNP will need location convenient for members. Cost will be approximately $5000-6000 per month.
Update regarding the closure of Agnews developmental Center in San Jose.
- The Alliance is having discussions with the California Department of Health Care Services (DHCS) regarding a contract to provide administrative services and care coordination for current Agnews residents.
- Meetings continue with Agnews staff and other local initiatives that will take Agnews residents.
Medi-Cal Rate Increase update.
- Alliance is talking to State legislators about Medi-Cal market pressures and Ingrid testified at hearing.
- If governor's May revise does not include a rate increase, a Sacramento strategy will start January 2007 for rates in 08-09.
Discussion of Member Advisory Committee (MAC) and compensation of similar committees at other health plans.
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None
Resolution 07-01 approved.
- Motioned by J. Garcia
- Seconded by C. Ridgell
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None
Ingrid Lamirault: begin developing Medi-Cal rate increase strategy by January 2007
None
|
| 5. CFO'S REPORT |
Financial Report: Month & Year to Date Ended January 31, 2007
Financial Report: Month & Year to Date Ended February 28, 2007
Financial Report: Month & Year to Date Ended March 31, 2007
|
J. Garcia &
J. Volkober
J. Volkober
Chris Pritchard and Marcy Pierce
|
Jane Garcia, Chair of the Finance Committee, and John Volkober, CFO, presented the attached Financial Reports for January, February, and March 2007.
- Financial Results Narrative
- Income Statement Reports
- Administrative Expense Detail Report
- Balance Sheet
- Cash Flow Statements
- TNE Calculations
Report by J. Volkober on the increase in inpatient expense, which is one of the primary causes of actual expense exceeding budget.
- High dollar cases (over $50,000), particularly among Group Care and Voluntary Medi-Cal members, are increasing.
- The average cost of cases under $50,000 is also increasing. This cost increase is not due to higher acuity cases. Hospital contract outlier clauses may be getting tripped.
- CalWIN implementation caused disenrollment of low-utilizers.
- Finance and Medical Services departments researching any opportunities to avoid high dollar cases. Car accident and premature birth cases cannot be avoided.
- Ten of the 30 high dollar cases in the last quarter were Group Care members, who are only 5% of the Alliance's membership. The acuity of Group Care member cases is increasing. (I. Lamirault)
- Group Care high cost hospital admits are increasing disproportionately compared to other programs. Adverse selection may be a factor. Discussions continue with County regarding a rate increase for Group Care. The Alliance is losing money on this program. (J. Volkober)
- The bulk of losses are still in the Medi-Cal program. Is there leverage to stop Voluntary Medi-Cal until the State increases reimbursement? (J. Garcia)
- Three County Organized Health Systems (COHS plans) used that tactic when their Tangible Net Equity (TNE) was very low, but the Alliance has a healthier TNE now. (I. Lamirault)
- We need to look at available strategies to obtain a rate increase now. The State is violating the legislation that created the Alliance. (M. Mahoney)
- By cutting the rates using the budget adjustment factor, the rates are not actuarially sound.
- In the governor's May Budget Revise, the rate methodology may change to reflect the population in our area. If the rates do not improve, in January we will come up with another legislative strategy. (I. Lamirault)
The Fiscal Year 2006-2007 Forecast was postponed until a future meeting.
Presentation on Moss Adams LLP by Chris Pritchard, Health Care Partner at Moss Adams' San Francisco office and Marcy Pierce, who oversees the California practice. Moss Adams LLP is an accounting and consulting firm serving over 1,000 health care clients, including, Children's Hospital & Research Center at Oakland, and St. Rose Hospital, and sister plans.
|
R. Davis
None
Moss Adams LLP approved as external auditors for one year contract.
- Motioned by C. Ridgell
- Seconded by R. Davis
- Abstentions by M. Mahoney and J. Garcia
|
None
J. Volkober: Present the Fiscal Year 2006-2007 Forecast at a future Board meeting
None
|
| 6. CHIEF MEDICAL OFFICER'S REPORT |
Formulary Update
Resolution to Approve Implementation of a P4P Program
|
A. Chen, MD
A. Chen, MD
|
Presentation on the revised Alliance Formulary, which was reviewed and recommended by the Pharmacy & Therapeutics Committee, for approval by the Board.
- Do our doctors check for side effects of statins on muscles? Can someone check on this? (G. Steele)
- Doctors should follow up on at least two major possible side effects, which are liver disease and muscle disorders. It would be hard for us to follow up on incidences of this since we don't have a monitoring system for it, but doctors are very aware of the risk factors. (A. Chen, MD)
Resolution to Approve Implementation of a Provider Pay-for-Performance (P4P) Program
Alliance works with Health Care Quality Committee (HCQC) on design for payouts through the P4P. Most recently, HEDIS measure and Ambulatory Care Sensitive Conditions (ACSCs) are considered.
|
Revised formulary approved.
Motion: L. Price, MD
Second: J. Norton, MD
Resolution #07-02 approved.
Motion: L. Price, MD
Second: J. Norton, MD
|
Medical Services: look into whether any members have had a diagnosis of Rhabdomyoly-sis potentially caused by statins
None
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| 7. OTHER BUSINESS |
| None |
None |
None |
None |
None |
| 8. PUBLIC COMMENTS |
| None |
Will Scott
Rosa Frazier
|
Mr. Scott introduced himself and stated that he is a member of the Alliance's Member Advisory Committee (MAC) and on the Board of the West Oakland Health Center. Mr. Scott addressed the Board with the following comments:
- My wife was disabled and I joined IHSS. I also work with the Long-Term Care Workers Union.
- It is a problem that the Public Authority for In-Home Supportive Services (IHSS) does not pre-screen IHSS workers. Many of the IHSS workers are taking care of others, but need the service themselves for their own physical conditions.
- I can work with the union to maker them aware of this issue that needs to be addressed.
- I recommend that the Public Authority for IHSS starts pre-screening workers and doing annual physicals in order to bring down the high level of expense. This is a way to help ensure that the Group Care program continues.
- This is a population that is needy because they are caregivers. It would help us to get a handle on them if they had to see a doctor, get checked, tested, and take care of themselves. I do think that they are a medical high-risk population. (G. Steele)
- Yes, or if they had to work a minimum number of hours to receive the health care coverage. (W. Scott)
- My understanding is that the IHSS recipient has the right to choose the worker they want. (C. Ridgell)
- If that person is not physically capable, maybe the Public Authority for IHSS could help them find somebody who is. (W. Scott)
- I see a lot of people who are getting paid as IHSS workers and they don't appear to be capable. (W. Scott)
- If you set these requirements for Group Care members, you would have to require them of the other Alliance program members. It would be discriminatory to make these requirements for certain Alliance members and not others. (D. Davis-Howard)
- We have had concerns about how the Public Authority for IHSS is screening for eligibility in the program. For example, people eligible for Medi-Cal and Medicare should be on that first. We will plan a session on eligibility, enrollment, and medical management of Group Care members for the July or other upcoming meeting. (I. Lamirault)
- The Public Authority for IHSS was created to establish collective bargaining for the workers because neither the State nor any County wants to accept responsibility or treat these workers as public employees. While this system is better than what existed before, it still keeps these employees at a poverty level, as a matter of public policy.
Ms. Frazier introduced herself as a member of the Alliance's Member Advisory Committee (MAC). Ms. Frazier asked whether Medi-Cal membership is currently decreasing or will decrease.
- My understanding is that the State forecasts that the Mandatory Medi-Cal population will continue to decline. Our Voluntary Medi-Cal membership (Seniors and Persons with Disabilities) is increasing. (J. Volkober)
- How can we serve the Voluntary Medi-Cal members with specialists on a closer/one on one basis? (R. Frazier)
- In the Members Services we unit, we will have more people who can reach out to do case management. This is something we can talk about in more detail at an upcoming MAC meeting. (I. Lamirault)
|
None |
Member Advisory Committee (MAC): discuss case management of Voluntary Medi-Cal members |