HomeMy WebLinkAboutMINUTES - 06151993 - H.5 /✓ S
TO: BOARD OF SUPERVISORS
FROM: Contra
Mark Finucane Costa
DATE'. Health Services Director Courty
SUBJECT: June 15, 1993
LETTER OF INTERRST TO DRYFLOP T nr AT TATTTT A x1W
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDATION
Notify the State Department of Health Services before June 30, 1993, of the Board of
Supervisors' interest in establishing the local initiative for Medi-Cal Managed Care in
Contra Costa County.
Establish the Medi-Cal Advisory Planning Commission ("MAPC") a 25 member special
committee which will assure provider, beneficiary, and community input into the
planning for the County sponsored local initiative.
II. FINANCIAL IMPACT
The local initiative will bring in an additional estimated $10413-million a year in Medi-
Cal revenues.
III. REASON FOR RECOMMENDATION / BACKGROUND
On March 31, 1993, the State Department of Health Services issued its Plan for
expanding Medi-Cal managed care which calls for a two-plan model of Medi-Cal
managed care in 13 target counties. Contra Costa County is one of the 13 counties.
The two plan model consists of a locally developed managed care system called the local
initiative and a non-governmental HMO to manage the care of the AFDC linked and
Medically Indigent Children Medi-Cal eligibles. Fee for service Medi-Cal for these
groups will be phased out when the two plan model is implemented.
CONTINUED ON ATTACHMENT: _ YES SIGNATURE: /
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON June 15 , 1993 APPROVED AS RECOMMENDED X OTHER
See Addendum attached for speakers and action of the Board.
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
CC*.: HSD ATTESTED June 15,_1993
CCHP
PHIL BATCHELOR, CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
BY 0DEPUTY
M382/7-83
ADDENDUM to H.5 June 15, 1993
The Board held a public workshop on Health First Planning.
Mark Finucane, Director of Health Services, reviewed the briefing
packet entitled: "Medi-Cal Managed Care: Health First Local
Initiative. " The following interested persons spoke: Pauline A.
Wills, M.D. , Contra Costa Community Coalition for Managed Care;
Edward F. Connolly, MD. , West County Coalition for Managed Care;
Carl Britto, 141 N Civic Drive, Walnut Creek; Doris Disbrow, Mt
Diablo Dietetic Association; and Randy Clarke, Los Medanos
Community Hospital .
The Board Chair acknowledged receipt of a June 7, 1993
letter from the Alameda-Contra Costa Medical Association,
expressing its views on the matter and (attaching letters from
them to the County' s legislative delegation asking them to oppose
the Governor' s proposal to take local property taxes to balance
the state budget) ; and a June 15, 1993 letter from Brookside
Hospital in support of a managed care system.
The Board discussed the matter in some detail and thereupon
APPROVED the recommendations listed in Section 1, including
authorizing a letter of interest to the State Department of
Health Services .
page two
If, by June 30 1993, the Board of Supervisors does not notify the State of its interest in
developing the local initiative, then other local stakeholders will have until August 31,
1993, to develop and submit a proposal for the local initiative. The County will have
lost this opportunity to have a major role in Medi-Cal managed care.
The establishment of the MAPC will assure major representation of both provider and
beneficiary groups in the planning for the local initiative. The State plan specifically
calls for inclusion of these groups in the local initiative process.
43.bo
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AGENDA
1. STATUS REPORT ON HEALTH FIItST PLANNING:
1.1 Internal Planning
1.2 External Task Forces
2. BRIEFING ON THE STATE PLAN FOR EXPANDING MEDI-CAL MANAGED CARE:
2.1 Two-plan Model
2.2 Mental Health Carve Out
2.3 Dental Carve Out
2.4 Community Prevention and Personal Incentives
2.5 Collaboration With Other Counties
2.6 Relationship to National Health Reform
3. REQUEST BOARD OF SUPERVISORS ACTION TO:
3.1 Inform State of Board of Supervisors' Intention to Establish
the Local Initiative
3.2 Establish the Local Medi-Cal Advisory Planning Commission
for the County sponsored Medi-Cal managed care system
L28:615
Briefing Packet ,
for
Board of Supervisors'
Workshop
Medi-Cal Managed Care:
Health First Local Initiative
June 15, 1993
Table of Contents
Pages
..Health First Planning 1.1
..State Plan for Managed Care 2.1-2.3
..Managed Care Eligibles in 3.1-3.7
Contra Costa County
..Managed Care Providers in 4.1-4.2
Contra Costa County
..Health First Mainstream and 5.1-5.3
local Initiative Options
..Community Participation 6.1-6.7
Health First
Planning
• -1 . 1-
HEALTH FIRST PLANNING
Health Services Department (HSD) Activities
ONGOING
1. Internal Planning Group
Members: HSD Senior Staff, CAO- Office, County Counsel
Office, CCHP Medical Consultant
Charge: * Health Services Department system changes needed
for the local initiative
* Relations with community providers
* Relations with community groups
2. External Planning Group
Members: HSD executive staff, representatives of district
hospitals, Children' s Hospital, Hospital Council,
ACCMA, Planned Parenthood,: interested HMOs
Charge: Involvement of community and HMO providers in two-
plan model
SPECIAL MEETINGS
Who: Community-based organizations (CBOs)/Consumer
Representatives
Meeting CBOs: March 3, March 19, June 9
Dates:
All Advisory Boards: Feb. 9, April 13 , June 8
i
The State Plan
for
Managed Care
' -2 . 1-
State Plan
for Expanding Medi-Cal Managed Care
1. Contra Costa is one of thirteen targeted counties to implement managed care for AFDC linked (Aid to
Families with Dependent Children) and MIC (Medically Indigent Children) eligibles.
2. Each targeted county to have two plans.
............... # - Board of Supervisors is given first opportunity to develop the local initiative which
will enroll approximately 60% of the AFDC linked and MIC eligibles or 33,750 individuals.
.................................................
# aristrea ' l" -
Non governmentally operated HMO - contract awarded on competitive bid basis
for approximately 40% of eligibles.
3. The Health Services Department currently serves 72% (or 24,000 individuals) of the proposed local
initiative enrollment.
4. Board of Supervisors given wide range of options for the local initiative.
5. Safety net and traditional providers including disproportionate share hospitals are protected.
" tiTetPractea's - Give care to both Medi-Cal beneficiaries and the indigent. Indigent patients
must be a significant portion of total number of patients served.
"Y' r � aadt ocW - Historically have given care to Medi-Cal beneficiaries.
..............................................:.............
6. Local initiatives must include "safety net" providers willing to provide services under the same terms
and conditions required of any other similar provider, and have "participation standards for traditional
providers which allow their substantial participation."
7. Mainstream plans are encouraged to include safety net and traditional providers (mainstream plan may
be required to contract with safety net disproportionate share hospitals to protect DSH payments).
8. AFDC linked and medically indigent children must enroll in a managed care plan. Other Medi-Cal
(aged, disabled and blind) may voluntarily enroll but may stay in FFS.
9. Beneficiaries have free choice of plans and of primary care providers within the plan.
10. California Children Services (CCS) continues under CCS program.
11. Mental Health Services - Intent to provide these services through county mental health programs in a
separate prepaid, managed care system.
12. Substance Abuse - No changes now in Medi-Cal funded State Department of Alcohol and Drug
Programs (DADP).
13. Dental services - State is exploring contracting with "dental only" prepaid plans.
L28:AC2 Juae 10, 1993
-2.2-
Managed Care ExCountiesExpansion
N e
Siskiyou 14iodac
Cntyname
ulubol t Trinity sh"ta Types of Managed Care
L
"�+..�--�- Counties with Expansion
Tchama Proposed CORS
plulnike Geographic Managed
Glom
Buttc CARE
.
lead o
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YOIO n Dom
onouia a
ti s
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Managed
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ed
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bi
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yc
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ible
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Alameda -
120,712 ,i•••'r•• +r.� _
Contra C06ta SUM$6,257 B`
Fresno
137,983 Veutura — :'' :s-- .•.
Kern72,322
; `
Los Angeles
Riverside
115,943 '�'"':.y.•,'r;1r< .ti..,+•;.�Yr�'•{:.:$
Bernardino 20
San He 7,429 :;: �X ;.�''.;:;, �.•��.;::;::;
San Vieco 217,505
_ ».»•.•••
San Francisco52,416
San Joaquin 80,871 '- c LM1MU1
Santa Clara 105,326
Stanislaus 55,835
Tulare 61,294
moral 2,289,358 :':AFDC LINKED AND MEDICALLY INDIGENT CHILDREN
-2 .3-
State Plan.
Two-year Timetable for Kcal Initiative
Action Date
1993 State Releases Plan for Expanded Medi-Cal Managed Care 4/1/93
State Releases Draft Regulations 5/15/93
County Submits Letter of Interest in Organized
Local Initiative 6/30/93
County Submits Formal Letter of Interest 9/30/93
State Issues Local Initiative Development Contract 10/30/93
County Executes and Returns Local Initiative Contract 11/30/93
1994 County Submits Local Initiative Workplan 3/1/94
State Submits Federal Waivers for Two-plan Model 7/1/94
County Submits Detailed Design Document for
Local Initiative to State 11/1/94
1995 Local Initiative (and mainstream plan) Begins Operations 3/31/95
Managed Care
Eligibles
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Community
Participation
Local
Medi-Cal
Advisory
Planning
Commission
Reword 6/8/93
DRAFT
Contra Costa County
MEDT-CAL ADVISORY PLANNING COMMISSION
OVERVIEW
The Medi-Cal Advisory Planning Commission (MAPC) is a 25 member special
committee appointed by the Contra Costa County Board of Supervisors to assure
provider, consumer, and community input into the planning for the County sponsored
local initiative Medi-Cal managed care system in Contra Costa County. The Board of
Supervisors will solicit nominations in June 1993 and make appointments to the
Commission by August 1993.
The Board of Supervisors will assure ethnic, cultural, and geographic diversity in its
appointments to the Commission. It will also seek to appoint representatives who
are knowledgeable and experienced in meeting the special needs of vulnerable
populations, including Medi-Cal and indigents. In its appointments the Board will also
assure that current patients in the County's health care system are involved in the
planning for transition to managed care.
The Commission will provide long range planning direction and will make
recommendations directly to the Board of Supervisors, the County Health Services
Director, and the Contra Costa Health Plan (CCHP) Advisory Board on the planning for
the County sponsored Medi-Cal managed care system.
FUNCTIONS
The Commission's purview encompasses the County sponsored Medi-Cal managed
care system, its Plan members, and providers. Specific areas which the Commission
will review, monitor, and make recommendations are:
1 . Outcome Measures: The Commission will approve a set of community and
patient outcome goals, and the specific measures to be used in determining the
extent to which these outcomes are being met.
2. Accessibility: The Commission will review and make recommendations on the
proposed access standards.
-6. 2-
3. Quality: The Commission will review and make recommendations on quality
of care issues.
4. Benefits: The Commission will review the scope of benefits and services
offered by the County sponsored system and make recommendations for
modifications.
5. Consumer Satisfaction: The Commission will review and make
recommendations on mechanisms for monitoring consumer satisfaction,
grievances, and complaints.
6. Provider Relationships: The Commission will review mechanisms for provider
satisfaction.
7, Community Health Related Needs: The Commission will review unmet health
related needs in the community and make recommendations how managed care
systems can address these problems.
MEMBERSHIP
The 25 members of MAPC shall be appointed by the CCC Board of Supervisors for a
two year term and shall include:
.....
2... ,abl,ct6enef,,��ary Rep�esentat,ves
6 Advisory Board Representatives -
1 Substance Abuse Advisory Board
1 Maternal & Child Health Advisory Board
1 Mental Health Advisory Board
1 Public & Environmental Health Advisory Board
2 Contra Costa Health Plan Advisory Board
Current Chair of CCHP Advisory Board
Immediate Past Chair of CCHP Advisory Board
3 Community Based Organizations' Representatives
3 Current or Past Medi-Cal Beneficiaries:
1 each from East, West, and Central Contra Costa County
-6. 3-
>';l'>Pra der>Reo se at es
......................................:;:;;p.::.::::::::_....................:.::.:::
1 Registered Nurse - nominated by North Bay Coastal Region IX, CNA
3 Physicians - nominated by the ACCMA:
1 from West County
1 from East County
1 from any region of the County
3 Community Hospitals' Representatives
(Hospitals must include non-County facilities who have historically
demonstrated a loyalty and competence in serving the special needs of
Medi-Cal beneficiaries.)
1 Community Based Provider Organization Representative- Planned Parenthood
1 Dentist nominated by the Contra Costa Dental Society
1 Pharmacist nominated by the Contra Costa Pharmacists' Association
1 other community provider
...............................
.................................
At L`
2 at-large seats appointed by the CCC Board 'of Supervisors.
COMMUNITY PARTICIPATION
To assure that all providers, beneficiaries, and members of the public have the
opportunity to participate in the planning for and implementation of the County
sponsored Medi-Cal managed care program, the Commission shall:
1 . Have regular open meetings conducted at least quarterly and in accordance
with the Ralph M. Brown Act (Gov. Code 54950 et seq.)
2. Annually hold regional hearings in East, Central, and West Contra Costa County
to elicit broad community input.
3. Establish such special committees on an ongoing or limited term basis as
necessary to conduct its work. In addition to the 25 Commission members any
individual or organization may attend and participate on any appropriate special
committee that is established. The Commission Chair shall appoint the Chair of
any special subcommittee. Examples of the types of special committees the
Commission may establish are: committee on issues of the physically disabled;
committee on cultural, linguistic, and ethnic accessibility of services; contract
provider committee.
-6 .4-
Committee meetings shall be regarded as open "workshops" designed to elicit
broad public participation.
OFFICERS & RULES OF PROCEDURE
The initial meeting of MAPC will be called to order by the Chair of the Contra Costa
Health Plan Advisory Board. The Commission shall subsequently elect a Chairperson
and a Vice-Chairperson for terms of one calendar year. The Chairperson and Vice-
Chairperson may serve two consecutive terms of one year each.
The Commission shall consider and adopt By Laws and other organizational rules. It
shall adopt a work plan which includes mission, goals, and principles.
In developing its work plan it shall consider and prioritize the following issues:
Beneficiary Issues:
♦ Client education, rights, responsibilities
♦ Grievance procedures
♦ Needs of special populations, e.g. foster children, children with special needs,
ethnic or cultural groups, mentally disabled, HIV/AIDs, homeless,
undocumented
♦ Accessibility issues
Provider & System Issues:
♦ Roles of traditional providers
♦ Public/private linkages
♦ Integrated service networks
♦ Management of specialized services in regional and central locations
♦ Health professionals' training, e.g. in serving a culturally diverse population
♦ Episodic care/emergency care/urgent care
Community Issues:
♦ Community wide prevention programs
STAFFING
The Commission and its special committees will be staffed by Contra Costa Health
Plan and County Health Services Department administrative staff.
-5 . 5-
i
SUNSET CLAUSE
The Commission will assist in the planning for all phases of the County sponsored
Medi-Cal managed care program. MAPC will be dissolved on September 1, 1996,
unless the Board of Supervisors determines prior to that date that the Commission is
still needed to provide ongoing planning, direction, and advice to the Board of
Supervisors.
L28:MAC 1
6/8/93
-6 .6-
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-5. 7-
i
Medi-Cal Advisory Planning Commission
Organization Chart
Contra Costa County
Board of Supervisors
/
/ Health Services
Department `
—————— Director — Medi Cal Advisory
/ Planning
Contra Costa Commission
Health Plan (MAPC)
Planning Body
(CCHP)
for All Phases
Advisory Board
Reviews All of County
CCHP Programs: Sponsored
Medi-Cal Managed
Medi-Cal Care Program
Medicare
a� Basic Adult Care
car Commercial
(individual,
small group,
large group)
1W MajorRisk
Medical Insurance
Program
1w AIM
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tREC VELE
F. 11
I i 1993
p
June 9, 1993
CLERK BOARD OF SUPERVISORS
CONTRA COSTA('O.
TO: THE CONTRA COSTA COUNTY BOARD OF SUPERVISORS
FROM: THE CONTRA COSTA COMMUNITY COALITION FOR MANAGED CARE
RE: COUNTY' S "HEALTH FIRST" MANAGED CARE PLAN
We are a county-wide coalition of private health care providers
engaged in full time, established primary care practice. We
all have, by tradition, provided services to beneficiaries
of the Medi-Cal program.
We wish to enter into the public record our adamant opposition
to this proposal in its present form, as well as to the transfer
of the administration of Medi-Cal to the county as proposed.
In doing so, we want to make clear that, in principle, we support
capitation financing and local administration of a publicly
sponsored managed care plan under Medi-Cal, open to all people
who want to enroll. But such a plan must assure a) freedom
of choice, b) easy access to community based care and c) a
structure for governance which ensures meaningful participation
by both beneficiaries and plan providers in policy formulation.
As written, the county plan is needlessly divisive for county
and private physicians who, in fact, share a common goal --
to bring health services of high quality to the poor and
disabled. But worse still, this plan would deny low income
minorities the viable opportunity to be integrated into
community-based care in public facilities close to home.
The crux of our opposition is the designation of a new,
centralized county hospital in Martinez as the "centerpiece"
of its plan. This location, now and even more so in the future,
is in no conceivable way, accessible to the minority poor living
in East or West county.
We view this facet to be its Achilles heel because it is
regressive and discriminatory, in clear conflict with widely
accepted health planning precepts, and grossly incompatible
with a pressing national need for health care cost containment,
especially when local taxpayers are, without a vote of the
people, put in the position of shouldering a very shaky financial
risk of a quarter of a billion dollars!
Here, in detail, is precisely why we feel this way:
°At an accelerating pace, health care advances derive
from new and expensive technology. Duplication of such resources
at the local level is no longer tenable, and must be resisted
at every turn by responsible community health leaders.
°A vast majority of the health care needs of a defined
2
population can best be met in a strategically located, community
based health care campus. Certain very high tech tertiary health
resources call for regionalization to avoid costly duplication
in service to many adjacent cities and towns.
.oThe modern community hospital is no longer the epicenter
, of a comprehensive local health strategy. It is, nonetheless,
still an indispensable component of community care due to a
growing array of specialized diagnostic and treatment technology
most efficiently shared by providers under prepayment on an
outpatient basis in a plan hospital. For this reason, location
of primary care centers in close proximity to both referral
specialists and the local hospital is essential to continuity
of care in a low income population with greatly restricted
mobility.
'Proximity also cultivates collaboration in case management
amongst primary physicians and referral specialists, which is
essential to the reduction of preventable admissions and length
of stay in the hospital among socially disadvantaged and disabled
people.
The single most crucial requisite for effective and fiscally
efficient health care is ready access to service facilities
by patients and physicians alike.
Our position, therefore, is easy to articulate and understand.
Managed care in Contra Costa County should be carried out for
vulnerable low income people as close to their homes as possible,
in the well equipped and ideally located district hospitals,
each with sufficient empty beds to serve both Medi-Cal
beneficiaries and county indigents.
Regrettably, this preferable option has never been seriously
explored in good faith by county officials, in spite of the
compelling advantages it offers:
'All problems of access now and in the future can be
permanently resolved.
OCounty patients would not have to be exposed to the
hazards inherent in the use of a long obsolete facility in
Martinez, repetitively in violation of basic licensing
requirements. The county' s liability exposure will continue
for the years it will take to open a new hospital.
oProfessional collaboration between county and private
physicians will be greatly enhanced. We hold in high regard
the medical staff at Merithew and welcome them warmly to the
staffs of the district hospitals. They comprise an invaluable
asset to cope with growing physician shortages in East and West
3
county.
'The mindless and extraordinary costs of building a surplus
hospital where none is needed will be obviated, relieving the
taxpayers of paying twice for the same purpose.
Care in district facilities will be made available on an
equitable basis , without regard to race, color, national origin
or disease. Contrary to assertions of county officials, the
staffs of district hospitals are fully prepared to accommodate
people with mental illness, drug and alcohol problems, as well
as AIDS victims and those in local detention facilities in need
of medical care.
If , in fact, district hospitals become the primary source of
care for low income people, they will be legally entitled to
every state and federal financial resource which has been
accorded county hospitals. But instead of duplicating existing
hospital resources, capital assistance, at vastly lower costs ,
could be put to use to upgrade buildings now used to house
primary care clinics and other county health programs.
Of even greater significance, augmentation of available health
manpower would enable expansion of clinic hours into the evening.
Coverage on nights and weekends of hospital emergency and
inpatient services could be more readily scheduled using county
and private physiciansworking in unison within a capitation
system.
We are anxious to meet, as soon as possible, in an appropriate
forum to explore exhaustively the alternative we propose to
the "HEALTH FIRST" plan.
Too much is at stake to do otherwise. A copy of this position
paper has been sent to Molly Coye M.D. M.P.H. , Director of the
State Dept of Health Services, District Hospital Directors and
the local press to inform the general public.
For further information please contact Pauline A.Wills , M.D.
COALITION CHAIR - 510 235-8870 .
COALITION CHAIR PERSON
PAULINE A. WILLS, M.D.
i
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
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6230 CLAREMONT AVE. • P.O. BOX 2895 • OAKLAND,CA 94618 • 510/654-5383 • FAX 510/6548959
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............. �.
June 7, 1993 DECEIVE®
i
JUN 1 51993
Mr. Mark Finucane, Director CLERK BOARD OF SUPERVISORS
Contra Costa County Health Services Dept. CONTRA COSTA Co.
20 Allen Street
Martinez, CA 94553-3191
Re: Revised Contra Costa County
Medi-Cal Managed Care Proposal
Dear Mr. Finucane:
On behalf of the Alameda-Contra Costa Medical Association (ACCMA) ,
I express our continued concern regarding the status of Contra
Costa County's development of the "Local Initiative" , of the Medi-
cal Managed Care plan. In a meeting on April 29, 1993, you assured
me and other ACCMA representatives that private practicing
physicians in the Contra Costa County would have a reasonable
opportunity to participate in the plan, in accordance with the
guidelines set forth by the State's Strategic Plan for the
development of Medi-Cal Managed Care systems. You also indicated
that you did not intend to pursue the "Health First" proposal in
view of the new State Strategic Plan and the numerous concerns
expressed by the ACCMA and others, with regard to the exclusion of
the private medical community in the planning process and as
participants. In our recent meetings with you and members of your
.department, it appears that your representations on April 29th were
false and not your true intentions.
The emphasis of your efforts appears to focus on gaining "market
share" and expanding the Contra Costa Health Plan to the detriment
of Medi-Cal patients and those private physicians who have
traditionally cared for large numbers of these patients. We have
stated to you in previous correspondence that this would be harmful
to the continuity of care for these patients and is unacceptable to
US.
You may recall that during our meeting on May 10, 1993, based on
the handout you gave us, we asked why private physicians were being
excluded from the Phase I expansion of Managed Care under the
"Local Initiative" . It was acknowledged that we had raised a good
point and that our observation was correct. Contracting with
private physicians, previously included in the Health First
proposal and deemed by you as indispensable to serving the Medi-Cal
population, had been eliminated. Further, we were informed that we
Cc: BOARD MEMBERS (ProvideO
Mr. Mark Finucane
June 7, 1993
Page 2
shouldn't be concerned because the initial expansion (from 9,000 to
24,000) , was merely the assumption of the current County Health
Services fee-for-service patients already being seen at the
County's facilities. Mr. Camhi was quick to point out that in Phase
IV, the organization chart showed that contracting with Community
M.D.s in their own offices would be accomplished..
Subsequent to this meeting, Mr. Gene Draper had a telephone
conversation with Mr. Camhi and raised our serious concerns about
this exclusion; that it contradicted your previous statements and
the State's Strategic Plan concerning the preservation of existing
physician-patient relationships and the inclusion of the
"traditional providers" in this process. Mr. Draper indicated, and
Mr. Camhi acknowledged, our opposition to this exclusion.
It was unfortunate that you were unable to attend the luncheon
meeting of May 20, 1993, held in your office. Representatives of
Raiser and Children's hospital were present when Mr. Draper
reiterated this issue. Mr. Camhi responded that it was the County's
intention to expand the CCHP by hiring seven physicians. This was.
presented as a simpler solution than contracting with private
physicians. One other reason given was the necessity for CCHP to
modify its plan with the Department of Corporations to establish a
capitated payment methodology, as opposed to the current salaried
methodology. Also, that it was much easier to control and
coordinate physicians' services through a staff model HMO. Mr.
Camhi asked Mr. Draper why the private physicians wanted to be
included in the "Local Initiative" instead of just being involved
in the "Mainstream Plan" . He advised Mr. Camhi that ACCMA believes
it was the intent of State Department of Health Services Director
to include, not exclude, the "Traditional Providers" from
participation. in either of the proposed models. Mr. Camhi
responded by saying that his interpretation of the Strategic Plan
is that the "Local Initiative" is only required to contract with
all safety net providers willing to do so, according to specific
requirements and standards. We disagree with this interpretation
and, as Mr. Draper indicated, the ACCMA will pursue this matter
further with the State Department of Health, State legislators and
the Contra Costa Board of Supervisors, if necessary.
The ACCMA and physicians in Contra Costa County do not believe that
you or your staff have a sincere intention of working in good faith
with the private physician community in the development of a plan
which meets the expressed intent of Doctor Molly Coye, who, in her
May 14, 1993 letter to physicians assured. . . "participation in the
locally-developed managed care plans to traditional and safety net
providers. "
r `
Mr. Mark Finucane
June 7, 1993
Page 3
Instead, we believe, it is your intent to significantly expand the
County owned and controlled Staff Model HMO, through a process only
referred to as a "Local Initiative" and, in doing so, to take those
patients currently served by the private physicians into that
system. This attempt is regarded by us as a conflict with the State
Strategic Plan and most likely an action that presents a conflict
of interest for the Contra Costa County Board of Supervisors.
Your response to our concerns is requested.
Sincerely,
c
Joseph W. Clift, M.D.
President
cc: Molly J. Coye, M.D. , Director, DHS
Mr. John Rodriguez, Chief Deputy Programs, DHS
Mr.- Jose Fernandez,' Deputy Director, DHS
Contra Costa County Board of Supervisors
Assemblyman Richard K. Rainey
Assemblyman Robert J. Campbell
Senator Daniel E. Boatwright
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
6230 CLAREMONT AVE. • P.O.BOX 2895 OAKLAND,CA 94618 • 5101654-5383 FAX 5101654-8959
June 2, 1993
The Honorable Richard K. Rainey
Member of the Assembly
The State Capitol
Sacramento, CA 95814
Dear Mr. Rainey:
On behalf of the 2,700 physician members of the Alameda-
Contra Costa Medical Association I ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the ,
devastating affect' it will have on local health care
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
Sincerely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
6230 CLAREMONT AVE. • P.O.BOX 2895 OAKLAND,CA 94618 51016545383 FAX 510 16548959
reo
June 2, 1993
The Honorable Barbara Lee
Member of the Assembly
The State Capitol
Sacramento, CA 95814
Dear Ms. Lee:
On behalf of the 2,700 physician members of the Alameda-
Contra Costa Medical Association I ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the
devastating affect it will have on local health care
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
Sincerely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
...............
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
N.
6230 CLAREMONT AVE. • P.O.BOX 2895 w OAKLAND,CA94618 510/654-5383 • FAX 510/65"959
lb Ito
June 2 , 1993
The Honorable Johan Xlehs
Member of the Assembly
The State Capitol
Sacramento, CA 95814
Dear Mr. Klehs:
On behalf of the 2,700 physician members of the Alameda-
Contra Costa Medical Association I ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the
devastating affect it will have on local health care
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
Sincerely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
6230 CLAREMONT AVE. • P.O.BOX 2896 OAKLAND,CA 94618 510 654-5383 • FAX 610 654959
0• rjvjw
June 2, 1993
The Honorable Delaine Eastin
Member of the Assembly
The State Capitol
Sacramento, CA 95814
Dear Ms. Eastin.*
On behalf of the 2,700 physician members of the Alameda-
Contra Costa Medical Association I ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the
devastating affect it will have on local health care
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
cerely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
1A
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
6 230 CLAREMONT AVE. • P.O.BOX 2895 • OAKLAND,CA 94618 • 510 654-5383 • FAX 510 654-8959
June 2, 1993
The Honorable Daniel E. Boatwright
The State Senate
The State Capitol
Sacramento, CA 95814
Dear Senator Boatwright:
On behalf of the 2,700 physician members of the Alameda-
Contra Costa Medical Association I ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the
devastating affect it will have on local health care
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
Si cerely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
...... . .......
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
6230 CLAREMONT AVE. • P.O.BOX 2895 • OAKLAND,CA94618 • 5101654-5383 • FAX sio/654.8959
June 2, 1993
The Honorable Nicholas Petris
The State Senate
The State Capitol
Sacramento, CA 95814
Dear Senator Petris:
On behalf of the 2,700 physician members of the Alameda-
Contra Costa Medical Association i ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the
devastating affect it will have on local health care
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
Sincerely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
6230 CLAREMONT AVE. • P.O.BOX 2895 • OAKLAND,CA 94618 • 510 6545383 FAX 510 t 6548959
reo
June 2, 1993
The Honorable William Lockyer
The State Senate
The State Capitol
Sacramento, CA 95814
Dear Senator Lockyer:
On behalf of the 2,700 physician members of the Alameda-
Contra Costa Medical Association I ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the
devastating affect it will have on local healthocare
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
ncerely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
M: ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
s 6230 CLAREMONT AVE. • P.O. BOX 2895 • OAKLAND,CA 94618 • 510/6545383 • FAX 510!654-8959
Ib b•wrtD
June 2, 1993
The Honorable Robert J. Campbell
Member of the Assembly
The State Capitol
Sacramento, CA 95814
Dear Mr. Campbell:
On behalf of the 2,700 physician members of the Alameda-
Contra Costa Medical Association I ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the
devastating affect it will have on local health care
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
Sincerely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
..... ........
ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION
x it 6230 CLAREMONT AVE. • P.O. BOX 2895 OAKLAND,CA94618 • 6101654-5383 • FAX 510/654-0959
IPATtV 3
..... .....
June 2, 1993
The Honorable Tom Bates
Member of the Assembly
The State Capitol
Sacramento, CA 95814
Dear Mr, Bates:
On behalf , of the 2,700 physician members of the Alameda-
Contra Costa Medical Association I ask you to oppose the
Governor's proposal to take $2.6 billion in local property
taxes to balance the state budget this year.
As voters and residents of your district, we are deeply
concerned about the unfairness of this tax shift and the
devastating affect it will have on local health care
services. There are other alternatives available to the
legislature that make it unnecessary to dump the state's
problems on the cities and county.
I hope you will oppose this shift. I would appreciate your
comments.
rely,
Joseph W. Clift, MD
President
JWC:dc
cc: Alameda County Board of Supervisors
Contra Costa Board of Supervisors
Lk)- I .s-
t���
BROOKSIDE DIRECTORS:
MINOT TRIPP CHAIR
HOSPITALKEVIN GERAGHTY, MD VICE CHAIR
JANE BEAM WOOD TREASURER
MICHAEL P. LAWSON BETTYE J.CASH SECRETARY
PRESIDENT&CHIEF EXECUTIVE OFFICER VERNON T.ARCHIBALD,MD ASSISTANT SECRETARY
June 15, 1993 RECEIVED
jUN 15 1993
Board of Supervisors
Contra Costa County CLERK BOARD OF SUPERVISORS
651 Pine Street CONTRA COSTA CO.
Martinez CA 94553
Dear Board Members:
Brookside Hospital supports the State of California's plan for the transition of Medi-Cal to a managed care
system. That support is based on our belief that such a plan can serve to bring providers back into the system
and improve access to care.
The Contra Costa County "Health First" proposal has the potential to serve as an appropriate vehicle for the
"local initiative" managed care plan for the County's Medi-Cal population. Its core, the Contra Costa Health
Plan, has a good reputation with existing beneficiaries and should serve as an excellent base to expand coverage
in West County.
As previously indicated in correspondence to you and State officials, our primary concern is that West County
residents continue to have access to Brookside Hospital and to the community physicians who have demonstrated
long-term support for all people in our District. The new plan must not inappropriately or unneccessarily direct
patients away from their community hospital and physician or impose financial or other constraints on patients
who seek care in their own community.
We are encouraged by statements from Mr. Finucane and other Health Department representatives that Brookside
and our community physicians are necessary,,and integral partners in the Health First plan. We are also
encouraged by Mr. Finucane's statements that providers who are willing to accept the risks of a capitated program
may participate as partners in the opportunities of the program. In the interim Brookside and other providers
require adequate reimbursement for the costs of delivering care.
We look forward to working closely with County staff in the implementation of the proposal and to the
improvement of timely access to health care resources in this hospital district.
Sincerely,
MICHAEL P. LAWSON, F.A.C.H.E.
President/Chief Executive Officer
MPL:ms
K:H,ROUPS\ADM W\BODSUPV.MPL
WEST CONTRA COSTA HOSPITAL DISTRICT • 2000 VALE ROAD • SAN PABLO, CALIFORNIA 94806 • (510) 235-7000
H;alth r` >rk;>h
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AGENDA
1. STATUS REPORT ON HEALTH FIRST PLANNING:
1.1 Internal Planning
1.2 External Task Forces
2. BRIEFING ON THE STATE PLAN FOR EXPANDING MEDI-CAL MANAGED CARE:
2.1 Two-plan Model
2.2 Mental Health Carve Out
2.3 Dental Carve Out
2.4 Community Prevention and Personal Incentives
2.5 Collaboration With Other Counties
2.6 Relationship to National Health Reform
3. REQUEST BOARD OF SUPERVISORS ACTION TO:
3.1 Inform State of Board of Supervisors' Intention to Establish
the Local Initiative
3.2 Establish the Local Medi-Cal Advisory Planning Commission
for the County sponsored Medi-Cal managed care system
L28:615