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Home My WebLink AboutMINUTES - 04191994 - 1.166 TCI: HOARD OF SUPERVISORS Contra FROM Mark FinucaneV,(' *gt' Costa Health Services Director •+ zawTE: CO .April 19, 1994 13UBJECT: Approval of Medi-Cal Advisory Planning Commission ("MAPC") Mainstream Plan Report ��IPEC I F I c REQUEST(S) OR RECOMMENDAT I ON M ac BACKGROUND AND JUST i F 1 CAT[ON L RECOMMENDATION: Approve the report from MAPC including criteria the Commission recommends the State Department of Health Services ("State") use in deciding which private HMOs to contract with in Contra Costa County and the results of a preliminary survey of private HMOs, and authorize the Chair, Board of Supervisors, to submit the report to the State. II. FINANCIAL IMPACT: Fee for service revenue to providers in Contra Costa County, including Merrithew Memorial Hospital & Clinics, for services given to AFDC linked Medi-Cal eligibles amounts to over $36-million annually. As the State moves to managed care, this fee for service revenue will be transferred into capitation payments to the CCHP Local Initiative and private HMO Mainstream Plan. The core requirements as set forth by the MAPC, should help to ensure a level playing field for the Local Initiative and Mainstream Plan. III. REASONS FOR RECOMMENDATIONS & BACKGROUND (See attached MAPC Mainstream Plan report.) The MAPC established a Mainstream Plan Committee in response to Supervisor Tom Torlakson's call at the first Commission Meeting for a level playing field for both the Local Initiative and the Mainstream Plan. The Commission approved the report of the Committee which contains ten core requirements and results of their initial survey of potential Mainstream Plan contractors. Of more immediate impact, one plan - PacifiCare - has put in an application for a Medi-Cal Contract in Contra Costa County to be implemented this Summer, and the State has asked the County to communicate any concerns it has with this. The enclosed Mainstream Plan report addresses the issues the County has regarding the Mainstream Plan expansion, and also responds to the State's request for County input on the PacifiCare application. CONTINUED ON ATTACWEHT: YES 21009ATURE: RECOMMENDATION OF CoUmTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE S I GNA E S ' ACTION OF BOARD ON April 19 , 1994 APPROVED AS RECOMMENDED X OTHER VOTE OF sUPER+r I SORV 1 HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: 4 � , NOES — AND ENTERED ON THE MINUTES OF THE BOARD ,-.7—SENT: 1 _ ABSTA i N: � OF SilPERV i SOBS ON THE DATE SFiDWN. M It S. Camhi, CCHP cc: Bobbi Baron, CCHP ATTESTED April 19, 1994 S51:130 PHIL BATCHELOR, CLERK OF THE BOARD OF SUPE VISORS AND COUNTY ADMINISTRATOR tT BYJAAA� ,DEPUTY M382f7-83 The Board of Supervisors Contra CP1rklofthehBoard and County Administration BuildingCOSta County Administrator 651+Pine St., Room 106 (510)646-2371 Martinez, California 94553 County Tom Powers,1st District Jett Smith,2nd District L" Gayle Bishop,3rd District Sunne Wright McPeak,4th District Tom Torlakson,5th District o: .y �OrrA COl1N•� `* April 19, 1994 Joseph Kelly, Chief Medi-Cal Managed Care Division SDOHS P.O. Box 942732 Sacramento CA 94234-7320 Dear Mr. Kelly: We appreciate the SDOHS giving us the opportunity to respond to the application by PacifiCare to provide services to Medi-Cal beneficiaries in Contra Costa County. The Contra Costa Board of Supervisors is keenly interested in the effects of Mainstream Plan expansion in our county. The Board at its meeting today approved a report by the Medi-Cal Advisory Planning Commission on potential Mainstream Plans in Contra Costa County. The Commission has completed a preliminary study of HMOs including PacifiCare to ascertain their willingness and capability to serve the special needs of Medi-Cal enrollees. Enclosed is a copy of the Board of Supervisors approved report. In response to your request for information on any special circumstances in Contra Costa County, I am enclosing a copy of the 1992 report of the Public and Environmental Health Advisory Board on the status of health in Contra Costa County, which describes demographic and socioeconomic trends in the county and excerpts from the United Way Needs Assessment report. Thank you again for keeping us notified about Mainstream Plan expansion in Contra Costa County. Sincerely, Tom Powers, Chair Board of Supervisors TP:BB/lmb Enclosures 1. MAPC Mainstream Plan Report 2. Public and Environmental Health Advisory Board 1992 Report 3. Needs Assessment IJ3:JKE -Epc Medi-Cal Advisory Planning Commission 595 Center Avenue,Suite 100 Martinez,California 94553 (510)313-6004 FAX (510) 313-6002 Memo to: Board of Supervisors From: Michael G. Harris, Chair 1 " COMMISSIONERS Medi-Cal Advisory Planning Commission Welby W.Bigelow,Jr.,M.D. Date: April 13, 1994 Margaret Dowling Heather Saunders Estes, M.S.W. Subject: Mainstream Plan Report Mary Lavender Fuji,M.S. R.D. Claudette Garner,M.Ed. RECOMMENDATION: Michael G. Harris, O.D.,J.D.,M.S. The Medi-Cal Advisory Planning Commission at its April 6, 1994 meeting voted to recommend to the Board of Supervisors that you endorse this Paul Katz Mainstream Plan report including criteria for evaluating Mainstream Plans Joan Lautenberger, R.N. in Contra Costa County and the preliminary results of the Commission's survey of interested HMOs. Furthermore, it is requested you forward this Michael P. Lawson initial report to the State Department of Health Services. Viola Lujan Eileen Lynette, R.N. BACKGROUND: The Medi-Cal Advisory Planning Commission established the Mainstream Suzanne MacDonald Plan Committee, consisting of Heather Saunders Estes, Chair, Viola Jack McGervey Lujan, and Jack McGervey at its February 3, 1994 meeting and charged them with ascertaining: Stephen Heisler, M.D. Bessanderson McNeil, M.P.H. 1. Willingness and capability of potential Mainstream Plan contractors Cynthia Miller to serve the special needs of Medi-Cal enrollees and Tony Paap 2. Their plans for relating to safety net and traditional providers Evelyn Rinzler,M.A. The Commission in setting up the special Mainstream Plan Committee was Dolores Sanchez,L.C.S.W.,M.P.H.,Ed.D. responding to Supervisor Torlakson's call at the first Commission meeting Raymond L.Smart for a level playing field for both the Local Initiative and the Mainstream Plan. The Commission requested that at the April 6, 1994 meeting the Gregg S. Sorensen, M.D.,M.P.H. committee report its recommendations on requirements for ensuring a Terry Tanner, D.D.S. level playing field and its analysis as to how well each Mainstream Plan Rev. Curtis A. Timmons, B.A.,Th.D. meets these requirements. BOARD OF SUPERVISORS LIAISONS Workplan: Tom Powers The committee developed a set of uniform questions for potential Mainstream Plan contractors. It then wrote to eleven health plans who Tom Torlakson were either currently operating in Contra Costa County or who had previously expressed an interest in Medi-Cal contracting. Two plans (Kaiser-Permanente and PacifiCare) responded with requests for interviews and two plans (Blue Cross/California Care and Health Net) sent in written responses to the questions. The committee interviewed representatives of Kaiser and PacifiCare and reviewed the Blue Cross and Health Net written responses. The committee decided to examine each responding plan against 10 core requirements which measure a plan's willingness and ability to serve Medi-Cal enrollees. The core requirements and the results of the committee's surveys are attached. The committee presented its report at the April 6 meeting which was approved by the commission and incorporated into this Mainstream Plan report. RESULTS: The MAPC notes that there still are many uncertainties about the responding plans and charges the Mainstream Plan Committee with reviewing any PHP contract applications in the interim period and any Mainstream Plan applications subsequently filed. The Mainstream Plan Committee will use the ten core requirements as the basis of this further review. From the information gathered so far, the Commission expressed concerns about the ability of individual private HMOs to serve the wide range of needs of Medi-Cal patients, particularly those of the disabled beneficiaries. The commission also notes that both Kaiser and PacifiCare were willing to take a portion of the Mainstream Plan enrollment but were uneasy with the prospect of being responsible for the entire amount. The commission agrees that the current "two plan model" has serious flaws and should be reconsidered by the SDOHS. The commission believes that multiple Mainstream Plans would better serve the Medi-Cal recipients. Further, we question the capacity of most plans to handle the entire "Mainstream" Plan enrollments. The commission recommends that the Board of Supervisors communicate our concerns to the State Department of Health Services. BB/lmb 7 Attachments: 1. Committee's Charge 2. Letter Sent to Plans 3. Core Requirements 4. Results of Survey of Mainstream Plans J 'I L33:FRR 1 4/13/94 I Contra Costa County j Medi-Cal Advisory Planning Commission I Mainstream Plan Committee I In response to Supervisors Tom Torlakson's call for a level playing field for both the Local 4 Initiative and the Mainstream Plan, the MAPC wishes to ascertain the willingness and capability j of potential Mainstream Plan contractors to serve the special needs of Medi-Cal enrollees. The MAPC also wishes to understand how the Mainstream Plan will relate to the safety net and i traditional providers who have historically served Medi-Cal patients. The MAPC set up the Special Mainstream Plan Committee to obtain from potential contractors in Contra Costa County their plans for serving Medi-Cal managed care eligibles both in the interim period (before the two-plan model is implemented) and once the two-plan model is in I operation. The committee is to develop a set of uniform questions to ask the plans and to request that the plans at their discretion either submit written responses or agree to be interviewed by the committee. i At the April MAPC meeting, the committee will report its recommendations on requirements for ensuring a level playing field and its analysis as to how well each Mainstream Plan meets these requirements. I I ( i I i 1.32:1R4 2116/94 t I l i -� aVa.,_ fflfl P C - �- Medi-Cal Advisory Planning Commission 595 Center Avenue, Suite 100 Martinez,California 94553 (510) 3136004 Feb 23, 1994 FAX (510) 3136002 February COMMISSIONERS Cynthia Suzuki Welby W.Bigelow,Jr.,M.D. Foundation Health Plan 3400 Data Drive Margaret Dowling Rancho Cordova CA 95670 Heather Saunders Estes,M.S.W. Dear Ms. Suzuki: Mary Lavender Fuji,M.S. R.D. Claudette Garner,M.Ed. The Contra Costa County Board of Supervisors has created a 25-member Michael G.Harris,O.D.,1.D.,M.S. Medi-Cal Advisory Planning Commission to assure provider, consumer, and community input into the planning for Contra Costa's implementation Paul Katz of the State Plan For Expanded Managed Care. Joan Lautenberger, R.N. The Commission will be making recommendations directly to the Board Michael P.Lawson of Supervisors on the county's managed care system with a special Viola Lujan emphasis on the Local Initiative. However, the Commission recognizing Eileen Lynette, R.N. that up to 40% of the county's managed care eligibles will be served by a Mainstream Plan wishes to learn how potential Mainstream Plan Suzanne MacDonald contractors will offer the same protections to beneficiaries that the Local Jack McGervcy Initiative is required to provide. Stephen Heisler, M.D. At its last meeting the Commission set up a special Mainstream Plan Bessanderson McNeil,M.P.H. Committee to ascertain the willingness and capability of potential Mainstream Plan contractors to serve the special needs of Medi-Cal Cynthia Miller enrollees and to learn how the Mainstream Plan will relate to the safety Antonit H.Paap net and traditional providers who have historically served Medi-Cal Evelyn Rinzier,M.A. patients. The committee is to report its findings and recommendations at the Commission's April 6 meeting. Jose Samaniego Dolores Sanchez,LC.S.W.,M.P.H.,Ed.D. The Commission has asked the Mainstream Plan Committee to obtain from potential contractors in Contra Costa County their plans for serving Raymond L Smart Medi-Cal managed care eligibles both in the interim period (before the Gregg S.Sorensen,M.D.,M.P.H. two-plan model is implemented) and once the two-plan model is 1n Terry Tanner,D.D.S. operation. Rev.Curtis A.Timmons,B.A.,Th.D. The Mainstream Plan Committee as part of its fact-finding process has Joyce White developed the attached set of questions to ask of each potential contractor. If you are considering the possibility of becoming a Mainstream Plan in BOARD OF SUPERVISORS LIAISONS Tom Powers Tom Torlakson Contra Costa County, we ask that you either provide written responses by Wednesday, March 9 or that you participate in an interview with the committee later in the month. Of course, if you wish you may provide both written comments and agree to be interviewed. Please send your replies to: Bobbi Baron, Medi-Cal Advisory Planning Commission, 595 Center Avenue, Suite 100, Martinez, CA 94553. You can call her at 510-313-6004 if you want more information or wish to schedule an interview. We are looking forward to learning from you about your plans for Medi-Cal managed care in our county. Sincerely, J60k McGervey Mainstream Plan Committee JM:BB/lmb Enclosures: 1. Questions 2. Medi-Cal Advisory Planning Commission Roster cc: Larry Lucero, SDOHS Milt Camhi Bobbi Baron uz:a�. Cynthia Suzuki Foundation Health Plan 3400 Data Drive Rancho Cordova CA 95670 Jackie Anderson Blue Cross 2155 Oxnard Street Woodland Hills CA 91367 Carol Rhodes PacifiCare 5701 Katella Avenue Cypress CA 90630 Sean O'Brien Health Net P.O. Box 9103 Van Nuys CA 91409-9103 Bob Eisenman Kaiser-Permanente 1950 Franklin - Third Floor Oakland CA 94612 Paul Swenson Aetna Health Plans of Northern California 1111 Bayhill Drive 1300 San Bruno CA 94066 Max Brown CaliforniaCare P.O. Box 4089 Woodland Hills CA 91365-4089 William Caswell Maxicare California 1149 S. Broadway Street ,#819 Los Angeles CA 90015 Karen Jansen PruCare of California, Northern California 177 Bovet Road #400 San Mateo CA 94402 R. Judd Jessup TakeCare Health Plan, Inc. 2300 Clayton Road #1000 Concord CA 94520-2100 Howard Davis Universal Care 1600 East Hill Street Signal Hill CA 90806 132:W7MW Contra Costa County Medi-Cal Advisory Planning Commission Questions for Mainstream Plans Administration and Operations: 1. Which model are you planning for: single mainstream; "consortium" of mainstreams; other? How would you modify this if single payor or alliance health reform was enacted? 2. How many Medi-Cal eligibles do you plan to enroll in the interim period? What is your proposed contract limit after the interim period? 3. Which Medi-Cal aid (AFDC, ATD, AB, etc. ) categories will you include in the interim period? After implementation of the State's two-plan model? 4. Will your Contra Costa Medi-Cal service area be countywide or in specified sub areas of the county? If in selected areas, which ones? • 5. How do you propose to respond under the two-plan model if the Mainstream Plan enrollment appears to be approaching the state limit of 40% of the managed care eligibles in Contra Costa County? Capabilities and Experience in Serving Medi-Cal and Other Low- Income Groups: 6. What is your health plan's experience in enrolling low- income individuals? 7. Will the provider groups you use in Contra Costa County have experience in caring for low-income individuals? 8. What arrangements will you make to take care of "special populations", e.g. people who can't speak English; those with disabilities (mobility, hearing, sight, etc) ; those requiring mental health or substance abuse services? Traditional and Safety Net Providers: 9. How do you plan to relate to the county's public health services (e.g. CHDP services, immunization and well baby clinics, expanded perinatal services) ? 10. Do you intend to contract with safety net providers (Board of Supervisors definition on next page) ; with traditional providers. If a Clinton type health reform is passed, what's your position on contracting with essential community providers? Contra Costa County Medi-Cal Advisory Planning Commission "Questions for Mainstream Plans" Page Two Communications and Community Support: 11. What will you do to provide evidence of broad community support for your health plan's efforts in Medi-Cal managed care? Would you be willing to sponsor and hold regional hearings in Contra Costa County on your health plan's mainstream proposal? 12. What are your mechanisms for providing ongoing Medi-Cal member input at a policy level? Community Health Issues: 13. The Local Initiative has committed itself to reinvesting a portion of any surplus from its Medi-Cal program into community health programs operating in Contra Costa County. Would you do the same? If so, how much and for what kinds of programs? 14. What community prevention and promotion activities do you plan to conduct targeted at the Medi-Cal population? 15. To help reduce Medi-Cal turnover problems, would you support guaranteed eligibility for selected groups (e.g. children) and/or lock-in? The Board of Supervisors defines safety net providers as: those clinical providers who over time have continually provided a substantial amount of comprehensive primary care or acute hospital inpatient services to a significant number of medically indigent and Medi-Cal patients. Such safety net providers are the main, if not sole, source of care for Medi-Cal beneficiaries and medically indigent persons. The Contra Costa County Board of Supervisors has identified such safety net providers as those who have traditionally shown a loyalty and competence in serving special vulnerable populations. The State and Federal governments have designated Federally Qualified Health Centers and institutions receiving DSH payments as safety net/essential community providers. I32:W 2123/44 - Revised 4/8/94 CAdvisorPlaniMnn g .; Membership Category WELBY W. BIGELOW, JR., M.D. Physician 2415 High School Street #1300 Concord CA 94520 Work: 685-2555 MARGARET DOWLING Beneficiary P.O. Box 783 Pittsburg CA 94565 427-1219 HEATHER SAUNDERS ESTES Planned Parenthood Planned Parenthood 2185 Pacheco Street, Concord CA 94520 Work: 676-0505 MARY FUJII Community Based Organization University of California Cooperative Extension 1700 Oak Park Boulevard A-2, Pleasant Hill CA 94523 Work: 646-6540 CLAUDETTE GARNER Community Based Organization East Bay Perinatal Project 3838 Macdonald Avenue, Richmond CA 94805 Work: 236-6990 MICHAEL HARRIS, O.D., J.D., M.S. Other Provider University of California School of Optometry Room 410 - Minor Hall, Berkeley CA 94720 Work: 642-2233 STEPHEN HEISLER, M.D. Physician 37 Quail Court #200 Walnut Creek CA 94596 Work: 944-1733 or 944-9711 PAUL KATZ Contra Costa Health Plan Advisory Board P.O. Box 222, Martinez CA 94553 Work: 228-1600 JOAN LAUTENBERGER, R.N. Nurse 3979 S. Peardale Drive, Lafayette CA 94549 Work: 428-3390 MICHAEL LAWSON, CEO Hospital Brookside Hospital 2000 Vale Road, San Pablo CA 94806 Work: 235-7000 VIOLA LUJAN Community Based Organization 3810 Crestview Drive, Pittsburg CA 94565 Work: 535-4092 EILEEN LYNETTE Hospital Executive Director of Long Term&Rehab Services John Muir Medical Center 1601 Ygnacio Valley Road, Walnut Creek CA 94596 Work: 947-5252 SUZANNE MACDONALD Maternal, Child& Adolescent Health Advisory Board Children's Hospital Dietary Services 747 52nd Street, Oakland CA 94609 Home: 223-3998 JACK MCGERVEY Contra Costa Health Plan Advisory Board 23 Marlee, Pleasant Hill CA 94523 Work and Home: 932-1378 BESSANDERSON MCNEIL, M.P.H. Public&Environmental Health Advisory Board University of California, San Francisco Hypertension Research Clinic 3012 Summit Street, 3rd Floor, B Wing, Oakland CA 94609 Work: 874-8061 CYNTHIA MILLER Mental Health Commission 105 Jose Lane, Martinez CA 94553 Home: 372-7678 ANTONIE H. PAAP, CEO Hospital Children's Hospital Oakland 747 52nd Street, Oakland CA 94609 Work: 428-3461 EVELYN RINZLER Member-at-Large Contra Costa Legal Services 1017 Macdonald Avenue, Richmond CA 94809 Work: 233-9954 DOLORES SANCHEZ, Ed.D. Member-at-Large 2033 Carquinez Avenue, El Cerrito CA 94530 Work: 215-4670 RAYMOND L. SMART Pharmacist 2068 Salvio Street, Concord CA 94520 Work: 685-8551 GREGG SORENSEN, M.D. Physician 53-A Manor Drive, Pittsburg CA 94565 Work: 458-6125 TERRY TANNER, D.D.S Dentist 265 16th Street, Richmond CA 94801 Work: 233-6515 REV. CURTIS A. TIMMONS, B.A., Th.D. Substance Abuse Advisory Board P.O. Box 8213, Pittsburg CA 94565 Work and Home: 432-0445 TOM TORLAKSON Board of Supervisors Liaison 300 East Leland Road #100, Pittsburg CA 94565 Work: 427-8138 TOM POWERS Board of Supervisors Liaison 100 37th Street, Richmond CA 94805 Work: 374-3231 Lc:srRosrER adazl�,�� 3 CORE REQUIREMENTS 1. Plan's Experience with Low Income Enrollees Does the plan have Medi-Cal contracts in Contra Costa County or in other areas of the state? Has the plan taken part in any state programs for low income individuals? Does the plan have its.own program for low income (non-Medi-Cal) individuals? 2. Plan Providers' Experience with Low Income Enrollees Does the plan now have providers in Contra Costa County who have a significant number of low income patients? 3. Arrangements for Special Populations Has the plan and its providers made arrangements to accommodate members with mobility problems; who do not speak English, who require special mental health and/or substance abuse services? Are these arrangements adequate? 4. Relationships with Public Health Services Will the plan utilize public health ser-vices such as CHDP and CPSP or will it duplicate these services through its own providers? 5. Contracts with Traditional Providers Will the plan contract with many community providers whose caseloads include a significant number of Medi-Cal eligibles? 6. Contracts with Safety Net Providers Will the plan contract with safety net providers such as community clinics and acute care hospitals who have continually over time provided a substantial amount of care to a significant number of Medi-Cal and indigent patients? 7. Community Support and Involvement Will the plan sponsor forums, hearings and/or other means of obtaining community input into its planning for Medi-Cal in Contra Costa County? 8. Ongoing Member Input Does the plan have mechanisms for providing Medi-Cal member input in a meaningful way? 9. Community Prevention and Promotion Activities What is the plan's record in sponsoring and/or running various prevention and health promotion activities aimed at the general community and not targeted just for its members? 10. Commitment to Enrolling Medi-Cal Has the plan expressed a firm commitment to enrolling a significant segment of the Medi-Cal population? Will the plan's Medi-Cal enrollment be a significant portion of its overall enrollment? Has the plan made operational adjustments to accommodate Medi-Cal members? Has the plan invested significant time and staff into the planning for a Medi-Cal contract? L32:FRR 3/3l/94 RESULTS OF SURVEY OF MAINSTREAM PLANS Core Requirement Blue Cross Kaiser PacifiCare Health Net Plan' experience with low income 0 + -- 0 enrollees 2 Plan ;providers' experience with low 0 + -- -- mcome enrollees 3 Arrangements fox "special 0 0 0 - populations ✓linguistic ✓disabilities ✓mental health/substance abuse 4 Relationships with public health - - 0 0 services S Contracts with traditional providers 0 -- 0 0 6Contracts with. safety net providers <' 0 -- 0 _ 7 Community support and 0 -- - -- mvolvement 8 Ongoing member input - + + 0 9 Community prevention and -- ++ 0 -- promotson activit>es 10 Commitment to erirolhng Medi' Cal ++ 0 ++ 0 Rating Scale: ++ Definitely meets core requirement + Somewhat meets core requirement 0 Uncertain - Probably does not meet core requirement -- Definitely does not meet core requirement The committee has not at this time assigned weightings to specific core requirements 132:FRR 1 4/11/94