1 of 84 REGULAR MEETING OF THE GOVERNING BOARD OF THE INLAND EMPIRE HEALTH PLAN November 13, 2017-9:00 AM Board Report #272 Riverside County Administrative Center 4080 Lemon Street Board Chambers - First Floor Riverside, CA 92501 If disability-related accommodations are needed to participate in this meeting, please contact Annette Taylor, Secretary to the IEHP Governing Board at (909) 296-3584 during regular business hours of IEHP (M-F 8:00 a.m. 5:00 p.m.) PUBLIC COMMENT AT INLAND EMPIRE HEALTH PLAN GOVERNING BOARD MEETINGS: The meeting of the Inland Empire Health Plan Governing Board is open to the public. A member of the public may address the Board on any item on the agenda and on any matter that is within the Board s jurisdiction. Requests to address the Board must be submitted in person to the Secretary of the Governing Board prior to the start of the meeting and indicate any contributions in excess of $250.00 made by them or their organization in the past twelve (12) months to any IEHP Governing Board member as well as the name of the Governing Board member who received contribution. The Board may limit the public input on any item, based on the number of people requesting to speak and the business of the Board. All public record documents for matters on the open session of this agenda can be viewed at the meeting location listed above, IEHP main offices at 10801 6 th Street, Suite 120, Rancho Cucamonga, CA 91730 and online at http://www.iehp.org. I. Call to Order AGENDA II. III. IV. Agenda Changes (Board Secretary) Comments from the Public on Matters on the Agenda Conflict of Interest Disclosure V. Adopt and Approve of the Meeting Minutes from the October 10, 2017 Regular Meeting of the Governing Board of the Inland Empire Health Plan and IEHP Health Access VI. IEHP: CONSENT AGENDA ADMINISTRATION (Bradley P. Gilbert, M.D.) 1. Approve the Ninth Amendment to the Chief Executive Officer Employment Contract
2 of 84 AGENDA November 13, 2017 2. Delegation of Authority to Renew the Agreement with Navia Benefits 3. Delegation of Authority to Sign an Agreement with Prudential Insurance 4. Delegation of Authority to Sign an Agreement with United Healthcare 5. Delegation of Authority to Sign an Agreement with CSAC EIA Delta Dental for the Provision of Dental Benefits 6. Delegation of Authority to sign an Agreement with Kaiser Permanente 7. Approve the Agreement with CSAC-EIA Medical Eye Services FINANCE DEPARTMENT (Keenan Freeman) 8. Approve the Increase in Spending Authority for the Workers Compensation Insurance Policy with Special District Risk Management Authority 9. Approve the Advance Payment of Department of Healthcare Services Directed Payments to Riverside University Heath System MARKETING DEPARTMENT (Susan Arcidiacono) 10. Approve the Memorandum of Understanding with the County of San Bernardino Human Services Transitional Assistance Department MEDICAL SERVICES DEPARTMENT (Jennifer N. Sayles, M.D., MPH) 11. Delegation of Authority to Approve a Professional Services Agreement with Brilliant Corners 12. Delegation of Authority to Approve a Professional Services Agreement with Institute on Aging 13. Delegation of Authority to Approve a Memorandum of Understanding with Riverside County Office on Aging 14. Delegation of Authority to Approve a Memorandum of Understanding with San Bernardino County Department of Aging and Adult Services 15. Approve the Award for an econsult and Referral Management Software Solution to Safety Net Connect. OPERATIONS DEPARTMENT (Rohan Reid) 16. Approve the First Amendment to the Professional Service Agreement with Clarity Software Solutions, Inc. 17. Approve the Third Amendment to the Professional Service Agreement with Transaction Applications Group, Inc. (a wholly owned subsidiary of Dell, Inc.)
3 of 84 AGENDA November 13, 2017 PROVIDER NETWORK DEPARTMENT (Kurt Hubler) 18. Ratify and Approve the Second Amendment to the Hospital Per Diem Agreement with Corona Regional Medical Center 19. Ratify and Approve the Twenty-Sixth Amendment to the Capitated IPA Agreement with Inland Faculty Medical Group 20. Ratify and Approve the Twelfth Amendment to the Capitated Full Service Agreement with Kaiser Foundation Health Plan, Inc., Southern California Region 21. Ratify and Approve the Ninth Amendment to the Hospital Per Diem Agreement with Mountains Community Hospital 22. Approve the Capitated Primary Care Provider Agreement with Primary Care Health Network, LLC, dba Integrated Health Partners 23. Ratify and Approve the Twenty Second Amendment to the Hospital Per Diem Agreement with Riverside University Health System Medical Center 24. Ratify and Approve Second Amendment to the Hospital Per Diem Agreement with Temecula Valley Hospital, Inc. 25. Ratify and Approve the Second Amendment to the Hospital Per Diem Agreement with Universal Health Services of Rancho Springs, Inc., dba Southwest Healthcare System 26. Ratify and Approve the First Amendment to the Hospital Per Diem Agreement for Behavioral Health Services with Vista Behavioral Hospital, LLC, dba Pacific Grove Hospital 27. Approval of the Evergreen Contracts 1) Ancillary Provider Agreement with AASTHA INC 2) Ancillary Provider Agreement with Charter Hospice Inc 3) Ancillary Provider Agreement with Enmed LLC. 4) Ancillary Provider Agreement with ProtoScript Pharmaceuticals Inc 5) Open Access Provider Agreement with Carrillo Urbina & Castuera Inc 6) Participating Provider Agreement with Muhammad S Akhtar 7) Participating Provider Agreement with Milan Kim. 8) Participating Provider Agreement with Barstow Primary Care Clinic. 9) Participating Provider Agreement with Girdhari S Purohit MD Inc. 10) Participating Provider Agreement with Murrieta Valley Surgery Associates Medical Group Inc APC. 11) Participating Provider Agreement Sameer Gupta MD A Medical Corporation. 12) Participating Provider Agreement with Ultimate Sports and Orthopedics 13) Urgent Care Provider Agreement with ABC Medical Corporation 14) Urgent Care Provider Agreement with Alliance Urgent Care Inc 15) Urgent Care Provider Agreement with Citrus Valley Medical Associates Inc
4 of 84 AGENDA November 13, 2017 POLICY AGENDA AND STATUS REPORT ON AGENCY OPERATIONS: ADMINISTRATION (Bradley P. Gilbert, M.D.) 28. Monthly Membership Report 29. Overview of the 2017 IEHP Employee Engagement Survey FINANCE DEPARTMENT (Keenan Freeman) 30. Review of Monthly Financials MEDICAL SERVICES DEPARTMENT (Jennifer N. Sayles, M.D., MPH) 31. Overview of 2017 Medicaid and Medicare Consumer Assessment of Health Providers & Systems Adult Member Satisfaction Survey Results 32. Overview of the Medi-Cal and Medicare Healthcare Effectiveness Data and Information Set Results for HEDIS 2016 (Calendar Year 2015). VII. VIII. MAIN OBJECTIVES FOR THE NEXT 90 DAYS AND SUMMARY COMMENTS (Bradley P. Gilbert, M.D.)New Agenda Outline Section 33. Main Objectives for next 90 Days and Summary Comments IEHP HEALTH ACCESS: CONSENT AGENDA PROVIDER NETWORK DEPARTMENT (Kurt Hubler) 34. Ratify and Approve the Second Amendment to the Hospital Per Diem Agreement with Corona Regional Medical Center 35. Ratify and Approve the Twenty-Sixth Amendment to the Capitated IPA Agreement with Inland Faculty Medical Group 36. Ratify and Approve the Twelfth Amendment to the Capitated Full Service Agreement with Kaiser Foundation Health Plan, Inc., Southern California Region 37. Ratify and Approve the Ninth Amendment to the Hospital Per Diem Agreement with Mountains Community Hospital 38. Approve the Capitated Primary Care Provider Agreement with Primary Care Health Network, LLC, dba Integrated Health Partners 39. Ratify and Approve the Twenty Second Amendment to the Hospital Per Diem Agreement with Riverside University Health System Medical Center 40. Ratify and Approve the Second Amendment to the Hospital Per Diem Agreement with Temecula Valley Hospital, Inc.
5 of 84 AGENDA November 13, 2017 41. Ratify and Approve the Second Amendment to the Hospital Per Diem Agreement with Universal Health Services of Rancho Springs, Inc., dba Southwest Healthcare System 42. Ratify and Approve the First Amendment to the Hospital Per Diem Agreement for Behavioral Health Services with Vista Behavioral Hospital, LLC, dba Pacific Grove Hospital 43. Approval of the Evergreen Contracts 1) Ancillary Provider Agreement with AASTHA INC 2) Ancillary Provider Agreement with Charter Hospice Inc 3) Ancillary Provider Agreement with Enmed LLC. 4) Ancillary Provider Agreement with ProtoScript Pharmaceuticals Inc 5) Open Access Provider Agreement with Carrillo Urbina & Castuera Inc 6) Participating Provider Agreement with Muhammad S Akhtar 7) Participating Provider Agreement with Milan Kim. 8) Participating Provider Agreement with Barstow Primary Care Clinic. 9) Participating Provider Agreement with Girdhari S Purohit MD Inc. 10) Participating Provider Agreement with Murrieta Valley Surgery Associates Medical Group Inc APC. 11) Participating Provider Agreement Sameer Gupta MD A Medical Corporation. 12) Participating Provider Agreement with Ultimate Sports and Orthopedics 13) Urgent Care Provider Agreement with ABC Medical Corporation 14) Urgent Care Provider Agreement with Alliance Urgent Care Inc 15) Urgent Care Provider Agreement with Citrus Valley Medical Associates Inc IX. COMMENTS FROM THE PUBLIC ON MATTERS NOT ON THE AGENDA X. CLOSED SESSION: 44. With respect to every item of business to be discussed in closed session pursuant to California Government Code Section 54956.87(c): 1. Employee Health Systems Medical Group DBA Inland Valleys IPA Contract and Contract Negotiations 2. Alphacare Medical Group, Inc. Contract and Contract Negotiations XI. ADJOURNMENT The next meeting of the IEHP Governing Board will be held on December 11, 2017 at the San Bernardino County Government Center.
6 of 84 ADMINISTRATION 1. APPROVE THE NINTH AMENDMENT TO THE CHIEF EXECUTIVE OFFICER EMPLOYMENT CONTRACT Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Ninth Amendment to the Chief Executive Officer Employment Contract, as attached hereto. Contact: Steve Sohn, Managing Counsel Background: Dr. Bradley Gilbert s current Chief Executive Officer Employment Contract has been effective since October 1, 2009. Dr. Gilbert s annual performance evaluation was conducted at the October 10, 2017 Governing Board Meeting. Discussion: The attached Ninth Amendment provides a 5% merit increase to his base salary, pursuant to the merit increase guidelines under his Employment Contract. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
7 of 84 ADMINISTRATION 2. DELEGATION OF AUTHORITY TO RENEW THE AGREEMENT WITH NAVIA BENEFITS Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) authorize the Chief Executive Officer, or his designee to, after legal review and approval, sign the Renewal Agreement with Navia Benefits for the provision of Employee Flexible Spending Accounts (FSA) for eligible Dependent Care and Health Care related expenses. The annual cost is projected to be $23,772 for the period of January 1, 2018 through December 31, 2018. Contact: Bradley P. Gilbert, Chief Executive Officer Background: The use of a FSA allows IEHP employees to use pre-tax dollars to pay for child care for eligible dependent children or elder care and eligible out-of-pocket health care expenses for themselves and their eligible dependents. Navia Benefits is IEHP s current provider. Discussion: IEHP is requesting to renew the existing agreement with Navia Benefits to contract for Flexible Spending Account services for the period of January 1, 2018 through December 31, 2018. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Pending
8 of 84 ADMINISTRATION 3. DELEGATION OF AUTHORITY TO SIGN AN AGREEMENT WITH PRUDENTIAL INSURANCE Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) authorize the Chief Executive Officer, or his designee, to, after legal review and approval, sign an Agreement with Prudential Insurance for Employee Benefits of Life, Accidental Death & Disbursement (AD&D), Short Term Disability (STD<D) Insurance and Employee Assistance Program (EAP). The annual premium rates are based on current staffing levels and are estimated to be $432,369 for the period of January 1, 2018 through December 31, 2018. Contact: Bradley P. Gilbert, M.D., Chief Executive Officer Background: IEHP provides Life & AD&D insurance for its employees equal to one times their annual salary. Optional life insurance is available to both IEHP employees and their eligible dependents. In addition, IEHP provides both STD and LTD benefits for its employees. IEHP provides an EAP which includes unlimited telephonic consultation in the areas of dependent care, financial and legal services, as well as three face-to-face counseling sessions. Discussion: IEHP is requesting to renew the Prudential agreement effective January 1, 2018 through December 31, 2018 for the benefits described above. Prudential s rates are based on current staffing levels: Benefit 2018 Annual Cost Basic Life &AD&D $97,382 STD & LTD $334,987 Annual Total $435,000 Prudential s Life/AD&D, Supplemental Life, STD and LTD renewal for 2018 is a rate pass, and guaranteed until December 31, 2018. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Pending
9 of 84 ADMINISTRATION 4. DELEGATION OF AUTHORITY TO SIGN AN AGREEMENT WITH UNITED HEALTHCARE Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) authorize the Chief Executive Officer, or his designee, to, after legal review and approval, sign an Agreement with United Healthcare for the provision of health care benefits for IEHP Team Members and their eligible dependents for the period of January 1, 2018 through December 31, 2018. Total estimated fiscal impact for all employees is approximately $13,279,495. Contact: Bradley P. Gilbert, M.D., Chief Executive Officer Background: IEHP provides health care benefits for IEHP Team Members and their eligible dependents. Discussion: IEHP is requesting to renew a contract with United Healthcare commencing January 1, 2018 through December 31, 2018. This is health insurance coverage which will be offered to Team Members alongside Kaiser Permanente HMO plan. United Healthcare rates are as follows: Benefit Level 2018 HMO Rates 2018 PPO Rates Employee $514.19 $602.36 Employee +1 $1,105.36 $1,295.07 Employee +2 or more $1,580.64 $1,855.27 Current Annual Premium $12,094,402 Projected Annual Premium $13,279,495 United HealthCare 2017 premium rates increased 7.8 % from the previous year due to high medical costs experienced. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Pending
10 of 84 ADMINISTRATION 5. DELEGATION OF AUTHORITY TO SIGN AN AGREEMENT WITH CSAC EIA DELTA DENTAL FOR THE PROVISION OF DENTAL BENEFITS Recommended Action: That the Governing Board of IEHP authorize the Chief Executive Officer, or his designee, to, after legal review and approval, sign an Agreement with CSAC EIA Delta Dental for the provision of Dental benefits for IEHP Team Members and their eligible dependents. The projected Annual Premium is $1,959,490 for the period of January 1, 2018 through December 31, 2018. Contact: Bradley P. Gilbert, M.D., Chief Executive Officer Background: IEHP provides dental benefits for IEHP Team Members and their eligible dependents. IEHP continues to participate in the CSAC-EIA Delta Dental plan. This allows IEHP to participate in a pool with public entities throughout California, thus reducing the annual premiums and administrative costs. Discussion: IEHP is requesting to renew the agreement with CSAC EIA Delta Dental contract commencing January 1, 2018 through December 31, 2018. There is no change to existing dental benefit offerings. CSAC EIA Delta Dental s rates for 2018 are as follows: CSAC EIA Delta Dental Benefit Level 2017 Rates 2018 Rates Employee $38.20 $36.40 Employee + 1 $72.70 $69.20 Employee + 2 or more $130.00 $123.80 Current Annual Premium Total: $2,057,675 Projected Annual Premium Total: $1,959,490 The 2018 Dental premium decreased 4.8% from last year s rates. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: N/A
11 of 84 ADMINISTRATION 6. DELEGATION OF AUTHORITY TO SIGN AN AGREEMENT WITH KAISER PERMANENTE Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) authorize the Chief Executive Officer, or his designee, to, after legal review and approval, sign an Agreement with Kaiser Permanente for the provision of health care benefits for IEHP Team Members and their eligible dependents for the period of January 1, 2018 through December 31, 2018. Total estimated fiscal impact is approximately $10,050,162. Contact: Bradley P. Gilbert, M.D., Chief Executive Officer Background: IEHP provides health care benefits for IEHP Team Members and their eligible dependents. This is the third year offering Kaiser Permanente as an option for health care coverage. Discussion: IEHP is continuing the contract with Kaiser Permanente for the period of January 1, 2018 through December 31, 2018. This is an additional plan offering which is available to Team Members alongside the existing United Healthcare HMO and PPO plans. Kaiser Permanente rates are as follows: BENEFIT LEVEL 2017 Rates 2018 Rates Employee $384.41 $443.96 Employee +1 $826.48 $954.50 Employee +2 or more $1,180.13 $1,362.92 Current Annual Premium: $8,702,230 Projected Annual Premium: $10,050,162 The 2018 Kaiser rate is an increase of 15.43% from the previous plan year due to high medical costs experienced. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: N/A
12 of 84 ADMINISTRATION 7. APPROVE THE AGREEMENT WITH CSAC-EIA MEDICAL EYE SERVICES Recommended Action: That the Governing Board of Inland Empire Health Plan ( IEHP ) Approve Agreement with CSAC-EIA Medical Eye Services ( MES ) for the provision of Vision Benefits for IEHP Team Members and their eligible dependents. At current staffing levels, the annual premium is projected to be $373,407 for the period of January 1, 2018 through December 31, 2018. Contact: Bradley P. Gilbert, M.D., Chief Executive Officer Background: IEHP provides vision benefits to IEHP team members and their eligible dependents. Discussion: IEHP is requesting to approve the agreement with CSAC-EIA (MES) commencing January 1, 2018 through December 31, 2021. CSAC-EIA (MES) provided the same rate guarantee through 2021. At current staffing levels, the total year s premium is projected to be $373,407. CSAC-EIA (MES) rates are as follows: BENEFIT LEVEL 2018 RATES Employee $8.45 Employee +1 $15.20 Employee +2 or more $21.79 Projected Annual Premium: $373,407 The premium rates are guaranteed for three (3) years, January 1, 2018 through December 31, 2021. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: N/A
13 of 84 FINANCE DEPARTMENT 8. APPROVE THE INCREASE IN SPENDING AUTHORITY FOR THE WORKERS COMPENSATION INSURANCE POLICY WITH SPECIAL DISTRICT RISK MANAGEMENT AUTHORITY Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the increase in spending authority for the Workers Compensation Insurance Policy with Special District Risk Management Authority (SDRMA) based on premium reconciliation for policy period ended July 1, 2017. The additional premium is $295,000 with the total premium not to exceed $1,603,000. Contact: Keenan Freeman, Chief Financial Officer Background: In June 2016 under Minute Order 16-93, the Governing Board approved the annual renewal of Workers Compensation Insurance Policy with SDRMA for policy period July 1, 2016 through July 1, 2017 for a total premium not to exceed $1,308,000. The proposed premium was based on a combination of estimated gross payroll for the policy period, Modification Factor (MOD) based on prior period and proposed per-employee rate, with a 15% discount related to the Credit Incentive Program (CIP), and it is subject to reconciliation at the end of the policy period with the actual payroll and the actual points earned in the CIP during the period. Discussion A premium reconciliation at the end of the policy period has been performed to compare the actual payroll to the estimate and the actual points earned in the CIP to the 15% discount advanced. The reconciliation results in an additional premium of $291,000 due to SDRMA for the annual policy period ended July 1, 2017 as shown below. Insurance Policy Workers Compensation Approved Premium Additional Premium Total Premium Insurance Provider Special District Risk Management Authority $1,308,000 $295,000 $1,603,000 Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 16/17 Budget Reviewed by Counsel: N/A
14 of 84 FINANCE DEPARTMENT 9. APPROVE THE ADVANCE PAYMENT OF DEPARTMENT OF HEALTHCARE SERVICES DIRECTED PAYMENTS TO RIVERSIDE UNIVERSITY HEATH SYSTEM Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Advance Payment of Department of Health Care Services (DHCS) Directed Payments in the amount of $10.8 million to Riverside University Health System (RUHS) for the advance against the 2017/2018 Rate Range payments for the months of July 2017 through October 2017. Contact: Keenan Freeman, Chief Financial Officer Background: IEHP receives several types of Directed Payments from DHCS that are required to be paid directly to IEHP s contracted hospitals. These Directed Payments are pending from DHCS related to RUHS: 1. Rate range payment for FY 2017-2018 estimated to be $32M Based on information provided by DHCS, IEHP expects to receive these funds by the end of June 30, 2018. Discussion: There continues to be delays in the State rate setting process and the related funding of directed payments. IEHP is requesting approval to issue a partial advance of funds expected to be received on behalf of RUHS, in the amount of $10.8 million. IEHP expects to receive the delayed payments by June 30, 2018. If the amount received by that time is less than the advance, or the payments are delayed beyond 2018, IEHP will recoup the funds from future payments of claims submitted by RUHS for medical services rendered to IEHP members. Claims payments will be withheld until the advance is fully recovered, and no interest will be charged to RUHS. An advance was approved by the Governing Board on October 10, 2017 for $25,223,205, which was since been recouped from RUHS. These funds will help RUHS with their cash balances, and do not have a material impact on IEHP s overall cash position. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: None Reviewed by Counsel: N/A
15 of 84 MARKETING DEPARTMENT 10. APPROVE THE MEMORANDUM OF UNDERSTANDING WITH THE COUNTY OF SAN BERNARDINO HUMAN SERVICES TRANSITIONAL ASSISTANCE DEPARTMENT Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) approve the Memorandum of Understanding with the County of San Bernardino Human Services Transitional Assistance Department for data sharing effective December 6, 2017 through December 5, 2020. Contact: Susan Arcidiacono, Chief Marketing Officer Background: The Transitional Assistance Department (TAD) administers the County s public assistance programs including Medi-Cal. Medi-cal is California s Medicaid program serving low-income individuals. Eligibility for Medi-Cal must be reevaluated on an annual basis. Failure to complete and return an Annual Redetermination to TAD results in loss of benefits for individuals and families. Discussion: To promote retention and successful renewals of IEHP Members, IEHP would like to encourage IEHP Members whose eligibility is being redetermined to complete and return their redetermination packets by contacting Members by mail, phone, text messaging, and referring questions or reschedules to the TAD Customer Service Center. In order to meet this goal, under the agreement of the MOU, IEHP will provide TAD with a complete list of San Bernardino County IEHP Members on a monthly basis through the Secure File Transfer Protocol (SFTP). IEHP will provide results of retention efforts to the County monthly by the tenth (10th) day of the month following contact. TAD will provide IEHP with lists of those mutual customers of IEHP and TAD who require an Annual Redetermination for continued Medi-Cal coverage on a monthly basis. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: None Reviewed by Counsel: N/A
16 of 84 MEDICAL SERVICES DEPARTMENT 11. DELEGATION OF AUTHORITY TO APPROVE A PROFESSIONAL SERVICES AGREEMENT WITH BRILLIANT CORNERS Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) authorize the Chief Executive Officer (CEO) or his designee to negotiate, after legal review and approval, sign a Professional Services Agreement (Agreement) with with Brilliant Corners for the Community Care Transitions Program in the amount of $6.3 Million effective December 1, 2017 through November 30, 2019. Contact: Jennifer N. Sayles, M.D. MPH, Chief Medical Officer Background: Brilliant Corners has successfully secured low-income housing and provided property related tenancy services (PRTS) for medically complex individuals for over 30 years. IEHP s housing initiative intends to assist 350 Members who are homeless to secure permanent supportive housing within 2 years. There are 3 populations of interest: 1. 150 homeless Members in Long Term Care, 2. 100 IEHP Members who are homeless, high-cost, and high-utilizers of health care ( 3H Members) who are not eligible for housing vouchers from the Department of Housing and Urban Development (HUD), and 3. 100 3H IEHP Members eligible for HUD housing vouchers. 1 Eligibility To optimize costs savings and health improvements, IEHP has developed data-driven eligibility criteria to identify 3H Members for permanent supportive housing: 1. Homeless, with: a. 3 or more Emergency Department visits within the previous 12 months, OR b. At least 7 Inpatient days in a facility within 12 months, OR c. At least 2 Inpatient admissions in a facility within 12 months, AND d. At least 1 chronic medical condition. An analysis of IEHP homeless patients that had over $40,000 a year in medical costs, revealed these members all had the above mentioned utilization and clinical characteristics. These characteristics were in turn used to develop the criteria for the program to ensure the most costly and highest utilizers of health care were prioritized initially. The average cost of members meeting the criteria was $76,000 a year. 1 For HUD eligible Members, IEHP will coordinate with HUD agencies on assisting these Members.
17 of 84 Services: Brilliant Corners is uniquely qualified to provide PRTS for the Community Transitions Program participants and 3H IEHP Members. Brilliant Corners successfully secured a contract through a competitive bid process for the Health Plan of San Mateo Community Care Settings Pilot. They also have successfully secured a contract with Los Angeles Department of Health Services to administer their Flexible Housing Subsidy Pool program. Brilliant Corners provides the following services: Administer a Flexible Housing Subsidy Pool for IEHP and other Inland Empire partners Provide Unit Identification Services Secure housing and establish site control Administer rental subsidies Provide owner/participant liaison services Manage unit repairs and modifications Provide unit habitability and tenant wellness checks Provide housing retention services Participate in interdisciplinary care team with IoA, other local Intensive Housing Case Management Service (ICMS) providers, and IEHP Provide regular reports to IEHP on outcomes of interest and key performance indicators Discussion: IEHP expects this program (in coordination with Institute on Aging and other ICIMS providers) to assist in the transition of the following groups of homeless Members over the next 2 years: 2 1. 150 Members in Long Term Care 2. 100 3H Housing and Urban Development (HUD) ineligible Members Long Term Care Members Cost Savings: Duration 2 Years Program Long Term Care Total Members Institutional Costs 3 Program Costs Cost Savings 4 150 $19.8M 5 IoA-$6.4M RCFE-$3.2M 6 BC-$1.9M Total Cost-$11.5M $8.3M 3H Members Cost Savings As previously noted, criteria for IEHP s permanent supportive housing program will target 3H Members with average annual medical costs of $76,000. Findings from other permanent supportive housing programs in similar populations support up to a 30% reduction in medical 2 For the 100 HUD eligible Members, IEHP will coordinate with HUD agencies on assisting these Members. 3 Costs calculated over 2 years. 4 Does not include medical cost savings 5 Based on current utilization data, Members cost $5,500/month while institutionalized at long term care facilities. 6 RCFE Residential Care Facilities for the Elderly. IEHP estimates that 30% of homeless long term care Members will end up in RCFE facilities, at a cost of $3,000/per month.
18 of 84 costs. Thus, we anticipate a medical cost savings of roughly $5 million over 2 years for 100 housed 3H Members. Permanent supportive housing programs in comparable 3H homeless populations additionally result in savings across multiple publicly-funded agencies (e.g., public social services, corrections, substance use/mental health). IEHP will be investing $4.2 million with Brilliant Corners and $3.8 million in ICMS providers over 2 years for 3H Members. 7 Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY17/18 Budget Reviewed by Counsel: Pending 7 ICMS intensive case management services. Planning to work with other organizations for these ICMS. Projected ICMS costs are $1,600 PMPM.
19 of 84 MEDICAL SERVICES DEPARTMENT 12. DELEGATION OF AUTHORITY TO APPROVE A PROFESSIONAL SERVICES AGREEMENT WITH INSTITUTE ON AGING Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) authorize the Chief Executive Officer (CEO) or his designee to negotiate and, after legal review and approval, sign a Professional Services Agreement (Agreement) with Institute on Aging (IoA) for the Community Care Transitions Program in the amount of $6.4 Million effective December 1, 2017 through November 30, 2019. Contact: Jennifer N. Sayles, M.D., MPH, Chief Medical Officer Background: IEHP has many Members who are in Skilled Nursing Facility (SNF) that do not require skilled care. These Members remain in long term care because they were homeless before admission to the facility or have lost their previous residence during an inpatient medical stay. Long term care cost about $5,500 per month in the Inland Empire; in contrast, the cost of a single bedroom apartment is about $1,100 per month to rent. Long-term support services (LTSS) are available to persons who need assistance to live independently in their own homes or shared homes. IEHP is supporting the Community Care Transitions Program, which has a goal of transitioning 150 Members from long term care to the community over a 2-year period. The Health Plan of San Mateo (HPSM) conducted a competitive bid process in 2014 and chose IoA and Brilliant Corners to transition the members described above out of nursing home environments and into the community. HPSM identifies Members who express a desire to move into the community. IoA develops a plan with the Members to transition them to the community and provides services necessary to execute the plan. Brilliant Corners provides the property related tenancy services necessary to match Members to appropriate affordable housing in the community. The support services provided by both organizations serve to successfully maintain Members in the community housing. IEHP hired IoA as a consultant early in 2017 to evaluate the Inland Empire SNF, LTSS, and housing environment to determine if it would be feasible to implement a program similar to HPSM s. Their report indicated that a similar program can be successfully implemented in the Inland Empire. Services The services in this contract include: Program Eligibility and Enrollment IoA will work with SNFs and IEHP to identify Members who desire and are most likely to succeed in community placement with intensive case management
20 of 84 IoA will screen IEHP members in SNFs, identify needs for the member to successfully transition to the community, and work with IEHP to prioritize members in the program Intensive Case Management Services IoA will provide case management and care coordination through the first 9-12 months of each Members transition to community care o Transition plan development o Benefits application, submittal and appeals processes o Coordination with property related tenancy service providers, conduct required home modifications, and identify all necessary supports for the member o Coordinate services related to transition plan Provide a package of wrap around services that are not part of traditional health care benefits o Medication management o Nutrition management o Transportation management o Habilitation skills counseling Partnership with Health Plan Participate in interdisciplinary care team for program participants Investigate and resolve participant grievances and appeals in the context of permanent supportive housing programs in accordance with Medicaid and Medicare regulations and guidelines Reporting to Measure Outcomes Cost Care utilization Placement success/retention Provider satisfaction Member satisfaction Discussion: IEHP expects this program (in coordination with Brilliant Corners) to assist in the transition of the 150 members from Long Term Care to the community over the next 24 months. It is estimated that cost savings will be roughly $8.3 Million over 2 years. See below grid for projections: Duration 2 Years Program Long Term Care Total Members Institutional Costs 1 Program Costs Cost Savings 2 150 $19.8M 3 IoA-$6.4M RCFE-$3.2M 4 BC-$1.9M Total Cost-$11.5M $8.3M 1 Costs calculated over 2 years. 2 Does not include medical cost savings 3 Based on current utilization data, Members cost $5,500/month while institutionalized at long term care facilities. 4 RCFE Residential Care Facilities for the Elderly. IEHP estimates that 30% of homeless long term care Members will end up in RCFE facilities, at a cost of $3,000/per month.
21 of 84 Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Pending
22 of 84 MEDICAL SERVICES DEPARTMENT 13. DELEGATION OF AUTHORITY TO APPROVE THE MEMORANDUM OF UNDERSTANDING (MOU) WITH RIVERSIDE COUNTY OFFICE ON AGING Recommended Action: That the Governing Board of the Inland Empire Health Plan authorize the Chief Executive Officer (CEO) to, after legal review and approval, approve the MOU with Riverside County Office on Aging for the Multipurpose Senior Service Program (MSSP). Contact: Jennifer N. Sayles, M.D., MPH, Chief Medical Officer Background: The Coordinated Care Initiative requires that MSSP be a Medi-Cal benefit available through the managed care health plan in specified counties. Riverside and San Bernardino counties are included in the initiative. MSSP provides social and health care coordination services for eligible seniors enabling them to remain in their homes. IEHP is responsible for providing MSSP as a managed care benefit through a contract with the California Department of Health Care Services (DHCS). Riverside County Office on Aging has been performing MSSP related administration and coordination tasks since 2012. Discussion: This MOU gives Riverside County Office on Aging the authority to continue performing these functions under a managed care system. It also allows both parties to share confidential recipient information to promote shared understanding of the Member's needs and ensure appropriate access to MSSP. The new term will begin on January 1, 2018 and continue until December 31, 2020. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: None Reviewed by Counsel: Pending
23 of 84 MEDICAL SERVICES DEPARTMENT 14. DELEGATION OF AUTHORITY TO APPROVE THE MEMORANDUM OF UNDERSTANDING WITH SAN BERNARDINO COUNTY DEPARTMENT OF AGING AND ADULT SERVICES Recommended Action: That the Governing Board of the Inland Empire Health Plan authorize the Chief Executive Officer (CEO) to, after legal approval, approve the Memorandum of Understanding with San Bernardino County Department of Aging and Adult Services (DAAS) for the Multipurpose Senior Service Program (MSSP) Contact: Jennifer N. Sayles, M.D., MPH, Chief Medical Officer Background: The Coordinated Care Initiative requires that MSSP be a Medi-Cal benefit available through the managed care health plan in specified counties. Riverside and San Bernardino counties are included in the initiative. MSSP provides social and health care coordination services for eligible seniors enabling them to remain in their homes. IEHP is responsible in providing MSSP as a managed care benefit through a contract with the California Department of Health Care Services (DHCS). San Bernardino County DAAS has been performing MSSP related administration and coordination tasks since 2012. Discussion: This MOU gives San Bernardino County DAAS the authority to continue performing these functions under a managed care system. It also allows both parties to share confidential recipient information to promote shared understanding of the Member's needs and ensure appropriate access to MSSP. The new term will begin on January 1, 2018 and continue until December 31, 2020. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: None Reviewed by Counsel: Pending
24 of 84 MEDICAL SERVICES DEPARTMENT 15. APPROVE THE AWARD FOR AN ECONSULT AND REFERRAL MANAGEMENT SOFTWARE SOLUTION TO SAFETY NET CONNECT. Recommended Action: That the Governing Board of Inland Empire Health Plan (IEHP) approve the Request For Proposal (RFP) 17-035 Award to Safety Net Connect for the procurement of an econsult platform at an estimated cost of $1.57 million for a two (2) year period. Contact: Jennifer N. Sayles, M.D., MPH, Chief Medical Officer Background: In June 2017, the Governing Board approved and granted the Chief Executive Officer the authority to negotiate, and after legal review and approval, sign all agreements for the Multi County econsult Initiative (MCEI). econsult is a secure online communication tool that allows Primary Care Providers (PCP) to request evaluation and treatment from a specialist. This system will allow PCPs to communicate electronically with specialists to provide clinical histories and questions regarding Member s care. These platforms are designed to improve patient care, increase appropriate access to specialist providers and improve provider satisfaction. On October 10, 2017 under Minute Order 17-184, the Governing Board approved a $2.0 million increase to the MCEI project budget for a total cost not to exceed $4 million. Discussion: IEHP has conducted a RFP with evaluators from Arrowhead Regional Medical Center (ARMC) and Riverside University Health System (RUHS) to select a vendor that offers solutions for an econsult platform. IEHP will procure the software for two (2) years and based on implementation success, ARMC and RUHS will then support the ongoing costs to utilize the platform long term. RFP Solicitation: On August 10, 2017, RFP 17-035 for an econsult and Referral Management Software Solution was posted on Public Purchase. IEHP received responses from the four (4) bidders below: 1. AristaMD 2. eceptionist 3. RubiconMD 4. Safety Net Connect The initial responses were reviewed and scored. Scoring for the RFP was based on a scale of 100 points with 100 points being the best possible score. Points were based on the following categories: Company Profile/Experience Vendor Qualifications (12 points) Scope of Services (38 points) Reporting Capabilities (20 points)
25 of 84 Overall Cost (25 points) Local Preference (5 points) RFP Evaluation Scoring Breakdown: IEHP, ARMC, and RUHS each provided four (4) evaluators to participate in the RFP Process. Each evaluator conducted the scoring on all the categories listed above for all four (4) bidders. Each category score from each evaluator was added together for a total awarded point value. All awarded points per category were added up for each vendor to get a grand total. The results of the RFP evaluation scoring are indicated in the table below: RFP Vendor RFP Proposal Scores AristaMD 38 eceptionist 46 RubiconMD 46 Safety Net Connect 51 Based on the initial RFP evaluation scores, the evaluators selected the top three (3) vendors (Safety Net Connect, eceptionist, and RubiconMD) to provide an onsite demonstration and interview at IEHP Headquarters in Rancho Cucamonga, California. On 9/19/2017, eceptionist notified IEHP that they would not provide financial documentation as required by the RFP and were subsequently disqualified prior to demonstrations. The demonstration/interview resulted in the following scores: RFP Vendor RFP Proposal Scores RubiconMD 70 Safety Net Connect 65 IEHP requested a Best and Final Offer (BAFO) from Safety Net Connect and RubiconMD. The BAFO results showed Safety Net Connect was more competitive in price. The cumulative results show the overall score for the bidders in the chart below: Combined Scoring RFP Evaluation Score with BAFO Pricing Demonstration Evaluation Score Safety Net Connect RubiconMD 63 56 65 70 Total Score 128 126 Overall Ranking 1 2 Based on the results, Safety Net Connect was selected due to its competitive costs and high scores in most areas of the RFP. This solidifies Safety Net Connect as the most responsive and responsible bidder.
26 of 84 IEHP will initiate contract negotiations with Safety Net Connect and, after legal review and approval, the Chief Executive Officer will execute a Professional Services Agreement with the vendor for the procurement of an econsult platform at an estimated cost of $1.57 million for a two-year period. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
27 of 84 OPERATIONS DEPARTMENT 16. APPROVE THE FIRST AMENDMENT TO THE PROFESSIONAL SERVICES AGREEMENT WITH CLARITY SOFTWARE SOLUTIONS, INC. Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the First Amendment to the Professional Services Agreement (Agreement) with Clarity Software Solutions, Inc. for the provision of printing and mailing of IEHP Membership ID Cards. The First Amendment increases the dollar amount by $2.25 million and extends the agreement to January 31, 2019. The total amount payable under this Agreement shall not exceed $5.25 million. Contact: Rohan Reid, Executive Officer Background: IEHP has been using Clarity Software Solutions, Inc. for ID card printing and mailing services since 2011. In late 2014, the agreement with Clarity Software Solutions, Inc terminated and, IEHP was required to solicit vendors through a Request for Proposal (RFP) for ID card printing and mailing services. After a thorough RFP IEHP selected Clarity Software Solutions, Inc. based on their product demonstration and pricing. In February 2015, under Minute Order 15-21, an Agreement with Clarity Software Solutions, Inc. for the printing and mailing of IEHP Membership ID Cards was signed for three (3) years for an amount not to exceed $3.0 million effective February 1, 2015 through January 31, 2018. Discussion: To meet the needs of the CORE transition in February 2018 it is necessary to reissue member ID cards to our Medi-Cal membership prior to CORE go live. This First Amendment will cover all anticipated expenses and includes the following: 1. Re-issuing member ID cards to entire Medi-Cal membership based on membership at the time of mailing; 2. Increase in membership for current Medi-Cal and Dual Choice - Cal MediConnect (CMC) based on IEHP Membership Forecast for current programs; and 3. Additional reserve for printing expenses to cover ID cards generated due to provider network changes. This service will assist in the CORE transition by providing a seamless transition of care for our members and providers. It is necessary to meet IEHP s anticipated growth along with ID card printing and mailing needs.
28 of 84 This Amendment increases the dollar amount by $2.25 million and extends the agreement to January 31, 2019. The total amount payable under this agreement shall not exceed $5.25 million. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
29 of 84 OPERATIONS DEPARTMENT 17. APPROVE THE THIRD AMENDMENT TO THE PROFESSIONAL SERVICE AGREEMENT WITH TRANSACTION APPLICATIONS GROUP, INC. (A WHOLLY OWNED SUBSIDIARY OF DELL, INC.). Recommended Action: That the IEHP Governing Board approve the Third Amendment to the Professional Services Agreement (Agreement) with Transaction Applications Group (TAG), for the provision of Claims Overflow Processing Services effective November 1, 2017 through October 31, 2019 for an additional an additional $5.4 million bringing the total amount payable under this Agreement to an amount not to exceed $15.3 million. Contact: Rohan Reid, Executive Officer Background: On May 7, 2013 under Resolution 13-80, the Governing Board approved an Agreement with TAG for medical claim processing services for $2.0 million over three (3) years. Since then, the Agreement being amended on July 11, 2014 under Minute Order,14-185 and again on July 14, 2015 under Minute Order 15-188. Discussion: IEHP is migrating to a new Core claims processing system. This transition includes maintaining the current Diamond system for approximately one (1) year to process claims incurred prior to the transition date. Additionally, in anticipation of the transition to the new CORE system, TAG will be used to provide additional capacity as needed. TAG has demonstrated high productivity and quality capabilities while providing dedicated resources that can scale upward as needed. TAG has significant industry presence and continually meets and exceeds the terms of the Agreement. Under the Third Amendment, the following terms will be incorporated into the Agreement: Term extension through October 31, 2019 that includes a one-time, one (1) year auto renewal provision. Increase the claims payment accuracy requirement to 98%. If targets are not met, the performance penalty amounts are as follows: o o Year 1: 1% per month not met and 2% for 3 or more consecutive months not met. Year 2: 1.5% per month not met and 2.5% for 3 or more consecutive months not met. Modify current transaction rates to the following volume based tiered rates:
30 of 84 Annual rate adjustments based on U.S. Bureau of Labor Statistics Employment Cost Index (ECI), whose 2017 2nd Quarter publication was 1.9%. Increase the weekly training rates from $1,150 per week to $1,300 per week beginning May 2018. Increases the termination for convenience clause from 30 to 120 days. This Third Amendment will be effective November 1, 2017 through October 31, 2019 for an additional an additional $5.4 million, bringing the total amount payable under this Agreement to an amount not to exceed $15.3 million. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: New Expenditure Reviewed by Counsel: Yes
31 of 84 PROVIDER NETWORK DEPARTMENT 18. RATIFY AND APPROVE THE SECOND AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH CORONA REGIONAL MEDICAL CENTER Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Second Amendment to the Hospital Per Diem Agreement with Corona Regional Medical Center, effective October 1, 2017. Contact: Kurt Hubler, Chief Network Officer Background: Corona Regional Medical Center is currently a contracted Hospital in the IEHP network. Discussion: The Second Amendment extends the Agreement term beginning October 1, 2017 through September 30, 2019. Attachments C1- Compensation Rates, C2-Notes to Compensation Rates, C3- Compensation Rates-Medicare Advantage Program, C4-Behavioral Health Compensation Rates and G-Medicare Advantage Program were replaced. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
32 of 84 PROVIDER NETWORK DEPARTMENT 19. RATIFY AND APPROVE THE TWENTY-SIXTH AMENDMENT TO THE CAPITATED IPA AGREEMENT WITH INLAND FACULTY MEDICAL GROUP Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twenty-Sixth Amendment to the Capitated IPA Agreement with Inland Faculty Medical Group, effective October 1, 2017. Contact: Kurt Hubler, Chief Network Officer Background: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twenty-Sixth Amendment to the Capitated IPA Agreement with Inland Faculty Medical Group, effective October 1, 2017. Discussion: Inland Faculty Medical Group is currently a contracted IPA in the IEHP network. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
33 of 84 PROVIDER NETWORK DEPARTMENT 20. RATIFY AND APPROVE THE TWELFTH AMENDMENT TO THE CAPITATED FULL SERVICE AGREEMENT WITH KAISER FOUNDATION HEALTH PLAN, INC., SOUTHERN CALIFORNIA REGION Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Twelfth Amendment to the Capitated Full Service Agreement with Kaiser Foundation Health Plan, Inc., Southern California Region, effective October 1, 2017. Contact: Kurt Hubler, Chief Network Officer Background: Kaiser Foundation Health Plan, Inc., Southern California Region is currently a contracted IPA in the IEHP network. Discussion: The Twelfth Amendment extends the Agreement term beginning October 1, 2017 through September 30, 2022. Attachment D, Financial Responsibility Matrix was replaced to reflect updates in the division of financial responsibility. In addition Attachment F, Delegation of NCQA Delegated Activities and Contracts was replaced with the Delegation Agreement. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
34 of 84 PROVIDER NETWORK DEPARTMENT 21. RATIFY AND APPROVE THE NINTH AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH MOUNTAINS COMMUNITY HOSPITAL Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Ninth Amendment to the Hospital Per Diem Agreement with Mountains Community Hospital, effective October 1, 2017. Contact: Kurt Hubler, Chief Network Officer Background: Mountains Community Hospital is currently a contracted Hospital in the IEHP network. Discussion: The Ninth Amendment extends the term beginning October 1, 2017 through October 31, 2017. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
35 of 84 PROVIDER NETWORK DEPARTMENT 22. APPROVE THE CAPITATED PRIMARY CARE PROVIDER AGREEMENT WITH PRIMARY CARE HEALTH NETWORK, LLC, dba INTEGRATED HEALTH PARTNERS Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the Capitated Primary Care Provider Agreement with Primary Care Health Network, LLC, dba Integrated Health Partners, effective January 1, 2018. Contact: Kurt Hubler, Chief Network Officer Background: Primary Care Health Network, LLC, dba Integrated Health Partners has agreed to participate in the IEHP Provider network with all product lines of business. Discussion: The Capitated Primary Care Provider Agreement was modified to include Attachment B-2, Performance Programs for Primary Care Health Network, LLC, dba Integrated Health Partners. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
36 of 84 PROVIDER NETWORK DEPARTMENT 23. RATIFY AND APPROVE THE TWENTY SECOND AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH RIVERSIDE UNIVERSITY HEALTH SYSTEM MEDICAL CENTER Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Second Amendment to the Hospital Per Diem Agreement with Riverside University Health System Medical Center, effective November 1, 2017. Contact: Kurt Hubler, Chief Network Officer Background: Riverside University Health System Medical Center is currently a contracted Hospital in the IEHP network. Discussion: The Twenty Second Amendment extends the Agreement beginning November 1, 2017 through April 30, 2018. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
37 of 84 PROVIDER NETWORK DEPARTMENT 24. RATIFY AND APPROVE THE SECOND AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH TEMECULA VALLEY HOSPITAL, INC. Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Second Amendment to the Hospital Per Diem Agreement with Temecula Valley Hospital, Inc., effective October 1, 2017. Contact: Kurt Hubler, Chief Network Officer Background: Temecula Valley Hospital, Inc. is currently a contracted Hospital in the IEHP network. Discussion: The Second Amendment extends the Agreement term beginning October 1, 2017 through September 30, 2019 and reflects new rates in Attachment C, Compensation Rates. In addition, the Attachments C2-Notes to Compensation Rates and F-Medicare Advantage Program were replaced. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
38 of 84 PROVIDER NETWORK DEPARTMENT 25. RATIFY AND APPROVE THE SECOND AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT WITH UNIVERSAL HEALTH SERVICES OF RANCHO SPRINGS, INC., dba SOUTHWEST HEALTHCARE SYSTEM Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the Second Amendment to the Hospital Per Diem Agreement with Universal Health Services of Rancho Springs, Inc., dba Southwest Healthcare System, effective October 1, 2017. Contact: Kurt Hubler, Chief Network Officer Background: Universal Health Services of Rancho Springs, Inc., dba Southwest Healthcare System is currently a contracted Hospital in the IEHP network. Discussion: The Second Amendment extends the Agreement term beginning October 1, 2017 through September 30, 2019 and includes new rates in Attachment C, Compensation Rates. In addition, the following Attachments C1-Notes to Compensation Rates, C2-Compensation Rates-Medicare Advantage Program, F-Participating Healthcare Facilities and G-Medicare Advantage Program were replaced. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
39 of 84 PROVIDER NETWORK DEPARTMENT 26. RATIFY AND APPROVE THE FIRST AMENDMENT TO THE HOSPITAL PER DIEM AGREEMENT FOR BEHAVIORAL HEALTH SERVICES WITH VISTA BEHAVIORAL HOSPITAL, LLC, dba PACIFIC GROVE HOSPITAL Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) ratify and approve the First Amendment to the Hospital Per Diem Agreement for Behavioral Health Services with Vista Behavioral Hospital, LLC, dba Pacific Grove Hospital, effective November 1, 2017. Contact: Kurt Hubler, Chief Network Officer Background: Vista Behavioral Hospital, LLC, dba Pacific Grove Hospital is currently a contracted Hospital in the IEHP network. Discussion: The First Amendment extends the current term of the Agreement until October 31, 2019 and reflects new rates in Attachment C, Compensation Rates. In addition, the Attachments B-Hospital Services, C2-Notes to Compensation Rates and F-Medicare DualChoice were replaced. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: Yes
40 of 84 PROVIDER NETWORK DEPARTMENT 27. APPROVAL OF THE EVERGREEN CONTRACTS Recommended Action: That the Governing Board of the Inland Empire Health Plan (IEHP) approve the listed Evergreen Contracts for an additional one (1) year to five (5) year term. Contact: Kurt Hubler, Chief Network Officer Background: An Evergreen Contract is a contract that automatically renews on the same terms and subject to the same conditions as the original agreement, unless sooner terminated in accordance with the terms and conditions. Discussion: Renewal under the Evergreen Clause of the following Agreements effective, December 1, 2017 1) Ancillary Provider Agreement with AASTHA INC Additional five (5) year term. 2) Ancillary Provider Agreement with Charter Hospice Inc Additional five (5) year term. 3) Ancillary Provider Agreement with Enmed LLC Additional five (5) year term. 4) Ancillary Provider Agreement with ProtoScript Pharmaceuticals Inc Additional five (5) year term. 5) Open Access Provider Agreement with Carrillo Urbina & Castuera Inc Additional five (5) year term. 6) Participating Provider Agreement with Muhammad S Akhtar Additional five (5) year term. 7) Participating Provider Agreement with Milan Kim Additional five (5) year term. 8) Participating Provider Agreement with Barstow Primary Care Clinic Additional three (3) year term. 9) Participating Provider Agreement with Girdhari S Purohit MD Inc Additional three (3) year term. 10) Participating Provider Agreement with Murrieta Valley Surgery Associates Medical Group Inc APC Additional five (5) year term. 11) Participating Provider Agreement Sameer Gupta MD A Medical Corporation Additional three (3) year term. 12) Participating Provider Agreement with Ultimate Sports and Orthopedics Additional five (5) year term. 13) Urgent Care Provider Agreement with ABC Medical Corporation Additional five (5) year term. 14) Urgent Care Provider Agreement with Alliance Urgent Care Inc Additional five (5) year term. 15) Urgent Care Provider Agreement with Citrus Valley Medical Associates Inc Additional five (5) year term.
41 of 84 Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: Included in FY 17/18 Budget Reviewed by Counsel: N/A
42 of 84 POLICY AGENDA November 13, 2017 ADMINISTRATION 28. MONTHLY MEMBERSHIP REPORT Recommended Action: Review and File Contact: Bradley P. Gilbert, M.D., Chief Executive Officer Background: This report reflects actual membership projections in the IEHP budget. Discussion: Membership remains essentially flat with some continued growth in Medicare and small decreases in Medi-Cal. Fiscal Year Month Forecast Membership Actual Membership + or Forecast + or Last Month FY 17/18 July, 2017 1,262,618 1,258,068 (4,550) (845) August, 2017 1,264,702 1,256,441 (8,261) (1,627) September, 2017 1,266,787 1,255,361 (11,426) (1,080) Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: None Reviewed by Counsel: N/A
43 of 84 ADMINISTRATION 29. OVERVIEW OF THE 2017 IEHP EMPLOYEE ENGAGEMENT SURVEY Recommended Action: Review and File Contact: Bradley P. Gilbert, M.D., Chief Executive Officer Janet Nix, Chief of Organizational Development Background: IEHP s growth has prompted a need to better understand the organization s strengths and opportunities in order to retain top talent and maintain a positive work culture. In order to understand how IEHP can improve the work environment and fully engage team members, IEHP has partnered with the Advisory Board to assess the level of engagement. Although this is the third year measuring employee engagement, it is the first year with the Advisory Board. The previous vendor, NBRI, did not provide IEHP with an effective way to analyze the data. The Advisory Board has a web based tool that allows each leader to access and analyze their results so that they can assess their strengths and weaknesses across a variety of workplace attributes. IEHP is using this information in comparison to other like industries, celebrate successes, and further improve the environment for IEHP Team Members. From September 11 th 22 nd, IEHP asked Team Members to complete the third annual company Engagement Survey. The Team Member participation rate was at 97% and for three years in a row, according to the Advisory Board, considered the best participation rate they have experience across their national database. Discussion: The Advisory Board works with over 1100 Health Care organizations throughout the United States and has over one million respondents in its engagement database. Engagement is measured through four (4) questions, measures the attributes of an engaged employee and serves as the dependent variable: 1. I am willing to put in a great deal of effort in order to help this organization succeed. 2. This organization inspires me to perform my best. 3. I would recommend this organization to my friends as a great place to work. 4. I am likely to be working for this organization three years from now. To be considered engaged, respondents must answer Strongly Agree to at least two (2) of the four (4) items listed above, and no less than Agree to any item. In addition to the four (4) engagement questions, respondents are asked an additional 42 questions that are called engagement drivers. These driver questions measure employee perceptions of items that impact engagement and serves as an independent variable. (See Attachment A)
44 of 84 Results: 62.8% of IEHP Team Members are engaged based on the methodology mentioned above. This puts IEHP in the 92 nd percentile based on the national benchmark and making IEHP one of the top performing organizations in the Advisory Board cohort. Top Driver Strengths: The top driver strengths are the 3-8 questions on which IEHP is performing the best, factoring in 1) IEHP score compared to the national benchmark; and 2) the relative impact of each driver on engagement. Driver % A/SA The benefits provided by my organization (such as health care, retirement savings, etc.) meet my needs. Bench % A/SA Gap Stat Sig Top Impact Driver 94.5% 62.9% 31.6% Y (+) Y I am kept informed of the organization's future plans and direction. 81.9% 61.3% 20.6% Y (+) N My organization supplies me with the equipment I need. 86.6% 67.8% 18.8% Y (+) N My organization gives back to the community. 95.7% 79.3% 16.4% Y (+) Y The actions of executives in my organization reflect our mission and values. 82.9% 66.6% 16.2% Y (+) Y I am interested in promotion opportunities in my unit/department. 81.3% 66.9% 14.5% Y (+) Y Executives at my organization respect the contributions of my unit/department. 73.7% 59.0% 14.7% Y (+) Y Top Driver Improvement Opportunities: The top driver improvement opportunities are the 3-8 questions on which IEHP has the greatest opportunity for improvement, factoring in 1) IEHP score compared to the national benchmark; and 2) the relative impact of each driver on engagement. Driver % A/SA My current job is a good match for my skills 77.3% 82.4% I know what is required to perform well in my job 85.7% 90.1% I receive effective on the job training 65.5% 67.9% Bench % A/SA Gap Stat Sig Top Impact Driver - 5.2% Y (-) Y - 4.4% Y (-) Y - 2.4% Y (-) N
45 of 84 Next Steps: IEHP is encouraged to be moving in the right direction as it continues a focus on Team Member engagement. During the month of November, each leader will be going over the results for their specific department/unit. Team members will have the opportunity to provide input as to how they and their team can celebrate what is working well and address some of the challenges in their work environment. Team member involvement in this phase of the engagement process will help further improve the Team Culture at IEHP. Each level of leadership will choose specific survey items and build a plan to address any deficiencies using the following guidelines: 1. Company-wide focus on two (2) of the top challenges in the area of job expectations or effective training. 2. Directors will choose 1 of the 2 company-wide focus areas plus one specific to their unit. 3. Managers/Supervisors will focus on the company wide area chosen at the Director level plus one specific to their unit. In six months IEHP will have the opportunity to do pulse surveys for those areas that have significant challenges to see if the action plans have made any impact on the targeted goals and adjust as needed. In conclusion, for the third consecutive year, IEHP has good overall scores and, with continued focus, expects next year s scores to continue to improve. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact: None Reviewed by Counsel: N/A
46 of 84 Attachment A Advisory Board Survey Questions Strongly Disagree Disagree Tend to Disagree Tend to Agree Agree Strongly Agree Questions Measuring Engagement I would recommend this ORGANIZATION to my friends as a great place to work. This ORGANIZATION inspires me to perform my best. I am likely to be working for this ORGANIZATION three years from now. I am willing to put in a great deal of effort in order to help this ORGANIZATION succeed. Drivers of Engagement 1) I am kept informed of IEHP s future plans and direction 2) I understand how my daily work contributes to the IEHP s mission 3) I know what is required to perform well in my job 4) My direct supervisor communicates messages that my coworkers need to hear, even when the information is unpleasant 5) My ideas and suggestions are valued by IEHP 6) My direct supervisor is open and responsive to staff input 7) I have the right amount of independence in my work 8) I have good personal relationships with coworkers in my unit/department 9) My coworkers do a good job 10) I receive the necessary support from Team Members in my unit/department to help me succeed in my work 11) I receive the necessary support from Team Members in other units/departments to help me succeed in my work 12) The actions of Chief Officers at IEHP reflect our mission and values 13) Abusive behavior is not tolerated at IEHP 14) My direct supervisor stands up for the interests of my unit/department 15) Conflicts are resolved fairly in my unit/department 16) I am interested in promotion opportunities in my unit/department 17) I receive effective on the job training 18) I have helpful discussions with my direct supervisor about my career 19) My direct supervisor helps me learn new skills 20) My most recent performance review helped me to improve 21) Training and development opportunities offered by IEHP have helped me to improve 22) My direct supervisor helps me explore other jobs within IEHP 23) My current job is a good match for my skills 24) I receive regular feedback from my direct supervisor on my performance 25) IEHP pays me fairly for my job 26) The benefits provided by IEHP (such as health care, retirement savings, etc.) meet my needs 27) I have job security 28) IEHP helps me deal with stress and burnout
29) IEHP recognizes colleagues for excellent work 30) Chief Officers at IEHP respect the contributions of my unit/department 31) IEHP provides excellent care to patients 32) IEHP provides excellent customer service to patients 33) IEHPN gives back to the community 34) I have a manageable workload 35) My unit/department has enough staff 36) I believe in IEHP s mission 37) IEHP supplies me with the equipment I need 38) My direct supervisor helps me balance my job and personal life 39) IEHP does a good job of selecting and implementing new technologies to support my work 40) IEHP supports colleague safety 41) IEHP understands and respects differences among colleagues (gender, race, age, religion, etc.) 42) Over the past year I have never been asked to do something that compromises my values 47 of 84
48 of 84 POLICY AGENDA November 13, 2017 FINANCE DEPARTMENT 30. REVIEW OF MONTHLY FINANCIALS Recommended Action Review and File Contact Keenan Freeman, Chief Financial Officer Background This report is presented monthly and is a Summary of the Financial Statements. Discussion Summary Income Statement for the Month Ended September 30, 2017. Highlights: Enrollment of approximately 1.3M members generated a net surplus of $11.3M for the month ended September 30, 2017. The positive revenue variance of $1.7M is due to higher than expected LTC enrollment in Medi- Cal offset by a retroactive rate retraction for Medicare Non Dual Part A members going back to January 2015. The negative medical cost variance of $3M is due primarily to a $2M City of Hope catastrophic claim, increased expansion of the transportation benefit and increasing facility costs. Summary Income Statement for the Month Ended September 30, 2017 on the following page. Strategic Priorities: Quality of Care Access to Care Practice Transformation Human Development Technology Not Applicable Fiscal Impact Included in FY 17/18 Budget Reviewed by Counsel N/A
POLICY AGENDA November 13, 2017 Inland Empire Health Plan Summary Income Statement for the Month Ended September 30, 2017 Actual Budget Variance $ Operating Revenue Medi-Cal 332,435,443 328,689,217 3,746,226 Medicare 29,252,470 31,328,208 (2,075,739) Net Revenue 361,687,913 360,017,426 1,670,487 Medical Costs Total Medi-Cal Costs 306,857,761 303,017,671 (3,840,090) Total Medicare Costs 29,626,356 30,408,650 782,295 Total Medical Costs 336,484,117 333,426,322 (3,057,795) Gross Margin 25,203,796 26,591,104 (1,387,308) Operating Expenses Total Operating Expenses 16,364,358 18,674,339 2,309,980 Operating Surplus (Deficit) 8,839,438 7,916,766 922,672 Total AB85 1,905,772 1,962,767 (56,996) Other Income (Expense) 793,848 437,865 355,983 Property Management Income (Expense) (245,284) (132,056) (113,228) (Expense) 2,454,336 2,268,577 185,759 Net Surplus (Deficit) 11,293,773 10,185,342 1,108,431 Note: Totals may be subject to immaterial rounding differences. 49 of 84
50 of 84 POLICY AGENDA November 13, 2017 Discussion Summary Income Statement on a Year-To-Date basis for the period ended September 30, 2017. Highlights: Member Months of approximately 3.8 million generated a net surplus of $13.7 million for three months ended September 30, 2017: The $5.5M negative revenue variance is due to an increase in MCE reserves totaling $13.6M for a Duals rate retraction and a Non-Dual Part A rate adjustment offset by $5.0M CMC Mid Year adjustment true up and $6.5M in retroactive enrollment gains for MLTSS Duals and LTC nonduals. The negative medical cost variance is due to a 50% increase in the MLTSS institutional enrollment dating back to 1/2017, expansion of the transportation benefit, adverse claim development for prior periods, catastrophic claim of $2M, and increase facility costs. Non-operating income includes $30M in AB85 25% rate range revenue. $25M was recorded in August 2017 related to FY1516 AB85 25%. Summary Income Statement for the Three Months Ended September 30, 2017 on the following page.
POLICY AGENDA November 13, 2017 Inland Empire Health Plan Year-To-Date Summary Income Statement for the period ended September 30, 2017. Actual Budget Variance $ Operating Revenue Medi-Cal 979,392,896 982,519,033 (3,126,137) Medicare 90,579,255 92,992,565 (2,413,311) Net Revenue 1,069,972,151 1,075,511,599 (5,539,448) Medical Costs Total Medi-Cal Costs 944,442,443 908,434,492 (36,007,951) Total Medicare Costs 94,494,856 90,683,111 (3,811,744) Total Medical Costs 1,038,937,298 999,117,603 (39,819,695) Gross Margin 31,034,853 76,393,995 (45,359,143) Operating Expenses Total Operating Expenses 48,198,886 56,809,328 8,610,442 Operating Surplus (Deficit) (17,164,033) 19,584,667 (36,748,700) Total AB85 30,476,115 5,918,108 24,558,007 Other Income (Expense) 915,100 1,314,099 (399,000) Property Management Income (Expense) (566,827) (420,737) (146,090) Total Non Operating Income (Expense) 30,824,388 6,811,470 24,012,918 Net Surplus (Deficit) 13,660,355 26,396,138 (12,735,782) Note: Totals may be subject to immaterial rounding differences. 51 of 84
POLICY AGENDA November 13, 2017 Discussion Balance Sheet as of September 30, 2017. Cash increased by $463.2M due to a primarily due to $456.0M related to funds for FY1516 IGT, SB208, and HQAF. The funds were not disbursed until the following month. Accrued Medical expenses increase by $419.4M is due primarily to undisbursed funding for $456.0M FY1516 IGT, SB208 and HQAF and a $2.0M one-time City of Hope in patient catastrophic claim offset by $25.2M advance payments to RUHS related to AB85 and IGT rate range and $13.2M quarterly MCE risk share payments. The 60 day Operating Expense Liquidity reserve is an internal reserve requirement set by IEHP executive management and the Board of Supervisors to address potential concerns regarding the timeliness of revenue payments from DHCS. At the end of September, the liquidity reserve is noncompliant at 90.95% of its target of 100%. However, IEHP s Tangible Net Equity exceeds the DMHC statutory requirement. The following graph shows the trend line for the liquidity reserve. 98.00% 96.00% 94.00% 92.00% 90.00% 88.00% Projected Liquid Reserve% Liquid Reserve% 86.00% 84.00% 82.00% Sep-16 Nov-16 Jan-17 Mar-17 May-17 Jul-17 Sep-17 Nov-17 Jan-18 Mar-18 52 of 84
POLICY AGENDA November 13, 2017 Inland Empire Health Plan Balance Sheet as of September 30, 2017 Sep Aug Jun FY1718 FY1718 FY1617 ASSETS CURRENT ASSETS Cash 1,145,046,334 681,821,977 949,040,116 Restricted Fund 300,000 300,000 303,662 DHCS Receivable 247,870,109 225,019,421 519,225,053 Other Receivables 170,428,768 196,527,430 193,569,877 Prepaid Expenses 9,066,674 10,906,462 8,865,964 TOTAL CURRENT ASSETS 1,572,711,886 1,114,575,289 1,671,004,673 FIXED ASSETS Building, Office Furniture & Equipment 226,971,825 223,869,455 215,012,173 Accumulated Depreciation (46,445,522) (45,584,254) (43,760,601) NET FIXED ASSETS 180,526,303 178,285,201 171,251,572 DEFERRED OUTFLOWS OF RESOURCES 47,538,705 47,845,237 47,820,320 NET OTHER ASSETS (21,311,572) (21,311,572) (21,311,572) TOTAL ASSETS 1,779,465,322 1,319,394,155 1,868,764,993 Note: Totals may be subject to immaterial rounding differences. 53 of 84
POLICY AGENDA November 13, 2017 Inland Empire Health Plan Balance Sheet as of September 30, 2017 LIABILITIES AND NET ASSETS CURRENT LIABILITIES MEDICAL Incurred But Not Reported (IBNR) 304,255,994 300,155,661 283,912,180 Accrued Medical Expenses 560,875,902 141,519,224 152,063,914 Capitation Payable 453,997 296,367 289,561 Deferred Revenue 35,276,845-32,664,167 OTHER Due to DHCS - - 512,847,641 Due to BOE 2,387,405 12,105,160 21,215,836 Due to CMS - - - Due to DOI - - - ADMINISTRATIVE Accounts Payable 2,337,634 2,987,765 1,210,287 Accrued Operating Expenses 25,168,227 25,189,127 23,208,518 Accrued Salaries and Benefits 11,020,367 10,765,125 17,191,545 Tenant Deposits & Prepaids 360,090 292,614 349,274 Current Portion of LTD 291,713 435,277 435,277 TOTAL CURRENT LIABILITIES 942,428,173 493,746,321 1,045,388,200 LONG TERM LIABILITIES Lease Payable 291,713 339,736 435,277 Note Payable - - - Less Current Portion of LTD (291,713) (435,277) (435,277) TOTAL LONG TERM LIABILITIES - (95,541) - DEFERRED INFLOWS OF RESOURCES 5,173,813 5,173,813 5,173,813 TOTAL LIABILITIES 947,601,986 498,824,592 1,050,562,013 Increase (Decrease) in Net Assets 13,660,355 2,366,582 129,486,977 TNE Requirement 154,241,115 152,973,139 148,243,204 Reserve for FQHC - - - Residual Fund Balance 663,961,866 665,229,841 540,472,800 NET ASSETS 831,863,336 820,569,562 818,202,981 TOTAL LIABILITIES AND NET ASSETS 1,779,465,322 1,319,394,155 1,868,764,993 Note: Totals may be subject to immaterial rounding differences. 54 of 84
55 of 84 POLICY AGENDA November 13, 2017 MEDICAL SERVICES DEPARTMENT 31. OVERVIEW OF 2017 MEDICAID AND MEDICARE CONSUMER ASSESSMENT OF HEALTH PROVIDERS & SYSTEMS ADULT MEMBER SATISFACTION SURVEY RESULTS. Recommended Action: Review and File Contact: Jennifer N. Sayles, M.D., M.P.H. Chief Medical Officer Background: The Consumer Assessment of Health Providers & Systems (CAHPS ) Adult Member Survey and Child Member Survey are National Committee for Quality Assurance (NCQA) required standardized member healthcare consumer satisfaction assessments. The surveys identify potential opportunities to improve members experiences for participating health plans. The 2017 CAHPS surveys used a mixed methodology approach (mail and telephone). 1. For the Medi-Cal adult survey, a systematic random sample of IEHP Members, age 18 years or older as of December 31, 2016, who were continuously enrolled in IEHP for at least six months. A total of 378 completed surveys were received to yield a 21.5% response rate. 2. For the Medicare adult survey, a systematic random sample of IEHP Members, age 18 years or older as of December 31, 2016, who were continuously enrolled in IEHP for at least six months. A total of 521 completed surveys were valid, yielding a survey response rate of 34.9%. Discussion: Medi-Cal 2017 Results 1. The following measures are used by NCQA Accreditation to score the Medi-Cal population: a. Overall Ratings: i. Personal Doctor ii. Health Care iii. Specialist iv. Health Plan b. Composites: i. Getting Needed Care (2 questions) ii. Getting Care Quickly (2 questions) iii. How Well Doctors Communicate (4 questions) iv. Customer Service (2 questions)
56 of 84 POLICY AGENDA November 13, 2017 2. Medi-Cal Overall Rating Results: One statistically significant change in the rates between the 2017 and 2016 rates was observed. Specifically, the Composite Rating: How Well Doctors Communicate demonstrated a statistically significant decrease in rates compared to the prior year. Medi-Cal Overall Ratings: The CAHPS Survey uses a 0-10 rating (0 worst, 10 best) to assess Member s Overall Ratings. The proportion of Members who scored 8, 9 or 10 is depicted in the chart below. 3. Medi-Cal Composite Ratings: The CAHPS Survey uses an always, usually, sometimes or never scale for Composite responses. The usually or always rate percentage is graphed below. The 2016 results were compared to the 2017 results for each composite performance area. The difference between the scores for How Well Doctors Communicate was found to be statistically significantly lower, as determined by z-test of proportions analyses (p < 0.05 for all comparisons). All other composites were not found to be to be statistically significant when compared to prior year performance (p > 0.05).