GOOD AFTERNOON AND THE CALL THE
ORDERS THIS INFORMATIONAL
HEARING OF THE SENATE COMMITTEE
ON HEALTH ON IMPROVING
PERFORMANCE IN ALIGNING
INCENTIVES IN COMMERCIAL HEALTH
INSURANCE AND MEDICAL.
AND I'M VERY EXCITED ABOUT THE
THIS INFORMATIONAL HEARING --
CERTAINLY THERE'S A LOT OF
INTERESTS IN HEALTH CARE --
EXPANDING ACCESS TO MORE PEOPLE
WHICH IS VERY IMPORTANT TO THE
DESPITE THE GAINS WE THREE MADE
WITH THE ACA WE STILL HAVE A BY
THINK ABOUT 7% --
70% PEOPLE WHO ARE STILL
UNINSURED --
CERTAINLY COST TO SOMETHING THAT
IS OF GREAT CONCERN AS A AS NOT
ONLY --
GOVERNMENT BUT ALSO --
INDIVIDUALS AND EMPLOYERS --
AND AND UNIONS WHO --
US BUT ALSO WE THINK ABOUT --
THOSE COSTS WE WANT TO THINK
ABOUT HOW WE DELIVERING CARE BE
SURE THAT PEOPLE NOT ONLY HAVE
COVERAGE BUT THEY ACTUALLY TRULY
OF ACCESS AND ACCESS TO QUALITY
CARE.
AND THAT ACTUALLY WE INVEST AND
CREATE INCENTIVES FOR PEOPLE --
TO TO PROVIDE QUALITY CARE THAT
CAN BE MORE COST EFFECTIVE AND
HELP LOWER THE LONG TERM COST
CURVE.
I WOULD MAKE NOTE THAT --
CITIES HAVE SHOWN APPROXIMATELY
40% OF ALL CALIFORNIANS HAVE AT
LEAST ONE CHRONIC CONDITION --
SO LOOK --
AND THAT --
THAT REPRESENTS PRACTICALLY
7280% OF OUR HEALTH CARE
SPENDING.
SO WE REALLY WANT TO THINK ABOUT
HOW WE'RE GOING TO NOT ONLY BEEN
THE COST CURVE BUT ALSO IMPROVE
OUR QUALITY --
IT IS LOOKING AT CHRONIC DISEASE
MANAGEMENT AND HOW DO WE HOW DO
WE CREATE THE KIND OF STRUCTURES
INCENTIVES THAT ENCOURAGE PEOPLE --
TO INVEST IN CHRONIC DISEASE I
THINK ONE OF THE ISSUES THAT
CERTAINLY.
WE OFTEN HAVE TO DEAL WITH THIS
THIS -- WE
THAT -- WITH
CHRONIC CONDITIONS SUCH AS
DIABETES OR ASTHMA OR OTHER
MENTAL HEALTH ISSUES --
OFTEN THERE THE EXPENSES OF
THEIR THAT CARE MAY ACTUALLY BE
GREATER THAN THE PREMIUMS THEY
PAY AND SO --
RISK BRING ALWAYS ASIA HEALTH
PLANS OFTEN HAVE TO FIGURE OUT
LIKE HOW DOOR TO FINANCE THEM
THEY HAVE TO HAVE FOR THE CALL
PROPER CASE MIX RIGHT.
SO YOU HAVE TO HAVE ENOUGH
HEALTHY PEOPLE TO PAY FOR THE
PEOPLE WHO ARE WHO HAVE THESE.
CONDITIONS AND UNFORTUNATELY
THOUGH THAT ALSO BECOMES A
DISINCENTIVE --
PERHAPS. TWO PEOPLE ACTUALLY
WANTING.
TO ATTRACT MORE PEOPLE CHRONIC
CONDITIONS AND ALSO IN PROVIDING
DEVELOPING --
BETTER SYSTEMS CARE NOTHING IF
PEOPLE DON'T WANT TO DO IT BUT
WE DON'T HAVE THAT FINANCIAL
INCENTIVE.
EDITION.
YOU DON'T WANT TO BE THE PLAN
THAT'S BEST KNOWN AS TAKING CARE
OF A PARTICULAR CHRONIC
CONDITION ARE MENTAL HEALTH
BECAUSE IF YOU TRACK MORE OF
THOSE PATIENTS THAT.
AGAIN MIXES UP YOUR CASE MIX --
SO THOSE ARE CERTAINLY SOME
DISINCENTIVES THAT ARE POSSIBLY
THERE BUT THERE ARE DIFFERENT
WAYS WE COULD TRY TO FIGURE OUT
HOW WE CAN STRUCTURE THINGS.
AND WE ALSO HAVE MODELS OUT
THERE TO TAKE MORE COST
EFFECIVE CARE SO I HOPE TODAY --
WE HAVE AGREED TO SAID THE
SPEAKERS WERE GOING LOOKING AT
THE DATA --
AND THEY KNOW WE HAVE DOCTOR
RIGHT OUT WHO'S GOING TO BE
STARTING US OFF WITH THE THE
CAN'T.
HEALTHCARE QUALITY COST IT BUT
WE'RE ALSO GOING TO HAVE --
STRATEGIES A THAT'S GOING
PRESENTED BY COVERED CALIFORNIA
CALPERS PACIFIC BUSINESS GROUP
ON HEALTH REALLY LOOK AT MEDI
CAL BECAUSE MEDI CAL AND COVERS.
A THIRD OF ALL CALIFORNIANS
ACTUALLY FOR ME IS A FEATURE
SHOULD HALF OF ALL CHILDREN HAVE
ALL THE LIVERIS IS A CERTAINLY A
LARGE PLAYER.
IN.
IN IN THIS SPACE AND THINKING
ABOUT HOW CAN WE BEND THE CURVE
AND BEND THE NEEDLE --
BECAUSE THAT ALSO SAY THAT IS A
POSITION MYSELF --
THAT ON THE FRONT LINES IN THE
FRONT LINES OF CARE OFTEN WHAT
HAPPENS IS THAT --
NOW WE DO HAVE DIFFERENT PLANS
AND ORGANIZATIONS TRYING TO
PROVIDE DOWN THE INCENTIVES ARE
THINGS TO YOUR P. FOR PETER THE
TYPES OF THINGS --
TERMINOLOGY AND ACRONYMS OF PAY
FOR PERFORMANCE.
TO THIRTY IS A CITY IN THE
ACCIDENTS HERE BUT PAY FOR
PERFORMANCE OTHER TYPES OF
THINGS TO TRY TO GET YOU KNOW ME
IN MY OFFICE TO DO THINGS BUT
YET.
OFTEN THEY'RE NOT AT SCALE RIGHT
AND SO AM I GONNA CHANGE THE
WHOLE WAY MY OFFICE DOES
SOMETHING BECAUSE A PLAN THAT
PROVIDES CARE 220% MY PATIENTS.
AND THAT INCENTIVE ISN'T REALLY
GOING TO BE ENOUGH TO COVER THE
COST OF THAT TRANSFORMATION
OFFICE TRANSFORMATIONS HOW DO WE
GET THAT KIND OF TIPPING POINT
TO ISSUES THAT WE WANT TO LOOK
AT AND THINK ABOUT AS WE MOVE
FORWARD BUT CERTAINLY TODAY.
HOPEFULLY THIS THROUGH THIS
INFORMATION HEARING WILL MAKE
YOUR A LOT OF INTERESTING IDEAS --
BE YOU'VE BECOME AWARE OF A LOT
OF DATA --
THAT'S GOING TO BE VERY HELPFUL
TO US AND THINK ABOUT WHAT KIND
OF POLICIES YOU MIGHT WANNA
CRAFT AS A STATE AND ALSO WHAT
KIND OF PARTNERSHIPS WHO WANT TO
HAVE CITY HAPPENED THAT WILL
LEAD US.
AS HIS MOVE US TOWARD --
NOW WE BETTER ACCESS BUT ALSO
BETTER QUALITY AND OF WE ALSO
MORE COST EFFICIENCY IN THE CARE
OF A FEW OF OUR CHRONIC
CONDITIONS SO WITH THAT I WANT
TO THINK OF ONLY.
FILL MEMBERS ARE BEING HERE I
KNOW IF ANYONE ELSE WANT TO MAKE
SOME REMARKS.
OKAY ALL RIGHT SOUNDS LIKE IT
WAS RATE AGO SO TO START WITH AN
FIRST --
PANEL IN A IS ACTUALLY DOCTOR
JEFFREY RIGHT OUT SEE OF THE
INTEGRATED HEALTH CARE
ASSOCIATION GIVING US AN
OVERVIEW THE CALIFORNIA HEALTH
CARE QUALITY AND COST.
DATA ATLAS WELCOME THANK YOU.
MEMBERS AND DOCTOR PAN
SPECIFICALLY FOR INVITING US
HERE TODAY ALSO LIKE TO
ACKNOWLEDGE TORSION AGRAHARA
WHO'S THE SENIOR EXECUTIVE WITH
AJ THAT OWNS MOST OF THIS WORK
AND HAS DONE A FABULOUS JOB.
AND WITH --
SECTOR DO WE IN THE AUDIENCE I
WAS GONNA DO THIS ANYWAY BUT I
WANT TO ACKNOWLEDGE HER
LEADERSHIP ON THE ALICE IN
PARTICULAR THAT SO.
BEEN GOING ON FOR SEVERAL YEARS
SO IT'S PROBABLY GOING TO BE
EASY TO BE OVERWHELMED WITH THE
INFORMATION WHAT I'M GONNA TRY
TO DO IS JUST HELP MAKE
EVERYBODY AWARE OF A FANTASTIC
TOOL.
THAT AT THE DISPOSAL THE STATE
OF CALIFORNIA THAT ACTUALLY WAS
BORN OUT OF THIS.
CALIFORNIA HEALTH AND HUMAN
SERVICES DEPARTMENT --
FIRST AS AN ORGANIZATION WE'RE
KIND OF A STRANGE.
AND ODD AND AND SOMEBODY
INTERESTING ORGANIZATION WE'VE
BEEN AROUND FOR TWENTY FIVE
YEARS WE ARE A NOT FOR PROFIT.
AND WE HAVE A COLLECTION OF VERY
STRANGE BEDFELLOWS HEALTH PLANS
A PROVIDER GROUPS HEALTH SYSTEMS --
WE HAVE --
CONSUMER GROUPS WE HAVE
PURCHASERS ALL AT THE TABLE I
WOULD LIKE TO ACKNOWLEDGE THAT
TO THE THREE PANELISTS IT WILL
FOLLOW ME OUR MEMBERS BY JAY IS
WHERE MEMBERS.
WE DON'T ACCEPT IT ASSOCIATIONS --
BY OUR BYLAWS SO --
BUT WE DO DO A LOT OF WORK WITH
PPG AGE AND WE DO GET A LOT OF
SUPPORT FROM THE CALIFORNIA
HEALTHCARE FOUNDATION.
THERE ARE TWO PROGRAMS AT A LIKE
TO HIGHLIGHT COUNTLESS IS ONE OF
THEM BUT THIS IS THE NEXT STEP
AFTER A LONG STANDING PROGRAM
CALLED CAMP --
DETAILS HERE THAT ARE IMPORTANT
AMP ACTUALLY IS A P. FOR P.
PROGRAM IT'S BEEN AROUND FOR
OVER TWENTY YEARS IT'S THE
LARGEST ALTERNATIVE PAYMENT
MODEL N THE COUNTRY AND
SUPPORTS ABOUT NINE MILLION
COMMERCIAL HMO MEMBERS.
IT'S UNIT OF MEASUREMENT IS THE
PROVIDER GROUP SOON IPA OR
MEDICAL GROUP IS THE PRIMARY
UNIT OF ANALYSIS.
INFORMATION FROM CAMP HAS BEEN
PUBLICLY AVAILABLE THROUGH THE
PA FOR MULTIPLE YEARS AND IT
MEASURES QUALITY PATIENT
EXPERIENCE WHICH I KNOW IS
IMPORTANT THIS COMMITTEE --
AND ALSO TOTAL COST OF CARE AND
THAT'S GOING TO BE A THEME
THROUGHOUT THIS TOTAL COST OF
CARE INCLUDING PATIENT COST
SHARING IS A BIG PART OF THE
MEASUREMENT WE'VE BEEN DOING FOR
ABOUT EIGHT YEARS.
THE ATLAS PROGRAM IS NEWER WERE
IN OUR COUPLE OF WEEKS THIS
STARTED --
ABOUT FIVE YEARS AGO FUNDING FOR
THIS CAME FROM THE CALIFORNIA
HEALTHCARE FOUNDATION FUNDING
FOR THE AMP PROGRAM IS LARGELY
THROUGH THE PLAN PARTICIPANTS.
WHO SUBMIT DATA?
POURTANT TO NOTE THAT THE
HAPLESS PROGRAM INCLUDES OVER
TWENTY NINE MILLION.
INDIVIDUALS IN CALIFORNIA SO
IT'S BY FAR ONE THE LARGEST SUCH
PROGRAMS IN THE COUNTRY IT ALSO
INCLUDES MEDICARE DATA.
ON COMMERCIAL HMO DATA AND HAS
INFORMATION AVAILABLE BY
DIFFERENT PRODUCT LINES LIKE A A
SO OR SELF FUNDED PROGRAMS.
THE REALLY IMPORTANT THING FROM
A TECHNICAL POINT OF VIEW IS
OVER THE LAST COUPLE OF YEARS WE
PUT THIS ON A SINGLE PLATFORM.
SO THESE ARE SEPARATE PROGRAMS
AT ALL DROP FROM THE SAME DATA
THE SAME FOR MATCH THE SAME
MEASURES SO EVERYTHING IS
STANDARDIZED AND THAT'S BEEN A
HUGE LIFT IT'S KIND OF A BEHIND
THE SCENES LEFT.
BUT IT'S EXACTLY WHAT YOU NEED
IF YOU'RE GOING TO DO ANY SORT
OF COMPARISONS THAT HAVE MEANING
ACROSS PLANS AND PROVIDERS AND
PROVIDER --
PROVIDER SYSTEMS.
KEY TAKE AWAYS SO THIS IS --
REALLY.
KIND OF THE THE PUNCHLINE I'LL
GIVE YOU SOME ANALYSIS IF YOU'D
LIKE AFTER THIS --
THERE'S WIDE VARIATION IN
QUALITY AND COST THROUGHOUT
CALIFORNIA IT'S PERSISTENT
OVERTIME IT'S PERSISTENT OVER
PRODUCT LINES --
NORTHERN CALIFORNIA AND URBAN
AREAS TEND TO BE HIGHER ON
QUALITY BUT THE CABBIE OUT THERE
IS.
NOT ALWAYS AND THERE'S A WIDE
VARIATION NO MATTER WHAT YOU
MEASURE NO MATTER WHERE YOU
MEASURE QUALITY.
SOUTHERN CALIFORNIA ACTUALLY
DOES BETTER ON TOTAL COST OF
CARE IN GENERAL I THINK WE
UNDERSTAND SOME OF THOSE TRENDS --
THE DATA IN THE ATLAS ACTUALLY
SUPPORTS PRECISE ANALYSIS
SOMEWHAT THAT MEANS.
THERE'S LESS VARIATION IN MEDIC
COW BUT ONE OF OUR CHALLENGES
THAT I'D LIKE TO LEAVE YOU WITH
HERE TODAY IS THE DATA THAT WE
HAVE FOR MEDI CAL IS MORE
LIMITED.
AND SO WE CAN DO SOME ANALYSIS
BUT IT IS NOT AS ROBUST OR AS
COMPLETE AS IT IS ON THE
COMMERCIAL MEDICARE SIDE SO SOME
OF WHAT WE CAN DO.
ON THE COMMERCIAL AND MEDICARE
SIDE WE CAN'T AT THIS POINT DO
ON THE MEDICAL SIDE.
HEALTH PLAN PRODUCTS THAT USE
INTEGRATED NETWORKS --
THOSE ARE MEDICAL GROUPS AND I.
P. A.'S ATTENDED AND TAKE
FINANCIAL RISK ACTUALLY SO
SUPERIOR COST AND QUALITY
PROFILES.
RELATIVE TO NON INTEGRATED
NETWORKS AND THAT INCLUDES AGAIN
THE PATIENT CARSHARING COMPONENT
OF THAT --
AND FINANCIAL REASSURING IN THE
FORM OF CAPITATION GIN TRYING
NOT TO GET TOO TECHNICAL ABOUT
THIS BUT THAT SEEMS TO HAVE A
DIRECT CORRELATION. TO OVERALL
QUALITY AND TOTAL COST OF CARE
PERFORMANCE SO IN SIMPLE TERMS
THE MORE RISK AN ORGANIZATION
TAKES.
EE AND AND COMFORTABLY THE
BETTER THEY SEEM TO DO ON BOTH
QUALITY AND COST.
OF NOTE ACCOUNTABLE CARE
ORGANIZATIONS WHICH YOU I'M SURE
OF HEARD OF IN OUR ANALYSIS THEY
PERFORM BETTER TAN NETWORKS
THAT ARE NOT INTEGRATED BUT THEY
DON'T PERFORM BETTER THAN THE
INTEGRATED NETWORKS THAT HAVE
EXISTED FOR FIFTEEN OR TWENTY
YEARS SO THERE'S VARIATION --
AND AGAIN THE LACK OF MEDICAL
DATA T THIS POINT IN ARE
PROCESS SEEMS TO LIMIT SOME OF
THE THINGS THAT MIGHT BE MOST
INTERESTING GIVEN THE GROWTH IN
MEDICARE MEMBERSHIP [inaudible]
YEAH.
THERE IN THE STATE OF CALIFORNIA.
CALIFORNIA'S ROLLED IN THE
MEDICAL PROGRAMS LIKE FOR
MISSING A VERY IMPORTANT
COMPONENT TO IT TO DATA FOR US
YES START ARE UP TO YOU --
I THINK THE THE BEST ANSWER IS
THIS WHOLE PROGRAM IS VOLUNTARY
IT'S WHAT'S CALLED A VOLUNTARY
MULTI PAYER CLAIMS DATABASE.
SO WE GET THIS INFORMATION FROM
THE HEALTH PLANS BASED ON THEIR
WILLINGNESS TO GIVE IT TO US --
AT THIS POINT MEDI CAL HAS BEEN --
NOT AS WILLING ORGANIZATIONALLY
AND I I WOULD SAY A COUPLE
CABBIE ODDS WE DO GET MEDI CAL
DATA FROM ONE HEALTH PLAN
PROMISE HEALTH PLAN --
WE HAVE AS MANY OTHER GENERALLY
THEY BE WILLING TO DO THAT THE
CHALLENGES BECAUSE OF THE CAR
ABOUT NATURE OF MANY OF THE
PLANS THAT DATA FROM THE SOURCE
IS NOT IS COMPARABLE SO IT'S
ACTUALLY EASIER TO GET IT
DIRECTLY.
FROM DH CS SO UP TO THIS POINT
WE'VE GOTTEN INFORMATION AND
PERFORMANCE FROM DH CS WE
HAVEN'T GONE THE DATE ITSELF.
AND THAT'S BEEN A FRIENDLY
DIALOGUE BUT IT'S JUST IT'S A
PROCESS AND I WOULD JUST POINT
OUT THOUGH WE WILL BE HEARING
FROM DHS TOWARD THE END OF MY
ALASKAN THAT --
TO I WENT OVER ONE YOU WITH THE
ANALYSIS I GUESS WHAT I WOULD.
LEAVE YOU WITH IS THAT WHATEVER
I SHOW YOU IS A FORM OF A USE
CASE OF WHAT CAN BE DONE WITH
THIS INFRASTRUCTURE THERE ONLY.
LIMITED TO THE TOPIC THAT WE'RE
TALKING ABOUT.
THIS IS MEASURING CHRONIC CARE
PERFORMANCE AND THE TAKE AWAYS
HERE RATES ARE GENERALLY LOWER
THAN YOU'D WANT IN THE VARIATION
IS QUITE HIGH SO --
AVERAGES HIDE A LOT OF TRUTH
THAT EVERYBODY NEEDS TO
UNDERSTAND SO IF YOU LOOK AT
THESE RATES ARE YOU CAN SEE THAT
SOME OF THE DIABETES MEASURES
ARE ACTUALLY IN THE 50% RANGE ON
AVERAGE.
OR IF YOU LOOK AT THE VARIATION --
PRETTY WIDE VARIATION AND THIS
EXISTS WHAT YOU'RE TALKING ABOUT
GEOGRAPHIES OR DIFFERENT HMO PPO
OR RISK SHARING ARRANGEMENTS --
I PUT A FEW THE COUNTIES THAT
PERFORM WELL ON THAT JUST TO
SHOW YOU THAT THERE IS A TREND
TOWARD NORTHERN CALIFORNIA BUT
NOT ALWAYS AND AGAIN WITHIN ANY
COUNTY THERE ARE HIGH PERFORMERS
AND LOW PERFORMERS --
COST THIS IS ANOTHER IMPORTANT
ANALYSIS TO SHARE TOTAL COSTS TO
CARE AGAIN INCLUDES --
CLINICAL RISK ADJUSTMENT SO NOT
TO GET TOO WALKING ABOUT IT BUT
THIS ACCOUNT FOR DIFFERENCES IN
PATIENT POPULATIONS AND DISEASE
SEVERITY.
IT ALSO INCLUDES WAGE
ADJUSTMENTS SO WE ARE JUST SEEN
AS BEST WE CAN FOR WHICH THE
DIFFERENTIALS IN NORTHERN AND
SOUTHERN CALIFORNIA --
PRETTY OBVIOUS TREND IN NORTHERN
ON A COMPARATIVE BASIS --
ALSO MUCH MORE VARIATION IN
NORTHERN CALIFORNIA THEN IN
SOUTHERN AND THERE'S LOTS OF
CONJECTURE ABOUT THIS.
US IN THE CALIFORNIA TENDS TO BE
BY MOST METRICS MORE COMPETITIVE
MARKET --
THE NORTHERN CALIFORNIA IN SOME
WAYS -- THE
DELIVERY MODEL MATTERS HERE I'M
GONNA SHOW YOU HOW INTEGRATED
CARE PERFORMS RELATIVE TO NON
INTEGRATED CARE --
THIS GIVES YOU A SENSE OF THE
POWER OF THE COMBINED DATABASE
EACH OF THOSE DOT IS A DIFFERENT
HEIGHT PA MEDICAL GROUP IN THE
STATE THERE ALMOST TWO HUNDRED
REPRESENTED.
AND THE AVERAGE FOR INTEGRATED
CARE ON A DIABETES COMPOSITE IS
ABOUT 55% THAT'S FIVE TO SIX
MEASURES WHERE YOU HAVE TO BE
GOOD ON ALL OF THEM TO GET
CREDIT SO.
THAT'S NOT NECESSARILY BAD IT'S
NOT NECESSARILY GOOD WHEN YOU
LOOK AT THE STATEWIDE AVERAGE
HOWEVER TAXES LOWER SO WHAT WE
SEE IS WHEN YOU START TO COMBINE
INTEGRATED AND NON INTEGRATED
DELIVERY SYSTEMS THINGS GET.
WORSE THIS INCLUDES THE
INTEGRATED SYSTEMS --
THE HIGHEST REGIONAL AVERAGE IS
ABOUT THE SAME AS THE INTEGRATED
AVERAGE AND IF YOU LOOK AT THE
TOP.
QUARTILE OF THE INTEGRATED
GROUPS IT'S MUCH HIGHER WITH
THIS TRANSLATES TO IN TERMS OF
ACTUALLY PATIENT CARE IS ABOUT
EIGHTY THOUSAND MORE DIABETICS
GETTING BETTER AND MORE
APPROPRIATE SCREENING.
THEN IN INTEGRATED CARE THEN AND
NON INTEGRATED CARE AND TIME
SECRETARY WHO STILL OKAY.
OKAY -- A
FEW THINGS TO SAY WHEN WE
STANDARDIZE ALL THE MEASURES AND
COMPARE HMO PPO.
HMO IS ACTUALLY CHEAPER IN TOTAL
COST OF CARE A LESS EXPENSIVE
SHOULDN'T USE WERE CHEAPER.
OF MOST OF THAT IS DUE TO THE
MEMBER COST SHARING AND IN OUR
IN OUR MINDS THIS IS THE ACTUAL
NUMBERS TO GO WITH IT.
IF YOU LOOK AT THOSE NUMBERS FOR
PATIENTS WITH CHRONIC CONDITIONS
IT'S TWO TO THREE TIMES HIGHER.
A TWO THREE HIGHER TIMES HIGHER
THAN THE ACTUAL NUMBER SO WE'RE
TALKING ABOUT NOW THOUSANDS OF
DOLLARS FOR PATIENTS WITH
CHRONIC DISEASE IN TERMS OF COST
SHARING SO MOST OF THE A
PRESUMED ADVANTAGE OF SHARON
SEEMS TO SHIFT TO THE PATIENTS.
LAST THING I'M GOING TO SHARE IN
THE NONSTOP --
WE TOOK ANOTHER LOOK AT THIS
AGAIN THE PLANS ARE REALLY
REALLY SUPPORTIVE OF PROVIDING
THE DATA AND ACTUALLY PAYING FOR
A LOT OF THIS INFRASTRUCTURE WE
ARE VERY APPRECIATIVE.
SO IT'S NOT SO MUCH ABOUT THE
PRODUCT LABEL HMO PPO TRULY
WHAT'S UNDERNEATH THE CHASSIS.
SO WE LOOKED AT ACTUALLY --
WHAT TYPES OF NETWORKS ARE
PROVIDING UNDER THESE PRODUCT --
PLANS SO WE WERE ABLE TO LOOK AT
WHETHER --
THE ENROLLEES ARE ACTUALLY IN
RISK SITUATIONS CAPITATED
SITUATIONS OR NOT.
SO WHEN YOU LOOK AT ACTUALLY NO
RISK WHICH TEND TO BE MORE PPO
BUT NOT ALWAYS.
THAT'S A COMPOSITE OF THEIR
QUALITY GOING.
FROM BOTTOM TO TOP GETS HIGHER
WHEN YOU TAKE ON MORE RISK AND
GETS EVEN A LITTLE HIGHER WHEN
YOU TAKE ON COMPLETE RISKS OF
THE FULL BUDGET. FOR OUTPATIENT
AND INPATIENT CARE COST GO THE
OPPOSITE DIRECTION --
SO -- WHAT
WE HOPE WITH THIS ANALYSIS WE
CAN SPLIT A BY PRODUCT LINE IS
LET'S LOOK AT SORT OF THAT THE
CHARACTERISTICS?
OF A OF A PRODUCT THAT PEOPLE
ARE BEING ASKED TO PURCHASER
BEING OFFERED --
AND WHAT DRIVES --
HIGHER VALUE CARE.
TIE WILL STOP THERE THE LAST
THING.
POR STOP THIS ACTUALLY LOOKS AT
THE NUMBER OF MEASURES.
THAT WE NOW CAN CALCULATE THESE
OF THE MEDI CAL VERSUS
COMMERCIAL VERSUS MEDICARE AS
YOU CAN SEE THERE'S BEEN A REAL.
NICE TRAINED UP FOR BOTH
MEDICARE AND COMMERCIAL DATA WE
HAVE NOT SEEN THAT SAME GROWTH
IN THE MEDI CAL.
INFORMATION PARTLY BECAUSE WE'RE
NOT CALCULATING THOSE RATES WE A
SUBJECT TO WHAT THE H. YES WOULD
LIKE TO DO WITH US.
SO I WILL.
STOP THEIR FEW THINGS FOR
ACTIONS WHICH COME OUT OF OUR
WORK [inaudible] TO THANK YOU
VERY MUCH ALRIGHT QUESTIONS
REMEMBERS YES CENTER LEYVA.
THINK MISTER CHAIR THANK YOU THE
DOCTOR RIGHT OUT FOR YOUR VERY
INFORMATIVE --
PRESENTATION HAVE TWO QUESTIONS.
HMO AND PPO COSTS AND THE PPO
COSTS ARE HIGHER TO THE THE
MEMBER THE THE PERSON WHO'S
PAYING THAT.
DO YOU THINK THAT IS BECAUSE I
AM SOMEONE WHO'S HAD AN HMO AND
AND HAVE HAD A PPO FOR A LONG
TIME.
DO YOU THINK THAT IS BECAUSE THE
HMO THOSE KIND OF CONTROL.
WHERE YOU CAN GO WHEN YOU CAN GO
TO THE DOG WITH THE PPO I CAN I
CAN THEORETICALLY GO TO WHOEVER
I WANT AND ITS EASE EGGS CALL
MAKE THE APPOINTMENT VERSUS
HAVING TO HAVE A REFERRAL DO
THINK THAT HAS ANYTHING TO DO
WITH THE COSTS --
THAT NO DOUBT OCCURS I WILL --
CAUTION EVERYBODY ON THE
COMMITTEE THIS IS OBSERVATIONAL
DATA AND THIS IS WHAT WE SEE
WHAT IS DRIVING THOSE
DIFFERENCES IS REALLY FOR
POLICYMAKERS AND OTHERS --
TO TO ASK AND ANSWER I THINK
FROM WHAT WE SEE IN THE DATA.
IS LARGELY BASED ON THE COST OF
DELIVERING THE CARE FOR ANY
MATCH POPULATION AND WHO'S
PAYING PART OF THAT SO.
IN AN HMO THE CAUTION IS MUCH
LOWER THE COPAYS AND DEDUCTIBLES
BY DESIGN MEDI CAL THEIR THEIR
NEXT TO NOTHING SO IF YOU USE
THE ACTUARIAL TERM THE ACTUARIAL
VALUE IS HIGHER IN AN HMO --
WHERE IS IN A PPO MORE THAT IS
SHIFTED AND THE PEOPLE THAT THEN
IN KERR THOSE COSTS FOR THE ONES
THAT YOU SERVICES?
GOT IT.
THANK YOU.
CAN YOU EXPLAIN WHEN YOU SAID
FINANCIAL RISK SHARING WHAT IS
THAT -- IN
COMMON TERMS IT'S CAPITATION
OKAY -- OR
BUDGETED SO BASICALLY PEOPLE
TAKING A SET AMOUNT OF MONEY TO
TAKE CARE OF AN ENTIRE
POPULATION REGARDLESS OF WHETHER
THAT POPULATION IS.
SICK HEALTHY.
SO IT BASICALLY CHANGES THE
INCENTIVE STRUCTURE FOR THE
GROUPS THAT ARE DOING THAT AT
THANK YOU WORK THANK YOU MISTER
CHAIR [inaudible]
QUESTION --
I I HAD A FEW QUESTIONS AND
AGAIN I WANT THANK YOU SO MUCH
FOR YOUR PRESENTATION AND I
THINK IT'S GIVES US A LOT OF
FOOD FOR THOUGHT --
THIS WERE YOU FORD --
SO FIRST ON TERMS OF YOU KNOW
MENTIONED ABOUT INTEGRATE CARED
A CIOS RIGHT AND MAYBE THERE'S A
DEATH I MEAN THERE DEVELOP
DIFFERENT TYPES OF ACS OUT THERE --
WHAT IS?
YOUR LOOKING AND I DON'T KNOW IF
YOU'RE ABLE TO GET TO THIS OR
SO SOMETIMES WHAT HAPPENS
SOMEONE SAYS WILL GRAHAM ACO AND
THEY SAID WELL IT'S IT'S ABOUT
MULTIPLE DISEASES ARE ACTUALLY
SO POPULATION RIGHT.
AND SOMETIMES YOU'LL SAY WELL
TODAY CO SHOULD BE FOCUSED ON
ONE PARTICULAR CHRONIC DISEASE
BECAUSE ACTUALLY YOU COULD
IMPROVE YOUR DIABETES CARE BUT
IF DAVIESS LUMPED IN WITH A
WHOLE BUNCH OF OTHER DISEASES
IT'S HARD TO SEE THE IMPROVEMENT
IN THE ONE SO.
I DON'T KNOW FROM THE OTHER YOU
HAD SOME THOUGHTS ABOUT IF IT IF
WE'RE TRYING TO TRY TO TACKLE --
YOU KNOW IT --
COME OF VALUE BASED SYSTEMS
THESE GROUPS VERSES POT YEAH
JUST JUMP POPULATION AND WHEN IT
COMES TO CHRONIC DISEASE A
MAGAZINE PREVENTION STANDPOINT
YOU WANTED. TO TACKLE WHOLE
POPULATION.
BUT FROM A YOU KNOW CHRONIC
DISEASE MANAGEMENT IS IT IN
TERMS OF FOR WRITING THE RIGHT
INCENTIVES.
DIAZ SAY OKAY WE'LL GIVE YOU A
SET AMOUNT FOR DIABETES
MANAGEMENT FOR YOUR POOL OF
DIABETICS AND THEN WILL HAVE A
DIFFERENT ONE FOR LET'S SAY
ASTHMA OR SOME OTHER CHRONIC
DISEASE VERSUS A WILL GIVE ME AN
ACL IT EVERYTHING'S LUMPED
TOGETHER --
SO.
BECAUSE YOU'RE THE WHAT
SOMETHING'S MAY ACTUALLY CREATE
CHANGES ACROSS MULTIPLE CHRONIC
DISEASES A LOT OF TIMES YOU'RE
DOING YOUR YOU'RE CREATING
PROCESS IS THAT THEY ACTUALLY
RELIEF.
PARTICULAR TAYLOR TOWARD ONE
PARTICULAR.
ONE AND SO I DON'T KNOW YOU ARE
A COMMON OF THAT A PARTICULAR MY
AT LET AND ALSO THE EXISTING
MODELS THAT WOULD INDICATE WHICH
WAY IS THE BETTER WAY TO GO.
SOMETHING CO A SORRY ACCOUNTABLE
CARE ORGANIZATION SO THAT YEAH
IT IS AS SAYING THAT THE
COUNTABLE CARE ORGANIZATION DIED
CONCEPT IS IS THAT'S A SURE SO
WHAT HAPPENS IS THAT YOU WOULD
GIVE A FIX THE ACE SOMEWHAT
FIXED AMOUNT FOR CARING FOR
PATIENTS AS A PARTICULAR
CONDITION.
RIGHT AND THEY'RE FOR DIRTY SO
CALLED SHARED SAVINGS OF YOU
ACTUALLY SO THAT THE DOCTOR IN
THE HOSPITAL THE PHARMACEUTICALS
AND ALL THAT DEPENDING WHAT'S
ALL LUMPED UNDER THE AC ON BELLA.
YEAH BASICALLY YOU MANAGE THEM
OUT MONEY WE ACTUALLY END UP
SPENDING MORE YOU LOSE MONEY IF
USE.
DO IT FOR LESS YOU ACTUALLY GET
TO KEEP THE SAVINGS ARE SOME
SORT OF SAVINGS ARRANGEMENTS
THOSE CALL OFTENTIMES IT'S
CULTURED STATING SO GIVES AN
INCENTIVE FOR PEOPLE. TO IF YOU
ACTUALLY LOWER THE COST OF CARE
BY APPROVING IT OUT THAT THE
COST EFFICIENCY YOU ACTUALLY GET
TO KEEP SOME OF THAT MONEY SO
YEAH THAT'S THE INCENTIVE TO TO
TRIP IT'S NOT OVER SIMPLIFYING
THINGS -- A
SEALS ARE LARGELY A MARKETING
TERM IN A BRAND AND A BRANDING
TERM -- WHAT
IT WHAT IN A CO IS EVEN IN THIS
DISCUSSION IT'S IT'S OBVIOUSLY?
COMPLICATED AND OUR WORK
ACTUALLY SHOWS THERE ARE NINE
DIFFERENT WAYS THAT PEOPLE GET
PAID UNDER A CEOS ARE EIGHT
DIFFERENT WAYS TO ATTRIBUTE
PATIENTS TO IN A CO IN
CALIFORNIA.
SO I I THINK I WOULD SAY WHAT IS
MORE IMPORTANT IS THE LOCUS OF
CARE DELIVERY AND WHETHER THAT
CARE DELIVERY SITE IS INTEGRATED
OR NOT SO --
INTEGRATED CARE TENDS TO PRODUCE
THE KIND OF RESULTS THAT PEOPLE
ARE LOOKING FOR SPECIAL FOR
CHRONIC CARE WHATEVER GETS
LABELED IS ALMOST SECONDARY AND
IF YOU CAN TOLERATE ONE MORE
SLIDE WE DID.
I JUST WANT TO SHOW YOU
SOMETHING ELSE THAT WE THANK YOU
USE USE THE USE OF YOUR SLIDE --
YEAH I MEAN THERE'S LOTS OF GOOD
ONES WE YOU KNOW WE CAN SPEND
ALL DAY SO THIS IS THE THE CURVE
A SHOWED YOU ABOUT THE LEVEL OF
RISK AND AGAIN.
ALL ON ATTRIBUTE TO DELORES ON
THIS WE ASK FOR ANY CO FLAG SO
WE ACTUALLY IN OUR DATABASE CAN
KNOW WHO'S IN ANY CO HAS A
HEALTH PLAN WOODS WOULD WOULD
SELF REPORT.
THIS IS WHERE THEY LAND RIGHT
NOW.
SO IT'S A LITTLE BIT BETTER THAN
AND NOTHING ON A IT'S NOT AS
GOOD AS MAYBE THE HIGHEST END OF
THE INTEGRATED GROUPS AND WE'RE
UPDATING THAT INFORMATION NOW --
SO WE'LL HAVE MORE UPDATES BUT I
GUESS THE MAIN POINT IS WE HAVE
THE CAPABILITY TO DO THIS AND
WE'RE NOW ASKING THOSE HARDERQUESTIONS ABOUT.
WHAT'S UNDER THE HOOD.
THANK YOU THAT SAID IT'S VERY
INTERESTING I THINK IT WILL --
I GUESS THE OTHER.
QUESTION I WAS HAVING IS IS THAT --
THAT IS SO I AND I GUESS UNDER
MEDICARE CARED VANTAGE --
THERE --
DOING SOME PAYMENT MODELS AND
AND SO WHEN WE TALK ABOUT
CAPITATION RATE SO OFTEN WHAT
HAPPENS IS THAT IT SHOULD AT
LEAST AT THE HEALTH PLAN LEVEL
WHERE YOU HAVE --
PEOPLE PAYING PREMIUMS INTO
THOSE WE WE DON'T WANT CHARTER
BASICALLY WE'VE ACTUALLY MADE
ILLEGAL FOR YOU TO CHARGE
DIFFERENT PREMIUMS TO PEOPLE
BASED ON THE CONDITION THAT WE
SHOULD HAVE THAT KIND OF
DISCRIMINATION BUT CLEARLY.
PEOPLE DEPENDING ON WHAT THE
CONDITIONS THEY HAVE WILL COST
DIFFERENTLY --
SO IN TERMS.
SAYS SOMEONE THINGS WE WANT TO
TRY TO FIGURE OUT HOW DO WE
AVOID THIS.
ADVERSE SELECTION PROBLEM RIGHT
AND AND FOR EXAMPLE IN THE
MEDICARE ADVANTAGE A CEOS --
THEY'VE ACTUALLY YOU KNOW GIVE
PAYMENT BASED ON AT LEAST SOME
ESTIMATION WHAT THE COST WOULD
BE TO GIVE THE OPPORTUNITY
CREATORS COST SAVINGS THROUGH.
WITH IT AND CARE INNOVATION AND
SO FORTH.
WE DID YOUR THOUGHTS ON ON HOW
WE MIGHT TRY IT IT'S FROM
LOOKING AT THIS DATA.
WHEN YOU'RE LOOKING AT
INTEGRATED MODELS IS THERE?
IN TERMS OF THEIR PAYMENT
MECHANISMS --
MATTER DDC PARTICULAR MODELS
THAT THAT SEEM TO SHOW THE MORE
PROMISE IN THAT REGARD.
YES -- WE
DIDN'T HAVE TIME BUT THE THE
TREND INFORMATION ON COMMERCIAL
IS PERFECTLY NEARED IN MEDICARE --
MEDICARE VERSUS MEDICARE
ADVANTAGE --
SO AND I THINK THE IMPORTANT
PART IS ON THE CLINICAL MEASURES
FOR MEDICARE ADVANTAGE.
GROUP VANTAGE POPULATION SO --
AND I THE INCENTIVES YOU'RE
TALKING ABOUT I THINK --
OR THE STAR SYSTEM SO BASICALLY
IF YOU LOOK AT THE STARS SYSTEM
AS A PERFORMANCE MEASUREMENT
THAT HAS.
BOTH --
INCENTIVE DOLLARS TO IT AND
PENALTIES FOR UNDER PERFORMANCE
THAT'S ESSENTIALLY BUILT ON THIS
KIND OF DATA --
THAT CMS AND GENERATE.
ENOUGH FINALLY EXIT --
AND I LOOKING FOR EXPLORING SOME
OF THESE THINGS ALSO THEIR
FUTURE BUT THEIR NECKS PANELS TO
BUT THE OTHER THING ACTUALLY I
JUST -- MAKENOTE BECAUSE YOU MENTIONED ABOUT
THE DIFFERENCE WE NORTHERN
SOUTHERN CALIFORNIA NOW --
THE DARTMOUTH ATLAS FOLKS HAD
ACTUALLY DID A STUDY MAYBE ABOUT
TEN THINKS ABOUT TEN OR FIFTEEN
YEARS AGO.
AND THEY ACTUALLY LOOKED AT END
OF LIFE CARE AND THEY DID JUST
LOOK AT MEDICARE DATA BECAUSE
THAT'S WHAT THEY HAD WORKING
WITH THEM.
AND ACTUALLY MADE NOTE THAT --
UTILIZATION FOR END OF LIFE CARE --
SO -- I
DON'T KNOW IF THINGS HAVE
CHANGED OVER TIME OR IS IT JUST
THAT AND THAT THEY ALSO NOTED
THAT.
SORT OF PRICE PER UNIT WAS
HIGHER NORTHERN CALIFORNIA SO
PRICE PER UNIT SERVICE.
BUT THAT BUT THE ACTUAL BUT THE
UTILIZATION ACTUALLY WAS HIGHER
SOUTHERN CALIFORNIA THEY
ACTUALLY TREATED POTENTIALLY
TOWARD ACTUALLY.
YOU SAID MORE YELTSIN'S MORE
COMPETITION BUT THE ACTUALLY THE
HAVING MORE SPECIALISTS AND
HAVING MORE ICE YOU BEDS
AVAILABLE MEANT THAT PEOPLE ARE
MORE LIKELY TO END UP IN ONE
WHICH WAS MORE INTENSIVE.
SO I KNOW WHETHER YOU --
YOU HAD A CHANCE TO EXPLORE --
THAT WHETHER THERE'S A BEEN A
SECULAR TREND SINCE THAT STUDY
WAS DONE BECAUSE IT SEEMS TO BE
LITTLE COUNTER TO WHAT YOU'RE
SEEING NOW WITH THE DAY THAT YOU
HAVE -- I'D
SAY I AM FAMILIAR WITH THE DATA
I THINK THAT IS A DIFFERENT
PHENOMENON.
ARE COMPARISONS ARE LARGELY
COMMERCIAL POPULATION SO THAT WE
CAN DO MEDICARE.
AND AND THEY ARE CLINICALLY RISK
ADJUSTED SO PRESUMABLY UP TO THE
POINT WHERE YOU CAN DO THIS THE
POPULATIONS ARE MATCHED --
THE DIFFERENCES BETWEEN NORTH
AND SOUTH SEEM TO BE --
RELATED --
TO UNIT PRICING --
AND THAT SAID IN DETAIL BY
DOCTOR SHUFFLER ANOTHER SAID AT
BERKELEY --
NOT UTILIZATION DIFFERENT.
AND THE BIGGEST ONE LAST SUMMER
TECHNICAL QUESTION BUT GIVES
YOUR TO DATE A GUY YOU'RE DOING
THE AND ATLAS --
WHAT DO YOU THINK I MEAN SOME
PEOPLE TALKED ABOUT ONE THE HOLY
GRAIL SAYS RISK BASE PREMIUM
PAYMENT RIGHT WHETHER IT'S
PREMIUMS ARE POOL AND
REDISTRIBUTION OR SOME KIND OF --
HIGH RISK POOL OR SOMETHING.
D. AS IS THE DATA TECHNOLOGY
THERE YET IN TERMS OF ACTUALLY
DOING RISK BASED PAYMENTS OF
BASICALLY ADJUSTING THE PAYMENT.
TO BUT IS HEALTH PLANS OTHER
RISK BEARING ORGANIZATIONS BASED
ON THE RISK OF THE POPULATION
CAN WE DO THAT ACTUALLY ENOUGH
SO THAT PEOPLE CAN'T OVERLY GAME
THE SYSTEM.
AND THEN PROVIDE THIS KIND OF
SENTENCE TO TAKE ON MORE PEOPLE
CHRONIC CONDITIONS --
IS IS THE TECHNOLOGY THAT REALLY
QUITE GOOD ENOUGH TO DO THAT.
SO THE THE WAY AN ANSWER I DON'T
THINK THIS IS A TECHNOLOGY FIX I
I THINK THE THE PROBLEMS ARE
VERY VERY CLEAR AND TAKE A
FAIRLY SIMPLE STEPS TOWARD
GETTING PEOPLE INTO INTEGRATED
SYSTEMS -- I
REMEMBER THE DAYS WHEN THERE IS
RISK ADJUSTED CAPITATION.
REALLY COMPLICATED REALLY HARD
TO EXPLAIN I THINK BASICALLY
THERE'S A LOT WE CAN DO SHORT OF
THAT KIND OF R. A. I. R. MACHINE
LEARNING KIND OF ENVIRONMENT --
AND MOST OF IT IS AVAILABLE THE
DATA THAT WE WE LOOK AT NOW.
RIGHT THANK YOU ANY OTHER
QUESTIONS.
ALL RIGHT THANK YOU SO VERY MUCH
REALLY APPRECIATED THANK YOU.
OKAY SO NEXT UP --
SO THANK YOU AGAIN BACKED RIGHT
OUT SO NEXT UP WE HAVE.
A PANEL ON NOT CONTRACT
STRATEGIES IMPROVE CHRONIC
DISEASE CARE AND AND REALLY
APPRECIATE WE GET --
DOUG MCKEEVER --
CHIEF DEPUTY DIRECTOR PROGRAMS
COVERED CALIFORNIA --
WITH KATHY DONNA SEND A CHIEF
HEALTH PLAN ADMINISTRATION
DIVISION CALPERS.
AND BILL KRAMER EXECUTOR IS
DOING ON BEHALF OF OUR ARE --
GOVERNMENT NOW STATE AND THE
GOVERNMENT EMPLOYEES AS WELL TO
RECAP FOR SYSTEM AND OF COURSE
REPEAT BUSINESS PERSPECTIVE SO
WE'LL START WITH THAT MISS RICKY
VERNAL.
AND SO THANK YOU WELCOME THANK
YOU MISTER CHAIR AND MEMBERS OF
THE COMMITTEE DOUG MCGEE EVER
COVER CALIFORNIA.
AND GREATLY APPRECIATE THE
OPPORTUNITY --
TO DEMONSTRATE AND COMMUNICATE
TO YOU HOW WE'RE GONNA PROVE THE
DELIVERY SYSTEM AND SIX MINUTES
OR LESS --
TO T. OUT MY COMMENTS TODAY I
WOULD LIKE TO PROVIDE SOME BRIEF
CONTEXT ON COVER CALIFORNIA.
THERE ARE SEVERAL MAIN AREAS WE
FOCUS ON CLEARLY AFFORDABILITY
IS.
ONE ACCESS QUALITY AND THE
OVERALL DELIVERY SYSTEM.
OUR GOAL IS TO MAXIMIZE OUR
ENROLLMENT.
AND HAVE AN OVERALL HEALTHY RISK
MIX. FOR COVERED CALIFORNIA THIS
IS RESULT IN US HAVING A STABLE
ENROLLMENT.
AND ONE OF THE HEALTHIEST
ENROLLMENT POPULATIONS IN THE
COUNTRY.
ON AVERAGE ARE CONSUMERS ARE 20%
HEALTHIER THAN THOSE ENROLLED IN
THE FEDERALLY FACILITATED
MARKETPLACE IS.
IN OTHER STATES.
UNDERLYING ALL THIS IS HOW MANY
STABLE AND EFFICIENT DELIVERY
SYSTEM. ONE HELD ACCOUNTABLE FOR
THE PROVISION OF EFFECTIVE AND
EFFICIENT CARE.
AND OUR ABILITY TO COLLABORATE
IN A LINE WITH OTHER PURCHASERS
AND THAT'S FROM THE SPEND MOST
OF MY TIME THIS AFTERNOON.
AS MANY OF YOU MAY KNOW WE HAVE
WHAT IS CALLED ATTACHMENT.
SEVEN WHICH PLACES CONTRACTUAL
REQUIREMENTS ON ARE QUALIFIED
HEALTH PLANS.
AND THEIR PROVIDERS.
THERE ARE NINE MEAN ARTICLES
WITH A HOST OF SUB ARTICLES
WITHIN EACH ONE OF THOSE.
RANGING FROM IMPROVING CARE.
PROMOTING BETTER HEALTH AND
LOWERING COSTS.
PROMOTING DEVELOPMENT AND USE OF
EFFECTIVE CARE MODELS.
REDUCING HEALTH DISPARITIES AND
INSURING HEALTH EQUITY.
AND PAYMENT INCENTIVES TO
PROMOTE HIGHER VALUE CARE.
SOME OF THE RESULTS WE ARE SEEN
MOSTLY FROM THE TO THESE TWO
THOUSAND AND SEVENTEEN PLAN YEAR
ARE.
VETERAN NATIONAL ANALYSIS SHOW
THAT HEALTH PLANS WORKING WITH
THEIR NETWORK PROVIDERS HAVE
MADE STEADY IMPROVEMENT IN
QUALITY.
CONSUMERS ARE GETTING THAT
QUALITY CARE AT THE RIGHT TIME.
AND WE ARE WORKING TOWARD
REDUCING HEALTH DISPARITIES.
AN EXAMPLE OF THIS ARE THE
GLOBAL QUALITY RATINGS ON THE
STAR RATING SYSTEMS A DOCTOR
RIGHT OUT POINTED OUT.
WHERE ALL OF OUR HEALTH PLANS
ARE AT LEAST THREE STARS AND TWO
OF THEM ARE CURRENTLY AT?
FIVE QUALIFIED HEALTH PLANS OF
SHOWN STEADY IMPROVEMENT.
OVER THREE YEARS FOR IMPORTANT
MEASURES INCLUDING H. P. A. ONE
C. LEVELS.
DIABETIC MEDICATION ADHERENCE
AND COLORECTAL CANCER SCREENINGS.
AS OF TWO THOUSAND AND SEVENTEEN
SIX OF OUR ISSUERS HAD
IMPLEMENTED VALUE BASED PAYMENTS
FOR HOSPITALS.
THESE HOSPITAL VALUE BASED
PAYMENTS PROVIDE THE FOUNDATION
FOR INSURERS TO MEET THE
REQUIREMENT.
THAT 2% OF HOSPITAL PAYMENTS FOR
EACH IN NETWORK HOSPITAL IS TIED
TO VALUE.
AS OF TWO THOUSAND AND SEVENTEEN
MOST HEALTH PLANS HAD ACTIVELY
RE CONTRACTED FOR PAYMENTS. FOR
LOW RISK OF C. SECTIONS.
WHILE THE REMAINING HELP PLANTS
HAVE BEGUN THE PROCESS.
RATES OF LOW RISK SEE SECTIONS
FOR FIRST TIME PREGNANCIES ARE
STEADILY COMING DOWN.
AND IN TWO THOUSAND AND
SEVENTEEN ALMOST FORTY FIVE
HUNDRED UNNECESSARY SEE SECTIONS.
WERE AVOIDED STATEWIDE.
HOSPITAL PARTICIPATION IN
PARTNERSHIP FOR PATIENTS
IMPROVEMENT COLLABORATIVE'S.
IS NOW NORMALLY UNIVERSAL.
A REFLECTION OF THE
COLLABORATION THROUGH SMART CARE
AND THE EFFORTS THAT WE
COLLABORATED WITH WITH DH CS
CALPERS.
IN PGH.
IN TWO THOUSAND SEVENTEEN
VIRTUALLY ALL 99% OF COVER
CALIFORNIAN ROWLEY'S OF WHICH
THERE ARE ABOUT ONE POINT FOUR
MILLION.
WERE MATCHED WITH THE PRIMARY
CARE CLINICIANS.
SOMETHING VERY UNIQUE TO THE
HEALTHCARE INDUSTRY.
ENROLLMENT IN PATIENT CENTERED
MEDICAL HOMES HAS INCREASED
SLIGHTLY BETWEEN THE TWO
THOUSAND AND SIXTEEN AND TWO
THOUSAND SEVENTEEN WE HAVE SEEN
SIGNIFICANT GROWTH IN ENROLLMENT
IN INTEGRATED HEALTH CARE MODELS
FOR THE ACCOUNTABLE CARE
ORGANIZATION SAID DR RIGHT OUT
SPOKE OF FOR OUR HEALTH PLANS
WITH BOTH.
E. IN PPO NETWORKS. 99% OF
ENROLLEES IN TWO THOUSAND AND
SEVENTEEN WERE OFFERED
TELEHEALTH SERVICES. 58% WERE
OFFERED PRIMARY CARE TELEHEALTH
VISITS AT THE SAME COST OF A
PRIMARY CARE VISIT.
AND 41% WERE OFFERED PRIMARY
CARE TELEHEALTH VISITS AT NO
COST SHARE.
WHILE THESE DATA POINTS ARE
ENCOURAGING WE CONTINUE TO
STRIVE TO ENHANCE OUR ABILITIES
TO MAKE THE HEALTHCARE SYSTEM
MORE AFFORDABLE.
ACCESSIBLE AND INCREASE QUALITY.
TO THAT END WE HAVE EMBARKED
UPON AN EFFORT OF REFRESHING OUR
CONTRACTUAL EXPECTATIONS.
DESIGNED TO PROMOTE
ACCOUNTABILITY AND DELIVERY
SYSTEM IMPROVEMENTS.
OUR GUIDING PRINCIPLES ARE
IMPROVING THE HEALTH OF THE
POPULATION.
THE EXPERIENCE OF CARE.
REDUCING THE COST OF CARE.
REDUCING ADMINISTRATIVE BURDEN.
AND REDUCING HEALTH CARE
DISPARITIES.
PROMOTING ALIGNMENT WITH OTHER
PURCHASERS AS MUCH AS POSSIBLE.
ALIGNING PAYMENT WITH PROVEN
DELIVERY MODELS.
AND FOCUSING MORE ON OUTCOMES
RATHER THAN PROCESS SEES. TO
INFORM OUR EFFORTS WE HAVE
ENGAGED OUTSIDE CONSULTANTS. FOR
THE FOLLOWING WE ARE IDENTIFYING
RELEVANT BENCHMARKS.
AND DATA SOURCES FOR VALID
COMPARISON POINTS FOR CURRENT
EXPECTATIONS AND PERFORMANCE
STANDARDS.
WE'RE REVIEWING OTHER LARGE
PURCHASER EFFORTS. TO IDENTIFY
KEY AREAS OF FOCUS.
STRATEGIES FOR PERFORMANCE
MEASURES THAT WE SHOULD CONSIDER
FOR ADOPTION AND OR ALIGNMENT.
AND WE'RE LOOKING TO THE
EVIDENCE FOR EACH VALUE ENHANCE
STRATEGY.
AND EVALUATE ITS POTENTIAL
AFFECTED MISS IN TERMS OF COST
QUALITY OF CARE.
IMPROVED HEALTH HEALTH OUTCOMES.
NOW WE'RE GONNA BE SOME RISE IN
THOSE FINAL --
THESE FINDINGS BY APRIL AND
TAKEN TO OR BOARD LATER THIS
YEAR FOR HOPEFULLY THEIR
APPROVAL AS WE MOVE INTO OUR
TWENTY TWENTY ONE CONTRACT YEAR.
FINALLY ON THE AREA OF
COLLABORATION --
AS YOU CAN SEE WE KNOW DOCTOR
RIGHT OUT WELL WE'RE PART OF THE
I. T. BOARD WE KNOW BILL WELL
PART OF P. BGH.
CLEARLY WE WORK A LOT WITH KATHY
DONNA SEND --
AND WE NEED TO CONTINUE THAT
EFFORT IT'S EXTREME IT WHERE WE
CAN ALIGN OUR EFFORTS. TO REDUCE
THE BURDEN ON THOSE PROVIDERS
THAT WE ALL CONTRACT WITH.
AND THAT'S OUR INTENTION MOVING
FORWARD IN OUR PROCESS SEES --
IN HOPES OF THE INFORMATION THAT
WE COME UP WITH OUR REFRESH
EFFORTS ON ATTACHMENT.
SEVEN IS TO ALIGN THOSE EFFORTS
WITH OTHERS AND UTILIZE EXISTING
MEASURE SETS ARE OU THERE SO
THAT WE DON'T OVER BURDEN THE
HEALTH CARE COMMUNITIES IN WHICH
WE ALL SERVE.
COM AS A REMINDER THAT THERE'S A
LOT MORE DETAIL THAT WAS
PROVIDED TO THE COMMITTEE.
AND INFORMATION THAT WE PROVIDED --
AND AGAIN THANK YOU FOR THE
OPPORTUNITY TO PROVIDE A QUICK
OVERVIEW OF OUR EFFORTS.
THANK YOU SO MUCH MISTER
ANDERSON.
GOOD AFTERNOON DOCTOR PAN
COMMITTEE MEMBERS ON KATHY DONNA
SIN CHIEF FOR THE HEALTH PLAN
ADMINISTRATION DIVISION --
WE AREN'T WE PURCHASE HEALTH
BENEFITS FOR ONE POINT FIVE
MILLION OF MEMBERS IN THE STATE
OF CALIFORNIA AND THROUGHOUT.
THE US AND IN OUR P. PO'S
THROUGHOUT THE WORLD.
WE ALSO --
FROM PURCHASE A BENEFITS FOR
TWELVE HUNDRED CONTRACTING
AGENCIES AND SCHOOLS.
AND WE PURCHASED FOR DEPEND --
OTHER MEMBERS.
THESE ARE THE HEALTH PLANS THAT
ARE PART OF OUR PORTFOLIO WE
HAVE SEVENTY TWO MILES AND AND
THREE PP OWES AND WE ARE SELF
FUNDED FOR OUR FOR PROVIDER
ORGANIZATION PLANS.
AND TODAY I'M GONNA TALK TO YOU
ABOUT HOW CALPERS WORKS WITH ITS
PLANS TO ITS CONTRACTS IN ITS
PERFORMANCE MEASURES TO ENSURE
THAT WE'RE GETTING QUALITY FOR
THE DOLLARS THAT WE SPEND.
THESE ARE ACTUAL SECTIONS FROM
OUR CONTRACT A WE HAVE FIVE YEAR
CONTRACTS IN PLACE FOR TWO
THOUSAND NINETEEN TO TWO
THOUSAND AND TWENTY THREE
HOWEVER WE JUST COMPLETED OUR
TWO THOUSAND FOURTEEN TO
EIGHTEEN CONTRACTS AND WITHIN
THOSE CONTRACTS WE HAVE
STANDARDIZED ALL OF OUR BENEFITS --
FOR PPO AN HMO THAT CONTRACT
REQUIREMENTS.
AND THIS PROGRAM INCLUDES IN THE
MEDICAL MANAGEMENT CHRONIC
CONDITIONS MANAGEMENT DISEASE
MANAGEMENT AND PHARMACY PROGRAM
DEVELOPMENT.
ADDITIONALLY A PORTION OF OUR
PREMIUM THAT EACH MEMBER PAYS
SUPPORTS WELLNESS OF PROGRAMS
PREVENTION PROGRAMS AND WE ARE
FULLY COMPLIANT WITH THE
AFFORDABLE CARE ACT IN TERMS OF
ZERO COPAYS FOR PREVENTIVE
SERVICES.
ON USPS TASK FORCE LIST.
I'M GOING TO GIVE YOU A COUPLE A
DATA POINTS.
IN TWO THOUSAND FIFTEEN WE
DEVELOPED A POPULATION HEALTH
APPROACH --
TO TAKING CARE OF OUR MEMBERS --
AND WE HAVE A DATA WAREHOUSE
WHICH CAPTURES THE DATA THAT WE
USE TO LOOK AT OUR PREVALENCE
THIS IS A PREVALENCE.
CHART FOR CHRONIC CONDITIONS ON
THAT DASHBOARD FOR EXAMPLE
ASTHMA CORONARY ARTERY DISEASE
DEPRESSION.
HYPERTENSION DIABETES AND THERE
ARE OTHERS BUT I WANTED TO SHOW
YOU THOSE THAT WE WHICH WE THINK
ARE OF INTEREST IN OUR TRACKING
TEA FOR YOU.
THIS IS A PPO PREVALENCE FOR THE
SAME CONDITIONS FOR THE SAME
YEARS TWO THOUSAND TWELVE TO
CURE 200-015-22000 AND SEVENTEEN
AND YOU CAN SEE.
THAT FOR THE PREVALENCE OVER
THOSE THREE YEARS IN BOTH
CATEGORIES WE ARE SEEING A
REDUCTION WE DO FIND THAT ARE OR
PPO PLANS ARE HIGHER IN TERMS OF
PREVALENCE AS A RESULT OF
DEMOGRAPHICS WITHIN THOSE PLANS
IN IN OUR CARE PRODUCT THERE IS
AN OLDER POPULATION.
WE ALSO TRACK HE JUST MEASURES
THIS IS THESE ARE FEW THE HE
JUST MEASURES THAT WE TRACK AND
WE HAVE A PAPER FOR PAY. FOR
PERFORMANCE FOR HEALTH PLANS DO
IT HERE IN REACH BENCHMARKS OR
AT LEAST REACH TARGETS WITHIN --
THE SPECIFIC CONTRACT PERIOD.
AND AS YOU CAN SEE FOR HMO
SWITCHER DISPLAYED HERE --
THAT WE HAVE --
THEY ARE AT LEAST MEDIAN AND IN
MANY INSTANCES EXCEEDING THE
BENCHMARKS.
AND YOU CAN SEE THAT IT'S WE
TRACK WHAT I HAVE HERE IS
CHILDREN WITH UPPER RESPIRATORY
INFECTION HE MICHAEL OF ANYONE
SEE.
TESTING RATES.
OUR USE OF STUDIES FOR LOW BACK
PAIN AND REMIND THE COMMITTEE
THAT IN THESE MEASURES HIGHER IS
BETTER SO YOU CAN SEE THE
BENCHMARKS FOR THE H. MILES.
AND YOU CAN SEE THE BENCH MARKS
OF FOR THE P. PO'S AS WELL SO WE
HAVE GREATLY IMPROVED OUR
OVERSIGHT AND OUR PERFORMANCE IN
TERMS OF THE PLANS THAT WE
MONITOR.
NOW OVER THE PERIOD OF BOTH THE
LAST FIVE YEAR CONTRACT IN THIS
NEW CONTRACT WE HAVE LEARNED TWO
THINGS THAT ARE IMPORTANT WE
BELIEVE TO THIS COMMITTEE.
OUR MEMBERS VALUE THEIR
RELATIONSHIP WITH THEIR
PHYSICIAN THE PRIMARY CARE
PROVIDER.
AND WE ARE GETTING BETTER
COMPLIANCE WHEN OUR MEMBERS ARE
AFFILIATED WITH A PRIMARY CARE
PROVIDER.
AND ENGAGE WITH THAT PROVIDER IN
TERMS OF EARLY DETECTION A CHECK
UPS ANNUAL PHYSICALS AND
MEDICATION ADHERENCE.
THE SECOND THING THAT WE HAVE
LEARNED IS THAT OUR MEMBERS IN
ORDER.
ARE OF ARE ABLE TO KEEP THOSE
PRIMARY CARE.
PHYSICIANS WITH THE NETWORK
OVERLAP WITH WHICH EXISTS WITHIN
OUR H. AMOUNTS.
AND ALSO FOR OUR P. PO'S --
ITCHING IN IN SERVE THE
ACCOUNTABLE CARE ORGANIZATION
WAY THAT JEFF AND DOUG DESCRIBED
THEIR RELATIONSHIP WITH A
PRIMARY CARE PROVIDER.
WE BELIEVE THAT COMPETITION
OFFERS OUR MEMBERS PLAN CHOICE
THAT ALLOWS THEM TO HAVE PREMIUM
COMPETITION AND AS WELL AS WITH
THAT NETWORK OVERLAP. TO KEEP
THEIR PRIMARY CARE PHYSICIAN
SHOULD A HMO PLAN.
WITHDRAW FROM AN AREA OR FOR
SOME OF THE RECENT SO WE'RE VERY
PLEASED WITH THE WORK THAT WE
HAVE DONE BOTH IN THE LAST FIVE
YEARS AND LOOKING FORWARD TO THE
NEXT FIVE YEARS THANK YOU.
THANK YOU VERY MUCH NINE MISTER
KRAMER [inaudible]
WELCOME.
THANK YOU I'D LIKE TO THANK AND
SEND PAN MEMBERS OF THE
COMMITTEE FOR THE OPPORTUNITY TO
SHARE INFORMATION WITH YOU ABOUT --
LESSONS WE'VE LEARNED ARE
WORKING WITH OUR MEMBERS AT
PACIFIC BUSINESS GROUP ON HEALTH
CARE FOR PATIENTS WITH MULTIPLE
CHRONIC CONDITIONS.
BY NAME IS BILL KRAMER I'M
EXECUTIVE RECTOR FOR HEALTH
POLICY AT P. BGH.
OR BRIEFLY --
FOR THOSE WE ARE NOT FAMILIAR
WITH P. BGH --
WE'RE CONSISTENT ABOUT.
SIXTY A LARGE EMPLOYER MEMBERS
INCLUDING CALPERS COVER
CALIFORNIA AS WELL AS MANY --
A PRIVATE SECTOR EMPLOYERS --
MANY OF THEM BASED IN CALIFORNIA
BUT WE ALSO HAVE A NUMBER OF
LARGE EMPLOYERS TO COVER THE
ENTIRE COUNTRY SO WE'VE
EXPERIENCED IN MULTIPLE MARKETS.
WE ARE NOT FOR PROFIT A FIVE OH
ONE C. THREE ORGANIZATION OF
PUBLIC BENEFIT ORGANIZATION.
WE'RE NOT A TRADE ASSOCIATION --
OUR MISSION IS TO IMPROVE THE
QUALITY AND AFFORDABILITY OF
HEALTH CARE SYSTEM WIDE THE
PRIMARY PURPOSE OUR MISSION IS
SYSTEM WIDE IMPROVEMENT.
WE ARE ENGAGE IN THREE CORE
STRATEGIES TO ACHIEVE THESE
IMPROVEMENTS IN VALUE --
ONE IS WE HAVE A TRUMP ARE THE
LARGEST PART OF OUR STAFF.
CAGED IN CARE REDESIGNED WORKING
DIRECTLY WITH PHYSICIANS
PHYSICIAN GROUPS HOSPITALS NOT
HOSPITAL SYSTEMS TO RECRUIT A
QUALITY OF CARE --
WE ALSO --
EMPHASIZE PAYMENT REFORM MOVING
AWAY FROM FEE FOR SERVICE
PAYMENT MODELS TOWARD VALUE
BASED PAYMENT MODELS WHETHER TO
PAY FOR PERFORMANCE BUILT ON FEE
FOR SERVICE INFRASTRUCTURE OR
MOVING TOWARD.
A GREATER TO RESERVE SHARED RISK
ALL THE WAY TO CAPITATION
ARRANGEMENTS.
AND WE HAVE A POLICY COMPONENT --
BECAUSE WE BELIEVE THAT IN ORDER
FOR SYSTEM WHY CHANGE THAT CAN
HAPPEN --
WHILE WE CAN INNOVATE AS PRIVATE
SECTOR PURCHASERS --
TEMPORE NHÍP PUBLIC PURCHASERS
WHETHER IT'S THE STATE MEDI CAL
PLANNED A STATE EMPLOYEE PLAN --
OR CREEK THE NATIONAL LEVEL
MEDICARE.
TO WE BELIEVE THE INNOVATIONS WE
SHARED --
CAN BE HELPFUL TO POLICY MAKERS
THAT'S THE GIST OF OUR POLICY
WORK -- WE'D
WHAT THE COMMITTEES INTEREST IN --
IMPROVING CARE FOR PEOPLE WITH
CHRONIC CONDITIONS THIS THIS IS
WE ARE GREATLY WARRANTED BECAUSE
WE KNOW THAT --
THE EIGHT PEOPLE MOP OF CRIME
CONDITIONS ENCOURAGE ARE.
SIGNIFICANT AMOUNT OF COSTS
AMONG LARGE EMPLOYERS WE
ESTIMATE THAT 40%.
OF A TYPICAL LARGE EMPLOYERS
TOTAL COST OF CARE.
FOR OF THE TERMS OF EMPLOYEE
BENEFITS USING KERR BY ABOUT 15%
OF THE EMPLOYEES AND THEIR
FAMILIES WHO HAVE MULTIPLE
CHRONIC CONDITIONS.
BUT WE ALSO KNOW IT'S NOT JUST
ABOUT COST --
THE QUALITY OUTCOMES FOR PEOPLE
WITH MULTIPLE CHRONIC CONDITIONS
IS OFTEN SUB STANDARD.
BY THE PATIENT EXPERIENCE IS OFF --
WE KNOW THAT TRADITIONAL BENEFIT
DESIGNS PARTICULARLY SIMPLE A
DEDUCTIBLE PLANS ARE HIGH
DEDUCTIBLE PLANS OFTEN CREATE A
FINANCIAL BARRIER TO PATIENTS
MULTIPLE CHRONIC CONDITIONS.
AND THAT THE SERVICES NEEDED BY
PATIENTS MULTIPLE CHRONIC
CONDITIONS ARE OFTEN NOT
COMPATIBLE WITH TRADITIONAL FEE
FOR SERVICE PROVIDER PAYMENTS.
TWO POINT SEPARATE SIZE --
IS THAT WE BELIEVE THAT WE HAVE
FOUND IN OUR EXPERIENCE THAT
PRIMARY CARE IS ESSENTIAL TO THE
IMPROVING OF CARE FOR PEOPLE
WITH MULTIPLE CHRONIC CONDITIONS --
ADVANCED PRIMARY CARE MODELS --
WE BELIEVE GOD CAN AND SHOULD BE
SPREAD MORE BROADLY AND COULD BE
A COULD AND SHOULD BE THE
FOUNDATION FOR IMPROVE
COORDINATION OF CARE --
AND IMPROVE MANAGEMENT OF THOSE
CHRONIC CONDITIONS TO IMPROVE
OUTCOMES PATIENT EXPERIENCE AND
TOTAL COST.
WE ALSO BELIEVE THAT BEHAVIOR
HEALTH MENTAL HEALTH INTEGRATION
IS VERY IMPORTANT. TOO MANY
TIMES -- THE
THE CARE DELIVERY SYSTEM AND THE
BENEFIT DESIGN IS CARVED OUT --
AND THAT IS TO THE DETRIMENT OF
BELIEVE OF MOST PATIENTS --
AND IT'S WRITTEN TOTAL TO THE
QUALITY OF CARE CATION
EXPERIENCE AND TOTAL COST OF
CARE.
IT'S TOUGH BUT WE HAVE SEEN
SUCCESSFUL MODELS AND WE BELIEVE
THAT'S WHERE THE GOOD.
I'D LIKE TO DESCRIBE.
ONE BGH PROGRAM THAT HAS BEEN
SUCCESSFUL IN MANAGING THE CARE
FOR PEOPLE POSSIBLE CHRONIC
CONDITIONS WHAT WE REFER TO AS
THE IN PATIENT CHART.
MISSPOKE INTENSIVE OUTPATIENT
CARE PROGRAM OR HIGH --
CP.
I CAN I SEE YOU BUT IN THE
OUTPATIENT SETTING --
THIS WAS LAUNCHED A NUMBER OF
YEARS AGO IN THE SEATTLE AREA BY
ONE OF OUR MEMBERS POLLING --
IT WAS SUBSEQUENTLY SPREAD --
TO SOME PILOTS IN NORTHERN
CALIFORNIA.
AND SUBSEQUENTLY WE HAD GOT A
CONTRACT FROM FEDERAL GOVERNMENT
FROM THE CENTERS FOR MEDICARE
MEDICARE INNOVATION CMMI. TO TO
SPREAD IT.
TOO CARE PRACTICES IN FIVE
WESTERN STATES.
BRIEFLY IT'S A PRIMARY CARE
BASED MODEL.
PAY AN UPFRONT CARE COORDINATION
FEE.
ARE AND WE HAVE A ROBUST SET OF
PERFORMANCE MEASURES.
AND OUR TO TO TRACK TO MAKE SURE
THAT THE THEIR PEOPLE GETTING
THE CARE THEY NEED NEED ONLY
PROVIDE THE CLINICAL TRAINING TO
HELP --
MEDICAL GROUPS AND THEIR CARE
TEAMS -- TO
DO THIS.
BEEN WILDLY SUCCESSFUL --
IT HAS IMPROVED THE OUTCOMES OF
CARE AT SOME THE UNNECESSARY --
AND FIVE VISITS TO THE EMERGENCY
ROOM UNNECESSARY
HOSPITALIZATIONS A RESULT FROM A
CRASH BECAUSE OF POORLY
COORDINATED KERR --
IT'S IT'S BETTER FOR EVERYONE
HIGH SO IT'S MIGHT BE PEOPLE ADD
A SUBJECT WE PROVIDE INFORMATION
ABOUT THAT PROGRAM AND SIMILAR
PROGRAMS.
BOB.
THERE ARE TWO SETS A
RECOMMENDATION TO LIKE TO SHARE
AND AGAIN I'LL PROVIDE THIS MY
WRITTEN TESTIMONY IN FOR AND
FORM TO BE ACCESSIBLE TO ALL OF
YOU -- AND
ALSO ANY IN FOLLOW UP
INFORMATION YOU MIGHT NEED.
BUT FOR PURCHASERS PUBLIC AND
PRIVATE PURCHASERS [inaudible]
BOB.
GREEN WITH A DOG AND CAT HE SAID
ALIGNMENT BETWEEN WHAT PRIVATE
SECTOR PURCHASERS IN PAIRS ARE
DOING WITH PUBLIC SECTOR
PURCHASERS IN PAIRS IS REALLY
IMPORTANT.
WE NEED TO BE USING CONSISTENT --
MEASURES PERFORMANCE MEASURES
CONSISTENT PAYMENT MODELS.
ARE CONSISTENT QUALITY STANDARDS
SO THAT.
PROVIDERS BUT THE DOCTORS THE
HOSPITALS.
OR PROVIDING THE BEST CARE AND
BE HELD ACCOUNTABLE FOR THAT
CARE REGARDLESS OF WHETHER THE
PERSON IS MEDI CAL RECIPIENT OF
THEIR COVERED BY CALPERS.
COVER CALIFORNIA PLAN OR ONE OF
COMMERCIAL PAYERS --
WE BELIEVE THAT --
THE USE OF MEANINGFUL MEASURES
IS REALLY IMPORTANT WE NEED TO
MOVE BEYOND TRADITIONAL.
CHECK THE BOX KIND OF MEASURES
TWO WERE ACTUALLY MEASURING
CLINICAL OUTCOMES AND IDEALLY
PATIENT REPORTED OUTCOMES --
WE HAVE A LONG WAY TO GO --
BUT WE I THINK THAT --
THEY'RE GOING AND NATIONALLY BUT
WE HAVE A FOR TO WORK WE CAN DO
TOGETHER.
WE NEED TO PURSUE ADVANCE
PAYMENT MODELS --
DOUG AND I WERE TALKING EARLIER
THAT THERE.
SEEMS TO BE UP THE DOLLARS MUCH
PROGRESS IN MOVING TOWARD AWAY
FOR MOVING AWAY FROM FEE FOR
SERVICE.
TOWARD TOWARD VALUE BASED
PAYMENT MODELS IN WHICH
PROVIDERS REWARDED FOR
DELIVERING GOOD QUALITY THAT'S
WHAT WE WANT --
SO THAT'S THAT'S A LAMP ISSUES --
SET OF RECOMMENDATIONS FOR
PURCHASERS STUFF WE'VE BEEN
WORKING ON FOR YEARS BUT WE HAVE
STILL MORE WORK TO DO AND AND
PARTICULARLY TO ALIGN THE WORK
OF PUBLIC AND PRIVATE PURCHASERS.
FUNNY FOR POLICY MAKERS I WOULD
ENCOURAGE YOU TO LOOK AT WAYS TO
STRENGTHEN PRIMARY CARE
THROUGHOUT THE STATE.
OTHER STATES HAVE ACTUALLY SET
TARGETS FOR INCREASED INVESTMENT
IN PRIMARY CARE AMAT FIRST
MONITORING AND THEN SETTING
TARGETS. FOR INCREASE PRIMARY
CARE SPENDING --
SECOND THING COURAGE YOU --
TO PUT --
SUPPORT THE WORK THAT PUBLIC
SECTOR PURCHASERS TO GREAT
CALPERS MEDICARE CALAR DOING.
OF TO MOVE TOWARD VALUE BASED
PAYMENT --
THERE'S TICKETS.
HONORED TO IT'S COMPLICATED AND
IT'S HARD.
UNDERSUPPLY WAS PUSHED BACK FROM
A PROVIDER'S BUT IT'S IMPORTANT
TO MOVE IN THAT DIRECTION --
BECAUSE DELIVERY MALLS ADVANCED
CARE DELIVERY MODELS --
WE'VE BEEN DOING A LOT OF OUR
WORK THROUGH FOUNDATIONS.
SUPPORT FROM CALIFORNIA
HEALTHCARE FOUNDATION AND OTHERS --
BUT THERE'S A LOT THAT CAN NEEDS
TO BE DONE PARTICULARLY SMALLER
INDEPENDENT PRIMARY CARE
PRACTICES.
STATE SIMPLY DON'T HAVE THE
RESOURCES TO BE ABLE TO INVEST
IN THE KIND OF DEVELOPMENT OF
CAPABILITIES FOR CARE DELIVERY
Mà DANCE CARE DELIVERY MODELS
THE STATE COULD PROVIDE A
TREMENDOUS BENEFIT AND WOULD PAY
BACK -- IN
ARTS FOR THE BETTER FOR THE OF
THE ENTIRE ALL EVERYONE IN THE
STATE.
AND FINALLY TO DEVELOP --
A WORK FORCE --
THAT IS CAPABLE OF PROVIDING THE
BEST POSSIBLE CARE FOR PEOPLE
WITH CHRONIC CONDITIONS --
ENCOURAGED TO TO LOOK AT SCOPE
OF PRACTICE LAWS --
TO ENABLE PEOPLE --
TO PROFESSIONALS TO WORK AT THE
TOP OF THEIR LICENSE TO BE PART
OF AN EFFECTIVE CARE DELIVERY
TEAM WE FOUND THAT.
IN OUR WORK THE CARE --
CARE TEAMS --
I HAS BEEN VERY SUCCESSFUL IN
GETTING THE BEST OUTCOMES FOR
PATIENTS.
I'M HAPPY TO ANSWER ANY
QUESTIONS BUT THANK YOU AGAIN
FOR YOUR INTEREST IN THIS ISSUE
IT'S IMPORTANT INITIATIVE AND I
THINK THERE'S MUCH TO STAY COULD
COULD DO. TO ADVANCE TO CARE FOR
THESE PATIENTS.
WELL CERTAINLY --
TRYING TO THINK ABOUT HOUSE
SUPPORT ADVANCED CARE DELIVERY
MODELS AS PART THE REASON WE'RE
HAVING THIS HEARING BUT
QUESTIONS.
MEANNESS YES SIR LEYVA
[inaudible]
AND THANK YOU MISTER CHAIR THANK%
YOU ALL THREE OF YOU FOR BEING
HERE TODAY.
I CAN NEVER LET AN OPPORTUNITY
PASS WITHOUT THINKING COVERED
CALIFORNIA --
FOR WHAT YOU HAVE DONE WITH THE
ACA I THINK THAT IT IS BEEN
INCREDIBLY SUCCESSFUL.
AND WE HEAR SO MUCH NEGATIVITY
ABOUT THE ACA AND FOR SOMEONE
WHO WAS IN THE LABOR MOVEMENT
AND HELP NEGOTIATE BENEFITS FOR
TWENTY YEARS FOR WORKERS.
I REALLY ONLY KNEW PEOPLE WHO
HAD HEALTH CARE.
AND WE BECAME NAVIGATORS AT MY
LOCAL UNION AND SO WE SIGNED UP
FIVE HUNDRED PEOPLE AND THE
GENERAL PUBLIC TO BE ON COVER
CALIFORNIA.
AND TO SEE THE STARK DIFFERENCE
WHO HAD ACCESS TO HEALTH CARE
FOR THEIR WHOLE LIFE AND PEOPLE
WHO WALK THROUGH OUR DOORS AND
HADN'T SEEN A DOCTOR IN TWENTY
OR THIRTY YEARS.
IT WAS -- IT
WAS LIFE CHANGING SO APPRECIATE
WHAT CAL A COVER CALIFORNIA'S
DOING AND I THINK THAT ALL OF US
SHOULD MAKE SURE WE DO
EVERYTHING WE CAN TO FIGHT
WHAT'S HAPPENING AT THE FEDERAL
LEVEL --
WITHOUT ACCESS TO HEALTH CARE
THERE'S JUST SO MANY THINGS YOU
CAN'T DO IN LIFE SO THANK YOU.
MS DAWSON I HAD A QUESTION ABOUT
WHO NEGOTIATES YOU YOU HAVE A
LOT OF PEOPLE YOU WORK WITH ONE
POINT FIVE MILLION I THINK YOU
SAID -- THE
AND AND OTHERS WHO DOES YOUR
NEGOTIATIONS FOR RATE INCREASES.
WE HAVE AN ENTIRE TEAM THAT
NEGOTIATES THE THE PREMIUM SEE
CHAIR OKAY.
AND THEY THEY USE THE DATA
WAREHOUSE WE USE INTERNAL AND
EXTERNAL ACTUARIES WE REALLY
HELPFUL TRANSPARENCY BOTH FROM
THE DATA WAREHOUSE AND FROM THE
WAYS WE PAY OUR OUR PLANS NOW
WEEK WE COLLECT THE PREMIUM.
AND THEN WE PAY OUT TO THE
PLAN'S COMPONENTS OF THAT
PREMIUM.
AND THEN THE STATE COMPTROLLER
OFFICE OF PAYS OUT THE FEE FOR
SERVICE CLAIMS FOR ANY OF THOSE
PLANS IT AND WHAT WOULD YOU SAY
IS THE PERCENTAGE INCREASE.
AVERAGE --
THAT BENEFITS THAT FOLKS ARE
PAYING HOW MUCH IS GOING UP EACH
YEAR.
WELL WE JUST THE ON NEGOTIATED
TWO THOUSAND NINETEEN IN THE
AGGREGATE NOT INCLUDES SAW
EVERYTHING MEDICARE COMMERCIAL
OF PPO HMO WAS ONE POINT 16% IN
THE PRIOR YEAR. FOR TWO THOUSAND
EIGHTEEN IT WAS A AND WAS
SLIGHTLY ABOVE 2% AND THEN THAT
PRIOR YEAR FOR TWO THOUSAND
SEVENTEEN IT WAS RIGHT AROUND 3%.
AND I WILL SAY WE HAVE WORKED
VERY HARD BETWEEN THE
NEGOTIATING TEAM FOR THE
PREMIUMS AND THE NEGOTIATING
TEAM FOR THE CONTRACTS. TO MAKE
SURE THAT WE ARE REALLY HOLDING
OUR PLANS LIKE NOT JUST FOR THE
CHRONIC CONDITIONS MANAGEMENT
THAT I I TALKED ABOUT BUT OTHER
PERFORMANCE MEASURED MEASURES
RELATED --
TO INFLATIONARY CAPS THAT ARE
ALSO WRITTEN IN TO OUR CONTRACTS
SO IF SOMEONE WHO HAD ANTHEM
BLUE CROSS --
HAD A 100% INCREASE IN THEIR%
PREMIUM THAT WOULD BE UNUSUAL.
YES OKAY I'LL TALK ABOUT THAT
PERSON OFF LINE ART THANK YOU
ALL FOR BEING HERE.
RIGHT CENTER RUBIO.
THANK YOU EVERYONE FOR BEING
HERE REALLY APPRECIATE THE
INFORMATION YOU PROVIDED I JUST
WANT TO POINT OUT DAM SEVENTY
IT'S NOT SO MUCH A QUESTION BUT
I'M NOTICING THAT AND I BELIEVE
DOCTOR I'M SORRY I MISSED MORE
YOU.
MENTIONED THE MENTAL HEALTH
INTEGRATION CONTINUES TO BE
LACKING IN.
A NOTICE IN THE CHARTS THAT
MISSED HONEST AND PROVIDED
DEPRESSION CONTINUES TO BE SORT
OF STEADY LIKE ALL THE OTHER
CATEGORIES ASK MOTHER CHRONIC
CONDITIONS WENT DOWN.
BUT DEPRESSION CONTINUES TO BE
PRETTY STUDY I'VE NOTICED I CAN
YOU SPEAK MORE TO THAT.
IN PARTICULAR.
YES I WOULD LIKE TO SPEAK TO A
BEHAVIORAL HEALTH DEPRESSION YES
BUT BEHAVIORAL HEALTH --
IN AS A GENERAL CATEGORY WE DO
NEED DOING WE CALPERS COVERED
CALIFORNIA I BELIEVE MEDI CAL TO
WE NEED TO DO MORE AND
APPROACHING SOME OF THE
CHALLENGES IN BEHAVIORAL HEALTH.
WE SERVE FIFTY EIGHT COUNTIES IN
ARE PPO SO YOU'VE GOT.
COUNTIES IN THE FAR NORTH IN
THESE REMOTE REGIONS WE THINK
THERE IS SOME PROMISE ESPECIALLY
FOR SOMETHING LIKE DEPRESSION
THAT COULD IN THE FUTURE.
COME FROM TELEHEALTH --
WE HAVE REDESIGNED OUR PURSE
SELECT PRODUCTS SO THAT EIGHT A
VISIT TO A BEHAVIORAL HEALTH
SPECIALIST.
IS THE SAME AS A VISIT TO A
PRIMARY CARE COPAYS UNDER THAT
NEW DESIGN FOR PERSONAL ACT.
SO THAT WE REDUCED --
OUR P. P. R. P. PO'S MEMBERS WHO
WILL IDENTIFY WITH A PRIMARY
CARE PHYSICIAN SIMILAR TO AN HMO.
IF THEY WILL DO THAT AND HAVE
THAT PRIMARY CARE PROVIDER CARE
FOR THEIR FAMILIES.
THAN THAT COPAYS GONE DOWN FROM
TWENTY DOLLARS TO TEN DOLLARS
AND THAT ALSO IS --
FOR BEHAVIORAL HEALTH AS WELL SO
THAT'S ONE OF THE WAYS THAT WE
ARE TRYING TO INTRODUCE THE
VALUE PROPOSITIONS.
INTO ARE PPO PRODUCTS THAT WE
ARE FULLY AT RISK FOR WERE FULLY
SELF FUNDED.
SO THAT THEY'RE GETTING THE IN
HMO LIKE APPROACH IN TERMS OF
CARE MANAGEMENT.
THANK YOU FOR THAT.
HI I WANNA THANK ALL OF YOU FOR
YOUR PRESENTATION OF THE U. --
A LOT OF INTERESTING --
ISSUES --
GETS WHAT ONE OF THE QUESTIONS I
WANT TO ASK YOU A QUESTION FIRST
ON THE CALPERS ON THE PREVALENCE
RATES WHICH ARE DECLARED AS WAS
MENTIONED BY SIR RUBIO.
MANY OF MORE DECLINING.
IS IS THAT WHAT'S THE REASON FOR
THAT IS THE CLIENT IS A CHANGE
IN THE POPULATION YOU'RE
COVERING OURS THIS BECAUSE OF
SOMETHING THAT --
YOU ARE ABLE TO DO WITH HEALTH
PLANS OR WHATEVER ELSE I MEAN
PRETENSIONS FROM SEVEN POINT ONE
TO SIX POINT THREE IS THIS.
IS A DEMOGRAPHIC CHANGE BECAUSE
OF A DIFFERENT GROUP OF PEOPLE
YOU'RE COVERING OUR DIABETES YOU
KNOW FROM SIX POINT TWO TO FIVE
POINT FIVE OR IS IT BECAUSE
SOMETHING THAT WAS ACTUALLY DONE
WITHIN.
THE BY THE THE PLANTS A
CONTRACTED WITH.
I BELIEVE IT'S A COMPANY YEAH
HMO PLANS INCLUDING THE NEW WORK
WE'RE DOING ON THE PP OWES --
IT COULD RELATE ALSO WE'VE GOT A
YOUNGER POPULATION COMING IN AND
AN OLDER POPULATION GOING INTO
MEDICARE SO IT'S PARTLY JUST A
CHANGING I BELIEVE CHANGING
DEMOGRAPHIC.
WE AGGREGATED THIS SEVEN H.
MODES IN THE SINGLE MEASURE IN
THE THREE PP.
PPO PLANS AND A SINGLE MEASURE --
IT'S IT'S A COMBINATION OF MANY
THINGS CARE DESIGN CARE CARE
PROGRAM DESIGNED ESPECIALLY
CLINICAL TEAM APPROACH UNDER
PRIMARY CARE MODELS SIMILAR TO
WHAT YOU HEARD.
ABOUT A CEOS AND THAT INTEGRATED
HEALTH MODEL SOME OF THAT IS
ALSO PART OF WHY WE'RE SEEING
THAT DIRECTION.
IN AND DEAL WITH A LOT OF
DISCUSSION ABOUT --
YOU'LL STRENGTH IN CARE PATIENT
CENTERED MEDICALHOME --
WHAT'S THE INTENSIVE OUTPATIENT.
SO SO I GUESS THE QUESTION I
HAVE A QUESTION FOR SERVE ALL
THREE OF YOU ABOUT.
CIVIL TO WHAT.
DEALS -- TO
WHAT SCALE ARE WE AT NOW TO AND
AND HOW FAR WE HAVE TO GO TO
BRING THAT THE FULL SCALE LIKE
ACROSS THE BOARD RATE SO HOW FAR
ALONG ARE WE AND WHAT'S.
KIND OF STOPPING US FROM GETTING
THERE EVERYONE DOWN WITH ME
THERE'S I'VE SEEN NUMEROUS
STUDIES SHOWING.
NO PRIMARY CARE IS REALLY
IMPORTANT --
IF YOU LOOK A BARBER STAR FUELS
WORK ACTUALLY I THINK I
APPRECIATE WHAT CALPERS SAID
THAT ABOUT NOT ONLY OF COURSE
HAVING A PRIMARY CARE.
PHYSICIAN BUT ALSO BEING SURE
THAT YOU HAVE SOME CONTINUITY A
PERSON THAT IS THAT IF YOU
HAPPEN TO CHANGE PLANS YOU STILL
THE OP HE STAY WITH THE SAME
PRIMARY CARE.
PHYSICIANS YOU'RE NOT CONSTANTLY
YOU KNOW REPEATING STAINS EVERY --
THAT'S WHAT MRS SAY SHOWS THAT
IT'S ACTUALLY THAT RELATIONSHIP
THAT AND THE TRUST HAT COMES
WITH IT THAT OFTEN TIMES.
IS THE CORE OF WHERE TO SAVINGS
EVENTUALLY COMES FROM RIGHT AND
AND THE KNOWLEDGE THE POSITION
HAS AND THE CARE TEAM HAS WITH
WITH THE PATIENT.
SITES SO I KNOW EACH OF YOU
MENTIONED --
THIS I GUESS I'M JUST TRYING TO
GET A SENSE OF OKAY WELL --
ARE WE ARE WE ARE READY THERE WE
HAVE PEOPLE THERE HOW FAR ALONG
ARE WE AND IF --
AND FOR THE WAYS AGO WE GET
THERE HOW MUCH HOW FAR CAN WE
BEND THE COST CURVE BY DOING
THAT.
SO I DON'T NOBODY'S DISCO MARCH
DOWN INTO AND I KNOW YOU SERVED
REFERENCE SENSE OF YOUR
TESTIMONY READY BUT I GUESS THAT
THAT'S A QUESTION LIKE.
HOW MUCH MORE CAN WE DO THERE
AND -- AND
AND WHAT WOULD RESULT FROM THAT --
DOCTORS PAN AND MEMBERS IT LET
ME TART BY SAYING WORK WE'RE
NOT THERE YET OKAY I THINK WE
HAVE A WAYS TO GO.
BY YOU'VE HEARD THE TERM
ALIGNMENT USED OFTEN THIS
AFTERNOON.
AND I THINK THE THE MORE WE CAN
ALIGN WITH WHAT OTHERS ARE DOING.
TO A COMMON DEFINITION.
RELATIVE TO THE VARIOUS THINGS
THAT WE TALKED ABOUT THE FOR
PATIENTS CENTER MEDICAL HOME
YOU'VE HEARD.
ACCOUNTABLE CARE ORGANIZATIONS
YOU'VE HEARD INTEGRATED HEALTH
CARE ALL MEANS DIFFERENT THINGS
TO DIFFERENT FOLKS AND SO
ALIGNMENT AROUND THE DEFINITIONS.
OF WHAT THOSE ARE I THINK WILL
BE IMPORTANT.
AND THEN THE THIRD THING IS THE
ALIGNMENT AROUND THAT AS DR
JONASSON MENTIONED EARLIER.
IT DOESN'T MATTER IF YOU'RE A
CALPERS NUMBER.
A MEDI CAL MEMBER A COVER
CALIFORNIA NUMBER WHEN YOU GO IN
TO SEE YOUR PHYSICIAN.
ARE YOU GOING TO A HOSPITAL
SETTING.
YOU'RE A PATIENT.
AND YOU'RE NOT VIEWED
DIFFERENTLY BECAUSE OF THE FACT
THAT YOU HAVE A DIFFERENT LABEL
SO TO SPEAK.
ASSOCIATED WITH YOU SO WE'D
THERE'S A LOT OF ROOM FOR
IMPROVEMENT --
I WOULD LIKE TO CALL OUT.
WHAT I. HA IS DOING IN THIS
REGARD -- IS
REALLY SETTING THE STANDARD.
FOR DEVELOPING THOSE STANDARDS --
I DON'T THINK JEFF SPOKE TO THE
ACCOUNTABLE CARE ORGANIZATION
STANDARD DATA SET THAT THEY'VE
DONE.
WHERE WE'VE COLLECTIVELY AGREED
TO WHAT THOSE DATA SETS ARE FOR
ACCOUNTABLE CARE ORGANIZATIONS --
BUT THE MORE WE WORK WITH GROUPS
LIKE I HA I THINK THE QUICKER WE
WILL GET TO WHERE WE WOULD LIKE
TO GO.
ACTUALLY JUST CENTER FOR ED SO
HOW FAR ALONG I MEAN A TO BE
LICENSE A LITTLE BIT AFTER
QUESTION BUT HOW I MEAN --
WE LIKE HALFWAY THERE COR THE
WAY THEY'RE TEN FOR SALE RELIEF
DOWN THE BOTTOM 10% OF THE WAY
THERE -- I
WOULD HATE TO PUT A PERCENTAGE
ON IT -- I
WOULD SAY WERE FURTHER ALONG
THEM WE HAVE BEEN --
AS I MENTIONED IN MY EARLIER
COMMENTS WE ARE SEEN A MOVEMENT
UP [inaudible]
IN --
PROVIDERS PARTICIPATING IN
INTEGRATED SYSTEMS --
BUT THERE AREN'T ENOUGH OF THEM
AND IN AGAIN ALSO NOTE DR
JONASSON MENTIONED.
RURAL AREAS INTEGRATED HEALTH
CARE IN RURAL AREAS IS REALLY
REALLY HARD.
YEAH AND SO WHAT YOU PUT IN
PLACE IN A URBAN AREA MAY NOT
NECESSARILY WORK IN A RURAL
SETTING AND SO WE'VE GOT TO
BRIDGE THAT GAP AS WELL.
SO -- WERE
WAYS AWAY.
I THINK WE UNDERSTAND WHAT WE
NEED TO DO TO GET THERE.
WE JUST NEED TO GET KICKED IN
THE REAR END A LITTLE BIT HARDER
TO GET US THERE FASTER THAN WE'D
LIKE OKAY AND MAYBE JUST ONE
OTHER AND THEN WHAT HAPPENED IS.
ASK YOU THE SAME QUESTIONS YOU
CAN GIVE THAT MIND SO IF WE WERE
ACTUALLY QUOTE ALL THE WAY THERE --
BECAUSE IT WAS WORRIED ABOUT
HEALTHCARE COSTS WERE ACT GOING
IF WE WERE QUOTE ALL THE WAY
THERE ARE ALMOST ALL THE WAY
THERE.
IS THAT GOING TO MAKE A
SUBSTANTIAL BEND IN THE COST
CURVE ARE WE GOING TO BE ABLE TO
THEN SAY YOU KNOW WHAT WE'RE
GOING TO I MEAN REALIZE IF
DEMOGRAPHICS WE HAVE TECHNOLOGY
CHANGE BUT IN TERMS OF THE THE
IT IS THEIR SAVINGS THAT YOU'RE
SAYING AS FAR.
AS WHERE WE HOW FAR WE'VE GONE
SO FAR IF WE ACTUALLY TOOK IT TO
THAT KIND OF SCALE WE COULD GET
IT ALL THE WAY THERE WE GOT AND
WE A LOT OF PROBLEMS TO GET
THEIR NUMBERS TO GO OVERCOME.
WHAT IT IS THAT GOING TO RESULT
IN A IT IN A PLACE WHERE YOU
KNOW KOSTER GNOCCHI AGAIN AND?
WILL HOPEFULLY SOME SAVINGS BUT
BABY ACOSTA RISE MUCH IT'S OUR
ENEMY THAT'S WHAT'S IT EVERY IT
ARE WE GOING TO DO YOU WHAT DO
YOU EXPECT TO SEE SOMETHING LIKE
THAT.
I DOCTOR PAN AYE POINT BACK
AGAIN TO THE DOCTOR RIGHT OUT
PRESENTATION ON THE DIFFERENCE
BETWEEN AN INTEGRATED MODEL AND
A PPO AND IN THAT DATE IS
ALREADY SO INDICATING THAT.
WE'RE GONNA GET THEIR THE MORE
WE MOVE INTO THAT INTEGRATED
APPROACH YOU'RE GOING TO SEE
AFFORDABILITY --
BECOME MORE PREVALENT THAN IT IS
TODAY.
THANK YOU NINE SELL PER SIX
PERSPECTIVE ON AS WELL WE ARE
SISTER AGENCIES SO WE HAVE BEEN
DOING WHAT WE'VE DONE FOR MANY
DECADES WE WORKED WITH --
PETER SAYS STAND UP COVERED
CALIFORNIA.
THEY ARE.
I THINK THEY'RE WILDLY
SUCCESSFUL RIGHT NOW BUT THERE
IS MORE TO DO HOWEVER HAVING
SAID THAT WE SHARE OUR CONTRACT
PERFORMANCE MEASURES WITH
COVERED CALIFORNIA.
AND WE HAVE ALSO PROVIDED THEM --
TO TO THE DEPARTMENT OF HEALTH
CARE SERVICES UNDER THE UMBRELLA
OF OUR SMART CARE CALIFORNIA
EFFORTS.
AND I WOULD LIKE TO GIVE A
LITTLE SHOUT OUT TO SHELVE WHOSE
AND THE CALIFORNIA HEALTHCARE
FOUNDATION.
WHO HAVE BEEN FUNDING US FOR
FOUR YEARS WE WORK VERY CLOSELY
IN COLLABORATIVELY TOGETHER OF
THE THREE AGENCIES?
SO IN FOUR YEARS WE HAVE MOVED
THE NEEDLE IS STUCK SAID ON
REDUCING SEE SECTIONS.
ARE MAKING HUGE ADVANCES IN
REDUCING PRESCRIBED --
WE ALSO TO GO TO ADVANCED
PRIMARY CARE.
WE IN OUR NEW PEOPLE ARE NEW
PURSE SELECT PRODUCT WE WANT
THAT PRIMARY CARE DOCTOR TO
REALLY BE LOOKING AT THE EVENT.
MANAGING THE FAMILY.
EVEN IN WITH CHRONIC CONDITIONS
THE OTHER THING IS WE DID SPEND
TWO YEARS DEVELOPING OUR
POPULATION HEALTH MODEL IN
DASHBOARD WHICH YOU SAW SOME OF
THE DATA FROM THAT.
WE HAVE DONE AN ENORMOUS AMOUNT
OF WORK BUT WE'VE DONE IT IN
COLLABORATION WITH OUR SISTER
AGENCIES BOTH HEALTH CARE
SERVICES.
AND COVERED CALIFORNIA AND WE
INTEND TO DO MORE AND SO FROM
FIRST PERSPECTIVE IN WITHIN YOUR
SYSTEM HOW FAR ALONG YOU THINK
YOU ARE --
WE NEED TO GET THE VALUE WE NEED
TO REACH WE NEED TO AND WE NEED
TO PAY FOR HIGH VALUE CARE AND
REDUCE LOW VALUE CARE.
AND THAT IS THE WORK WERE
CONTINUE TO USE IT I I AGAIN I
KNOW IT'S SOMEWHAT ANSWER.
AT THE BEGINNING ARE YOU HALFWAY
THERE YOU LIST OF THE WAY THERE.
LONELY THERE.
I WOULD SAY WE'RE OVER WE'RE
WE'RE OVER HALF OKAY A LOT TO DO
BUT WE AYE IF YOU I CAME HERE IN
TWO THOUSAND AND TWO WHEN WE
WERE NEGOTIATING RIGHTS FROM
SPREAD.
AND WE DIDN'T HAVE A WAY TO
MEASURE DISEASE MANAGEMENT SO
EXCEPT FOR WHAT WE GOT ANNUALLY
FROM HE DOES SO.
I THINK WE'RE WELL OVER FIFTY
OKAY AND I'M ALSO HEARING FROM
ALL OF YOU THAT YOU KNOW WE ALSO
IT'S IT'S NOT JUST US SILOS BUT
THERE'S THE CONNECTION THEIR
SIDE DIE DO I KNOWLEDGE THAT
[inaudible]
THANK YOU.
OF ALL.
OUR FOLKS ARE MARKED ACCOUNT
PRIMARY KERR --
I THINK IF YOU SIMPLY LOOK AT
THE AMOUNT IS BEING SPENT
PRIMARY CARE IN CALIFORNIA
VERSUS SOME OF THE OTHER STATES --
OREGON RHODE ISLAND SOME OTHERS
WE SPEND LESS BOND AND I A
THAT'S A CRUDE MEASURE OBVIOUSLY
BUT BY THAT MEASURE WERE
PROBABLY HALF TO TWO THIRDS OF
THE WAY PART WHERE WE SHOULD BE
IN TERMS OF THE RIGHT BALANCE OF
SPENDING ON PRIMARY CARE VERSUS --
STRICTLY CARE HOSPITAL CARE AND
SO ON IT'S NOT JUST THAT'S AND
HARD TO PUT A NUMBER ON THAT BUT
I THINK WE ARE MAKING PROGRESS
SIGNIFICANT PROGRESS IN RECENT
YEARS.
PARTLY BECAUSE OF THE
EXPECTATIONS FROM --
CALPERS COVER CALIFORNIA MEDI
CAL AND PRIVATE SECTOR
PURCHASERS.
AS WELL AS THE SUPPORT.
THAT'S BEEN PROVIDED THROUGH OUR
ORGANIZATION AND AND MANY OTHERS
TO HELP OTHERS PRACTICES
PARTICULARLY THE SMALLER MEDIUM
SIZED INDEPENDENT PRACTICES --
GET UP TO SPEED TO GET THE
ELECTRONIC HEALTH RECORDS A NEED
TO DEVELOP TO CARE BASED TEAM --
PROTOCOLS --
THAT TO HELP THEM.
QUALITY SO I THINK THERE'S A
SIGNIFICANT PROGRESS THERE OF
COURSE WEAK WE CAN DO A MUCH
BETTER.
BOB TERMS OF THE OVERALL HEALTH
SYSTEM --
ALL A REMARK THAT.
THE ESTIMATES OF WASTE IN THE
HEALTH CARE SYSTEM RIGHT NOW ARE
STILL AROUND 30% --
HI DAVID LANSKY ARE PRESENT CEO
TESTIFIED BEFORE THE SENATE
HEALTH EDUCATION LABOR AND
PENSIONS COMMITTEE LAST --
LAST SUMMER.
AND ALL THAT THE PEOPLE WHO ARE
TESTIFYING EXPERTS ROUGH AROUND
THE COUNTRY.
SAID AROUND 30% IS ABOUT RIGHT
THAT'S A COMBINATION OF THINGS
THERE SOME UNNECESSARY CARE
BEING PROVIDED --
SOME POOR QUALITY CARE THAT
RESULTS IN PEOPLE HAVING TO GO
BACK TO BE READMITTED OR FOREVER
HEATHER SHOULD BE RE DONE.
THURS --
EXORBITANT PRICES BEING CHARGED
FOR CERTAIN PROCEDURES CERTAIN
DRUGS --
THERE'S AN EXCESS ADMINISTRATIVE
BUT THAT TELLS ME THERE'S AN
ENORMOUS OPPORTUNITY SO.
I'M.
I JUST.
HELLO MY DIFFERENT ABOUT MY
COLLEAGUES HERE I THINK WE'RE
MAYBE HALFWAY THERE --
ALWAYS BEEN FOR HER WORK IN
HEALTH CARE FOR A LONG TIME.
SOME DAYS I WAKE UP AND AMEND
TREMENDOUSLY PROUD OF THE
ADVANCES HAVE BEEN MADE --
AND THERE HAVE BEEN DVANCES BUT
OTHER DAYS I LOOK AT YOU KNOW
WHERE WE ARE WITH PERFORMANCE
MEASURES WE STILL DON'T HAVE
GOOD OUTCOME MEASURES --
STUFF.
FOR WE ARE REPORTING UNDERSTATED
WAY THE OUTCOMES FOR KEEPING THE
REPLACEMENTS WE CAN'T COMPARE.
SURGEONS AND HOSPITALS AROUND
THE COUNTRY ON THE QUALITY WE
HAVE NO OLD.
QUALITY MEASURE FOR ADVERSE DRUG
EVENTS HAS BEEN ENDORSED BY
NATIONAL QUALITY FORUM.
STUFF TECHNICAL ISSUE BUT WHY IS
THAT -- AND
THE MOVEMENT TOWARD VALUE BASED
PAYMENT HAS REALLY STALLED OVER
THE LAST TEN YEARS --
THERE'S A LOT OF EXCITEMENT
ABOUT MOVING TO ADAPT BUT IT
REALLY HASN'T MADE A LOT OF
PROGRESS SO.
THE OPPORTUNITIES TO IMPROVE
EVERYBODY IS GETTING THE BEST
QUALITY CARE REGARDLESS OF WHERE
THEY LIVE.
REGARDS OF WHO'S WHO THEY'RE
COVERED BY --
IS IS ANOTHER AREA WHICH IS HIS
HIDDEN UNDER THE AGGREGATE
STATISTICS BUT NEEDS TO BE
ADDRESSED AS WELL.
SO -- I DAYS
I WAKE UP AT LEE WITH THE CUP IS
HALF FULL OTHER DAYS I THINK
IT'S HALF EMPTY --
THERE'S A LOT TO BE PROUD OF IT
BUT A LOT STILL TO DO
[inaudible]
RIGHT [inaudible] THIRTY TWO NO
THANK YOU --
I I ACTUALLY I AND ACTUALLY
BECAUSE EQUITY TO LOSE IN THE
AUDIENCE I I HAVE TO ALSO
ACKNOWLEDGE HER NUYS SAY THAT
WE'VE HAD SOME CONVERSATIONS AND
WE FEEL HEARD THE NUMBER ABOUT
THE 30%.
I THINK THE CHALLENGES IS --
SHOE TOLD ME I IS OKAY FOR ME TO
SAY THIS.
BUT I WILL SAY IS IS THAT.
SO NOW IT'S ABOUT THAT WHAT YOU
SAID WAS THAT AND NOW YOU AGREED
WITH YOU IS IS THAT I OFTENTIMES
YOU'LL KNOW 30% OR SOME
PERCENTAGE SIZEABLE PERCENTAGE
IS QUOTE WASTE BUT IT'S HARD TO
IDENTIFY WHAT IT IS.
I MEAN V. CONCERT GLOBALLY SAY
BUT YOU START SAYING EACH
INDIVIDUAL DECISION WAS THIS THE
RIGHT ONE IT'S CENTER I MEAN
SOME PREY EASIER THAN OTHERS BUT
IT'S NOT ALWAYS.
THAT'S BEEN ONE OF THE
CHALLENGES LIKE SO --
AND I'VE SEEN DIFFERENT STUDIES
PEOPLE TRIED TO PICK OUT WHICH
ONES AND SO FORTH BUT PERHAPS --
I THINK OF THE LOOKS LIKE YOU
GOT SOME HANDS.
ANSWER THAT I THINK IT'S
IMPOSSIBLE TO DO BUT I THINK
SOMETIMES IT CAN BE A LITTLE
CHALLENGING AND PERHAPS CHRONIC
CONDITIONS THAT SOCIAL
DETERMINANTS YES AND HEALTH
EQUITY --
IT'S IT'S A IT'S A COMPONENT
THAT WE NEED TO ENSURE THAT WE
ENGAGE IN THE CONVERSATION AND
INCLUDE.
SOCIAL DETERMINANTS --
AS A CONTRIBUTOR TO AND MOST
LIKELY A A SISTER OF GETTING
THESE CHRONIC CONDITIONS IN IN --
A BETTER PLACE AND THEY ARE
TODAY.
A SOMEONE TO TALK ABOUT SOCIAL
TERMS OF HEALTH I COULD NOT
AGREE MORE --
SO I GUESS THE OTHER OBSERVATION --
JUST MAKE BEFORE I LET YOU ALL
GO IS IS THAT WE HAVE COVERED
CALIFORNIA.
PURRS WE HAVE A LARGE PRIVATE
SECTOR GROUP AND MAYBE CAN HELP
US RECRUIT MORE AND I'M GONNA
HAVE MEDI CAL COME OUT.
AND ONE OF THE THINGS I'VE HEARD
FROM YOU IS THAT WE NEED
ALIGNMENT WE NEED TO TRY TO PUT
THINGS SIMILARLY.
SO -- I
GUESS I WOULD BEFORE I LET YOU
GO SAY LET ME KNOW.
LIKE WHAT WE CAN TRY TO DO TO DO
THIS WE HAVE YOU ALL HERE LET'S
WHAT CAN WE DO AND I FOR YEAH WE
HAD --
TALKED RIGHT OUT HERE EARLIER AS
WELL AND I THINK SOMEONE YOU
KNOW THE CENTER STONE ASKED BUT
YOU KNOW LOOK IF BETWEEN IF WE
ADD TO ALL OF YOU OUT.
WE GOT A PRETTY GOOD CHUNK OF
THE MARKET RIGHT AND SO WHAT CAN
WE ALL DO TOGETHER TO TRY TO
ACHIEVE SOME OF THESE AIMS YOU
TALKED ABOUT SO WE CAN MOVE THAT
FARTHER ALONG I REALIZE IS AN
ABSTRACT QUESTION BUT UT YOU
KNOW MOVE FROM.
IT HALFWAY OR YOU KNOW IT IN THE
BEGINNING OF EVER TO TO TO THE
HIGHER SCALE SO --
THINKING ABOUT WHAT THE
APPROPRIATE ROLE GOVERNMENT MAD
MAD BILL PLAY IN TERMS OF IS A
CONVENE OR AT SOLELY I WANT.
TO SEE THAT WHAT WE CAN TRY TO
DO TO HELP MAKE THAT HAPPEN.
THANK YOU VERY MUCH FOR BEING
HERE THANK YOU.
OKAY SO OUR NEXT PANEL WILLIAMS
SHIFT TO MEDI CAL --
BUT IT'S ALL PART OF A SCENE
HEALTHCARE SYSTEM --
WE HAVE CHRISTOPHER PERONE THE
DIRECTOR IMPROVING ACCESS IN THE
CALIFORNIA HEALTHCARE FOUNDATION
[inaudible]
WELCOME.
LOOKING FORWARD TO YOUR
PRESENTATION.
AND I'M GONNA ASSUME THAT WELL
IN SOME WAYS ALTHOUGH THERE
LOWER INCOME THAT WE'RE STILL
TALKING ABOUT PEOPLE IN HUMAN
BEINGS AND PERHAPS OF THE SAME
THINGS APPLY RIGHT NOW.
BUT I WILL LET LET LET YOU
PRESENT AND YOU CAN TELL ME.
WELL THANK YOU --
CHAIRPERSON PAN AND MEMBERS
COMMITTEE FOR THIS INVITATION TO
DISCUSS OPPORTUNITIES TO IMPROVE --
PERFORMANCE --
IN MEDICAL PROGRAM --
IN A FEW MINUTES THAT I HAVE I
WILL ADDRESS SIR TO QUESTIONS
TODAY -- THE
FIRST IS WHAT WE KNOW ABOUT THE
QUALITY OF CARE --
IN THE MEDICARE PROGRAM --
MANAGED CARE WERE 90% OF FULL
SCOPE MEDI CAL AND RELEASE GET
THEIR COVERAGE AND WHAT MIGHT
CALIFORNIA DO DIFFERENTLY. TO
ACCELERATE IMPROVEMENTS AND
ACCESS TO CARE AND QUALITY FOR
MEDI CAL AND WILLYS.
THE FIRST WE KNOW THE QUALITY OF
CARE -- IT
IS HIGHLY VARIABLE DEPENDING ON
WHERE YOU LIVE WHAT PLAN YOU'RE
ENROLLED IN IN YOUR RACE AND
ETHNICITY.
ACCORDING TO THE MEDI CAL
MANAGED CARE DASHBOARD THAT'S
PRODUCED QUARTERLY BY THE
DEPARTMENT HEALTH CARE SERVICES.
AGGREGATED SCORES OF QUALITY
FREE TO THE HEALTH PLANS VARIES
BY A FACTOR OF TWO AND A HALF.
THESE AGGREGATE SCORES ROLL OUT
SEVERAL QUALITY MEASURES. TO
PROVIDE A SINGLE SNAPSHOT OF
OVERALL QUALITY FOR EACH PLAN
BUT MASK IMPORTANT.
CLINICAL INSIGNIFICANT EXCUSE ME
IMPORTANT DOT CLINICAL AND HUMAN
TOLL OF THE VARIATION. FOR
EXAMPLE 74% OF WOMEN AND ROLLED
IN SAN FRANCISCO HEALTH PLAN
RECEIVED THEIR RECOMMENDED
CERVICAL CANCER SCREENING.
AMONG WOMEN ENROLLED IN HEALTH
NET IN SAN DIEGO ONLY 41% DID.
AMONG MEDICARE BENEFICIARIES
WITH HYPERTENSION RESIDING IN
THE INLAND EMPIRE 69% OF THOSE
ENROLLED INLAND EMPIRE HEALTH
PLAN HOW THEIR BLOOD PRESSURE
ADDED WE CONTROLLED.
WHEREAS LESS THAN 40% OF THOSE
ENROLLED IN MOLINA HEALTH CARE
DEAD SO THEY'RE NOT JUST YOU
RAPID DISPARITIES EVEN WITHIN
COUNTY FIND SOMEBODY'S
DISPARITIES.
THE DEPARTMENT ALSO FOUND
DISPARITIES BY RACE AND
ETHNICITY WITH BLACK IN NATIVE
AMERICANS FREQUENTLY FARING
WORSE THAN OTHER MEDI CAL
BENEFICIARIES.
SECOND WE ARE ALSO LEARNING THAT
OVER THE LAST TEN YEARS QUALITY
OF CARE HAS NOT IMPROVED PROGRAM
LIED ON MOST QUALITY MEASURES.
A STUDY BY UCSF RESEARCHERS THAT
IS SOON TO BE PUBLISHED FINDS
OUT OF FORTY ONE QUALITY
MEASURES QUALITY AND PATIENT
EXPERIENCE MEASURES COLLECTED
AND REPORTED BY DIETZ YES.
THERE'S BEEN SIGNIFICANT
IMPROVEMENTS ON ONLY SIXTY
ACROSS ALL MEDI CAL MANAGED CARE
PLANS FOR TWENTY THERE'S BEEN
LITTLE CHANGE AND FOR FIVE THESE
MEASURES HAS ACTUALLY BEEN
DECLINING QUALITY.
SO HOW COULD THIS BE THERE ARE
MANY POSSIBILITIES BUT I WOULD
LIKE TO DRAW YOUR ATTENTION TO
TWO IN PARTICULAR.
FIRST WEN A MEDI CAL AND
MANAGED CARE PLAN MAKES
INVESTMENTS TO IMPROVE THE
QUALITY OF CARE FOR ITS MEMBERS.
AND THESE INVESTMENTS ALSO LEAD
TO MORE EFFICIENT AND LOWER COST
CARE D. H. U. S. REDUCES WHAT IT
PLAYS THE PLAN.
IN THE NEXT RATE SETTING CYCLE.
THIS PHENOMENON CALLEDPREMIUM
SLIDE DISCOURAGES MANAGED CARE
PLANS FOR MAKING LARGE
INVESTMENTS AND SERVICES TO
TOUCH SOCIAL DETERMINANTS LIKE
HOUSING SUPPORT ARE MEDICALLY
TAILORED MEALS.
OR INVESTING TO EXPAND AND
IMPROVE THE PROVIDER NETWORK.
AND FOR THOSE THAT DO YOU
PREMIUMS SLIDE MAKES IT MORE
DIFFICULT TO CAN YOU MAKING
THESE INVESTMENTS OVER TIME.
SECOND UNLIKE MOST OTHER METHODS
GIVE ME UNLIKE MANY OTHER
MANAGED CARE PROGRAMS.
CALIFORNIA DOES NOT HAVE A
FINANCIAL INCENTIVE PROGRAM FOR
IT'S HEALTH PLAN THAT REWARDS
PLANS WHEN THEY PROVIDE
EXCELLENT QUALITY CARE OR
IMPROVE.
A QUALITY OVER TIME.
SO WHAT MY CALIFORNIA DO
DIFFERENTLY TO CATALYZE
SIGNIFICANT IMPROVEMENTS IN
ACCESS AND QUALITY FOR MEDI CAL
ENROLLEES.
TAKING THESE FACTORS INTO
ACCOUNT AND HAFTER HEARING FROM
A DIVERSE CROSS SECTION OF MEDI
CAL STAKEHOLDERS THAT THEY
SUPPORT A VISION OF SHARED
ACCOUNTABILITY. TO PROVIDE HIGH
QUALITY HIGH VALUE HOLE PERSON
CARE.
THE CALIFORNIA HEALTHCARE
FOUNDATION LAUNCHED A PROJECT TO
DESIGN A FINANCIAL INCENTIVE
PROGRAM THAT WOULD ADDRESS THE
PREMIUM SLIDE.
ISSUE AND PROMOTE MORE RAPID
QUALITY IMPROVEMENT.
WE HIRED CITY MAN FORMER
DIRECTOR OF THE CENTER FOR
MEDICAID AND CHIP SERVICES IN
YOUR BOMB ADMINISTRATION AND
ENGAGE IN ADVISORY GROUP THAT
HEALTH PLAN CEOS AND CFO'S.
THERE EVER PRODUCED
RECOMMENDATIONS FOREIGN PLAN
IF IT MEETS THREE CRITERIA.
FIRST A GENEROUS COST SAVINGS
GREATER THAN A THRESHOLD
ESTABLISHED BY THE DEPARTMENT
AND ITS ACTUARIES.
SECOND NEEDS QUALITY TARGETS
BASED ON PROVIDING EXCELLENT
QUALITY OF CARE OR DEMONSTRATING
SIGNIFICANT QUALITY IMPROVEMENT.
AND THREE IT DEMONSTRATES THAT
IS INVESTING AT LEAST A
SPECIFIED AMOUNT INTO HEALTH
RELATED INVESTMENTS AS DEFINED
BY THE STATE. ONE OF THE MAIN
BENEFIT OF THIS APPROACH IS
THAT IT WOULD NOT REQUIRE
ADDITIONAL STATE FUNDING.
THIS APPROACH HOWEVER IS JUST
ONE OF SEVERAL APPROACHES
CALIFORNIA COULD TAKE IN TODAY
THE FOUNDATION PUBLISHED A NEW
REPORT DESCRIBES FIVE DIFFERENT
TYPES OF FINANCIAL INCENTIVE
PROGRAMS.
I THINK YOU HAVE BEFORE YOU.
THIS REPORT MAKING QUALITY
MATTER MEDI CAL MANAGES CARE
DESCRIBES EACH OF THESE FIVE
APPROACHES AND FOR EACH PROVIDES
AN EXAMPLE OF HOW THE STATE IS
PUTTING.
THIS APPROACH IN THE PRACTICE.
SOME ARE SIMPLER TO ADMINISTER
THAN OTHERS SOME WOULD REQUIRE
ADDITIONAL STATE FUNDING OR
REALLOCATION OF EXISTING MEDICAL
FUNDS.
OF COURSE FINANCIAL INCENTIVES
IN VALUE BASE PAY ARE NOT A
PANACEA AND DH YES HAS AND USES
MANY TOOLS IN ITS TOOL CHEST. TO
MANAGE THE MANAGE CARE PROGRAM.
PROCUREMENT CONTRACT MANAGEMENT
AND OVERSIGHT PUBLIC PURPORTING
TO NAME A FEW.
LATER THIS SPRING WE WILL
PUBLISH A REPORT THE PROVIDES
RECOMMENDATIONS IN EACH OF THESE
AREAS BASED ON A REVIEW OF
PRACTICES BY DH CS COVER
CALIFORNIA CALPERS.
AND FIVE OTHER STATE MEDICAID
PROGRAMS.
LASTLY I WANT TO ACKNOWLEDGE THE
H. YES AND IT'S PLAN PARTNERS.
FOR WORKING HARD TO IMPROVE
QUALITY CARE FOR THEIR MEMBERS.
AND THE SUCCESSFUL EFFORTS OF
PLANTS ARE REFLECTED IN
IMPROVEMENTS IN THEIR QUALITY
SCORES OVER TIME.
MOREOVER WHAT DH YES AND IT'S
HEALTH PLANS HAVE ACCOMPLISHED
IN JUST THE LAST SEVEN YEARS IS
TRULY IMPRESSIVE AS A PROGRAM
WAS EXPANDED TO INCLUDE MILLIONS
OF NEW ENROLLEES.
MANY WITH COMPLEX CHRONIC
CONDITIONS OR TACKLING KEY
PRIORITIES SUCH AS ADDING A NEW
MAP MILD TO MODERATE MENTAL
HEALTH CONDITIONS.
WITH STRONGER INCENTIVES
INAPPROPRIATE FLEXIBILITY
HOWEVER WE CAN AND SHOULD EXPECT
BETTER OUTCOMES FROM A MEDICAID
MANAGED CARE PROGRAM AS MANY
STATES ALREADY DO.
I'LL BE HAPPY TO TAKE YOUR
QUESTIONS.
THANK YOU VERY MUCH QUESTIONS
FROM COMMITTEE MEMBERS YES
CENTER STONE.
THANK YOU FOR YOUR PRESENTATION --
I WAS NEVER --
M. SLIDE.
AND IT -- I
FIND IT RATHER SHOCKING.
THAT --
HEALTHCARE PLAN THAT INVESTS AND
YOU KNOW.
MAKING SURE THAT THE THE
DIABETICS ARE WELL CONTROLLED
ENTIRE PRETENCES SO THE BLOOD
PRESSURE THEIR BLOOD FATS ARE
REGULARLY MONITORED AND
CONTROLLED.
A WE GET PENALIZED IN THE
FOLLOWING YEAR --
FOR THEIR MAKING THEIR PATIENTS
HEALTHY WHICH IS THE GOAL I
THINK OF OF OF WHAT OUR HEALTH
CARE PLAN SHOULD BE DOING IS
TRYING -- TO
MAKE PEOPLE HEALTHIER IN THE
STATE OF CALIFORNIA AND IN IN TO
MAKE THOSE INVESTMENTS IN THE
FRONT AND WHICH WILL SAVE YOU A
LOT OF MONEY IN IN IN IN THE
BACK AND WHAT CAN WE DO. TO TO
MAKE.
GET RID OF THIS --
TERRIBLE POLICY --
THAT.
PROVIDES EIGHTY ANTI INCENTIVE
FOR PREVENTIVE CARE --
WELL THE REPORT THAT I MENTIONED --
OFFERS A NUMBER OF DIFFERENT
OPTIONS THAT ARE AVAILABLE TO
THE STATE AND HAS --
THE REPORT INDICATES OTHER
STATES TEXAS FLORIDA NEW YORK --
THE DISTRICT OF COLUMBIA ARE
EMPLOYING THESE TYPES OF
FINANCIAL INCENTIVES FOR HEALTH
PLANS.
MANY OF THESE MODELS WOULD
ADDRESS THE PREMIUMS LIKE NOT
ALL OF THEM.
AS A SAID SOME WOULD COST THE
STATE SOME MORE MONEY BUT THERE
ARE TRADE OFFS TEAM MADE IN
TERMS OF COMPLEXITY VERSUS COST --
BUT THERE ARE THERE ARE
APPROACHES THAT ARE BEING USED
IN THE FIELD AND AND THE REPORTS
TO BE PRODUCED OFFER SOME SOME
OPTIONS THERE I'M SURE THOSE
HIGHER COSTS OR NOT GOING TO BE
IN COMPARISON TO THE INVESTMENT
IS MADE IN THE FRONT AND A WHAT
THE PLANS ARE.
GONNA HAVE TO PAY AND THE AND
THE BACK AND WHEN SOMEBODY HAS
AN CONTROLLED --
BLOOD PRESSURE ENDS UP IN A
HOSPITAL WITH A STROKER OF A
HEART ATTACK THE COULD HAVE BEEN
PREVENTED THROUGH REGULAR
MONITORING AND A LITTLE BIT OF
AN INVESTMENT.
SO -- YOU
KNOW I LOOK FORWARD TO WORKING
WITH THE CHAIR AND FINDING OUT
WAYS IN WHICH WE CAN --
ELIMINATE THIS TERRIBLE POLICY
AND EMBRACE MAYBE SOME OF THE
SUCCESSES AND OTHER STATES OF
HAND.
AND I JUST WANNA FOLLOW UP ON
WHAT CENTER STONES AND I'VE MET
THAT I ACTUALLY --
FORTUNATELY WAS AWARE OF THE
PREMIUM SLIDE I'VE HAD
CONVERSATIONS WITH DIRECTOR TENT
AND A DRUG CAN'T WELL --
ABOUT --
THIS -- I
WAS TOLD THAT SOME OF THIS HAS
TO DO IS SEE CURIOUS AS TO HOW
THE OTHER STATES DO IT IF CMS IS
THE REASON WE CAN'T.
KNOW THAT WE HAVE TO MAKE THOSE
ADJUSTMENTS.
BECAUSE IT'S YOU KNOW THERE'S A
FEDERAL MATCH INVOLVED FOR MEDI
CAL. FOR MEDICAID --
HOW HOW THIS TAXES OR THE OTHER
STATES HAVE FORTUNATE CHANCE TO
REACH YOUR FULL REPORT BUT?
I MEAN IS IS THERE A FEDERAL
BARRIER TO BE ABLE TO SAY WELL
YOU KNOW OKAY SO WHIMS WE MADE
INVESTMENT WE IMPROVE OUR
DIABETES CARE NOW THAT THE
SPENDING DROPPED IS THE FED'S GO
BACK AND SAY WELL BECAUSE WE PAY
HALF OF THAT.
WE'RE NOT GOING TO LET YOU YOU
KNOW WE WERE GOING TO PAY LESS I
MEAN THE TWENTY OUT OF CAN YOU
PERHAPS SHED SOME LIGHT ON THE
ROLE OF THE FEDERAL GOVERNMENT
PLAYS AND CMS PLAYS GIVEN THE
FACT THAT MEDICAID IS A FIFTY
FIFTY WITH --
LEASE FOR US FIFTY FIFTY
SUPPOSED STATE TO GET BETTER
FEDERAL MATCH FOR US IN TERMS OF
MUST BE ABLE.
TO ADDRESS THE PREMIUM SLIDING
PROVIDE POSITIVE SENATOR PEOPLE
FOR PLANS AND OTHERS WHO ARE
INNOVATING WHO.
WELL IT --
THE DEVIL'S IN THE DETAILS AND
CAN FEDERAL POLICY IS --
EVOLVING FORGE THAT ARE GIVING
STATES FLEXIBILITY --
TO TACKLE SOCIAL DETERMINANTS OF
HEALTH --
HIGH SO IT REALLY DEPENDS ON HOW
YOU APPROACH TO MODEL --
THERE ARE SOME --
APPROACHES THAT --
DIRECTLY TACKLE --
THINGS LIKE SOCIAL DETERMINANTS
THAT DO REQUIRE FEDERAL WAIVERS --
THIS IS A HARD TIME TO BE
REQUESTING FEDERAL WAIVERS THERE
ARE OTHER PROCEDURES THAT ARE
WITHIN THE BOUNDS OF WHAT STATE
MEDICAID.
PROGRAMS CAN ALREADY DO --
AND AND WORK THAT WE DID WITH --
WITH -- CITY
MAN WITH HER FEDERAL EXPERTISE
OFFER AN APPROACH --
MEDICAID WAIVER OKAY SO FOR SIR
FOR FREE OKAY AND THEN I GUESS
THE OTHER THING JUST TO FOLLOW
UP ON THE PREVIOUS PANEL AND
SOME OF YOUR THOUGHTS --
THERE'S A LOT OF DISCUSSION
ABOUT THE PORTS OF ALIGNMENT AND
SO.
WE DON'T THINK ABOUT MEDI CAL
THE SYSTEM OVER HERE AND
EVERYONE ELSE FOR SHEER.
SO DO YOU HAVE SOME --
PERHAPS AND I KNOW IF YOU'RE
HERE TO HEAR THE OTHER PANEL
YOU'VE OKAY GOOD --
SO AND I KNOW THE CALIFORNIA
HEALTHCARE FOUNDATION DOES A LOT
OF WORK NOT ONLY WITH MEDI CAL
BUT ALSO PRIVATE.
I MEAN WHO WHO IS YOUR
PERSPECTIVE FORTY OPPORTUNITIES
AND HOW IMPORTANT IT IS IT FOR
MEDI CAL.
IS A PAIR THAT COVERS A THIRD OF
ALL CALIFORNIANS TO ALSO BE IN
THE SAME ALIGNMENT AS OUR
PRIVATE SECTOR PARTNERS ARE A
PART OF HERS AND ARMS COVERED
CALIFORNIA AND AND AND AND OTHER
PRIVATE PURCHASING GROUPS.
AND TERMS OF BEING ABLE --
TO TO ACTUALLY YOUNG FRATELLI
BASED PAYMENT AND BEND THE COST
CURVE OVERALL FOR THE STATE'S.
MAIL PIZZA DOES TO WHAT DEGREE
SHOULD THE M. AND WE NEED THIS
MEDI CAL NEED TO BE LINED UP
WITH EVERYONE ELSE SO THAT
INSTEAD OF BEING A PROGRAM APART.
WELL IT IS --
I THINK IT'S ALIGNMENT --
GREATER LINE IT IS CRITICALLY
IMPORTANT IT'S REALLY ESSENTIAL
FOR GONNA MOVE --
THAT DELIVERY SYSTEM FORWARD --
TO REALLY ALL CALIFORNIANS --
ME NO MEDI CAL IS A UNIQUE
PROGRAM IS A UNIQUE COVERAGE
PROGRAM THAT COVERS MANY
POPULATIONS THAT OTHER SOURCES
OF COVERAGE AND DO NOT --
SO I THINK WE HAVE TO BE MINDFUL
OF SOME OF THE UNIQUE ATTRIBUTES
OF SOME OF THE MEDI CAL AND
MEDICAID IN GENERAL AND YET
THERE ARE IN ORDER FOR NORMA'S
OPPORTUNITIES FOR GREATER
ALIGNMENT --
ONE OF THE EFFORTS THAT WE'RE
INVOLVED IN IS EXPANDING ACCESS
TO TELL HEALTH PARTICULARLY IN
RURAL AREAS OF THE STATE TO TRY
TO ADDRESS SOME OF THAT --
MILLION DOLLARS NETWORK ISSUES
SURE SHORTAGES OF PHYSICIANS
PARTICIPATING IN MEDICARE
PROGRAM --
AND WHAT WE FIND IS EVEN WHEN
THERE IS A PLAN THAT IS VERY
COMMITTED --
INCLUDING SOME PLANS THAT ARE
HERE TODAY TO EXPANDING ACCESS
TO TELL HEALTH IT TAKES MORE
THAN ONE PLAN THAT'S COMMITTED --
THAT PROVIDERS THAT THEY'RE
WORKING WITH --
AS YOU'VE HEARD --
AND HAS BEEN YOUR EXPERIENCE.
REALLY NEED TO MAKE SURE THAT
ALL OF THE PLANS THAT THEY'RE
WORKING WITH OUR SORT OF ROWING
IN SYNC SO THE NOT GETTING
DIFFERENT CENTERS OR SOME PLANS
ARE PLAYING FOR THINGS AND SOME
PLANS AREN'T SO.
GREATER IN LYMAN WHETHER IT'S IN
PAYMENT OR WHETHER IT'S IN --
INCENTIVE PROGRAMS IN VALUE
BASED PAYMENT IS --
IS CRITICAL.
THANK YOU AND A SO AS TO THEM --
TOOK QUITE CONCERNED ABOUT DOES
YOUR FINDING THAT THERE'S LACK
OF IMPROVEMENT AND THE
PERFORMANCE I MEAN QUALITY
PERFORMANCES BEEN.
DONE.
THE SUM UP SOME DOWN BUT
GENERALLY THERE HASN'T.
BEEN A PROVEN OVER TIME SO I
THINK TO ME THAT'S PRETTY
CONCERNING --
WHEN I WAS JEERED SOMEBODY
HEALTH COMMITTEE?
WE MADE THAT THAT MEDI CAL PLANS
ON THE CAPS SURVEY GENTLY
PERFORM THOSE COMMERCIAL PLANS
ARE SOMEWHERE BETWEEN THREE AND
FIVE BUT THE MOST THE MEDICAL
PLANS WERE WANTS.
TO AND THAT WAS VERY CONCERNING
AS WELL AND SO --
I THINK SOME OF THE THINGS THAT --
NOW IF YOU HAVE SOME THOUGHTS AT
IN TERMS OF AND I KNOW WE'RE
GOING TO HAVE SOME --
SOME OUTSTANDING PLANTS
PRESENTING BUT THE YOU KNOW IT'S
GREAT TO TALK ABOUT THE BEST BUT
WE'D FATHER BUT FROM EQUITY
STANDPOINT EVERYONE SHOULD BE AT
THAT LEVEL.
SO WHAT ARE SOME OF THE THINGS
PERHAPS THAT YOUR THOUGHTS THAT
MEDI CAL SHOULD BE DOING TO MOVE
THE PLANS THAT MIGHT BE IN THE
MIDDLE OR BOTTOM.
UP TO A HIGHER STANDARD.
WELL I THINK --
I THINK YOU'RE ABSOLUTELY RIGHT --
AS WE LOOK AT THE QUALITY AND
PATIENT EXPERIENCE SCORES THERE
ARE PLANS THAT ARE DOING A
TREMENDOUS JOB AND HAVE IMPROVED --
EITHER SCORES FOR INDIVIDUAL
QUALITY MEASURES OR IN AGGREGATE
THEY'VE MOVE THOSE FORWARD --
AND YET --
DAY ARE PERHAPS MORE THE
EXCEPTION THAN THE RULE --
AND IN THE APPROACH THAT WE CAME
TO AGAIN LOOKING AROUND OTHER
STATES IS THE NOTION OF WE NEED.
TO AS WE SEE MANY PLANS.
OPERATING PAY FOR PERFORMANCE
AND OTHER VALUE BASED PROGRAMS
WITH THEIR PROVIDERS --
IT'S PERHAPS TIME TO THE STATE
TO DO THE SAME --
REALLY WANTS TO SEE BIGGER
IMPROVEMENTS IN QUALITY AND AND
PATIENT ACCESS.
NEEDS TO MAKE SURE THAT THE
INCENTIVES ARE LINED WITH THOSE
WITH THOSE CALLS.
ANY OTHER QUESTIONS HERE.
ADDITION CENTERS THEM.
THE JUDGES TO FOLLOW UP ON ON
SENATOR HANDS --
A COMMENTS ABOUT THE IMPROVING
KAREN AND MEDI CAL SHE IN RURAL
AREAS IS CHALLENGING.
AND IT'S IT'S IT'S IT'S A
CHALLENGE BECAUSE A LOT OF
PROVIDERS JUST WON'T TAKE MEDI
CAL BECAUSE THE FEES ARE JUST
RIDICULOUSLY LOW.
SO WOULD YOU SEE AN ACCESS TO
THE THE FEES THAT ARE PAID AND
MEDIC HOW WORK WERE FOR MORE
PROBABLY TO FEE FOR SERVICE NOW
ALTHOUGH I'M SURE THE MANAGED
CARE.
ALEXI A LARGER CAPITATED A
BUDGET AS WELL.
BUT DO YOU SEE AN ACCESS TO THE
THE FEE AND THEY QUALITY OF CARE
THIS DELIVERED I'M SORRY DO I
SEE A WHITE TO THE NEXUS BETWEEN
THE MEDI CAL FEE PAID FOR FEE
FOR SERVICE AND THE AND THE AND
THE LOWER RATINGS IF YOU WILL OF
SERVICE OF PEOPLE.
ARE REPORTING.
WELL --
THAT'S A THAT'S EIGHT IT'S A
DIFFICULT QUESTION TO ANSWER I
THINK WHEN WE LOOK AT THIS IN
THE PAST WHEN MEDI CAL WAS
MOSTLY A FEE FOR SERVICE PROGRAM --
AND WE LOOKED AT NATIONALLY AT
THE RELATIONSHIP BETWEEN
MEDICAID FEE FOR SERVICE RATES
AND MEASURES OF ACCESS --
THERE IS DEFINITELY A
RELATIONSHIP THERE INSTANCE
STATED GENERALLY TO PAY LOWER
AXIS IS POOR AND STATES THAT PAY
BETTER ACCESS IS THAT TENDS TO
BE BETTER --
YOU KNOW THE CHALLENGES IT MEDI
CAL IS PREDOMINATELY A MANAGED
CARE PROGRAM AND PAYMENTS TO
PHYSICIANS IS --
IS IS ABSURD BEHIND A FIREWALL
RIGHT IS WE DON'T WE DON'T HAVE
PUBLIC INFORMATION WHAT THE
PLANS ARE PAYING --
WE CERTAINLY HEARING YOU MAY
HEAR THIS THIS AFTERNOON FROM
PLANS THAT ARE PAYING WELL ABOVE
MEDI CAL FEE FOR SERVICE RATES
OFTEN IN EXCESS OF WHAT MEDICARE
PAYS -- TO
ENSURE THAT THEIR NET THEIR
MEMBERS HAVE APPROPRIATE ACCESS
TO CARE ON SOMETIMES THEY WILL
SAY EVEN THAT'S NOT ENOUGH TIME
TO GET --
THE PHYSICIANS TO PARTICIPATE IN
THE PROGRAM SO --
BUT WE JUST WE DON'T REALLY HAVE
GOOD DATA NOW TODAY IN THE IN
THE IN THE WAY THE PROGRAM WORKS --
IT'S NOT ONLY THAT IS NOT
TRANSPARENCY THAT MANY POSITION
GROUPS ARE CAPITATED SO THERE
ISN'T A DIRECT RELATIONSHIP
BETWEEN A SERVICE AND A PAYMENT
ANYMORE --
SO THERE'S A COUPLE THINGS THAT
SORT OF COMPLICATE THAT THAT
QUESTION THANK YOU.
I HOPE I WOULD MAKE NOTE THAT
ACTUALLY --
ARE BUDGET SUBCOMMITTEE --
AT IT WE DID THAT HEARING ON A
RATE SETTING HOW SO HOW THIS
MEDI CAL ACTUALLY --
DTS SETS RATES WITH HEALTH PLANS
WE KNOW THAT SOME HEALTH PLANS
THAT WE HAD HEALTH PLAN FOR THEM
MEDI CAL HEALTH PLAN THAT SAID
THE ACTUAL PAY MEDICARE RATES.
SO THE WERE DAY NEGOTIATED THAT
WE HAD OUT THAT ARE REALLY
ANOTHER ONE THAT DOESN'T HOT --
AND THEY REPORTED MORE THEY SEEM
THE FOR FOR MORE ISSUES AND I
THINK WE'RE PLAYING TO FOLLOW UP
ON THAT AS WELL SO --
I THINK WE'LL LOOK AT SOME
FUTURE OF AS WELL SO WILL
CONTINUE TO EXPLORE THAT ISSUE
BUT THANK YOU FOR IN THAT UP
CENTER STOP.
AND DOCTOR PAN ON THE ON THE
QUESTION THAT YOU ASKED THE
PREVIOUS PANELISTS ABOUT HOW FAR
ALONG ARE WE RECOGNIZING THAT
THEY'RE THEY'RE DEAD DELIVERY
SYSTEM ACROSS THE COMMERCIAL
PAYERS AND MEDICAL IS NEXT --
BUT THERE ARE SOME.
UNIQUE ATTRIBUTES OF THE MEDI
CAL DELIVERY SYSTEM --
A GREATER RELIANCE ON PUBLIC
HOSPITALS IN FEDERALLY QUALIFIED
HEALTH CENTERS AND I WOULD SAY
THERE WE ARE JUST SCRATCHING THE
SURFACE --
HE I WOULD POINT --
I THINK I WAS AT A POINT OF
PRIDE FOR THE STATE OF
CALIFORNIA AND ARMY HEALTH CARE
SERVICES IS THE PRIME PROGRAM A
WAIVER PROGRAM FOR PUBLIC
HOSPITALS.
IS A VALUE BASED PAYMENT PROGRAM
THAT TIES PAYMENTS --
TO QUALITY AND REDUCING
DISPARITIES --
I THINK WE IF WE WANT TO SEE THE
KINDS OF IMPROVEMENTS --
THAT WE'RE TALKING ABOUT HERE
TODAY WE NEED TO X. THE PROGRAM.
THANK YOU AND THANK YOU FOR I
DIDN'T WANT TO ACKNOWLEDGE THAT
DINNER LAST WAIVER AND I WANT TO
THANK THE LEADERSHIP AT DTS FOR
BUILDING AT VALLEY BASED
APPROACH WITH THE PUBLIC
HOSPITALS.
AND SO --
HOPEFULLY WE CAN FIGURE OUT WAYS
TO EXPAND ON THAT I KNOW IT'S A
LITTLE CHALLENGING IN DC AND OUR
RELATIONSHIP WITH THE WITH WITH
THEM BUT HOPING WE CAN.
THAT MUTUALLY THEY'LL EVER WILL
SEE BOTH THE FEDERAL GOVERNMENT
AND OUR STATE --
OPPORTUNITIES --
FOR FOR DEVELOPING BETTER MODELS
THAT WILL ACTUALLY SAVE US BOTH
MONEY SO THANK YOU VERY MUCH FOR
BEING HERE THANK YOU.
ALL RIGHT SO NEXT UP.
WE HAVE FROM HELL.
MEDICARE CHRONIC DISEASE
MEDICARE CORONATION WE HAVE --
FOR PLANS ARE FACTUALLY.
WILL SOME PLANS AND SOME SYSTEMS
HERE -- WE
HAVEDOCTOR ROBERT MOORE CHIEF
MEDICAL OFFICER PARTNERSHIP.
DOCTOR TO RESEARCH --
MEDICAL DIRECTOR FOR AND THE
TREE CARE QUALITY OF INTER A
COUNTY HEALTH CARE AND BILL
HENNEMAN.
DIRECTOR SPECIAL PROGRAMS THE
ANTHEM BLUE CROSS I WANT TO
WELCOME YOU ALL HERE AND CHRISSY
HERE --
SHARING WITH US --
SOME OF THE COOL THINGS YOU'RE
DOING AND INTERESTING THINGS
YOU'RE DOING WITH THE CHRONIC
DISEASE MEDICARE COORDINATION
AND HOW HOPEFULLY WE CAN ALSO
TOUCH ON A LITTLE BIT HOW YOU'D
SEE TAKING WHAT YOU'RE DOING TO
SCALE ACROSS MEDI CAL I REALIZE
THAT MANY YOU'VE YA I HAVE MY
OWN.
CLINIC SYSTEM A HEALTH PLAN BUT
YOU KNOW YOU COLLEAGUES WELL
ENOUGH TO SPEAK TO THAT SO
WELCOME THANK YOU AND I GUESS
WE'LL START WITH ACT MORE
[inaudible]
HE ALL RIGHT THANK YOU.
THANK YOU SO CHAIR PAN AND
SENATORS IT'S A PLEASURE TO BE
HERE JUST --
SPEAKING WITH YOU MY NAME IS
ROBERT MOORE AND THE CHIEF
MEDICAL OFFICER FOR PARTNERSHIP
HEALTH PLAN OF CALIFORNIA WHICH
IS A NOT FOR PROFIT COMMUNITY
BASED --
MEDI CAL BANISH CARE
ORGANIZATION --
PARTNERSHIP IS PART OF THE YES
COUNTY ORGANIZED HEALTH SYSTEM
MODEL TALK TOUCH BASE A LITTLE
BIT MORE BUT IT'S GOVERNED BY A
BOARD OF COMMISSIONERS THERE'S
SELECTED BY THE COUNTY
GOVERNMENTS OF THE FOURTEEN
COUNTIES.
THAT WE SERVE IN NORTHERN
CALIFORNIA LARGELY RURAL
NORTHERN CALIFORNIA SERVING
ABOUT FIVE HUNDRED AND FIFTY
THOUSAND MEMBERS JUST A NOTE ON
THE CASE MIX --
IN REATION TO THE COUNTY
ORGANIZED HEALTH SYSTEM MODEL A
BECAUSE THERE IS NO COMMERCIAL
PLANNED THAT SORT OF THAT THAT
WE SHARE OR OR OR OR COMPETE
WITH IN IN THAT MODEL.
THERE'S NO THERE'S NO --
INCENTIVE AT THE HEALTH PLAN
LEVEL TO TRY TO SHUFFLE OUT HIGH
COST PATIENTS LIKE PEACE WITH
HEPATITIS C. OR AVOID OF
PROVIDING CARE ANYWAY SO THAT'S
ONE SYSTEMATIC METHOD OF OF
APPROACHING OUT.
SO AS AS THE CHIEF MEDICAL
OFFICER MIGHT --
WHEN I WAKE UP EACH MORNING TO
THINKING ABOUT IS HOW TO IMPROVE
WHAT ARE THE MECHANISMS THAT THE
AYE AYE IS A?
AS A HEALTH PLAN A FAMILY
DOCTORS WORKING WITHIN THE
HEALTH PLAN CAN LEVERAGE TO
IMPROVE THE QUALITY OF CARE
PROVIDED BY OUR OUR PRIMARY CARE
NETWORK.
AND AND SO I'VE IN MY WRITTEN
TESTIMONY OF SUMMARIZE SOME OF
THE MAJOR POINTS OF OF THAT I'VE
LEARNED OVER THE YEARS BUT THEY
THEY'RE IN FOUR CATEGORIES ON
THE FIRST IS --
THE LEVELS AT WHICH THE
DIFFERENT A DIFFERENT LEVELS IN
WHICH THE HEALTHCARE DELIVERY
SYSTEM CAN IMPACT CHRONIC
DISEASE CARE --
THE SECOND IS --
LOOKING AT THE DOMAINS OF
QUALITY THAT THAT CAN BE
AFFECTED AND REALLY A LOT OF OUR
CONVERSATIONS IS FOCUSING ON
JUST A SUBGROUP OF THOSE TO
MAYES WE'VE KIND OF TOUCH
BRIEFLY ON THINGS LIKE CAPS AND
AND SOCIAL DETERMINANTS BUT
THERE ARE THERE EVEN MORE THAN
WHAT WE PRODUCT --
THERE'S ALSO THE LEVERS ON FOR
ACTUALLY CHANGING BEHAVIOR TO
IMPROVE QUALITY AND I WILL JUST --
AND I'LL --
I'LL JUST SAY THAT OF THE THE
SEVEN MAJOR LEVERS FIRM FOR
CHANGING BEHAVIOR --
PAY FOR PERFORMANCE IS PROBABLY
THE THIRD WORST IT'S NOT THE NOT
NOT THE BEST ONE ITS INTEREST
THERE OTHER STRONGER ONES.
AND THEN LASTLY JUST A FEW
UNINTENDED CONSEQUENCES FOR THE
PAY FOR PERFORMANCE PROGRAMS CAN
HAVE THE TO KEEP IN MIND WHEN
WE'RE WHEN WE'RE CREATING THAT.
AMONG HAT IS ONE MAKE FOUR
POINTS IN OF TURNOVERS MIGHT MY
COLLEAGUES THE FIRST IS THAT --
THE QUALITY OF OF CHRONIC
DISEASE FIGHT IT IS LARGELY A
FUNCTION OF WHAT HAPPENS IN THE
IN THE OFFICE BETWEEN PHYSICIANS
THEIR CARE TEAMS AND THEIR
PRIMARY CARE ORGANIZATIONS
THAT'S THAT'S FOR THE MONEY SO.
THAT'S THAT'S WHERE THIS
ACTIVITY HAPPEN SO AND AND ALL
PAUSE AND I'LL BE COMING BACK TO
THAT LATER.
ON THE SECOND IS THINKING ABOUT
ABOUT PAY FOR PERFORMANCE
PROGRAMS --
WITHIN SORT OF THE MEDI CAL
MANAGED CARE MODEL I WOULD
SUBMIT THAT IT'S NOT THE HOLY
GRAIL IT'S NOT THE WAY OF IT BY
TWEAKING OR COMING UP WITH A A
PARTICULAR PAY FOR PERFORMANCE
PROGRAM WE CAN.
MAKE A DIFFERENCE BUT IT'S NOT
GOING TO ACHIEVE ALL THE GOALS
WE WANT TO AND AND THERE ARE
WEAPONS PARTICULARLY IF YOU
THINK ABOUT.
RATCHETING THE PAY FOR
PERFORMANCE DOWN TO THE PROVIDER
LEVEL THERE'S SOME THOUGHT THAT
WELL YOU JUST KIND OF KEEP
PAYING FOR PERFORMANCE ALL THE
WAY DOWN TO THE FRONT LINE LEVEL
THAT SOMEHOW MAGICALLY RESULTS
IN IMPROVEMENT.
THERE OTHER ACTIVITIES THAT WE
FOUND THAT ARE REALLY CRITICAL
TO HELPING IMPROVE QUALITY.
OF THE INCLUDE SHARING DATA AND
THAT TAKES --
MONEY EFFORT TO CREATE
MECHANISMS FOR STANDARDIZING
DATA AND SHARING IT WITH OUR
PROVIDER SO THEY KNOW WHICH KIDS
NEED THERE'S THERE'S THEIR TWO
YEAR OLD SHOTS YOU KNOW BUT
WHICH IN WHICH KIDS ARE AT RISK
OF NOT HAVING THEIR VACCINATIONS
BE UP TODAY PAGE --
TO ALSO THERE'S TECHNICAL
ASSISTANCE AND TRAINING WE DO WE
DO WITH FOR INSTANCE I'M I'M
FIVE DRAWING UPON --
VACCINES AS AN EXAMPLE --
TRAININGS ON WHAT WE LEARNED FOR
BEST PRACTICES THAT PRACTICES
MIGHT DO TO CHANGE THE THE
LANGUAGE AROUND VACCINATION FOR
EXAMPLE --
PROVIDING COMPARATIVE DATE IS A
POWERFUL A TOOL WHERE YOU
ACTUALLY --
LET ALL A BUNCH OF DIFFERENT
PROVIDERS SEE HOW THEY COMPARE
WITH EACH OTHER THE LOWER
PROVIDERS CAN ASK THE HIGHER
PROVIDERS WHERE THEY DO
DIFFERENTLY MAYBE FEEL A LITTLE
EMBARRASSED BIKE AT THAT SOCIAL
PRESSURE WHICH IS THE TOP METHOD
OF CHANGING BEHAVIOR --
AND TO BRING THAT TO BEAR AND
THEN THERE ARE SOME DIRECT TO
MEMBER ACTIVITIES THAT HEALTH
PLANS MADE DUE TO TO INFLUENCE
AT SOME OF THE ONES WE'VE DONE
AROUND --
VACCINATIONS AS AN EXAMPLE
INCLUDE MEMBER INCENTIVES FOR
FOR COMPLETING VACCINATIONS ARE
WELL CHILD VISITS --
A MARKETING CAMPAIGN WERE RE --
TALK --
BROADER MEDIA CAMPAIGN TO KIND
OF CREATE A MESSAGE THAT DOESN'T
TURN OFF --
A PARENTS WHO WERE CONSIDERING
NOT VACCINATE THEIR CHILDREN BUT
TO GIVE THEM --
THE SOME ADDITIONAL INFORMATION
TO MAYBE TO MAYBE START TO
CHANGE OUR MINDS.
AND EVEN HOLDING VACCINE EVENTS
WITH WITH PUBLIC HEALTH RECURSOS
WHAT KIND OF ACTIVITIES ARE THEY
MAY BE SEPARATE FROM THE
DELIVERY SYSTEM THAT WE CAN
INTERVENE SUGGEST THAT CONCEPT
OF THE MONEY DOESN'T ALL SLOW
DOWN SECOND POINT.
ON THIRD POINT IS THAT IT'S VERY
IMPORTANT IN OUR EXPERIENCE WITH
WORKING AND PAY FOR PERFORMANCE
PROGRAMS.
THAT IT IT TO CREATE BE VERY
CAREFUL IN OUR DESIGN --
IF THE IF IT'S NOT DESIGN WELL
YOU CAN HAVE SOME MAJOR NEGATIVE
UNINTENDED CONSEQUENCES ULCER
ONE THAT WE'VE NOTICED IN OUR
DELIVERY SYSTEM AGAIN HAVING TO
DO WITH VACCINATION SINCE I KNOW
THAT'S NEAR AND DEAR --
TO CENTER PANTS HEART IS THAT --
IF WE SET THE BAR REALLY HIGH
FOR FOR A PEDIATRIC VACCINATIONS
FOR INSTANCE TRYING TO ACHIEVE
THE NINETIETH PERCENTILE IN
SCITUATE --
NATIONALLY SOME PRACTICES WILL
SAY YOU KNOW I'VE GOT THESE
PARENTS TO REFUSING VACCINATION
I'M JUST GONNA GET A MODERATE
PRACTICE AND THEN WHAT WE HAVE
WHAT WE CALL --
SORT OF THEIR VACCINE REFUGEE
PAY FOR PERFORMANCE PROGRAM THIS
IS GOING TO SUFFER IF THEY GET
THEM IN THERE SUCH AN EXAMPLE
THE NAY OF CONSEQUENCE FOR WE'VE
DONE IT PARTNERSHIP AS WE
LOWERED THE THRESHOLD LITTLE BIT
JUST BECAUSE IT'S NOT THAT WE'RE
NOT WE DON'T WANT TO TO HIT. 90%
TELL BUT WE DON'T WANT THAT
RIGHT THAT THAT THAT SORT OF THE
THE KIDS WITHOUT PRIMARY CARE
HOMES.
AND THEN ON THE LAST THE LAST
POINT IS I KNOW THAT --
CHRIS KIND OF TALKED A BIT ABOUT.
THE THE CHANGES WITH MEDICAL
MANAGE COLONEL JUST FROM MY
PERSPECTIVE AS SOMEONE WHO'S THE
RECIPIENT OF THE DH CS IS --
ACTIVITIES ONE THING I'VE
NOTICED ABOUT --
ABOUT THREE YEARS AGO THEY THEY
DEFINITELY RAMPED UP DCS RAMPED
UP ITS ITS ATTENTION TO THE
QUALITY OUTCOMES.
AND IT TAKES A LITTLE WHILE TO
SEE THAT AFFECT BUT WE DID SEE
THAT IF YOU COMPARE
200-016-22000 SEVENTEEN HE JUST
DATA THAT'S WHEN THE ACTUAL
ACTIVITY HAPPEN TWO THOUSAND
EIGHTY IS BEING COLLECTED NOW
SHE WON'T HAVE THAT.
TILL THIS SUMMER ON THERE IS
ABOUT A 425% IMPROVEMENT
GLOBALLY IF YOU JUST LOOKED AT
ALL THE PLANTS GLOBALLY ACROSS
THAT I KNOW THAT BECAUSE WE HAD
A RAW DATA AND LEAD IMPROVE BY
ABOUT 45% WE WERE VERY EXCITED
ABOUT THAT.
BUT BUT A RELATIVE RANKING SEE
OTHER HEALTH PLANS WAS ABOUT THE
SAME BECAUSE SO I THINK THAT.
THAT IT EXTRA ATTENTION
INCLUDING THREATS OF OF
FINANCIAL SANCTIONS CORRECTIVE
ACTION PLANS GOING INTO TO SEE
THAT GOING TO THE DEPARTMENT
EXPLAIN ALL THE ACTIVITIES
YOU'RE DOING ARE HAVING AN
IMPACT IN THE BIG QUESTION IS.
WHEN YOU PAY A LOT OF ATTENTION
TO SOMETHING DO YOU HOW MUCH
ADDITIONAL BENEFITS YOU GET A
FEW OUT OF FINANCIAL CENTER ON
TOP THAT'S AN OPEN QUESTION SO?
SO THAT'S THOSE ARE THE MAIN
THOUGHT IN AND JUST. ONE FOLLOW
UP ON THE CONCEPT OF INTEGRATION
I WISH THAT THERE WERE MORE
INTEGRATED SYSTEMS LIKE A
CONTRACT WITH UP AND YOU KNOW
HUMBOLDT AND AND AND MODOC
COUNTY SAN AND SISKIYOU COUNTY
BUT THEY'RE IN OUR RURAL AREAS
TO JUST THERE AREN'T ANY SO
ALTHOUGH IT OUT THE IDEA.
OF GREATER INTEGRATION IS A GOOD
STRATEGY FOR LIKE LA --
FOR RURAL AREAS THE BEST WE CAN
DO IS A PSEUDO INTEGRATION AND
HEALTH PLAN LIKE A COUNTY WE'RE
GONNA SELL SYSTEM THAT'S MY GOAL
IS TO BE A PSEUDO INTEGRATOR OF
THAT HEALTH CARE.
AND AND I'D LOVE TO TURN OVER --
TO OF ONE OF ONE OF MY
COLLEAGUES AND FRIENDS WHO IS
THE CEO AND ALSO PHYSICIAN AT A
HIGH PERFORMING HEALTH CENTER IN
YOLO COUNTY TO KIND OF SEE TO
KIND OF EXPLAIN HOW WHAT WE DO.
AFFECTS THEIR WHOLE CENTER.
LOS.
THANKS DOCTOR PAN AND MEMBERS OF
THE COMMITTEE --
LIKE BOB SAID I MELISSA MARSHALL
AND A FAMILY DOCTOR IN THE CO
COMMUNICATOR JUST ACROSS THE
RIVER.
WE TAKE CARE OF ONE EIGHT YOU'LL
COUNTY RESIDENTS ABOUT A HUNDRED
THIRTY FIVE THOUSAND VISITS A
YEAR.
SO PRETTY SIGNIFICANT IN TERMS
OF THE POPULATION WERE SERVING.
A BEFORE I START I ACTUALLY
WANTED TO TALK ABOUT YOUR
ALIGNMENT QUESTION.
AND IT MADE ME THINK ABOUT
PRIMARY CARE SPEND.
SO NATIONALLY WE KNOW THAT
PRIMARY CARE SPEND IS ABOUT 527%
OF THE TOTAL SPEND.
AND PARTNERSHIP ACTUALLY INVEST
QUITE A BIT MORE IN THEIR Q. I.
P. THAT ACTUALLY ATTRIBUTES FOR
A HIGHER LEVEL OF SPEND.
WE ALSO SEE THAT IN PRIVATE
INTEGRATED HEALTH SYSTEMS.
SO PLACES LIKE HIGHS ARE ALSO IN
CARE.
AND WHEN YOU'RE TALKING ABOUT
THE SLIDE IN TERMS OF PAYMENTS
FOR HEALTH PLANS YOU'RE ACTUALLY
TALKING ABOUT EVERYBODY GETTING
SQUEEZED IN TERMS OF THE PRIMARY
CARE SPEND.
AND SO I THINK IN TERMS OF
LEGISLATION OR THINGS YOU CAN DO.
ALIGNING INVESTMENT IN PRIMARY
CARE IS PROBABLY ONE OF THE
BIGGEST BANKS ARE GOING TO HAVE
FOR THE BUCK --
I WANT TO TALK ABOUT Q. I. P.
BECAUSE IT'S HAD A SIGNIFICANT
ROLE FOR COMMUNICATOR --
IT ALLOWS US TO INVEST IN BOTH
ROLES AN INFRASTRUCTURE --
THE ROLES ARE PRETTY VARIED SO
WE A COMMUNICATOR WE HAVE A
CHIEF QUALITY OFFICER I I WAS
PRETTY EXCITED TO JOIN
COMMUNICATOR THE FACT THAT WE
WOULD HAVE A CHIEF QUALITY
OFFICER --
IT SHOWED THAT THERE WAS A
LEADERSHIP INVESTMENT IN QUALITY
AND INFRASTRUCTURE --
WE ALSO HAVE PREVENTIVE CARE
COORDINATORS IN EACH OF OUR
SITES AND THOSE FOLKS BASICALLY.
THEY SERVE AS KIND O THE RING
MASTER FOR ALL OF THE QUALITY
IMPROVEMENT EFFORTS.
WE ALSO HAVE A CASE MANAGER THE
DOES CARE TRANSITIONS SO ANYTIME
SOMEONE'S IN THE HOSPITAL OR IN
IN THE EMERGENCY ROOM WE HAVE
SOMEONE HELPING TO BRIDGE THAT
PERSON BACK TO THE HEALTH CENTER.
WE BELIEVE THAT REDUCES COSTS.
I'M WITH OUR REGIONAL CONSORTIA
REDWOOD COMMUNITY HEALTH
COALITION WE'VE INVESTED IN A
DATA ANALYTICS PLATFORM CALLED
RELEVANT.
AND THIS MAY NOT SOUND VERY
EXCITING UNLESS YOUR DATA GEEK
LIKE MYSELF --
BUT RELEVANT ACTUALLY ALLOWS US
TO SEE THE DATA.
I KNOW WHEN I FIRST STARTED IT
COMMUNICATOR IT WAS HARD WE
WOULD GET MAYBE THIRTY
SPREADSHEETS A MONTH FROM
PARTNERSHIP AND WE WERE TRYING
TO MATCH THE SPREADSHEETS ABOUT
WHO THE MEMBERS WERE.
WHO NEEDED THE IMMUNIZATIONS WHO
NEEDED THEIR CALL IT'S REALLY
HARD TO DRILL DOWN TO THAT DATA?
AND NOW WE HAVE A SYSTEM THAT
HAS ACTIONABLE.
LIVE DATA THERE'S A DOWNLOAD
EVERY TWENTY FOUR HOURS AND WERE
ABLE TO DRILL DOWN TO THE
PATIENT AND PROVIDER LEVEL --
WE WORKING CARE TEAM SO ACTUALLY
THAT DATA IS --
WHAT I CALL DEMOCRATIZED MEANING
THAT EVERYONE HAS ACCESS TO IT
AND IT'S TRANSPARENT?
AND I THINK THIS IS A CULTURE
SHIFT FOR US --
WELL WE APPRECIATE --
PARTNERSHIPS EFFORT TO DO A LOT
OF TRAINING I THINK THAT'S
PROBABLY FOUNDATIONAL IN TERMS
OF US DEVELOPING.
A CULTURE OF QUALITY WE'VE NOW
SORT OF TAKEN IT TO THE NEXT
LEVEL.
AND ULTIMATELY IT HAS TO DO WITH
EVERYONE ON THE CARE TEAM REALLY
FEELING INVESTED IN IN THIS
CULTURAL QUALITY --
ARE CARE TEAMS WORK ON STANDING
ORDERS THEY ACTUALLY CAN LOOK AT
THAT OUR SYSTEM AND THEY CAN SAY
WHO ARE THOSE PEOPLE THAT ARE
DUE FOR VACCINATIONS AND THEY'RE
GOING.
TO YOU KNOW THEY'RE GOING TO BE
TWO NEXT MONTH SO WE BETTER GET
A MAN NEXT WEEK --
AND THIS IS NOT THE POSITION AT
THE TIME OF THE VISIT THIS IS
NOT ME DOCTOR MARSHALL SEEING A
PATIENT AND TRYING TO DECIDE
EVERYTHING THAT MY PATIENT NEEDS
ALTHOUGH WE DO THAT.
TOO THIS IS ALSO OUT REACH THIS
IS TRUE POP IT'S INTERESTING I
JUST WANNA TELL A QUICK STORY
ABOUT THAT SO --
COMMUNICATOR AND I'VE TOLD THIS
TO BOB ALREADY I'M PRETTY PROUD
OF THIS --
COMMUNICATOR ACTUALLY MET ALL OF
OUR CLINICAL QUALITY MEASURES --
AND MOST OF THOSE ARE AT THE
NINETIETH PERCENTILE FOR HE DOES --
SO YOU THINK ABOUT OUR
POPULATION WE DON'T TURN ANYONE
AWAY -- YOU
KNOW WE'RE IN COMMUNITIES LIKE
WEST SACRAMENTO JUST ACROSS THE
RIVER WHERE WE HAVE VERY COMPLEX
PATIENTS.
AND WE MET ALL OF OUR CLINICAL
QUALITY MEASURES WE WERE LACKING
ONE ONE PATIENT ONE MEASURE ONE
CLINIC.
AND OUR CLINIC MANAGER BIANCA.
WAS AT HOME TAKING CARE FOR SICK
CHILD READ AMMONIA.
AND DECIDED THAT WHILE HER CHILD
WAS NAPPING SHE WAS GOING TO
ACTUALLY GO ON TO RELEVANT AND
LOOK THROUGH THE LIST ONE MORE
TIME JUST TO SEE.
AND SHE FOUND A PATIENT THAT SHE
HAD TAKEN CARE OF WHEN SHE WAS
SERVING AS A MEDICAL ASSISTANT
AT COMMUNICATOR.
WHO OFTEN WENT BY HER MAIDEN
NAME?
AND HAD JUST BEEN IN THE
HOSPITAL BECAUSE SHE HAD TAKEN
CARE FOR AND SO SHE WENT INTO
THE HOSPITAL MEDICAL RECORD AND
SHE FOUND THAT LAST LOSS COULD
BE.
ALLOWING US TO ACHIEVE THAT LAST
MEASURE.
AND REALLY I MEAN I WAS SO
EXCITED ABOUT THIS BECAUSE I
THOUGHT THIS IS EXACTLY WHAT WE
THE WORKING FOR IS THAT EVERYONE
REALLY CARES ABOUT THE QUALITY
OF CARE THAT WE WE DELIVER
PATIENCE.
I'M.
JUST TO JUST TO WRAP THINGS UP I
DO WANT TO TALK ABOUT HEALTHCARE
DISPARITIES.
BECAUSE A COMMUNICATOR EVEN
THOUGH WE ARE A TOP PERFORMER
QUALITY OR NOT A TOP PERFORMER
ACROSS THE BOARD.
WERE TOP PERFORMER IN
PARTNERSHIPS --
QUALITY INCENTIVE PROGRAM BUT
WHEN YOU LOOK AT SOME OF OUR
OTHER PATIENTS THEY'RE NOT
MEETING THE SAME MEASURES
THEY'RE NOT HAVING THE SAME
QUALITY OF CARE.
AND SOME OF THAT HAS TO DO WITH
WE DON'T HAVE FOR TO DELIVER.
OR JUST STARTING NOW THAT WE
HAVE THE DATA NOW THAT WE HAVE
THE STATE ANALYTICS PLATFORM TO
REALLY EXPLORE HOW WE CAN BETTER
MEET THE CLINICAL QUALITY FOR
ALL OF OUR PATIENTS ACROSS THE
BOARD.
WHETHER THEY HAVE MEDI CAL
MANAGED CARE WHETHER THEIR
MEDICARE WHETHER THEY'RE
UNINSURED --
AND WE'RE REALLY WORKING HARD ON
THAT BUT I DO THINK IT IS AN
INVESTMENT IN PRIMARY CARE
THAT'S GOING TO MAKE THE
DIFFERENCE [inaudible]
THANK YOU [inaudible]
AFTER A
GOOD AFTERNOON.
THE CAN AND COMMITTEE --
MY NAME IS THERESA CHAU I'M THE
MEDICAL DIRECTOR OF QUALITY OF
INTER COUNTY HEALTH CARE AGENCY --
AND I'M HERE TO TALK A LITTLE
BIT ABOUT THE PRIME PROGRAM AND
HOW WE'VE USED THE ALLIES THAT
TORE BENEFIT AT VENTURA.
I AM JOINED BY JOHNSON KILL IN
THE AUDIENCE WHO IS OUR CEO FOR
IN THE TRI CARE POPULATION
HEALTH AND HE'S HERE REALLY TO
ANSWER THE HARD QUESTIONS THAT
WE CAN SAVE THEM FOR HIM --
I A LITTLE BIT ABOUT MYSELF I AM
FAMILY MEDICINE TRAINED --
AT THE VENTURE PROGRAM I A TEN
YEARS AGO DEVELOPED AN INTEREST
IN DIABETES --
INTERESTINGLY IN PART BECAUSE
OUR SPECIALISTS WERE NOT.
INTERESTED IN DEVELOP TO IN
ADDRESSING THE CHRONIC DISEASE
PART OF DIABETES CARE SO AS
DIABETES REALLY --
BECAME A WIDENING US ABOUT FIELD
WITH MORE MEDICATIONS AND
DEVICES AND OTHER MODALITIES --
IT SEEM LIKE RELEASED DEVELOPING
THAT EXPERTISE MANAGEMENT WAS
REALLY SOMETHING A FAMILY
PHYSICIANS TO DO.
SO VENTURA COUNTY HEALTH CARE
AGENCY IS THE PUBLIC HEALTH
SYSTEM IN VENTURA COUNTY AND WE
ARE A MAJOR MEDICAL PROVIDER IN
THE REGION --
AT THE AGENCY INCLUDE AMATEUR
CARE ACUTE CARE PUBLIC HEALTH
BEHAVIORAL HEALTH HEALTH CARE
PLAN CALLED VENTURE CAN
HEALTHCARE PLAN AND EVEN ANIMAL
SERVICES.
WE HAVE EIGHTEEN PRIMARY CARE
SITES AS ALL SIXTEEN SPECIALTY
CLINIC THAT ARE MOSTLY COLOCATED
WITH THOSE PRIMARY CARE.
CLINICS --
WE ALSO TO HOSPITALS --
AND I DIDN'T ADD THIS YEAR BUT
WE HAVE TWENTY SEVEN BEHAVIORAL
HEALTH FACILITIES IS OFF TO
PUBLIC HEALTH CLINICS.
OUR CLINICS OF OVER --
EIGHTY THOUSAND MANAGEMENT CAL
OF PATIENTS IN THE GOLD COAST
HEALTH PLAN AND OF THE PRIMARY
CARE OUTPATIENT VISITS TO OUR
HEALTH SYSTEM 87% OF THEM ARE
ENROLLED IN THAT MANAGEMENT
HEALTH PLAN.
BECAUSE COUNTY OR TO PLAN OF
KNOW WE'RE NOT AT THE MOMENT
WE'RE NOT NOW YOU'RE A FOR IS A
COUNTY ACCOUNT ORDER.
YEAH BECAUSE YEAH BUT WE'RE NOT
A TO PLAN MODEL OKAY.
YEAH YEAH OKAY THAT'S WHAT THE
YES AND NO --
BUT THE PRIME PROGRAM A AND THE
INVENTOR IS ONE OF THAT TWENTY
ONE PUBLIC HEALTH SYSTEMS THAT
PARTICIPATE IN PRIME WHICH IS
PART OF ELEVEN FIFTEEN MEDICAL
WAIVER --
PRIME IS A PAY FOR PERFORMANCE --
PROGRAM WHICH IN WHICH EACH OF
THE SYSTEMS TAKES ON FIFTY TO
SEVENTY PERFORMANCE METRICS OVER
NINE PROJECTS WHEN I BECAME THE
QUALITY MEDICAL DIRECTOR IT WAS
KIND OF ON THE TAIL END OF
DISTRICT --
DISTRICT WAS --
IF THEY DID HAVE A QUALITY
COMPONENT TO IT BUT THE AGENCIES
WERE ALLOWED TO PICK THEIR OWN
MEASURES IN THEIR OWN BENCHMARKS.
TIME IS VERY DIFFERENT IN THE
SENSE THAT WE ALL OF SAME HIGH
LEVEL BENCHMARKS.
ON THE INCLUDE PRIMARY SPECIALTY
CARE CARE TRANSITIONS AND
THERE'S A PARTICULAR FOCUS ON
HIGH RISK POPULATION SUCH AS THE
ONES THAT WE SERVE.
IT OFFERS FROM MY CLINIC.
SO THE FUNDING MECHANISM FOR
PRIME IS SUCH THAT YOU YOU
REALLY HAVE TO MEET THE METRIC
TO GET THE MONEY --
AND SO WHAT'S DIFFICULT ABOUT IT
ALTHOUGH IT ALIGNS VERY CLOSELY
WITH WHAT WE'RE CLINICALLY
INTERESTED IN DOING IN OUR
SYSTEM -- IT
REALLY REQUIRES YEAR OVER YEAR
PERFORMANCE IMPROVEMENT IN OTHER
WORDS YOU CAN GET YOUR YOU CAN
GET YOUR TO YOUR BENCHMARK FOR
ONE YEAR BUT THEN THAT BENCHMARK
DOES NOT STAY STAGNANT YOU HAVE
TO GO ANOTHER 10% TOWARDS THE
NINETIETH PERCENTILE. TO GET
YOUR MONEY FOR THE FOLLOWING
YEAR SO.
THE MET THE BENCHMARKS OUT RISE
OVER TIME AND THE FUNDING I SHE
DOES DECREASE OVER THE THE A A
LIFETIME OF THE PROGRAM --
SO THAT'S THE THE GAP CLOSURE
MECHANISM THAT REALLY JUST
ALLOWS US NOT TO I JUST REST ON
OUR LAURELS BUT REALLY KIND OF
CONTINUE THAT PERFORMANCE --
FOR THAT WORK HERE EVERY YEAR --
NOTABLY THE ALL OF THE AGENCIES
THAT PARTICIPATE HAVE TO PROVIDE
THE NON FEDERAL SHARE UP FRONT
TO LEVERAGE THE FEDERAL FUNDING
AND THIS HAS NO IMPACT ON THE
STATE GENERAL FUND.
SO FOR VENTURE IN PARTICULAR
PRIME FUNDING IS ESSENTIAL PART
OF OUR VISIT IT'S A IT'S A LARGE
AMOUNT OF MONEY FOR US AND IT IS
REALLY HELPFUL --
IN TERMS OF GETTING
ADMINISTRATIVE SUPPORT FOR THE
NEED FOR PRIVATE FOR REAL --
CLICK A QUALITY IMPROVEMENT --
WE TRY TO BE AS THAT OTHERS HAVE
FOR THAN IT OF MORE THINGS
MENTIONED THAT THE IMPORTANCE OF
DATA SHARING ON THAT'S BEEN ONE
OF THE BIGGEST IMPROVE
IMPROVEMENTS IN OUR COUNTY.
ON GETTING THAT DATA TO THE
CLINICS TO AND SO THAT EACH
INDIVIDUAL CUT CAN UNDERSTAND
WHERE THEY'RE SHAUN CAREY GAPS
ARE -- AND
THEN TIE TRYING TO TAKE THAT TO
SORT OF MORE OF AN INCENTIVE
TYPE OF A ROLE THAT THE
CONNECTION PLAY TO GET THERE.
MEASURES IMPROVED.
OF WE A NO HAVE DESIGNED A LOT
OF WAYS TO HELP WITH CHRONIC
DISEASE MANAGEMENT IN THE COUNTY
WE HAVE A HIGH PREVALENCE OF
DIABETES AND IN MY DIMAS CLINIC
I THINK EACH OF US AS CONDITIONS
THINGS WE DO IS A VERY GOOD JOB
RIGHT.
AND I DON'T THINK THAT BEFORE
PRIME WE HAD TRULY AN IDEA OF
HOW WE WERE DOING THE NOT ONLY
FOR OURSELVES BUT IN COMPARISON
TO OTHERS.
ONSO WE HAD GROUP MEDICAL
VISITS VIçT EDUCATION SESSIONS
A MULTI DISCIPLINARY CARE WITH A
PSYCHOLOGIST A NUTRITIONIST ALL
OF THE THINGS THAT.
ONCE WE WERE ABLE TO REALLY
LEVERAGE THAT DATA OUT OF THE HR.
WE DID FIND THAT WOULD DO QUITE
WELL IT'S IDEAS MANAGEMENT SO
FOR THE PERCENTAGE OF PATIENTS
WHO HAVE POOR CONTROL OR HE WILL
BE WITH THE OVER 9% WE HAVE
ALWAYS BEEN UNDER THE BAR.
SO THIS IS ON THIS PERFORMANCE
MEASURES METRIC FOR LOWER IS
BETTER SO YEAR OVER YEAR WE'VE
BEEN ABLE TO MAINTAIN THAT HOT
THAT THAT HIGH LEVEL OF
PERFORMANCE --
SO IT SEEMS LIKE SOME OF THE
THINGS THAT WE WERE DOING WHICH
ARE THINKING OUTSIDE THE BOX A
LITTLE BIT BY A DOG PROVIDING
MULTI DISCIPLINARY CARE AND
GROUP VISITS AND THESE OTHER
MODALITIES REALLY DID HELP US.
IT ALSO DOESN'T HELP US LOOK AT
SOMETHING SOMETHING THAT MIGHT
BE TRENDS WE'RE NOT SURE --
WHY THERE IS THAT SLIGHT UPTICK
IN THE PERSON AGAIN I YOU KNOW
WHEN WE WERE DATA FOR THIS IS
THE TYPE INFORMATION WE WOULD
NOT HAVE EVEN SEEN TO BE ABLE TO
PREEMPTIVELY?
FIGURE OUT WHAT THE BARRIERS ARE.
SO IF I WERE TO REALLY SPEAK TO
THE ACCOMPLISHMENTS THAT WE HAVE
SEEN OF A TRAP DAIS ON PRIME I
WAS THE THE FIRST THING IS THE
DATA YOU KNOW WE ARE VERY AGAIN
AS I MENTIONED DATA POR PART.
TIME -- MOST
OF OUR DATA WAS COLLECTED
THROUGHOUT MANUAL CHART AUDITS --
AND SO WHEN WE FIRST IMPLEMENTED
THE HR I NAIVELY THOUGHT THAT
THIS WOULD BE JUST A PUSH OF A
BUTTON AND YOU WOULD KNOW
EXACTLY HOW MANY DIABETIC
PATIENTS YOU HAVEN'T EXACTLY HOW
MANY HAD ANYONE SAY OVER 9% BUT
THAT'S NOT AS EASY AS WE THOUGHT
SO YOU REALLY.
NEED SOME EXPERTISE AT THE AT
THE DATA LEVEL OF PEOPLE WHO
SPEAK COMPUTER LANGUAGE PEOPLE
WHO CAN ACTUALLY SYNTHESIZED
THAT DATA.
AND PULL IT OUT OF THE H. ARE
YOU ALSO NEED EXPERTISE FROM
PEOPLE WHO KNOW TO BUILD THINGS
INTO YOUR EHR AND ONCE THEY
BUILD IT UNDERSTAND HOW THAT
GETS PULLED OUT ON THE BACK AND
IS ACTUALLY USEFUL DATA US ALL
THOSE PIECES ARE.
LEVELS OF EXPERTISE THAT I WAS A
WE DID NOT HVE A A TRIP HARD TO
PRIME.
AND THEN HAND IN HAND WITH THAT
DATA IS A DEVELOPMENT OF QUALITY
TEAM SO THESE ARE PEOPLE WHO ARE
LOOKING AT THE STATE AT TRYING
TO MAKE MEANINGFUL --
PERFORMANCE OF FROM THE PROJECT
OUT OF THE DATAAND THAT'S NOT
WHAT MY TEAM DOES WITH THE
INVENTORY CARE DIVISION IS TO
LOOK AT THAT DATA.
AND THEN GO TO THE CLINICS AND
DEVELOP BEST PRACTICES --
AND AGAIN THAT IS SUPPORTED BY
SHOWING EVERYBODY THEIR OWN
PERFORMANCE.
AND WITH THAT DATA WERE ABLE TO
TRULY ENGAGING CARE COORDINATION
SO WE HAVE NURSES AND MEDICAL
ASSISTANTS AT THE CLINICS THAT
TAKE THAT LISTED THEY THEN CALL
PATIENTS WHO HAVE NOT HAD THEIR
COLOR TO CANCER SCREENING HAVE
NOT HAD THE FLU SHOT --
AND BRING THOSE FOLKS AND FOR
THAT CARE KNOWINGLY WHO HAS
THOSE NEEDS --
AND THAT THE OUTRAGE CAN BE
FOCUSED ON THOSE PATIENTS OF
RATHER THAN HAVING A HEALTH FOR
WHERE YOU INVITE EVERYBODY TO
COME AND GET A FLU SHOT --
IN THIS OF FLU FIT EVENT WHAT WE
DID WAS WE CALLED ALL THE
PATIENTS THAT WE KNEW ALREADY
HAD NOT HAD FLU SHOTS.
AND WE ALSO FOCUS ON THOSE
PEOPLE AND MADE OVER FIFTY WOULD
NOT HAD COLORECTAL CANCER
SCREENING SO THIS IS MY CLINIC.
HOLDING BY THOSE WEEKEND EVENTS
AND BRING PEOPLE IN TO TRY TO
DEMYSTIFY.
THE COLLECTION OF STILL SAMPLES
FOR THE PURPOSE OF SCREENING FOR
COLORECTAL CANCER.
PRESS ALSO HELPED US A REALLY
COORDINATOR EFFORTS WITH OTHER
ARMS AGENCY LIKE PUBLIC HEALTH
AND BEHAVIORAL HEALTH AND BY WAY
OF EXAMPLE MENTIONED THAT.
TOBACCO CESSATION COUNSELING
USED TO BE A DOCTOR JUST TELLING
A PATIENT QUIT SMOKING AND THAT
RIGHT THAT AND THE NARRATIVE AND
THEY WOULD ASK ME WHY I COULDN'T
CAPTURE THAT DATA.
AND I WILL TRY TO EXPLAIN THAT
THE DATA A DOCUMENTATIONS A VERY
IMPORTANT PIECE OF COLLECTING
DATA -- AND
WHAT WE DO NOW IS WE TRAIN OUR
STAFF TO NOT ONLY PROVIDE THAT
COUNSELING BUT THERE'S AN
AUTOMATIC REFERRAL BUTTON IN.
THE ELECTRONIC HEALTH RECORD
THAT GOES STRAIGHT --
TO PUBLIC HEALTH AND PUBLIC
HEALTH OR REACH OUT TO THE
PATIENT SIGN THEM UP FOR A
TOBACCO CESSATION CLASS. FOR
THAT TYPE OF AUTOMOTIVE CITY
MAKES IT MUCH EASIER TO PARTNER
WITH OUR WITH OTHER ON TO THE
AGENCIES --
TO HELP THE PATIENT WITH THOSE
TYPES OF THINGS.
SENDING ADOLESCENTS ADULTS FOR A
ALCOHOL AND SUBSTANCE ABUSE ON
THAT AGAIN WAS NOT DONE ON A
SYSTEMATIC.
AGENCY WIDE LEVEL --
AND SO THAT IS --
IF A PATIENT DOES NEED SOME
EXTRA HELP WE PARTNER WITH
BEHAVIORAL HEALTH FOR THAT
REFERRAL.
SO COLORFUL CANCER SCREENING --
IS AN AREA WHERE WE REALLY WERE
PERFORMING QUITE POORLY NEEDED --
TO IT TO DO MANY THINGS TO TRY
TO GET THAT IMPROVED I I
MENTIONED AGAIN --
OUTRAGE I THINK THAT'S A BIG
PIECE OF IT HAVING THE DATA TO
BE ABLE TO DO THAT WORK THIS
DATA SHOWS YOU THAT WE'RE NOW UP
258% FROM A FROM A FAIRLY LOW
INITIAL PERFORMANCE AND REALLY
IT REFLECTS DOING OVER FOUR
THOUSAND MORE FIT TESTS PER YEAR.
AND SAVING A PEOPLE FROM DYING
FROM CANCER SO OVERALL I WOULD
SAY PRIME REALLY HAS HELPED US
DEVELOP THE INFRASTRUCTURE --
INVENTOR COUNTY I THINK WE WERE
BEHIND IN OUR QUALITY WORK
TRUTHFULLY WHEN THIS STARTED I
THINK WE'VE REALLY CAUGHT UP.
BUT THAT WAS --
IN LARGE PART DUE TO THIS WHERE
WE HAVE FROM THE PROGRAM AND
MISTREATMENT.
GOOD AFTERNOON THAT VERY MUCH --
MY NAME IS BEAU HANNON I'M
DIRECTOR OF SPECIAL PROGRAMS FOR
ANTHEM BLUE CROSS PART OF OUR
OUR CALIFORNIA MEDI CAL PLAN --
IN MY ROLE IN OUR SPECIAL
PROGRAMS I'VE OVERSIGHT FOR
SEVERAL STATE PROGRAMS AND AND
BENEFITS INCLUDING LONG TERM
SERVICES AND SUPPORTS --
OUR OUR PALLIATIVE CARE BENEFIT --
SOME EFFORTS WERE DOING WITH
WITH SEVERAL ARE COUNTIES AROUND
THE THEY COUNTY WHOLE PERSON
CARE PILOTS --
ALSO SOME MORE GROUND SOCIAL
DETERMINANTS OF HEALTH IN IN
BIGGEST THING THAT I'M HERE TALK
ABOUT TODAY IS IS THE
IMPLEMENTATION OF THE STATE'S
HELP HOMES PROGRAM --
SO THE STATE'S OLD HOMES PROGRAM.
NO IS A A NEW PROGRAM IN
CALIFORNIA THAT'S THAT'S REALLY
JUST GETTING STARTED --
IT WAS MADE POSSIBLE THROUGH
THREE SECTION TWENTY SEVEN OH
THREE OF THE AFFORDABLE CARE ACT
AS WELL AS ASSEMBLY BILL THREE
SIXTY ONE HEARING CALIFORNIA
SEVERAL YEARS BACK --
WHICH WHICH REALLY ALLOWED
HEALTH PLANS TO BUILD THIS NEW
CASE MANAGEMENT CARE
COORDINATION PROGRAM --
DATES THAT'S A LITTLE BIT
DIFFERENT AND A LITTLE BIT
UNIQUE --
COMPARED TO OTHER COMPOUND
COMPLEX CASE MANAGEMENT AND
OTHER TYPES OF PROGRAMS THAT
WE'VE OPERATED AT THE HEALTH
PLAN SYSTEM --
THERE IS FUNDING FOR THE PROGRAM
TO RECEIVE FEDERAL FUNDING THE
STATE RECEIVES FEDERAL FUNDING
IT'S A 90% FEDERAL MATCH FOR FOR
THE FIRST TWENTY FOUR MONTHS OF
THE PROGRAM.
IN CURRENTLY UNDER STATE LAW
THERE'S A AN AGREEMENT WITH
CALIFORNIAN DOWN THAT TO TO
COVER THE OTHER 10% FOR TWENTY
FOUR MONTHS SO THAT'S A A SHORT
WINDOW WHICH IS ONE OF THE
THINGS THAT I WANT TO BRING UP
TODAY IS TWENTY FOUR MONTHS IS
IS NOT A LOT.
OF TIME TO STAND UP A PROGRAM
AND GET TO THE POINT WHERE WE
SEE THE SUCCESSFUL IMPACT WE'RE
ANTICIPATING SEEING --
YOU KNOW THE THING THAT MAKES
THIS PROGRAM UNIQUE IS.
IN OR DOES TARGET INDIVIDUALS
WITH MULTIPLE CHRONIC CONDITIONS
INDIVIDUALS WITH SEVERE MENTAL
ILLNESS --
AND AND INDIVIDUALS WHO ARE
HOMELESS --
BUT THESE ARE ARE TYPICALLY
INDIVIDUALS THAT WE HAVEN'T BEEN
SUCCESSFUL IN REACHING --
THESE ARE INDIVIDUALS WHO HAVE
BEEN DISENGAGE FROM THE HEALTH
CARE SYSTEM THEY'VE THEY'VE
TYPICALLY NOT BEEN GOING TO GET
PRIMARY CARE --
YOU KNOW THE BIGGEST SOURCE OF
THEIR CARE IS IN THE EMERGENCY
ROOMS OR IN THE INPATIENT
SETTING --
AND AND SO YOU KNOW WHAT ALLOWS
US TO TAKE A DIFFERENT APPROACH
BECAUSE RATHER THAN US AS THE
HEALTH PLAN TRYING TO REACH OUT
AND GAUGES MEMBERS OR OR JUST.
SOLELY TRYING TO RELY ON THEIR
PC P. TO ENGAGE THEM WORKING IN
PARTNERING CLOSELY WITH
COMMUNITY BASED CLINICS FQHCS
ADULT DAY HEALTH CARE CENTERS --
TO REALLY BE THERE ARE THERE ARE
PERSON CENTER MEDICAL HOME AND
AND REALLY PROVIDE THE
INTEGRATED CARE COORDINATION
THAT THAT THIS THIS POPULATION
NEEDS -- AND
SO YOU KNOW IT DOES THERE IS A
DEFINITELY A LOT MORE FOCUS ON
ON OUR REGION ENGAGEMENT --
YOU KNOW ONCE MEMBERS ARE
IDENTIFIED FOR THE PRO --
GOING OUT ON THE STREETS IN THE
HOMELESS SHELTERS AND HOMELESS
ENCAMPMENTS CONNECTING WITH THE
LOCAL HOSPITALS TRYING TO FIND A
MEMBER WHEREVER THEY CAN AND AND
REALLY SPENDING --
A SIGNIFICANT AMOUNT OF TIME
INVESTED IN IN --
IN A RELATIONSHIP WITH THAT
MEMBER SO IT'S NOT A MATTER OF
HEY THIS PERSON'S ELIGIBLE FOR
THE PROGRAM GET THEM ENROLLED
ANOTHER LIKE SKINNER GOING TO BE
BETTER.
YOU ACTUALLY HAVE TO SPEND
SOMETIMES TWO THREE MONTHS.
GETTING BUILDING A A LAYER OF
TRUST WITH THAT INDIVIDUAL AND
AND SO THAT THEY CAN START TO
FULLY ENGAGE IN THEIR CARE --
ADAM WAS WAS ONE OF TWO HEALTH
PLANS TO TO GO LIVE IN THE FIRST
PHASE OF THE PROGRAM IN JULY OF
THIS YEAR IN SAN FRANCISCO
ALTHOUGH I WILL CALL OUT THAT
OTHER PLANTS WHICH IS.
HIS PARTNERSHIP AND DOC MORE OF
HAD OTHER PILOTS THAT ARE VERY
SIMILAR FOR FOR QUITE SOME TIME --
IN ROLLING IT OUT IN SIX
ADDITIONAL COUNTIES IN IN JULY
OF THIS YEAR INCLUDING.
SACRAMENTO SANTA CLARA --
SACRAMENTO SANTA CLARA FRESNO
TULARE LOS ANGELES AND ALAMEDA
COUNTY --
BUT YOU KNOW I I THINK.
WE'RE WE'VE ALSO DONE THIS IN IN
SEVERAL OTHER STATES --
SLIGHTLY DIFFERENT MODELS BUT
BUT WE HAVE IMPLEMENTED HEALTH
PROBLEMS PROBE HEALTH FUNDS
PROGRAMS AND OTHER STATES AND
AND YOU KNOW IN THE LONG TERM
YOU KNOW WE DO FEEL THAT THIS IS
THIS IS BRING IN --
AND A NEW LAYER OF BENEFIT TO
THE HARD TO SERVE MEMBERS IT IS
MAKING BIG IMPROVEMENTS IN THEIR
LIVES -- WE
DO STE ANTICIPATE THAT IN THE
LONG TERM WE ARE GOING TO START
SEEING MORE MORE COST SAVINGS
AND REDUCTIONS IN THE NEW YEAR
NECESSARY UTILIZATION IS IS
WE'RE GETTING THESE MEMBERS
RECONNECTED TO THEIR HEALTHCARE
SYSTEM --
BUT IN THE SHORT TERM THERE ARE
THAT WE HAVE TO OVERCOME --
THE THE PROGRAM.
DOES REQUIRE A SIGNIFICANT
AMOUNT OF START UP EFFORT NOT
JUST FROM THE HEALTH PLAN LEVEL
I MEAN IT'S IT'S BEEN A LOT OF
WORK FOR US AT THE HEALTH PLAN.
BUT I THINK IT'S EVEN A BIGGER
BURDEN ON THE LOCAL CLINICS --%
YOU KNOW SOME OF THE CLINICS
THAT WE'RE WORKING WITH.
YOU KNOW THESE SACRAMENTO FOR
EXAMPLE --
YOU KNOW THERE'S THERE'S A
VARIETY OF WORKING WITH CLINICS
LIKE THE WELL SPACE CLINICS WHO
HAVE PROGRAMS IN STRONG
INFRASTRUCTURE AND THEY'RE GONNA
BE ABLE TO COME ON BOARD QUICKLY
WE HAVE OTHER CLINICS WHICH YOU
KNOW THEY'RE ALL ON BOARD THEY
SEE A LOT OF VALUE IN THIS THEY
WANT. TO CHANGE THEIR SYSTEM TO
TO SERVE THIS PROGRAM BUT IT'S
AN EXTREMELY HEAVY LEFT.
AND SO IT IT IT DOES BECOME A
BURDEN TO START UP THE PROGRAM --
ALSO IT'S A VERY SLOW STARTING
PROGRAM IT'S IT'S IT'S NOT ONE
THAT YOU KNOW DAY ONE WERE WERE
ROLLING OUT AND WE'VE GOT
HUNDREDS THOUSANDS OF MEMBERS
RECEIVING THE BENEFIT --
SO SO YOU KNOW JUST TO OUT OF
SUCCESS WE'VE SEEN STORIES COME
WE'RE SEEING THE IMPACT IT'S
HAVING ON THEIR LIVES --
BUT YOU KNOW IT DOES NEED WE DO
NEED TO MAINTAIN THE FINANCIAL
SUPPORT OF THE PROGRAM AND WE DO
HAVE OTHER COUNTIES.
TO ARE NOT PART OF OF THE THE
IMPLEMENTATION OVER THE NEXT
YEAR --
REQUIRING BECAUSE THEY WANT TO
SEE THE SERVICES EXPANDED TO
THEM AS WELL.
THANK YOU THANK YOU SO VERY MUCH
QUESTIONS FROM.
SO I JUST THE FOR SO I GO I
THINK ALL OF YOU FOR PRESENTING
AT EIGHT I GUESS --
THIS IS A QUESTION --
FOR A DOCTOR CHAU --
SO YOU PRESENTED ACTUALLY YOU
PRESENTED TO EXAMPLES ONE THE
AYE COLORECTAL YOU GOT A LOT
MORE PEOPLE TO GET SCREEN THAT
LOOK REALLY GREAT.
THE OTHER ONE ON THE DIABETES SO
WELL SO WHAT HAPPENS IS THAT THE
GOOD NEWS IS THAT YOU'RE A
PERFORMING SO WELL THAT YOU KNOW
THE BENCHMARK IS COMING DOWN
YOU'RE FAR AWAY FROM IT.
BUT I ALSO NOTE THAT.
YOU'RE YOU KNOW YOU TO
PERFORMANCE THAT YOU HAD OVER
THE FOUR YEARS.
BASICALLY YOU KNOW THERE'S A
CELL THAT AND ONE THOUSAND AND
DISOBEYED Là BASICALLY NOT
SIGNIFICANTLY CHANGED OVER THAT
FOR YEARS.
IF THE VENTURE CAPITAL V. WHERE
YOU WERE THAT MY BEEN. FOR A
VERY PROBLEMATIC AND MAYBE MAYBE
YOU MAXED OUT --
HOW MUCH CHANGE YOU COULD MAKE
AT YOUR PROVIDER IS SO HIGH
PERFORMING COULD SQUEEZE ANYMORE
OUT OF IT BUT?
CAN YOU COMMENT ON THAT I MEAN
IT'S IT'S THEIR ARE YOU JUST
LIKE -- WE
WERE SWEET WE DID DOING
EVERYTHING SO WELL WE DID WE
JUST KEEP DOING WHAT WE'RE DOING
OR WAS THERE ACTUALLY WELL WE
TRY TO DO SOME STUFF IT'LL BUT
ACTUALLY WE DIDN'T SEE A BEND IN
THE CAR AND AND AND THEIR
PERFORMANCE CURVE.
I I THINK A LITTLE BIT OF BOTH
TUNA AND I THINK THAT --
YOU KNOW WE A LOT RIGHT AROUND
WHEN DAD ARE NO NUMBER SIR TO GO
UP ON THE DIABETES IS WHEN WE
HAD AND IT ANOTHER PROGRAM WHICH
I I DIDN'T SPEAK ABOUT WHICH IS
Q.I. P. --
AND THAT ADDED ANOTHER TWENTY
SIX QUALITY MEASURES TO THE ONES
WE WERE ALREADY LOOKING AT I
THINK THAT IT SORT OF SPEAKS --
TO IT THERE'S ONLY SO MUCH YOU
CAN LEVERAGE AT THE CLINIC LEVEL
YOU KNOW THEY'RE ALL VERY YOU
KNOW THEY HAVE THEIR OWN ISSUES
AND SO TO GO AND TO TRY TO
ALWAYS HAVE YOUR EYE ON EVERY
SINGLE BALL.
AT ONE TIME IS VERY DIFFICULT SO
I DO AGREE THAT TO SOME EXTENT
WE HAD BIGGER FISH TO FRY SO THE
DIABETES THING BECAME SENATE
SOMEONE THE BACKGROUND BECAUSE
WE WERE IS DOING WELL ON IT.
BUT YOU KNOW THERE'S OBVIOUSLY
COST FOR CONCERN BECAUSE THERE'S
A LITTLE BIT OF AN UP TICK THERE
IN THE PERCENT THAT ARE OVER 9%.
I DO ALSO THINK THAT WE YOU KNOW
WITH THE DATA HAS ALLOWED US TO
LOOK AT AT TRI CRITICALLY TO
FIGURE OUT WHY THERE IS THAT
I'VE TAKEN WE DO FIND THAT.
INNER LATINO PATIENTS THEY ARE
ABOUT 5% HIGHER IN TERMS OF THAT
UNCONTROLLED DIABETES RATE AND
SO WE TRY TO ADDRESS THAT BUT
AGAIN BY CARE COORDINATION BUT
ALSO.
OUR GROUP MEDICAL VISITS ARE
HEAVILY.
WEIGHTED FOR THE LATINO
POPULATION WE HAVE A 75% OF THEM
ARE IN SPANISH SO WE DID TRY. TO
FIGURE OUT WHAT WAS GOING ON AND
ADDRESS THAT MAYBE THAT WASN'T
ENOUGH IT'S A HARD AND EARLY TO
TELL.
BUT I THINK THERE'S A LITTLE BIT
OF BOTH WHAT YOU'RE TALKING
ABOUT -- FOR
PARTNERSHIP HEALTH PLAN A CHIEF
MEDICAL OFFICER SO WE NEED MAYOR
OF YOUR MAYBE OUT ON SO MUCH OF
THE FINANCIAL SIDE WE HEARD
PREVIOUSLY FROM CALIFORNIA A
STRIPPER OWN ABOUT THE PREMIUM
SLIGHT ISSUE.
THIS FOR THIS WAY I KNOW THAT
THE HEALTH PLAN IS ALWAYS AND
THEN PART OF IT'S IN MY DISTRICT
IS ALWAYS WORKING TO TRY YEAH
WHATEVER --
BUT SAME TIME THAT DOES CREATE A
FINANCIAL DISINCENTIVE IS.
IS DO YOU FROM YOUR PERSPECTIVE
AND IS IF WE COULD ELIMINATE THE
PREMIUMS SLIDE WITH THAT HELP
PROVIDE MORE RESOURCES FOR THE
HEALTH PLAN TO BE ABLE TO DO
MORE.
INNOVATION.
AND ANY SORT FOCUS MY REMARKS ON
P. FOR P. I THINK WE WERE TRYING
TO THINK ABOUT MORE INTEGRATION
ACO TYPE STUFF.
IT SOME OF IT MAY BE P. FOR P.
BUT I MEAN BEYOND THAT BUT I
MEAN DO YOU DO THAT FINANCIALLY
I MEAN TO DO ARE THERE SOME OF I
MEAN ARE YOU DO YOU FEEL LIKE.
YOU OF LIFE SAFETY OF ALL THE
MONEY YOU NEED BUT BASICALLY IF
YOU HAD MORE FINANCIAL RESOURCE
ARE A BASICALLY YOU HAD A BETTER
FINANCIAL INCENTIVE WOULD THAT
CREATE MORE OPPORTUNITIES FOR
YOUR HEALTH PLAN OR YOU CAN LIKE
NO WE RE DID WE'RE DOING
EVERYTHING WE CAN TO READY.
AND THAT'S NOT NECESSARY --
YOU KNOW THE PREVIOUS LIGHT IS
IS A REAL ISSUE THERE IS ONE
SLIGHT BUFFER ON THAT WHICH IS
THAT IF YOU SAVE MONEY IN ONE
YEAR IT TAKES A COUPLE YEARS
BEFORE YOU LOSE IT SO YOU GET A
TRANSIENT BENEFITS IS NOT A LONG
TERM BUT THAT TRANSIT BENEFIT.
TO STILL SOME SOME FINANCIAL
BENEFIT -- A
GOOD EXAMPLE OF OUR CONCERN
ABOUT PREVIOUS LIGHT IS THAT THE
PILOT PROGRAM THE ASIAN CARE
MANAGEMENT PROGRAM WHICH IS A
SORT OF A HEALTH HOMES LIKE
PROGRAM --
WE WE ARE FINANCIAL ANALYSIS
SHOWS A FOR EVERY DOLLAR WE
SPEND WE SAVED ABOUT --
TWO DOLLARS AND FORTY CENTS ON
AVERAGE ACROSS THAT PERIOD BUT
IT'S BEEN GOING ON FOR SEVERAL
YEARS THAT'S ALREADY BUILT BUILT
INTO OUR RATES WHICH OF YOU KNOW
GOING DOWN AS RESULT OF THAT SO.
SO IF WE STOPPED IT THINGS WOULD
NOW WE LOSE MONEY YOU KNOW SO
THAT WOULD BE A BAD THING SO
THAT THAT WOULDN'T BE A GOOD
BECAUSE IT REDUCES
HOSPITALIZATION AND SO ON SO --
SO WE ARE NUMBER PROGRAMS ARE --
THAT ARE THAT ARE LIKE THAT AND
THE PALETTE OF KERR PROGRAMS
ANTHER EXAMPLE THAT --
PALETTE OF KERR WAS IMPLEMENTED.
WITH NO ADDITIONAL FUNDING FROM
DHS BECAUSE OF THE WEB PARTLY
BECAUSE OF THE RESEARCH THAT WE
DID A PARTNERSHIP SHOWING THAT
ABOUT A THREE TO ONE OF SAY IS
THREE DOLLARS SAY FOR EVERY ONE
DOLLAR SPENT ON PALLIATIVE CARE
SO THAT YOU DON'T NEED TO
PROVIDE EXTRA MONEY.
AGAIN THAT THAT GETS THAT THE
MONEY THAT SAVE FROM INCREASING
PALETTE OF KERR IS THERE FOR
SHORTER TIME THEN IT GOES AWAY
SO.
SO IT'S IT'S IT'S AN IMPORTANT
FACTOR AND DOWN TO THE EXTENT
BECAUSE WE'RE NOT FOR PROFIT ANY
MONEY THAT'S LEFT THAT WE HAVE
IS IS REINVESTED RECENTLY
INVESTED TWENTY FIVE MILLION
DOLLARS IN VARIOUS --
SYNERGISTIC LIVES WE RESET WE
SUPPORTED --
WE ACTUALLY ARE SUPPORTING THREE
DIFFERENT --
TRANSITIONS PROGRAMS FROM FROM A
CAR BEING INCARCERATED TO BEING
BACK OUT IN THE COMMUNITY IN
TRYING TO TO DECREASE HOSPITAL
EXPENSES THERE --
THAT WE WE HAVE A UP FOR A
COUPLE OF PROGRAMS THAT ARE
WORKING ON A SOBRE US WITH THE
CALL SOBRE CENTERS RETARDED --
SOBER SOBER LIVING SO THEIR
INNOVATIVE WAYS THAT THAT MONEY
HAD TO COME FROM THE THE MONEY
WE SAVE FROM SOMEWHERE THAT THE
READ THAT THAT THAT WASN'T
BECAUSE WE'RE NOT GONNA GET
REIMBURSED FOR THOSE PROGRAMS
FROM THE STATE SO BUT THEN.
THE QUESTION IS IT WHEN THAT
EXTRA MONEY GOES AWAY WOULD DO
TO YOU KNOW DO WE CONTINUE TO
PROVIDE THAT ARE OR HOW MUCH CAN
WE DO THAT AND IT EVENTUALLY
REACH A LIMIT TO HOW MUCH YOU
CAN DO SO.
AND THEN ON THE HEALTH HOMES --
REPRESENT RECORD SO ONE TWO
WEEKS SO EASE THAT ARE DO YOU
HAVE DATA YET WHEN YOU EXPECTING
MY HAVE SOME DATA ABOUT THE
ABOUT.
HOW MUCH IMPROVEMENT YOU BAIL
MADE WITH THIS PROGRAM?
YEAH I I I THINK YOU KNOW
LOOKING AT UTILIZATION DATA.
YOU KNOW THERE'S MORE WE'RE
STARTING TOGETHER THAT NOW AND I
WOULD SAY YOU KNOW BY THE END OF
THE FIRST TWENTY FOUR MONTHS WE
WE SHOULD HAVE A GOOD IDEA BUT I
I THINK YOU KNOW THERE'S THERE'S
THE WAY THE PROGRAM IS
STRUCTURED NOW.
YOU KNOW A I THINK THERE WERE
WERE SOME ASSUMPTIONS MADE THAT
THAT THE ENROLLMENT NUMBERS
WOULD COME IN REALLY REALLY
QUICK SO WE'LL HAVE SOME
EVALUATION DATA THAT SAYS ON A
PER MEMBER BASE IS A SERVICE
FAVES THIS BUT IT'S IT'S NOT
GOING TO BE LIKE PROGRAM WHY
WHAT'S.
THE BIG IMPACT THIS IS HAVING
AND I THINK EVEN EVEN THE WAY
THE THE RATES ARE STRUCTURED NOW
THERE WERE SOME ASSUMPTIONS MADE
THAT.
YOU KNOW ALL THE ENROLLMENT
WOULD OCCUR WITHIN THE FIRST
TWELVE MONTHS AND THEN HEALTH
WOOD DRASTICALLY IMPROVED BY THE
SECOND TWELVE MONTHS AND SO
THEIR SHIPS AND RATES IN THE
SECOND YEAR.
AND WE'RE FINDING THAT THAT'S
THAT'S ABSOLUTELY GET PEOPLE
INTO THE PROGRAM --
ACTUALLY TAKES OVER A REALLY
LONG TIME AND AND I THINK THAT
THAT'S GOING TO CONTINUE NOT
JUST FOR TWENTY FOUR MONTHS BUT
EVEN BEYOND THAT IS WE HAVE
OTHER YOU KNOW NEW MEMBERS WHO
WERE GOING TO FALL INTO THE
ELIGIBILITY PUCK.
YEAH I MEAN I THINK PEOPLE SIZE
UNDERESTIMATE.
HOW MUCH EFFORT TAKES TO MAKE
CHANGE AND --
PEOPLE HAVE TO HAVE CONFIDENCE
IN AND KNOW SOME OF YOU HERE
RANK CLASS HE SORT.
OF SO INCOMES THESE AS WE WANT
TO CHANGE THE WAY YOU DO THINGS
RIGHT WHETHER IT'S OF THE MAIN
H. R. L. CHANGING QUALITY AND
AND THAT THAT TAKES A LOT OF
WORK TO MAKE THAT TRANSITION.
I MEAN THAT THERE'S A LOT OF
THINGS DIFFERENT PEOPLE ARE
DOING AND THE TEAM WE TALK ABOUT
TEAM BASED CARE EVERYONE HAS A
ROLE OF READY IT'S NOT LIKE THEY
HAVE NOTHING TO DO.
AND NOW YOU'RE ASKING THINGS TO
DO THINGS DIFFERENTLY AND HOW DO
YOU REINFORCE THE NEW WAY INTO
THE TRAINING AND BE SURE THAT
PEOPLE ARE DOING THAT.
BY THEN HEY IF YOU'RE IF YOU'RE
REALLY GOOD AT A REALLY FAST SIX
MONTHS GOT BY RIGHT.
A YEAR YEAR AND A HALF AND I
THINK WE NEED TO WHEN WE LOOK AT
THESE THINGS WE ALSO NEED.
TO FIGURED OUT OUT TO AN AND
HAVE REASONABLE EXPECTATIONS.
WHAT THANK YOU VERY MUCH FOR
BEING HERE REALLY APPRECIATE
HEARING ABOUT THE WORK YOU'RE
DOING THANK YOU SO MUCH?
OKAY SO NEXT UP WE HAVE THE FARM
HEALTH CARE SERVICES AND I WANNA
THANK --
DIPPY DIRECTOR A MERRY CAN'T
WELL AND ALSO G. C. COOPER
SENIOR ADVISER HEALTH CARE
PROGRAMS WELCOME THANK YOU FOR
BEING HERE.
AND THEN --
SO REALLY APPRECIATE YOU BEING
HERE I GUESS --
IN YOU MAY ALREADY HAVE PREPARED
SOME REMARKS BUT I ADDRESS THAT
PERHAPS SOME OF THINGS THAT CAME
UP EARLIER IN THE HEARING IF
TALK ABOUT THINGS LIKE ALIGNMENT
OF MODELS AND MEASURES AND SO
FORTH AND HOW MEDI CAL FITS AND
I NOTES ITS SIZE SOMEWHAT
DIFFERENT POPULATION SOME WAYS.
YOU KNOW IT'S LOW INCOME
ETCETERA.
AND BUT HOW US THE PERHAPS IT
DOES -- SOME
COMMENTS ABOUT HOW --
MEDI CAL CAN FIT INTO THIS
BARTER SYSTEM WE HEARD A
QUESTION ABOUT ALSO ABOUT
PARTICIPATING IN DATA FOR THAT
WITHIN A GREAT HEALTHCARE
ASSOCIATION SO.
WELCOME AND THANK YOU FOR THINGS
DOCTOR PAN --
ASSUME --
YOUR STAFF DID HAVE A FEW TOPICS
THAT THEY ASKED US TO TALK ABOUT
SO -- WILL
THERE WERE THREE SORT OF
SPECIFIC ONES ALL TALK ABOUT TO
THEM AND THEN --
GZ COOPER WILL WILL FOLLOW UP
AND THEN I THINK WE CAN GET INTO
SOME OF THE QUESTIONS I KNOW YOU
HAVE AND STUFF THAT HAS BEEN HAS
BEEN RISEN SO --
SO THE FIRST THE FIRST TOPIC
AREA WOULD RELATED TO THE
GOVERNOR'S VALUE BASED
PURCHASING PROPOSAL AND JUST
SORT OF MORE ASKING FOR MORE
INFORMATION ABOUT IT TOTALLY
REASONABLE --
WE DON'T HAVE A TON MORE RIGHT
NOW WE STAKEHOLDER IN
LEGISLATIVE INPUT THE DETAILS
AROUND WHAT METRICS WE'RE
LOOKING AT AND HOW WE'RE
THINKING OF PAYING AND WHO MIGHT
BE ELIGIBLE --
I THINK AS AS YOU KNOW WHAT WE
SHARED SO FAR AS WE'RE REALLY
FOCUSING ON FOUR AREAS.
A PRENATAL CARE AND POST PARTUM
CARE --
EARLY CHILDHOOD WELLNESS
IMMUNIZATIONS.
YOU KNOW THOSE THOSE KINDS OF
THINGS A CHRONIC DISEASE
MANAGEMENT AND THEN BEHAVIORAL
HEALTH INTEGRATION SO THAT'S
WHERE THE MEASURES ARE FOCUS AND
CERTAINLY WE'RE GOING TO BE.
HOPING AND EXPECTING THAT FOLKS
CAN HELP US SORT OF REFINE THAT
AND AND MAKE SURE THAT IT'S
GOING TO MAKE SENSE I THINK AS
SOME OF THE PANEL MEMBERS.
EARLIER MENTIONED WHEN YOU GET
TO VALUE BASED PAYMENT AND YOU
GO DOWN TO THE PROVIDER LEVEL IT
CAN BE CHALLENGING IN TERMS OF
ARE THERE ENOUGH --
DENOMINATOR OF PATIENTS TO BE
HAVING A METRIC ON AND SO YOU'LL
SEE SOME OF THOSE CHALLENGES
WHEN WE RELEASED THE PROPOSAL
AND CERTAINLY WILL BE --
HAPPY TO HAVE YOUR FEEDBACK AS
WELL AS A PHYSICIAN WHO OPERATED
IN IN OUR PROGRAM TO SORT OF
KNOW ARE WE HEADING IN THE RIGHT
MARK PARTICULARLY ON THE EARLY
CHILDHOOD STUFF.
SO WE'LL BE LOOKING FOR THAT --
WILL CERTAINLY GET THAT OUT WILL
BE HAVING A WEAPON ARE.
AS WELL AND SEEKING --
HAVING A PUBLIC COMMENT PERIOD
IN ORDER TO THEN SERVER FOR THE
WHOLE BUDGET PROCESS AS WE GO
THROUGH ASSUMING THAT.
CONTINUES TO BE A PART OF THE
BUDGET THAT.
EVERYONE AGO SHEETS WITH THE
GOVERNOR --
BUT ONE OF THE OTHER TOPICS THAT
YOU ASKED US TO ADDRESS REALLY
RELATES TO HOW DO WE MEASURE
COST AND QUALITY AND I THINK
WE'VE.
YOU KNOW WE TALK ABOUT THIS A
LOT -- WITH
YOU SO JUST TO TOUCH AT A HIGH
LEVEL I THINK YOU HEARD A LOT OF
A LOT OF IT ALREADY IN TERMS OF
WHAT.
THE FOUNDATION TALKED ABOUT IN
SOME OF OUR PLANS BUT WE DO HAVE
A SET OF THE X. THE THE A. S.
EXTERNAL ACCOUNTABILITY SET THAT
WE MEASURE THAT DOES CHANGE
EVERY YEAR OF WHICH YOU KNOW WE
DO.
WORK WITH OUR MANAGER CALL THE
ADVISORY GROUP TO DETERMINE
WHICH MEASURES MAKE THE MOST
SENSE TRY TO HAVE STABILITY BUT
ALSO MAKE SURE IF THERE'S
SOMETHING.
SORT OF IMPORTANT THAT WE'VE
BEEN MISSING OR SOMETHING WE'RE
NOT DOING.
REALLY WELL AND THAT WE FOCUS ON
THAT WE DO HAVE FOR THE
REPORTING YOUR TWENTY NINETEEN I
BELIEVE THERE SEVENTEEN MEASURES
WITH.
I THINK TWENTY EIGHT DIFFERENT
ELEMENTS TOTAL SOMETHING LIKE
THAT -- YOU
KNOW SORT OF SPANNING SOME OF
THE DIABETES STUFF THEY SOME OF
THE OTHER FOLKS TALK ABOUT.
SO WE DO HAVE THAT THAT WE HOLD
PLANS ACCOUNTABLE --
TO YOU HEARD A CHRIS TALK ABOUT
THE PERFORMANCE DASHBOARDS THAT
WE PUT OUT THAT I KNOW WE'VE
SHARED AND TALK ABOUT WITH YOU
BEFORE -- I
THINK AS MANY FOLKS OF MENTION
WE SIR WE HAVE CERTAINLY RAMPED
UP OUR EFFORTS IN THIS AREA --
IN WAYS THAT I'M PARTICULARLY
PROUD OF AND I THINK THAT'S
DEFINITELY BEEN TRUE OVER THAT.
THE TIME SINCE I'VE BEEN HERE
REALLY SEEING A SHIFT IN
FOCUSING ON NOT ONLY MONITORING
AND TRACKING THE QUALITY BUT
REALLY BEING ABLE TO SHARE THAT
OUT SO THAT WE CAN.
HAVE TRANSPARENCY ABOUT THAT AND
HAVE FOLKS UNDERSTAND WHERE
WE'RE DOING WELL AND WHERE WE
MAY BE STRUGGLING AND HOW DO WE
HOW DO WE CORRECT THAT AND SO.
USING THAT THOSE DATA WE DO WORK
WITH OUR PLANS AND AGAIN YOU
HEARD FOLKS TALK ABOUT THEIR
QUALITY IMPROVEMENT PROJECTS AT
THE REQUIRED TO DO --
AND AND MAKING SURE THAT THEIR
MEETING THOSE THOSE METRICS
OBVIOUSLY WHEN PLANS ARE NOT.
BUT PERFORMING TO THE THE
STANDARD THAT WE SET WE DO WE
HAVE BEGUN ISSUING SANCTIONS I
THINK.
YOU WILL CONTINUE TO SEE US USE
THAT AS A TOOL WE HAVE SEEN I
THINK --
FROM MY PERSPECTIVE IT BE VERY
USEFUL.
IN CORRECTING ISSUES --
SO NOT THAT WE LIKE TO PENALIZE.
PLEASE PEOPLE BUT IN TERMS OF IT
REALLY BECAUSE START GETTING
ATTENTION OF OF LEADERSHIP IN
THOSE VARIOUS AREAS TEND TO MAKE
SURE THAT WE'RE ADDRESSING THOSE --
IT SO IF YOU KNOW FROM A COST
PERSPECTIVE WE DID AS YOU
MENTIONED YOU HAD THE COSTA.
BECOMES RATE SETTING --
A HEARING LAST YEAR I THINK I
FEELS LIKE EVERY YEAR WHO WHO
NOT SOMETIME --
AND SO WE DO OBVIOUSLY IT
CAPTURE THE COST INFORMATION I
THINK AS AS AS FOLKS TALKED
ABOUT IT'S ALWAYS A CHALLENGE
AND I THINK YOU KNOW AS AS YOU
MENTIONED AND OTHERS HAVE
MENTIONED.
WHEN YOU'RE TALKING ABOUT
MANAGED CARE AND --
REALLY UNDERSTANDING THAT THE
HEAVILY CAPITATED NATURE EVEN
NOT JUST US TO THE PLANS BUT AS
YOU KNOW PLANS TO PROVIDER
GROUPS AND AND OTHER.
DELEGATED ENTITIES AND SO REALLY
IT'S A VERY HEAVILY DELEGATED A
CAPITATED SYSTEM AND NOT A FEE
FOR SERVICE SYSTEM --
AND SO IT SO THAT'S WHY THAT
INFORMATION ON TO ABOUT PER
SERVICE COST ISN'T AVAILABLE
BECAUSE THAT'S NOT HOW ANYONE'S
PAID BUT SERVE OVERALL OBVIOUSLY
WE TRACK COST AND WE DO DO A FEW
THINGS IN THE RIGHT SETTING THAT
THAT WE SHARED FOR IN TERMS OF
SOME OFFICIALS THE ADJUSTMENTS.
RELATED TO PHARMACY AND
POTENTIALLY PREVENTABLE
ADMISSIONS --
TO TRY TO DRIVE SOME OF THAT
THAT BUT CERTAIN BENCHMARKS OF
OF MAKING SURE THEY'RE BEING
ANSWERED MOST EFFICIENT IN IN
THOSE AREAS AND WE CONTINUE TO
LOOK AT WAYS --
TO FURTHER THAT AND FIGURE OUT
HOW DO WE WANT TO CONTINUE TO
DRIVE MORE VALUE.
AND I THINK --
BLESSING I'D SAY BEFORE TURNING
OVER CITY SEE BECAUSE SHE'S
GOING TO TALK A LOT ABOUT SOME
OF THE STUFF THAT WE'RE THINKING
ABOUT DOING --
BUT I WOULD SAY THAT WE REALLY
ARE LOOKING AT THE END OF THIS
WAIVER AND SORT OF THE START OF
TWENTY TWENTY ONE BEING AN
OPPORTUNITY TO REALLY HAVE A
CONVERSATION ABOUT.
HOW MUCH HOW CAN HOW CAN WE PUSH
MORE CHANGE IN HOW WE CAN WE
FOCUS MORE ON VALUE IN QUALITY?
AND SO THAT'S WHAT YOU SEE WILL
TALK ABOUT IN TERMS OF THE AREAS
WERE THINKING ABOUT AND
CERTAINLY WORKING WITH FOLKS ON
ON THOSE IDEAS AS WE GO THROUGH
SORT OF THE NEXT COUPLE OF YEARS.
TWENTY TWENTY ONE IS NOT THAT
FAR AWAY.
THANK YOU WILLOW GOOD AFTERNOON --
SO I THINK YOU KNOW THERE WERE --
WE'RE CONVERSATIONS EARLIER
AROUND STRATEGIES AND THINGS WE
CAN IMPLEMENT TO IMPROVE CARE
COORDINATION AND CHRONIC DISEASE
MANAGEMENT I THINK ONE OF OUR
GOALS OUR MAIN GOALS IS TO AS
MENTIONED BEFORE ENSURE THAT ANY
BENEFICIARY REGARDLESS OF WHERE
THE RECEIVING CARE IN THE STATE
IS GETTING CONSISTENT CARE --
AND THAT IS PREDICTABLE --
AND THAT THAT CARE DOESN'T
CHANGE THAT THEIR HEALTH OUTCOME
JUST BY BASED ON WHERE THEY LIVE --
AND SO THE DEPARTMENT IS LOOKING
AT A NUMBER OF OPPORTUNITIES. TO
EXPLORE FOR FUTURE CHANGES IN
WHICH MEANT AMEND TODAY ALL WALK
THROUGH THREE STRATEGIES THAT WE
CAN LOOK INTO --
SO THE FIRST ONE WOULD BE
LOOKING INTO IDENTIFYING MEMBER
RISK IN NEED THROUGH MORE
POPULATION HEALTH MANAGEMENT
STRATEGIES AND TARGETED
INTERVENTIONS.
ON THE SECOND ONE IS REDUCING
VARIATION AND COMPLEXITY ACROSS
THE SYSTEM AND THE LAST ONE IS
LOOKING AT IMPLEMENTING
INCENTIVES --
THAT WOULD IMPROVE HEALTH
OUTCOMES IN SUPPORT VALUE BASED
PAYMENT ARRANGEMENTS ARE SHARED
SAVINGS MODELS SO GO INTO EACH
OF THOSE THREE ITEMS A QUICKLY --
SO AS THE DEPARTMENT LOOKED AT
THOSE OPPORTUNITIES THE FIRST
ONE REALLY BEING AT HOW DO WE
BETTER IDENTIFY INDIVIDUALS THAT
NEED THE SERVICES.
I THINK WE WANT TO LOOK AT OUR
CONTRACT REQUIREMENTS IN
LANGUAGE TO SEE HOW CAN WE
TIGHTEN UP --
LANGUAGE AROUND CARE
COORDINATION DISEASE ON CHRONIC
DISEASE MANAGEMENT TO ENSURE IT
IS APPROPRIATE MAKE SHIRTS
MEASURABLE --
AND TO ENSURE THAT DATA
ANALYTICS ARE BEING USED TO
DRIVE CLINICAL DCISION MAKING --
SPECIFICALLY AROUND HOW WE
IDENTIFY TARGET POPULATIONS
WITHIN --
THE PLANS AND THEN HOW
INTERVENTIONS ARE BEING TIED TO
THOSE POPULATIONS AND HEALTH
PLANS ARE INCENTIVIZING NOW ON
THE DOWNSTREAM TO THINK THERE'S
AN OPPORTUNITY FOR US TO LOOK AT
THE CONTRACT.
WHERE YOU DO SEE A DOCTOR MORE
TODAY GIVE SOME GREAT EXAMPLES
OF PLANS DOING THAT --
THERE'S AN OPPORTUNITY FOR TO
LOOK AT THE CAR CROSS THE STATE
FOR SOME PLANS ARE THAT AND SOME
ARE NOT --
AND SO THERE IS AN OPPORTUNITY
TO LOOK AT THAT INFORMATION AND
TO PROVIDE.
RECOMMENDATIONS IN THAT AREA --
THE OTHER THING IS WE WOULD LIKE
TO LOOK AT OUR PROCESSES FOR HOW
WE CURRENTLY SCREEN AND ASSESS
SCHOOL RISKY NEED AS WELL AS
LOOKING AT SOCIAL DETERMINANTS
OF HEALTH --
TO BETTER TARGET APPROPRIATE
INTERVENTIONS --
FOR OUR MEDICARE POPULATION I
THINK IT'S FAIR TO SAY OUR
POPULATION IS MAYBE DIFFERENT --
THEN ALL OF THE OTHER AREAS
TODAY -- AND
THERE ARE UNIQUE INTERVENTIONS
THAT NEED TO BE PUT IN PLACE TO
ENSURE THAT THEY'RE GETTING THE
SERVICES THAT THEY NEED --
AND THAT GETS TO THE THE LARGER
THOUGH THE LAST PART OF THIS
PARTICULAR ONE IDENTIFYING USING
DATA ANALYSTS TO DRIVE WHO ARE
THE TARGET POPULATIONS THAT ARE
NEEDED FOR THIS CARE WHO ARE
HIGH RISK --
ARE THE HIGH NEED POPULATIONS --
BUT THEN THERE'S THE
INTERVENTION PARDON TO THE
DEPARTMENT DOES KNOW THAT WE MAY
NEED TO LOOK AT OPPORTUNITIES.
UP HERE --
YOU HEARD SOME AMAZING THINGS
ARE CARE COORDINATION HANSEN
SAID FOR US TO LOOK AT OTHER
OPPORTUNITIES AROUND EVEN
SOLUTIONS OUTSIDE OF THE FOUR
WALLS OF A CLINIC --
WE HAVE SEEN GREAT --
INNOVATIONS IN WHOLE PERSON CARE --
SOME VERY GREAT THINGS IN A
PRIMARY CARE CLINICS WHICH IS
VERY IMPORTANT BUT ALSO REACHING
OUT TO INDIVIDUALS OUTSIDE OF
THE FOUR WALLS OF THE CLINIC.
INTO THE COMMUNITY --
WE'VE SEEN VERY EFFECTIVE USE OF
THAT THROUGH WHOLE PERSON CARE
I'M AND HOW DO WE SKILLED THAT
UP NOT JUST TO HOLD PERSON CARE --
LEAD ENTITIES --
BUT ACROSS ACROSS OUR MEDI CAL
POPULATION --
IS SOMETHING THAT THE DEPARTMENT
IS VERY INTERESTED IN LOOKING AT
AND THAT INCLUDES THINGS LIKE
LEE --
HOUSING LIAISON SERVICES POST
INCARCERATION PEER SUPPORT A
VARIETY OF INTERVENTIONS THAT
HAVE BEEN TESTED --
HERE IN CALIFORNIA WE THINK ARE
VERY PROMISING TO LOOK AT FOR
FUTURE.
OPPORTUNITIES --
AS OF RIGHT NOW THOSE ARE ONLY
AVAILABLE IN CERTAIN COUNTIES --
AND SO THE IDEA WAS BE HOW WOULD
WE BE ABLE TO HIGHER STATE FOR
HE'S AROUND IN LIEU OF SERVICES
SO THERE IS AN OPPORTUNITY TO
LOOK AT IN LIEU OF SERVICES --
TO IDENTIFIED MEDICALLY
APPROPRIATE AND COST EFFECTIVE --
SOLUTIONS THAT WOULD ESSENTIALLY
BE ABLE TO SUBSTITUTE EXISTING
STATE PLAN BENEFITS --
ONE VERY GOOD EXAMPLE OF THIS IS
RECRUITED OF CARE SO --
A LARGE NUMBER OF OUR WHOLE
PERSON CARE PILOTS HAVE
IMPLEMENTED RECUPERATIVE CARE.
IN IT IS A VERY EFFECTIVE IN
ORDER TO GET SOMEONE WHO MAY BE
HOMELESS WHO'S IN AN EMERGENCY
ROOM AN INPATIENT SETTING.
OUT OF THAT HOSPITAL ENVIRONMENT
IN INTO A LOWER LEVEL BUT NOT
GOING TO THE STREETS THAT THEY
DON'T HAVE STABLE HOUSING
LOOKING FOR OPPORTUNITIES TO
FIND THEM SOMEWHERE TO GO SAFELY --
FOR WHATEVER PERIOD OF TIME IS
NECESSARY --
TO TO LOOK AT OPPORTUNITIES
THERE SO THAT THE DEPARTMENT IS
LOOKING AT THOSE OPPORTUNITIES
AS WE LOOK AT THE WAIVER RENEWAL
AND WE LEARN FROM THESE WHOLE
PERSON CARE PILOTS ABOUT WHAT
CAN BE SCALED UP IN WHAT WE CAN
BUILD WITHIN THE THE CONFINES OF
FEDERAL REQUIREMENTS.
THE NEXT ONE IS LOOKING AT
REDUCING VARIATION IN COMPLEX A
COMPLEXITY ACROSS THE SYSTEM --
SO AS YOU WOULD IMAGINE CARE
COORDINATION CAN BE VERY
UNPREDICTABLE IF THE SYSTEM IS
VERY COMPLICATED --
AND SO IT IS WHY ONE OF THE
REASONS HAITIAN ACROSS CAL --
AS WAS MENTIONED IN A VARIETY OF
WAYS TODAY --
IF YOU'RE IN ONE COUNTY IT CAN
BE VERY DIFFERENT FROM THE
COUNTY NEXT YOU AND SOMETIMES
EVEN FROM ONE PLAN TO THE OTHER
EVEN SAW THAT WITH SOME OF THE
REMARKS CHRIS MADE TODAY --
SO WE ARE LOOKING AT WAYS TO
LOOK AT THAT THERE'S THREE MAIN
AREAS WHERE WE THINK WE COULD
FOCUS ON THAT VARIATION.
ON THE FIRST ONE IS WHERE
BENEFITS ARE ADMINISTERED IN THE
DELIVERY SYSTEM --
SO IT'S OBVIOUSLY A LARGER LOOK
BUT REVIEWING WHAT IS CARVED IN
AND OUT OF MANAGED CARE
SOMETHING THE DEPARTMENT IS
INTERESTED IN LOOKING AT FOR
EXAMPLE LONG TERM CARE
TRANSPLANT OR OTHER LARGER
THINGS LIKE MENTAL HEALTH AND
SHE DE OF COURSE.
BUT LOOKING ACROSS THE SYSTEM.
THE OTHERS IS FUNDING SILOS THAT
HAVE CREATED SYSTEM DELIVERY
SYSTEM IN EQUITIES --
IS SOMETHING THAT I THINK WE
COULD REALLY LOOK INTO TO FIGURE
OUT HOW TO TO DRIVE SOME
POTENTIAL OPPORTUNITIES.
ON THE OTHER IS ENROLLMENT IN
MANAGED CARE SO --
REVIEWING EIGHT CODES
POPULATIONS ZIP CODES WE STILL
HAVE PARTS OF THE STATE WHERE --
MANAGED CARE IS NOT THE MAIN
DELIVERY SYSTEM OR THE REQUIRED
DELIVERY SYSTEM --
AND LASTLY IN REGARDS TO
VARIATION IS INCREASING PARITY
IN THE OVERSIGHT AND MONITORING
ACROSS OUR DELIVERY SYSTEM SO
NOT JUST ON THE MANAGED CARE
PLAN.
PLAN SIDE BUT ON THE MENTAL
HEALTH AS SHE DE INTO TO ENSURE
WE HAVE THE SAME MONITORING THEN
THE LAST IS LOOKING AT
OPPORTUNITIES AROUND --
IMPLEMENTING INCENTIVES --
THAT IMPROVE HEALTH OUTCOMES IN
SUPPORT VALUE BASED PAYMENT
ARRANGEMENTS AND SHARED SAVINGS
MODELS OF THE DEPARTMENT IS VERY
OPEN. TO HAVING CONVERSATIONS
AROUND OPPORTUNITIES IN THE
SPACE --
SPECIFICALLY AROUND THINGS LIKE
PRIME YOU HEARD I TALKED ABOUT
TODAY HOW DO WE TAKE PRIME WHICH
HAS BEEN VERY EFFECTIVE IN OUR
PUBLIC AND DISTRICT HOSPITALS TO
SCALE UP ACROSS THE STATE --
AS WELL AS LOOK AT MORE RISK
BASED ALTERNATIVE PAYMENT MODELS --
SURE SAVINGS MODELS IN OTHER
RATE CHANGES SO I THINK THE
DEPARTMENT IS VERY OPEN TO THOSE
OPPORTUNITIES --
AS WE MOVE FORWARD AND LOOK AT
THINGS LIKE PROP FIFTY SIX AS
MERRY MENTIONED OTHER DIRECTED
PAYMENTS OR OTHER OPPORTUNITIES.
FOR CREATIVE FINANCING TO DRIVE
THE INTENDED OUTCOMES AND CLOSE
THOSE GAPS SO.
SO JUST TO BUILD ON TO THAT TO
ADDRESS A COUPLE OF THINGS THAT
WERE MENTIONED OBVIOUSLY --
THE FOUNDATIONS REPORT IN TERMS
OF THE SHARED SAVINGS MODEL --
AS I CAN'T MEMBER CHRISTMAS AND
MENTIONED I WAS AN ADVISER ON
THAT GROUP OBVIOUSLY NOT A
MEMBER OF THE COMMITTEE AND NOT.
PART OF THE RECOMMENDATIONS BUT
I THINK WHAT YOU WHAT YOU HEARD
HIM DESCRIBE AND WHAT YOU'VE
HEARD JC TALK ABOUT IS REALLY
THE DIRECTION WE'RE WANTING TO
GO WE UNDERSTAND THE LIMITED.
INCENTIVE AND AS YOU HEARD I
THINK OUR PARTNERSHIP --
PLANNED DISCUSS IT'S NOT THAT
THERE IS NO INCENTIVE BECAUSE
THERE'S A TIME LIMITED CHAIN YOU
KNOW PERIOD.
BUT HOW DO WE BETTER INCENTIVIZE
AND WITHOUT AND I THINK AND I
APPRECIATED THE FOUNDATION OF
THE WORKGROUPS WORK IN
RECOGNIZING THAT THE FIRST STEP.
CAN'T NECESSARILY ALWAYS BE JUST
PUT MORE MONEY IN THERE AND SO I
YOU KNOW I THINK THAT WE'RE
REALLY TRYING TO LOOK AT WHAT
ARE THE WHAT ARE THE WAYS TO DO
THIS IN A COST NEUTRAL OR COST
NEUTRAL OVER YOU KNOW.
A FAIRLY SHORT PERIOD OF TIME SO
WE ARE TALKING ABOUT INCREASING
STATE EXPENDITURES ARE
NECESSARILY BUT WE WANT TO MAKE
SURE WE'RE DRIVING THE RIGHT
INCENTIVES AND SO LOOKING AT AS
THREE D. C. SAID LOOKING AT HOW
DO WE SCALE --
EIGHT AS A PART OF OUR MANAGED
CARE PLANS BECAUSE AGAIN IF THAT
IS ARE AT THAT HAS BEEN OUR
PRIMARY DELIVERY SYSTEM SO HOW
DO WE RELY ON THEM. TO TO DO
SOME OF THIS AND HAVE IT BE MORE
CONSISTENT ACROSS THE STATE.
ALSO AS YOU SEE MENTION A LOT OF
THE WHOLE PERSON CARE STAFF WERE
VERY EXCITED ABOUT.
OBVIOUSLY WITH THE EXPIRATION OF
THE WAIVER THAT PARTICULAR
PROGRAM WILL BE GOING AWAY BUT
WE ARE REALLY LOOKING AT THE
SUCCESSES THERE AND HOW DO WE
BUILD ON THAT INFRASTRUCTURE
THAT'S ALREADY EXISTS.
IN OUR COUNTIES AND WITH OUR
PLANS AS THEIR PARTNERS --
TODAY AND HAVE THAT BE
ADMINISTERED THROUGH THE PLAN SO
THAT WE CAN PROVIDE SOME OF THE
SERVICES.
THAT TRADITIONALLY HAVE NOT BEEN
PAID FOR AND ACCOUNTED FOR AND
MAKING SURE THAT THEN WE ARE
SORT OF USING THE FORTIES WE CAN
TO GET THE FEDERAL FUNDING FOR
THAT I THINK THAT YOU HAVE THAT
QUESTION EARLIER OF YOU KNOW.
WE WE ARE SOMETIMES LIMITED IN
WHAT WE'VE BEEN ABLE TO
ACCOMPLISH BECAUSE OF FEDERAL
REQUIREMENTS AROUND HOW WOULD
YOU RATE SETTING AND AND ALL OF
THOSE THINGS I THINK WE'RE
TRYING TO TAKE A BROADER LOOK AT
AT WHAT ARE THE STORIES THAT ARE
POSSIBLE AND I THINK.
AGAIN DEPENDING ON OUR
FEDERALIST FIFTEEN WEBER I THINK
IT'S GOING TO HELP US. TO NOT
HAVE SOME OF THOSE COST --
COST DRIVEN AT THINGS THAT WE
HAVE TO DO TODAY --
AND REALLY LOOKING AT THE
CONCEPT OF ALLOWING PLANS IN
REQUIRING PLANS TO PROVIDE THESE
SORT OF LESS COSTLY SERVICES AND
THOSE BE RECOGNIZED AS A PART OF
THEIR RATE DEVELOPMENT AND NOT
HAVE THIS ISSUE THAT PEOPLE ARE
SAYING THAT THEY'RE INVESTING
AND THEN --
THEIR COSTS GO DOWN AND THAT'S
NOT REFLECTED IN THEIR IN THEIR
RATES SO THAT CERTAINLY IS
SOMETHING I'M VERY EXCITED ABOUT
I THINK IT IS I WOULD CAUTION.
AS I ALWAYS DO WITH CAL STUFF
IT'S ALWAYS MUCH MORE
COMPLICATED RATE THAN ANY OF US
WANT IT TO BE --
YOU KNOW JC IS LEADING OUR WORK
IN THIS AREA AND REALLY HAVING A
TIME FRAME IN A TIME LINE. FOR
THESE TYPES OF CHANGES THAT WE
WANT TO MAKE AN MEDI CAL --
AS SHE KNOWS AND EVERYONE WHO'S
HEARD ME TALK ABOUT THIS AND
OTHER PLACES NO YOU KNOW I TALK
ABOUT IT AS LIKE A FIVE TEN AND
FIFTEEN YEAR. FOR HER RISE IN IN
TERMS OF BEING ABLE TO DO YOU
KNOW TURN A BIG SHIP PEOPLE
DON'T LIKE WHEN I CALL THE
TITANIC BECAUSE THERE AND LIKE
WE'RE NOT THINKING.
OF YOU KNOW IT JUST IT'S IN MY
EXPERIENCE HAVING BEEN HERE
EIGHT YEARSWE KNOW WE'VE SEEN A
LOT OF POSITIVE CHANGE.
BUT IT IT IS HARD AND ONE OF THE
REASONS THAT WE'VE STRUGGLED TO
DO SOME OF THESE THINGS IS THE
LACK OF STANDARDIZATION AND THE
I'D SAY HI COMPLEXITY OF THE
FUNDING SIDE THINGS OPERATE IN
CERTAIN WAYS AND SO --
YOU KNOW WE'RE WE'RE REALLY
INTERESTED IN TRYING TO THINK
ABOUT IF WE WERE.
NAY IN A SORT OF HOW I FRAMED IT
TO OUR STAKEHOLDER COMMUNITY IF
WE WERE ALL DECIDING TO CREATE
THE MEDICAL PROGRAM NEW TODAY.
WE KNOW IT WOULD LOOK LIKE HOW
IT LOOKS TODAY RIGHT I MEAN.
NO ONE WOULD HAVE LIKE SAID THIS
IS THE MOST RATIONAL WAY.
TO STRUCTURE THE DELIVERY OF
THIS CARE --
SO HOW SHOULD HOW WOULD WE WANT
TO LOOK AND IS IT POSSIBLE TO
GET THERE OR WHAT CHANGES WOULD
WE HAVE TOMAKE TO GET THERE AND
THAT'S REALLY WHERE I TALK ABOUT
SORT OF THE FIVE TEN AND FIFTEEN
YEARS BECAUSE I THINK THAT. FOR
FUNDAMENTAL CHANGE AND HOW DO WE
LOOK AT THE ISSUES OF AGAIN
WHAT'S CARVED INTO MANAGED CARE
WHO'S OPERATING THE DELIVERY
SYSTEM.
THE FUNDING IS OBVIOUSLY ALWAYS
A CHALLENGE NOT JUST THE FEDERAL
FUNDING PEACE BUT OBVIOUSLY THE
STATE FUNDING AS YOU WELL KNOW
FROM BEING YOU KNOW THE BUDGET
SUBCOMMITTEE CHAIR WE HAVE A LOT
OF NON STATE GENERAL FUND FUNDED
PIECES OF OUR NON FEDERAL SHARE
WHETHER IT'S YOU FROM OUR COUNTY.
PARTNERS OR TAXIS ARE ALL THESE
DIFFERENT THINGS THAT ALL HAVE
HAD COME WITH VERY SPECIFIC WAYS
OF THE MONEY BEING SPENT.
SO IT REALLY DOES TAKE A SORT OF
ALL HOW IT HOW COULD THIS LOOK
AND CAN WE GET THERE WITH WHAT
WE HAVE SO.
THAT REALLY IS OUR FOCUS OVER
THE NEXT FEW YEARS IS TO REALLY
TRY TO GET TO A PLACE WERE IN
TWENTY TWENTY ONE WE'RE HAVING
SOME FAIRLY SIGNIFICANT.
CHANGE IN BOTH THE WAIT WHAT THE
SERVICES ARE BEING PROVIDED AND
HOW WE'RE PAYING FOR THEM --
THAT I'M VERY EXCITED ABOUT IT
DOES IT IS A LITTLE SCARY I
THINK.
YOU SEE GET SCARED OUR TEAM GET
SCARED THAT TWENTY TWENTY ONE IS
ACTUALLY VERY CLOSE --
MA BUT I I THINK.
THERE ARE CERTAIN THINGS THAT WE
HAVE TO DO TO EVEN BE ABLE TO
HAVE FURTHER CONVERSATION OF
BETTER INTEGRATION FROM ACROSS
THE DELIVERY SYSTEMS.
AND THAT FIRST STEP IS REALLY
THAT SIMPLIFICATION AND
STANDARDIZATION SO THAT'S SO
THAT'S ONE PIECE AND THEN JUST
IN TERMS OF THE ALIGNMENT WITH
THE OTHER --
HEALTH CARE SYSTEM CERTAINLY YOU
KNOW.
WE WANT TO MAKE SURE THAT THINGS
MAKE RATIONAL SENSE AND AGAIN I
THINK FOR YOU AS A PROVIDER
STRUGGLE TO RATE IF YOU'RE
DIFFERENT RULES ARE DIFFERENT
THINGS LIKE THAT ARE DIFFERENT
QUALITY METRICS --
SO WE WANT WE WANT TO TRY TO
HAVE A LIGHT MEANT THERE I THINK.
THE WE DO HAVE CHALLENGES AS AS
CHRIS MENTIONED AND OTHERS IN
TERMS OF BOTH THE UNIQUENESS OF
MEDI CAL IN TERMS OF THE
POPULATION WE SERVE SO OBVIOUSLY
OUR POPULATION IS.
FUNDAMENTALLY DIFFERENT RATE
THAN THE I WOULD SAY THE CALPERS
POPULATION --
OTHERS I MEAN IT'S IT IS SICKER
POOR POPULATION THAN THAN MOST
WE ALSO HAVE THE MEDICAID
REQUIREMENTS.
THAT -- THAT
DO COME WITH STRINGS AND THINGS
THAT WE NEED TO PAY ATTENTION TO
YOU.
AREA AND SO I THINK WHAT WHAT WE
ALWAYS.
WHAT WE WANT TO DO AS PART OF
THE ALIGNMENT CONVERSATION IS I
THINK IT'S CHALLENGING FOR US
AND WHEN IT'S PRESENTED AS MEDI-CAL SHOULD ALLY AND THAT'S NOT
HOW YOU PRESENT IT BUT IS?
HOW IT MEDI CAL SHOULD ALIGN
WITH OTHERS INSTEAD OF HOW DO WE
ALL A LINE TOGETHER?
AND SEE NO NOT HAVING ONE PART
OF THE HEALTHCARE DELIVERY
SYSTEM SORT OF SET HOW THINGS
SHOULD LOOK AND THEN THE REST OF
US FOLLOW --
PARTICULARLY WHEN YOU'RE TALKING
ABOUT THE MEDICAL DELIVERY
SYSTEM WHICH IS SUCH A LARGE
PIECE WE CERTAINLY THINK IT
WOULD BE.
IMPORTANT TO HAVE US BE A PART
OF THE CONVERSATION OF WHAT
SHOULD THINGS LOOK LIKE AND HOW
SHOULD WE MEASURE THEM AND SO --
WE'RE HAPPY TO HAVE THAT
CONVERSATION WE DO WORK WITH ALL
THE FOLKS THAT YOU HAD UP HERE
WE HAVE CERTAINLY HAD
CONVERSATIONS.
AND WORKED WITH THEM ON IN
VARIOUS CAPACITIES I THINK IT'S
JUST YOU KNOW ONE OF THOSE --
THINGS THAT CAN BE CHALLENGING
BECAUSE WE ALL HAVE OUR OWN
THINGS WERE TRYING.
TO SORT OF RESPONSE TO AND SO
THEN WE END UP HAVING IN SOME
CASES SOME DESPERATE THINGS AND
FOR SOME REASON. FOR SOME
BECAUSE THEY HAVE TO BE AND I
AND FOR SOME BECAUSE WE THANKS
VERY MUCH --
SO I GUESS MY FIRST QUESTION IS
ACTUALLY ABOUT DISSIPATION IN
THE AND CALLING COSTED AUS WIE
SNOW WAS ASKED BEFORE --
THERE'S AND I A CERTAINLY HEAR
WHAT YOU'RE SAYING ABOUT TWELVE
YOU KNOW MEDI CAL IS THAT THIS
IS A BIT DIFFERENT ACTUALLY
INTERESTING ENOUGH AS YOU POINT
OUT YES SICKER AND POOR YET WE
SHOULD BE PAID MORE THAN XIN WE
FOR THAT.
I MEAN REALLY.
IT'S A BEING THE LOWEST FARES
ACTUALLY THE HIGHEST PAIR
BECAUSE AFTER ALL THE SECOND
FLOOR RIGHT SO WE DID TAKES MORE
RESOURCES RIGHT.
SIDES POINT THAT OUT.
SO -- AND I
KNOW IT'S NOT YOU KNOW THAT
THAT'S A DECISION BY THE WAY
MADE COLLECTIVELY INCLUDING
MYSELF ON THE LEGISLATURE.
SO -- IT'S
NOT IT'S NOT A STEP FIGURE OUT
YOU IT'S FOR ME IN MANY WAYS
ONLY I HAD THE POWER TO DECIDE
EVERYTHING.
BUT HOWEVER I DO THINK IN TERMS
OF AND AND AND SURE --
I MEAN THAT THAT --
PERHAPS THE ON THE AND
SOMETHING'S DIFFERENT THAT SAME
TIME --
HEAVY BE ABLE TO THEN DRAW
COMPARISONS RIGHT --
TO CERTAIN DEGREE AND ALSO WAS A
SAID DEBORAH CAL PATIENTS ARE
STILL YOU KNOW THEY'RE STILL
PEOPLE IN HUMAN BEINGS RIGHT
THEY HAVE SEEN SOMEONE ELSE SO
THE STRUGGLE MORE WITH SOME OF
THE WITH WITH HE INCOMES OF THE
SO.
DO YOU SEE --
ACTUALLY --
HOW WE CAN HAVE --
THE MEDIC OUR MEDICAL PLANS
PARTICIPATE IN THE QUALITY INN
COSTED OUT LIST SERVE THEIR
THINGS WE CAN TRYTO DO. TO TO
GET THAT INTO THEIR STORE AND I%
I I THINK --
AS AS DR RIGHT WOULD MENTION AMY
THINK THERE'S NOTHING THAT
PROHIBITS OUR PLANS FROM
PARTICIPATING I THINK THE
CHALLENGE THEY'RE BEING THAT
OBVIOUSLY THEY'RE NOT THE ENTIRE
DELIVERY SYSTEM --
AND SO THERE'S MISSING PIECES I
THINK FROM OUR PERSPECTIVE
OBVIOUSLY THE CHALLENGE ALWAYS
WITH US.
PROVIDING DATA TO OTHER ENTITIES
ONE IS OBVIOUSLY WE'RE VERY
FOCUSED ON USING IT TO DO OUR
OWN MONITORING AND TRANSPARENCY
AND ALL THE RESOURCES THAT IT
TAKES TO DO THAT.
AND I THINK WHAT WE'RE WE'VE HAD
CHALLENGES AND I THINK THIS IS
WHERE WE HOW WE LANDED WHERE WE
DID WITH PROVIDING SUMMARY
INFORMATION INSTEAD OF SORT OF
ACTUAL PATIENT LEVEL DATA.
IS JUST DUE TO THE COMPLEXITY OF
THE WAY THAT OUR STRUCTURE WORKS
IT ACTUALLY REQUIRES IT'S NOT AS
IT'S NOT APPLES TO APPLES WITH
DATA THAT FROM A COMMERCIAL
HEALTH PLAN RIGHT IT'S NOT.
THE WAY THAT PAYMENTS ARE MADE-THE WAY THAT BENEFITS ARE
CONSTRUCTED WHAT BENEFITS ARE
COVERED.
AND SO WHEN WE HAVE ALL THESE
ISSUES OF SOME --
THAT YOU'RE WELL HERE HOWEVER WE
HAVE BILLIONS OF DOLLARS OF THAT
AND HOW DO YOU.
HOW DO YOU COUNTER NOT COUNT
THOSE THINGS IN CERTAIN MEASURES
LIKE TOTAL COST OF CARE?
BECOME SUPER COMPLEX AND SO I
THINK WE STRUGGLE WITH HOW DO WE
HOW DO WE HOW DO WE JUST HAVE
DATA IN THERE WHEN IT'S NOT AN
APPLES TO APPLES COMPARISON AND
SO WE'VE TRIED TO SORT OF WORK
AROUND.
THIS WAY OF PROVIDING BUT MORE
SUMMARY INFORMATION.
AND ALSO SHARE OUT ALL THE ALL
THE REPORTING AND DATA THAT WE
ARE NOT THE ONLY PLACE THAT
PROVIDES REPORTING OF QUALITY IN
CONTRACTOR BY MADE IT I THINK I
THINK THERE'S ACTUALLY TO LEAD.
TO I REALIZE MAY NOT BE OBSOLETE
APPLES APPLES BUT I THINK THAT
THERE IS AND SO SOMETHING IS A
MOBILE ASTERIX AND PLACES BUT I
THINK THAT --
Và.
WE HEARD A LOT IN THIS HEARING
ABOUT NOW ONLY ALIGNMENT BUT IT
NAY ON TERMS OF BUT ALSO IN
TERMS OF YOU KNOW TRYING TO
CREATE --
BECAUSE IT IS A SITE YOU YOU
WANT TO I MEAN THERE IS A
CERTAIN DEGREE ONE CAN ARGUE
THERE ARE SOME DEAL MEDI CAL
PROVIDERS ONLY SEE MEDI CAL AND
SO FORTH AND BUT I THINK AS WE
THINK ABOUT --
AND STARS HEALTHCARE SYSTEM IN
OUR STATE ALSO AND AND AND AND
SOME OF THE OTHER PLANS.
YET BE ABLE TO HAVE A COMMON
DATA.
SOURCE OUT NOT EVERYTHING MAY BE
EXACTLY THE SAME BUT I THINK
FIRST OF ALL HELPS US BENCHMARK
HOW WELL OUR MEDICARE PROGRAMS
DOING HAVE THIS BENCHMARK OUR
COMMERCIAL PLANS ARE DOING YOU
KNOW AND THAT IT WAS A
COMMERCIAL AND WE'RE TALKING
ABOUT STATE.
FINANCED PAID FOR HEALTH CARE
RIGHT CALPERS COVERED CALIFORNIA
IT'S ADDRESS SO --
SO I THINK TRYING TO WORK TOWARD
BEING ABLE TO HAVE.
THIS I THINK IT'S GONNA BE VERY
IMPORTANT AND HELPFUL AS I JUST
FOR CURIOSITY'S SAKE I MEAN WE
TALK ABOUT VALUE BASED
PURCHASING SO IF YOU'RE GOING
OUT DOING VALUE BASED PURCHASING
ONE IS YOU CAN LEVERAGE OFF AT
OTHER MODELS ALSO YOU HAVE A
SENSE OF WHERE YOU STAND.
COMPARED TO WEAR AS A PURCHASER
AS TO WHAT OTHER PEOPLE ARE
STANDING OKAY WAIT A MINUTE
OUTCOME I'M PAYING ABOUT MUCH
MORE ARE OUT OF MY SYSTEMS WERE
A YEAH THERE'S THAT WHILE WE'RE
DOING BETTER THAN THEY ARE THAT
SO I THINK THERE'S THAT THAT
IT'S HELPFUL FOR EVERYONE. TO BE
ABLE TO DO THAT SO WE SHOULD
HOPEFULLY LOOK AT HOW WE CAN TRY
TO GET MORE IN THAT DIRECTION IN
MY MIND.
AND IT BECAUSE IN THE END IT IS
GOING TO BE --
YOU HAVE A PROVIDER LIKE MYSELF
AND ALL HAVE FAILED WELL
ACTUALLY LOT OF MEDICAID --
SOME COMMERCIAL AND OF AYE EVANS
IS THAT WE'RE TRYING TO GET YES
EXACTLY THE SAME BUT ANY AND
THAT WELL YOUR MEDICATION A DO
DO THAT RIGHT AS SO.
AND ACTUALLY MAY IT MAY WAS
ACTUALLY LOOKING MEDI CAL --
ACTUALLY WE HAD A PRESENTATION
ABOUT GMC IN SACRAMENTO AND THAT
IS WITH INTERESTING THE ALWAYS
IT EXCEPT FOR KAISER BECAUSE
KAISER BASICALLY TREATS ALL THE
PATIENTS THE SAME TO WRITE AND
SELL.
THEIR DELIVERY MODELS OF WHETHER
YOU'RE MEDI CAL ARE YOU BUYING
FIRST.
AND THAT'S KIND OF WHAT WE WANNA
SEE ACROSS THE SYSTEM RIGHT SO
IT DOESN'T REALLY MATTER WHICH
INSURANCE CARD YOU SHOW UP WITH.
AND SO HOW CAN WE MOVE CLOSER IN
THAT DIRECTION --
THAT -- AND
AND AND AND AND TRY TO GET TO
THAT DIRECTION SO I I CERTAINLY
WOULD URGE AND HOPE THAT --
AND WITH AND NOW PLANNED ASK HOW
WE MOVING IN THAT DIRECTION --
IT THINK THE IN AND ALSO I THINK
ESPECIALLY WE'RE DOING VALLEY'S
IS PURCHASING THE PROPERTY SIX
AT CETERA I THINK BEING ABLE TO
PARTICIPATE IN THIS LARGER DATA
THING IS GOING TO HELP.
DIED AT AT LEAST IN MY MIND --
DTS TO BE MORE EFFECTIVE AT
DOING VALUE BASED PURCHASING
TYPE ARRANGEMENTS AND ESPECIALLY
TO LEVERAGE OFF OTHER PEOPLE'S
TO WRITE.
IS NOT JUST LIKE ALL OF YOUR
MEDICARE WILL DO THIS BUT LIKE
MEDI CAL AND AND THIS ALSO
INCOMING GALLOPING ALL SAID DO
THIS I MEAN I THINK.
EVEN THE GOVERNOR IS SAYING LIKE
WE ALWAYS TO PULL ALL OF HER.
YOU KNOW PHARMACY FIRSTLY WE
WILL GET INTO ALL THAT BUT BUT
YEAH THAT THE MAXIMALLY LEVERAGE
EVEN EVEN FROM THE STATE'S
PERSPECTIVE AS A PURCHASER IS A
PAIR.
ACROSS EVERYTHING INSTEAD OF
HAVING EVERYTHING AND SILAS SO --
SO BIG WE CAN WE CAN DO THAT I
THINK THE OTHER ISSUE YOU KNOW --
CALIFORNIA'S GOV INITIATION
MENTIONED DEL D. A LACK OF
IMPROVEMENT OVER TIME AND I MEAN
THERE'S PRESSURE SOME MEASURES
WENT UP AND DOWN --
SO I APPRECIATE YOUR SAYING
LET'S FIGURE OUT HOW WE MOVE
PEOPLE OUT BUT I MEAN THE RIGHT
NOW IF WE HAD A SYSTEM WHERE HE
SAID WE'RE GOING TO EXPECT
IMPROVING TRADE AND HAVE PAYMENT
EVERY YEAR WE'RE NOT HITTING
THAT SO.
I I HOPE THAT --
WE LOOK FORWARD TO HEARING ABOUT
YOUR YOUR PLANS FOR THAT --
TOO AND AND I APPRECIATE THAT
YOU OFTEN SAY YOU KNOW WE'RE
LOOKING AT WE'RE COVERING IT
CENTER -- I
AM INTERESTED IN KNOWING.
THAT THE RESULTS --
SO I I HEAR TWENTY TWENTY ONE
I'M STILL IN OFFICE IN --
TWENTY TWENTY ONE NINE YOUR
TOGETHER YES WE'RE ALL BE HERE
TOGETHER AND YOU KNOW AND AND
AND YOU KNOW WHAT THE SCARY PART
IS THOUGH IS AFTER I LEAVE
OFFICE.
I'LL BE SEEING MORE MEDI CAL
PATIENTS.
I EXPECT TO BE DIFFERENT.
BETTER THAN IT WOULD AND IT'S
TEN YES.
OKAY AND THEN I THINK THE
PREMIUM SLIDE AS WELL IN LIFE
AND SO I APPRECIATE YOU WERE.
AT EXIT RISING WHATEVER YOUR
ROLE WAS WITH THIS WAR BUT WE WE
REALLY DO NEED TO LOOK AT THAT
AND AND I'M WAITING KNOWLEDGE.
YEAH HAVE A KNOWLEDGE THAT --
YOU KNOW THAT YES THERE'S A BIT
OF A LAG BETWEEN WE TALKED ABOUT
IT -- AND
AND BUT THAT LAG ISN'T VERY LONG
AND SO IT REALLY ISN'T A
POSITIVE SENATE FOR PEOPLE WHO
HAVE TO DO ANYTHING.
YOU KNOW THEY HAD A BETTER RATE
SO THAT THAT JUST DOESN'T SOUND
RIGHT MESSAGE SO.
AND I REALIZE THERE'S A CMS
COMPONENT BUT WE'VE GOT TO
FIGURE FIGURE THAT OUT AND WHO
KNOWS MAYBE WE'LL.
THAT MAYBE WILL BE LOOKING TO BE
A DIFFERENT MINISTRATIONS
ATTITUDE BY THE END.
I JUST PUT IT THAT WAY --
SO -- SO I
APPRECIATE THE THE WORK THE DO I
AM LOOKING FORWARD TO HEARING
ABOUT IT BOTH IN --
THE HEALTH COMMITTEE BUT ALSO IN
THE BUDGET SUBCOMMITTEE AS WELL --
I THINK WE NEED TO THINK ABOUT
AFTER SOME RESOURCES WE MIGHT
NEED TO PUT AND TO MOVE THINGS
ALONG BUT IT'S AT THE A IT IS
REALLY ABOUT.
CULTURE CHANGE SYSTEM CHANGE AND
THEN -- I
MEAN IF IT'S ALSO IMPORTANT THAT
WE THINK ABOUT METRICS AS WELL
SO THAT'S I MEAN THAT'S THE ONLY
THING ALIGNMENT OF MODELS
ALIGNMENT METRICS BECAUSE THAT
WAY WE CAN COMPARE THINGS RIGHT --
SO I THINK THE I THINK THAT
THAT'S VERY IMPORTANT.
I MEAN AGAIN I I THINK WERE VERY
MUCH ON THE SAME PAGE WITH SORT
OF THE DIRECTION THAT YOU'RE
TALKING ABOUT AND AGAIN I THINK
THAT WE HEARD OUR PARTNERS TALK
ABOUT THAT REALLY IS.
WHERE WE WANT TO GO I YOU KNOW I
THINK IT'S TIME FRAME --
AND IT'S NEVER GONNA BE AS FAST
AS THE ALL WHAT.
I I'VE BEEN LATELY POINT THIS
OUT THOUGH I MEAN I THINK THAT --
AND IT'S NOT JUST ABOUT MEDI CAL
AND WITH THIS HEARING WAS ABOUT
NEXT AMERICA ALONE.
IS THE THERE'S A REASON HEALTH
CARE WAS REALLY THE TOP OF THE
AGENDA IN THIS LAST ELECTION AND
WHEN --
AFTER EVEN AFTER GOVERNOR
NEWSOME WAS ELECTED --
WHEN THE TV I SEE DID A POLL OF
ALL THE PROMISES HE MADE?
THE TOP ON THE PUBLIC SAID THEY
WANT TO DEAL WITH HEALTHCARE
RATE -- WE
SEE YOU KNOW THAT WE WE SEE
WORKERS WHOSE --
BASICALLY TAKE HOME PAY HAS
REMAINED STAGNANT FOR VERY LONG
TIME AND THERE COASTAL
CONVERSATIONS GOT OUT BUT IT'S
BIZARRE BY HEALTH CARE RIGHT.
AND WE WE NEED --
TO SO WE REALIZE IT'S YOU KNOW
IT'S LIKE A BIG GIANT OCEAN
LINER BUT WE GOT FOR YOUR HOW
TURN THAT THING A BIT MORE
QUICKLY.
AND THERE ARE AND I THINK WHAT
WE HEARD IS THERE ARE OP PROOF
QUALITY AND AND THIS IS REALLY
WHERE THE MONEY IS RIGHT PEOPLE
THAT'S WHY THE FOCUSING ON
PEOPLE TRYING TO GET ENOUGH
SANDERS AND OTHER PLACES MIGHT
BE CRYING BECAUSE HE THAT'S
INCLUDES MENTAL HEALTH TO PAY.
FOR IT ABSOLUTELY AND SO YOU
KNOW THAT THAT 7080% OF OUR
HEALTHCARE SPENDING SO WE'VE GOT
TO FIGURE OUT HOW TO CRACK THAT
NIGHT WE KNOW THERE'S DATA SHOWS
US THAT WE DO WE GET THESE
INTEGRATED SYSTEMS ETCETERA WE
WILL.
SPEND THAT CURVE SO WE'VE GOT TO
FIGURE HOW WE CAN MOVE THEIR
MORE QUICKLY AND ACTUALLY IT'S
NOT JUST MEDI CAL ALONE AND I
KNOW YOU CARE MORE ADDS THAT CAL --
IT'S NOT JUST THE COMMERCIAL
SIDE IT'S NOT JUST COVER
CALIFORNIA BUT ALL OF US DOING
TOGETHER SO THAT EVERYONE WHO'S
PART OF THIS KNOWS THAT THAT'S
THE WAY THEY HAVE TO GO.
AND CERTAINLY --
YOU KNOW I APPRECIATE THE THAT
TALK BRING IT TO SCALE BECAUSE
IT'S GREAT WE HAVE THE PRIME AND
SO FORTH I GOT IT AND THOSE ARE
LOOKING THE WAY FOR WE'VE.
IF WE HAVE LOTS OF PILOTS AND
THE ONLY LOTS POUNDS SHOW GOOD
RESULTS WE'VE GOT TO BRING THOSE
TO SCALE UNDER PERCENT AGREE
WITH YOU RIGHT YEAH SO IS THAT
THE I MEAN THAT'S REALLY THE
NEXT AT THAT FRANKLY I'M NOT
SURE THAT.
WE DON'T KNOW WHAT TO DO THAT WE
DON'T KNOW HOW TO BRING THEM TO
SCALE AND THAT'S WHAT WE HAVE TO
TACK ON BRING THE SCALE RATE SO
WE FEARED LOTS OF EXAMPLES OF
STUFF.
SO -- SO I
LOOK FORWARD TO WORKING WITH YOU
ON THIS AND I I KNOW THAT YOU'RE
MORE AT THE FRONT EDGE BUT YOU
KNOW I MEAN BUT I MEAN I REALLY
WANT A DIALOGUE ABOUT HOW WE CAN
BE SURE WITH THE POLICIES AND
WHAT THE LEGISLATURE CAN DO IN
THE FINANCING.
AND TO BE SURE WE CAN GET THOSE
IT'S TO ACHIEVE THOSE GOALS.
I LOOK FORWARD TO IT OKAY ALL
RIGHT THANK YOU ANY OTHER
COMMENTS THEN YOURSELF.
KNOW ALL RIGHT SO I KNOW YOU
HAVE YOUR WORK CUT OUT FOR YOU
OKAY THANK YOU.
ALL RIGHT.
OKAY THANK YOU SO VERY MUCH ALL
RIGHT SO WE'RE GONNA GO AHEAD
AND TAKE PUBLIC COMMENT I DO
JUST WANT TO MAKE NOTE THAT I
TECHNICALLY THIS IS TO BE IS.
THAT THE ESTATE ALLOCATION BOARD
MEETING RIGHT NOW WHICH I'M.
THERE SO I'M GONNA ASK IF PEOPLE
CAN KEEP THE REMARKS BRIEF AND
ACTUALLY FEEL FREE TO SEND
WRITTEN MARX'S FOLLOW UP AS WELL
AS YOU IT TO ELABORATE ON THE
POINTS YOU'VE MADE.
HERE SO I DON'T WANT TO CUT
ANYWAY I DON'T WANT TO LIKE CUT
PEOPLE OFF BUT I'M GONNA ASK YOU
CAN KEEP IT UNDER A MINUTE OR
LESS AND AND AND DO HIT THE
HIGHLIGHTS AND AND AND AND AND
THEN WE CAN --
FOLLOW UP ON THAT ALL RIGHT
THANK YOU AND WELCOME.
GOOD AFTERNOON CHAIR LINDA WAY
WITH WESTERN CENTER ON LAW AND
POVERTY WE APPRECIATE THE CHAIR
TAKING A CLOSER LOOK AT THIS
ISSUE AS THEIR CERTAINLY STEPS
THAT THE LEGISLATURE IN THE
MINISTRIES CHIN CAN DO. TO
IMPROVE QUALITY FOR ITS MEDI CAL
ENROLLEES SPECIFICALLY WE
RECOMMEND HOLDING MEDI CAL PLANS
ACCOUNTABLE TO HIGHER STANDARDS
THAN THE BOTTOM QUARTILE OF THE
NATIONAL MEDICAID PLAN
PERFORMANCE.
AND WE ARE EXCITED ABOUT THE
INNOVATIVE PRO MANAGED CARE
PLANS HIGHLIGHTED --
BUT DO YOU THINK THAT THESE
SHOULD NOT BE BASED ON WHERE
YOU'RE YOU'RE ENROLLED IN IT ARE
COUNTY THAT YOU RESIDE IN AND SO
DO APPRECIATE THE DEPARTMENT
REVISITING --
COUNT CONTRACT REQUIREMENTS AND
SCALING UP BUT DO YOU THINK THAT
WE NEED TO DEVELOP A STATEWIDE
QUALITY PERFORMANCE AND
FINANCIAL INCENTIVE PROGRAM THAT
IS DEVELOPED TO A ROBUST
STAKEHOLDER PROCESS.
AND THAT MAYBE BASED ON DATA
THAT STILL NEEDS TO BE BUILT UP
THANK YOU OKAY THANK YOU I I
HEAR SUGGESTION PERHAPS FOR A
FOLLOW UP HEARING --
AN INTERIM WHICH I WILL
CERTAINLY AM VERY OPEN TO THE
IDEA.
HI GOOD AFTERNOON M. JDS WOULD
HELP ACCESS CALIFORNIA OUT WE
APPRECIATE THIS HEARING AND ALSO
THE ISSUES THAT HAVE BEEN
RESURFACED AND WE HIGHLIGHTED
ESPECIALLY AS WE THINK ABOUT.
HOW WE ALIGN INCENTIVES ARE
ACROSS DIFFERENT TYPES OF
COVERAGE WHETHER PRIVATE
COMMERCIAL OR MEDI CAL --
PARTICULARLY WE DO WANT TO
HIGHLIGHT THAT THERE ARE GOING
TO BE DIFFERENCES IN POPULATION
SERVED AND ALSO THE RICHNESS OF
COVERAGE AVAILABLE BETWEEN YOU
KNOW PURSE COVERAGE VERSUS A
COVER CALIFORNIA COVERAGE.
AND WE'RE WORKING THROUGH
IDENTIFYING WHAT THOSE MEASURES
SHOULD BE --
KNOWING VERY WELL THAT THERE
WILL BE DIFFERENCES IN JUST THE
POPULATIONS SERVED AND LASTLY ON
COVER CALIFORNIA SPECIFICALLY
WHILE WE APPRECIATE THE
AGGREGATED DATA.
ON HOW QUALIFIED HEALTH PLANS IN
COVER CALIFORNIA ARE PERFORMING
AND PROVIDING QUALITY CARE BUT
WE WOULD ALSO LIKE TO WORK WITH
COVER FRONT COVER CALIFORNIA.
AND WOULD YOU AND UNDERSTANDING
SPECIFICALLY BY PLAN IN TERMS OF
WHICH PLAN ARE ACTUALLY GETTING
THAT GOLD STAR AND WHICH ONES
ARE FEELING.
THANK YOU.
WELCOME.
BLOW OF MARKETS CUSTER ON OF
SLEEP IN THE CALIFORNIA SENATE
HEALTH NETWORK --
LIKE THINK THAT YOU'RE FOR
HOLDING THIS --
INFORMATIONAL HEARING --
DEPEND AGREES WITH THE
COMMITTEES --
BUT IS TO BE INNOVATIVE WITH HOW
THE DELIVERS SERVICES TO IMPROVE
HEALTH OUTCOMES.
AND WE BELIEVE THAT --
ANY INCENTIVE BASED MODEL
IMPLEMENTED SHOULD BE ONE THAT
PUSHES FOR HEALTH EQUITY BY TIME
THOSE INCENTIVES TO REDUCTION
AND DISPARITIES ACROSS --
THE DEMOGRAPHIC GROUPS AND
ENSURE CONSUMERS OF ALL
BACKGROUNDS EXPERIENCE --
BETTER HEALTH OUTCOMES NOT ONLY
OBSERVED IMPROVEMENT --
FOR EXAMPLE --
REDUCING EMISSIONS OF PATIENTS
IN AND PROVING --
MENTAL HEALTH MATERNAL AND
INFANT MORTALITY RATES WHICH
DISPROPORTIONATELY AFFECTS
AFRICAN AMERICAN WOMEN --
WE BELIEVE A POSSIBLE SOLUTIONS
UTILIZING AS YOU MENTIONED --
YOU KNOW PROP FIFTY SIX REVENUES --
SUPPORTING LEGISLATION THAT'S
BEEN INTRODUCED THIS YEAR AND
SUPPORT IN THE PAST AND
INCENTIVIZE MEDI CAL PLANS AND
PROVIDERS. TO DELIVER IMPROVED
OUTCOMES IN AREAS SUCH AS
CHRONIC --
AND BEHAVIORAL HEALTH --
AS WE KNOW SUCH AS KIM IS A
COLOR WHICH OF THE MEDICAL
POPULATION IS MADE UP OF TWO
THIRDS OF THOSE ON ALSO THE
STATE SHOULD INVEST IN --
INSURING THAT PLANS AND
PROVIDERS COLLECT MORE ROBUST
DATA ON THE POPULATIONS THAT
THEY SERVE --
AND THAT THAT'S IT THANK YOU
[inaudible]
YOU'RE [inaudible]
WELCOME.
THANK YOU GOOD AFTERNOON KELLY
BEING FOR THE CALIFORNIA MEDICAL
ASSOCIATION WE APPRECIATE YOUR
CHAIRS AND THE COMMITTEES
DEDICATION AND ADDRESSING
AFFORDABILITY AND ACCESS AND
HEALTH CARE --
WE ARE ALSO COMMITTED TO
IMPROVING QUALITY LOWERING COSTS
PROMOTING BETTER HEALTH --
THROUGH IMPROVE CARE DELIVERY
AND REDUCING HEALTH CARE
DISPARITIES BROADLY IN THE
HEALTHCARE SYSTEM.
WE ALSO SUPPORT EFFORTS TO
BALANCE QUALITY GOALS WITH THE
NEED TO REDUCE ADMINISTRATIVE
BURDENS ON PROVIDERS.
REDUCING ADMINISTRATIVE IN
CAPITAL BURDENS ON PHYSICIANS
WILL NO MATTER THE WAY THEY
PRACTICE WILL OUT HIM TO FOCUS
ON POPULATION HEALTH AND CARE
FOR PATIENTS ESPECIALLY THOSE
WITH CHRONIC CONDITIONS AND CO
MORBIDITIES.
WE LOOK FOR TO THE COMMITTED
CONTINUE DISCUSSION THANK YOU
OKAY THANK YOU.
WELCOME I A GOOD AFTERNOON CHAIR
PAN -- SHOCK
OF IT I WITH THE SERVICE
EMPLOYEES INTERNATIONAL UNION
AND THE CERTAINLY IS A VERY --
ROBUST TOPIC --
I WOULD JUST SAY THAT --
WE BELIEVE THAT ANY CONVERSATION
ON CAL SHOULD BE CENTERED AROUND
THE MEDI CAL POPULATION BECAUSE
OF THE DEMOGRAPHIC DIFFERENCES.
AND I THINK HAVING A SORT OF A
MORE STATEWIDE --
QUALITY PLAN AND FOCUS THAT
LOOKS AT A COMMUNITIES OF COLOR
IN PARTICULAR IS IT IS IMPORTANT
AND WE NEED TO MOVE DH CS AT
MORE IN THAT DIRECTION --
BUT EVEN STILL IT'S BECAUSE THE
PROGRAM IS SICKER POORER AND
BROWN -- SO
EVEN STILL --
THERE ARE GOING TO BE
DIFFERENCES AMONG REGIONS AND SO
FOR EXAMPLE I KNOW YOU'RE
INTERESTED IN THE OPIOID
EPIDEMIC CERTAINLY IN NORTHERN
CALIFORNIA IN OUR MEDICAID
POPULATION THAT'S GOING TO BE A
HUGE DEAL.
BUT IN OTHER REGIONS WE'RE GONNA
NEED TO FOCUS MORE ON ISSUES
LIKE ASTHMA OR DIABETES OR
HYPERTENSION AND SO JUST REALLY
REFINING THE MEDIC HOW QUALITY
STRATEGY TO BE ABOUT THE MEDI
CAL POPULATIONS NEEDS.
AND GETTING PROVIDERS TO THAT
PLACE WOULD BE A GREAT STARTING
POINT AND THEN YOU CAN EXPAND
OUT FROM THERE THINK ON THE
COMMERCIAL SIDE THERE WAS SOME
STUFF TALKED ABOUT EARLIER IN
TERMS OF THE YOU KNOW VALUE OF
INTEGRATED MODELS THOSE SORTS OF
THINGS AND I WOULD JUST NOTE.
THAT --
WORKING PEOPLE HAVE AND ALWAYS --
ACCRUED THE BENEFITS OF WHAT AS
YOU KNOW DEMONSTRATED IN THE
NUMBERS OR WHATEVER AND SO I
THINK IT'S JUST IMPORTANT TO
KEEP IN MIND THAT WE NEED
EFFORTS THAT.
ALSO PASS SOME OF THOSE SAVINGS
AND SOME OF THAT VALUE ALONG TO
THE WORKERS WERE PAYING FOR
PREMIUMS AND CO PAYS AND DON'T
SEEM TO ALWAYS BE GETTING --
THE BENEFITS THEY'RE SO LOOK
FORWARD TO OUR CONTINUED
CONVERSATIONS THANK YOU.
OKAY THANK YOU AND I APPRECIATE
THE THE PUBLIC COMMENT I WOULD
MAKE NOTE THAT PART OF THE
REASON I'M INTERESTED TRAFIGURA
HOW DO WE GET STATEWIDE DATA
BECAUSE IT IS EQUITY RIGHT I
MIGHT BE SURE THAT WE HAVE WE DO
CHIEF EQUITIES I WE DON'T.
SAY THAT WELL IT'S OKAY BECAUSE
OF YOUR MEDI CAL YOUR THIS BUT
IF YOU'RE IN THE REST OF THE
SYSTEM YOU GET THAT.
I APPRECIATE IS ALSO DIFFERENT
COMMUNITIES --
THE DIFFERENT REGIONS HAVE
DIFFERENT HEALTHCARE NEEDS WERE
PAID FOR A BIG STATE.
AND I FULLY AGREE WITH THE IDEA
THAT PART OF THE REASON WE ALSO
WANT TO TRY TO MOVE IT AND AND
GET THIS DATA IT AND AS WELL AS
THE METRICS IS THAT.
WE DO WANT THE SAVINGS
EVENTUALLY GET BACK TO THE
PEOPLE OF CALIFORNIA AND THE
WORKERS WHO ARE PAYING THE
PREMIUMS AND SO FORTH SO I MEAN
WE AT THAT SOMETHING THAT --
BUT YOU DON'T KNOW IT'S HARD TO
TELL WE WANT TO BE SURE THAT
THAT HAPPENS AS WELL SO I
APPRECIATE THE PUBLIC COMMENT --
I WANNA THANK ALL THE SPEAKERS I
THOUGHT WE HAD A VERY ROBUST
DISCUSSION I REALIZED AT THE
TIME WAS VERY BRIEF AND WE ASK
PEOPLE TO COVER.
WHAT COULD BE COURSES IN AND A
SCHOOL PUBLIC HEALTH OR PUBLIC
POLICY AND AND AND BIKE THREE
MINUTES SIR OUR ARE ARE FIVE
MINUTES?
SO I APPRECIATE EVERYONE --
THE SPEAKERS UP TO SPEEDING AND
AND AND REALLY SUMMARIZING
THINGS AND I LOOK FOR TO TO
ACTUALLY THIS I WOULD SAY IS
THAT THIS HEARING IS.
NOT A LEADER NOT TENDED NOW EVEN
THOUGH WE'RE GONNA TURN THE
HEARING BUT THIS IS AN ONGOING
CONVERSATION AND I ALSO LOOK
FORWARD TO WORKING WITH.
THE FARM HEALTHCARE SERVICES
CALPERS --
COVERED CALIFORNIA OTHER GROUPS
AS WELL TO BE SURE WE KEEP
MOVING IN THE IN THE RIGHT
DIRECTION SO AND AND AND MEDI
CURVE SO WITH THAT --
THIS HEARING INFORMATIONAL
HEARING OF THE SENATE COMMITTEE
ON HEALTH IS NOW ADJOURNED
THANKS RUMMAGE