PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEETING MINUTES PAGE 1 OF 14

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1 Committee: Date / Time: Physician Advisory Committee September 13, :35 to 8:58 am PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEETING MINUTES PAGE 1 OF 14 Committee Approved 11/08/2017 Members Present: Members Excused: Members Absent: Jeffrey Bosworth, MD - TC Michael Ginsberg, MD Shandi Fuller, MD Jeffrey Gaborko, MD (Chair) Steven Gwiazdowski, MD Thomas Paukert, MD Michele Herman, MD Tracy Johnson, MD Willard Hunter, MD Melissa Marshall, MD Antoinette Martinez, MD TC Mills Matheson, MD TC Mitesh Popat, MD Michael Stacey, MD Danielle Oryn, DO - TC Colleen Townsend, MD Lisa Ward, MD Visitors: Ann Finkelstein, MD Brittany Speer, Lilly Consultant Note: via Video Conf. (VC) via Teleconference (TC) PHC Staff Present: Liz Gibboney, Chief Executive Officer Patti McFarland, Chief Financial Officer Wendi West, Northern Executive Director- VC Margaret Kisliuk, Behavioral Hlth Administrator Lynn Scuri, Regional Director - VC Jennifer Chancellor, N. Regional Mgr.- VC Karl Santos, Director of Network Operations Ledra Guillory, Sr. Prov. Relations Rep. Mgr. Robert Moore, MD, CMO, Acting Chair Peggy Hoover, RN, Sr. Director, Health Services James Cotter, MD, Regional Medical Director Scott Endsley, MD, Assoc. Medical Director, Quality Stan Leung, Pharm.D., Pharmacy Director Debra McAllister, RN, Dir. Utilization Management Carly Fronefield, RN, N. Region, HS Dir. VC Marshall Kubota, MD, Regional Medical Director - VC Jeff Ribordy, MD, NW Regional Medical Director - VC Mark Netherda, MD, Regional Medical Director Bettina Spiller, MD, N. Associate Medical Director Rachael French, Sr. Mgr., Quality Compliance/ Accreditation Megan Wilson, Quality Program Manager Nancy Steffen, N. Region Manager of QI Programs Public Comments / ACTION The HealthPlan s Chief Medical Officer (CMO) presided over the meeting in the Committee N/A Chairman s absence, and asked for public comments. None were presented. TARGET N/A Upgraded Audio Conference System Quorum The Plan s Director of Network Operations expressed the team s excitement in the audio system just added to Fairfield s main conference rooms. Improving the performance for meetings, such as the Physician Advisory Committee, has been a goal for the Information Technology (IT) team. Due to the sensitivity of the microphones, meeting participants should be aware that sidebar conversations may be picked up. Those needing to conduct a private conversation may want to consider stepping away, or ensuring their microphone (mic) is muted. (But, please remember to unmute the mic when addressing the group.) In addition to the gooseneck microphones situated on the tables, ceiling mics have been added strategically throughout the rooms, allowing for normal speaking tones. New cameras have also been added to the system, which will improve coverage for larger meetings. Congratulations to this Committee, which is acting as the pilot / go-live meeting for the system. Committee quorum requirements not met. There were no Motions on Action Items during the meeting. 10/11/17

2 Physician Advisory Committee Minutes - Page 2 of 14 I. Approval N/A of Minutes / ACTION Approval of minutes deferred, due to lack of quorum. TARGET 10/11/17 II.A. Status Update Administration The HealthPlan s Chief Executive Officer (CEO) provided the following status report on PHC activities. - Affordable Care Act (ACA) Repeal / Replace There has been some additional efforts in Washington, D.C. to install a number of provisions that have been discussed in other Repeal/Replace efforts (i.e. moving Medicaid to Block Grants and reducing the overall funding to the Medicaid program). The proposals have until the end of September to use Budget Reconciliation as a method of passing with a smaller majority vote. PHC staff continues to watch the attempts to Repeal / Replace closely. There is some traction with a bipartisan effort to address some of the provisions under the Exchanges (in this state it is Covered California), which is being reviewed by a number of committees. Extra attention is being given to those counties in the country that may not have, or may lose, a participating health plan, and in securing the Federal Government subsidies given to health plans offering services to lower income Americans. These provisions are more scaled back and focused. The third component receiving a lot of attention lately is the Single Payor / Medicare for All, and a more holistic approach to the Health Care Reform efforts. Nationally, there are a number of Senators interested in this component, in light of their 2018 mid-term election campaign. In California, the Health Policy Leadership will designate a committee to focus on Single Payor and Health Care Reform in California. - California Health Insurance Program (CHIP) Reauthorization In California, CHIP was the Healthy Families (HF) Program. Several years ago, children under the HF Program were rolled into Medi-Cal, and funding remained under the same Federal source. That program is up for renewal / reauthorization. Fortunately, there is a fair amount of bipartisan support for reauthorization of coverage for children. What may change is the amount of funds paid into it by the Federal Government, which has been a favorable match. The State has anticipated the fund reduction, so the current Budget assumes a lower Federal share in that program. Partnership has approximately 70,000 children funded through CHIP. - Statewide Commission, California s Future Workforce The HealthPlan will be serving on this statewide Commission, which will be reviewing areas of need for the medical community (i.e. physicians, nurses, and ancillary providers). The examination will take into account the educational system, and how it can better support and train those upcoming workers, along with retaining those workers in the state. The Plan s CEO anticipates the need of information from this and other committees as part of her report back to the Commission.

3 Physician Advisory Committee Minutes - Page 3 of 14 II.A. Status Update Administration, / ACTION - Housing Initiative Update Several months ago, Partnership s Board allocated $25 million from Strategic Use of Reserve funds for the housing grants. PHC has received $45 million in proposals, representing each of the fourteen counties. Decisions on the applications should be made in the next few weeks. - Transportation Benefit There has been a very robust start since the benefit was implemented under Medi-Cal on July 1. Over 5,300 rides have been provided or arranged. PHC staff has been very busy working on this. Utilization statistics pulled show: One-quarter of 1% of the Plan s population has used the new benefit. The average trip is 24.5 miles. Only 60 grievances have been received, which is considerably low when comparing to the number of rides. The Plan has added LIFT to its transportation providers. Guidance and revisions from the Department of Health Care Services (DHCS) regarding this benefit continues. PHC s policies and procedures, now under review by DHCS, may need to be revised again to reflect changes. As of October 1, 2017, Partnership will be providing transportation services to non-partnership covered services (i.e. dental and county mental health). There is some anxiety around this addition, as Plan staff cannot always verify the services that the ride is supposed to support. The HealthPlan appreciates providers enduring patience on this matter, and will continue provider updates as DHCS offers information and clarity regarding the benefit. Dr. Johnson questioned whether practice sites should be advertising this benefit to its members. The Plan s CEO noted that advertising may not be necessary, but if office staff, who work closely with patients, are aware of the need, the staff can help link that member by calling PHC s Member Services department to arrange for a ride. Dr. Herman shared that La Clinica staff were made aware of this benefit, and created flyers for distribution to patients who share that they are unable to make an appointment, due to transportation issues. The Plan s CEO advised that similar materials are available through the HealthPlan, should that be needed by providers. II.A. Status Update Medical The HealthPlan s Chief Medical Officer (CMO) presented an overview of some Health Services activities. - Confidential Screening/Billing Report (PM 160) Claim Form The State has indicated that their current plan is to phase this form out on January 1, As a reminder, the primary reason the State has continued the PM 160 is for one IT report, and Partnership does not require the form for its own use. Since individual counties may require information from the PM 160, providers are urged to contact their county office to determine if that information can be obtained through another means. - National Committee for Quality Assurance (NCQA) Accreditation Preparations HeathPlan staff continue to work on preparing for NCQA Accreditation, targeted for September There is a great deal of effort ongoing by PHC departments, with a current focus on policies and procedures, reporting mechanisms, and associated term analysis. Results of those efforts will be routed through various committees, some of which report to the Physician Advisory Committee (PAC). Staff is confident that they will meet that deadline. The new standards, which the HealthPlan will be held accountable (upon the first accreditation), were just released and are being incorporated into activities, so no additional changes should occur.

4 Physician Advisory Committee Minutes - Page 4 of 14 II.A. Status Update Medical, - Healthcare Effectiveness Data and Information Set (HEDIS) Results HEDIS results will be reviewed in detail later on the agenda. On a separate note, Plan staff recognized deficiency in mammography access in Trinity and Modoc counties, when reviewing breast cancer screening. There are no providers offering this service in those two counties. This information was shared with the Board at their August meeting. Northern Region staff is investigating options on how to improve this access. - Quality Improvement Program (QIP) Changes The QIP Advisory Committee, which is the subcommittee that reviews measures, has begun evaluating some changes to the QIP, due to: 1) the State s verbal guidance regarding what is acceptable for reconciliation for Prospective Payment Systems (PPS) providers, and, 2) to change the methodology for relative improvement, to only kick in at the 25 th percentile or above. Very low performance will no longer be paid for improvement. Recommendations will be brought to this Committee in October. - Medical Director Newsletter This month s Newsletter will be coming out soon, delayed due to other priorities. However, results of the HealthPlan s version of the Consumer Assessment of Health Providers and Systems (CAHPS) Survey for large provider sites has been compiled. The Survey focuses on two areas, access (patient s perception of access), and the patient s perception of communication (how well they can communicate with their providers). Plan staff is pleased with the overall results, as 80% of provider sites met the established benchmark. Of note, the same provider may have a significant disparity between their pediatric and internal medicine groups. Providers will be receiving their own scores. However, high performers included: Communication Pediatric: Redwood Pediatric Medical Group, based in Fortuna, received the highest score for pediatric communications, followed by NorthBay Healthcare, then Sutter Medical Foundation West, and Adventist Health in the Clearlake area. Highest scores received for health centers was received by Open Door Community Health Centers. Adult (Internal Medicine): The highest communication scores for adults was received by West County Health Centers, then Sutter Medical Foundation West, Petaluma Health Center, and Intercommunity Medical Group, as well as Dignity Healthcare Foundation in Woodland. United Indian Health received the highest scores for that population. Access Pediatric: Redwood Pediatric Medical Group, followed by Sutter Medical Foundation, NorthBay, and Open Door. Adult: Sutter Medical Foundation West, but Sutter Lakeside received the second highest score, followed by Dignity Health, Petaluma Health Center, Ukiah Valley, and Alliance.

5 Physician Advisory Committee Minutes - Page 5 of 14 II.A. Status Update Medical, PHC s Regional Medical Director for Napa County presented a brief overview. - Palliative Care Benefit Update There are currently four active sites taking Partnership members in the counties of Napa, Yolo, Humboldt / Del Norte, and now Mendocino. There are providers in the counties of Shasta and Lake, though the Plan is waiting to receive word on their first patients being enrolled. Marin, Sonoma, and Solano counties will soon be added, and there is progress with Lassen, Modoc and Trinity counties. The latter three are the most difficult, as they are rural counties and there are no hospice organizations to work with. For the active sites, there have been three care audits performed, showing an impressive level of work. - Housing Initiative To add on to the CEO s update, the Plan s Intensive Outpatient Care Management (IOPCM) program pays a bonus to providers when a homeless person is added to their care management program. Plan staff has been tracking the payments, but not their outcomes. Provider sites are now being asked to give feedback regarding this homeless population. As example, the Marin site has taken in seven homeless patients during the past couple months. Their homeless outcomes vary (i.e. three are still homeless and one is living in a van). When calculated, there are well over 100 homeless members that the bonus has been paid for. This information will be required when the State s benefit is implemented, so it is prudent to start this process now. PHC s Regional Medical Director for the Southeastern (SE) counties advised that there were no new updates to share for Yolo or Solano counties. N/A -- PHC s Regional Medical Director for the Southwestern (SW) counties presented a brief overview. - Marin Public Health The Marin Board of Supervisors meeting was attended last evening to offer insight on one of their discussion topics - the proposal for Marin Public Health Department to stop providing direct clinical care, and moving the clinics into the Federally Qualified Health Center (FQHC) sites. Having participated in similar events with the HIV Clinic in Sonoma County ten years ago, that transition experience was of value to the Supervisors. The decision came down to two basic claims, that 1) Marin Community Clinic is an excellent clinic to house some of the services, and 2) the success of the transition by Sonoma County Public Health. - Quality Improvement Program (QIP) Improvement Meeting A two county meeting will be held in Ukiah next week, to address QIP and HEDIS score improvements. - Providence (St. Joseph Medical Center) in Sonoma County has granted funds to the Committee on the Shelterless (COTS) to assist homeless individuals for up to 90 days, while they get their lives in order. The County is fortunate to have a large organization to assist in these endeavors. COTS is an outstanding institution, in terms of helping people get housing and taking care of some of their social needs. - The HealthPlan is looking at a local initiative to address the high number of hospital administration days (particularly at Memorial Hospital in Santa Rosa), and ways to reduce that number. - The Plan s Regional Director shared that Petaluma Health Center has partnered with WalMart (a Vision Service Plan [VSP] provider) in setting up a satellite Optometric Clinic that will offer exams within WalMart. It is understood that the Clinic, which started last weekend, will offer services Friday through Sunday, while WalMart will provide the glasses. This is a new type of undertaking for FQHCs. PHC s Senior Provider Relations Director noted that the HealthPlan worked with both entities regarding this new venture.

6 Physician Advisory Committee Minutes - Page 6 of 14 II.A. Status Update Medical, PHC s Regional Medical Director for the Northwestern (NW) counties presented a brief overview. Access - Waterfront Recovery Center The Plan s Board meeting was held in Eureka last month, offering members and staff an opportunity to tour the new facility. The original target date for opening was Monday of this week, but that was delayed. The opening is now targeted for October. This will be a dual-diagnosis center for inpatient detoxification and psychiatric care. The medical director, Dr. Ruby Byron, is specialized in this field. Like other programs in the area, there is a challenge in hiring enough nursing staff. - New Physicians in Area Recent changes have more physicians coming to the area than leaving, and primarily at Open Door Community Health Center. There are three new practitioners at their Fortuna location, two of which also specialize in obstetrics. Staff is looking forward to the new facility opening, as the current location is rather cramped. At the Arcata site, there is a new obstetrics / gynecology (OBGYN) physician, who was accompanied by her husband to the area, an anesthesiologist. He will be working at Mad River Hospital. One of the big recruiting issues for the area is the ability of a physician s spouse to find work. This is a critical part of recruiting and retaining physicians for the region. Anything the HealthPlan can do to build on the relationship with the County or Humboldt State University, the largest employer in the area, could improve the recruitment of medical personnel. The Eureka Community Health Center also received a couple new providers (internist and family medicine physicians). Of note, all these providers are from out of the area, and not transitioning from other practice sites. In the absence of the HealthPlan s Northern Regional Medical Director, PHC s Associate Medical Director for the North presented a brief overview on activities for the Northeastern (NE) counties. - Regional Fires One of the hot topics in Redding has been the ongoing fires, and the Air Quality Index, which has been poor, but it is improving. There has been an increased need for nebulizers, and clinic staff have been putting in extra time to see patients. Surprisingly, neither patients homes nor physical locations of clinics have been as impacted as expected. There were some evacuations, but nothing substantial. Even though the fires have destroyed thousands of acres, the areas were very rural. Considering the events, overall the community is doing very well, and the smoke is diminishing. - Access There has been a lot of movement of providers between different clinics in the area. Of favorable news, the HealthPlan s Board approved the Provider Recruitment Assisted Program (Recruitment Program) for an additional two years, which will greatly help the rural areas. Smaller practice sites have more difficulty competing with the larger groups or cities, in terms of signing bonuses, etc. The Recruitment Program has helped to even out the field, along with stabilizing primary care in the region over the past few years. Recently, the Recruitment Program helped to bring in six new providers to the area (two for Hill Country Clinic, one for Shasta Community Health Center, along with others).

7 Physician Advisory Committee Minutes - Page 7 of 14 II.A1. Update - Dr. Stacey was not available to present an epidemiology report for the area. Cnty Public Hlth N/A -- II.A.2 Committee Member Highlight PHC s CMO advised that, in an effort for Committee members to better know one another (beyond the scope of meeting comments), a member will present a more detailed background about themselves at each meeting. Dr. Johnson will be sharing today about himself, his practice, and his history with Partnership. For information only, no formal action required. Dr. Tracy Johnson shared that he is an internal medicine physician in Solano County, specializing in infectious disease. He attended the University of Texas, Southwestern Medical School in Dallas, graduating in His internship and residency extended from 1965 to 1972, due to being drafted into the U.S. Air Force and stationed in Hawaii for 3.5 years. His residency was completed in Dallas, which was followed by a Fellowship in Infection Disease at Parkland Memorial Hospital, along with J. Stanford. As a payment back for the time he spent at Parkland, and for his final training, the Air Force stationed him in Germany for his remaining four years of service, which was completed in Once leaving the service, Dr. Johnson looked to possible clinic sites, and joined Intercommunity Medical Group in Fairfield. He was the fifth internal physician to the newly formed clinic, joining an endocrinologist and nephrologist. Their Fairfield office represented the only internist group in the City at that time. The group expanded to include an interventional cardiologist, a gastroenterologist, and several other internal medicine physicians, peaking at eleven members in 1990, and resulted in opening an additional office in Vacaville. Since that time, the group has gradually decreased in numbers, currently at three physicians (two internists and one interventional cardiologist). As of December 1, the Vacaville office will be closed. Dr. Johnson s personal interests are what brought him to the area (running and skiing), which has evolved to seeing Shakespeare in Ashland. Other spare time is spent on house improvements, carpentry, some welding, which is interspersed with cooking and wine making. After leaving the small wine-making town in Germany, his first project at the house with his wife was to build an underground wine cellar. He and his wife spend time with their five sons, whose lives and vocations vary from computer engineer, entomologist in Hawaii, vineyard manager in Sonoma, and an inventor in Los Gatos. Dr. Johnson s interactions with Partnership began with an introductory meeting through Solano Coalitions for Better Health at NorthBay Medical Center. Attendance included physicians from Kaiser, Sutter, NorthBay, and Solano County, and the discussions revolved around common goals of improving care for patients, especially those who were uninsured and received in emergency rooms. All of which was intriguing to him. Medi-Cal was discussed at that time, which resulted in the area s transformation. This led to the development of the HealthPlan, enlisting Jack Horn to oversee the venture. Around 1993, this Physicians Advisory Committee (PAC) was developed. In addition to PAC, Dr. Johnson has participated on the Plan s Pharmacy & Therapeutics, Strategic Planning, and the Credentials committees. He has found a special quality in how the HealthPlan approaches its dedication to patient care, which is unlike the typical health care enterprises in the states. Partnership s focus on patients care has been, and continues to be, impressive to him, especially in light of achieving those goals on Medicare / Medicaid dollars.

8 Physician Advisory Committee Minutes - Page 8 of 14 II.A.2 Committee Member Highlight, The HealthPlan has been able to maintain a greater than 95% medical loss ratio, which is an accomplishment in itself, while taking into account the views of its providers, stakeholders, patients, and pharmacists, and incorporating that input into its operations, which is in contrast to commercial-type plans. For himself, Dr. Johnson has enjoyed watching how the Plan engages with the State and Federal Government, and overcoming the uncertainties around those developments. In conclusion, Dr. Johnson shared that he plans to retire next year, and has truly enjoyed his participation with the HealthPlan. TARGET II.B. Quality/ Utilization Advisory, & II.E. Credentialing committees Partnership s CEO noted that Dr. Johnson is as kind and pleasant as he seems, and has been at the table with Plan staff discussing a whole host of topics over the past 20+ years. The HealthPlan could not have asked for a better partner and advocate, as well as a wonderful physician for its members. Due to the lack of Quorum, approval on the activities by the Quality / Utilization Advisory and Credentialing committees was tabled until the October meeting. Agenda items tabled until the October meeting. 10/11/17 III.A. CAHPS Results from the State The Plan s CMO reported that the State has not provided the CAHPS analysis, which is generally distributed much earlier than this. The results presented under his overview were that of the HealthPlan s survey. N/A -- IV.A. Healthcare Effectiveness Data Information Set (HEDIS) Performance Results for 2016 (HEDIS Results 2016) PHC s Senior Manager of Quality Compliance & Accreditation (Senior Manager) introduced the Plan s HEDIS Program Manager (Program Manager), recently promoted to the position, who will be co-presenting with the Associate Director of Quality Improvement (Associate Director of QI) for the Northern Region, who will be highlighting the 5-year strategic plan on improving HEDIS scores. The Plan s Program Manager advised that HEDIS is a library of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). The measures are meant to ensure that health plans are offering quality, preventative, and disease care management services to its members. The HEDIS process allows staff to identify areas of opportunity for focus. DHCS selects a subset of the NCQA measures, holding health plans accountable for their performance, relative to other Medicaid plans in California, as well as national benchmarks. In light of the HealthPlan s goal to achieve NCQA Accreditation in 2019, it is key that efforts are focused, as HEDIS and CAHPS make up 50% of the Plan s score, and the volume of measures will increase significantly.

9 Physician Advisory Committee Minutes - Page 9 of 14 IV.A. HEDIS Results 2016, There are two types of measures for HEDIS, administrative and hybrid. For administrative measures, data is collected through transactions or other administrative data sources. This helps to define the eligible population, as well as the numerators. For hybrid measures, staff pull a statistically significant sample of the eligible population, along with a collection of data and key data elements from the patient s medical record (MR) chart. The stronger the administrative data is, the fewer MR charts are needed to be reviewed. Staff typically reviews around 15,000 MRs during the HEDIS season. HEDIS data is collected across all fourteen counties that PHC serves, and performance is reported across four reporting regions (SE, SW, NE, and NW). A few years ago, the HealthPlan adopted a plan-wide scoring methodology, used to monitor its HEDIS performance relative to the prior year. It is important to track improvements on measurements the Plan is held accountable to. Each measure in each region is given a score from zero to four, based on its percentile ranking. A plan-wide score is calculated by dividing the total number of points by the maximum number of available points, arriving at a single performance statistic across all regions and measures. In comparison, DHCS uses a very complex scoring methodology to determine a Quality Factor Score, which ranks the Medicaid health plans in California. Performance scores are distributed annually by DHCS, and generally received this time of year. Once received, the ranking scores will be brought to this Committee. The Plan s goal this year was to achieve high quality health care, by evidence of a plan-wide HEDIS score of 45%, which was exceeded with a score of 48%. Three of the core reporting regions showed a significant improvement over the prior year. Overall, there were less measures that fell below the minimum performance level (MPL) of the 25 th percentile. At that level, 75% of all other health plans are performing better than PHC for those measures. Last year, 16 measures were below the MPL, this year there are 9. The Plan s scores for measurement year 2016 are included in the meeting packet by region and county. There are two measures highlighted throughout the packet (Asthma Medication Ratio [AMR], and Breast Cancer Screening [BCS]), as both were introduced into the measurement set this year. Health plans are not held accountable for the first year of a measure by DHCS. However, the data needs to be provided as reference, and for quality improvement activities. A color coding scale was used for easier assessment of scores. The HealthPlan s goal for each measurement is the 90 th percentile, which would place the PHC in the top 10% of all health plans for those measures. Numbers were broken out to show the Plan s regional performance relative to national Medicaid benchmarks. The final set of measurement scores in the packet showed a comparison of the Plan s external accountability set for HEDIS relative to the PHC s Primary Care Provider (PCP) Quality Improvement Program (QIP) measurement set. As the HealthPlan becomes more aligned, there will be some shifting of measures moving forward. As previously noted, there were nine measurements that fell below the MPL, as compared to sixteen the year before. Trends identified were shared, which included: 1) Comprehensive Diabetes Care (CDC) Nephropathy There was an 11% shift in the Plan s benchmark, resulting in a significant impact to its performance. For reporting year (RY) 2016, the measurement was at 75 th percentile across all regions. For RY 2017 (2016 data), the Plan was either at or below the MPL. 2) Childhood Immunization Status, Combo 3 (CIS-3) For the past two reporting years, the Northeast and Northwest regions have been below the MPL, but have shown consistent improvements.

10 Physician Advisory Committee Minutes - Page 10 of 14 IV.A. HEDIS Results 2016, 3) Annual Monitoring for Patients on Persistent Medications (MPM) This measurement has had consistently low performance (below the MPL over multiple regions). However, this past year showed an overall improvement, despite another benchmark shift. Had the benchmark remained the same as the prior year, the Plan s numbers would have been above the MPL. There were three measurements added to the measurement set last year (Breast Cancer Screening, Asthma Medication Ratio, and Immunization for Adolescents with Human papillomavirus [HPV]), though health plans are not held accountable for first year performances. Several regions fell below the MPL on those new measures, so work is underway to improve the scores through the end of this year, which will be reported. 4) Breast Cancer Screening The Quality team will be piloting the incentive program, which is similar to the MPM incentive program done last year. 5) Asthma Medication Ratio Two regions fell below the MPL for this measurement. The Plan s Pharmacy department is working on a Plan-Do-Study-Act (PDSA) to target patient education as a means of improving this measure. 6) Immunization for Adolescents (IMA) with HPV This measure is a fusion between the original IMA Combination 1, which was a tetanus, diphtheria, and pertussis (Tdap) meningococcal vaccine by age 13. HPV has been added, which had not been reported previously. This resulted in a Combination 2 vaccine. There was a specification change for HPV, going to a 2 dose vaccine for HEDIS 2018, versus a 3 dose vaccine for The Plan s Senior Manager shared that benchmarks for this measurement is pending, as health plans are not generally held accountable when there are any specification changes to the measure. As of yesterday, DHCS distributed an All Plan Letter, stating that there is a pending threshold on the measure. Should they release the benchmark, the HealthPlan will be held accountable. Staff is monitoring the progress of this. However, reducing to a 2 dose from a 3 dose should naturally result in an improvement. Dr. Johnson requested clarification of the NCQA benchmarks, as they relate to non-ncqa Accredited organizations, and how Medicaid benchmarks compare to commercial plans. PHC s CMO shared that all Medicaid health plans that report HEDIS data are compiled into the benchmark numbers. Approximately one-third of the organizations are not NCQA Accredited, but their numbers are included. There are states that only the traditional family aid codes are factored in, not including the senior persons with disability (SPD) aid codes. Those scores tend to be high, as most factored into the data are relatively healthy individuals. Another factor, which has recently come to light, is the accuracy of the data used by DHCS. When reviewing the MPM data, it is difficult to understand how the majority of health plans in California are below the Minimum Performance Level.

11 Physician Advisory Committee Minutes - Page 11 of 14 IV.A. HEDIS Results 2016, / ACTION The Plan s Senior Manager of Quality Compliance & Accreditation will prepare a comparison of Medicaid versus commercial plan benchmarks to share with the Committee. Partnership s Senior Manager can prepare a side-by-side comparison of Medicaid versus commercial plan benchmarks, and do a follow-up off-line with the group. But, there are definite shifts between the two, depending on the measure. For example, when reviewing Kaiser s CDC Nephropathy measure to the Medicaid side, the latter had an 11% shift, while Kaiser had a shift of 7% or 8%. PHC s Program Manager advised that an internal quality improvement excellence program is being done to focus on improving scores for the IMA measure next year. TARGET 11/1/17 Changes to HEDIS 2018 were highlighted: - Screening for Clinical Depression and Follow up Plan (CDF) This was the first behavioral health measure that was outside of the Plan s NCQA library. This measure is now being pulled from the measurement set and being replaced with a Depression Screening and Follow up for Adolescents & Adults (DSF) measure. This measure is called an electronic clinical data system (ECDS) measure, a type just piloted by NCQA last year with several health plans. The Plan s auditing firm, Health Services Advisory Group (HSAG), along with DHCS, has reached out to better understand the measurement requirements. This group will be updated, as more is learned. The Plan s Senior Manager noted that this measure will be very meaningful in four to five years, and there may be additional measures under the ECDS process. For the hybrid method, the goal is to reduce the number of MR charts being collected in the field, and using more of an electronic change of data. There is currently a degree of anxiety within health plans trying to determine which sources of data are allowed, and how PCPs and behavioral health physicians can access that data, etc. As a result of reaching out to DHCS, which in turn reached out to NCQA, a webinar was developed for health plans to better explain the process. This new measurement should be considered experimental. - Management of Persistent Medication (MPM) According to NCQA, this measurement shows high performance / low variation across the nation, so may be retired. - Children & Adolescents Access to Primary Care Practitioners (CAP) Once again, NCQA may retire this measure. Though PHC has been reporting on this measurement for several years, it has not been held accountable. - The most significant change to HEDIS measurements for 2018 is that NCQA shifted the medical record timeline with a stop date of May 9 th, versus May 15 th. This will require the HealthPlan s project to move up 2 weeks to accommodate, requiring a lot of coordination for staff and other departments.

12 Physician Advisory Committee Minutes - Page 12 of 14 IV.A. HEDIS Results 2016, Plan staff truly appreciates all the support and cooperation they receive from providers. To assist them in compiling the necessary information for reporting under this new deadline, there is the ability to remote access to electronic medical records. This would allow a more accurate retrieval of the data. Outreach is being done in both the North and South regions by Quality staff. Additionally, timely billing of claims by providers will also assist in the data collection process. For administrative measures, staff cannot retrieve the information through medical records, as it relies on claims, etc. PHC s Associate Director of QI in the Northern Region presented the strategic planning process for HEDIS improvement. This past year, staff had a goal to develop a five year strategic plan that would support HEDIS score improvement. In the early months of 2017, staff set out to interview health plans who exhibited best practices. In addition to three in California, staff reviewed organizations nationwide, and included rural settings. The stakeholders reached were very helpful. Several PHC Board Members in the North and South regions were also solicited for their perspectives, along with senior Executive Team members, and directors and managers in functional areas of the HealthPlan. Added to these interviews was input from primary care practice sites of varied sizes, the Community Clinic Consortia, and the Consumer Advisory Committee. The accumulated information led to vision and goal setting, and what Partnership s overall strategic plan for HEDIS should look like. Of importance, a theme resonated, that PHC would deliver consistently high and best quality care as evidenced by its HEDIS scores. As determined by the Plan s Executive Team, goals were set, which also support efforts toward NCQA Accreditation. The scores represent high quality care and help the Partnership s overall mission, which is to help our members be healthier. 1) PHC would exceed the minimum performance level (25 th percentile nationally), across all four regions by July ) Achieve above the 50 th percentile across all four regions by July ) Achieve above the 75 th percentile across all four regions by July Taking a deeper view, the Plan s aim is to improve HEDIS scores via population health management (PHM) strategy. This theme became very apparent during the interview process, especially when consulting health plans that have been successful with these efforts. PHM can take on different meanings. For HEDIS scores, PHC s perspective for PHM means an aggregation of patient data across multiple health information sources, which can be analyzed for prioritization of actions that the Plan can partner with its providers to achieve better health outcomes, and ultimately better health of members. This broke out into three focus areas: - Primary Care Population Health Management By working closely with its network, PHC will better understand their data sources, and ways to measure from their information. - PHC PHM and Direct Member Engagement How does the Plan use its current systems to better engage members directly with preventative health measures. - Data and Analytics Infrastructure Improving, expanding, and placing more focus around PHC s data and analytics, which ties all of the efforts together. Activities for Year 1, of the five year plan, that are underway were highlighted: - Partner with PCPs to implement improvement projects (some mandated by DHCS) that are presented through the PCP QIP. - Through the performance improvement team, offer technical assistance and training to practices to help develop the culture of quality - Bring more awareness to PHC s management and staff regarding priority measures, addressing gaps and considering pilot work for years 2 and 3 - Continuing efforts to provide actionable data, how the data is managed, stored, and monitored, along with identifying new opportunities for driving HEDIS score improvements.

13 Physician Advisory Committee Minutes - Page 13 of 14 IV.A. HEDIS In conclusion, the Quality team appreciates the collaborative process that has been underway with the provider Results 2016 network. Achieving continued improvements with HEDIS cannot be done without help from the providers. For review and information only, no formal action required. IV.B. Discussion Topic: Role of Health Centers in Supporting Health Care Needs of Post- Incarceration Populations The Plan s CMO opened the discussion regarding reentry health for Californians living in jails and prisons. An Executive Summary of Reentry Health was included in the meeting packet, a draft report by the California Health Policy Strategies dated August The author s permission was received before its inclusion. An indepth analysis was conducted regarding health issues related to the population that is incarcerated, along with long term health issues for some that are released. The White Paper concludes with the seven major recommendations that the analysis suggests. 1) Establishing eligibility for Medi-Cal / reducing the time after release 2) Coordination of care after release, as well service delivery 3) Maximizing Federal participation to help support the efforts 4) Improving the flow of information 5) Looking at residential and outpatient treatment capacity, particularly with the substance use category 6) Housing 7) Evaluation of programs put into place Dr. Ann Finkelstein of La Clinica, North Vallejo, shared that La Clinica s Transitions Program, which Partnership helped to support, just recognized its one year anniversary. The Program is now serving over 50 patients with chronic medical conditions. Patients are enrolled within six months of release from incarceration, though the aim is to get patients into the Program within the first two weeks from being released. Coordination with probation and parole has improved, as it is understood how critical the initial time is for newly released individuals. Medical home services are provided by Dr. Finkelstein, along with a community health worker who has personal experience with incarceration. Her focus is on all the areas associated with social determinants of health (i.e. housing, finding a source of income, etc.) La Clinica has been relatively successful to date, and hopes to build the Program to serve 100 patients. The Transitions Program was modeled after a one pioneered in San Francisco and in New Haven, and is part of a national transitions program network. There are several sites in the Bay Area, along with S. California. Dr. Bosworth shared that Shasta Community Health Centers (SCHC) has not specifically targeted this population, but tries to provide services as presented. Through SCHC s homeless program, this population gets targeted as they often have housing, substance use, and mental health issues to be addressed. However, there is a special program through Shasta County s Probation Department. For those who have been recently released and have substance use issues, staff can refer the patients for Vivitrol therapy. Through SCHC s Developing Integrated Substance Abuse Program patients can get fast-tracked. Medical assisted therapy is offered for a small number of patients who would benefit from that service. Typically, there are about half-dozen patients in the Program at one time.

14 Physician Advisory Committee Minutes - Page 14 of 14 IV.B. Discussion Topic: Role of Health Centers in Supporting Health Care Needs of Post- Incarceration Populations, The Plan s Behavioral Health Administrator advised that there are quite a few individuals recently released from jail or prison that are part of the HealthPlan s current service system. Staff has been in discussions with the State regarding matching databases to try to get a better sense of the numbers, where they are, and getting them into a program. One of the Plan s responsibilities under Drug Medi-Cal will be serving individuals upon their release from jail or prison. In general, the consensus is that the largest proportion coming into the community are from State Prison, as opposed to local, and may be going straight to local probation or local parole. Studies have shown that access to primary care is a direct factor to whether the individual will execute another crime. For discussion purposes only, no formal action required. PHC s CMO noted that Touro University is conducting a community lecture series, which is focusing on incarceration and public health. Their initial speaker from Chicago, Rueben Jonathan Miller, discussed the concept of mass supervision. For every person who is incarcerated, there are four to five post-incarcerated individuals dealing with a number of challenges that stem from laws restricting their Civil Rights. This impacts their well-being and ability to function in society. The surrounding issues are larger, and include the social determinants of health along with the transition issue. Adjournment The Committee adjourned at 8:58 AM Respectfully submitted: Linda Largent The foregoing minutes were APPROVED AS PRESENTED on: November 8, 2017 Date Jeffrey Gaborko, M.D., Committee Chairman The foregoing minutes were APPROVED WITH MODIFICATION on: Date Jeffrey Gaborko, M.D., Committee Chairman