MINUTES OF THE MEETING OF THE SAN JOAQUIN COUNTY HEALTH COMMISSION June 27, 2018 Health Plan of San Joaquin Community Room

Transcription

1 MINUTES OF THE MEETING OF THE SAN JOAQUIN COUNTY HEALTH COMMISSION Health Plan of San Joaquin Community Room COMMISSION MEMBERS PRESENT: Greg Diederich, Chair Michael Herrera, DO Sheela Kapre, MD Michael Kirkpatrick Monica Nino Chuck Winn John Zeiter, MD COMMISSION MEMBERS ABSENT: Brian Jensen George Khoury, MD Larry Ruhstaller, Vice-Chair Miguel Villapudua STAFF PRESENT: Amy Shin, Chief Executive Officer Michelle Tetreault, Chief Financial Officer Marc Radner, VP of Human Resources Charlene Giles, Compliance Officer Andrea Brown, VP of Provider Networks Michael Nguyen, Government Affairs Representative James Mark Myles, County Counsel Sue Nakata, Executive Assistant I. Call to Order: Chair Diederich called the meeting to order at 5:12 p.m. and Roll Call was taken by Sue Nakata. Page 1

2 II. Approval of May 30, 2018 Meeting Minutes Chair Diederich presented for approval the May 30, 2018 meeting minutes. The motion was made, seconded and unanimous to approve the May 30, 2018 meeting minutes as presented (6/0). III. Public Comments No comments were forthcoming. Commissioner Herrera joined the meeting at this time. IV. Consent Items Chair Diederich presented two consent items for approval: 1. Community Affairs Committee 6/14/18 a. March 14, 2018 Meeting Minutes b. Health Education Presentation i. Enhanced Case Management (AXIS) ii. New Member Packet iii. HealthReach Advice Nurse Line iv. Dental Transformation Initiative c. Announcements d. Termination and Addition of New CAC Member 2. Finance & Investment Committee 6/20/18 a. March 21, 2018 Meeting Minutes (Health Commission approved on 5/30/18) b. Call the Car Contract c. Verve Networks Contract d. RubiconMD Contract RubiconMD contract was pulled for discussion with Andrea Brown, VP of Provider Networks providing highlights on key benefits and key aspects: Benefits of using econsult Improve appointment access to critical specialties that are in short supply within the network (endocrinology, rheumatology, pulmonary, neurology, psychiatry, gastroenterology) Improve patient satisfaction by eliminating unnecessary specialty visits Improve utilization by encouraging PCPs to treat more minor conditions that may have previously gone to specialists Improve efficiency by providing diagnostic testing results to specialists prior to the patient s office visit and eliminating duplication Page 2

3 RubiConMD s Key Aspects econsult is a service provided by RubiconMD, a software technology company econsult is an electronic platform that allows physician to physician consult through a HIPAA compliant portal using a computer, smartphone or tablet econsult contracts with a nationwide network of specialists in over 150 different specialties that are available to respond in 4-12 hours to respond to consult requests from PCPs and other physicians Amy Shin, CEO reported, that this project is being led by San Joaquin General Hospital (SJGH). Under SJGH s workgroup, on which HPSJ was a member of, RFQs were issued to several econsult vendors. It was unanimous that RubiconMD s platform fits the project requirement. Additionally: Under 1115 Waiver s PRIME program, California Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program to build upon the Delivery System Reform Incentive Payment (DSRIP) program established under the Bridge to Reform waiver Commitment is to offset some of the costs for physicians to be able participate HPSJ will host the software and platform, bearing the cost of license fee and will be paying for the actual consult Approval request is only for the vendor part of $222,750 for year one and $243,000 for subsequent years Upon review of the materials provided, questions were raised by the following Commissioners: Q: Kapre - What are PCP s buy-in of this program? A: Shin This is one of the requirements of PRIME for SJGH and therefore, econsult must be implemented. SJGH is taking the lead on physician buy-in and HPSJ expects the clinics/physician groups to own implementation including physician buy-in. Q: Kapre - How many specialists in SJC are part of the RubiconMD network? A: Shin - All SJGH specialists are in their network. Dr. Fadoo has taken the lead as this is their project. Other FQHCs will implement later and SJGH is first to implement. Q: Kapre Which providers are using this right now? A: Shin Dr. Fadoo has background information including reference checks as this is SJGH s project. Q: Herrera - How are providers credentialed and what is the liability of physicians that is giving consult on patients that they have never seen? A: Shin - This platform is physician to physician consult, and does not have patient to physician contact. HPSJ has delegated credentialing to RubiconMD as HPSJ has done with other groups in our network. Q: Kapre - If HPSJ is accepting the credentialing for physicians, how is it handled? A: Shin - HPSJ mandates that all entities who have been delegated credentialing, use NCQA approved process. Page 3

4 Q: Kapre - Is the program being used and robust with other counties? A: Shin Yes, econsult has become a routine part of provider network development. The lack of certain of specialties across the state has provided adoption of econsult as one of the strategies to ease access. Q: Kirkpatrick - Does the information flow through HPSJ s quality management department? A: Shin - We expect econsult information to be between the physicians like all physician to physician consults. Eventually, we hope the information will be available through HIE. Q: Winn - In regards to cost, is HPSJ paying for all clinics and FQHC s? A: Brown HPSJ is paying for the RubiconMD platform and licensing. Clinics/FQHCs will pay for their implementation. Costs are based on numbers of physician users; unlimited access for these physicians. Q: Winn - Is the system able to incorporate into Cerner? A: Shin - Yes, each organization will work on integration with their EMR during implementation. Q: Winn Is the total cost with no additional add-ones down the line? A: Shin & Brown Yes, there will not be no additional costs on top of user licenses and platform costs. Q: Nino Does HPSJ need to comply with PRIME? A: Shin No, HPSJ does not need to comply to PRIME, only public hospital system such as SJGH are participating. The motion was made, seconded and unanimous to approve the two consent items as presented (7/0). V. May 2018 Financial Reports Michelle Tetreault, CFO presented for approval, the May 2018 YTD financials, highlighting the following: 2018 Fiscal Year to Date, Statement of Profit and Loss for all Business Units Net Income of $59M $18.4M favorable to budget Tangible Net Equity (TNE) is 809% (above 475% goal) Days Cash on Hand is 129 Liquid Reserves 3.46 months of premium revenue 3.87 months of total expense o Member Months Favorable to Budget San Joaquin is 2,761 unfavorable in the TANF and SPD business Stanislaus is 78,979 favorable in all lines of business o Premium Revenue is $33.3M favorable to budget driven by the rate adjustment for both counties. Rate adjustments were related to the funding for new costs Proposition 56 payments to providers for Evaluation and Management (E&M) services Page 4

5 Non-Medical Transportation (NMT) o Prior Period Adjustments are favorable and are driven by changes in IBNR estimates and updated rates received in April 2018 for fiscal year 2017 In the beginning of June, the Center for Medicaid/Medicare Services (CMS) notified DHCS that they were mandating the FY 2017 managed care rates for the ACA expansion category of aide include a provision requiring a minimum MLR of 85%, as was required for the first 30 month period. The most recent HPSJ/DHCS contract amendment did not include this provision. As such, neither DHCS nor HPSJ were expecting the need to calculate and accrue Contra Revenue. As a result of this unexpected notification, included in the May 2018 prior period adjustments is an entry in the amount of $10.4M to record Contra Revenue for the ACA expansion category of aide for fiscal year 2017 o Medical Expenses are $42M unfavorable to budget Member months greater than budget accounts for $18.7M of the unfavorable medical expense variance The remaining $23.3M of unfavorable medical expenses are primarily related to higher institutional outpatient utilization and unit cost than anticipated The unfavorable variance in Professional services is driven by the new Proposition 56 payments to providers that was not budgeted as this was an unknown/undisclosed item at the time the budget was developed o State Payable The increase in State Payable is due to the accrual of the ACA expansion contra revenue for FY 2017 as referenced in Prior Period Adjustments o Other Liabilities Increase in other liabilities is mainly driven by an accrual for Proposition 56 payments to providers that HPSJ received a final All Plan Letter in April directing exactly what needs to be adjusted Upon review of the financials presented, Chair Diederich asked for clarification on Prior Period Adjustments, if the Contra Revenue was institutionalized in ACA. Ms. Tetreault and Shin responded that the law only applies to the first 30 months. However, because of the methodology DHCS used to calculate the rates by using a blend of SPD and TANF adults, CMS believes there is risk that the rates are overstated. Thereby, requiring the minimum 85% MLR. The motion was made, seconded and unanimous to approve the May 2018 financial report as presented (7/0). VI. Peer Review and Credentialing Committee 6/14/2018 Dr. Lakshmi Dhanvanthari presented for approval, the Peer Review and Credentialing Committee report for 6/14/18, highlighting the following: Total Credentialed/Re-credentialed: 6 Providers Direct Contract Providers o Initial Credentialed for 3 years = 1 o Initial Credentialed for 1 year = 1 o Re-credentialed for 1 Year = 1 Page 5

6 o Re-credentialed for 3 Years = 3 With no further questions or comments, a motion was made with one abstention (Herrera) to approve the Peer Review and Credentialing Committee report for 6/14/2018 as presented (6/1). VII DHCS Medical Audit Results Charlene Giles, Compliance Officer presented on the 2017 Department of Health Care Services (DHCS) Medical Audit for the period of July 1, 2016 through June 30, 2017, highlighting the following: Onsite review was conducted in August 2017 o Document review o Verification studies o Interviews with HPSJ personnel Audit evaluated six areas o Quality Management (QI) o Member Rights o Access and Availability to Care o Utilization Management (UM) o Continuity of Care o Administrative and Organizational Capacity Audit Findings o Category 2 - Case Management and Coordination of Care - The health plan delegates Behavioral Health Services (BHT) for Autism spectrum disorder to Beacon. The delegate s policy was missing four of the required elements as detailed in All Plan Letter The same elements were missing from the treatment plans. #5 - Identify measureable long, intermediate and short term goals and objectives that are specific, behaviorally defined, developmentally appropriate, socially significant and based upon clinical observation. #6 - Include outcome measurement assessment criteria that will be used to measure achievement of behavior objectives #7 - Include the current level, date of introduction, estimated date of mastery, specify plan for generalization and report goal as met, not met, or modified (include explanation) #13 - Include an exit plan Timeline o April 4, Received draft Audit Report o April 10, Exit Conference o June 8, Received final Audit Report o July 2, HPSJ s response to DHCS Ms. Shin reported, based on timeline, HPSJ did not receive the report until June 2018 (11 months after the onsite audit). Management is concurrently responding to findings while uploading new information for the August 2018 audit. The issue of the delay has been Page 6

7 addressed to DHCS to ensure HPSJ has ample time to put corrective actions in place (current guidance states that DHCS will issue final audit report to health plans in 90 days). Ms. Shin acknowledged staff on a job well done. She stated that the audit findings have dramatically decreased from 52 findings from 5 years ago down to 4. Commissioner Kapre questioned, didn t HPSJ have issues with Beacon previously. Ms. Shin responded that the findings were not repeat findings, however, she acknowledged that there are gaps with HPSJ s oversight of Beacon. HPSJ is diligently working on an improved delegation oversight plan. VIII. Legislative Update In the absence of David Hurst, Michael Nguyen, Government Affairs Representative provided an update on State Budget, highlighting the following: Denied Medi-Cal Expansion and Augmentation Medi-Cal Expansion for: Undocumented youth ages Undocumented seniors ages 65 and older Restoration of remaining Optional Benefits FQHCs & RHCs same-day mental services Still Subject to Negotiations 340B Trailer Bill Language. Budget rejects DHCS proposal to eliminate 340B for Medi-Cal. Stakeholders continue to work on trailer bill language to narrowly address duplicate discounts Prop 56 Supp. Payments for FY Negotiations continue on total amount and specific allocations IX. CEO Report Ms. Shin reported, aside from state audit previously reported (stemming from Senator Galgiani s request to JLAC), there are two other audits pending to be announced: Bureau of State Audits (BSA) - mostly directed to DHCS around EPSDT benefits Legislative Audit Office (LAO) looking into plan to plan delegation (the predominant model for LA Care) Commissioner Nino asked if HPSJ is the only health plan to be audited on the audit originated by Senator Galgiani. Ms. Shin noted that the audit request was mostly DHCS oversight of Medi-Cal plans around various functions but for compensation oversight portion of the audit, it states HPSJ and, other like plans. HPSJ have yet to hear from the State Auditor s office of when the initial meeting and start of audit will be held. Sue Nakata, Executive Assistant provided a demo on Commissioner s access to the Health Commission Board Book (enhancements were made on the application). Page 7

8 X. Chairman s Report Chair Diederich announced the following: Congratulated Dr. Lakshmi and Medical Management team in their achievements in receiving NCQA re-accreditation The July 25, 2018 Health Commission will be canceled and meeting will resume on August 29, 2018 Ad-Hoc CEO Performance Evaluation Committee have been initiated with first meeting to be scheduled in July XI. Commissioner Comments No reports were forthcoming. XII. Closed Session At this time, the Health Commission adjourned to Closed Session at 6:20 p.m. Trade Secrets Welfare and Institutes Code Section Title: Proposed FY Corporate Objectives The motion was made, seconded and unanimous to approve the proposed FY Corporate Objectives as presented (7/0). The Health Commission came out of Closed Session at 6:42 p.m. XI. Adjournment Chair Diederich adjourned the meeting at 6:43 p.m. The next regular meeting of the Health Commission is scheduled for Wednesday, August 29, Page 8