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HomeMy WebLinkAboutMINUTES - 05161995 - 2.2 i c Th; BOARD OF SUPERVISORS 9•-2, FROM: Mark Finucane rrnt Health Services Director ., vol , ra uwa DATE : May 4, 1995 Cointy SUBJECT: Restructure of Contra Costa Health Plan Advisory Board and ^Iledi-Cal Advisory . Planning Commission into the establishment of a Managed Care Commission. SPECIFIC REQUEST(S) OR RECOMMENDATIONS ) & BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: A. ESTABLISH the Managed Care Commission (MCC) which integrates the functions and duties of the current Contra Costa Health Plan Advisory Board (Advisory Board) and the Medi-Cal Advisory Planning Commission (MAPC) and upon the appointment of members of the MCC dissolve the CCHP Advisory Board and the MAPC. B. APPROVE the attached document which establishes the functions and duties and community participation for the MCC; and defines six MCC standing committees, their membership and functions; and establishes membership criteria and the appointment and transition process for the MCC. FINANCIAL IMPACT: Funding for staff and committee functions comes from Local Initiative development funds from the State and Federal government and from Medi-Cal capitation payments by the State. CONTINUED ON ATTACHMENT: XX YES SIGNATURE: —. - _ RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON May 16 , 1995 APPROVED AS RECOMMENDED X OTHER 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. Contact : Milt Camhi 313-6004 cc: Health Services Director ATTESTED May_16,___1995 Contra Costa Health Plan PHIL BATCHELOR. CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR D BY DEPUTY M382-'7-83 -9 BACKGROUND/ REASON FOR RECOMMENDATION: Restructuring of the Contra Costa Health Plan (CCHP) guidance mechanism is essential in light of the impending Local Initative changes required by the State Medi-Cal program and the advent of intense competition for Medi-Cal enrollment by managed care organizations. In Contra Costa County there will be two or more private HMOs competing with CCHP both for current CCHP Medi-Cal enrollees and for the Medi-Cal beneficiaries in Fee-for-Service who must select an HMO within the year. There will be rigorous competition to sign up all these Medi-Cal beneficiaries. The County Board of Supervisors needs to have the benefit of a unified advisory panel to help the Board make the critical service and operating decisions that will allow CCHP to meet its competition. Currently CCHP has two advisory bodies; the Advisory Board and the MAPC. Much of their work intersects and overlaps. Currently the Advisory Board functions in an advisory capacity to CCHP on all aspects of the health plan, including Medi-Cal, Medicare and commercial and Basic Adult Care membership issues. The MAPC was created to ensure provider, beneficiary, and community input to the development of the Medi-Cal Local Initiative. It has a September 1996 sunset date and the term of office for its members expires December 31, 1995. With the major influx of Medi- Cal members and the need for continued input from the community, joining of the functions and duties of both bodies is warranted and the resultant streamlining is beneficial. The CCHP Advisory Board and the MAPC met independently several times, met together, and formed a Joint Work Group in order to formulate a plan of restructuring. Options were examined with the assistance of Dr. Henrik Blum, Professor Emeritus UC Berkeley, who served as a consultant on the project. The proposed Managed Care Commission recommendations were adopted unanimously by the CCHP Advisory Board; unanimously by the Joint Work Group; unanimously by the MAPC Executive Committee; by a majority of the full MAPC; and unanimously by the Board of Supervisors on April 11, 1995. CONTRA COSTA COUNTY MANAGED CARE COMMISSION OVERVIEW The Managed Care Commission is a 15 member Advisory Body appointed by the Board of Supervisors to act as the guidance mechanism of CCHP. The MCC replaces the CCHP Advisory Board and the MAPC and takes on the functions of both bodies. Meetings of the MCC and its committees are open to the public, consistent with the Ralph M. Brown Act and County statutes. Work of the committees, once accepted by the MCC, would be the basis for MCC advice to relevant bodies including the Board of Supervisors, the State Department of Health Services, the Federal Health Care Financing Administration, among other agencies. FUNCTIONS AND DUTIES Functions and duties of the MCC will include: a. Cover the health care concerns for the Medi-Cal, Medicare, Commerical and Medically Indigent persons served by the County. b. Assure provider, consumer and community, as well as gender, ethnic, cultural and geographically diverse population input to deliberations and decision- making. (The Board of Supervisors does this by its requirements for membership on the MCC and the MCC does likewise by its appointments to its committees.) C. Do long range planning and policy formulation and make recommendations to Board of Supervisors, County HSD Director and Executive Director of CCHP/Local Initiative. d. Study and make recommendations to the Executive Director of CCHP on operational objectives, policies and procedures and recommend changes as well as revised service, product development, marketing, and data gathering priorities. e. Assure effectiveness, quality (including good outcomes), efficiency, access, acceptability of CCHP services by ongoing as well as periodic formal reviews of information produced by an up-to-date Management Information System and other sources. f. Regularly review the CCHP operational budget and amendments thereto. .�7 g. Review, analyze and advise the Board of Supervisors, HSD Director and Executive Director of CCHP of the overall progress, constraining or threatening needs and special problems of CCHP. h. Encourage public understanding of CCHP and provide support throughout the County for its development. i. Prioritize and assign issues to appropriate committees. COMMITTEE STRUCTURE,• MEMBERSHIP• AND FUNCTIONS 1. There will be an Executive Committee of the MCC with at least one member who is a subscriber member of the CCHP. 2. There will be six standing committees of the MCC with names and functions as follows: a. Health Care Delivery and Quality Maintenance Study outcomes of delivery approaches, of regionalization of services, of modes of access, of modes of treatment and of follow-up to determine if desired objectives are met. Make recommendations. b. Finance and Mana eg ment Study budgets, expenditures, income streams and discrepancies between budgeted versus actual occurrences. Create and maintain up-to-date financial practices. Maintain forward looking personnel practices. Review and coordinate with County business and personnel practices. Make recommendations. C. Product Development and Marketing Study needs of current and potential subscribers for scope of services, scope of benefits, coverage, price, access, acceptability, satisfaction including concerns of providers. Examine patterns of enrollments and disenrollments of CCHP members and of competitors. Study alternative procedures. Make recommendations. d. Provider Issues Determine and analyze issues of recruitment, retention, satisfaction, loss of providers, as well as factors affecting productivity, patient relations, means of covering hard to serve areas, seniority, bonuses, termination, interprofessional relationships, utility of teams, accessibility, referral and specialist issues, as well as provider concerns regarding facilities. Make recommendations. e. Member and Consumer Advocacy Obtain feedback from current and potential subscribers, analyze issues raised, also trends of difficulties and desires, geographic, gender, ethnic and other facets of consumer concerns, and cover access and beneficiary issues, overview grievance procedures. Make recommendations. f. Planning, Governance and By-Laws Crucial long term function is to carry out continuing study of impending and threatened Federal and State program and financing changes and their relationship to CCHP growth trends and functional needs. Create plans accordingly and recommend policy, structural and governance changes, as well as strategic plans. 3. There may be Ad Hoc Committees of the MCC. These will be created by the MCC for special issues or concerns that do not fit into the work of the standing committees or that may involve several of them. The assignment, membership, and duration will be set by the MCC. 4. Committee chairs must be members of MCC. Committee members need not be members of MCC. In addition to the 15 Commission members any individual or organization may attend and participate on any appropriate committee that is established. 5. MCC committee chairs are appointed by the MCC chair (initially co-chairs). MCC MEMBERSHIP; APPOINTMENTS• AND TRANSITION PROCEDURES 1. The Board of Supervisors as a whole shall make the appointments to the MCC. There will be 15 appointed members of the MCC: no less than one Medi-Cal subscriber; one Medicare subscriber; one commerical subscriber; one person sensitive to medically indigent health care needs; one physician, non-contracting; one other provider, non- contracting; and no less than nine at large members, non-contracting. 2. The Board of Supervisors appointments reflect the County's ethnic, cultural, gender and geographic diversity. 3. The Board of Supervisors will appoint members of the MCC who are dedicated, health-care interested, capable, public-spirited individuals, who want to make CCHP an outstanding health care plan. The Board of Supervisors will not select individuals because they fit any specific skill or area of expertise. However, a list of desirable capacities appears below to be used in making the choices for the members to be appointed. These are in no way prerequisites for a position on the MCC, but do bring valuable areas of experience to the MCC when present in a suitable candidate: Ambulatory care Business interests Consumer advocacy Evaluation of outcomes Finance Health care law Health Issues: children, women, elderly, cultural, ethnic, linguistic, disabled HMO administration Labor Marketing Nursing administration and practice Nutrition education and services Personnel Public health and prevention 4. They are voluntary, unpaid positions, but actual and necessary expenses are to be reimbursed as per County practice. INITIAL APPOINTMENTS 1. In the first round of MCC appointments, the Board will endeavor to appoint a majority from current members of the HMO Advisory Board and MAPC bodies if there is sufficient interest and expertise among the current eligible membership. 2. Term of office is for three years. Persons who are involved as contractors with CCHP cannot be members of the MCC nor can Health Services Department employees. Once selected by the Board of Supervisors, the 15 initial appointees will be chosen by lottery, 1/3 for 1 year, 1/3 for 2 year term, and 1/3 for 3 year term. 3. Reappointment can be made to a maximun of 2 consecutive full 3 year terms. Subsequently, after an absence of 1 year, a former MCC member can be appointed for a full term. 4. Initially the current chairs of the MAPC and HMO Advisory Board will be appointed to the MCC as part of the majority who are drawn from the current MAPC and Advisory Board. They will serve as interim co-chairs of the MCC for a period not to exceed 4 months. They will appoint the initial committee chairs and members of the MCC standing committees. The MCC will elect its chair once the co-chair term is over. 5. A special recommendation committee of 2 members each from the MAPC and the Advisory Board, and CCHP Executive Director or his designee(s), will recruit widely for MCC applicants, assure that all applications including those of current eligible HMO Advisory Board and MAPC members are forwarded to the Board of Supervisors, and recommend to the Board initial members for the MCC. 6. The Director of Health Services is an ex-officio, non-voting member. 7. The Executive Director of CCHP is an ex-officio, non-voting member. 8. The Board of Supervisors function as ex-officio, non-voting members. BY LAWS The MCC shall establish By-Laws which include officers; member absence policies; rules of procedures; conduct of business; and establishment of rules for a quorum. CONFLICT OF INTEREST Board Policy for Managed Care Commission. A. Even though persons who are involved as contractors with CCHP cannot be members of the MCC, in the course of MCC business, issues or events may arise that could possibly constitute a conflict of interest for members. Therefore, MCC members must file an initial and annual conflict of interest statement. Failure to file such a statement may result in the member's removal. B. Members may participate on issues in all discussions including those having a direct financial impact on the members and/or their institutions. However, no member may vote on an issue in which the member and/or the member's organization or their immediate family member(s) has a direct financial conflict of interest. STAFFING The MCC and its committees will be staffed by Contra Costa Health Plan and County Health Services Department administrative staff. 7