Sacramento Medi-Cal Managed Care Advisory Committee
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1 Meeting Minutes September 22, 2014, 3:00 PM 5:00 PM Sacramento Medi-Cal Managed Care Advisory Committee DHHS Administration 7001A East Parkway Sacramento, CA Conference Room 1 COMMITTEE MEMBERS x DHHS, Primary Health Sandy Damiano, PhD Chair x Hospital Rosemary Younts x Advocate Sujatha Branch Co-Chair x Hospital Tory Starr x Advocate Jenni Gomez x Hospital Laura Niznik Williams x Clinic J. Miguel Suarez, MD x IPA Sean Atha x Clinic Jonathan Porteus, PhD IPA Anna Berens - excused x DHA Mary Behnoud x PHAB Raquel Simental x DHHS Sherri Heller, EdD x Pharmacy Frank Cable x DHHS, Behavioral Health Uma Zykofsky x Physician Marvin Kamras, MD DHHS, Social Services Debbi Thomson - excused x Physician Nathan Allen, MD Health Plan Cathy Lumb-Edwards - excused EX-OFFICIO MEMBERS Health Plan Effie Ruggles - excused County Board of Supervisors Ted Wolter - excused x Health Plan Steve Soto x County Board of Supervisors Lisa Nava x Health Plan Scott Coffin x State DHCS Keith Parsley x Hospital Ellen Brown x Health Care Options Lili Zahedani MN MCMC Page 1 of 6
2 Committee in Attendance: 22 Public in Attendance: 30 Topic Welcome, Introductions and Opening Remarks Minutes Sandy Damiano, PhD, welcomed the committee and members of the public, facilitated introductions, reviewed the agenda and focus topic for today s meeting. Minutes for last month s presentation focused on Hospital Emergency Department Utilization Mental Health are posted on the website. State DHCS Update ACA Updates Keith Parsley reported: DHCS continues with rural conversion project of transitioning individuals with aid codes of Seniors and Persons with Disabilities (SPD) from Fee for Service (FFS) Medi-Cal to Managed Care Medi-Cal. Target is 12/1/2014. On 9/29/14 notices and contact information will be sent to 24,000 individuals. Stakeholder meetings have been held regularly through webinars. The last stakeholder meeting focused on reviewing the notices and process for noticing individuals. The plans, CBOs and Counties have worked with DHCS on this process and outreaching stakeholders. The next stakeholder meeting webinar is scheduled 9/25/2014. To register for the webinar: tp.gmc@dhcs.ca.gov. Request for Application (RFA) draft will combine San Diego and Sacramento and will be released within the next 30 days for review and public comment. DHCS will allow 2-4 weeks for comments. The final version will be released between by March DHCS continues work on the Coordinated Care Initiative (CCI) with Counties. ACA Updates Facilitated by Sujatha Branch Jenni Gomez reported that they are seeing clients whose applications are stuck. She asked Mary Behnoud to explain. Mary Behnoud reported: There are technical difficulties, called soft pause, resulting in applications being stuck between CALHEERS and CALWIN systems. There are procedures in place to address MN MCMC Page 2 of 6
3 the glitch. Since October 2013, DHA received 150,623 applications, processed 128,147 applications, and approximately 30,000 applications are backlogged. DHA plans to be caught up before next open enrollment. Prior to October 2013, DHA received 8,000 9,000 applications a month. Since then, DHA receives approximately 15,000 applications a month. See Enrollment Data 2014 and Monthly Default Average available on website under Health Plan Data Sandy Damiano reported: Medi-Cal Managed Care Enrollment Data as of September 1 st is now at a total enrollment of 352,422 beneficiaries. That is a 19,040 net gain last month which includes new enrollment and disenrollment. Since January 2014, GMC enrollment has increased by over 91,000 beneficiaries. The California Simulation of Insurance Markets (CalSIM) provides estimates for key populations including Medi-Cal. The 2014 estimates include a potential eligible population of 101,000 for Newly Eligible and 166,000 of Previously Eligible but not enrolled for the Sacramento Region (four counties). Scott Coffin, Anthem Blue Cross provided an overview of. Representatives from El Hogar Community Services (Alex Bolte), Sacramento Native American Health Center (Britta Guerrero), CARES Community Health (Bob Kamrath) and WellSpace Health Inc. (Jonathan Porteus) were present to contribute to the discussion. Network Capacity: Anthem Blue Cross continuously reviews network capacity and ratios of providers to members. Anthem contracts directly with independent providers, IPAs, health clinics, community organizations, and medical groups. Plans cannot easily estimate capacity at their providers when these providers contract with multiple plans. Network Access: Goal is to assign 100% members to a medical home. Newly enrolled members are assigned a medical home within the first 45 days of enrollment. When members are not able to access care in a timely fashion, Customer Care Center will assist members with securing timely medical appointments. For members requiring specialty care, the Access to Care Team will assist with finding a specialty provider. Network Capacity and Access for Specialty Care: Many specialists in Sacramento are no longer accepting Medi-Cal patients. For certain specialties, patients must seek care in other counties. Plans assist with transportation. MN MCMC Page 3 of 6
4 Committee Discussion Current Efforts/Future Plans: Customer service teams are available to assist members when facing access difficulties. Anthem is working with the safety net providers to assist members in changing behaviors from utilizing EDs as primary care provider instead of medical homes. Sandy Damiano reported that providers have access to care requirements: urgent care is 48 hours for services not requiring a pre-authorization, non-urgent 10 days. (Will provide detail regarding all access requirements on a document at a later date.) Sujatha Branch reported that many consumers have concerns with timely access requirements/ patient rights. Disability Rights of California created two publications available for consumers to download at Jenni Gomez reported that timely access to care has improved, but there continues to be some problems. She will continue to work with the health plan first to resolve issues. Sean Atha reported that a new challenge in access has occurred in that some providers no longer accept Medi-Cal. He requests that Plans and Hospitals work collaboratively for adequate specialists. Steve Soto commented that it is both a money issue and a supply issue. Many specialists associate only with certain hospital systems which reduces access for some plans. Jonathan Porteus reported that care coordination would improve if an electronic system was in place to find out when members are in EDs so that care coordination may readily occur between hospitals, health plans and medical homes. Sean Atha reported that River City actively uses nurses to provide case management and they are electronically connected to all EDs in the area. Rosemary Younts reported: Navigators are stationed at each Dignity hospital and are linking people to their PCPs and sending health data to medical homes. The navigators work closely with Health Net, who funds the project, to enhance the program. An identified problem is the volume. One MN MCMC Page 4 of 6
5 Committee Discussion navigator serving 20 patients per day is not sufficient. Hospital Data: 80% patients were given follow up appointments. 67% of them attended their appointments. Since navigators were implemented, 63% reduction in readmission in Dignity hospitals and urgent care reduced 23-27%. This means Navigators are successfully helping members to get to their medical home, with reminders and transportation assistance in getting to appointments. (Note: See July Meeting minutes for detailed information regarding the Dignity Health hospital navigator program.) Britta Guerrero, Representative from Native American Health Clinic, reported that receiving Utilization Reports from EDs helps clinics to assist members to engaging in follow-up care and linkage to medical home. Currently reports are provided approximately 1-2 times a year. More frequent utilization reports would be helpful. Steve Soto reported that Molina has an access to care team called Member Service Team. Molina is in the process of hiring navigators to identify individuals who use EDs often to redirect back to medical home. When members have transportation issues, individuals may call the health plan for assistance. Tory Starr indicated that Sutter Hospital has a navigator/ case manager program staffed 24 hours/7 days a week. An identified problem has been insufficient capacity to get individuals seen in a timely manner at their medical homes. Dr. Kamras reported that when clients have scheduled follow-up visits after being seen in the ED, half no show. Service authorization is approved by IPAs. Each IPA has different authorization standards. He recommends expedited referral for specialist when member is identified in the hospital as needing a specialist instead of having to return to medical home for referral. Ellen Brown, Kaiser, reported Patient Care Coordinators work at Kaiser. Dr. Miguel Suarez, HALO, reported doing the following to assist members to use care appropriately: Media in the lobby educates members about services their clinic providers. HALO contract with specialists who provide services on site. HALO patients get behavioral health services in collaboration with El Hogar. MN MCMC Page 5 of 6
6 Committee Discussion Public Comment Closing Remarks and Adjourn Scott Coffin reported that there is still confusion about how to access mental health benefit that went live Jan 1 st. Medical homes need to know what constitutes specialty MH care. Health Plans are working with County Behavioral Health Services Division on clarifying the access paths, what happens when consumers do noy know where to go. He suggested standardized scripts on how to access. Sandy Damiano noted some areas which areas for possible exploration: Health plans have different names for member services or other functions. Navigators need to know who to call for which service at each plan. IPAs and Health Plans have different rules for authorizing services, which is difficult for providers. Navigators are also working in the homeless community and with criminal justice populations. Clarification is needed to assist with those special populations. Time did not permit Scott and presenters to approach all areas they had planned. Janice Milligan, formerly with Health Net, now with River City, commented that the discussion today was excellent. She expressed her concern and interest in the Sacramento GMC RFA. The process in San Diego includes significant input from Healthy San Diego. She recommends stakeholders look at the RFA to ensure plans address the challenges that are unique to Sacramento County and that they work collaboratively. Sandy Damiano thanked everyone for attending and participating in today s meeting. With no additional business to discuss, the meeting adjourned. Next Meeting Monday, October 27, :00 5:00 PM DHHS Administrative Building 7001A East Parkway, Conference Room 1 Focus Continued discussion on network capacity and planning. Given there is considerable overlap, all three plans will join. Possible topics clinic expansion plans, tools for Navigators to access health plan services, and Mental Health benefit. MN MCMC Page 6 of 6
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