Blue Shield/Care1st and Centene/Health Net Undertakings IHA Stakeholder Meeting
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1 Blue Shield/Care1st and Centene/Health Net Undertakings IHA Stakeholder Meeting Presented by: Shelley Rouillard Director September 19, 2017 HealthHelp.ca.gov 1
2 Overview DMHC s activities on provider directories Blue Shield / Care1st Merger Centene / Health Net Merger HealthHelp.ca.gov 2
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11 Increased Call Volume in Help Center - Media Inquiries Began Deficiencies Referred to DMHC Office of Enforcement Settlement of Enforcement Action - Follow-up Surveys Began - SB 137 Passed - Undertakings Approved Blue Shield Advisory Committee Health Plans To Comply With Standards Jan Oct Sep Jan Jun Jan Jul Dec Non- Routine Surveys Began SB 137 Sponsored by Consumer Advocates SB 137 Implementation DMHC Released Draft Standards HealthHelp.ca.gov 11
12 Blue Shield/Care1st Merger On October 8, 2015, DMHC approved Blue Shield s acquisition of Care1st $1.2 billion transaction Brought Blue Shield into the Medi-Cal program Public Meeting for stakeholder input Negotiated undertakings related to plan operations, quality improvements and community investments HealthHelp.ca.gov 12
13 Blue Shield/Care1st Undertakings Provide $200 million in community investments o $10 million to locally based consumer assistance programs o $50 million to develop a statewide centralized provider directory database o $140 million to the Blue Shield Foundation HealthHelp.ca.gov 13
14 Centene / Health Net Merger On March 22, 2016, the DMHC approved Centene s acquisition of Health Net and its subsidiaries. $6.8 billion transaction involving several states. Public meeting for stakeholder input Negotiated undertakings related to plan operations, quality improvements and community investments. HealthHelp.ca.gov 14
15 Centene/Health Net Undertakings Provide $340 million in community investments over 5 years o $5 million for consumer assistance o $10 million to improve enrollee health outcomes in rural/underserved areas o $50 million to strengthen the Medi-Cal delivery system o $75 million infrastructure investment to provide capital to entities in underserved areas o $200 million to build a service center and create 300 jobs HealthHelp.ca.gov 15
16 Questions? HealthHelp.ca.gov
17 Community & Infrastructure Investments Undertakings 29 Integrated Healthcare Association Annual Stakeholders Meeting Presented By Carol Kim Vice President Community Investments & Public Affairs September 19, 2017 Privileged & Confidential
18 Merger of Centene and Health Net Merger contingent on fulfilling a set of Undertakings Undertaking 29 focuses on Community & Infrastructure Investment (CII) Undertaking 29 Purpose Target Region(s) Community Investments $65M Infrastructure Investments $75M a) Locally-based consumer assistance programs ($5M over 5 years) b) Improved health outcomes in rural and/or underserved communities ($10M over 5 years) c) Improved completeness & accuracy of encounter data ($50M over 5 years) g) Capital investments for health care infrastructure and care delivery improvements Statewide Statewide with focus on Central Valley: Kern, Kings, Fresno, Madera, Merced, Tulare, Stanislaus, San Joaquin Statewide Statewide 2015 Health Net, Inc. Confidential: Do not distribute 2
19 Getting to work Community & Infrastructure Investment (CII) Team Responsible for the framework and execution of the grant program Carol Kim, VP of Community Investments & Public Affairs Stephanie Landrum, Community Grants Manager (NoCal) Mercy Siordia, Community Grants Manager (CV) Thomas Tran, Community Grants Manager (SoCal) Katherine Murphy, Community Grants Administrator Health Care Experts Composed of Health Net business leaders and health care experts with diverse and deep experience in health care Community Investment Advisory Committee Required by Undertaking 29(d) to advise as well as provide expertise and guidance for the development and implementation of the grant program Infrastructure Investment Advisory Committee Required by Undertaking 29(g) to advise as well as provide expertise and guidance for the development and implementation for investments 2015 Health Net, Inc. Confidential: Do not distribute 3
20 Advisory Committees 2014 Health Net, Inc. Privileged & Confidential 4
21 Advisory Committee: Community Investments Patrick Johnston, Committee Chairman and Former State Senator Sean Atha, SVP Business & Network Development for River City Medical Group Jennifer Kent, Director of the California Department of Health Care Services Carol Kim, Vice President of Community Investments & Public Affairs for Health Net Jim Lott, Management Consultant, former Chief Strategy Officer of MLK Community Hospital Louise McCarthy, President & CEO of Community Clinic Association of LA County Chris Perrone, Director of Improving Access of California Health Care Foundation Shelley Rouillard, Director of the California Department of Managed Health Care Stephen Schilling, Chief Executive Officer of Clinica Sierra Vista Committee advises Health Net on the Five-Year $65M Community Grants Program 2015 Health Net, Inc. Confidential: Do not distribute 5
22 Advisory Committee: Infrastructure Investments Inaugural Meeting scheduled for early October member Advisory Committee to be chaired by Sandra Shewry, VP of External Engagement at California Health Care Foundation Undertaking Requires representatives from: CA HHS: Secretary Diana Dooley DMHC: Shelley Rouillard, Director of DMHC Centene: Christopher Isaak, SVP, Corporate Controller Health Net: Carol Kim, VP of Community Investments & Public Affairs Undertaking Requires an Independent Investment Advisor McDonnell Investment Management selected by Centene Additional Committee Members represent providers, health information technology, health care policy and foundations/philanthropic entities Committee will advise Health Net on the $75M Infrastructure Investments 2015 Health Net, Inc. Confidential: Do not distribute 6
23 Community Investments 2017 Grant Cycle 2014 Health Net, Inc. Privileged & Confidential 7
24 Community Investments 2017 Grant Cycle 2017 Grant Cycle is a start-up year affording Health Net an opportunity to achieve the following: Test and pilot grant approach Collect data to inform future grant programs Meet key milestones $6M-$10M total target grant funding amount for 2017* Grant Cycle Funding Focus Undertaking Addressed Status Enhanced Access Outreach, Enrollment (a) Consumer Assistance Completed ($1M) & Retention Spring 2017 Culture of Quality Quality Improvement (b) Improve Health Outcomes Completed ($500K) Technical Assistance Culture of Quality Health Workforce (b) Improve Health Outcomes In Progress ($1.5M) Fall 2017 Encounter Data (c) Improve Encounter Data Improvements Encounter Data Pilot In Progress Completeness & Accuracy ($3M-$7M) * Pending Centene Budget Approval and Allocation 2015 Health Net, Inc. Confidential: Do not distribute 8
25 Spring 2017 Grant Awards - $1.5M Total Funding NORTHERN CALIFORNIA SOUTHERN CALIFORNIA CENTRAL VALLEY HEDIS MEASURES GRANTEE SCOPE OF WORK COUNTIES Enhanced Access: Outreach, Enrollment & Retention $1M total over 18-months Ampla Health Sacramento Covered Community Health Initiative of Kern County Centro La Familia Advocacy Services Culture of Quality: Quality Improvement Technical Assistance $500K total over 18-months Bridget Cole, Institute for High Quality Care Bobbie Wunsch, Pacific Health Consulting Group Assess QI Capacity for 6-10 PCPs/ FQHCs Create improvement roadmap for each Customize and facilitate QI learning Produce QI improvement dashboard East Valley Community Health Center Maternal and Child Health Access Northeast Valley Health Corporation Southside Coalition of Community Health Centers The Children's Clinic Sacramento San Joaquin Los Angeles Cervical Cancer Screening Childhood Immunizations Prenatal Care 2015 Health Net, Inc. Confidential: Do not distribute 9
26 Proposed Fall 2017 Grant Cycle* Culture of Quality RFP released on July 14, 2017 and proposals currently under review $1.5M total target funding to support Health Workforce Development in rural and underserved areas Focuses on Training, Retention and Recruitment $100K-$150K over 18-month per grantee Encounter Data Improvement $2.5M-$3M total target funding to improve short-term, immediate encounter data needs Advisory Committee engaged in thoughtful, deliberate and informed approach for the $50M over 5 years for Encounter Data Improvement efforts The Committee has invited key experts and leaders for in-focus discussions to help inform future long-term investment opportunities and strategies * Pending review and guidance by Community Investment Advisory Committee 2015 Health Net, Inc. Privileged & Confidential 10
27 Encounter Data Improvement 2014 Health Net, Inc. Privileged & Confidential 11
28 Multi-Year, Multi-Phase Grant Approach* Considering short-term, one-time investments to help address immediate needs for encounter data Potential funding considerations include Infrastructure, Capacity Building and Training to improve encounter data Looking to support Medi-Cal Managed Care Provider Organizations: FQHCs/Clinics Individual Private Medical Practices Provider Groups Management Services Organizations Exploring long-term approach for plurality of $50M to improve encounter data Multi-Year, Multi-Phased Approach: Phase I, Assessment Phase II, Design Phase III, Implementation * Pending consultation with Health Net Leadership and Community Investment Advisory Committee Health Net, Inc. Contingent on Consultation with Health Net Leadership & Community Investment Advisory Committee
29 Thank You 2014 Health Net, Inc. Privileged & Confidential 13
30 CII Team Contact List Carol Kim, VP of Community Investments & Public Affairs Stephanie Landrum, Community Grants Manager (No Cal) Mercy Siordia, Community Grants Manager (CV) Thomas Tran, Community Grants Manager (SoCal) Katherine Murphy, Community Grants Administrator 2015 Health Net, Inc.
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