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HomeMy WebLinkAboutMINUTES - 06252013 - C.155PDF Return C.155 To: Board of Supervisors From: William Walker, M.D., Health Services Director Date: June 25, 2013 Contra Costa County Subject:2011 and 2012 Annual Report from the Managed Care Commission APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 06/25/2013 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS Contact:Patricia Tanquary, 313-6004 cc:T Scott D Gary Deboran Everist I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: June 25, 2013 David Twa, BY:, Deputy RECOMMENDATION(S): Receive the 2011 and 2012 Annual Report submitted by the Managed Care Commission. FISCAL IMPACT: No fiscal impact. BACKGROUND: On June 18, 2002, the Board of Supervisors adopted Resolution NO. 2002/377, which requires that each regular and ongoing board, commission, or committee shall annually report to the Board of Supervisors on its activities, accomplishments membership attendance, required training/certification (if any), and proposed work plan or objectives for the following year. BACKGROUND: (CONT'D) Annual reports shall follow the following format and shall not exceed two typewritten pages: Advisory Body Name Advisory Body Meeting Time/Location Chair (during the reporting period) Staffperson (during the reporting period) Reporting Period AgendaQuick©2005 - 2022 Destiny Software Inc., All Rights Reserved 2011 ANNUAL REPORT of the CCHP MANAGED CARE COMMISSION to the CONTRA COSTA COUNTY BOARD OF SUPERVISORS Chair: Joan Lautenberger Meeting Time/Location: 3rd Wednesday of every other month, 4-5:30 p.m. 595 Center Avenue, Suite 200B, Martinez Staff: Deboran Everist The primary topics discussed throughout 2011 were the Health Care Reform and Waiver legislations with budgetary concerns for Provider Payment Reductions in conjunction with SPD Readiness, SPD Cultural Sensitivity Training, and Pediatric Obesity Efforts and Outcomes. Managed Care Commission – Activities and Accomplishments for 2011 • The 2011 Annual Quality Management Program Description & Work Plan was introduced and accepted. Highlights included HEDIS data submission and the algorithm used to determine the default. Gradually CCHP’s share of default assignments increased to 100% based on quality and safety net access. CCHP received an A-plus for efforts to improve the quality of care for children enrolled in the Healthy Families Program. CCHP was one of six statewide to achieve the “Superior Performance” designation in 2008, awarded by the Managed Risk Medical Insurance Board. • Monitored status of key CCHP units throughout the year with standing reports from Quality Assurance, Customer Relations and Resource Management including Pharmacy, Authorizations / Utilization Management, Case Management, Marketing and Member Services and the Advice Nurse units. • Updated on enrollment numbers for all the health plan products at each meeting. • Accepted resignations – - CCHP Commercial Subscriber Seat (retired, moved out of the area), - Member-at-Large Seat #9 (contracted with CCHP) • Reappointed the three Commissioners whose terms were expiring in August. CCHP is grateful that all Commissioners wished to continue service on the MCC. • Welcomed 2 new appointments for Member-at-Large and Commercial Subscriber seats. • Kept apprised of health care reform through reports of meetings, testimony, and detailed analysis reports. • Tracked the on-going success of mandated SPDs into Managed Care and the impact of the program on the county. • Presented the monthly Grievance Report reflecting the small numbers of complaints. The complaints ranged from <1% to <5% notwithstanding the addition of approximately 1,000 mandated new members a month from the SPD population. • Reviewed the growth trends in populations served. MediCal grew 17%, SNP grew 54%, county employees grew by 1%, Healthy Families grew by 33% and overall membership grew by 11%. Managed Care Commission – Focus Topics • The 2011 Annual Quality Management Program Description & Work Plan was introduced and accepted. Highlights included HEDIS data submission and the algorithm used to determine the default. Gradually CCHPs share of default assignments increased to 100% based on quality and safety net access. CCHP received an A-plus for efforts to improve the quality of care for children enrolled in the Healthy Families Program. CCHP was one of six statewide to achieve the “Superior Performance” designation in 2008, awarded by the Managed Risk Medical Insurance Board. • CCHP prepared for the mandatory enrollment of the non-dual Medi-Cal Fee-for-Service adults (Seniors and Persons with Disabilities – SPDs) into Managed Care. The enrollment began in June 2011 and continued over a 12-month period. SPD strategic planning had three components: (1) Provider Recruitment; (2) Member Orientation; and, (3) Transition Care. Databases for transitioning care were created to transmit state utilization, claims and Treatment Authorization Request (TAR) data about these members to the providers, Authorization/Utilization Department and Pharmacy Department within the Health Plan to facilitate their continuity of care. The data was also useful in identifying high risk and low risk members needing case management. • CCHP created a SPD Cultural Sensitivity Training program. CCHP conducted two (2) community physician trainings, one in East County and one in West County in addition to all of CCHP staff. The training is on-going and available on-line. The focus of the training is sensitivity and practical items, such as: what is disability? Disability is the interaction of physical, sensory, or cognitive impairment with environmental factors, either temporary or permanent including mental health conditions. • CCHP closed its Special Needs Program (SNP). CCHP is actively restructuring to serve this population in a different way as the state eliminated in California the entire benefit of Adult Day Health Care (ADHC) as of December 2011. This benefit will become the Community Based Adult Services (CBAS) benefit for those deemed eligible by DHCS. The Medi-Cal and Duals who received ADHC services were enrolled in Managed Care in October 2011 and CCHP received most of these patients in our county. This population will be mandated into managed care under a Duals Pilot Implementation Program by the year of 2014. CCHP staff is concentrating on continuing to provide the best services in our Culture of Caring while concurrently creating a structure to meet the challenges. • The 2012 focus will be people enrolled in both the federal Medicare program and the state-run Medi-Cal program known as “dually eligible beneficiaries” or “dual eligibles.” New coordinated care systems have been proposed by the State for development and implementation in an effort to make accessing care less confusing and more efficient for dual eligibles. CCHP will be in the forefront of this transition. 2012 ANNUAL REPORT of the CCHP MANAGED CARE COMMISSION to the CONTRA COSTA COUNTY BOARD OF SUPERVISORS Chair: Joan Lautenberger Meeting Time/Location: 3rd Wednesday of every other month, 4-5:30 p.m. 595 Center Avenue, Suite 200B, Martinez Staff: Deboran Everist The primary topics discussed throughout 2012 were people enrolled in both the federal Medicare program and the state-run Medi-Cal program known as “dually eligible beneficiaries” or “dual eligibles”, Health Care Reform, Care Transitions Intervention Program, and the implementation of the electronic medical record system – ccLink. Managed Care Commission – Activities and Accomplishments for 2012 • The Managed Risk Medical Insurance Board (MRMIB) honored the Quality Management group for the second year in a row for superior performance with CCHP HEDIS measures submitted. Out of 11 measures, 5 of the measures scored above the national commercial 90 percentile. CCHP was 1 of 7 Healthy Families plans statewide to receive this honor and 1 of 2 local initiatives. • Monitored status of key CCHP units throughout the year with standing reports from Quality Assurance, Customer Relations and Resource Management including Pharmacy, Authorizations / Utilization Management, Case Management, Marketing and Member Services and the Advice Nurse units. • Apprised of the successful transition of thousands of Seniors and Persons with Disabilities (SPDs) into the Medi-Cal Managed Care System. • Apprised of the Implementation of the Care Transitions Intervention Program to improve quality and safety of care during care transitions. • Kept apprised of the successful implementation of the new electronic health record system (ccLink) and current delivery. • Continuous update on health care reform legislation through reports of meetings, testimony, and detailed analysis reports. • Reviewed monthly Grievance Report reflecting the small numbers of complaints. The complaints ranged from <1% to <5% consistently. • Updated on enrollment numbers for all the health plan products at each meeting and reviewed the growth trends in populations served with 10% of county residences receiving CCHP services. • Accepted resignations – - Member-At-Large Seat #6 resigned by letter. • Approved reappointment of three Commissioners whose terms were expiring. CCHP is grateful that all Commissioners wished to continue service on the MCC. • Welcomed 3 new appointments for two Member-at-Large and one Commercial Subscriber seats Managed Care Commission – Focus Topics • CCHP started the year with the Governor’s Budget Changes to Managed Care to expand managed care to other populations and services. The State changed and added new benefits under Medi-Cal Managed Care. The first part of 2012 focused on changes in the Adult Day Health Center (ADHC), skilled nursing care and Long term care, and In Home Supportive Services (IHSS) changing to CBAS – Community Based Adult Services on March 1, 2012. • The Contra Costa Coordinating Council was established by CCHP to encompass a broad continuum of home and community based service providers to partner with CCHP in improving the dual population’s access to long-term services and supports through the county. • The completion of the successful transition of thousands of Seniors and Persons with Disabilities (SPDs) into the Medi-Cal Managed Care System. • The new electronic health record (EHR) product, ccLink, was launched on July 1, 2012. This system takes advantage of federal funds available for EHR implementation and benefits patients by improving health outcomes. Additionally, this product is the EHR for many of the hospitals and health systems in the Bay Area. • The joint pilot between Advice Nurses and clinic physicians was established. This successful pilot reduced the number of appointments by giving callers the ability to talk with an Advice Nurse who screened callers wanting same day appointments with a promised 2-hour turnaround callback from a physician. The physician can order a lab, change a prescription, order an x-ray and/or schedule a visit if necessary. • The Implementation of the Care Transition Intervention Program which improves the quality and safety of care during care transitions. This transition model is a skill transfer model. It is a coaching model which teaches the patient to take care of themselves. The patient and caregiver are coached to be self empowered and comfortable in making their own healthcare decisions. • 2013 is the preparation year for Health Care Reform. CCHP is preparing for the advent of Health Care Reform (Affordable Care Act) in 2014, which will necessitate NCQA accreditation, and application to participate in the California Health Benefit Exchange (CoveredCalifornia) effective 2014. An early phase of Health Care Reform is the transition of CCHP’s Healthy Families Children into Medi-Cal Managed Care in March 2013.