Board of Commissioners Meeting Agenda PHC's Southwest Office located at 495 Tesconi Circle, Santa Rosa, CA December 6, 2017: 10 a.m. 2 p.m.

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1 Section Video Conference Locations: PHC s Southeast Office located at 4665 Business Center Drive, Fairfield, CA PHC's Northwest Office located at 1036 Fifth Street, Eureka, CA PHC's Northeast Office located at 2525 Airpark Drive, Redding, CA Conflict of Interest Reminder - Commissioners should abstain from voting on any agenda item where they might have a conflict of interest. PHC Mission Statement is "to help our members, and the communities we serve, be healthy" Public and Guest Reminder - Public comment is welcome during designated "Public Comments" time frames. Start / End Time Board of Commissioners Meeting Agenda PHC's Southwest Office located at 495 Tesconi Circle, Santa Rosa, CA December 6, 2017: 10 a.m. 2 p.m. Page Item Description Presenter :00 AM Opening Call to Order An adjourned regular meeting of the Partnership HealthPlan of California will be called to order on 12/6/17 at PHC's Southwest Office located at 495 Tesconi Circle, Santa Rosa, CA Richard Fogg, Acting Chair 1.2 Roll Call Board Clerk 1.3 Agenda Approval or Modifications Richard Fogg, Acting Chair Action/ Discussion 1.4 Resolution to Approve the New Board Member 4-5 Appointment for Sherri Provolt This resolution approves the new Humboldt County appointment of Sherri Provolt. She will be representing Humboldt County as the Health Center Representative on the PHC Board. Liz Gibboney Action Approval of Board Meeting Minutes This action approves the Board meeting minutes for 10/25/17. Richard Fogg, Acting Chair Action 1.6 Commissioner Comments At this time, Commissioners may provide comments and announcements. Commissioners Information 1.7 Public Comments At this time, members of the public may address the Board on any non-agenda item of interest to the public that is within the subject matter jurisdiction of the Board. Members of the public will have the opportunity to address the Board on a scheduled agenda item during the Board's consideration of that item. Speakers will be limited to three (3) minutes. Public Information 1.8 Correspondence Board Clerk Information CEO Report Cyber Security Performance Report Liz Gibboney Information 28 Cyber Security Dashboard 2 Consent Calendar - Ratification of Finance Committee Action All matters listed on the Consent Calendar are to be approved with one motion unless a member of the Board removes an item for separate action. Any Consent Calendar item for which separate action is requested shall be heard as the next Agenda item :00 AM Resolution to Ratify Finance Committee's approval of DHCS Contract Amendments 36-38) This resolution authorized the CEO to sign the DHCS Contract Amendments for the period July 2014 to June 2015 and July 2015 to June Liz Gibboney Action Action Action Page 1 of 135

2 Section Start / End Time Page Item Description Presenter Action/ Discussion :05 AM Link to Committee Minutes below: Finance Committee Minutes - (11/15/17) :10 AM PHC Website Consent Calendar All matters listed on the Consent Calendar are to be approved with one motion unless a member of the Board removes an item for separate action. Any Consent Calendar item for which separate action is requested shall be heard as the next Agenda item. Internal Quality Improvement (IQI) Minutes - (See Q/UAC minutes for 10/18/17) Physician Advisory Committee (PAC) Minutes - (8/9/17) Physician Advisory Committee (PAC) Minutes - (9/13/17) Provider Advisory Group (PAG) Minutes - (11/17/17) Quality and Utilization Advisory Committee Minutes (Q/UAC) - (10/18/17) Strategic Planning Committee - (7/12/17) Link to Physician Advisory Committee Packet Link to Operation Reports Resolution to Approve Quality and Utilization Advisory Committee Membership Changes This resolution approves membership changes due to the new appointment of Dr. Swales and the resignation of Dr. Pirruccello. Resolution to Approve 340B Advisory Committee Membership Changes This resolution approves membership changes due to the new appointment of Daniel Santi, the new chairperson appointment of Dean Germano, and the resignation of Julie Johnston. Resolution to Approve Strategic Planning Committee Membership Changes This resolution approves a membership change due to the resignation of Kenneth Platou. Resolution to Approve Board Membership Changes This resolution approves membership changes due to the Humboldt County reappointments of Herrmann Spetzler and Nancy Starck. Resolution to Approve the Quality Improvement Program Work Plan and Quality and Performance Improvement Program Description for FY This resolution approves the QI Department's evaluation of key quality and performance improvement activities. Resolution to Approve Commendations and Appreciation for Kenneth Platou This resolution approves commendations for the outstanding service that Commissioner Platou has provided to the Board and PHC over the past four years and two months. Regular Agenda Items Resolution to Approve the Compliance Dashboard This resolution approves PHC's dashboard outlines activities to track the HealthPlan s Compliance Program and regulatory and contractual requirements. Richard Fogg, Acting Chair Liz Gibboney Liz Gibboney Liz Gibboney Liz Gibboney Liz Gibboney Liz Gibboney Liz Gibboney Accept :15 AM Reports Metrics and Financial Update for August Patti McFarland Information Operations Update Sonja Bjork Information Press Releases Liz Gibboney Information CMO Report on Quality Robert Moore, M.D. Information Action Action Action Action Action Action Action 6 Lunch Break 12:00 PM Adjournment for a 30-minute lunch break All Page 2 of 135

3 Section Start / End Time Page Item Description Presenter 7 Educational Session :30 PM Provider Relation Operations Update Mary Kerlin / Kelley Sewell Action/ Discussion Information :45 PM Member Survey and Call Center Technology Kevin Spencer / Information Kelley Sewell 7.3 1:00 PM Compliance Training Michelle Rollins Information 8 Member Story & Adjournment 2:00 PM John and Faith Richard Fogg, Acting Chair Information 9 Upcoming Board Meetings 2/28/ Main location is (TBD in Napa) 4/25/ Main location is Santa Rosa 6/27/ Main location is Fairfield 8/22/ Main location is Sheraton Hotel Redding 10/24/ Main location is Fairfield 12/5/ Main location is Santa Rosa Government Code requires that public records related to items on the open session agenda for a regular commission meeting be made available for public inspection. Records distributed less than 72 hours prior to the meeting are available for public inspection at the same time they are distributed to all members, or a majority of the members of the Commission. The Commission has designated the Board Clerk as the contact for Partnership HealthPlan of California located at 4665 Business Center Drive, Fairfield, CA 94534, for the purpose of making those public records available for inspection. The Board Meeting Agenda and supporting documentation is available for review from 8:00 AM to 5:00 PM, Monday through Friday at all PHC regional offices (see locations above). It can also be found online at PHC meeting rooms are accessible to people with disabilities. Individuals who need special assistance or a disability-related modification or accommodation (including auxiliary aids or services) to participate in this meeting, or who have a disability and wish to request an alternative format for the agenda, meeting notice, agenda packet or other writings that may be distributed at the meeting, should contact the Board Clerk at least ten (10) days prior to the scheduled meeting at (707) or by at Board_FinanceClerk@partnershiphp.org. Notification in advance of the meeting will enable the Board Clerk to make reasonable arrangements to ensure accessibility to this meeting and to materials related to it. This agenda contains a brief description of each item to be considered. Except as provided by law, no action shall be taken on any item not appearing on the agenda. Page 3 of 135

4 BOARD MEMBER APPOINTMENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Recommendation by: Humboldt County Board of Supervisors and PHC Staff Topic Description: On November 7, 2017, the Humboldt County Board of Supervisors appointed Sherri Provolt, to the PHC Board as the Humboldt County Health Center Representative. Ms. Provolt is the Chief Executive Officer of United Indian Health Services (UIHS), and she will be filling the vacant seat left by Steve Engle on the PHC Board for a four-year term of office, commencing on December 6, 2017, and terminating on December 31, Reason for Resolution: To get Board approval to appoint Sherri Provolt to the PHC Board as the Humboldt County Health Center Representative. Financial Impact: There is no financial impact to the HealthPlan. Requested Action of the Board: Based on the recommendation of Humboldt County Board of Supervisors and PHC Staff, the Board is asked to approve the new appointment of Sherri Provolt to the PHC Board. Page 4 of 135

5 BOARD MEMBER APPOINTMENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Number: 17- IN THE MATTER OF: APPROVING THE NEW HUMBOLDT COUNTY APPOINTMENT FOR SHERRI PROVOLT TO THE PHC BOARD Recital: Whereas, A. Certain agencies have responsibility for appointing Board members. B. The Humboldt County Board of Supervisors appointed Sherri Provolt to the PHC Board on November 7, C. Humboldt County has a vacant seat created when Steve Engle left. D. The Board has authority to approve and appoint committee members. Now, Therefore, It Is Hereby Resolved As Follows: 1. To approve the new Humboldt County appointment of Sherri Provolt to the PHC Board for a four-year term of office. PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: EXCUSED: Commissioners: Commissioners: Commissioners: Richard Fogg, Acting Chair Date ATTEST: BY: Cynthia McCamey, Clerk Page 5 of 135

6 Page 1 MINUTES OF THE MEETING OF PARTNERSHIP HEALTHPLAN OF CALIFORNIA (PHC) Meeting held at PHC s Southeast Office located at 4665 Business Center Drive, Fairfield, CA Video Conference from PHC s Northeast Office located at 2525 Airpark Drive, Redding, CA PHC s Northwest Office located at th Street, Eureka, CA PHC s Southwest Office located at 495 Tesconi Circle, Santa Rosa, CA On October 25, 2017 Commissioners Present: Camille Applin-Jones, Aimee Brewer, Paula Cohen, Greta Elliott, Donnell Ewert, Richard Fogg, Robert Gardner, M.D., Dean Germano, Catherine Harshbarger, Randall Hempling, Howard Himes, Gerald Huber, Dave Jones, Karen Larsen, Viola Lujan, Joy Newcom-Wade, Kenneth Platou, Mitesh Popat, M.D., LaSonja Porter, Kathryn Powell, Herrmann Spetzler, Nancy Starck, Karen Tait, M.D., and Allan Yamashiro, Pharm.D. Commissioners Excused: Tanir Ami, Lewis Broschard, M.D., Tammy Moss Chandler, Grant Colfax, M.D., Letty Garza, Sarada Mylavarapu, M.D., Barbie Robinson, and Heather Snow Commissioners Absent: None Staff Present Rebecca Boyd Anderson, Sonja Bjork, Jennifer Bush, Rachael French, Carly Fronefield, Nicole Hamblin, Peggy Hoover, Dawn James, Kirt Kemp, John Lemoine, Mary Kerlin, Margaret Kisliuk, Marshall Kubota, M.D., Regina Littlefield, Dustin Lyda, Patti McFarland, Sue Monez, Robert Moore, M.D., Tommee Naenphan, Michelle Rollins, Lynn Scuri, Kelley Sewell, Lyle Smith, Kevin Spencer, Nancy Steffen, Cody Thompson, Michael Vovakes, M.D., Wendi West, Meredith Wurden, Liz Gibboney, CEO, and Cynthia McCamey, Clerk Guests Present T. Abraham, Gregory Fearon, Pritika Dutt, Marcie Cudziol, and Bob McGarry AGENDA ITEM 1.0 OPENING AGENDA ITEM 1.1 CALL TO ORDER Commissioner Kathryn Powell, Chair, called the bi-monthly meeting to order at PHC s Southeast Region Office at 4665 Business Center Drive, Fairfield, CA, and welcomed everyone to the meeting. Board members were reminded to abstain from voting on any agenda item where they might have a conflict of interest. Also to state their name before asking questions or making motions. As a Page 6 of 135

7 reminder, Commissioner Powell read the PHC Mission Statement that is, to help our members, and the communities we serve, be healthy. In addition, she reminded members of the public and guests not to interrupt or speak during the actual meeting. There will be an opportunity at designated times for public comment. AGENDA ITEM 1.2 ROLL CALL Cynthia McCamey, Clerk of the Commission, called the roll indicating there was a quorum. AGENDA ITEM 1.3 AGENDA APPROVAL OR MODIFICATION Commissioner Powell asked if there were any changes to the agenda. Hearing none, she asked for a motion to approve the changes to the agenda. MOTION: Commissioner Huber moved to approve the agenda as presented, seconded by Commissioner Himes. AGENDA ITEM 1.4 TO APPROVE THE BOARD APPOINTMENT OF CAMILLE APPLIN-JONES Ms. Gibboney stated that Ms. Applin-Jones is joining the meeting from our Santa Rosa office. She is one of four Board members representing Sonoma County. She is currently the Medical Group Administrator at Kaiser Permanente in Santa Rosa, and she is responsible for all ambulatory care operations and services. Her health career spans 20 years in healthcare delivery, operations, and leadership. Her career began in nursing operations in the U.S. Army and she has also studied business. She has held a number of volunteer positions including the Planning Commission in the City of Fairfield. She will be representing Mich Riccioni who left the Board in April. Commissioner Powell asked if anyone had questions for Ms. Gibboney. Hearing no questions, she asked for a motion to approve resolution 1.4. MOTION: Commissioner Lujan moved to approve resolution 1.4 as presented, seconded by Commissioner Fogg. Commissioner Powell asked for commissioner or public comments. Hearing none, she called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY: 23 yes, 0 no, 0 abstention. Motion carried with Commissioners Ami, Broschard, Moss Chandler, Colfax, Garza, Mylavarapu, and Snow excused. Camille Applin- Jones was unable to vote until appointed. AGENDA ITEM 1.5 APPROVAL OF AUGUST 23, 2017 MINUTES Commissioner Powell asked if anyone had questions, corrections, or comments regarding the minutes. Hearing none, she asked for a motion to approve. MOTION: Commissioner Hempling moved to approve the Board meeting minutes for August 23, 2017 as presented, seconded by Commissioner Brewer. Commissioner Powell asked for commissioner or public comments. Hearing none, she called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY: 24 yes, 0 no, 0 abstention. Motion carried with Commissioners Ami, Broschard, Moss Chandler, Colfax, Garza, Mylavarapu, Robinson, and Snow excused. Page 2 Page 7 of 135

8 AGENDA ITEM 1.6 COMMISSIONER COMMENTS Commissioner Powell asked if there were any commissioner comments or announcements. Commissioner Platou stated that he was proud to announce that he is retiring on November 10, so this will be his last meeting with the Board. He thanked Board members and said that he was very proud to have been a part of this great group of people. It has also been a pleasure from the provider side to see a payer side actually share in their mission. AGENDA ITEM 1.7 PUBLIC COMMENTS Commissioner Powell asked if there were any public comments. She mentioned that members of the public or alternate Board Commissioners might address the Board on any non-agenda item of interest to the public that is within the subject matter jurisdiction of the Board. Members of the public will also have the opportunity to address the Board on a scheduled agenda item during the Board s consideration of that item. Speakers will be limited to three minutes. There were no comments. AGENDA ITEM 1.8 CORRESPONDENCE Commissioner Powell asked if there were any correspondence. Cynthia McCamey, Clerk of the Commission, replied that a resignation letter was received from Commissioner Platou dated October 23, 2017, stated that he was resigning from the Board due to his retirement. AGENDA ITEM 1.9 CEO REPORT Ms. Gibboney began her report by highlighting some updated information on the items included in her written report. Northern California Fires Due to the fires in Northern California, our offices in Santa Rosa and Fairfield were closed for a few days due to power outages and being in the evacuation zone. During the office closures, our calls and work cues were rerouted to our Northern Region offices. However, we had many staff who worked from home, as well as a number of staff who came into the Fairfield office to handle the work volume. Despite the office closures, our service levels remained high. Page 3 Provider Impact in Santa Rosa One of our large clinics under the Santa Rosa Community Health Center organization, Vista, with over 14,000 PHC members assigned, was partially burned in the fires. The remainder of the damage was due to the sprinkler system operating for many hours that flooded the building, making it unusable for many months to come. In response to this, the health center leadership has provided PHC and DHCS with their shortterm and long-term work plan to accommodate their assigned members as well as their non-phc patients who receive care at their clinic. They are making provisions to extend hours at their other clinic locations, as well as bringing in modular offices. They are trying to handle as many appointments by telephone as possible. It is going to take a number of months before PHC can regain that capacity, but staff will continue to have weekly phone calls with the health center leadership, as well as with DHCS to ensure access is not impaired. PHC will also monitor emergency room utilization, member grievances, and member calls to ensure access is being met. Commissioner Germano commented that a number of health centers have offered to loan the clinic medical vans. He mentioned that he is also aware that a number of the county health centers have similar vehicles like Shasta Community Health Centers, so maybe there could be an organized process to get some of the surplus down to the clinic while they are rebuilding their main site. Ms. Gibboney said she would certainly raise that question with Naomi Fuchs and her team and make the offer. Ms. Gibboney said in addition to that primary care site, PHC had about 170 long-term care patients who had to be evacuated to other skilled nursing facilities throughout the region, which is very difficult. Sonoma Developmental Center, which is scheduled for closure had to evacuate approximately 10 PHC members, so staff is monitoring this situation very closely. Approximately Page 8 of 135

9 600 early prescription refill overrides for patients displaced have been processed, since the fires began. ACA Repeal & Replace Efforts Staff are closely monitoring the executive orders issued on October 12 that directed the Health and Human Services Secretary to look at expanding access to health plans so they can potentially offer health care across state lines, expand coverage to lowcost or short-term skinny insurance policies. One of the biggest components of that executive order was rescinding the cost savings reductions (CSR), known as subsidies that the exchanges are able to offer to lower income members. In California, approximately 90% of the members on the exchange get some level of subsidies, so taking away the subsidies would have a significant impact. Eighteen states have filed a suit against the Trump administration to continue those subsidies and PHC should know today if the court is going to require that the subsidies continue while the cases are litigated. Federal Budget There is still significant interest in making cuts to Medicaid in terms of the total funding or the type of funding through block grants or per capita allocations, in addition to the tax cut packages being discussed, Medicaid savings could be used to fund the tax cuts. Staff will continue to work with our national association, as well as our federal lobbyist to ensure that importance of the Medicaid expansion and adequate funding for Medicaid is shared with our legislators. Children s Health Insurance Program (CHIP) Reauthorization Funding for this program still needs to be reauthorized. In California, there is plenty of funding to last for a number of months even though the funding technically expired at the end of September. California does not anticipate an issue since there seems to be bipartisan support for continuing CHIP funding into the new year, so staff will continue to monitor funding levels. There is a good opportunity that CHIP could be reauthorized with one of the upcoming hurricane relief funding packages. Housing and Homelessness Initiative We received almost 40 applications for our $25 million dollar housing initiative. We received $45 million dollars in funding requests and received at least one funding request from every county. The applications are falling into four buckets: 1. Definitely fund 2. Definitely do not fund 3. Needs additional clarification from applicants 4. Needs additional work from applicants Most of the applications fall into needing additional clarification from the applicants or needing additional work before staff can make a decision. Staff intend to finalize our internal review with some of the Board members who volunteered to review applications by early next week. PHC will be able to make the first round of announcements shortly afterwards. However, staff anticipate that applications that need clarification or additional work will take at least six to eight additional weeks so staff can work with the applicants to make modification to their applications. Annual Board Strategic Planning Retreat The retreat is coming up at the end of February. Staff will be working with Bobbie Wunsch to organize it; however, she will not be available to facilitate the meeting in person this year. Potential topics for the day are: 1. Social determinants of health / Blue Zones Communities 2. Health workforce 3. Federal funding strategies 4. California s 2020 Waiver 5. Single payer / Universal Coverage 6. Technology 7. Artificial intelligence 8. Member Engagement Page 4 Page 9 of 135

10 Staff will be meeting with the Strategic Planning Committee within the next couple of weeks and they typically do all the planning for the agenda, and we welcome Board members ideas. Commissioner Larsen asked with the 2020 conversation if we could include the mental health carve out and what that could look like in Big 5 State Initiatives: CCS Redesign Staff are currently planning to begin no sooner than January 2019, so in 2018, we will be ramping up our planning and the implementation of our new program. Staff anticipate having individual conversations with counties about how those arrangements will work in each county. Drug MediCal Staff are continuing to finalize our financial model and are meeting with DHCS today to review our model. In the last few weeks, we met with DHCS and Commissioners Starck and Ewert were part of those conversations to talk about our approach, as well as encourage continued funding for these services into the future, since staff believe that providing comprehensive treatment will reduce health care costs. The Governor signed SB 232, which is a bill that allows FQHCs to become Drug MediCal providers. Health Homes PHC should receive draft rates sometime in October. PHC is scheduled to be in group one that is set to begin in July Final Rule Implementation Staff are expecting a contract amendment from DHCS soon, which will be brought to the Board for authority to sign. This will encompass all of the changes that staff need to make to our contract because of the final rule. Proposition 56 funding will also be included, so PHC should have some additional payments to pass through to our primary care providers, specialists, and mental health providers for some E & O codes. Program of All-Inclusive Care for the Elderly (PACE) Staff are awaiting the final State guidance on how PACE organizations will interact with managed care counties, which should be released this week. This is significant for PHC because when a member is eligible to be placed in a skilled nursing facility and elects to go into a PACE organization, they are disenrolled from their health plan. In a County Organized Health System (COHS), this is a significant change. PHC expects to be asked to endorse or approve of PACE organizations wanting to operate in our counties throughout the planning process. Once the final guidance is released, we will develop internal criteria for whether or not to endorse those organizations. Transportation In late September, PHC received clarification from DHCS for programs like CCS. If those programs are already providing transportation, the expectation is that they will continue to provide transportation if a MediCal recipient requested it. However, under no circumstances should PHC get into a dispute with other organizations about who should provide the transportation because it is important that members get those services. Commissioner Huber asked if counties who submitted applications for the homeless grant have not heard anything about their application are they ok. Ms. Gibboney said that no notifications have been made, but staff will be communicating with all applicants to let them know if they are ready to go for funding in round one or if their application requires additional work. Commissioner Spetzler asked about transportation and if there is additional augmentation that the State is giving to Partnership. Ms. Gibboney replied yes, PHC received those rates a number of weeks ago and feel they are adequate. Cyber Security Performance Report Both reports are included for information. The dashboard shows the relative subject area of any attempts and any resulting breaches. There were no breach attempts, but PHC did have a short Internet outage related to the fire in Santa Rosa, so our office Page 5 Page 10 of 135

11 there lost Internet, phones, and power for a few days, but our Operations team was able to get them back up quickly. Commissioner Powell asked if anyone had additional questions for Ms. Gibboney. Hearing none, she moved on to the consent calendar. AGENDA ITEM 2.0 CONSENT CALENDAR RATIFICATION OF FINANCE COMMITTEE ACTION 2.1 Resolution to Ratify Finance Committee s approval of the New Building Interior Budget 2.2 Resolution to Ratify Finance Committee s approval of the Converting the PCP QIP Fixed Pool Measures to the PCP QIP Core Measurement Set Commissioner Powell stated that the Finance Committee approved all these items at their meeting last week, and now they require ratification by the Board. All items would be approved with one motion unless someone wants to pull an item for further discussion. Hearing no requests, she asked for a motion to approve resolutions MOTION: Commissioner Gardner moved to approve resolution as presented, seconded by Commissioner Yamashiro. Commissioner Powell asked for commissioner or public comments. Hearing none, she called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY: 24 yes, 0 no, 0 abstention. Motion carried with Commissioners Ami, Broschard, Moss Chandler, Colfax, Garza, Mylavarapu, Robinson, and Snow excused. AGENDA ITEM 3.0 CONSENT CALENDAR 3.1 Resolution to Approve Committee Minutes / Operation Reports on PHC s Website 3.2 Resolution to Approve PHC s Conflict of Interest Code Policy, CMP Resolution to Approve PHC s Intergovernmental Transfers Policy, ADM-27 Commissioner Colfax asked if the I.G.T. policy is asking us to use some of the funds for the Drug MediCal organized delivery system, if so should counties participating abstain from voting. Ms. Gibboney replied no, those funds would go into our larger fund to be utilized for that benefit. Commissioner Powell stated that all items on the consent calendar would be approved with one motion unless someone wants to pull an item for further discussion. Hearing no requests, she asked for a motion to approve resolutions MOTION: Commissioner Gardner moved to approve resolutions as presented, seconded by Commissioner Tait. Commissioner Powell asked for commissioner or public comments. Hearing none, she called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY: 24 yes, 0 no, 0 abstention. Motion carried with Commissioners Ami, Broschard, Moss Chandler, Colfax, Garza, Mylavarapu, Robinson, and Snow excused. Page 6 Page 11 of 135

12 AGENDA ITEM 4.0 REGULAR AGENDA ITEMS AGENDA ITEM 4.1 TO ACCEPT MOSS ADAMS AUDIT REPORT FOR THE PERIOD OF JULY 1, 2016 TO JUNE 30, 2017 Ms. Gibboney introduced John Feneis and Chris Pritchard (by phone) from Moss Adams to do the overview of our external audit that was just completed. The Finance Committee heard the report last week. Page 7 Commissioner Germano asked if there was time to ask a question about the change in the consent agenda while we are waiting for Ms. Pritchard to call into the meeting. Ms. Gibboney said yes. Commissioner Germano mentioned that the change to the QIP program is a significant change on how organizations practices are going to be evaluated and incentivized. Ms. Gibboney agreed. It is a significant change and staff have discussed this with the Finance Committee as well as with our Physician Advisory Committee. PHC needs to improve our HEDIS scores and the QIP program is the best vehicle to get that done, so staff made a couple of changes. PHC is not going to pay for measures under the minimum performance level (MPL). We are also making Relative Improvement points more challenging to earn. The Finance Committee will discuss this again in November as they finalize the dollar amounts that will be paid. Commissioner Spetzler asked if those discussions will include any of our contractors or is it internal to the Board. Ms. Gibboney replied, there is a technical work group made up of providers throughout the service area that have been able to comment on the changes to the PCP QIP. Mr. Pritchard stated that the audit packet contains the draft Financial Statements, a Communication letter from Moss Adams to the Board, as well as a copy of their presentation today. Mr. Pritchard presented a summary of PHC s audit report ending June 30, 2017 that was presented to the Finance Committee last week. Based on all the procedures performed during the audit Moss Adams issued an unmodified audit opinion, which is the highest level of assurance they can give as our audit firm that these financial statements are free of material misstatements. It also reflects management s hard work in reconciling and keeping the books and records accurately. Congratulations to the Finance Team! Mr. Feneis reviewed the audited information related to PHC s balance sheet and some of the audit procedures performed and the fluctuations from year to year end, as well as some other financial information and required communications. PHC s cash and cash equivalents increased this year by approximately $153 million dollars, and all that increase was covered by operations. There have been no changes or suggestions to modify the cash or cash equivalent reported by management. California Department of Health Care Services and receivables have gone down this year and the balance was properly stated. The other change on the statement of net position was related to the composition of capital assets, which increased by $15 million dollars for purchases minus depreciation. The other Medicare receivables, other assets, net pension assets, and deferred outflows of resources were compared with prior years and were properly stated. Accounts payable increased by $24 million dollars, which related to expenditures subsequent to year-end. We determined that the balance was properly stated. The payable to the State of California has increased this year by approximately $30 million dollars. That balance is comprised of medical loss ratio and the overpayment from the State, both of those balances increased. The overpayment from the State increased to $218 million and the MLR increased $323 million dollars. Both of these balances were properly stated. We determined that management was slightly over reserved for accrued claims payable based on last year s balance in by approximately $30 million dollars, but management s estimated process continues to be reasonable and properly stated. The other change was in net position, which decreased by $8 million dollars that was attributed to overall change in the net position of the health plan. Page 12 of 135

13 Mr. Pritchard said total operating expenses and operating revenue is consistent with last year. Based on the pie chart, there was a slight shift in fee for service and a 1% shift in other expenses, but from their perspective, everything looks reasonable and everything is trending as expected. PHC s Tangible Net Equity (TNE) remains higher than the State of California s requirement. There was a slight reduction that relates to a small loss in the current year. There were no issues with the information provided or issues with management s calculations on the general ledger to the financial statements, and they were properly reconciled and in accordance with accounting policies. Mr. Pritchard stated that they had no proposed audit adjustments and they did not find any issues in completing their work, nor did they have any disagreement over the way things were accounted for. He further stated that because of PHC management support and the level of getting information to Moss Adams in a timely manner, they were able to execute the audit as expected. Commissioner Powell asked if anyone had questions for Mr. Feneis or Mr. Pritchard. Hearing no questions, she said that it is always impressive to hear the audit report, especially in an organization this size, and it really speaks well of the Finance Department and the leadership. Ms. Gibboney thanked Patti McFarland and her team for having yet another wonderful audit. It is always great to work with Moss Adams. Commissioner Powell asked for a motion to approve resolution 4.1. MOTION: Commissioner Spetzler moved to approve resolution 4.1 as presented, seconded by Commissioner Lujan. Commissioner Powell asked for commissioner or public comments. Hearing none, she called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY: 24 yes, 0 no, 0 abstention. Motion carried with Commissioners Ami, Broschard, Moss Chandler, Colfax, Garza, Mylavarapu, Robinson, and Snow excused. Commissioner Fogg asked how long PHC has used the same auditors. Ms. McFarland said she is not sure how long PHC has used Moss Adams, but companies typically change out partners not firms. She will look into how long we have used Chris Pritchard. AGENDA ITEM 4.2 RESOLUTION TO APPROVE COMMENDATIONS AND APPRECIATION FOR KAREN TAIT, M.D. S SERVICE TO THE HEALTHPLAN AND THE BOARD Ms. Gibboney stated that Dr. Tait is the county representative for Lake County on the PHC Board and she holds one of the two Board seats for Lake County. Dr. Tait has served on the Board for four years and now she is retiring in early December. Ms. Gibboney wished her well in her retirement and thanked her for serving on the Board so steadfastly and being a consistent contributor to discussions. Ms. Gibboney presented Commissioner Tait with a plaque to show our appreciation for her service. Dr. Tait said that she is so impressed with this organization and that she is taking away more than she gave. Commissioner Powell asked if anyone had questions for Ms. Gibboney. Hearing no questions, she asked for a motion to approve resolution 4.2. MOTION: Commissioner Gardner moved to approve resolution 4.2 as presented, seconded by Commissioner Yamashiro. Page 8 Page 13 of 135

14 Commissioner Powell asked for commissioner or public comments. Hearing none, she called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY: 23 yes, 0 no, 1 abstention from Commissioner Tait. Motion carried with Commissioners Ami, Broschard, Moss Chandler, Colfax, Garza, Mylavarapu, Robinson, and Snow excused. AGENDA ITEM 5.0 OTHER REPORTS AGENDA ITEM 5.1 FINANCIAL UPDATE Ms. McFarland began her report by saying that staff are moving to a new format with some slight modifications in this fiscal year, which were reviewed with the Finance Committee. The new format is expected to make the financial statements easier to read and more robust, with an explanation on some of the bigger variances. Please Ms. McFarland if you would like to see anything else. Financial Analysis for the Current Period Total (Deficit) Surplus / Revenue - For the month ending August 31, 2017, PHC had a loss of $13.7 million dollars, which was $4 million dollars over budget loss. This was primarily due to a revenue reduction that was caused by erroneously accruing revenue for capitated primary care members in our system, which was identified during a Member Improvement project that compared files coming from the State with internal data. This was a $500,000 dollar expense over a threeyear period. Staff discussed doing a claw back with the Finance Committee and they agreed with our recommendation not to do a claw back from our providers. Page 9 Commissioner Huber asked that in regards to those members who lost their membership, is that an issue with the county not identifying members dropping off MediCal eligibility for some other reason or does PHC get a notice from the State. Ms. McFarland said that we get eligibility loaded into our system daily from the State, but apparently something happened in our system and our data was overriding loaded data. The problem appears to be on members who were deceased. PHC has been working with the State for a decade to get our internal membership data to match the State s data, but it has not happened yet. Until it does, staff have implemented some workarounds to catch these types of errors. Healthcare Costs Overall costs were to budget, but PHC had some minor fluctuations. Some of the negative to budget costs had to do with ancillary physician costs for Behavioral Health Therapy, which is the Autism treatment. Staff have started to see an increase in utilization for this benefit. Our long-term care (LTC) variances were favorable to budget. It takes approximately nine months or so, before PHC can budget the true LTC expenses. Pharmacy variances were also favorable to budget, this was due to collecting pharmacy rebates, which is new for PHC. Ms. McFarland pointed out an accounting adjustment of $25 million dollars that made it appear that PHC had a favorable amount in our Health Care Investment funds. This relates to the money budgeted for housing for July and August. Since this will not be paid out until January, PHC wanted to show the accrual for those expenses on a monthly basis. Administrative Costs PHC was under budget by $0.7 million for the current month, which was expected at the beginning of the fiscal year. PHC is generally under budget until positions that were approved during the year are filled. Membership Staff saw an increase of 715 members this month compared to July. Unrestricted Reserves This is the money not earmarked for Strategic Use of Reserves (SURs), buildings, capital equipment, or the Board designated expenses is currently at $210 million dollars, Page 14 of 135

15 which is very healthy. In the next month or so, PHC expects to get discussion items from the State on our rates for next fiscal year. Unrecorded Items The State has been trying to put as many members as possible into MediCal, but CMS said that a number of these members should have been in Medicare so PHC was asked to do an adjustment. The State is now planning to do a claw back to recover the overpayment for those members. Since our numbers do not match up with theirs, staff are not going to do anything until we make sure our numbers match. This could cost us about $30 million dollars. The other positive thing that PHC needs to record is the MediCal Expansion Medical Loss Ratio (MLR) money that we have been accruing for months, which needs to be paid back to the State for not reaching the 85% MLR in the first two and a half years. Commissioner Spetzler asked if PHC has reserves for MLR. Ms. McFarland replied yes, PHC has had a huge reserve on the balance sheet. Commissioner Cohen asked about the membership increase numbers, and the decrease in the Northern Region. Is that decrease typical or is it skewed for any reason. Ms. McFarland was unsure of the reason. For months, staff have noticed that some counties go down while others go up and since the counties handle eligibility it could have to do with their backlog. It can also have to do with the unemployment rate in different counties. Commissioner Popat said it looks like we have good reserves and some challenges on an operating basis. What is the general approach on an operating basis looking at the expense side? Ms. McFarland said the negative is expected. Over the last three years, we built up reserves mostly due to the MediCal expansion population. We spend less than 4% on administration, so it left 11% that we put in our reserves. The Board approved seven to eight iterations of SURs, so the losses are a result of spending down those reserves for well over 200 projects. Commissioner Fogg asked if the State understands what we are doing with SURs and that this program is legal. Ms. McFarland replied that it is absolutely legal. It has always been understood that if a plan and their Board decides to spend money on things like increasing rates, that they would have to absorb the costs for two years before it is built into their rates. However, housing expenses are not allowed in our rate development. Page 10 ACTION: No action required. Commissioner Powell asked if anyone had additional questions for Ms. McFarland. Hearing none, she moved on to Sonja Bjork for the Operations Update. AGENDA ITEM 5.2 OPERATIONS UPDATE Ms. Bjork began the report by highlighting some information included in her written report. Operational Excellence/PMO: Transportation The experience of implementing this new benefit has been interesting. This new benefit model had some unique challenges. As of October 18, PHC has provided 14,000 rides since July 1. Staff have been tracking two different types of reports that look at our vendor (MTM) and their call center (e.g. answer times, hold times, and hang-ups), as well as the type of rides provided (e.g. taxi, bus, paratransit, Amtrak, or gas mileage reimbursements). Of those, approximately 11,500 rides took place by taxi or lift vans, and 85 rides took place by bus or Amtrak, and 2,400 were gas reimbursements. The State wants us to track the number of rides that are for services not covered by PHC. Since October 1, PHC has been required to provide transportation to services like dental, severely mentally ill, drug and alcohol treatment, etc. Tracking services for those are more difficult since we do not have the information in-house. We need to ask questions such as; why they were referred to PHC; why they do not have a ride; and all the other eligibility Page 15 of 135

16 Page 11 questions. After PHC has several quarters of tracking data, staff will bring an update back to the Board. We were glad when we received the rates for transportation and our Finance Department found them to be acceptable. However, but we are still waiting for clarification on this complex benefit. The State is currently developing a FAQ that will become part of the All Plan Letter (APL). PHC still has quite a few member no-shows and that is frustrating, so we would like to be able to track no-shows in our case management program. Staff are also working hard to develop the network in some of our rural areas. In some of the more urban areas, we are not using gas mileage reimbursements, as members are able to take the bus. But, that does not work in our Northern rural areas. The best option may be to have someone drive them to their appointment. Commissioner Ewert asked if PHC could provide some material that they can use to promote this service to providers. Ms. Bjork said not until PHC receives the FAQ from the State. Right now, the State has to approve all member communications and they have not developed approved language on this benefit. Once we receive the FAQ sheet, we will be happy to distribute it to our Board members and provider network. For now, they need to call our Member Services number since our staff are trained to take the calls. Commissioner Spetzler asked how the benefit works in our rural areas if a neighbor gives the member a ride and they get into an automobile accident. Who carries the liability? Ms. Bjork responded that the important thing is for people to call five days ahead of time. That way staff can ask questions such as is the automobile in good working order, whether they have a driver s license, and if they have automobile insurance. The liability should fall under the driver s responsibility. Commissioner Spetzler suggested pushing this issue back to the State to see if there is some kind of blanket coverage available for this type of situation. Ms. Gibboney and Ms. Bjork agreed to include this question in their conversation with the State. Marcie Cudziol asked what PHC s vision is, particularly for medical providers who do not provide those types of services, like dental. How can the county assist with managing those transportation requests and tracking those trips? Ms. Bjork said that anyone could call in to set up a ride. Ms. Fronefield stated that anyone could reach out to MTM s 800 number or to our Member Services number and get assistance scheduling a ride. If they call Member Services, staff can connect them to MTM for the non-medical transportation. Commissioner Huber expressed concern about redundancy and the infrastructure not in place if someone calls into a call center, county, or region. It would be good for medical transportation management to know what is being planned since they are working to reduce costs as well as to avoid confusion with the population it is serving. Ms. Bjork said PHC is expecting our vendor to get more sophisticated about each county. Commissioner Applin-Jones asked about incentives for clinics and providers so offices can get people to preventative health care services. Does this transportation benefit cover incentives? Ms. Bjork said that PHC s transportation benefit absolutely covers those types of services. ACTION: No action required. Commissioner Powell asked anyone had additional questions for Ms. Bjork. Hearing none, she moved on to Dustin Lyda for the Legislative Update. Page 16 of 135

17 AGENDA ITEM 5.3 LEGISLATIVE AND REGULATORY UPDATE Mr. Lyda began his report by highlighting some things on his written reports. He stated that the legislative session ended on September 15. The Governor had until October 15 to sign any of the bills he received. He signed 859 bills and vetoed 118 bills. Three big things that happened on a global scale: 1. Spring: the Infrastructure Revenue and Spending Package this was a 10-year, $52 billion dollar transportation infrastructure spending plan. 2. Summer: the Greenhouse Gas Emission Law, Cap-and-Trade Spending Authority AB 398 extended the cap-and-trade program from 2013 to Fall: the Housing Package was signed and passed on the last day of the session. The bill is expected to generate $250 million dollars a year to subsidize affordable housing. Update on Bills that PHC s Strategic Planning Committee is Focusing On: 1. SB 323 by Senator Mitchell this bill authorizes a federally qualified health center (FQHC) or rural health clinic (RHC) to enroll as a Drug MediCal (DMC) certified provider and receive reimbursements for services. PHC letter sent. 2. AB 275 by Assemblyman Wood this bill is in direct correlation to what happened with Rockport Healthcare Services and long-term care facilities in the Eureka area. This bill expanded the notification that facilities would need to give to not only the ombudsman, but also to residents and it requires a 60-day notice. PHC letter sent. 3. SB 222 by Senator Hernandez this bill is still in the Appropriations Committee. It applies to MediCal members incarcerated, and it extends the suspension of MediCal benefits throughout their entire incarceration to remove the gap of not having access to care when they are released from prison. PHC letter sent. Update on Bills: 1. AB 1250 this bill is being held in the Rules Committee. 2. Assembly Select Committee on Health Care Delivery Systems and Universal Coverage - They have had two hearings on Monday and Tuesday to discuss health care in California and what might be the appropriate model. PHC will continue to monitor discussions as they unfold. Page 12 Commissioner Huber asked about the status of AB Mr. Lyda said DHCS and the California Association of Hospitals opposed the bill, so it has been held over. Mr. Lyda also mentioned PHC s press releases are focused on our Managing Pain Safely Program and curbing the Opioid impact. ACTION: No action required. Commissioner Powell asked if anyone had additional questions for Mr. Lyda. Hearing no questions, she moved on to Robert Moore, M.D. for the Quality Update. AGENDA ITEM 5.4 QUALITY UPDATE Dr. Moore began his report with a focus this month on HEDIS trends. 1. HEDIS results for PHC Kaiser Members In general, staff found that Kaiser s 2016 results raised the quality scores in our Southern Regions due to their high quality scores. In 2017, the Southeast Region s score slipped slightly compared to last year. Both measures were for hypertension control, which showed a significant decline. In the Southwest Region, scores that were already below the MPL level slipped further, which was childhood Page 17 of 135

18 immunizations. There are many challenges with immunizations in all of our regions. Note: there are no Kaisers in the Northern Region. When Kaiser members are excluded, the performance in PHC s regions from highest to lowest is Southeast, Southwest, Northwest, and Northeast. 2. Statewide trends in Opioid Use The State published a dashboard of data related to opioid overuse on their website. 1,925 opioid overdose deaths in fentanyl overdose deaths in ,935 opioid (excluding heroin) overdose ED visits in ,684,377 opioid prescriptions written in 2016 Overdose deaths are rising in some areas, and falling in others, even while prescriptions for opioids are decreasing. In Tennessee, they found as opioid prescriptions decreased, people switched to street drugs like heroin and fentanyl, resulting in increased overdose deaths. If PHC can shift this trend, then we should start seeing fewer deaths. PHC needs to promote medication-assisted therapy with methadone, buprenorphine, and naltrexone. Commissioner Lujan asked how PHC s trends compare with the other COHS plans. Dr. Moore said there has been a statewide decrease. The data is available on the State website. Commissioner Spetzler mentioned that statistics really get goofy when you start looking at small populations, should we get some of this information to an institution like HSU in Fresno so they can do an analysis on smaller populations. Dr. Moore said that Mr. Spetzler s Quality Improvement Officer would be proud of him for bringing this issue up. He agreed that small denominators could make the rate go very high or low. Commissioner Yamashiro said Dr. Moore talked about the pipeline and part of that equation is decreasing the opioid prescriptions, but the other part of the equation is what is shifting with street drugs. Does PHC understand what is happening with street drugs? Dr. Moore said PHC does not have much data on street drugs, so it is tricky since they do not get prescriptions for things like heroin, so all we know is that they are not paying for opioids. 3. Patient Experience Survey Results PHC performs one patient experience survey that is plan wide. It is also part of the QIP analysis on an individual large site level for larger PCP providers. The big drivers are access and communication. Dr. Moore mentioned some of the practices who did very well. Open Door Community Health Centers Access scores Sutter Medical Foundation-West Access scores Redwood Pediatric Medical Group Access and Communication scores NorthBay HealthCare Access and Communication scores Shasta Community Health Centers Access scores ACTION: No action required. Commissioner Powell asked if anyone had additional questions for Dr. Moore. Hearing none, she adjourned the meeting at 12:00 PM for a 30-minute lunch break. Page 13 Page 18 of 135

19 AGENDA ITEM 6.0 LUNCH BREAK Commissioner Powell called the meeting back to order at 12:30 PM for the Education Session Updates. The afternoon session began with Peggy Hoover and Carly Fronefield for the Care Coordination Update. AGENDA ITEM 7.0 EDUCATION SESSION AGENDA ITEM 7.1 CARE COORDINATION UPDATE Ms. Fronefield began the afternoon session with an update on the Napa, Solano, and Sonoma County fires and the activities from Health Services. The fires affected many of our members, providers, and staff. On October 9, the Community Emergency Response Team (CERT) was enacted to address the growing concerns due to the fire. A few days later, PHC enacted the Business Continuity Plan with the CERT group. The Northern Region Health Services group processed 4,043 TARs and they answered 1,077 calls with a performance level of 86%. Staff quickly identified affected patients and transferred records for the evacuated LTC members. Ms. Hoover said PHC was fortunate to have teleworkers who were able to continue working when the Fairfield office had to close. We were also very grateful that the Northern Region was able to assume such a large part of the responsibility for our high call volume. In the Fairfield office, we immediately began to serve the community with our Community Emergency Response Team. Our Provider Relations Department made daily calls with our providers to track sites that were open, closed, and if closed, when they would be able to reopen, as well as damages. Our Communications Team posted resources on our external and internal website for members and staff. PHC had 96 vulnerable members who needed dialysis in the Sonoma County area, so staff immediately contacted our medical transportation vendor to get a list of members who were scheduled for transportation on that Monday and Tuesday, so we could secure dialysis centers or places that they could receive their dialysis. Our largest transportation vendor had 17 of their 20 drivers who were unable to report to work. Of the 96 patients who needed dialysis and with all our efforts and the efforts of the centers, those members only missed one day of dialysis. PHC also had residents at the Sonoma Development Center evacuated to shelters and then were able to return to the center. PHC identified 175 long-term care facility members who were moved to other facilities ranging from Las Vegas to Oregon. Our biggest challenge now is to identify all those members and make sure arrangements are made to get those facilities paid. Now that some of the Sonoma facilities are up and running, they want their patients back, so staff need to arrange transportation for all those members. The other issue is that some of those members want to stay where they were placed. It will take a lot of manpower to figure this all out. Ms. Hoover also recognized Santa Clara Health Care and several other sister health plans who offered to help us. Staff asked them to help locate skilled nursing facilities who could take our members and they were successful. Our Pharmacy Department did special decision on prescriptions. They did 547 medication overrides during this time to ensure people who had to evacuate their homes were able to get their medication refilled. Page 14 Commissioner Germano asked Ms. Gibboney if PHC had some lessons learned from this disaster exercise that could benefit counties where fires and tsunamis are a real possibility. Ms. Gibboney said yes, PHC has two emergency protocols. One Page 19 of 135

20 is our Community Emergency Response Team (CERT), which is activated when there is an external emergency in the community that affects our members and providers. The other is our Business Continuity Plan that is activated when a PHC facility is unable to function, like our data center here, which is why PHC has a data center off site that is a replica of our Fairfield data center where PHC could move our operations to if it is needed. This incident started as a CERT incident, but became a business continuity situation when PHC had to do a soft evacuation of our Fairfield building. Staff are in the process of developing lessons learned, as well as identifying activities and steps that we want to implement for these kinds of incidents. PHC still has some things to work out with staff communications, but overall the communication with staff via our website worked fairly well. Commissioner Lujan asked if PHC has an emergency preparedness position. Ms. Gibboney replied that we have committees. However, we have a dedicated person in our IT Department who works on the Business Continuity Plan and redundancies within our systems and she is part of the CERT Team and the Business Continuity Plan Team. The committees have representatives on it from each PHC department. PHC also has a Safety Team. Commissioner Spetzler was appreciative of PHC s decision in an emergency to allow members to get care wherever there is access. However, he would like to see that practiced as an organization a little better to prevent confusion. Ms. Gibboney said she would add it to our list. Commissioner Powell asked if anyone had additional questions for Ms. Hoover or Ms. Fronefield. Hearing no questions, she moved on to Robert Moore, M.D., Rachael French, and Nancy Steffen for the Quality Department Overview Update. ACTION: No action required. AGENDA ITEM 7.2 QUALITY DEPARTMENT OVERVIEW UPDATE Dr. Moore began by reading a quote from William Foster, quality is never an accident. It is always the result of high intention, a sincere effort, intelligent direction, and skillful execution. It represents the wise choice of many alternatives. Incentive Programs Major activities include Primary Care Provider Quality Improvement Program (QIP), Hospital QIP, Long Term Care QIP, and Partnership Quality Dashboard. Performance Improvement Major activities include Managing Pain Safely, Offering and Honoring Choices, HEDIS Improvement, EyePACs, ADVANCE, ABCs of QI, Advanced Access Collaborative, and Internal PI Training. HEDIS Project Major activities includes collecting HEDIS data. Patient Safety - Major activities include Facility Site, Medical Record Review, and Peer Review. QI Compliance - Major activities include Delegation Oversight, DHCS QI Requirements, Quality Committees, and QI Policy Oversight. These activities are required by DHCS. Ms. French provided an update on NCQA Accreditation She said there are three evaluation options that include Interim (18 months), First (36 months), and Renewal (36 months). PHC s goal is to obtain an Interim accreditation status by September This accreditation will be good for 18 months. Page 15 Page 20 of 135

21 Dr. Moore said of the 24 MediCal managed care plans in California only 12 are accredited by NCQA. The strategies that PHC is using to focus on improved HEDIS scores are our incentive programs and QI compliance activities. Ms. Steffen discussed specific strategic efforts to improve HEDIS scores. She said DHCS requirements are driving our work in the present environment. The things that are critical to them are taking a subset of measure out of the NCQA HEDIS tool measurement set, and then evaluating how PHC and other plans compare relative to other Medicaid and MediCal plans in California. They are looking at our performance relative to the national benchmarks across all Medicaid plans. They pay particular interest to any performance on an annual basis where PHC reports scores below the minimum performance level (MPL), which is the 25 th percentile. We are paying close attention to triggers and corrective action plans (CAP). Last year, we were told that our Northeast region was very close to having more than 50% of accountability set measures below MPL. We have worked hard to improve those scores and we could not have done it without our partners and community stakeholder groups in the region. Since 2017, our Quality Improvement Team has been working on establishing a strategic plan that is specific to HEDIS score improvement. PHC set three goals to improve all HEDIS measures to achieve: 1. The minimum performance level (25 th percentile) across all four regions by July Above the 50 th percentile across all four regions by July Above the 75 th percentile across all four regions by July 2022 To do this PHC is going to focus improvement around our Population Health Management strategy. Dr. Moore discussed quality outcomes and he said there are four challenges that PHC faces as a health plan and the strategies that staff need to use to improve. 1. Non-Integrated Network PHC is not a Kaiser. We have to do our best through our partnership with our providers to link our activities, so we look more integrated than we actually are on paper. 2. Lack of Resources PHC needs to take savings from better utilization and reinvest those savings into quality initiatives, and avoid over-utilization and improve State regulators. 3. Regulatory Environment PHC needs to pursue NCQA accreditation and avoiding duplicate regulatory because it pulls us away from focusing on quality. 4. Vulnerable Population PHC needs to focus on addressing Social Determinants of Health with things from our SUR projects like housing. In addition, PHC can use lessons that Kaiser learned in achieving quality. PHC can also look at the lessons learned from Baldrige. Although Quality and Performance Improvement are leading the work, NCQA and HEDIS is a highly collaborative process across the entire organization, including our provider partners. Page 16 Commissioner Huber asked if a copy of the PowerPoint could be sent to Board members. Dr. Moore replied yes. Commissioner Brewer asked what we could do as Board members to better influence our PHC members. Board members have many struggles in our organization so are we allowed to give incentives. Dr. Moore said member incentives are permitted, but PHC has not found them to be effective. Commissioner Germano asked Dr. Moore for his perspective on the relationship between quality scores and the size of a practice. As well as how we can work together to develop Page 21 of 135

22 our core leadership. Dr. Moore replied that in general, the larger sites have had better quality scores, but there are exceptions. The quality of an organization s leadership could affect those trends. If you have access issues because of not having enough providers, it is going to be difficult to focus on quality. Leadership development is a heavy lift for an organization, but you need to find a way to promote leadership growth to mid-level staff in your organization. Commissioner Tait mentioned NCQA requires a big focus on providers. One of the issues is not just the vulnerable population, but it is the cultural issue in rural areas. Their concept of wellness is not the same so participation in a product like NCQA does not happen. It is really a rural urban issue to some extent. Dr. Moore said that is a good observation. Commissioner Hempling commented that NCQA has an extraordinary cost on top of normal operations. The money will not be wasted, but it will be duplicated if PHC has to do anything with Knox Keene, so legislatively PHC needs to continue addressing the issue with our legislators. Commissioner Powell asked if anyone had additional questions for Dr. Moore, Ms. French, or Ms. Steffen. Hearing none, Commissioner Powell asked if there was any further business to discuss, hearing none, she adjourned the Board meeting at 2:00 PM. Minutes respectfully submitted by: Cynthia McCamey, Clerk Board Approval Date: Signed: Cynthia McCamey, Clerk Kathryn Powell, Chair Page 17 Page 22 of 135

23 Report from the Chief Executive Officer November 29, 2017 ACA Repeal & Replace Efforts. The fourth attempt at ACA repeal, focused on the ending the individual mandate as part of a large tax cut measure, has cleared the House and the Senate Budget Committee. It may get a final vote this week. At this time, it appears that concessions were made to continue the federal subsidies for exchanges and to continue allowing up to $10,000 in property taxes from taxable income. Assuming the Senate passes a tax bill, its version will need to be reconciled with the House s version via a conference committee. Federal Budget. At this time, there is still a Continuing Resolution in place that expires at the end of December. With the focus currently on the tax bill, there has not been much public progress on another Continuing Resolution or on a final budget package. HHS Leadership and CMS Waiver Strategy At this time, Alex Azar is the nominee to run the Health and Human Services Agency, filling the spot vacated by Secretary Tom Price. In addition, CMS Administrator Seema Verma recently announced a new direction for Medicaid, saying she wants to reset the federal/state relationship. Children s Health Insurance Program (CHIP) Reauthorization. The House did pass a CHIP reauthorization bill, Championing Healthy Kids Act, which also includes significant funding for health centers. The situation in Senate remains uncertain due to partisan differences over funding offsets. Housing and Homelessness. We announced the first round of funding for housing grants in mid November, with at least one successful grantee from each county. There are remaining funds in three counties and we will be working with HHS leadership on priorities for their counties to determine final recommendations to use unspent funds. Annual Board Strategic Planning Retreat. We are planning the annual Board dinner, meeting and retreat to be held in Napa on Tuesday, February 27 th (dinner) and Wednesday, February 28 th. We have finalized the speakers and topics at this time, with the assistance of our Strategic Planning Committee. Big 5 State Initiatives. CCS Redesign PHC is scheduled to begin no sooner than January, Drug MediCal Our application has been approved by DHCS and we continue to work with DHCS on our fiscal model. 1 Page 23 of 135

24 Health Homes PHC is scheduled for phase one, to begin July, 2018, pending rates. Palliative Care Our extended pilot is active and our provider network growing, in anticipation of the statewide benefit launching January, PPS Redesign This is also still pending DHCS activity as they come to agreement with CMS on terms. CA Future Health Workforce Commission. We are continuing to participate in this health workforcefocused commission charged with developing a strategic plan and recommendations by December, The Commission is being co chaired by UC President Janet Napolitano and Dignity Health CEO, Lloyd Dean. The Commission has three focus areas including primary care, behavioral health and aging. Geographic Expansion. Butte, Plumas, Colusa, Glenn, and Tehama Counties have passed resolutions indicating their desire to leave the Regional Model of MediCal managed care and to join PHC as soon as possible. The posted DHCS re procurement schedule for these counties remains unchanged, with a golive date of HealthPlans/Medicaid Expansion Medical Loss Ratios (MLR). You may have seen recent articles in the LA Times and SF Chronicle regarding significant health plan profits made during the Medicaid Expansion launch, under the auspices of the Affordable Care Act (ACA). The articles called into question several health plans, both commercial and local MediCal plans, and their surpluses generated during this period. As you know, PHC has over $320M reserved and ready to return to the federal government, via DHCS, due to premiums received in excess of the required Medical Loss Ratio. Northern California Fires. At the State s request, we are participating in regular calls relative to any access issues faced by Vista Community Health Center (Santa Rosa) which was severely damaged in the recent fires. NCQA Accreditation. We are in compliance with approximately one quarter of the standards needing to be completed and signed off by our consultant by June 30, 2018, in order to successfully seek Interim Accreditation under NCQA. Program of All Inclusive Care for the Elderly (PACE). DHCS has released final guidance that would allow for profit PACE programs to operate in California, and for PACE programs to operate in County Organized Health System (COHS) counties, including PHC s service area Business Center Drive Construction. We are on schedule, despite recent rains. Staff Count. We currently have 747 employees. Next Board Meeting: Tuesday, February 27 th (approx. 6:00 pm) Board Dinner, location: TBD/Napa Wednesday, February 28 th (8:00 am) Board meeting and planning retreat: TBD/Napa 2 Page 24 of 135

25 CYBER SECURITY PERFORMANCE REPORT Data Results from 8/31/ /30/2017 File Systems/AV 9/30/17-10/30/17 Number of Attempts Thwarted Breaches Comments Viruses, Spyware and Risks /31/17-9/29/17 Viruses, Spyware and Risks Number of Attempts Web 9/30/17-10/30/17 Thwarted Breaches Comments High Priority Web Application Attacks High Priority Web Application Attacks Number of Attempts Thwarted Breaches Comments 1M 1M 0 8/31/17-9/29/17 9/30/17-10/30/17 Spam Blocked at Firepower - 4 Malicious Files Blocked at Firepower Spam Blocked at Security Appliance (ESA) - 53,912 Malicious files Blocked at Security Appliance (ESA) - 7 8/31/17-9/29/17 Spam Blocked at Firepower - 1 Malicious Files Blocked at Firepower - 1,526 Page 25 of 135

26 1.8M 1.8M 0 Spam Blocked at Security Appliance (ESA) - 64,297 Malicious files Blocked at Security Appliance (ESA) - 8 9/30/17-10/30/17 Number of Attempts Thwarted Breaches Comments Misc Activity Attempted Information Leak Potential Corp. Policy Violation Attempted User Privilege Gain Attempted Administrator Privilege Gain 8/31/17-9/29/17 Misc Activity Attempted Information Leak Potential Corp. Policy Violation Attempted User Privilege Gain Attempted Administrator Privilege Gain Page 26 of 135

27 Name Definition Virus Spyware Security Appliance Malicious Files Potential Corp. Policy Violation Attempted User Privilege Gain Attempted Administrator Privilege Gain Quarantined Breaches Thwarted A type of malicious software program ("malware") that, when executed, replicates by reproducing itself (copying its own source code) or infecting other computer programs by modifying them. Infecting computer programs can include as well, data files, or the "boot" sector of the hard drive Software that enables a user to obtain covert information about another's computer activities by transmitting data covertly from their hard drive Defends mission-critical systems at the gateway, and automatically stop spam, viruses, and other threats An application or a file, which is harmful to the computer user. Malicious software includes computer viruses, worms, trojan horses, spyware, adware or rootkits Generic rule - the traffic that was blocked may violate corporate policy Attempts by an attacker to gain a user's privileges but have failed. An attacker intentionally attempting to elevate privileges and is failing, and that unsuspecting users are unknowingly aiding in a system compromise Attempts that would result in superuser-, root-, or administrator-level access to a host. An attacker attempting to gain administrator-level access When items are quarantined (a virus or some other type of threat is found in a file), they are stored in a special location on your computer, and blocked from being used An incident in which an individual's name plus a Social Security number, driver's license number, medical record or financial record (credit/debit cards included) is potentially put at risk because of exposure To prevent the occurrence, realization, or attainment of (e.g. PHI) Page 27 of 135

28 KEY PERFORMANCE INDICATOR METRIC OWNER FISCAL YEAR 2017 / 2018 Q1 Q2 Q3 Q4 DESCRIPTION OF MEASURE COUNTER MEASURE / COMMENTS TARGET >> Kirt Kemp 4221 Internet Outages Kirt Kemp Carrier internet outage (AT&T) 2 ACTUAL >> 1 Kathleen 7847 TARGET >> File Systems - Security Breaches Kirt Kemp ATTEMPTS >> 59 0 BREACHES >> 0 # of Security Breaches TARGET >> Web - Security Breaches Kirt Kemp ATTEMPTS >> BREACHES >> 0 # of Security Breaches TARGET >> Security Breaches Kirt Kemp ATTEMPTS >> 4M 0 BREACHES >> 0 # of Security Breaches RED THRESHOLD Contact Person Contact Number Source of Data How measure is calculated (specification) Page 28 of 135

29 AGENDA REQUEST FOR RATIFICATION for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board / Finance Committee (when applicable) Agenda Item Number: Meeting Date: November 15, Board Meeting Date: December 6, 2017 Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Approved by: Finance Committee Topic Description: The DHCS Contract adjusts PHC s MediCal managed care capitation rates for the period of July 2014 to June 2015 and July 2015 to June 2016 (Amendment 36 through 38). Reason for Resolution: To get Board authorization for the Chief Executive Officer (CEO) to sign the DHCS Contract Amendments 36 through 38. Financial Impact: There is no financial impact to the HealthPlan since PHC has been recording revenue at the rates reflected in the amendment. Requested Action of the Board: Based on the approval of the Finance Committee, the Board is asked to ratify the authorization for the CEO to sign the DHCS Contract Amendment 36 through 38. Page 29 of 135

30 AGENDA REQUEST FOR RATIFICATION for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board / Finance Committee (when applicable) Agenda Item Number: Meeting Date: November 15, Board Meeting Date: December 6, 2017 Resolution Number: 17- IN THE MATTER OF: RATIFYING THE FINANCE COMMITTEE S APPROVAL TO AUTHORIZE THE CEO TO SIGN THE DHCS CONTRACT AMENDMENTS 36 THROUGH 38 Recital: Whereas, A. The Board has the responsibility for authorizing the CEO to sign rate amendments. B. PHC s Finance Department staff have reviewed rate details to ensure the accuracy of the adjustment. Now, Therefore, It Is Hereby Resolved As Follows: 1. To ratify the Finance Committee s approval to authorize the CEO to sign the DHCS contract amendments 36 through 38. PASSED, APPROVED, AND by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: EXCUSED: Commissioners: Commissioners: Commissioners: Richard Fogg, Acting Chair Date ATTEST: BY: Cynthia McCamey, Clerk Page 30 of 135

31 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Recommendation by: Quality and Utilization Advisory Committee Topic Description: Christopher Swales, M.D., from Woodland Clinic has expressed interest in joining the Quality and Utilization Advisory Committee (Q/UAC). Dr. Swales is Board Certified in Family Medicine. Michael Pirruccello, M.D., from Woodland Clinic has requested resignation from the Quality/Utilization Advisory Committee due to his retirement. Reason for Resolution: To get Board approval for membership changes to the Q/UAC due to new appointments and resignations. Financial Impact: There is no financial impact to the HealthPlan. Requested Action of the Board: Based on the recommendation from Q/UAC, the full Board is being asked to approve membership changes to Q/UAC due to new appointments and resignations. Page 31 of 135

32 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Number: 17- IN THE MATTER OF: APPROVING THE QUALITY AND UTILIZATION ADVISORY COMMITTEE (Q/UAC) MEMBERSHIP CHANGES Recital: Whereas, A. Christopher Swales, MD, is well qualified for the Q/UAC and he has expressed an interest in joining the committee. B. Michael Pirruccello, M.D., has requested removal from the committee. C. The committees have a need for a physician. D. The Board has authority to appoint committee members. Now, Therefore, It Is Hereby Resolved As Follows: 1. To approve membership changes to Q/UAC due to new appointments and resignations. PASSED, APPROVED, AND by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: EXCUSED: Commissioners: Commissioners: Commissioners: Richard Fogg, Acting Chair Date ATTEST: BY: Cynthia McCamey, Clerk Page 32 of 135

33 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Recommendation by: PHC Staff Topic Description: Julie Johnston has requested removal from the 340B Advisory Committee, due to leaving Shasta Community Health Center and relocating to the Seattle area. Daniel Santi is the Director of Finance at Shasta Community Health Center and he has expressed interest in joining the 340B Advisory Committee. He will serve on the committee as Julie Johnston s replacement. Dean Germano the CEO of Shasta Community Health Center serves as a member of the 340B Advisory Committee, and he has graciously agreed to be the new chairperson of the committee replacing Dr. Craig Lindquist, M.D. who left in September Reason for Resolution: To get Board approval for membership changes to the 340B Advisory Committee due to new appointments and resignations. Financial Impact: There is no financial impact to the HealthPlan. Requested Action of the Board: Based on the recommendation from PHC staff, the full Board is being asked to approve membership changes to the 340B Advisory Committee due to new appointments and resignations. Page 33 of 135

34 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Number: 17- IN THE MATTER OF: APPROVING A 340B ADVISORY COMMITTEE MEMBERSHIP CHANGES Recital: Whereas, A. Julie Johnston has requested removal from the 340B Advisory Committee, due to leaving Shasta Community Health Center and relocating to the Seattle area. B. Daniel Santi has expressed interest in joining the 340B Advisory Committee. C. The committee has a vacant seat due to Julie Johnston s resignation. D. The Board has authority to appoint committee members. Now, Therefore, It Is Hereby Resolved As Follows: 1. To approve membership changes to the 340B Advisory Committee due to new appointments and resignations. PASSED, APPROVED, AND by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: EXCUSED: Commissioners: Commissioners: Commissioners: Richard Fogg, Acting Chair Date ATTEST: BY: Cynthia McCamey, Clerk Page 34 of 135

35 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Recommendation by: Strategic Planning Committee Topic Description: Kenneth Platou has requested removal from the Strategic Planning Committee, due to his retirement from Dignity Health Mercy Medical Center Mount Shasta. Reason for Resolution: To get Board approval for membership changes to Strategic Planning Committee due to a resignation. Financial Impact: There is no financial impact to the HealthPlan. Requested Action of the Board: Based on the recommendation from PHC staff, the full Board is being asked to approve membership changes to the Strategic Planning Committee due to a resignation. Page 35 of 135

36 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Number: 17- IN THE MATTER OF: APPROVING A STRATEGIC PLANNING COMMITTEE MEMBERSHIP CHANGE Recital: Whereas, A. Kenneth Platou has requested removal from the Strategic Planning Committee, due to his retirement from Dignity Health Mercy Medical Center Mount Shasta. B. The Board has authority to approve changes to the Strategic Planning Committee. Now, Therefore, It Is Hereby Resolved As Follows: 1. To approve membership changes to the Strategic Planning Committee due to a resignation. PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: Commissioners: Commissioners: Richard Fogg, Acting Chair Date ATTEST: BY: _ Cynthia McCamey, Clerk Page 36 of 135

37 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Approved by: Humboldt County Board of Supervisors and PHC Staff Topic Description: The Partnership HealthPlan Board is structured so approximately one-half of the Board is up for reappointment every other year. Each Commissioner serves for a term of four years, unless specified in the counties ordinance. Humboldt County has two Board members whose term expires on December 31, 2017 and requires a reappointment. The Humboldt County Board of Supervisors met on November 7, 2017 and reappointed Herrmann Spetzler as the Humboldt County Community Health Center Representative on the PHC Board for another 4-year term of office, commencing on December 31, 2017 and terminating on December 31, The Humboldt County Board of Supervisors met on November 7, 2017 and reappointed Nancy Starck as the Humboldt County Representative on the PHC Board for another 4- year term of office, commencing on December 31, 2017 and terminating on December 31, Reason for Resolution: To get Board approval for membership changes to the Board due to Humboldt County reappointments. Financial Impact: There is no financial impact to the HealthPlan. Requested Action of the Board: Based on the recommendation of the Humboldt County Board of Supervisors and PHC Staff, the full Board is being asked to approve Board membership changes due to Humboldt County reappointments. Page 37 of 135

38 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, IN THE MATTER OF: APPROVING BOARD MEMBERSHIP CHANGES Resolution Number: 17- Recital: Whereas, A. Certain agencies have responsibility for appointing Board members. B. Herrmann Spetzler and Nancy Starck are Humboldt County Board representatives and their appointment requires a reappointment. C. The Humboldt County Board of Supervisors reappointed Herrmann Spetzler and Nancy Starck to the PHC Board for another four-year term of office. D. The Board has authority to appoint committee members. Now, Therefore, It Is Hereby Resolved As Follows: 1. To approve membership changes to the Board due to Humboldt County reappointments. PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: EXCUSED: Commissioner: Commissioner: Commissioners: Richard Fogg, Acting Chair ATTEST: Date BY: Cynthia McCamey, Clerk Page 38 of 135

39 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Recommendation by: Quality Utilization Advisory Committee Topic Description: The purpose of the Quality Improvement Program Work Plan is to evaluate key activities done throughout PHC departments that work closely with the Quality and Performance Improvement Department (QI/PI) to improve care and service to our members. The Quality and Performance Improvement Program Description provides a systematic process to monitor clinical and service aspects of health care delivery to all PHC members and it describes the programs purpose, goals, responsibilities, methods, measurements, and feedback. Reason for Resolution: To allow the full Board the opportunity to review and approve the Quality Improvement Program Work Plan and the Quality and Performance Improvement Program Description for FY Financial Impact: There is no financial impact to the HealthPlan. Requested Action of the Board: Based on the recommendation from the Quality Utilization Advisory Committee, the full Board is asked to approve the attached Quality Improvement Program Work Plan and Quality and Performance Improvement Program Description. Page 39 of 135

40 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Number: 17- IN THE MATTER OF: APPROVING THE QUALITY IMPROVEMENT PROGRAM WORK PLAN FOR AND PROGRAM DESCRIPTION FY Recital: Whereas, A. The Board has ultimate responsibility for quality improvement. B. Quality improvement is a stated important priority for PHC. Now, Therefore, It Is Hereby Resolved As Follows: 1. To approve the Quality Improvement Program Work Plan for FY To approve the Quality and Performance Improvement Program Description for FY PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: EXCUSED: Commissioners: Commissioners: Commissioners: Richard Fogg, Acting Chair ATTEST: Date BY: Cynthia McCamey, Clerk Page 40 of 135

41 Partnership Health Plan of California QI Program Work Plan 1. QI Program Infrastructure Project or Program Goal(s) Primary Objectives/Activities a. QI Program Documents b. Physician Advisory Committee (PAC) oversight of QI Program Compliance with NCQA HP standard QI 1, Elements A and B by Sept 30, 2018 Ensure PAC oversight of PHC s QI Program Annual completion and approval by Board of Commissioners of QI Program Description, Work Plan and Evaluation Send documents to NCQA Consultant for review against QI 1 standards PAC oversight of Quality/Utilization Advisory (Q/UAC) Committee, Pharmacy & Therapeutics (P&T) Committee, Provider Advisory Group (PAG), and Credentialing Committee via inclusion of minutes in PAC packets Reports to PAC on progress of activities reflected in QI Work Plan Timeline Responsible Staff Monitoring of Previous Issues Documents Responsible: Director of completed Quality and Performance annually by July 30 Improvement (Jessica Approved by IQI Thacher) and QUAC annually by Aug 31. Approved by PAC annually by Sept 30. Approved by Board annually by Oct 31. Ongoing 7/1/17 6/30/18; PAC meeting scheduled monthly, excluding July and December QI Work Plan approved by PAC Sept and progress reports delivered Feb, May and Sept Contributing: QI department and other Health Services staff who contribute to development, implementation and management of QI Program Responsible: Chief Medical Officer (Robert Moore) Contributing: Administrative Assistant to the CMO (Linda Largent) Director of Quality and Performance Improvement (Jessica Thacher) QI Compliance Team Timelines of document completion and approval updated to better reflect 1) fiscal year planning cycle and 2) annual availability of HEDIS results to inform QI evaluation and determination of next year s priority activities The PAC is PHC s QI Committee, as described in NCQA Standard QI 2, Element A. The Q/UAC is a sub committee of the PAC. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 41 of 135

42 Partnership Health Plan of California QI Program Work Plan 2. Measurement, Analytics and Reporting Project or Program Goal(s) Primary Objectives/Activities a. HEDIS Reporting Report HEDIS 2018 Analyze and disseminate scores annually HEDIS 2017 Results (required External Accountability Set Prepare administrative measures) to data for HEDIS 2018 NCQA and HSAG in reporting, including: June Run rates monthly Monitor encounter data for changes in well child visit and immunization volume following CHDP transition Evaluate impact of supplemental data sources Conduct Medical Record Project, including: Collect data from approximately 12,000 medical records Pass the annual HEDIS Medical Record Review Validation Audit Timely record retrieval and abstraction Timeline Responsible Staff Monitoring of Previous Issues Preliminary HEDIS Responsible: HEDIS analysis Sr. Manager of Quality project evaluation complete by Compliance and will inform 8/31/17; detailed Accreditation (Rachael changes to HEDIS analysis complete French) 2018 data by 10/31/17 collection and Preparation/plann reporting project. ing for 2018 Evaluation to be project 7/1/17 completed Fall 12/31/ HEDIS Project Execution 1/1/18 6/15/18 Report rates by NCQA deadline in early June 2018 Contributing: HEDIS Analyst (Sarah Molteni Casper) HEDIS Program Manager (Megan Wilson) Performance Improvement Clinical Specialist II (Martha Layne) HEDIS project team, including QI, IT and Analytics staff Due to vendor termination of contract, need to identify and contract with new medical record retrieval vendor for HEDIS Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 42 of 135

43 Project or Program Goal(s) Primary Objectives/Activities b. Member Experience Data Collect data on the member experience to inform QI priorities via administration of member experience surveys Conduct the annual PHC Member Experience Survey Conduct provider level CAHPS survey for PCPs with >1100 visits by unique members Continue Complaint Process Redesign project so that member complaint data is available for detailed member experience analytics by 12/31/18 Release RFP to potential vendors for the administration of an annual health plan CAHPS survey beginning Spring 2019 Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Field 2018 PHC (Only project leads PHC survey Member identified to save space) Monitoring Experience response rate. Survey: 3/1 PHC Survey: Project 2016 response 5/31/2018 Manager II, Member rate was 9.7%. Field 2018 Services (Anna Did additional provider level Hernandez) outreach in CAHPS survey: Provider level survey: May July 2018 QI Project Coordinator Provider survey Ongoing work on II (Joy Dionisio) Monitor trends in complaint Complaint Project: how sites earn classification Project Manager II, points on this through 12/31/18 Administration (Matt measure. CAHPS vendor RFP Hintereder) released by RFP: Sr. Manager of 6/30/18 Quality Compliance and Accreditation (Rachael French) Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 43 of 135

44 Project or Program Goal(s) Primary Objectives/Activities c. NCQA Network Adequacy Data d. PCP QIP ereports System Monitor data on the following access standards across primary care and specialty care: Ratio of members to providers Geographic proximity to providers Appt wait times Leverage ereports to motivate improvement work on PCP QIP measures and improve PHC s HEDIS performance Revise QI Access policy (MPQP 1023) to reflect updated PHC standards for the metrics included here Conduct PHC Capacity Survey and Appointment Wait Time Survey Prepare reports to analyze performance plan wide and at the regional and county level relative to PHC standards in MPQP Launch ereports by Sept 1, 2017 for 2017 Transition Period and by March 1, 2018 for 2018 Measurement Year. Investigate use of ereports as a repository of manually tracked PCP QIP submissions Utilize ereports data as a source of non standard supplemental data for at least one measure in HEDIS Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Revise policy by Responsible: Exact measures 12/31/17 Policy work Sr. Project and objectives Surveys complete Manager (Barbara Selig) may change, by 9/30/17 and Improvement pending Team Report complete Advisor (Farashta Goal decisions in by 6/30/18 Zainal) August 2017 Survey and performance report Sr. Director of Provider Relations (Mary Kerlin) 9/1/17 launch 1 3/1/18 launch 2 Decision regarding using ereports for manual submission by 6/30/18 Due date to integrate ereports data for HEDIS reporting 2/28/18 Contributing: NCQA Network Adequacy Team Goal Workgroup, including staff from PR, Finance and QI Responsible: QI Analyst (Cody West) Contributing: QI Project Manager I (Tara Fogliasso) QI Analyst (Anne Gulley) QIP and IT project team members QIP staff maintain tracker of PCP and internal enhancement requests over course of year ereports data failed 2017 HEDIS audit and PHC was not able to integrate into HEDIS 2017 reporting Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 44 of 135

45 Project or Program Goal(s) Primary Objectives/Activities e. Partnership Quality Dashboard f. HEDIS related data quality, timely access and completeness Improve PHC s and our network s ability to conduct population health management by implementing a new quality analytic platform Partnership Quality Dashboard. Improve HEDIS scores and population health management capabilities by monitoring and continuously improving HEDISrelated data quality, timely access, and completeness Finalize Module 1 and release for provider network pilot Finalize Module 2 user security and logins Integrate MY 2015, MY 2016, and monthly project HEDIS data into the DW to support PQD BRD, design and UAT for Modules 3, 4 and 5 (HEDIS, QIP Clinical Measures, and KPIs) Continue efforts to centrally locate HEDIS data in the data warehouse Continue development of PHC Data Dictionary to improve data management and governance Continue identifying data stewards within the business and define and monitor quality criteria for HEDIS related data sources Leverage the Quality Measure Encounter Data (QMED) dashboard to improve detection of gaps in encounter data that are key to HEDIS Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Pilot module 1 Responsible: IT Project Significant project with 10 provider Manager (Nicole Nguyen) delays in fiscal organizations year Need Fall 2017 Contributors: to assure Release Manager of Quality adequate staffing completed tool, Incentive Programs to keep project including Modules (Jess Liu) moving according 1 5, by 6/30/18. PQD Team, including to current staff from IT, QI and timelines. Analytics. Ongoing through 6/30/18 and beyond Responsible: Director, Enterprise Information Management (Dave Hosford) QI Analyst (Cody West) NR Associate QI Director (Nancy Steffen)Director of EDI Development (Thenn Subramanian) Director, IT Strategic Initiatives (Naresh Vemparala) (contributors not listed to conserve space; for global update on all activities, see Improvement Advisor, Caron Lee) Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 45 of 135

46 Project or Program Goal(s) Primary Objectives/Activities Implement PHC internal HIE to directly import electronic health record data from provider EHRs to support HEDIS related outreach/compliance Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Evaluation/Status (Provide narrative description for activities marked delayed or other ) 3. Value Based Payment Programs Project or Program Goal(s) Primary Objectives/Activities a. Primary Care Further leverage the Move program from a Provider Quality PCP QIP program to fiscal to a calendar year Improvement support health plan (aligned with HEDIS Program (PCP improvements in reporting year). QIP) HEDIS scores Research potential strategic program changes to support HEDIS score improvement, including updates to relative improvement methodology, payment methodology, and continuous enrollment requirement Support provider education to improve QIP and HEDIS performance Ensure program impact for PPS providers by addressing DHCS guidance following San Mateo ruling Timeline Responsible Staff Monitoring of Previous Issues The program will Responsible: Despite significant start on a Manager of Quality investment in PCP calendar year Incentive Programs (Jess QIP, PHC effective Liu) and QI Project continues to see 1/1/2018, with Manager (Ro Summers) low scores on transition year certain HEDIS 7/1/17 Contributing: measures. The 12/31/17 QIP Team, QIP Technical focus this year All changes Workgroup, including will be better identified here staff from Finance, IT, leveraging the should be Provider Relations, and PCP QIP researched with regional leadership investment to an associated drive action plan in performance, and place by 6/30/18 ultimately Provider improve HEDIS education is scores. ongoing 7/1/17 6/30/18 Revisions to program based on DHCS feedback implemented by 1/1/18 Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 46 of 135

47 Project or Program Goal(s) Primary Objectives/Activities b. Hospital Quality Improvement Program (H QIP) c. Long Term Care Quality Improvement Program (LTC QIP) d. Palliative Care QIP Continue relationshipbuilding with new and existing participants Increase LTC facility engagement in the program Launch program to support expanded palliative care pilot by July 1, 2017 and onboard Palliative Care providers as they are credentialed Organize the first Hospital Quality Symposium in August 2017 Coordinate in person meetings with hospital participants as possible Implement two training opportunities to support LTCs in improving QIP performance Continue to expand the QIP to more facilities in 2018 Coordinate a kick off webinar with palliative care providers Create specifications document Ongoing correspondence and troubleshooting with providers Monitor performance and engagement Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Hospital Responsible: QI Project Symposiums Coordinator II (Amy schedule 8/8 and Lasher) 8/10/17 Hospital meetings ongoing 7/1/17 6/30/18 Training opportunities implemented by 6/30/18 Facility expansion due 12/31/17 Year 1 program 7/1/17 6/30/18 Contributing: QI Project Coordinator (Jessica DeLaney) QIP Team H QIP Technical Workgroup Responsible: Program management: QI Project Manager (Ro Summers) Trainings: QI Project Coordinator (Jessica DeLaney) Contributing: QIP Team, LTC QIP Technical Workgroup Responsible: Sr. QI Project Manager (Barbara Selig) Contributors: Manager of Quality Incentive Programs (Jess Liu) QIP Team Palliative care implementation team H QIP is a newer program. Participant engagement is critical to success. In addition to general program administration, building relationships with hospitals will be a focus this year. Similar to H QIP, LTC QIP is a new program and building participant engagement is a top priority. To align the structure of the palliative care program with the hospital savings that are expected to underwrite it, the pilot program included an incentive for avoiding hospitalization and ED use and Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 47 of 135

48 Project or Program Goal(s) Primary Objectives/Activities e. Perinatal QIP Determine effective provider incentive strategies to improve outcomes on the Perinatal HEDIS measures Pilot paying per attestation of timely prenatal and postpartum care, and administration of TDAP vaccine, with two non FQHC provider sites Determine spread plan (larger pilot) based on learnings from the initial pilots Research effective models for incentivizing FQHCs and Rural Health Centers that provide perinatal care under PPS reimbursement structure Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues another for the quality of the program. These were critical parts of the structure of the program and the financial solvency of the program may be significantly compromised if this is missing from the expanded pilot. Initial pilot Responsible: QI Project DHCS is issuing programs Fall Coordinator II (Joy guidance 2017 Dionisio) regarding what Determine spread types of pay forperformance plan by 1/1/18 Contributing: Research QIP Team measures are FQHC/RHC Perinatal QIP Technical excludable from options by Workgroup the FQHC PPS 10/1/17 system. Based on verbal comments, the draft model for Perinatal QIP may not work for FQHCs. Team is evaluating options and next steps while we pilot the draft model with a non FQHC provider. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 48 of 135

49 Project or Program Goal(s) Primary Objectives/Activities f. Community Pharmacy QIP Operate an incentive program to support clinical pharmacy activities that aim to optimize medication therapy and improve member health outcomes Enrollment of invited pharmacies into program Data submission to PHC Results calculation, validation and final payment Annual measure development and approval Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Annual program Pharmacy Services runs on the fiscal Director (Stan Leung) year: 7/1/2017 6/30/18 Data for year due by 7/31/17 Enrollment in program: July August 2017 Measure development for QIP year: April June 2018 Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun Improvement Projects Clinical Quality Project or Program Goal(s) Primary Objectives/Activities a. Managing Pain Safely (MPS) Initiative Maintain improvements realized during MPS Strategic Initiative, as measured by: MED P100MPM Total Members on Opioids PMPM Members on Unsafe Dose (>120 MED)PMPM Transition MPS Initiative to sustainability phase, continuing data monitoring, provider education, and community support to maintain gains Timeline Responsible Staff Monitoring of Previous Issues Ongoing 7/1/17 Responsible: QI Project 6/30/18 Manager (Danielle Carter) County, region, and plan level data will be tracked quarterly, and displayed every six months Contributors: Provider Relations representatives and regional medical directors Local PHC leads, including regional medical directors, regional managers, regional directors PHC saw significant improvement in opioid utilization between 2014 and 2017 as a result of the MPS initiative. Ongoing work will focus on sustaining these gains. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 49 of 135

50 Project or Program Goal(s) Primary Objectives/Activities b. Social Determinants of Health Initiative Support achieving PHC s mission to help our members and the communities we serve be healthy by expanding the health plan s focus to include an emphasis on the Social Determinants of Health. Support counties throughout the Partnership Network with $25 million in grants or investments to support local capacity in expanding the supply of housing. Begin assessing current connections between the social service and healthcare systems, and explore opportunities to support both health care providers and members more easily make connections between both systems. Identify and develop education and technical assistance opportunities for providers and stakeholders. final year of grants management for existing Social Determinants of Health implementation grants. Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Housing grants Responsible: Because this is a dispersed by Housing support broad topic, PHC 6/30/18 Behavioral Health developed a SDH Begin social Administrator 3 year strategic service (Margaret Kisliuk) plan, emphasizing assessment by activities QI the following 6/30/18 Project Manager focus areas for Minimum one (Danielle Carter) : educational opportunity Contributors: Housing implemented by SDH/Housing Team Goal Navigation 6/30/18 Members Provider and Grant stakeholder management support ongoing 7/1/17 6/30/18 More details on SDH project objectives are available within this plan, and an accompanying operational plan. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 c. Offering & Honoring Choices Initiative Support the provision of high quality, effective advance care planning and palliative care Advance Care Planning is a measure in the PCP QIP Program Promote culture of ACP in communities by providing funding to up Ongoing 7/1/17 6/30/18 Responsible: Sr. QI Project Manager (Barbara Selig) Contributors: QIP and PI Teams In 2015, PHC launched a pilot program offering community based palliative care services. In Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 50 of 135

51 Project or Program Goal(s) Primary Objectives/Activities services across to 4 start up ACP PHC s network. community coalitions Implement and monitor PHC s Palliative Care Expanded pilot, including complementary Palliative Care QIP Provide training and technical assistance to promote high quality advance care planning across PHC s service area. d. HEDIS Score Improvement Annual Monitoring for Patients on Persistent Medications (MPM ACE/ARB, MPM Diur) Reduce number of MPM measures below the Minimum Performance Level across PHC s regions from 5 to 0. Baseline performance below MPL: SW Region: MPM ACE/ARBs and MPM Diuretics NE Region: MPM ACE/ARBs and MPM Diuretics NW Region: MPM ACE/ARBs Measure in PCP QIP 4 Clinics working on MPM improvement projects via ADVANCE program Potential PDSAs with provider partners, exact scope pending guidance from DHCS Researching in home blood draw option for feasibility/potential impact Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues PHC Medical Directors response to the OCMO/QI state delaying the Administrative palliative care Assistants benefit start date from April 2017 to July 2018, PHC opted to expand our Palliative Care pilot program. QIP ongoing ADVANCE Program duration: 3/30/17 3/23/18 PDSA per DHCS direction Determination on next steps with blood draw intervention by 12/31/17 Responsible: QIP measure Manager of Quality Incentive Programs (Jess Liu) ADVANCE/PDSA/Blood Draw intervention Manager of Performance Improvement (Jennifer Kaufer) Contributors: QIP and PI Teams Very small distance between performance targets for this measure. The MPL is high; small changes in rates could move us above the MPL. Small scale PDSAs may not impact regional rates absent spread strategy. Will also monitor pilotlevel performance outcomes. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 51 of 135

52 Project or Program Goal(s) Primary Objectives/Activities e. HEDIS Score Reduce number of Improvement CIS 3 measures Childhood below the Minimum Immunization Performance Level Status, across PHC s regions Combination 3 from 2 to 0. (CIS 3) HEDIS 2017 regions below MPL on CIS 3: NW and NE New PCP QIP measure 2 Clinics working on CIS improvement projects via ADVANCE program Spread best practices from Well Child Workflow/Capacity intervention with Hill Country Health & Wellness Center in Shasta County a vehicle for opening access to timely immunizations Engage regional medical directors to assist in Provider Education where strong member resistance to vaccinations exists PIP topic with DHCS/HSAG; exact details and timing dependent on further direction from DHCS/HSAG Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Measure in QIP Responsible: New QIP measure effective 1/1/18 QIP measure Manager will not impact ADVANCE of Quality Incentive HEDIS scores until Program duration: Programs (Jess Liu) HEDIS /30/17 3/23/18 ADVANCE Manager of Hill Country PDSA Performance Small scale PDSAs Spread ongoing Improvement (Jennifer may not impact through 6/30/18 Kaufer) regional rates Provider Well child intervention absent spread education spread QI Program strategy. Will also ongoing through Manager (Ely Hoerber) monitor pilotlevel 6/30/18 Provider Education QI performance PIP per DHCS Manager of Clinical outcomes. direction Quality and Patient Safety (Lauri Stevenson) PIP Project TBD Northern Region QI Project Manager Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 f. HEDIS Score Improvement Comprehensive Diabetes Care, Nephropathy Screening (CDC Neph) Decrease the total CDC Nephropathy measures below MPL across PHC s regions from 2 to 0. Measure in PCP QIP for MY 2017; exploring adding back to measurement set for Family Practice sites in QIP Year is for annual performance 1/1/17 12/31/ QIP Year is for annual Responsible: Manager of Quality Incentive Programs (Jess Liu) Contributors: QIP Team The 25 th Percentile target for this measure increased by 11% between HEDIS 2016 and HEDIS Historically, Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 52 of 135

53 Project or Program Goal(s) Primary Objectives/Activities HEDIS 2017 regions Higher CDCbelow MPL on CDC Nephropathy Neph: SW and performance target NW reflected in 2017 QIP program g. HEDIS Score Improvement Breast Cancer Screening (BCS) Perform above MPL on the BCS measure across all PHC regions HEDIS 2017 regions below MPL on BCS: SW, NW, NE Implement networkwide BCS Staff Incentive Program; build a BCS supplemental database to support HEDIS project BCS added as a PCP QIP measure, effective 1/1/2018 Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues performance health plan 1/1/18 performance on 12/31/18. this measure was Will determine high, which is why whether to add we originally back to PCP QIP opted to remove Family Practice this measure from measurement set the PCP QIP by 9/2017 Family Practice measurement set. Staff Incentive Program: 9/1/17 12/31/17 New PCP QIP measure effective 1/1/18 Responsible: Manager of Quality Incentive Programs (Jess Liu) Contributors: QIP and HEDIS Teams BCS was a new measure for HEDIS The plan reported data but was not held to any minimum performance standards by DHCS. HEDIS 2018 will be the first year PHC is held to specific performance targets for the BCS measure. Adding BCS to QIP will not impact HEDIS scores until HEDIS 2019, which is why a separate incentive program is under development. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 53 of 135

54 Project or Program Goal(s) Primary Objectives/Activities h. HEDIS Score Perform above MPL Improvement on the AMR Asthma measure across all Medication PHC regions Ratio (AMR) HEDIS 2017 regions below MPL on AMR: NW and NE Pediatric Practice measure in PCP QIP, effective January 1, 2018 Pharmacy department led PDSA: working with PHC contracted pharmacies to do patient education at time of medication refill Education to primary care providers regarding asthma controller medication prescribing Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues PCP QIP measure Responsible: AMR was a new effective QIP Manager of measure for 1/1/2018 Quality Incentive HEDIS The Pharmacy PDSAs Programs (Jess Liu) plan reported scheduled to PDSA Pharmacy data but was not launch Fall 2017 Services Director (Stan held to any and complete by Leung) minimum 7/31/18 performance Provider Contributors: QIP and standards by education Pharmacy Team members DHCS. HEDIS beginning 7/ will be the first year PHC is held to specific performance targets for the AMR measure. Without being in the Family Practice measurement set, impact of QIP inclusion may be minimal on overall regional rates. Small scale PDSAs may not impact regional rates absent spread strategy. Will also monitor pilotlevel performance outcomes. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 54 of 135

55 Project or Program Goal(s) Primary Objectives/Activities i. HEDIS Score Improve Improvement performance on Comprehensive CDC Eye measure Diabetes Care, across PHC regions Eye Exam (CDC Eye) SE: Improve from 50 th to 75 th percentile SW: Improve from 50 th to 75 th percentile NE: Improve from 25 th to 50 th percentile SW: Improve from 25 th to 50 th percentile Measure in PCP QIP Continue support for Diabetic Retinopathy Screening Program (EyePACS) Year 2 of providing up to 6 clinics with EyePACS technology and supportive assistance to enable access to diabetic retinopathy screening at the PCP site. Final submission of DHCS PIP on Improving Diabetic Eye Exam Rates in a Rural Health Center. Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues QIP and EyePACS program ongoing through 6/30/18 DHCS PIP due 8/15/17 Responsible QIP measure Manager of Quality Incentive Programs (Jess Liu) EyePACS program QI Project Coordinator II (Sandra McMasters) PIP Improvement Advisor (Caron Lee) Regarding EyePACS program, PHC has learned a lot about the complexity and challenges of offering diabetic retinopathy screening at the PCP site from the first year of the program. Best practices learned will be shared with sites joining for first time in Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 j. HEDIS Score Improvement Cervical Cancer Screening (CCS) Improve performance on Cervical Cancer Screening measure across PHC regions SE: Improve from 75 th to 90 th percentile SW: Improve from 50 th to 75 th percentile Measure in PCP QIP 3 Clinics working on CCS improvement projects via ADVANCE program Multi Media Awareness campaign in Humboldt and Del Norte QIP measure ongoing through 6/30/18 ADVANCE Program duration: 3/30/17 3/23/18; Campaign to run May July 2017 Responsible: QIP measure Manager of Quality Incentive Programs (Jess Liu) ADVANCE Manager of Performance Improvement (Jennifer Kaufer) Media campaign NW Regional Manager (Jennifer Chancellor) Contributors: QIP Team Small scale PDSAs may not impact regional rates absent spread strategy. Will also monitor pilotlevel performance outcomes. Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 55 of 135

56 Project or Program Goal(s) Primary Objectives/Activities NE: Improve from 25 th to 50 th percentile k. HEDIS Score Improvement Timeliness of Prenatal Care (PPC Pre) in the Northeast Region l. HEDIS Score Improvement Well Child Visits NW: Improve from 25 th to 50 th percentile Improve performance on the Timeliness of Prenatal Care in the NE Region from 25 th to 50 th percentile Improve performance on Well Child measure across PHC regions SE: Improve from 75th to 90th percentile Pilot and launch Perinatal QIP pilot with large prenatal care provider in NE region Continue collaboration in Shasta County on Perinatal Care with key PCPs, OB Specialists, Public Health, and County Eligibility stakeholders final cycle of DHCS mandated PDSA on PPC Pre with Shasta Community Health Centers and on PPC Post with Fairchild Medical Clinic Measure in PCP QIP Explore provider education re Well Child templates that also incorporate counseling for nutrition and physical activity. Continue Birthday Club PDSA with Churn Creek Health Care in Shasta Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues ADVANCE Coaches NR Associate QI Director (Nancy Steffen) QIP pilot: 7/1/17 12/31/17 Meetings initiated in January 2017 continue quarterly PDSA due 7/31/17 All activities ongoing through 6/30/18 Responsible: NR Associate Director of QI (Nancy Steffen) Contributors: Chief Medical Officer (Robert Moore) QI Project Coordinator II (Joy Dionisio) QI Manager of Clinical Quality and Patient Safety (Lauri Stevenson) QI Analyst (Christina McClenaghan) Responsible: QIP/Well Child Education Manager of Quality Incentive Programs (Jess Liu) Birthday Club QI Project Manager (Tara Fogliasso) Applying lessons learned from DHCS mandated PDSAs to Perinatal QIP pilot and program launch Apply and spread lessons learned from Well Child PDSAs Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 56 of 135

57 Project or Program Goal(s) Primary Objectives/Activities SW: Improve from County and evaluate for 50th to 75th spread percentile Spread best practices NE: Improve from from Well Child 25th to 50th Workflow/Capacity percentile intervention with Hill NW: Improve Country Health & from 50th to 75th Wellness Center in percentile Shasta County m. HEDIS Score Improvement Controlling High Blood Pressure n. HEDIS Score Improvement Immunizations for Adolescents (IMA) Improve performance on CBP measure across PHC regions SE: Improve from 50th to 75th percentile SW: Improve from 75 th to 90 th percentile NE: Improve from 75 th to 90 th percentile NW: Improve from 25 th to 50 th percentile Improve scores relative to baseline on the HEDIS IMA measure PCP QIP Measure 4 Clinics working on CBP improvement projects via ADVANCE program Final submission of PIP on Controlling High Blood Pressure at Open Door Community Health Centers Eureka due August 15, Measure in PCP QIP Family Practice set, effective 1/1/18 Support on going IZ clinics in co sponsorship with Shasta County Public Health; Spread PHC/PH IZ clinic Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Well child intervention QI Program Manager (Ely Hoerber) QIP ongoing 7/1/17 6/30/18 ADVANCE Program duration: 3/30/17 3/23/18 Final PIP submission due 8/15/17 Ongoing through June 30, 2018 Responsible QIP measure Manager of Quality Incentive Programs (Jess Liu) ADVANCE Manager of Performance Improvement (Jennifer Kaufer) PIP NR QI Associate Director (Nancy Steffen) Responsible: QIP measure Manager of Quality Incentive Programs (Jess Liu) IZ clinics QI Program Manager (Ely Hoerber) Small scale PDSAs may not impact regional rates absent spread strategy. Will also monitor pilotlevel performance outcomes. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 57 of 135

58 Project or Program Goal(s) Primary Objectives/Activities intervention to other counties o. HEDIS Score Improvement Reducing Disparities PIP Identify disparities in HEDIS outcome data and implement an improvement project to address at least one disparity DHCS has mandated that all health plans have a Performance Improvement Project (PIP) focused on a disparity. The exact topic is pending review of PHC s HEDIS 2017 results by race and ethnicity Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Topic due to DHCS/HSAG in August Additional milestones pending DHCS/HSAG direction. Responsible: Project Manager (Danielle Carter) Contributors: TBD, pending topic decision PHC had launched an improvement project focused on a HEDIS 2016 disparity in timeliness of post partum care in the SE region. Data revealed lower rates of timely care among the African American population, compared to white population. HEDIS 2017 results showed no disparity so the decision was made to cancel the pilot. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun Improvement Projects Service and Patient Experience Project or Program a. Primary Care Access Improvement Goal(s) Improve member access to primary care services Primary Objectives/Activities Support workforce development programs to expand availability of PAs and NPs within our primary care network Timeline Responsible Staff Monitoring of Previous Issues Workforce Responsible: development, Workforce development and recruitment and provider recruitment PCP QIP Administration Project ongoing through Manager (Cody Thompson) 6/30/18 Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 58 of 135

59 Partnership Health Plan of California QI Program Work Plan Project or Program a. Specialty Care Access Improvement Goal(s) Improve member access to specialty care services Primary Objectives/Activities Continue to support Provider Recruitment via PHC s Provider Recruitment program Incentivize improvement at the PCP level via related measures in the PCP QIP, including PCP Office Visits per member/per year and access related questions within the program s CAHPS/Patient Experience Domain. Program evaluation and alumni event for Advanced Access Collaborative to determine and support program s sustainability and spread potential Improve accuracy of specialty utilization data and compare to actuarial benchmarks Track and trend specialty utilization by county and by specialty Continue to promote and expand the use Timeline Responsible Staff Monitoring of Previous Issues Advanced Access QIP Manager of Quality program Incentive Programs (Jess Liu) evaluation and Advanced Access Collaborative alumni event QI Sr. Project Manager Fall 2017 (Barbara Selig) Ongoing through 6/30/18 Contributing: Provider Recruitment Team (Project Coordinator, Project Manager, NR Executive Director and COO) Performance Improvement Team QIP Team Responsible: SW Regional Director, Administration (Lynn Scuri) Specialty Access Improvement Team Goal Program Manager, Administration (Kelli Cousineau) Telehealth and econsult Contributing: Apply learnings from previous year to identify specialty resources, assess capacity and recommend strategies to increase access to specialty care. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 59 of 135

60 Partnership Health Plan of California QI Program Work Plan Project or Program b. Provider Directory Goal(s) Implement a webbased physician and hospital directory that offers information to members that is useful in selecting a physician and/or hospital Primary Objectives/Activities of telehealth services and econsult Continue focus on improving access to endocrine services by educating providers on new referral guidelines. Assess access to rheumatology services and develop access improvement plan. Educate Specialty Access Team on NCQA Standards and track NCQA Team progress Support Specialty Hub pilot at Rohnert Park Health Center in Sonoma County (expansion to three specialties) Get stakeholder approval for Provider Directory Requirements which cover SB 137, NCQA and DHCS requirements for online searchable Provider Directory, Provider Data Cleansing and Timeline Responsible Staff Monitoring of Previous Issues Specialty Access Team Goal Group Finance Department to assist with data accuracy Analytics Department to update utilization reports on ongoing basis and compare to benchmarks Work with regional medical directors and provider relations staff to promote adoption of endocrine referral guidelines Provider Relations Department to assess current rheumatology resources and current capacity relative to need Regional Director to update Team on progress of Specialty Hub Pilot Implement directories per SB137 requirements by 1/1/18. Responsible: Director, IT Strategic Initiatives (Naresh Vemparala) Contributors: Sr. Director of Provider Relations (Mary Kerlin) Provider Directory Team DHCS guidance for SB 137 was not available in time. We also noticed that the requirements have evolved and go live date has changed multiple times. We need to continue to Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 60 of 135

61 Partnership Health Plan of California QI Program Work Plan Project or Program c. Member Portal Goal(s) Create a selfintuitive, reliable and self serving member portal that enables PHC members to access Primary Objectives/Activities Provider Attestation & validation modules. Enhance SUGAR System with new data elements that are identified as part of above mentioned approved requirements. Engage with Lexis Nexis for Provider Data Cleansing & Provider Data Attestation modules and ensure the data flows into SUGAR and EDW to support other projects as necessary. Go thru IT Software Development Life Cycle (SDLC) to meet approved requirements. Key phases in IT SDLC include analysis, design, development, testing (QA & UAT) and Go Live. Assess the current state of PHC s knowledge of NCQA standards related to the member portal (MEM standards) Timeline Responsible Staff Monitoring of Previous Issues engage with DHCS and proceed further with the latest available information knowing that the current go live is 1/1/2018. Release the member portal system for all users into Production by June 30, 2018 Responsible: Senior IT Project Manager (Neal Cronin) Contributors: Department business owners from Health Services (including Care Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 61 of 135

62 Partnership Health Plan of California QI Program Work Plan Project or Program Goal(s) clinical and nonclinical information, while supporting PHC to obtain NCQA accreditation. The portal will also improve Member Services and Care Coordination customer service efficiency for providing services to PHC members. Services include online information access to health appraisals, selfmanagement tools, pharmacy benefit Information, and health plan services (e.g., requesting ID cards and requesting PCP changes) Primary Objectives/Activities Stakeholder sign off on the portal s features and functionality, including those that meet NCQA MEM standards for member online selfservice Design and architecture Development IT testing User acceptance testing (UAT) Pilot Release into Production Timeline Responsible Staff Monitoring of Previous Issues Coordination, Utilization Management and Pharmacy), Provider Relations, and Member Services Evaluation/Status (Provide narrative description for activities marked delayed or other ) 6. Population Health Management and Care for Members with Complex Needs Project or Program Goal(s) Primary Objectives/Activities a. Essette Improve Care Configure system; train Implementati Coordination staff; start using system on efficiency and for new cases; effectiveness and Timeline Responsible Staff Monitoring of Previous Issues Go Live 5/22/17 Responsible: Sr. Director of Health Services (Peggy Hoover) Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 62 of 135

63 Project or Program Goal(s) Primary Objectives/Activities move toward discontinue use of NCQA survey previous system readiness by transitioning Care Coordination Operations into new Case Management System, so that work is performed solely in Essette b. Expand Maternal/Chil d Unit focus (Population Health) c. Complex Case Management d. Member Assessments Improved HEDIS performance on the following measures via an expanded Maternal/Child Care Coordination Unit: PPC Pre PPC Post CIS 3 IMA Updated Complex Case Management program description to meet NCQA requirements Assess all new members within 90 days of enrollment Assist pregnant moms with accessing care for themselves while pregnant as well as accessing care for their babies and other children in their homes Review DHCS and NCQA requirements for Complex Case Management and revise existing program to meet new requirements Implement HIF/MET (Health Information Form/Member Evaluation Tool), Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Stop using CMR Contributors: Care Coordination (old system) leadership team including Carly 12/31/2017 Fronefield and Rebecca Boyd Anderson Ongoing 7/1/17 6/30/18 Evaluate 3/2018 Send updated program description to IQI January 2018 HIF/MET 7/1/2017 Responsible: Director of Care Coordination (Rebecca Boyd Anderson) Contributors: Care Coordination Supervisors (Doreen Crume and Laura Cardenas) Responsible: Director of Care Coordination (Rebecca Boyd Anderson) Contributors: Care Coordination leadership team including Peggy Hoover, Carly Fronefield, and Katherine Barresi Responsible: Director of Care Coordination (Rebecca Boyd Anderson) Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 63 of 135

64 Project or Program Goal(s) Primary Objectives/Activities with the health revise HRA (Health plan Risk Assessment), develop scoring algorithm, route to Essette, assign cases and provide Care Coordination interventions per DHCS and NCQA requirements. e. Care Coordination Program Description Updated Program Description to reflect NCQA and DHCS objectives Review DHCS contract and NCQA 2018 guidelines Amend program description to reflect contract and guidelines Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Revised HRA 10/1/2017 Routed to Essette 11/1/2017 Send to IQI January 2018 Contributors: Care Coordination leadership team including Peggy Hoover, Carly Fronefield, and Katherine Barresi Responsible: Director of Care Coordination (Rebecca Boyd Anderson) Contributors: Care Coordination leadership team including Peggy Hoover, Carly Fronefield, and Katherine Barresi Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 f. Medication Adherence Improve medication adherence for diabetes, hypertension, and dyslipidemia patients Medication adherence, reported as Proportion Days Covered (PDC), is provided to PHC quarterly by Medimpact. Pharmacist will identify high risk patients with suboptimal PDC and provide education material to promote medication adherence. By 9/17, pharmacist will develop process for identifying high risk patients with suboptimal adherence. By 12/17, pharmacist will create education material promoting medication adherence By 1/18, education material will be Pharmacy Services Director (Stan Leung) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 64 of 135

65 Project or Program Goal(s) Primary Objectives/Activities g. Smoking Cessation Assist high risk smokers to quit smoking by providing education, optimize smoking cessation therapy, and enrollment into the CA Smokers Helpline. Create member and provider education and identify high risk members based on comorbidities and smoking cessation product utilization. Contact patient to discuss adherence gaps in smoking cessation therapy, provide education on smoking cessation, and assist with enrollment in the CA Smokers Helpline (CSH) if patient consents. Follow up call to determine if patient is smoke free and to assess CSH outreach and services. Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues sent to targeted members with suboptimal adherence. 6/18 analyze medication adherence results. Member Pharmacy Services Director outreach began (Stan Leung) 4/17 9/17 summarize and analyze results of intervention program Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 65 of 135

66 Partnership Health Plan of California QI Program Work Plan 7. Quality Assurance and Patient Safety Project or Program Goal(s) Primary Objectives/Activities a. Potential Quality Issues Make operational improvements to the PQI Review process to ensure timely review of PQIs (<=120 days) and DHCS survey readiness Regular review by the PQI/Peer Review Leadership Team of program operational data including referral patterns and case load volume, timeliness statistics, summary of case ratings, and provider trending to ensure compliance with policies and procedures Plan wide IRR process Implement worksheet for standardized, comprehensive case notes and record keeping Collaborate with IT to develop a plan for a new PQI database Staff education and development of a PQI primer Timeline Responsible Staff Monitoring of Previous Issues Ongoing 7/1/17 6/30/18 Responsible: Manager of Quality Assurance and Patient Safety (Rose Santos) Contributors: Patient Safety Team All major workflows and processes associated with PQI/Peer Review have been identified and desktop procedures were developed (last year s goal). This year s goal is to implement a standardized and improved PQI process region wide. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 66 of 135

67 Project or Program Goal(s) Primary Objectives/Activities b. Facility Site and Medical Record Review c. Initial Health Assessment Help promote PHC member safety at our contracted provider offices via the implementation of standardized, timely and DHCScompliant Facility Site and Medical Record Reviews. Improve PHC s Initial Health Assessment (IHA) Completion Rates 95% of site reviews on time, per DHCS regulations. Implement Interrater Reliability (IRR) process to promote consistency between all Site Review nurses. testing of Site Review electronic tool (Etool) and implement use without need for corresponding paper tool. Provide Palliative Care Site Review process and tool for new Palliative Care sites. Implement pilot projects with PHC facilities to work toward improved IHA compliance as well as assisting PHC sites with identifying members who have not had an IHA and are still within the time frame for compliance. Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Ongoing 7/1/17 6/30/18 Projects to begin in 7/17 and complete by 11/17 New QIP measure effective 1/1/18 Responsible: QI Manager of Clinical Quality and Patient Safety (Lauri Stevenson) Contributors: Patient Safety Team Responsible: Pilot projects QI Manager of Clinical Quality and Patient Safety (Lauri Stevenson) QIP Manager of Quality Incentive Programs (Jess Liu) Contributors: Pilot projects Performance Improvement Clinical Specialist (Sara Nopwaskey) Medical Record Review (MRR) IRRs are conducted by the State on a regular basis. The Site portion of the IRR has been left to the plans to perform. A similar project has been completed with positive results Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 67 of 135

68 Project or Program Goal(s) Primary Objectives/Activities Initial Health Assessment added to the PCP QIP as a Unit of Service measure d. Hepatitis C Treatment Monitoring e. Concurrent Opioid and Benzodiazepine notification Improve Hepatitis C medication treatment adherence and completion rate Inform prescribers of concurrent opioid and benzodiazepine prescribing to reduce concurrent opioid and Pharmacy reviews TAR for all HCV treatment requests. TAR approval for HCV treatment is granted on a partial regimen basis to track and monitor therapy. HCV treatment is monitored by Walgreens Specialty Pharmacist who communicates all potential nonadherence issues to PHC pharmacist. PHC pharmacist will involve CC and MS as necessary to assist with ensuring member completes their HCV therapy. Medimpact will send fax to the prescriber when their patient fills an opioid prescription issued by them and the patient has filled a Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Walgreens became PHC s exclusive service provider for HCV treatment in 11/16 1/18, collect and analyze results for all 2017 approved HCV medication treatments, and completed patient surveys Concurrent opioids and benzos prescriber notification began May Pharmacy Services Director (Stan Leung) Pharmacy Services Director (Stan Leung) Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 68 of 135

69 Project or Program Goal(s) Primary Objectives/Activities benzodiazepine benzo in the past 30 utilization days. Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Expected end date 10/17 Evaluation/Status (Provide narrative description for activities marked delayed or other ) f. LTBI 12 dose treatment monitoring Identify and address gaps in the LTBI 12 dose treatment regimen resulting from nonadherence, inappropriate prescribing, and/or inappropriate dispensing Pharmacy will conduct a weekly utilization review for the LTBI 12 dose regimen (Isoniazid and Rifapentine). Pharmacist will contact the pharmacy and/or prescriber if utilization does not align with the 12 dose regimen LTBI treatment monitoring began September 2016 and continues on a weekly basis. Pharmacy Services Director (Stan Leung) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun Quality Improvement Training and Coaching Project or Program Goal(s) Primary Objectives/Activities a. ADVANCE Improvement Advisor Training Program Promote a culture of quality improvement and development performance improvement capacity within our primary care network by offering a 12 month 12 learning sessions offered (8 via webinar, 4 as twoday in person trainings) Weekly coaching with PHC ADVANCE coach Application of curriculum to QI project led by 13 ADVANCE teams Timeline Responsible Staff Monitoring of Previous Issues 3/30/17 3/23/18 Responsible: Manager of Performance Improvement (Jennifer Kaufer) Contributors: Southern Region Performance Improvement Team Cohort 3 of ADVANCE was adapted based on learnings from Cohort 2. One major change is the addition of HEDIS measure related affinity groups. We are interested to evaluate this as a Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 69 of 135

70 Project or Program Goal(s) Primary Objectives/Activities improvement advisor training program to 13 practices throughout the PHC network b. ABCs of QI Build quality Plan, coordinate, and improvement train ABCs of QI x 5 in skills across at least three different PHC s provider locations across PHC s network by network offering a 1 day QI basics training course featuring the Model for Improvement Methodology Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues more direct strategy to improve HEDIS scores via the ADVANCE program. Ukiah Training July 2017 Ongoing 7/1/17 6/30/18 Responsible: Southern Region Trainings: Manager of Performance Improvement (Jennifer Kaufer) Northern Region Trainings: NR QI Associate Director (Nancy Steffen) Contributors: Trainers from QI department and local consortia; PI coordination staff Staff debrief following each training and identify areas to keep or continue and to improve. Evaluation responses from past trainings are documented for reference. Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 c. QI Ex (PHC s Internal Performance Improvement Training Program) Build PHC s internal capacity for quality improvement via a formalized training curriculum and application of learning to a HEDIS related quality improvement project Implement cohort 2 of QI Ex with 3 5 improvement teams, including staff from QI and Pharmacy departments Support development of a menu of effective health plan member outreach strategies to support quality improvement 8/17 2/18 Responsible: Manager of Performance Improvement (Jennifer Kaufer) Contributors: Performance Improvement Team Expand timeline for training and project application based on Cohort 1 feedback. Where possible, build off learnings from year 1 projects, including CCS member outreach and Well Child Member Incentives. Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Areas of project focus: CIS Combo 3, IMA, MPM, AMR Page 70 of 135

71 Project or Program Goal(s) Primary Objectives/Activities d. 1:1 Provider Site Visits e. QI Technical Assistance in Partnership with Northern Region Consortia Develop and implement strategies for QIP/HEDIS provider onsite education or coaching visits Partner collaboratively with Northern Region consortia, HANC and NCCN, to promote and support QI capacity building in the clinic setting through At least 35 onsite provider visits (target 15 in Southern Region and 20 in Northern Region) that emphasize HEDIS and QIP education. In Southern Region, better integrate the Patient Safety team into HEDIS improvement work via measure specific education for staff and piloting of tactics to leverage site review visits for HEDIS related data collection and provider education. Host an annual QI summit in a rural Northern Region counties Host QI focused meetings during biannual regional Rural Roundtables Utilize HANC s annual site Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues 35 provider onsite visits complete by 6/30/18 Site review integration: Develop a proposed plan for integration by 10/31 relevant nurse training on HEDIS/QIP program and plan pilot by 2/28 Pilot approach with 6 sites and evaluate/refine model by 5/31 Determine spread plan for operationalizing new role by 6/30 Ongoing through 6/30/18 Responsible: NR QI Associate Director (Nancy Steffen) Northern Region site visits Manager of Quality Incentive Programs (Jess Liu) Southern Region site visits Manager of Quality Assurance and Patient Safety (Rose Santos) Site review integration Contributors: staff from across QI, medical director and other department support based on needs of clinic Responsible: NR QI Associate Director (Nancy Steffen) Contributors: Leadership from HANC and NCCN Consortia Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Jul. 1 Oct. 31 Nov. 1 Feb. 28 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Mar. 1 Jun. 30 Page 71 of 135

72 Project or Program Goal(s) Primary Objectives/Activities trainings, peerto peer assessments to sharing, identify and individual opportunities to site assessments support member clinic QI work f. Primary Care Provider Webinar Training Support improvement of QIP/HEDIS improvement via webinar based training and best practice sharing Implement at least 2 measure specific training/peer sharing webinars on underperforming HEDIS measures. Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Minimum 2 webinars by 6/30/18 Responsible: Manager of Quality Incentive Programs (Jess Liu) Contributors: staff from QIP, HEDIS and Performance Improvement teams Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 g. Crossdepartmental collaboration to improve HEDIS scores Improve PHC s capacity to act upon gaps in care for members who contact PHC and/or who are enrolled in existing care coordination programs As an initial step, create and implement learning and sharing opportunities specific to HEDIS measures among Care Coordination, Members Services, QI and other relevant departments. Provide training on at least 10 priority HEDIS measures by 6/30/18 Responsible: Northern Region QI Manager of Clinical Quality and Patient Safety (Lauri Stevenson) Performance Improvement Clinical Specialist II (Martha Layne) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun Cultural and Linguistic Services See PHC 2017 Health Education/Cultural and Linguistic Work Plan Page 72 of 135

73 Partnership Health Plan of California QI Program Work Plan 10. Delegation Oversight Project or Program Goal(s) Primary Objectives/Activities a. QI Delegation Oversight Conduct Quarterly oversight on QI functions delegated to Kaiser and Beacon Review Quarterly delegate submissions and complete audit survey tool Timeline Responsible Staff Monitoring of Previous Issues Quarterly Sr. Manager of Quality Compliance and Accreditation (Rachael French) Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 b. NCQA Delegation Readiness Meet NCQA Interim delegation requirements Identify all delegates within the scope of the NCQA audit Execute new or updated delegation agreements (as needed) with all delegates following NCQA standards and guidelines Majority of agreements in place by 6/30/18 Director of Regulatory Affairs (Dina Cuellar) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun NCQA Accreditation Readiness Project or Program Goal(s) Primary Objectives/Activities a. NCQA Project Management Infrastructure Continue building project management infrastructure to ensure successful completion of Partner with PMO to maximize the use of Workfront to maintain NCQA Accreditation project planning and reporting Timeline Responsible Staff Monitoring of Previous Issues Ongoing 7/1/17 Responsible: QI Sr. Project 6/30/18 Manager (Sue Lee) Contributors: NCQA Accreditation Steering Committee and Operations Workgroup Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 73 of 135

74 Project or Program Goal(s) Primary Objectives/Activities NCQA Develop a standard Accreditation process for document goals collection and submission for Mock Interim Survey Run monthly compliance reports for Interim and First and present through operations and executive steering committees b. Compliance with NCQA Survey Standards Achieve 100% compliance with Interim Survey standards Schedule 1:1 checkins no less than monthly to review standards and ensure progress is on track to achieve compliance by 6/30/18 Update key stakeholders of 2018 standards/guidelines changes impacting Interim Leverage expertise of NCQA consultant to review evidence against standards and determine compliance/readiness Partnership Health Plan of California QI Program Work Plan Timeline Responsible Staff Monitoring of Previous Issues Internal deadline for compliance with interim standards is 6/30/18 Responsible: QI Sr. Project Manager (Sue Lee) Contributors: NCQA Accreditation Steering Committee and Operations Workgroup Evaluation/Status (Provide narrative description for activities marked delayed or other ) Jul. 1 Oct. 31 Nov. 1 Feb. 28 Mar. 1 Jun. 30 Page 74 of 135

75 WORK PLAN APPROVAL 9/20/17 Quality/Utilization Advisory Committee Chairperson Date Approved 11/08/17 Physician Advisory Committee Chairperson Date Approved 12/05/17 Board of Commissioners Chairperson Date Approved Page 75 of 135

76 QUALITY AND PERFORMANCE IMPROVEMENT PROGRAM DESCRIPTION July 1, 2017 June 30, 2018 MPQD1001 Partnership HealthPlan of California Page 1 of 22 QI/PI Program Description Page 76 of 135

77 TABLE OF CONTENTS Program Purpose and Goals... 3 Scope of QI/PI Program... 4 Authority and Responsibility... 5 Approach to Quality and Performance Improvement... 9 Cultural Competency.16 Communication Systems Delegation Review by Outside Licensing Agencies or Accrediting Bodies Sanctions Annual Program Evaluation Statement of Confidentiality Statement of Conflict of Interest Program Approval Attachment A PHC QI/PI Department Organizational Chart Attachment B Standing Staff Members of PHC Quality Committees Partnership HealthPlan of California Page 2 of 22 QI/PI Program Description Page 77 of 135

78 PROGRAM PURPOSE AND GOALS The Partnership HealthPlan of California (PHC) Quality and Performance Improvement QI/PI program provides a systematic process to monitor clinical and service aspects of health care delivery to all PHC members. It includes an organized framework to review activities to identify opportunities to improve the quality of health care services provided, promote efficient and effective use of health plan financial resources, and to improve health outcomes. The program promotes consistency in application of quality assessment and improvement functions for the full scope of health care services while providing a mechanism to: ensure integration with current community health priorities, standards, and public health goals, identify and act on opportunities to improve care and service, identify overuse, misuse, and underuse of health care services, identify and act on opportunities to improve processes to ensure patient safety, address potential or tangible quality issues, and review trends that suggest variations in the process or outcomes of care. The QI/PI program goal is to optimize the quality and cost effectiveness of clinical care and service to PHC members by: systematically monitoring and evaluating service and care provided, actively pursuing opportunities for improvement in areas that are relevant and important to our members health, and implementing strong interventions when opportunities for improvement are identified. This goal aligns with PHC s mission: To help our members and the communities we serve be healthy. The QI/PI program provides a structured framework to consistently monitor and evaluate the care and service provided to our members. Evaluation is based on the measurement and trending of selected indicators and professionally recognized standards of practice. Objectives of the program are to: Identify opportunities for improvement and act on opportunities that have the greatest impact on patient care and that are aligned with PHC s mission, vision, and values. Monitor and ensure compliance with contractual quality requirements, state and federal quality regulations, evidence-based standards of care, and standards of selected accrediting bodies. Through PHC s Grievance Department, provide a process for receiving, analyzing, and responding to provider and member complaints, grievances, appeals, or suggestions relating to quality of care and service. Support the credentialing/re-credentialing process with measurement and evaluation of PCP transfer requests, office site surveys and medical record reviews, and clinician quality issue investigation/peer review. Establish, maintain, and enforce confidentiality and conflict of interest policies regarding peer review activities and protection of confidential member and provider information. Accurately document quality improvement (QI) investigations and activities, including documentation of committee meetings and quantitative and qualitative evaluation reports. Ensure regular reporting of QI/PI activities, problem identification, risk management, resource management, network management and member satisfaction information to the plan's Internal Quality Improvement Committee (IQIC), Quality/Utilization Advisory Committee (Q/UAC), Physician Advisory Committee (PAC), and Board of Commissioners. Educate and inform PHC staff, members and contract practitioners regarding the philosophy, procedures, QI processes, practice, and expectations of the PHC QI/PI program. Provide relevant QI/PI information and tools to contracted providers to assist them in clinical decisionmaking processes in the provision of care and service. Administer PHC s financial incentive programs. This includes measure research and specification design, the provision of technical assistance to practice sites, management of supporting information systems, and calculation of performance scores for participating practices. Partnership HealthPlan of California Page 3 of 22 QI/PI Program Description Page 78 of 135

79 Collaborate with the PHC Health Educators in development and implementation of a comprehensive health education and Cultural Linguistics Program. Effectively coordinate QI/PI activities with other health plan management functions including utilization management, care coordination, health education, behavioral health, pharmacy, provider relations and member services in an effort to promote continuous quality improvement in organization-wide performance. Assure that the objectives, scope, organization and mechanisms for overseeing effectiveness of monitoring, evaluation and problem solving activities in the QI/PI program are assessed and revised at least annually. SCOPE OF QI/PI PROGRAM The scope of the QI/PI program includes the quality of clinical care and the quality of service for all members. Partnership has a single product line Medi-Cal and this program covers that product line. The monitoring and evaluation of clinical issues reflects the population served by PHC without regard to age group, disease category, or risk status. In partnership with other PHC departments, the QI/PI program encompasses all aspects of medical care including: Potential quality issues and other patient safety indicators Diagnoses and procedures with a wide variation in cost or utilization patterns Identifying overuse, misuse, and underuse of health care services Identifying and addressing racial/ethnic and other disparities in health care delivery or outcomes Identifying and addressing access or quality issues related to behavioral health services through delegated contracts Promoting cultural and linguistic competence of PHC staff and network practice sites and providers Member experience outcomes Facility Site Review survey to assess compliance with patient safety standards Ambulatory Medical Records Review Part C Reviews that include an assessment of accessibility for seniors and persons with disabilities Preventive health care guideline compliance Clinical Practice Guideline (CPG) compliance, chronic and acute care Continuity and coordination of care between PCPs and Specialists, PCPs and other provider types, and PCPs and Behavioral Health Practitioners (through Care Coordination of Health Services department) Accessibility and quality of primary, specialty and behavioral health care Member grievances (through the Grievance/Complaint/Appeals department) Health promotion to educate members about preventive and chronic care (in collaboration with Health Educators in the Health Services Department) Provider satisfaction (through the Provider Relations Department) Provider credentialing (through the Provider Relations Department) Supporting clinics in achieving patient centered health homes The QI/PI program encompasses monitoring and evaluation of care and service in the following settings: Acute hospital services Ambulatory care, including preventive health care, perinatal care, chronic disease management, and family planning Emergency and urgent care services Behavioral health services* (mental health and substance abuse) Ancillary care services, including but not limited to home health care, skilled nursing care, subacute care, pharmacy, medical supplies, Durable Medical Equipment (DME), therapy services, laboratory, vision, and radiology services Long-term care including Skilled Nursing Facility Care, Rehabilitation Facility Care, and Home Health Care Partnership HealthPlan of California Page 4 of 22 QI/PI Program Description Page 79 of 135

80 *QI Program scope as it relates to behavioral health services: As a Managed Care Plan (MCP), PHC has been held responsible by DHCS since January 1, 2014 for the provision of mental health services for conditions deemed to be mild to moderate impairments of mental, emotional, or behavioral functioning. PHC delegates the provision of such services to Beacon Health Options in all fourteen counties served by PHC and to Kaiser Permanente in five counties where a portion of PHC Members are assigned to Kaiser Permanente. This mandate is detailed in DHCS All Plan Letter issued November 27, Specialty Mental Health Services for mental health conditions deemed to be moderate to severe in terms of level of impairment (also referred to as serious and persistent mental health conditions or SMI) are assigned by DHCS to County Mental Health Plans (MHPs) and include all conditions that meet the medical necessity criteria pursuant to Title 9, California Code of Regulations (CCR), Chapter 11, Sections , , and ) All Behavioral Health QI management and improvement activities are delegated by PHC to Beacon Health Options and Kaiser Permanente. PHC oversight of these delegated QI functions is achieved through: 1) annual audits, 2) review of QI reports produced by these entities, and 3) discussion of quality management and development of quality improvement projects (e.g., improved PCP referral forms, review of quality issues related to neuropsychological testing, requesting of additional reports related to QI, monitoring of access standards) through frequent meetings. AUTHORITY AND RESPONSIBILITY Board of Commissioners The Board of Commissioners on Medical Care (the Commission) promotes, supports, and has ultimate accountability, authority, and responsibility for a comprehensive and integrated QI/PI program. The Commission is ultimately accountable for the quality of care and services provided to members. The Commission has delegated direct supervision, coordination, and oversight of the program to the Physician Advisory Committee (PAC). The PAC is supported by two other quality committees the Quality and Utilization Advisory Committee (Q/UAC) and the Internal Quality Improvement Committee (IQIC), which are described in more detail below. Members of the Commission are appointed by the county Boards of Supervisors for each geographic area and include representation from the community, consumers, business, physicians, providers, hospitals, community clinics, HMO s, local government, and County Health Departments. The Commission meets at least quarterly. Chief Executive Officer The PHC Chief Executive Officer s (CEO) primary roles in quality management and improvement are fourfold: maintain a working knowledge of clinical and service issues targeted for improvement, provide organizational leadership and direction, participate in prioritization and organizational oversight of quality improvement activities, and ensure availability of resources necessary to implement the approved QI/PI program. Chief Medical Officer The CMO, with the assistance of the members of the PAC, Q/UAC, and IQIC, is responsible for providing professional judgment regarding matters of quality of care, peer review, clinical, and medical procedures. The CMO is the chair of the IQIC and Q/UAC and has significant involvement in all QI/PI, Pharmacy and Health Services activities as well as providing oversight to these programs on a day-to-day basis. Mental Health Clinical Oversight The Mental Health Clinical Director, with the assistance of other members of the PHC Behavioral Health Leadership Team (Senior Director, Health Services; Chief Operating Officer; Executive Director, Northern Region; Regional Director, Santa Rosa Regional Office; Team Supervisor, PHC Care Coordination), is responsible for providing professional judgment regarding matters of quality of care, peer review, and clinical policies and procedures, through oversight of PHC activities in these areas and through oversight of these activities as provided by PHC s delegated behavioral health providers. Annual audits by PHC of Beacon Health Options and Kaiser Permanente (mental health Partnership HealthPlan of California Page 5 of 22 QI/PI Program Description Page 80 of 135

81 delegates) stipulate that the organizations produce evidence that Behavioral Health Specialists at the level of Ph.D. and/or M.D. are on their QI Committee or on teams that report to their QI Committee. Both organizations meet this standard. Program Staff PHC QI/PI program staff and their titles are included in Attachments A and B. Committee Functions Physician Advisory Committee (PAC) The PAC monitors and evaluates all Health Services activities and is directly accountable to the Commission for the oversight of the QI/PI program. The PAC meets monthly at least ten times a year and voting membership includes external Primary Care Providers (PCPs) and board certified high-volume specialists. A voting physician member of the committee chairs the PAC. The PHC CMO, Associate Medical Director of Quality, and leadership from the QI/PI, Provider Relations, Member Services, Utilization Management, Care Coordination, Pharmacy, and Grievance Departments attend the PAC meetings regularly. PHC staff attend on an ad hoc basis to provide expertise on specific agenda items. The PAC oversees the activities of the Q/UAC and other quality-related committees and reports QI/PI activities to the Board of Commissioners. Quality/Utilization Advisory Committee (Q/UAC) The Q/UAC is responsible to assure that quality, comprehensive health care and services are provided to PHC members through an ongoing, systematic evaluation and monitoring process that facilitates continuous quality improvement. This responsibility includes providing significant input on the QI Program Description, Annual Evaluation and Work Plan. Q/UAC voting membership includes external physicians whose specialties are internal medicine, family medicine, pediatrics, OBGYN, nephrology, neonatologists, among others and a consumer representative. The Q/UAC also includes a psychiatrist whose role is to monitor and advise on policy, procedures, and clinical behavioral health topics. The PHC CMO (chair of the committee), Associate Medical Director of Quality, and leadership from the QI/PI, Provider Relations, Member Services, Utilization Management, Care Coordination, Pharmacy, and Grievance Departments attend the Q/UAC meetings regularly. PHC staff attend on an ad hoc basis to provide expertise on specific agenda items. The committee usually meets monthly, but at least quarterly. Q/UAC activities and recommendations are reported to the PAC and to the Commission at least quarterly. The Q/UAC provides guidance and direction to PHC staff by coordinating all quality improvement activities. Coordination includes but is not limited to: Review and approve the QI/PI Program Description, the QI/PI Program Evaluation and Work Plan annually. Review and approval of standardized utilization review criteria and protocols. Approve and ensure implementation of evidence-based guidelines and policies of medical practice including preventive, chronic care, and behavioral health initiatives. Analyze summary data and make recommendations for action plans for quality improvement activities. Assure that appropriate follow-up activities occur for all Corrective Action Plans (CAPs) and QI/PI activities. Provide oversight of delegated QI activities except for Credentialing activities, which are reviewed by the Credentialing Committee. Peer Review Committee The Peer Review Committee is a subcommittee of the Q/UAC and membership includes external practitioners representing PCPs and board certified specialists. The PHC CMO, the Regional and Associate Medical Directors, Performance Improvement Clinical Specialists (quality nurses), and the Manager of Patient Safety and Quality Assurance support the Committee. The committee usually meets monthly but at least quarterly. Peer review functions are: Review potential and actual quality issues and provider/member complaints and appeals related to quality of care. Make recommendations for Corrective Action Plans (CAP) and practitioner discipline or sanctions to the Credentialing Committee. Make recommendations on improvements to systems of care based on specific occurrences. Partnership HealthPlan of California Page 6 of 22 QI/PI Program Description Page 81 of 135

82 Credentialing Committee The PHC CMO, or designee, chairs the Credentialing Committee. Committee members include the PHC Senior Provider Relations Director, Director of Provider Relations, Provider Relations Credentialing Supervisor, and Provider Relations Credentialing Specialists, QI/PI staff, and a minimum of five contracted PHC physicians/practitioners. The committee convenes as needed, but at least quarterly. The functions of the Credentialing Committee are to: Participate in and make recommendations regarding the structure and process for the credentialing and re-credentialing of providers and licensed practitioners. Participate in the development, implementation, and annual review of related policies and procedures. Review and approve PHC staff recommendations for routine credentialing of practitioners who do not meet exception criteria. Review qualifications and circumstantial details for contracted practitioners who meet exception criteria and make credentialing decisions. Review and evaluate the qualifications, utilization, and quality data of each practitioner seeking recredentialing as a contracted provider at least every three years, and assure compliance with established criteria. Verify that credentialing requirements are met by each provider in the network, including implementation of and adherence to any CAPs to meet standards. Decisions regarding provider credentialing and re-credentialing. Develop and recommend disciplinary or sanction actions of practitioners. Provide oversight of any delegated credentialing activities. Summary information of credentialing activities is presented to the PAC and to the PHC Board of Commissions at the regularly scheduled meetings. Pharmacy and Therapeutics Committee (P&T) The P&T Committee is chaired by the PHC CMO and is comprised of PHC staff and network practitioners including pharmacists, PCPs, and specialists including behavioral health. P&T makes decisions and recommendations on development and review of the drug formulary, pharmacy policies and procedures, new drugs, and drug approval criteria. The P&T meets quarterly, providing regular activity reports and recommendations to the PAC, the approval authority for P&T related activities. Provider Advisory Group (PAG) The PAG is one of the Commission s advisory committees and acts as a liaison between practice site office staff and PHC. The committee has representatives from physician groups and individual offices, community clinics, ancillary providers, long-term care facilities, county health departments, and community advisory groups. The PAG reports to the Physician Advisory Committee (PAC) and provides feedback and recommendations on health care service issues, community health activities, and issues for special needs populations. Consumer Advisory Committee (CAC) The CAC is composed of PHC health care consumers who represent the diversity and geographic areas of PHC s membership. There are two CAC committees one in PHC s Northern seven counties and a second in PHC s Southern seven counties. Both groups meet quarterly. The CAC is a liaison group between members and PHC, advocating for members by ensuring that the health plan is responsive to the health care and information needs of all members. The CAC provides important feedback pertinent to quality improvement issues directly to the Commission and a consumer serves on the Q/UAC to provide consumer input to the quality program and reports to the CAC. Internal Quality Improvement Committee (IQIC) An internal PHC committee comprised of appropriate PHC department directors and staff, the IQIC tracks progress towards successful completion of quality initiatives, surveys, audits, and accreditation. The IQIC meets ten times per year and reviews policies, procedures and QI activities. Multidisciplinary improvement teams may be designated to complete analysis and intervention recommendations for quality improvement issues and activities. The IQIC serves to integrate quality activities organization-wide. Activities and progress are reported to the Q/UAC and PAC. Partnership HealthPlan of California Page 7 of 22 QI/PI Program Description Page 82 of 135

83 Over/Under Utilization Committee The Over/Under Utilization Committee is an internal PHC committee that evaluates services that may be overutilized or under-utilized compared to optimal utilization. Its goals are to use the results of the analysis to drive quality improvement activities, accuracy of data collection and analysis, and the most cost-effective use of resources. The committee is chaired by PHC s CMO and supported by the Health Analytics department. Representatives from Health Services, Compliance, Member Services, Provider Relations and Claims also attend. A summary of activity from the committee is annually reported to IQI, QUAC and PHC s Compliance Committee. Partnership HealthPlan of California Page 8 of 22 QI/PI Program Description Page 83 of 135

84 APPROACH TO QUALITY AND PERFORMANCE IMPROVEMENT PHC s QI/PI program focuses on simultaneous pursuit of the triple aim population health, patient experience and cost efficiency via seven primary levers: Measurement, Analytics and Reporting Value Based Payment Programs Improvement Projects Care for Members with Complex Needs Quality Assurance and Patient Safety Activities Training and Coaching Community Partnerships Measurement, Analytics and Reporting The QI/PI Department collects data annually on clinical indicators for Medi-Cal through the Health Effectiveness Data Information Set (HEDIS) initiative. Every three years, PHC analyzes data on CAHPS measures for both children and adults. Internally administered member experience surveys are conducted and analyzed annually. Summary results from access studies, grievances, Initial Health Assessments, facility site and medical record reviews, potential quality issues, targeted improvement projects, and activities from the Partnership Improvement Academy are presented to the Internal Quality Improvement Committee (IQIC) and physician committees at least annually. Project measures are reviewed more regularly during improvement team meetings. We complete a robust, comprehensive evaluation annually for our major programs and quality improvement projects and initiatives. Partnership HealthPlan of California Page 9 of 22 QI/PI Program Description Page 84 of 135

85 At the organization level, the Executive Team and Board of Directors review a comprehensive dashboard including metrics across the organization at least quarterly. There are also four organization-wide goals set annually, of which there is always a quality-related goal. Externally, feedback on performance is shared through data reports and data presentations given at Medical Director meetings, during academic detailing visits, provider site visits, webinars and community meetings. Through PHC s value based programs, providers receive reports showing their performance against the PHC network average (and/or across a peer group) at least annually. The Primary Care Provider value based program (PCP QIP) provides reports on non-clinical measures bi-monthly and real time access to clinical measure data through an online tool called ereports that is updated weekly. The reports identify those members with gaps in preventive and chronic disease care. In 2016 PHC began developing the Partnership Quality Dashboard. The tool will provide more data at the primary care practice level beyond the value based program measures. CAHPS site level data, IHA rates, HEDIS, and several utilization measures will be incorporated into a more comprehensive online data report. Further, comparative reporting (practice level comparisons to national and local benchmarks), drill down analysis, and ability to trend data over time will be built into the system. Phase 1 of the Partnership Quality Dashboard will be released in Value Based Payment Programs Primary Care Provider Quality Improvement Program (PCP QIP) This program provides financial incentives, data reports and technical assistance to primary care providers for improving in key domains of quality: clinical care, patient experience, access and operations, and resource use. The Provider Advisory Committee (PAC) oversees the PCP QIP. A group of providers and administrators (QIP Advisory Group) across counties and practice types recommend measures for the PCP QIP each year. Following this group s recommendations, the draft measures are released to the PHC provider network during a public comment period. Feedback from the public comment period is shared with the QIP Advisory Group at which time measure recommendations are forwarded to the PAC for review and approval. The measures and detailed specifications can be found on our website. Hospital QIP (HQIP) The Hospital Quality Improvement Program, established in 2012, is a pay-for-performance program for select PHC hospitals. Participants report on measures the following measurement domains: Readmissions, Palliative Care, Clinical Quality, Patient Safety, and Quality Improvement. Like the PCP QIP, the program is collaboratively designed with our hospital partners and formally overseen by the PAC. The measures and detailed specifications can be found on our website. Pharmacy QIP The Pharmacy QIP, established in 2013, is designed to support and improve the access to and quality of community pharmacy services provided to our members. The Pharmacy QIP program was developed with measures that are simple, stable, meaningful and collaborative with participants. Only community pharmacies are eligible to participate in the Pharmacy QIP. The domains address clinical, patient experience, cost efficiency, and access measurement areas. Measures are: Comprehensive Medication Review for Customers, Chronic Pain Medication Oversight, Free Blood Pressure (BP) checks, Medication delivery, Generic fill rate, After hours, and Safe Medication Disposal. Specialist QIP The Specialist Quality Improvement Program was developed in 2014 to reward in-network specialists for actively accepting referrals and seeing PHC Medi-Cal members. In order to participate, a specialist must be contracted with PHC and be located within the PHC service region. Specialists who work primarily in an inpatient setting are excluded. The funding for the Specialist QIP is equal to 10% of the Plan s expenditures on specialty care during the measurement period. The funds are distributed to participating providers based on the number of unique members seen during the measurement year. In order to receive payment, the specialist must see a minimum of 24 unique members. Payments are issued annually in November for the prior fiscal year ending in June. The calculation for payment is: (Total Fund Amount / Total number of members seen by all qualified specialists) * number of members seen by individual physician. Partnership HealthPlan of California Page 10 of 22 QI/PI Program Description Page 85 of 135

86 Long Term Care QIP (LTC QIP) The Long Term Care QIP launched in PHC designed the program to support and improve the access to and quality of long-term care provided by our contracted facilities. The program, overseen by the PAC, offers financial incentives for quality that are separate and distinct from the usual reimbursement for services. The measurement domains are Clinical, Functional Status, Resource Use, and Operations/Satisfaction. To participate, facilities must contract with PHC and sign a Letter of Agreement. Improvement Projects The first step is to define areas for focused improvement efforts. The drivers that help define areas include projects required by regulators (DHCS), areas where performance is lower than expected, the state or 1115 waiver priorities, and stakeholder feedback. Data sources used to determine focus areas include HEDIS, Consumer Assessment of Health Providers and Systems (CAHPS) survey, facility site and medical record review results, Initial Health Assessment rates, utilization data in areas shown to exhibit strong practice variation (i.e., pain medications), and county level/public health data. To ensure that rates are calculated in accordance with specifications, PHC participates in compliance audits with the state-contracted External Quality Review Organization (EQRO). PHC analyzes data to identify priorities for improvement. Criteria for selection include: Clinical or service areas where provider variation in practice is greatest Meaningful clinical or service areas to both providers and members Measures that align with other measures being evaluated in our regions (i.e. UDS, Meaningful Use, etc.) Evidence suggests interventions can improve outcomes Overuse or misuse results in high cost to the plan Measures that impact large populations of members Measures or areas that are mandated by regulatory agencies Measures not meeting or exceeding regulator and committee designated Minimum Performance Levels (MPL) Using the criteria above, the QI/PI Department, members of the IQIC, and the Chief Medical Officer propose focus areas and projects. Once projects are approved, an improvement team is formed, usually across departments, and includes a project manager and individuals who are involved in the improvement effort. For , improvement efforts include but are not limited to: Primary, Specialty and Mental Health Access, Managing Pain Safely (appropriate and safe prescribing of opioid medications), addressing Social Determinants of Health, Offering and Honoring Choices (advance care planning and palliative care), Blood Pressure Control, Diabetic Retinopathy Screening, Annual Monitoring for Patients on Persistent Medications, Timeliness of Prenatal and Post-Partum Care, Childhood Immunizations and Immunizations for Adolescents PHC uses the Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle, LEAN methods, and robust project management infrastructure to guide strategic improvement initiatives and targeted improvement projects. Partnership HealthPlan of California Page 11 of 22 QI/PI Program Description Page 86 of 135

87 Small tests of change (PDSA) are used with pilot populations (i.e. testing with a few patients or providers) to test changes to see what works and how changes need to be adapted to make improvements on a larger scale. Changes are then spread to more sites and patients as more is known about the change and the resources and infrastructure needed to support the change on a larger scale. Figure 2 outlines this approach. Examples of Improvement Projects Improving Primary Care Access PHC has a number of projects aimed at improving primary care access. One of the largest projects is the Provider Recruitment Program (PRP), which includes advertising and recruitment assistance to primary care clinics, incentives for provider candidates to enhance packages that clinics offer, and assistance developing training programs to rotate students through the communities PHC serves. Partnership HealthPlan of California Page 12 of 22 QI/PI Program Description Page 87 of 135

88 Managing Pain Safely The goal of Managing Pain Safely (MPS) is to optimize different uses of medication and other modalities, so that pain is treated appropriately depending on the needs of the patient, informed by current medical science. The problem of over-use of opioids can be addressed at three levels: 1. Opioids should only be initiated when indicated, and only for the time period that is appropriate. Non-opioid medications should be given priority preceding to the use of opioids for mild to moderate pain. 2. Opioid medications should only be escalated if medically appropriate. 3. Patients on harmful, high doses should have their opioid dose tapered. Diabetic Retinopathy To improve retinopathy screening rates and decrease rates of diabetes-associated vision loss among diabetic members, PHC allocated funding to purchase digital retinopathy screening equipment from EyePACS, LLC, for distribution to six primary care clinics. The use of digital retinopathy screening technology in primary care clinics is an evidence-based intervention that increases access and utilization of preventative retinopathy screening services, and increases the likelihood of early detection and treatment of sight-threatening eye disease. Offering and Honoring Choices (Advance Care Planning and Palliative Care) The Offering and Honoring Choices initiative seeks to ensure that PHC members and their families are knowledgeable about health care treatment options, empowered to define their treatment goals, and able to make informed choices about the interventions they choose during the last years of life. The three main areas under Offering and Honoring Choices are: 1) Advance Care Planning, 2) Palliative Care, and 3) Policy and Public Education and Engagement. Social Determinants of Health (SDH) The SDH project at Partnership works in collaboration with key partners throughout the health system and within the community to target social determinants of health. Examples of social determinants of health include: employment, housing, food security, literacy, access to transportation, and education level. Our aim is to increase the opportunity for PHC members to be born, live, grow-up, work, and age in a healthy environment by increasing the number of health centers in our network who are actively working to address social determinants of health. HEDIS Improvement Projects PHC has a number of projects underway to improve performance on our annual HEDIS project. Measures of focus for include Annual Monitoring for Patients on Persistent Medications, Childhood and Adolescent Immunization, Diabetic Nephropathy Screening, Breast Cancer Screening and Asthma Medication Ratio. A complete list of improvement projects is available in PHC s QI Program Work Plan. Care for Members with Complex Needs PHC provides telephonic intervention and care coordination for those members with complex or multiple chronic conditions who have modifiable risk factors. The following is a summary; please see the Care Coordination Program Description for additional details. Care Managers and Health Care Guides work closely with members to educate them regarding their health condition and assist them in modifying habits or lifestyles that put them at risk for exacerbation of their condition. Cases are identified by diagnosis using high-risk screening criteria. The nurse coordinating care uses a team approach; involved care team members may include the attending physician, specialist provider, home health agencies, discharge planners, physical therapists, social workers, and other providers as appropriate. PHC will apply specific tailored interventions to PHC s population. In addition to telephonic care coordination for members with complex needs, PHC offers complex case management via the health plan s Intensive Outpatient Care Management Program (IOPCM). In this model, an Intensive Care Case Manager (ICCM) may be assigned to individual physician practice sites to assist with care management for their high risk members, or the member s assigned Primary Care Clinic may provide intensive outpatient care services, which are sponsored by PHC. This varies from other programs offered by PHC because this is a face-to-face model. The member is met in the physician s office, in their home, or at a mutually agreed upon site and the ICCM also follows that member face-to-face in any setting the member encounters. An Individualized Care Plan addressing both Partnership HealthPlan of California Page 13 of 22 QI/PI Program Description Page 88 of 135

89 clinical and non-clinical components is developed in collaboration with the member, primary care physician and other caregivers. activities related to Care for Members with Complex Needs include: Disease Management Programs for members with Asthma and Diabetes are in development. Offering and Honoring Choices program (described above) program to promote Advance Care Planning and Palliative Care. Social Determinants of Health program (described above) program to address the social determinants of health that influence member health outcomes. Quality Assurance and Patient Safety Activities Quality Assurance and Patient Safety activities include identifying and responding to Potential Quality Issues (PQIs), pharmacy patient safety initiatives, facility site and medical record reviews, monitoring initial health assessment (IHA) rates. Potential Quality Issues The Performance Improvement Clinical Specialists (PICS nurse) under direction of the Chief Medical Officer (CMO) and Associate Medical Director of Quality oversee the Peer Review Process, which provides a systematic method for identification, reporting, and processing potential quality issues (PQIs). A PQI is defined as a suspected deviation from expected provider performance, clinical care, or outcome of care, which requires further investigation to determine whether an actual quality issue or opportunity for improvement exists. Not all PQIs represent quality of care problems. A quality issue is defined as a confirmed deviation from expected provider performance, clinical care, or outcome of care, which has been determined to be inconsistent with professionally recognized standards of care. Behavioral health potential quality issues that are identified by our delegated providers (Beacon and Kaiser), are investigated and followed up by those providers. These issues are tracked by the delegates and monitored by PHC s Mental Health Clinical Director, through the delegation agreement with each organization. PHC identifies PQIs through: information gathered through concurrent, prospective, and retrospective utilization review referrals by health plan staff or providers facility site reviews focused studies pharmacy utilization data member/provider satisfaction surveys claims/encounter data medical records audits, including HEDIS medical record reviews phone log detail member appeals/grievances member calls through the Member Services Department ancillary providers/vendors/delegates such as Beacon, VSP, etc. provider sentinel or never events such as adverse events that are serious and possibly preventable via review of Provider Preventable Condition Reporting as required by the State. The PICS nurse reviews the case in accordance with Policy MPQP1016. Medical records and other supporting documentation are collected, and where issues are identified, the provider of concern is given an opportunity to respond. Peer Reviewers are engaged and in some cases, the Peer Review Committee. Cases with significant concerns are communicated to the Credentialing Committee at the recommendation of the Peer Review Committee. Annual reports are presented to IQIC and Q/UAC showing trends related to referral patterns and quality of care concerns. Pharmacy Department Patient Safety Initiatives PHC has a number of activities in place to ensure medication safety and adherence for our members. These activities include: Partnership HealthPlan of California Page 14 of 22 QI/PI Program Description Page 89 of 135

90 Managing Pain Safely. Pharmacy utilization management to promote the safe use of opioids. Development of the MPS Pharmacy and Naloxone tool kit to increase knowledge, share best practices and support community pharmacies effort in preventing opioid misuse. Medication Adherence Program (diabetes, high blood pressure, dyslipidemia). Identify high-risk members with suboptimal medication adherence and provide interventions that include but are not limited to patient education, therapeutic recommendation to prescriber, and support to dispensing pharmacy. Hepatitis C Treatment Monitoring. Tracking and monitoring Hep C medication adherence to help ensure optimal compliance with therapy. Collaborate externally with Walgreens Specialty Pharmacy and internally with PHC internal resources to find resolutions when potential access or gap in care issues are identified. IOPCM. Provide patients enrolled in the IOPCM program with a comprehensive medication review (CMR) and consult with the PCP with therapeutic recommendations based on the medication review with the patient. Functions include thorough analysis of medical chart notes and medication history, in person interaction with the member and PCP, documentation of CMR and therapeutic recommendations provided to PCP, monitor patient pharmacotherapy and consult with Care Coordination if additional intervention is required. Beacon Grand Rounds. Provide analysis and recommendation on pharmacotherapy to help ensure optimal therapeutic outcome for members accessing behavioral health services. Smoking Cessation. Smoking cessation program targets high-risk tobacco users based on patient's underlying chronic condition and suboptimal use of tobacco cessation therapies. Functions include provider outreach, educating members on medication adherence to tobacco cessation products, and assist with enrollment in the CA Smokers Helpline program. Latent Tuberculosis Therapy (LTBI) Monitoring. LTBI monitoring to ensure patients receive appropriate therapy and interact with providers and public health officer to ensure completion of therapy and identify patients that may have fallen out of therapy. Facility Site and Medical Record Reviews PHC also conducts facility site and medical record reviews that include a review of the physical site, medical records, and a review that evaluates accessibility for Seniors and Persons with Disabilities (SPDs) Part C review. The internal and external quality improvement committees review the results from the sites reviews, initial health assessments, and Part C reviews least annually. Results from these assessments are reported to the Credentialing Committee. Initial Health Assessments (IHAs) It is a requirement of the California Department of Health Care Services that all newly enrolled health plan members receive an initial health assessment (IHA) with a primary care physician within 120 calendar days of enrollment to the health plan. PHC monitors these rates quarterly and works with low performing providers to increase compliance. In addition to the above, PHC collaborates with network practitioners and providers to improve patient safety by: Identifying areas where training is needed Identifying and sharing best practices Seeking input from network practitioners about systems PHC can put in place to improve patient safety (i.e. pharmacy data on-line) Providing technical assistance, resource materials, and training in areas where indicated Collaborating with network practitioners, including behavioral health specialists, to improve processes in the area of communication and coordination of care Training and Coaching The Partnership Improvement Academy provides a space for clinicians, administrators and staff to gain quality improvement expertise from industry leaders and peers. Each of the Academy's initiatives prepares provider sites to optimize population health, enhance their patients' experiences of care, promote provider and care team satisfaction, and foster a culture of continuous quality improvement. Partnership HealthPlan of California Page 15 of 22 QI/PI Program Description Page 90 of 135

91 ADVANCE, a 12-month Improvement Advisor training program that prepares participants to lead and sustain health care quality improvement initiatives. Learning objectives for the course are: Learn from quality improvement leaders Apply learning in real time to a practice-selected quality improvement project Receive 1:1 coaching from Partnership HealthPlan QI staff Gain quality improvement and change management knowledge, tools, and skills Establish infrastructure and affect practice culture to advance future improvement endeavors Quality improvement experts guide participants in practical, participatory learning sessions. The topics covered are grounded in the Model for Improvement framework and include basics of improvement, PDSAs in action, understanding variation, relating data to improvement, change management, spread and sustainability. ABCs of QI is a one-day in-person training designed to teach healthcare organizations the basic principles of quality improvement, including, how to create an Aim (goal) statement, how to use data to drive their work, and how to identify change ideas and test them on a small scale. Community Partnerships In general, the quality improvement efforts that have the biggest impacts on the health of our members usually involve significant community collaboration and coalitions with community partners. This is also true at Partnership HealthPlan. Our community partners include county health departments (including the public health officers), the five consortia that serve the Community Health Centers in our community, law enforcement, and various community not-for-profit organizations. Most fundamentally, our network of providers not only provide health care services to our members, most are also partners in larger community-level interventions. This includes primary care physicians, Community Health Centers, Rural Health Centers, Indian Health Service Health Centers, Hospitals, Long-term Care facilities, specialist physicians, hospice agencies and community pharmacies, to name a few. Partnership s participation in community partnerships can be in one of five roles: Leader, Convener, Participant, Funder and Advocate. Some current major initiatives involving community partnerships include: 1. Managing Pain Safely 2. Offering and Honoring Choices 3. Mental Health Integration 4. Improving Specialty Access 5. Supporting breastfeeding 6. Testing interventions for addressing Social Determinants of Health 7. Developing a regional approach to treating substance use disorder Member Input Member input is obtained from member experience surveys, member focus groups, member complaint/grievance data, Consumer Advisory Committee feedback, PCP/Specialist access and availability data, Member Services telephone access reports, member suggestions, and member requests for PCP transfers. Consumers are also represented on the Q/UAC. Various workgroups meet to review the data collected at least quarterly and the workgroups recommend areas for improvement and action plans. These are presented and monitored by the Internal Quality Improvement Committee (IQI). Performance in HEDIS measures and progress made in other QI activities is shared with our members through the Q/UAC, CAC and through the member newsletter. Physician Input Through PHC s committee structure, clinicians provide input on the quality improvement program including focus areas, strategies to improve care and service, and effective ways for measuring performance in projects. In addition, clinician input is provided on various projects such as the pay-for-performance programs for primary care, specialty care, and hospitals. PHC holds provider comment periods where physicians and their staff can provide input on Partnership HealthPlan of California Page 16 of 22 QI/PI Program Description Page 91 of 135

92 priorities for these programs. Across all of our work, PHC solicits input on priorities and interventions through Committee meetings and other meetings with provider practices and clinic consortiums. CULTURAL COMPETENCY PHC is committed to delivering culturally and linguistically appropriate services (CLAS) to all eligible beneficiaries. The Cultural and Linguistic Program regularly assesses and documents member cultural and linguistic needs to determine whether all medically necessary covered services are available and accessible to all members regardless of race, color, national origin, creed, ancestry, religion, language, age, gender, marital status, sexual orientation, health status or disability, and that all covered services are provided in a culturally and linguistically appropriate manner. PHC s Health Services, Provider Relations and Members Services Departments are responsible for the operations of the Cultural and Linguistic Services Program. Additionally, the Consumer Advisory Committee provides advice on the development and implementation of cultural and linguistic accessibility standards and procedures. PHC s policies and procedures comply with standards and performance requirements for the delivery of culturally and linguistically appropriate health care services. PHC has systems and processes to: Assess, identify, and track linguistic capability of interpreters, bilingual employees and contracted staff in medical and non-medical settings. Conduct a Health Education and Cultural and Linguistic Group Needs Assessment (GNA) every 5 years to: identify member health education and cultural and linguistic needs and continuously develop and improve contractually required health education, cultural and linguistic services, and educational materials. Provide cultural competence, sensitivity, or diversity training for staff, providers or subcontractors. PHC monitors and evaluates the effectiveness of cultural and linguistic services by reviewing and responding to: Member satisfaction surveys Member complaints and grievances Reports of utilization of interpreter services by language Provider satisfaction surveys Provider assessments and site reviews Disparities in HEDIS data In addition to the Cultural and Linguistic Program Description, PHC maintains a Health Education and Cultural and Linguistic Work Plan documenting the activities, evaluation and status of service areas and goals. Service areas and goals include: Identify Health Equity/Disparities Consumer Advisory Committee Analyze Member Grievances Standards of Care Assess & Track Language Capability of Providers & Staff Monitor Provider Compliance with Language Assistance Requirements Inform Limited English Members of Free Language Assistance Services Health Education and Quality Improvement activities More details about PHC s Cultural and Linguistic Program can be found in the Cultural & Linguistic Program Description, MPLD7001 and the Cultural & Linguistic Work Plan. COMMUNICATION SYSTEMS PHC communicates its QI/PI program activities internally and externally through the following mechanisms: Solicit input regularly from our members through the Consumer Advisory Committee to assist in program design and evaluation. Partnership HealthPlan of California Page 17 of 22 QI/PI Program Description Page 92 of 135

93 Solicit input regularly from providers by leveraging committees, consortia meetings, the Provider Advisory Group, regional medical director/quality meetings, and offering provider comment periods to share feedback on the QIP measures. Bi-weekly QI/PI Department meetings to provide project updates and identify critical issues and a plan of action that involve two or more team members. PHC Website: maintain current information on the website related to all QI project and programs. Content is reviewed and updated at least quarterly. Provider Relations: meet at least twice annually with PR and member services to provide information on key QI/PI projects and identify strategies for getting information out to the network and members where appropriate (member newsletters and provider newsletters). Northern region meeting monthly with PR department. Webinars/teleconferences/Onsite meetings: provide overviews of the QIP and key QI/PI projects at least annually. QI/PI Department monthly newsletter that describes all activities and training resources related to improving quality of care. Conferences, trainings and webinars to share best practices across regions. Share information regarding improvement activities within the Health Services Department through monthly HS Leadership Committee meetings. DELEGATION Activities that are delegated to contracted providers are reviewed and approved at least annually by the Delegation, IQIC and Q/UAC committees. A delegation agreement, including a detailed list of activities delegated and reporting requirements, is signed by both the delegate and PHC. Reporting quality improvement activities and analyses to PHC on a quarterly or annual basis is done for delegated QI activities. Reports are summarized for review and evaluation by the Delegation, IQIC and Q/UAC. Evaluation includes a review of both the processes applied in carrying out delegated activities, and the outcome achieved toward quality improvement in accordance with the respective policy (ies) and agreement governing the delegated responsibility. The Delegation, IQIC and Q/UAC review evaluations and make recommendations regarding opportunities for improvement and continuation of delegated functions. PHC QI/PI staff communicates feedback from the Delegation, IQIC and Q/UAC to contract providers, and incorporates improvement activities initiated in the annual QI/PI work plan. REVIEW BY OUTSIDE LICENSING AGENCIES OR ACCREDITING BODIES Medi-Cal is a federal/state-funded program and CMS has delegated administration of the state program to the California DHCS. CMS permission is required in order for the state to delegate program administration to PHC. The state must document the cost effectiveness of the program, and provide assurance that program beneficiaries are not negatively impacted by this delegation. PHC operations, including the QI/PI program, are audited annually by DHCS. PHC submits periodic compliance reports to DMHC and undergoes periodic compliance audits. Opportunities for improvement identified through all compliance or regulatory audits are addressed by multidisciplinary teams and corrective action plan development and implementation are reported to the IQIC and Q/UAC. PHC maintains a compliance plan that includes monitoring and reporting of fraud, waste, and abuse. The PHC Compliance Committee consists of representatives of each department including QI/PI. SANCTIONS Should any sanctions be imposed on PHC, or if PHC fails to meet minimum performance levels established by regulatory agencies or purchasers, a quality review team is initiated to develop and implement a corrective action plan. This team at a minimum includes the PHC CEO, CMO, Compliance Officer, Director of Quality & Performance Improvement, Health Services Senior Director, and Pharmacy Director. Action plans and progress reports are shared with the Q/UAC. Partnership HealthPlan of California Page 18 of 22 QI/PI Program Description Page 93 of 135

94 ANNUAL PROGRAM EVALUATION The overall effectiveness of the QI/PI program is evaluated in writing annually by the IQIC and Q/UAC and is approved by the Q/UAC, PAC, and the Commission. The evaluation includes: A description of completed and ongoing QI activities that address quality and safety of clinical care and quality of service. Trending of measures to assess performance in the quality and safety of clinical care and quality of service. Analysis and evaluation of the overall effectiveness of the QI/PI program and of its progress toward influencing network-wide safe clinical practices. The following are not included in the QI evaluation but rather as separate evaluations: Evaluation of cultural and linguistic competency work plan activities Evaluation of UM and Care Coordination Activities A comprehensive evaluation of member complaints and grievances A summary of the program evaluation, including a description of the program, is provided to members or practitioners upon request. When the evaluation is complete, an announcement indicating the availability of QI information is published in the member and provider newsletters. STATEMENT OF CONFIDENTIALITY Confidentiality of provider and member information is ensured at all times in the performance of QI/PI Program activities through enforcement of the following: All members of the Q/UAC, PAC, and Credentialing Committee are required to sign a confidentiality statement that is maintained in the QI files. All QI/PI and UM documents are restricted solely to authorized Health Services Department staff, members of the PAC, Q/UAC, PRC, and Credentialing Committee, and reporting bodies as specifically authorized by the Q/UAC. Confidential documents may include, but are not limited to Peer Review and Credentialing meeting minutes and agendas, QI and Peer Review reports and findings, PQI and QI files, UM reports, or any correspondence or memos relating to confidential issues where the name of a provider or member are included. Confidential peer review documents that are protected by California Evidence Code 1157 are designated Confidential Protected by CA Evidence Code Confidential documents are stored in locked file cabinets with access limited to authorized persons only. Confidential documents are destroyed by shredding. PHC has designated a Privacy Officer responsible to oversee compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other state and federal privacy laws. PHC maintains administrative structure, reporting procedures, due diligence procedures, training programs and other methods to ensure effective compliance in use and disclosure of members Protected Health Information (PHI). STATEMENT OF CONFLICT OF INTEREST Any individual who has been personally involved in the care and/or service provided to a patient, an event or finding undergoing quality evaluation may not vote or render a decision regarding the appropriateness of such care. All members of the Q/UAC and Credentialing Committee are required to review and sign a conflict of interest statement, agreeing to abide by its terms. Partnership HealthPlan of California Page 19 of 22 QI/PI Program Description Page 94 of 135

95 PROGRAM APPROVAL 9/20/17 Quality/Utilization Advisory Committee Chairperson Date Approved 11/8/17 Physician Advisory Committee Chairperson Date Approved 12/6/17 Board of Commissioners Chairperson Date Approved Partnership HealthPlan of California Page 20 of 22 QI/PI Program Description Page 95 of 135

96 Attachment A: PHC QI/PI Department Organizational Charts Page 96 of 135

97 Attachment B: Standing Staff Members of PHC QI Committees PAC, Q/UAC and IQI (Does not include external physician or consumer membership) PAC PHC Standing Members Chief Executive Officer Chief Medical Officer Chief Financial Officer Northern Region Executive Director Senior Director, Health Services Senior Director, Provider Relations Director, Quality & Performance Improvement Director of Utilization Mgmt Director, Pharmacy Services Director, Member Services Regional Medical Directors Associate Medical Director of Quality QUAC PHC Standing Members Chief Medical Officer Regional Medical Directors Associate Medical Director of Quality Northern Region Executive Director Sr. Director, Health Services Sr. Director, Provider Relations Director, Quality & Performance Improvement Director, Pharmacy Services Director of Utilization Mgmt Director, Care Coordination Director, Northern Region Health Services Director, Northern Region MS & PR Director of Government and Public Affairs HS Mental Health Director Regional Director, Southwest Associate Director, Care Coordination Associate Director, Provider Relations Associate Director, Northern Region Quality Sr. Manager, Provider Relations Manager of Quality Improvement Programs Manager of Quality Assurance/Patient Safety Manager of Health Analytics Grievance System Manager Regional Manager, Northwest Senior Health Educator Credentialing Supervisor, Provider Relations QI Project Coordinator IQI PHC Standing Members Chief Executive Officer Chief Operating Officer Chief Medical Officer Regional Medical Directors Associate Medical Director of Quality Sr. Director, Health Services Sr. Director, Provider Relations Sr. Director, Claims Sr. Director, Policy/Program Development Director, Quality & Performance Improvement Director, Pharmacy Services Director of Utilization Mgmt Director, Northern Region Health Services Director, Northern Region MS & PR Director of Operations Excellence & PMO Regional Director, Southwest Associate Director, Care Coordination Associate Director, Pharmacy Operations Associate Director, Northern Region Quality Sr Manager of Provider Education Manager of Quality Improvement Programs Manager of Quality Assurance/Patient Safety Manager of Northern Region QI Performance Improvement Quality Manager, Health Services Grievance System Manager Regional Manager, Northwest Team Manager, Utilization Management Senior Health Educator QI Project Coordinator PHC staff members attend the quality committee meetings on an ad hoc basis. Page 97 of 135

98 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Recommendation by: PHC Staff Topic Description: Kenneth Platou has been a Board commissioner representing Siskiyou County as the Hospital Representative. On October 23, 2017, Commissioner Platou notified the Board Clerk that he would be retiring from Mercy Medical Center Mt. Shasta in January 2018 and that his last PHC Board meeting would be October 25, Commissioner Platou has made numerous outstanding contributions to Partnership HealthPlan of California (PHC) and the Board from August 28, 2013 to October 25, He has provided excellent leadership and has been a dedicated commissioner and volunteer. Commissioner Platou has been of great value to the HealthPlan and he has kept the needs of the HealthPlan, members, providers, and the community as a guiding principle. Reason for Resolution: To provide Commissioner Platou with the highest level of commendations and appreciation for his outstanding service to PHC and the Board over the past four years and two months. Financial Impact: There is no financial impact to the HealthPlan. Requested Action of the Board: Based on the recommendation of PHC staff, the Board is asked to approve the commendations and appreciation for the support Commissioner Platou has provided to PHC and the Board. Page 98 of 135

99 CONSENT AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Number: 17- IN THE MATTER OF: APPROVING COMMENDATIONS AND APPRECIATION FOR COMMISSIONER KENNETH PLATOU S SERVICE TO PHC Recital: Whereas, A. Kenneth Platou has provided valuable advice and support for Partnership HealthPlan and the Board. B. Kenneth Platou has served for the past four years and two months as a commissioner on the PHC Board. Now, Therefore, It Is Hereby Resolved As Follows: 1. To provide Kenneth Platou with the highest level of commendations and appreciation for his service on the Board. PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: EXCUSED: Commissioner: Commissioner: Commissioners: Richard Fogg, Acting Chair ATTEST: Date BY: Cynthia McCamey, Clerk Page 99 of 135

100 REGULAR AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA Recommendation by: Compliance Committee Topic Description: The Compliance Program Dashboard outlines activities to track the HealthPlan s Compliance Program and regulatory and contractual requirements. Reason for Resolution: To provide the Board with PHCs Compliance Program Dashboard for review and approval twice a year. Financial Impact: There is no measurable impact to the HealthPlan. Requested Action of the Board: Based on the recommendation of the Compliance Committee, the Board is being asked to approve PHCs 2017 Compliance Program Dashboard. Page 100 of 135

101 REGULAR AGENDA REQUEST for PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: December 6, Resolution Number: 17- IN THE MATTER OF: APPROVING PHCS COMPLIANCE PROGRAM DASHBOARD Recital: Whereas, A. PHC staff is committed to conducting business in compliance with all required standards. B. It is our policy to have the Board review the Compliance Program Dashboard twice a year. C. The Board has responsibility for approving strategic direction. Now, Therefore, It Is Hereby Resolved As Follows: 1. To approve PHCs 2017 Compliance Program Dashboard. PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 6 th day of December 2017 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: ABSENT: EXCUSED: Commissioners: Commissioners: Commissioners: Richard Fogg, Acting Chair ATTEST: Date BY: Cynthia McCamey, Clerk Page 101 of 135

102 Regulatory Affairs Compliance Dashboard Q2 and Q3 of 2017 Category Description Q2 Q3 Comments Compliance The compliance function promotes the prevention, detection and resolution Quarterly Review of Policies/Procedures impacted by regulatory updates percentage of impacted Quarter 3 reasoning: of actions that do not conform to legal, policy or business standards. policies updated with regulatory requirements current through end of the quarter. APL : Impacts MCCP2016. Past review date of 1/20/ % 33% Health Services approved at IQI in August of 2017; pending vote at Physicians Advisory Committee (PAC) 11/8/2017. APL : Impacts MCLP7002. Next review date of 1/18/2018. Closed out CAP(s) Issued by Regulatory Agencies percentage of closed PHC CAPs that met requirements and were submitted timely as prescribed by regulatory agencies 100% 100% Delegation Oversight The Delegation Oversight Review Sub Committee ensures that delegated activities of subcontracted entities are in compliance with PHC policies and procedures, NCQA standards and any regulatory and contractual requirements. Annual Delegate / Subcontractor Audits percentage of delegate/subcontractor audits conducted annually, either through direct facilitation or evidence collection from responsible department. Closed out CAP(s) Issued to Delegates percentage of CAPs which have been accepted by the issuing department and are considered closed out. 100% 100% Quarter 2 reasoning: PHC Claims imposed CAP on Beacon through monthly monitoring 100% 100% Quarter 3 reasoning: Annual audits of Kaiser and Beacon were conducted, but preliminary findings/caps have not yet been issued Oversight of Reporting percentage of timely review and submission of delegate/subcontractor regulatory reports submitted to PHC. 100% 100% Training Staff are informed of the PHC Code of Conduct, Compliance Plan, FWA Training Sessions d Compliance Primers percentage of new hires that have completed their Prevention Program, and HIPAA policies and procedures relevant to their job compliance primers as part of new hire LMS trainings within the quarter. functions to ensure compliance with requirements. 100% 100% Quarter 2 reasoning: Reported 8/8 subcontractors/delegates at June 2017 Delegation Oversight Review Subcomittee (DORS) Quarter 3 reasoning: No report out on MedImpact at September 2017 DORS, as they report out semi annually (not quarterly); frequency subject to change Regulatory Affairs The Regulatory Affairs functions promote compliance with applicable laws, regulations and policies. Timely Submission of DHCS/Regulatory Agency Deliverables percentage of timely submissions of deliverables to DHCS. This includes but is not limited to requests from DHCS to demonstration compliance with new or existing rules, regulations, and/or guidance; new benefits or other type of implementation project deliverables, survey requests. 100% 100% Q2: 29 deliverables were submitted to DHCS. Q3: 24 deliverables were submitted to DHCS. Regulatory Reporting DHCS Reports Submitted Timely percentage of regulatory reports submitted timely by RAC with no extension request or missed due date. Reporting Rejection Rate percentage of standard regulatory reports submitted by RAC and rejected by DHCS for either incompleteness, wrong template, or for other findings. 100% 100% Q2: 17 reports were submitted timely. Q3: 7 reports were submitted timely. Quarter 2 reasoning: 1 of 17 reports rejected (APL / Grievance report) 6% 29% Quarter 3 reasoning: 2 of 7 reports were rejected (APL / Call Center and BHT Quarterly Report) Hotline A confidential telephone and web based process to collect info on compliance, ethics, and FWA Total Hotline Referrals Hotline Referrals Investigated percentage of Hotline referrals investigated or referred to appropriate department within the quarter. 100% 100% Page 102 of 135

103 Regulatory Affairs Compliance Dashboard Q2 and Q3 of 2017 HIPAA Referrals Appropriate safeguards, including administrative policies & procedures, to protect the confidentiality of PHI and ensure compliance with HIPAA regulatory requirements. Timely DHCS Privacy Notification Filings percentage of notifications that PHC filed timely within applicable DHCS required timeframe. *Initial within 24 hours, PIR within 72 hours and complete PIR within 10 business days. 77% 83% Quarter 2 and 3 reasoning: Primary corrective action needed: unit s shortage in staffing, training, and balancing of work duties needing to be prioritized. RAC's action plan: cross training to build redundancy during staffing shortages and retraining existing staff on processes to assure timely submissions. Additionally, daily huddles were implemented with management oversight to review cases, prioritize deliverables, and assure resources are properly allocated. Timely Member Notification percentage of member notifications mailed timely when breach criteria is met. *PHC is required to provide member notification within 60 days of the breach discovery. 100% 100% Timely State Notification percentage of timely state notification of incidents meeting breach criteria. *PHC is required to notify the California Office of Attorney General on all breaches involving 500 or more members. Timely Federal Notification percentage of timely federal notification of incidents meeting breach criteria. *PHC is required to report all breach incidents to the HHS OCR annually for breaches for less than 500 members per incident and immediately when incident involves more than 500 members. 100% 100% 100% 100% Quarter 2 reasoning: 2 breach incidents requiring 3 member notifications Quarter 3 reasoning: 1 breach incidents requiring 2 member notifications FWA Referrals Total FWA Investigations Regulatory Affairs oversees the Fraud, Waste and Abuse Prevention program Timely DHCS FWA Notifications percentage of notifications that were timely filed with DHCS intended to prevent, detect, investigate, report and resolve suspected within 10 business of discovery as per contractual obligations. and/or actual FWA in the PHC daily operations and interactions, whether internal or external. 88% 75% Quarter 2 and 3 reasoning: Primary corrective action needed: unit s shortage in staffing, training, and balancing of work duties needing to be prioritized. RAC's action plan: cross training to build redundancy during staffing shortages and retraining existing staff on processes to assure timely submissions. Additionally, daily huddles were implemented with management oversight to review cases, prioritize deliverables, and assure resources are properly allocated. Page 103 of 135

104 FINANCIAL HIGHLIGHTS Of The Partnership HealthPlan Of California For the Period Ending September 30, 2017 Financial Analysis for the Current Period Total (Deficit) Surplus For the month ending September 30, 2017, PHC reported a deficit of -$3.6 million, bringing the year-to-date deficit to -$25.6 million. The current month and year to date actual deficit is lower than the budgeted deficit primarily due to the favorable health care cost variances explained below. Revenue Current month s State Capitation Revenue of $208.3 million increased by $6.2 million in comparison to the previous month due to an increase in enrollment of 998 members as well as the previous month including a $4.9 million one-time revenue reduction. As explained in prior month s highlights, the $4.9 million was the result of a one-time adjustment to account for erroneously accrued revenue for members who should have been termed or made inactive due to death or other factors. Healthcare Costs Significant health care cost variances are addressed as follows: The unfavorable Non-Capitated Physician and Ancillary Services variances continue to be the result of higher than anticipated costs for the BHT (Autism Treatment) and Medicare copays and deductibles than originally budgeted. Average actual monthly costs associated with BHT and copays continue to be $394,000 and $400,000 higher than budget, respectively. The unfavorable Inpatient Hospital FFS variance for the current month and year-to-date are the result of a change in estimate related to high dollar IP claims. The favorable Long Term Care variance is due to a reduction in estimated costs to be paid retroactive to 08/01/2016. As noted in prior month s highlights, each year, DHCS releases new facility-specific LTC rates several months after their effective date and PHC in turn adjusts payments made to the facilities. While PHC is generally able to accurately estimate the impact, this past year the actual adjustments were less than projected and thus a reduction to the amount allocated for this adjustment was recorded in the prior month and further refined in the current month. The favorable Pharmacy variance is primarily due to the increase use of alternative lower cost Hepatitis C drugs and a 25% decrease in utilization from the budget base period. The favorable Quality Assurance variance is primarily due to position vacancies in the Quality and Care Coordination departments as well as HEDIS costs not yet incurred. The budget for this line item is spread evenly over a 12 month period, whereas actual cost is dependent upon specific hire dates or seasonality, in the case of HEDIS related costs. The favorable Healthcare Investment Funds variance is due to the timing of expected Strategic Use of Reserve (SUR) funds. In general, the budget for Medical costs are spread evenly over a 12 month period. The timing of the actual costs can vary throughout the year. As the year progresses and actual costs are realized, the favorable variance is expected to decrease. Page 104 of 135

105 FINANCIAL HIGHLIGHTS Of The Partnership HealthPlan Of California For the Period Ending September 30, 2017 Administrative Costs Total actual administrative costs are under budget by $1.2 million for the current month and $3.2 million for year-to-date. This does not appear unreasonable given the administrative budget is evenly spread over the fiscal year and the timing of actual expenses can vary throughout the year, in particular, employee expenses that relate to vacant positions being filled and number of working days in the month. Balance Sheet Total Cash & Cash Equivalents decreased by $33.5 million in comparison to the previous month primarily due to the quarterly MCO tax payment for $31.9 million disbursed in the current month. State DHS Cap Receivable increase is primarily due to the reclassing of previous fiscal year overpayments to the State DHS Cap Payable Account. The reclass was recorded as amounts for previous fiscal years net to an amount owed. The balance for the Receivable account is now $287.4 million, and only pertains to the current fiscal year. The balance for the Payable account consists of all of the prior years overpayments of $201.7 million as well as the unchanged balance of the Adult Expansion MLR revenue reduction of $322.9 million. Accounts Payable decreased in comparison to the previous month primarily due to the quarterly payment of MCO taxes noted above offset by current month s MCO tax accrual. The Strategic Use of Reserve balance is currently at $94.9 million. SUR activity recorded in the current month includes the quarterly update of SUR health care related costs (Hospital OP increases, Medicare Copays and Deductibles, and Long Term Care rate increases) in the amount of $17 million, $2.1 million for the Housing and Sober Living initiative and $2.6 million for new building construction costs. In order to not understate the SUR balance, the SUR amounts that have exceeded their original budget have been excluded in calculating the ending balance. See reconciliation of the Unspent SUR to-date on the Strategic Use of Reserves Update schedule. General Statistics Membership Membership increased by 998 members during the month. The Southern and Northern Regions had increases of 685 members and 313 members, respectively. Utilization Metrics and High Dollar Case For fiscal year 2017/18 through September 2017, the number of members exceeding $250,000 in total cost is 12 with an average cost per case of $313,647. For the prior fiscal year 2016/17, the number of members reached 358, and the average cost per case is $404,954. For fiscal year 2015/16, 277 members reached the $250,000 threshold with an average claims cost of $425,854. Page 105 of 135

106 FINANCIAL HIGHLIGHTS Of The Partnership HealthPlan Of California For the Period Ending September 30, 2017 Current Ratio/Board Designated Reserve Current Ratio Including Board Designated Reserve: 1.85 Current Ratio Excluding Board Designated Reserve: 1.34 Board Designated Reserves & Knox Keene: $448,257,893 Total Fund Balance: $814,814,507 Days of Cash on Hand Including Board Designated Reserves & Knox Keene: Excluding Board Designated Reserves & Knox Keene: Days of Cash on Hand Excluding MLR Payable Including Board Designated Reserves & Knox Keene: Excluding Board Designated Reserves & Knox Keene: Page 106 of 135

107 Partnership HealthPlan of California Strategic Use of Reserves Update As of September 30, 2017 Budgeted Amount $ Spent To-Date Balance at 9/30/17 Focus Area Initiative Access Hospital Outpatient Rate Increase (to 165%) $54,000,000 $39,250,000 $14,750,000 Long Term Care Provider Rate Increase (2%) $25,800,000 $20,942,000 $4,858,000 Medicare Copays and Deductibles $12,000,000 $25,300,000 ($13,300,000) Billing Limit $8,400,000 $12,600,000 ($4,200,000) 1% Reduction $7,800,000 $7,800,000 $0 Provider Recruitment Program $8,562,270 $2,642,576 $5,919,694 s $24,267,651 $23,968,125 $299,526 Access Total $140,829,921 $132,502,701 $8,327,220 Care Coordination CarePlus (Home Visit Program) $2,700,000 $2,700,000 $0 Case Management System $2,500,000 $2,173,341 $326,659 IOPCM Grants (Marin CC, Shasta CHC) $900,000 $900,000 $0 Analytics Support $750,000 $358,319 $391,681 IOPCM Grants (Mendo, PHC, QVMC, La Clinica) $1,500,000 $1,500,000 $0 s $1,663,140 $3,020,346 ($1,357,206) Care Coordination Total $10,013,140 $10,652,006 ($638,866) Community Partnership Local Innovation Fund: SDOH (Round 2) $2,300,000 $1,907,108 $392,892 SUR Funding Project for Housing & Sober Living $25,000,000 $6,249,900 $18,750,100 LOCAL INNOVATION FUNDS- Provider Access $1,600,000 $1,329,213 $270,787 Discharge Grant $500,000 $500,000 $0 s $775,310 $332,372 $442,938 Community Partnership Total $30,175,310 $10,318,593 $19,856,717 New Benefits Optional Medi-Cal Benefits (JH) $18,000,000 $18,000,000 $0 Cardiac Rehab Benefit (RM) $300,000 $300,000 $0 Coverage Of Chiropractors & Acupuncturists For Patients On A Narrow Basis (Rm) $300,000 $300,000 $0 Palliative Care Benefit $1,800,000 $1,800,000 $0 s $413,000 $540,225 ($127,225) New Benefits Total $20,813,000 $20,940,225 ($127,225) Plan Infrastructure New Building in Fairfield Bus. Ctr. Dr. $53,006,400 $12,341,516 $40,664,884 NR Buildings (Redding and Eureka) $4,000,000 $3,112,511 $887,489 Enterprise Data Warehouse $2,700,000 $2,700,000 $0 Technical Infrastructure For Hie And Clinical Data $2,000,000 $38,574 $1,961,426 Analytics Department $1,500,000 $1,500,000 $0 s $3,995,850 $2,993,297 $1,002,553 Plan Infrastructure Total $67,202,250 $22,685,897 $44,516,353 Quality Pharmacy QIP $3,200,000 $3,200,000 $0 Clinic Consortia Quality Improvement $1,275,000 $1,275,000 $0 Improve Prenatal Care With Pay For Performance Program $1,000,000 $0 $1,000,000 PCP QI Planning $330,000 $330,000 $0 Expand Hospital P4P Programs $7,500,000 $4,750,000 $2,750,000 s $410,000 $194,135 $215,865 Quality Total $13,715,000 $9,749,135 $3,965,865 Total Net SUR $282,748,621 $206,848,559 $75,900,062 Over Expenditures To-Date $18,984,431 Total Unspent SUR To-Date $94,884,494 Page 107 of 135

108 Partnership HealthPlan of California Executive Dashboard: Medi Cal Southern Region (Excluding Lake) Key Measures of Financial Performance as of September 30, / / / / /16 LOB: Medi Cal Budget Estimated FYTD Budget Actual Actual Average Enrollment 386, , , , ,243 Cost Per Member Per Month: Global Subcapitation $38.39 $37.41 $34.20 $37.39 $34.91 Medical Services $99.46 $ $95.01 $99.36 $90.23 Inpatient Hospital $98.94 $97.07 $93.22 $87.63 $87.03 Pharmacy $40.36 $38.39 $41.84 $38.69 $38.29 Long Term Care $49.47 $47.70 $45.17 $47.64 $48.43 Total $ $ $ $ $ Total Capitation Revenue PMPM $ $ $ $ $ Annual Bed Days/1000 N/A Annual Admissions/1000 N/A Avg Length of Stay (ALOS) N/A Avg Cost Per Bed Day N/A $4,164 $3,660 ED Visits/1000 N/A Physician Visits PMPY N/A Pharmacy Avg Cost Per Fill N/A $72.66 $68.37 Pharmacy Pct. Generic Fills N/A 90% 90% Pharmacy Fills PMPY N/A FY Utilization measures as of 6/30/17. Pharmacy 12% Medi Cal Expenditures by Cost Category FY 2017/2018 Long Term Care 15% Inpatient Hospital 30% Medical Services 32% Global Subcapitation 11% Pharmacy 13% Medi Cal Expenditures by Cost Category (excluding Kaiser) FY 2017/2018 Long Term Care 17% Inpatient Hospital 34% Medical Services 36% Global Subcapitation Inpatient Hospital Long Term Care Medical Services Pharmacy Medical Services Pharmacy Inpatient Hospital Long Term Care I:\HCCMTHND\MOR\Dashboard\FY 1718\Dashboard_ xlsx Page 108 of 135

109 Partnership HealthPlan of California Executive Dashboard: Medi Cal Northern Region (Including Lake) Key Measures of Financial Performance as of September 30, / / / / /16 LOB: Medi Cal Budget Estimated FYTD Budget Actual Actual Average Enrollment 187, , , , ,962 Cost Per Member Per Month: Medical Services $ $ $ $ $ Inpatient Hospital $ $ $ $ $94.35 Pharmacy $50.40 $47.74 $51.08 $48.42 $47.03 Long Term Care $45.74 $44.30 $40.28 $44.68 $42.47 Total $ $ $ $ $ Total Capitation Revenue PMPM $ $ $ $ $ Annual Bed Days/1000 N/A Annual Admissions/1000 N/A Avg Length of Stay N/A Avg Cost Per Bed Day N/A $4,088 $3,618 ED Visits/1000 N/A Physician Visits PMPY N/A Pharmacy Avg Cost Per Fill N/A $66.01 $60.60 Pharmacy Pct. Generic Fills N/A 90% 90% Pharmacy Fills PMPY N/A FY Utilization measures as of 6/30/17. Medi Cal Expenditures by Cost Category FY 2017/18 Pharmacy 15% Long Term Care 14% Medical Services 36% Inpatient Hospital 35% Medical Services Inpatient Hospital Pharmacy Long Term Care I:\HCCMTHND\MOR\Dashboard\FY 1718\Dashboard_ xlsx Page 109 of 135

110 PARTNERSHIP HEALTHPLAN OF CALIFORNIA ACTUAL V. PROJECTED MEDI CAL ENROLLMENT OCTOBER 2016 OCTOBER , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,000 OCT 16 NOV 16 DEC 16 JAN 17 FEB 17 MAR 17 APR 17 MAY 17 JUN 17 JUL 17 AUG 17 SEP 17 OCT 17 Projected (Budgeted) Actual Page 110 of 135

111 Partnership HealthPlan of California Comparative Financial Indicators Monthly Report Fiscal Year & Fiscal Year Average / Month 42,978 As of As of FINANCIAL INDICATORS Jul-17 Aug-17 Sep-17 YTD Sep-17 Sep-16 Total Enrollment 568, , ,705 1,709, , ,168 Total Revenue 205,914, ,463, ,643, ,021, ,673, ,567,196 Total Health Care Costs 196,109, ,452, ,021, ,583, ,861, ,829,483 Total Administrative Costs 7,493,740 8,045,192 7,555,930 23,094,863 7,698,288 7,350,252 Medi-Cal Hospital & Managed Care Taxes 10,654,816 10,654,816 10,654,816 31,964,448 10,654,816 10,130,334 Total Current Year Surplus (Deficit) (8,343,140) (13,689,157) (3,589,032) (25,621,329) (8,540,443) 6,257,127 State DHS Cap Payable 538,743, ,571, ,648, ,648, ,321, ,756,449 Total Claims Payable 222,550, ,631, ,639, ,639, ,940, ,022,385 Total Fund Balance 832,092, ,403, ,814, ,814, ,770, ,921,481 Capital Assets 57,893,788 60,201,112 62,527,138 62,527,138 60,207,346 48,355,883 Restricted Funds - Strategic Use of Reserves 104,524,973 98,369,480 94,884,494 94,884,494 99,259, ,866,126 Restricted Funds - Required Reserves 450,075, ,170, ,257, ,257, ,168, ,096,529 Unrestricted Fund Balance 219,597, ,662, ,144, ,144, ,135, ,602,943 Fund Balance as % of Restricted Funds % % % % % % Current Ratio 1.36:1 1.39:1 1.34:1 1.34:1 1.36:1 1.52:1 Medical Loss Ratio w/o Tax % % 98.00% % % 93.21% Admin Ratio w/o Tax 3.84% 4.19% 3.82% 3.95% 3.95% 3.67% Profit Margin Ratio w/o Tax -4.27% -7.14% -1.81% -4.38% -4.38% 3.12% FINANCIAL INDICATORS Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 YTD Jun-17 Average / Month As of Total Enrollment 571, , , , , , , , , , , ,661 6,857, ,474 Total Revenue 194,370, ,338, ,993, ,018, ,367, ,550, ,672, ,939, ,757, ,029, ,100, ,390,400 2,514,527, ,543,953 Total Health Care Costs 182,378, ,566, ,543, ,042, ,111, ,735, ,786, ,833, ,852, ,129, ,106, ,760,826 2,308,846, ,403,885 Total Administrative Costs 6,946,551 7,729,715 7,374,490 7,189,966 7,268,683 7,832,465 7,735,829 7,483,998 8,494,673 7,238,308 8,214,262 8,590,278 92,099,218 7,674,935 Medi-Cal Hospital & Managed Care Taxes 92, ,942 29,906,447 10,560,690 10,031,553 10,031,818 10,029,169 10,052,799 10,030,332 10,028,380 10,034,142 10,101, ,291,809 10,107,651 Total Current Year Surplus (Deficit) 4,952,380 12,650,158 1,168, ,459 1,956,429 3,949,973 (878,500) 2,569, ,365 (6,366,585) (8,254,382) (20,062,630) (7,710,211) (642,518) State DHS Cap Payable 369,926, ,487, ,855, ,104, ,777, ,827, ,992, ,522, ,493, ,493, ,436, ,422, ,422, ,778,272 Total Claims Payable 248,712, ,517, ,836, ,809, ,906, ,840, ,653, ,960, ,047, ,207, ,354, ,130, ,130, ,498,258 Total Fund Balance 853,098, ,748, ,917, ,142, ,099, ,049, ,170, ,740, ,119, ,752, ,498, ,435, ,435, ,564,449 Capital Assets 47,798,772 48,787,838 48,481,038 49,868,021 50,591,798 51,959,275 52,222,049 52,492,002 53,530,812 55,057,671 55,055,351 57,512,533 57,512,533 51,946,430 Restricted Funds - Strategic Use of Reserves 122,506, ,506, ,584, ,584, ,946, ,956,914 90,184,740 84,745,158 81,611, ,091, ,057,869 70,903,997 70,903, ,390,135 Restricted Funds - Required Reserves 425,853, ,535, ,900, ,472, ,502, ,367, ,039, ,428, ,120, ,432, ,637, ,672, ,672, ,080,269 Unrestricted Fund Balance 256,939, ,918, ,951, ,217, ,058, ,765, ,724, ,074, ,856, ,171, ,748, ,346, ,346, ,147,615 Fund Balance as % of Restricted Funds % % % % % % % % % % % % % % Current Ratio 1.52:1 1.53:1 1.52:1 1.56:1 1.53:1 1.48:1 1.52:1 1.46:1 1.45:1 1.42:1 1.42:1 1.39:1 1.39:1 1.48:1 Medical Loss Ratio w/o Tax 93.88% 90.29% 95.67% 96.26% 95.35% 94.06% 96.55% 95.00% 95.56% 99.56% % % 96.47% 96.47% Admin Ratio w/o Tax 3.58% 3.68% 3.74% 3.62% 3.66% 3.95% 3.89% 3.73% 4.25% 3.67% 4.09% 4.31% 3.85% 3.85% Profit Margin Ratio w/o Tax 2.55% 6.03% 0.59% 0.11% 0.99% 1.99% -0.44% 1.28% 0.19% -3.23% -4.11% % -0.32% -0.32% Page 111 of 135

112 $900.0 Partnership HealthPlan of California Fund Balance Comparison (in Millions of Dollars) For the Past 12 Months Ending September 30, 2017 $800.0 $262.2 $268.1 $270.8 $306.7 $315.1 $317.9 $288.2 $280.7 $285.3 $219.6 $210.7 $209.1 $700.0 $600.0 $500.0 $400.0 $129.6 $125.9 $127.0 $103.1 $101.1 $90.2 $84.7 $81.6 $70.9 $425.5 $424.5 $423.4 $423.0 $422.4 $422.1 $422.4 $423.6 $426.7 $104.5 $98.4 $94.9 $450.1 $449.2 $448.3 $300.0 $200.0 $100.0 $0.0 $49.9 $50.6 $52.0 $52.2 $52.5 $53.5 $55.1 $55.1 $57.5 $57.9 $60.2 $62.5 Oct 2016 Nov 2016 Dec 2016 Jan 2017 Feb 2017 Mar 2017 Apr 2017 May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Capital Assets Required Reserves Strategic Use of Reserves Unrestricted Funds Page 112 of 135

113 PARTNERSHIP HEALTHPLAN OF CALIFORNIA Membership and Financial Summary For The Period Ending September 30, 2017 CURRENT MONTH PRIOR MONTH INC / DEC MEMBERSHIP SUMMARY CURRENT YTD AVG PRIOR YTD AVG VARIANCE 110, , Medi-Cal Solano 110, ,884 (3,181) 28,633 28, Medi-Cal Napa 28,595 28,917 (322) 53,777 53,797 (20) Medi-Cal Yolo 53,705 53,765 (60) 113, ,408 2 Medi-Cal Sonoma 113, , ,262 38, Medi-Cal Mendocino 38,066 36,988 1,079 39,552 39, Medi-Cal Marin 39,505 37,410 2,095 30,783 30, Medi-Cal Lake 30,671 29,625 1,046 11,370 11, Medi-Cal Del Norte 11,373 11, ,030 51, Medi-Cal Humboldt 52,018 51, ,522 7, Medi-Cal Lassen 7,492 7, ,068 3,060 8 Medi-Cal Modoc 3,057 3, ,597 59, Medi-Cal Shasta 59,453 60,817 (1,363) 17,453 17,502 (49) Medi-Cal Siskiyou 17,544 17, ,325 4,317 8 Medi-Cal Trinity 4,339 4,578 (238) Healthy Kids (183) 570, , TOTAL 569, ,168 (367) ACTUAL MONTH BUDGET MONTH ACT vs BUD MONTH FINANCIAL SUMMARY ACTUAL YTD BUDGET YTD ACT vs BUD YTD 208,643, ,510, ,694 Total Revenue 617,021, ,365,260 (4,343,672) 194,021, ,318,663 5,296,934 Total Healthcare Costs 587,583, ,941,932 6,358,326 7,555,930 8,767,134 1,211,204 Total Administrative Costs 23,094,863 26,301,402 3,206,539 10,654,816 10,654,816 - Medi-Cal Managed Care Tax 31,964,448 31,964,448 - (3,589,032) (10,229,864) 6,640,832 Total Current Year Surplus (Deficit) (25,621,329) (30,842,522) 5,221, % % 3.82% 4.43% Medical Loss Ratio (HC Costs as a % of Rev, excluding Managed Care Tax) % % Admin Ratio (Admin Costs as a % of Rev, excluding Managed Care Tax) 3.95% 4.46% Page 1 of 5 Page 113 of 135

114 PARTNERSHIP HEALTHPLAN OF CALIFORNIA Balance Sheet As Of September 30, 2017 September 2017 August 2017 Current Assets A S S E T S Cash &Cash Equivalents 877,294, ,772,703 Receivables Accrued Interest 97,400 69,800 State DHS - Cap Rec 287,408, ,728,566 Funds Receivable - Prov Risk 7,427,844 7,427,844 Miscellaneous Receivable 10,177,659 10,353,541 Total Receivables 305,111, ,579,751 Current Assets Payroll Clearing (1,788) 1,283 Prepaid Expenses 2,302,428 2,621,843 Total Current Assets 2,300,641 2,623,126 Total Current Assets 1,184,706,486 1,103,975,580 Non-Current Assets Fixed Assets Motor Vehicles 115, ,311 Furniture & Fixtures 5,796,180 5,796,180 Computer Equipment - HP 541, ,886 Computer Equipment 5,478,165 5,298,100 Computer Software 13,114,225 13,062,375 Leasehold Improvements 962, ,374 Land 6,767,292 6,767,292 Building 30,758,528 30,758,528 Building Improvements 6,841,168 6,841,168 Accum Depr - Motor Vehicles (83,944) (81,351) Accum Depr - Furniture (5,100,963) (5,084,224) Accum Depr - Comp Equip - HP (541,591) (541,296) Accum Depr - Comp Equipment (4,839,785) (4,805,858) Accum Depr - Computer Sftware (7,347,158) (7,056,278) Accum Depr - Lsehld Improve (885,954) (883,883) Accum Depr - Building (3,067,210) (3,001,486) Accum Depr - Bldg Improvements (1,809,665) (1,751,807) Construction Work-In-Progress 15,828,279 13,264,080 Total Fixed Assets 62,527,138 60,201,112 Non-Current Assets Deposits 248, ,113 Board-Designated Reserves 447,957, ,870,817 Knox-Keene Reserves 300, ,000 Net Pension Asset 814, ,521 Deferred Outflows Of Resources 1,285,519 1,285,519 Total Non-Current Assets 450,606, ,518,970 Total Non-Current Assets 513,133, ,720,081 Total Assets 1,697,839,670 1,615,695,661 Page 2 of 5 Page 114 of 135

115 PARTNERSHIP HEALTHPLAN OF CALIFORNIA Balance Sheet As Of September 30, 2017 September 2017 August 2017 L I A B I L I T I E S & F U N D B A L A N C E Liabilities Current Liabilities Accounts Payable 51,453,657 68,996,127 Unearned Income 242, ,879 Suspense Account 1,048,260 1,010,841 Capitation Payable 3,387,134 3,189,206 State DHS - Cap Payable 524,648, ,571,500 Claims Payable 101,208,703 83,663,347 Incurred But Not Reported-IBNR 120,431, ,968,287 Quality Improvement Programs 80,057,304 73,088,075 Total Current Liabilities 882,477, ,744,263 Non-Current Liabilities Deferred Inflows Of Resources 547, ,859 Total Non-Current Liabilities 547, ,859 Total Liabilities 883,025, ,292,122 Fund Balance Invested In Capital Assets 62,527,138 60,201,112 Unrestricted Fund Balance 209,144, ,662,130 Restricted Funds Reserve For Restricted Fund-Board Designated 432,957, ,870,817 Reserve For Restricted Fund-Knox-Keene 300, ,000 Reserve For Restricted Fund-Board Designated-Infrastructure 15,000,000 15,000,000 Reserve For Restricted Fund-Strategic Use Of Reserve 94,884,494 98,369,480 Total Restricted Funds 543,142, ,540,297 Total Fund Balance 814,814, ,403,539 Total Liabilites And Fund Balance 1,697,839,670 1,615,695,661 Page 3 of 5 Page 115 of 135

116 PARTNERSHIP HEALTHPLAN OF CALIFORNIA Statement of Cash Flow For The Period Ending September 30, 2017 Current Month Activity Year-To-Date Activity CASH FLOWS FROM OPERATING ACTIVITIES: Cash Received From: Capitation from California Department of Health Care Services 191,396, ,617,010 Revenues 1,543 (2,021) Cash Payments to Providers for Medi-Cal Members Capitation Payments (38,592,521) (118,405,796) Medical Claims Payments (129,089,626) (443,508,456) Cash Payments to Vendors (49,825,907) (95,915,803) Cash Payments to Employees (5,669,090) (20,507,193) Net Cash (Used) Provided by Operating Activities (31,778,880) (56,722,258) CASH FLOWS FROM CAPITAL FINANCING & RELATED ACTIVITIES: Purchases of Capital Assets (2,796,114) (6,405,678) Net Cash Used by Capital Financial & Related Activities (2,796,114) (6,405,678) CASH FLOWS FROM INVESTING ACTIVITIES: Board-Designated Reserve Transfers 912,924 (21,584,952) Interest and Dividends on Investments 183, ,763 Net Cash (Used) Provided by Investing Activities 1,096,683 (20,862,189) NET (DECREASE) INCREASE IN CASH & CASH EQUIVALENTS (33,478,311) (83,990,125) CASH & CASH EQUIVALENTS, BEGINNING 910,772, ,284,517 CASH & CASH EQUIVALENTS, ENDING 877,294, ,294,392 RECONCILIATION OF OPERATING (LOSS) INCOME TO NET CASH PROVIDED (USED) BY OPERATING ACTIVITIES: TOTAL OPERATING (LOSS) INCOME (3,800,391) (26,387,892) DEPRECIATION 470,087 1,391,073 CHANGES IN ASSETS AND LIABILITIES: Receivables 175, ,657 California Department of Health Services Receivable (114,679,985) 5,604,526 Assets 322,485 (206,476) Accounts Payable and Accrued Expenses 63,755,464 (51,097,775) Accrued Claims Payable 15,008,348 (4,490,529) Quality Improvement Programs 6,969,229 18,312,158 Net Cash Provided (Used) by Operating Activities (31,778,880) (56,722,258) Page 4 of 5 Page 116 of 135

117 PARTNERSHIP HEALTHPLAN OF CALIFORNIA Statement of Revenues and Expenses For The Period Ending September 30, 2017 **The Notes to the Financial Statement are an Integral Part of this Statement ACTUAL MONTH BUDGET MONTH $ VARIANCE MONTH ACTUAL MONTH PMPM BUDGET MONTH PMPM ACTUAL YTD BUDGET YTD $ VARIANCE YTD ACTUAL YTD PMPM BUDGET YTD PMPM 570, ,705 - TOTAL MEMBERSHIP - PROJECTED 1,709,404 1,709,404 - REVENUE 208,329, ,329, State Capitation Revenue 615,925, ,820,130 (4,894,373) ,359 80, , Interest Income 766, , , , ,670 1, Revenue 329, ,010 24, ,643, ,510, , TOTAL REVENUE 617,021, ,365,260 (4,343,672) HEALTHCARE COSTS 14,582,711 15,038, , Global Subcapitation 44,396,381 44,831, , ,909,516 1,917,637 8, Capitated Medical Groups 5,707,556 5,725,127 17, Physician Services 5,808,025 5,778,780 (29,245) PCP Capitation 17,426,017 17,313,357 (112,660) , ,377 (259) Specialty Capitation 1,231,191 1,225,584 (5,607) ,760,629 17,538,087 (222,542) Non-Capitated Physician Services 54,328,738 52,494,339 (1,834,399) ,978,289 23,726,244 (252,045) Total Physician Services 72,985,945 71,033,280 (1,952,665) Inpatient Hospital 16,064,242 16,232, , Hospital Capitation 48,050,351 48,529, , ,084,692 42,381,019 (703,673) Inpatient Hospital - FFS 128,208, ,848,851 (1,359,735) , , Hospital Stoploss 2,975,010 2,975, ,140,604 59,605,561 (535,043) Total Inpatient Hospital 179,233, ,353,188 (880,759) ,145,716 27,429,718 4,284, Long Term Care 74,742,639 81,411,764 6,669, ,596,880 24,501,887 2,905, Pharmacy 67,673,622 73,327,464 5,653, Ancillary Services 1,348,499 1,334,640 (13,859) Ancillary Services - Capitated 4,006,775 3,970,648 (36,127) ,979,759 32,666,688 (2,313,071) Ancillary Services - Non-Capitated 102,876,610 97,744,320 (5,132,290) ,328,258 34,001,328 (2,326,930) Total Ancillary Services 106,883, ,714,968 (5,168,417) Medical 1,388,967 1,920, , Quality Assurance 4,124,915 5,761,518 1,636, ,359,897 2,624, , Healthcare Investment Funds 7,352,450 7,690, , , ,000 (11,642) Advice Nurse 304, ,000 (4,132) ,663 16,670 4, HIPP Payments 33,249 50,010 16, ,497,357 1,466,587 (30,770) Transportation 4,793,312 4,390,219 (403,093) ,370,526 6,128, , Total Medical 16,608,057 18,192,117 1,584, ,969,229 6,969, Quality Improvement Programs 19,352,074 19,352, ,021, ,318,663 5,296, TOTAL HEALTHCARE COSTS 587,583, ,941,932 6,358, ADMINISTRATIVE COSTS 5,049,286 5,843, , Employee 15,691,389 17,530,005 1,838, ,423 62,091 36, Travel And Meals 87, ,273 98, , , , Occupancy 2,169,854 2,707, , , ,612 47, Operational 763,448 1,006, , ,166,242 1,323, , Professional Services 3,474,429 3,969, , , ,651 35, Computer And Data 907, ,953 (5,795) ,555,930 8,767,134 1,211, TOTAL ADMINISTRATIVE COSTS 23,094,863 26,301,402 3,206, ,654,816 10,654, Medi-Cal Managed Care Tax 31,964,448 31,964, (3,589,032) (10,229,864) 6,640,832 (6.29) (17.93) TOTAL CURRENT YEAR SURPLUS (DEFICIT) (25,621,329) (30,842,522) 5,221,193 (14.99) (18.04) Page 5 of 5 Page 117 of 135

118 PARTNERSHIP HEALTHPLAN OF CALIFORNIA NOTES TO FINANCIAL STATEMENTS September 30, ORGANIZATION The Partnership HealthPlan of California (PHC) was formed as a health insurance organization, and is legally a subdivision of the State of California, but is not part of any city, county or state government system. PHC has quasi-independent political jurisdiction to contract with the State for managing Medi-Cal beneficiaries who reside in various Northern California Counties. PHC is a combined public and private effort engaged principally in providing a more cost-effective method of health care. PHC began serving Medi-Cal eligible persons in Solano in May That was followed by Napa in March of 1998, Yolo in March of 2001, Sonoma in October 2009, Marin and Mendocino in July 2011, and eight Northern Counties in September In November 04, 2005, the Department of Managed Health Care (DMHC) issued a license to PHC to provide a Healthy Kids Insurance Program to eligible Solano, Napa, Yolo and Sonoma resident s ages 0-18, and to operate as a full service health care plan under the provisions of the Knox-Keene Health Service Plan Act of PHC began enrollment into the program effective December 1, Effective June 2010 due to a decrease in available funding, Napa termed their contract with PHC and accordingly, all Napa members were disenrolled as of that date. Effective July 2011, enrollment was opened to residents living in Marin County; however effective July 2015 the Marin Healthy Kids members were transitioned to Kaiser. As of the end of November 2016, the majority of the members enrolled in Healthy Kids (primarily undocumented children) have been transitioned to the Medi-Cal program. In September 2006, the HealthPlan entered into agreement with the Centers for Medicare and Medicaid Services ( CMS ) and became a Medicare Advantage Organization ( MAO ) under the commercial name Partnership Advantage. As a MAO, the Company provides medical services to its members. The service contract for fiscal year 2012/2013 became effective with the January 2013 through December 2013 contract and continued with the January 2014 through December 2014 contract. Due to significant losses, the Board approved terminating the Partnership Advantage Program at the end of calendar year As a public agency, the HealthPlan is exempt from state and federal income tax. 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES ACCOUNTING POLICIES: The accounting and reporting policies of PHC conform to generally accepted accounting principles and general practices within the healthcare industry. Page 1 of 4 Page 118 of 135

119 PARTNERSHIP HEALTHPLAN OF CALIFORNIA NOTES TO FINANCIAL STATEMENTS September 30, 2017 PROPERTY AND EQUIPMENT: Effective July 1, 2015, property and equipment totaling $10,000 or more are recorded at cost; this includes assets acquired through capital leases and improvements that significantly add to the productive capacity or extend the useful life of the asset. Costs of maintenance and repairs are expensed as incurred. Depreciation for financial reporting purposes is provided on a straight-line method over the estimated useful life of the asset. The costs of major remodeling and improvements are capitalized as building or leasehold improvements. Leasehold improvements are amortized using the straight-line method over the shorter of the remaining term of the applicable lease or their estimated useful life. Building improvements are depreciated over their estimated useful life. Buildings purchased are recorded at cost and are depreciated on the straightline basis over their estimated useful lives. INVESTMENTS: PHC investments can consist of U.S. Treasury Securities, Agency Notes, Repurchase Agreements, Shares of Beneficial Interest and Commercial Paper and are carried at fair value. BOARD-DESIGNATED & KNOX KEENE RESERVES: In April 2004, PHC s Board established a policy to set aside in a reserve account a designated amount that represents the Knox-Keene Tangible Net Equity (TNE) requirement. This policy was subsequently revised in May 2012 and beginning with July 1, 2012 the new methodology has been reflected on the balance sheet. Based on this policy and as of September 30, 2017, PHC has Board- Designated and Knox-Keene Reserves of $448.0 million and $0.3 million respectively. To account for the Board approved Strategic Use Of Reserves (SUR) initiatives, $94.9 million has been set aside as a Reserve for Restricted Fund-Strategic Use of Reserves. The amount represents the net amount remaining of all of the SUR projects that have been approved to date; this balance is periodically adjusted as projects are completed. 3. STATE CAPITATION REVENUE Medi-Cal capitation revenue is based on the monthly capitation rates, as provided for in the State contract, and the actual number of Medi-Cal eligible members. Capitation revenues are paid by the State on a monthly basis in arrears based on estimated membership. Prior to January 1, 2010, enrollment was subject to retrospective adjustments by the State upon completion of the 6th and 12th months following the month of service. Effective January 1, 2010, the retrospective adjustments have been replaced with monthly reconciliations with the State. As such, capitation revenue includes an estimate for amounts receivable from or refundable to State for these retrospective adjustments. These estimates are continually monitored and adjusted, as necessary, as experience develops or new information becomes known. Effective with the enrollment of the Adult Expansion Population per ACA on January 1, 2014 the HealthPlan is subject to State requirements to meet a minimum 85% medical loss ratio (MLR) for this population. Specifically, the HealthPlan will be required to expend at least 85% of the Medi- Page 2 of 4 Page 119 of 135

120 PARTNERSHIP HEALTHPLAN OF CALIFORNIA NOTES TO FINANCIAL STATEMENTS September 30, 2017 Cal capitation revenue received for this population on allowable medical expenses as defined by the State. In the event the HealthPlan expends less than the 85% requirement, the Health Plan will be required to return to the State the difference between the minimum threshold and the actual allowed medical expenses. This difference is recorded as a reduction to Medi-Cal capitation revenue and the related liability is recorded in State DHS Cap Payable. As of September 30, 2017, the amount due to the State is $322.9 million. Additionally recorded in State DHS Cap Payable is $201.7 million of capitation revenue; this is due to the State s continual overpayment of higher than contracted rates to the HealthPlan, which occurred in previous fiscal years. Effective October 2009, the State of California imposed AB 1422, the California Children and Families Act of 1998, on all Medi-Cal Managed Care Health Plans with a retroactive effective date of January 1, AB 1422 requires all such plans to pay a 2.35% gross premium tax on Medi- Cal Revenue (MCO Tax). AB 1422 expired June 30, 2011 and was reinstated in September 2011 with a new expiration date of June 30, Effective with California SB 78 and beginning July 1, 2012, the health plans were again required to pay a gross premium tax on Medi-Cal Revenue. The rate in effect from July 1, 2012 to June 30, 2013 would remain at 2.35% and beginning July 1, 2013, the tax rate increased to 3.94% and expired on June 30, Effective July 1, 2016, SB X2-2 revised the MCO Tax, which is implemented by DHCS. The tax is calculated by DHCS and is based on projected membership. Projected tax for fiscal year 2017/18 is $127.8 million. 4. HEALTH CARE COST PHC continues to develop completion factors to calculate estimated liability for claims incurred but not reported. These factors are reviewed and adjusted as more historical data become available. Budgeted capitation revenues and health care costs are adjusted each month to reflect changes in enrollee counts. 5. QUALITY IMPROVEMENT PROGRAM PHC maintains quality incentive contracts with acute care hospitals and primary care physicians. As of September 30, 2017, PHC has accrued a Quality Incentive Program payout for Fiscal Years 2016/2017 and 2017/2018 of $60.7 million and $19.3 million respectively. 6. ESTIMATES Due to the nature of the operations of the Partnership HealthPlan, it is necessary to estimate amounts for financial statement presentation. Substantial overstatement or understatement of these estimates would have a significant impact on the statements. The items estimated through various methodologies are: - Value of Claims Incurred But Not Received Page 3 of 4 Page 120 of 135

121 PARTNERSHIP HEALTHPLAN OF CALIFORNIA NOTES TO FINANCIAL STATEMENTS September 30, Quality Incentive Payouts - Earned Capitation Revenues - Total Number of Members - Retro Capitation Expense for Certain Providers 7. COMMITMENTS AND CONTINGENCIES In the ordinary course of business, the HealthPlan is party to claims and legal actions by enrollees, providers, and others. After consulting with legal counsel, HealthPlan management is of the opinion any liability that may ultimately be incurred as a result of claims or legal actions will not have a material effect on the financial position or results of the operations of the HealthPlan. 8. UNUSUAL OR INFREQUENT ITEMS REPORTED IN CURRENT MONTH S FINANCIAL STATEMENTS IBNR was reduced by approximately $4 million in conjunction with the reduction to Long Term Care; while PHC is generally able to accurately estimate impacts to IBNR, the adjustments for this past year were less than projected and thus a reduction was recorded in the prior month and further refined in the current month. On the Balance Sheet, the State DHS Cap Payable previously contained the Adult Expansion MLR revenue reduction as well as the overpayments from the State pertaining to fiscal year 2015/16. Only affecting the Balance Sheet, all of the overpayments from the state from all of the other previous fiscal years (approximately $81.6 million) have been transferred from the State DHS Cap Receivable account to the Payable account. Page 4 of 4 Page 121 of 135

122 Partnership HealthPlan of California Investment Schedule September 30, 2017 Name of Investment Investment Type Yield to Maturity Trade Date Maturity Date Call Date Face Value Market Value Credit Rating Agency Credit Rating FUNDS HELD FOR INVESTMENT: Highmark Money Market Cash & Cash Equiv NA Various NA NA NA $ 1,475,236 NA NR Certificate of Deposit for Knox Keene Cash & Cash Equiv /12/ /30/2017 NA NA $ 300,000 NA NR FUNDS HELD FOR OPERATIONS: Merrill Lynch Insitutional Cash for Operations NA NA NA NA NA $ 59,274,023 Merrill Lynch MMA - Checking Cash for Operations NA NA NA NA NA $ 8,522,779 UBOC - General/MMA and Checking Cash for Operations NA NA NA NA NA $ 1,145,235,041 UBOC - Healthy Kids Cash for Operations NA NA NA NA NA $ 5,713,267 Government Investment Pools (LAIF) Cash for Operations NA NA NA NA NA $ 65,000,000 Government Investment Pools (County) Cash for Operations NA NA NA NA NA $ 38,089,247 West America Savings (Restricted for Lease) Cash for Operations NA NA NA NA NA $ 380 West America Payroll Cash for Operations NA NA NA NA NA $ 1,940,012 Petty Cash Cash for Operations NA NA NA NA NA $ 2,300 GRAND TOTAL: $ 1,325,552,285 Board Designated Assets & Knox-Keene Reserve Board Designated Assets $ 447,957,893 Knox Keene Reserves $ 300,000 Total Board Designated Reserves $ 448,257,893 MLR Payable MLR Payable Through 08/31/2017 $ 443,571,500 Cash on Hand / Cash Days Available: Including Board-Designated and Knox Keene $ 1,325,552,285 Excluding Board-Designated and Knox Keene $ 877,294,392 Cash Days Available incl. Board Designated and Knox Keene Cash Days Available excl. Board Designated and Knox Keene Excluding MLR Payable; Including Board-Designated and Knox Keene $ 881,980,785 Excluding MLR Payable; Excluding Board-Designated and Knox Keene $ 433,722,892 Cash Days Available excl MLR Payable; incl. Board Designated and Knox Keene Cash Days Available excl MLR Payable; excl. Board Designated and Knox Keene Page 122 of 135

123 Partnership HealthPlan of California Investment Yield Trends FISCAL YEAR 17/18 JUL AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN YTD Interest Income 332, , , ,563 Cash & Investments at Historical Cost (2) 940,691, ,772, ,294, ,586,346 Computed Yield 0.42% 0.72% 1.01% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Total Rate of Return (1) 0.42% 0.72% 1.01% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% CA Pooled Money Investment Account (PMIA) (3) 1.05% 1.08% 1.11% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Cash & Investments at Book Value 940,691, ,772, ,294, Cash & Investment at Market Value 940,691, ,772, ,294, Computed unrealized gain / (loss) FISCAL YEAR 16/17 JUL AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN YTD Interest Income 80,298 30,619 30,713 90,163 31,703 49,919 99,388 75,911 39, ,714 56, , ,790 Cash & Investments at Historical Cost (2) 1,079,287,360 1,087,524,486 1,092,966,561 1,043,824,539 1,103,685,069 1,195,168,624 1,141,085,272 1,163,647,839 1,175,000,644 1,225,866,387 1,196,396, ,792,709 1,122,353,822 Computed Yield 0.09% 0.12% 0.16% 0.26% 0.29% 0.34% 0.45% 0.53% 0.57% 0.77% 0.82% 1.03% Total Rate of Return (1) 0.10% 0.12% 0.16% 0.26% 0.29% 0.34% 0.45% 0.53% 0.57% 0.77% 0.82% 1.03% CA Pooled Money Investment Account (PMIA) (3) 0.59% 0.61% 0.63% 0.65% 0.68% 0.72% 0.75% 0.78% 0.82% 0.88% 0.93% 0.98% Cash & Investments at Book Value 1,079,287,360 1,087,524,486 1,092,966,561 1,043,824,539 1,103,685,069 1,195,168,624 1,141,085,272 1,163,647,839 1,175,000,644 1,225,866,387 1,196,396, ,792,709 Cash & Investment at Market Value 1,079,287,360 1,087,524,486 1,092,966,561 1,043,824,539 1,103,685,069 1,195,168,624 1,141,085,272 1,163,647,839 1,175,000,644 1,225,866,387 1,196,396, ,792,709 Computed unrealized gain / (loss) NOTES: (1) Total Rate of Return is computed based on year-to-date interest income annualized divided by an average of the fiscal year's portfolio's market value at month-end. (2) Investment balances include Restricted Cash and Board Designated Reserves YTD for Cash & Investments is average year-to-date (3) LAIF limits the amount a single government entity can deposit into LAIF; currently that amount is set at $65 million. INVGRAPH1803, board rpt new 11/2/2017, 3:46 PM Page 123 of 135

124 Partnership HealthPlan of California Investment Yield Trends 1.110% 1.010% 0.910% Percentage Yield 0.810% 0.710% 0.610% 0.510% FISCAL YEAR 17/18 PMIA 17/ % 0.310% 0.210% FISCAL YEAR 16/17 PMIA 16/ % 0.010% JUL AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN Periods Page 124 of 135

125 Operations Report Sonja Bjork, Chief Operating Officer December 2017 Health Services: UM/Care Coordination The Sonoma Developmental Center (SDC) is slated for closure by the end of Our Care Coordination team has been working closely with SDC staff and Regional Center staff to ensure a good transition for our members who have been moving from institutional care to community placements. We have approximately 83 members remaining at the SDC. Over the coming months we will continue to collaborate with our community partners to ensure that these members have the supplies, medication and care they need. Utilization Management is focused on gathering required documentation for the upcoming DHCS audit scheduled to begin in January In addition, the team is working diligently to fine tune policies and procedures to ensure alignment with NCQA requirements. The Care Coordination team is on track to meet all regulatory requirements for processing the Health Information Form (HIF) being sent to all new members, and the new Health Risk Assessment (HRA) that will be sent to all Seniors and Persons with Disabilities (SPDs) beginning January 1, Provider Relations Provider Relations has been working closely with DHCS to monitor access to primary care in Sonoma County in light of fire damage suffered by some providers. The State has requested our participation in regular phone conferences with their staff and the leadership of the affected primary care sites. In addition, we have been asked to monitor related member complaints or requests to transfer primary care providers. Staff has also devoted many hours to implementation of the online provider directory requirements outlined in Senate Bill 137. The new requirements, effective January 1, 2018 include: 1 Page 125 of 135

126 Specialty Board certification Website URL Practitioner license and language(s), and distance to practitioner s office Whether primary care offices are accepting new patients The contracting team has been very busy amending contracts to effectuate a new payment methodology for Indian Health Services providers. In addition, primary care provider agreements have been amended to include the new Quality Improvement Program (QIP) criteria. items that the Provider Relations team has been diligently working are: Amendments to network effective December 1, 2017 to adjust CBAS rates Good news bulletin to be published in December regarding Senate Bill 56 which provides additional payments to physicians for specific CPT codes, retro to July 1, 2017 Implementation of the Palliative Care benefit effective January 1, 2018 Network development work plan for PHC Drug Medi Cal program, effective July 1, 2018 Operational Excellence/PMO Transportation Benefit Department staff continues to support the refinement of this benefit by working closely with Care Coordination, Member Services, Provider relations, Regulatory & Compliance, and our vendor MTM. MTM has provided 14,000 rides to 2500 members. These include taxi, bus and gas mileage reimbursement. As of go live, there have been 231 member no shows and 72 driver no shows of which 40 trips were rescheduled. Total of 116 complaints currently, of which has decreased by 50% from 7/3/17. Joint Operations meetings with MTM continue to be biweekly to discuss ongoing issues related to network adequacy and the status updates with providers contracting with MTM. Telehealth Members of the OpEx/PMO Telehealth team participated in the Telemedicine Coordinator Workshop in Sacramento on November 13, 2017 sponsored by California Health Care Foundation and the California Telehealth Resource Center. The focus was to share best practices, expand use and improve efficiency for member specialty care utilizing telehealth. EConsult Program: 15 Operational Locations 42 closed econsults for October consults closed overall 2 Page 126 of 135

127 econsult webinar to be held in early December to help promote the program Video Consult Program: 22 Operational Locations 331 consults during the month of September. October data not yet available 4,568 televideo consults completed since program launch 2014 Claims Our Claims turnaround time continues to remain well under 20 days from receipt of claim. Most are turned around in less than 30 days. The ecif (Claims Inquiry Form) turnaround is also at under 20 days from receipt. We are well positioned for the holidays on both claims and CIF processing. Our staff has been very involved in reviewing the requirements for a new PHC core system for claims payment. Major claims configuration projects include: Preparing to pay the OMB rate to Indian Health Services clinics effective 1/1/18 Implementation of COBA, the new Medicare coordination of benefits agreement required by CMS Automation of generic drug pricing Preparing our system to handle payments for our new substance abuse treatment benefit effective 7/1/18 Working with the Finance Department on a coordination of benefits project to record and store other coverage/third party liability information Northern Region Provider Recruitment We had five accepted offers by provider candidates in the last 60 days: Marin Coastal Health Alliance (1 Physician) Sonoma West County Health Centers (1 Physician); Petaluma Health Center (1 NP) Shasta Shasta Community Health Center (1 Physician) Humboldt Fortuna Family Medical Group (1 Physician) LTC Luncheon Long Term Care Provider luncheons were held in Shasta and Humboldt County this last month. Along with an education session, our LTC providers were spotlighted and acknowledged for their commitment and efforts in assisting PHC place our members post hospital discharge. Staff 3 Page 127 of 135

128 from our Health Services, Provider Relations, Claims, and Quality departments were all present and over 20 Northern Region LTC providers were represented. Trinity County Helena Fire Fundraiser HR and Northern Region staff combined their efforts for a fundraiser to aid Trinity County fire victims. We held a vendor fair where participating vendors agreed to donate between 20% 100% of their proceeds. In total, the 10 vendors donated $ to the American Red Cross on behalf of Partnership. This was a win win for all involved! Breast Cancer Screening Incentive The Northern Region team is pleased to have 28 primary care providers participating in the breast cancer screening staff incentive opportunity, launched in late September. Member gap lists for outreach will be provided for the remainder of 2017 and then this measure will be included in the QIP. The Northern Region team entered into a new partnership with MD Imaging, the largest mammography provider in the NE region, to engage in further breast cancer screening improvement work. They are outreaching directly to members who they have screened in the past and are due in They are also working with area PCPs to coordinate appointments. Member Services 2017 Member Satisfaction Survey and Member Portal We are very pleased with the results of this year s member satisfaction survey. Last year we had a response rate of only 9.7%. Through outreach and marketing strategies, we were able to achieve an 18% response rate this year, with good overall survey results as you will see in the Member Services education session. In addition, our Member Services team has continued work on development of the PHC Member Portal. This has included gaining valuable feedback from members of our Consumer Advisory Committee. Overall, the goal of the portal is to create an intuitive, self service portal allowing members access to clinical and non clinical benefit information. Another goal of the portal is to develop an online searchable provider directory in compliance with Senate Bill 137. Our user friendly and interactive portal will also help Partnership meet NCQA accreditation requirements. 4 Page 128 of 135

129 IN THE NEWS... Press Releases Distributed ( October 9, 2017 PHC expands services due to North Bay fires November 11 - Solano Coalition for Better Health: It s diabetes awareness month Published (PHC Mentioned) Date Headline Lede Publication 10/9/2017 PHC EXPANDS SERVICES DUE TO NORTH BAY FIRES 10/31/2017 Group formed to address opioids 11/6/2017 Why is Humboldt short of doctors? Healthcare in High Demand: Doctors Wanted, Pt. 1 11/7/2017 Why is Humboldt short of doctors? Healthcare in High Demand: Doctors Wanted, Pt. 2 Partnership HealthPlan of California (PHC), which administers Medi-Cal benefits in 14 Northern California counties, is expanding services to its members affected by the fires in Sonoma, Napa, Lake, and Mendocino counties The nonprofit organization that administers Medi-Cal benefits in Del Norte County has created a local coalition to address opioid use in the community. It s no secret that booking an appointment with a primary care doctor can be difficult in Humboldt County. Wait times in the ER almost always seem lengthy and even hospital employees are effected. A response to the shortage of doctors in Humboldt County is underway. According to Open Door Community Health Center CEO, Herrmann Spetzler, between St. Joseph Health Group and Open Door, more than 60 new providers have started to serve the North Coast in recent months. Sonoma County Gazette Del Norte Triplicate Channel 3 - NBC - Eureka (KIEM) Channel 3 - NBC - Eureka (KIEM) 11/9/2017 The Impossible Possible With roughly three weeks on the clock, members of the Humboldt Homeless and Housing Coalition are fighting time, weather and the specter of past failures to accomplish an utterly reachable but seemingly audacious goal: A six-month, 24-hour homeless shelter that will shield people from the rain and cold, beginning Dec. 1. North Coast Journal Page 129 of 135

130 IN THE NEWS... Date Headline Lede Publication 11/12/2017 Solano Coalition for Better Health: It s diabetes awareness month 11/25/2017 Sutter's local leaders reflect on rural health There are different types of diabetes. Type 1 (formerly called Juvenile Diabetes) most commonly starts in childhood. The cause of this of Type 1 diabetes is unknown. It occurs when the cells in the body that produce insulin die off. Lake County is a wonderful place to live and work, but it s also home to a host of health care challenges. During the recent National Rural Health Day on Nov. 16, Leeann Hadgis, director of Sutter Lakeside ambulatory clinics, and Dan Peterson, chief administrative officer for Sutter Lakeside Hospital reflect on successes the community can celebrate, and reaffirm Sutter s commitment to caring for Lake County residents. Vallejo Times Herald Lake County News Page 130 of 135

131 CMO Report on Quality December, 2017 Robert Moore, MD MPH MBA For this month s report, we will review three areas: 1. Security and Privacy Educational Session 2. Top performers in the QIP 3. Medi-Cal Managed Care Plan Quality rankings 1. Security and Privacy Educational Session Concerns over litigation have led the compliance departments and legal counsel of many organizations to an over-restrictive interpretation of HIPAA s privacy standards related to health information exchange that can have negative impacts on individual patient health outcomes. PHC and Connect Healthcare are hosting a presentation by a national expert to help give our organizations greater clarity on this issue. Lucia Savage is the former Chief Privacy Officer for the Office of the National Coordinator in Washington D.C. She is extraordinarily knowledgeable on IT privacy policy, and can cut through complexity to help us understand how to make Health Information Exchange work to improve quality, while meeting privacy laws and statutes, but without getting carried away with interpretations that would seriously limit the benefits of Health Information Exchange. She gave a presentation at a state-wide Health Information Exchange meeting a year and a half ago. She is an impressive speaker. We encourage attendance from your organization s counsel and privacy officer. She can really speak to their concerns. If you have an interest in this area, you find it approachable enough to learn new ways of thinking about this area as well. Title: Important New Developments in Privacy and Security Event date: Thursday, 2/8/2018, noon to 3 pm, lunch (provided) and presentation followed by discussion of desired future educational programs Locations: Partnership Health Plan offices in Redding, Eureka, Fairfield, Santa Rosa Registration: Page 131 of 135

132 2. Top Performers in the Quality Improvement Program (QIP) The incentive payments for the Fiscal Year QIP for primary care sites and hospitals were sent to each organization on October 31. Here is a summary of the highest performers. Primary Care QIP Top 10 Overall Highest Adjusted Points Earned QIP ID County Site Name Total Adjusted Points Earned A504 MARIN MARIN COMMUNITY CLINICS LARKSPUR P116 SONOMA CUETO SALAS, MARTHA F510 MENDOCINO BAECHTEL CREEK MEDICAL CLINIC F674 SISKIYOU SHASTA FAMILY CARE F507 MARIN MARIN COMMUNITY CLINICS SAN RAFAEL F117 SONOMA PETALUMA HEALTH CENTER F137 YOLO WINTERS HEALTHCARE FOUNDATION F174 SONOMA ROHNERT PARK HEALTH CENTER P113 SOLANO NORTHBAY PEDIATRICS F148 YOLO SALUD CLINIC Northern Region Top 10 Highest Adjusted Points Earned QIP ID County Site Name Total Adjusted Points Earned F674 SISKIYOU SHASTA FAMILY CARE F659 SHASTA SHASTA COMM. HLTH. CTR. SHASTA LAKE FAMILY HEALTH F603 DEL NORTE UNITED INDIAN HLTH. SRVCS., INC. KLAMATH CLINIC F676 SISKIYOU SWENSON MEDICAL GROUP F685 HUMBOLDT OPEN DOOR COMM. HLTH. CTRS. FERNDALE COMM. HLTH. CTR F689 HUMBOLDT FULL CIRCLE CENTER FOR INTEGRATIVE MEDICINE F602 DEL NORTE UNITED INDIAN HLTH. SRVCS., INC. CRESCENT CITY CLINIC F661 SHASTA SHINGLETOWN MEDICAL CENTER F670 SISKIYOU DIGNITY HEALTH MERCY LAKE SHASTINA COMMUNITY CLINIC A609 SHASTA ANDERSON WALK IN MEDICAL Southern Region Top 10 Highest Adjusted Points Earned QIP ID County Site Name Total Adjusted Points Earned A504 MARIN MARIN COMMUNITY CLINICS LARKSPUR P116 SONOMA CUETO SALAS, MARTHA F510 MENDOCINO BAECHTEL CREEKMEDICAL CLINIC F507 MARIN MARIN COMMUNITY CLINICS SAN RAFAEL F117 SONOMA PETALUMA HEALTH CENTER F137 YOLO WINTERS HEALTHCARE FOUNDATION F174 SONOMA ROHNERT PARK HEALTH CENTER P113 SOLANO NORTHBAY PEDIATRICS F148 YOLO SALUD CLINIC F152 NAPA OLE HEALTH ST. HELENA Page 132 of 135

133 Providers with 30+ Point Increases Since QIP ID County Site Name Adjusted Total Point Earnings Adjusted Total Point Earnings # Points Increased F605 HUMBOLDT FORTUNA FAMILY MEDICAL GROUP F674 SISKIYOU SHASTA FAMILY CARE F602 DEL NORTE UNITED INDIAN HLTH. SRVCS., INC. CRESCENT CITY CLINIC F676 SISKIYOU SWENSON MEDICAL GROUP A506 MENDOCINO REDWOOD MEDICAL CLINIC F689 HUMBOLDT FULL CIRCLE CENTER FOR INTEGRATIVE MEDICINE A504 MARIN MARIN COMMUNITY CLINICS LARKSPUR Hospital QIP: Kaiser, Dignity and Sutter Hospitals are not participating in this program. Small hospitals and large hospitals have different criteria. For details on the measures see Top 7 performers (85% or above) Mendocino County: Adventist Frank Howard Memorial Mendocino Coast District Hospital Adventist Ukiah Valley (Large hospital pool) Marin County: Marin General Hospital (Large hospital pool) Trinity County: Trinity Hospital Sonoma County: Sonoma Valley Hospital Humboldt County: St. Joseph Health: Redwood Memorial Hospital Page 133 of 135

134 3. Medi-Cal Managed Care Plan Quality rankings The Department of Healthcare Services uses a methodology annually to aggregate and rank CA Medi-Cal health plans based on their Healthcare Effectiveness Data Information Set (HEDIS) performance. Partnership HealthPlan of California (PHC) is pleased to announce our results for Measurement Year 2016, Report Year In summary, across 53 reporting Medicaid regions/health plans in California, our Southeast Region positioned 7th and our Southwest Region positioned 17th out of 53. The Northeast Region positioned 41st and Northwest Regions positioned 35 th out of 53. Although our Regional positions on the Medicaid Dashboard declined, our Aggregate Quality Factor Scores increased significantly from prior year. This means that not only did we improve, but so did many Medicaid health plans in CA. Please see table below highlighting PHC s position and percentile for reporting year 2017 relative to reporting year 2016 and Page 134 of 135

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