ALAMEDA ALLIANCE FOR HEALTH
BOARD OF GOVERNORS MEETING/STRATEGIC PLANNING RETREAT
Minutes July 23, 2009
6:00 p.m.


SUMMARY OF PROCEEDINGS

Present:	Excused:	Unexcused:
Jane Garcia (Chair) Michael Mahoney (Vice-Chair) Ingrid Lamirault Wright Lassiter Pamela Gumbs Gail Steele John Norton Marty Lynch Ray Davis, Jr. MD Will Foster Mila Thomas	None	None

Agenda Item	Speaker	Discussion Highlights	Action	Follow-Up Required
Call to Order	Jane Garcia	Meeting was called to order at 6:15 pm by Jane Garcia. A quorum of the members was present	None	None
2. APPROVAL OF AGENDA & MINUTES
Approval of Agenda 2a. AAH Agenda 7.23.09	Jane Garcia	J. Garcia asked for a motion to accept the July 23 revised agenda.	Motion: W. Foster Second: G. Steele Vote: Unanimous Approval	None
Approval of May Minutes 2b.Minutes - BOG 5.29.09 APPROVED	Jane Garcia	J. Garcia asked for a motion to accept the May 28, 2008 meeting minutes	Motion: P. Gumbs Second: J. Norton Vote: Unanimous Approval	None
3. CHAIR'S REPORT
Chair’s Report	Jane Garcia	J. Garcia reported on 5/28/09 Closed Session: Approval of Provider Credentialing & Recredentialing Recommendations. The Ad Hoc Nominating Committee met on July 23rd. There were two agenda items: Nomination of Board Officers and Interest in At-Large vacant seat. At this time, the Nominating Committee recommends postponing their nomination of officers to the Board for approval until the November Board meeting. The last selection occurred in November 2007 (with the Board agreeing on a second term for the officers in 2008-09); the four year limit on the current Chair and Vice-Chair serving does not expire until November 2009. The Nominating Committee explained the interest from CFMG to fill an at-large vacant seat. The Nominating Committee recommended postponing a recommendation until November 2009, which will give staff time to request that CFMG submit their request and provide some standard questions about their nominees for Board consideration. G. Steele mentioned the need to have a mental health professional on the Board. Many Alliance members have need for behavioral health services and we need to be aware of the impact of mental health on medical health. G. Steele also inquired about progress with identifying candidates for the member seats. I. Lamirault explained there is one vacant member seat. The bylaws allow that seat to be filled by a consumer-member or a consumer advocate. Staff have been reaching out to many of the county's organizations serving SPDs and children, and is looking for advocate candidates to present to the Nominating Committee. M. Mahoney discussed the need to revisit the Alliance bylaws to ensure that the requirements on Board composition, selection, terms, representation etc were still relevant given changes in our business environment. M. Mahoney made a motion to instruct staff and Ad Hoc Nominating Committee to review bylaws and composition of Board and make recommendations for changes to ensure that the governing Board has the capacity to address future member and organizational needs. J. Garcia asked for more volunteers to join the Ad Hoc Nominating Committee. R. Davis volunteered.	Motion: M. Mahoney Second: G. Steele Vote: Unanimous Approval	Ad Hoc Nominating Committee Review Alliance By-Laws and report on governing needs
4. CHIEF EXECUTIVE OFFICER'S REPORT
4. July 2009 CEO Report Final	I. Lamirault	I. Lamirault provided an update on National Health Care Reform, known impacts of the State budget to the Medi-Cal, Healthy Families, and Group Care lines of business. Of note: It appears that most legislators agree that Medicaid should be left out of the Exchange/Gateway. The State will still be responsible for providing coverage to Medi-Cal beneficiaries and could choose to continue to deliver coverage as it done now with a mixture of managed care and fee-for-service arrangements. In addition, there may be an opportunity for plans like the Alliance to compete with commercial plans for the newly insured. The Alliance would probably need to do so for financial viability and to position itself if at some point in the future Medi-Cal beneficiaries must obtain benefits through plans operating in the Exchange/Gateway. It is still unknown how the State will achieve $1.3 billion savings in Medi-Cal. Although we have been informed that we are receiving a 0.6% rate increase, this increase could be at risk. It is also unknown if the State wants to achieve savings for the SPD and dual eligible population through managed care or through other forms of care coordination/medical home concepts. It is still unknown how the State will achieve $124 million savings in Healthy Families. Our scheduled rate increase for this program may be in jeopardy. There was group discussion about the potential of losing Alliance GroupCare members if the IHSS workforce is reduced. As many as 14,000 of the workforce statewide could be dropped. Will Foster asked what advocacy actions could be taken. I. Lamirault responded that we could take the topic to the next Member Advisory Committee to educate members and advocates on the impact of the State reduction. I. Lamirault made an update on staff recommendations for providing Medi-Cal optional benefits eliminated by the State on July 1st. On May 28th, the Board made a decision about all of the optional benefits except vision benefits. The staff recommended that the Alliance not cover vision services (eye exams, frames, and lenses) with an understanding that "sick eye" care would be provided by ophthalmologists. The annual retinal eye exam for members with diabetes that according to HEDIS guidelines can be performed by an optometrist or ophthalmologist will now be performed by ophthalmologist for Medi-Cal beneficiaries. This will ensure that the State considers the utilization and cost information for these members in our experience rating tied to future Medi-Cal rate payments. Board members talked about the four options and focused on Options 3 and 4 that would provide for exams and not frames/lenses. Staff talked about how this would be operationalized through a separate vision plan - March Vision. The estimates that March Vision provided are based on having a limited network and the costs are as low as possible. I. Lamirault suggested that we look at the options in the context of the projected Medi-Cal budget. W. Lassiter and other Board members emphasized that the Board's decision on optional benefits is a policy decision, not a financial one. The Board did not vote on the vision optional benefit resolution. Instead, staff were instructed to meet with the Alameda/Contra Costa Counties Medical Association and others to assess the feasibility of a coalition developing a community solution that would include some funding from the Alliance for exams and finding other contributions for exams, frames and lenses. Staff will report back at September 2009 meeting.		Advocacy actions re: reduction in IHSS workforce to be taken to next Member Advisory Committee. Follow up report on vision services.
5. FINANCE COMMITTEE'S REPORT
Three Attachments 6b. Financial Statements 5.31.09 6a. Financial Statements 6.30.09 6c.BOG Presentation 7-23-09	W. Lassiter	W. Lassiter reported on the Finance Committee member held on June 25, 2009 in which the Finance Committee voted affirmatively to present the May financial report and a July - December 2009 budget to the Board for approval. For greater detail, he asked Neal Jarecki to present the May and June financial reports and Carol vanOosterwijk to present the six month "placeholder" budget. May 2009 Financial Report For the month of May, the Alliance recorded a net income of $481,000 compared to a budgeted net loss of $786,000, resulting in a favorable variance from budget. Year to date, the Alliance recorded a net loss of $588,000 compared to a budgeted net loss of $9.8 million, resulting in a favorable variance from budget of $9.2 million. Current assets totaled $34.5 million compared to current liabilities of $21.7 million yielding a current ratio of 1.59:1. Tangible net equity (TNE) was $20.9 million compared to the minimum TNE required by the Department of Managed Care of $9.3 million. June 2009 Financial Report For the month of June, the Alliance recorded a net income loss of $576,000 compared to a budgeted net loss of $887,000, resulting in a favorable variance from budget. Year to date (or estimated year-end), the Alliance recorded a net loss of $1.2 million compared to a budgeted net loss of $10.7 million, resulting in a favorable variance from budget of $9.5 million. I. Lamirault commented that the Alliance would have realized a greater than breakeven year if the State's Medi-Cal 10% cut that took place in 2008-09, and later stopped by the court from August 18 through February 28th, had not occurred. The reduction sustained by the Plan, and not passed on to providers, for that six-week period totaled approximately $1.5 million - $2 million. Current assets totaled $36.3 million compared to current liabilities of $23.6 million yielding a current ratio of 1.54:1. Tangible net equity (TNE) was $20.4 million compared to the minimum TNE required by the Department of Managed Care of $9.4 million. July to December 2009 Budget The Board approved the attached six-month budget in anticipation of a July 2009 through June 2010 budget presentation to the Board for approval in September 2009.	May Report: Motion: M. Mahoney Second: M. Thomas Vote: Unanimous Approval June Report: Motion: M. Mahoney Second: M. Thomas Vote: Unanimous Approval Provisional Budget: Motion: M. Mahoney Second: W. Lassiter Vote: Unanimous Approval	Final FY 09-10 Budget will be presented for approval in September 2009.
9. OTHER BUSINESS
None	None	None	None	None
10. PUBLIC COMMENTS
None	None	None	None	None
11. SET NEXT MEETING DATE
The next Board meeting will be held on Thursday, September 24, 2009.
12. ADJOURNMENT
	J. Garcia	The meeting was adjourned at 7:33 pm	Motion: R. Davis Second: J. Norton Vote: Unanimous	None

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