JOINT HEARING OF THE SENATE
HEALTH AND ASSEMBLY HEALTH
COMMITTEES AND WHAT THANK
EVERYONE FOR BEING HERE THIS IS
AN INFORMATIONAL HEARING ON
MEDI CAL ACCESS TO CARE AND
REGIONAL MODEL IN CHILDREN'S
PREVENTIVE SERVICES. AND I
APPRECIATE EVERYONE BEING HERE
TODAY- THIS YEAR TO CALIFORNIA
AUDITOR RELEASED TWO REPORTS
THAT LOOKED AT THE DEPARTMENT
HEALTH CARE SERVICES OVERSIGHT
OF MEDI CAL AND THE DELIVERY
SERVICES TO BENEFICIARIES. ONE
REPORT CONCLUDED THAT MEDI CAL
BENEFICIARIES RESIDING IN RURAL
COUNTIES UNDER TO REGIONAL
MODEL DID NOT HAVE ADEQUATE
ACCESS TO CARE. ANOTHER REPORT
FOUND THAT MILLIONS OF CHILDREN
MEDI CAL DID NOT RECEIVE
PREVENTIVE SERVICE IS TO WHICH
THERE WEREN'T ARE ENTITLED.
TODAY'S INFORMATIONAL HEARING
WILL REVIEW THE FINDINGS OF ITS
TWO PARTS WE WERE ASKED TO THE
PART OF HEALTH CARE SERVICES
AND STAKEHOLDERS TO RESPOND TO
THE FINDINGS. THIS DISCUSSION
IS PARTICULARLY IN THIS
DEPARTMENT CARE SERVICES ENTERS
IN AND YOU SAID. OF STAKEHOLDER
MEETINGS FOR THE NEXT MEDI CAL
WAIVER. IT SEE IT ENTERS INTO
AN RFP PROCESS FOR MANAGED CARE
PLAN CONTRACTS. WE NEED TO MAKE
SURE THAT THE STATE IS DOING
EVERYTHING IT CAN TO ENSURE ALL
MEDI CAL THE FISHERIES HAVE
ACCESS AND RECEIVE- QUALITY
HEALTHCARE I WOULD MAKE NOTE
THAT. ARE MEDI CAL PROGRAM
WHICH IS A STATE. RUN IN FUNDED
PROGRAM STATE AND FEDERALLY
FUNDED PROGRAM. COVERS A THIRD
OF ALL CALIFORNIANS AND IS A
PEDIATRICIAN I'D BE REMISS IF I
DIDN'T SAY HALF OF ALL
CHILDREN. SO CERTAINLY-
DEFICIENCIES AND PREVENTIVE
CARE FOR CHILDREN AS WELL AS IN
A RURAL COMMUNITIES IS
PARTICULARLY SIGNIFICANT AND
HAS A HUGE IMPACT ON. PEOPLE'S
ACCESS TO CARE. SO BEFORE WE
OUGHT TO BEGIN I WOULD MAKE
NOTE THAT CHAIR WOODS IS-
ASSEMBLY HEALTH COMMITTEE- WILL
BE COMING IN A LITTLE LATER HE
IS OF COURSE ENGAGE IN THIS
DISTRICT WITH THE- CHALLENGES-
WITH THE- WILD FIRES AND-
BLACKOUTS AS WELL AND WE MAY
EVEN TOUCH ON SOME OF THAT
BECAUSE THAT CERTAINLY ALSO
AFFECTS ACCESS AS WELL. SO WE
WILL WELCOME HIM OUT BY HIM TO
GIVE A REMARKS- HE ARRIVES. SO
WITH THAT LIST AGAIN I WANNA.
ASK THAT THE AUDITOR. PLEASE
COME UP TO PRESENT THE FINDINGS
OF THE FREEH REPORT. OF A HOT
ON MEDI CAL REACHED THE MEDICAL
REGIONAL MODEL AND I THINK-
SOUTH THANK YOU SO MUCH FOR
BEING HERE AND- ALSO I THINK-
MISTER- MACABRE AS WELL. SO
THANK YOU VERY MUCH. BETTER
MONITOR AND- LOOK FORWARD TO
YOUR PRESENTATION OF- THE FIRST
THE FIRST OF THE TWO REPORTS-
MEDI CAL REGIONAL MODEL THANK
YOU WELCOME. THERE OKAY OKAY
OKAY TEST THERE WE GO AWRY.
THANK YOU MISTER CHAIR FOR THE
RECORD MY NAME'S ELAINE HOWELL
AND THE CALIFORNIA STATE
AUDITOR WITH ME IS SHAUN
MACABRE SEAN WAS THE SUPERVISOR
ON THIS PARTICULAR PROJECT
WORKING WITH THE TEAM. DOING
THE ANALYSIS THAT THEY ARE
JOINT LEGISLATIVE AUDIT
COMMITTEE ASKED US TO CONDUCT-
WITH RESPECT TO THE REGIONAL
MODEL. AND RURAL COUNTY SAID
THE MEDICAID OR MEDICARE CALYX
MANSION- INTO SOME OF THESE
RURAL COUNTIES WE ISSUED THIS
REPORT IN AUGUST OF TWENTY
NINETEEN JUST A COUPLE OF
MONTHS AGO- WHAT I WILL DO IS
I'M GONNA GO VERY HIGH LEVEL
OF. THE FINDINGS THAT WE
IDENTIFIED IT REPORT AND THEN
I'M GOING TO HAND IT OFF TO
MISTER MACABRE AND HE WILL STEP
THROUGH. WE HAVE A HAND OUT
IT'S VERY DENSE TEXT WISE BUT
HE'S GONNA STEP YOU THROUGH THE
KEY RECOMMENDATIONS THAT WE
MADE AND WHAT THE CURRENT
STATUS IS AS FAR AS THE SIXTY
DAY RESPONSE THAT WE'VE
RECEIVED FROM. PART IN HEALTH
CARE SERVICES AS A YEAR WHERE
DOCTOR PAN- AGENCIES WHEN WE
CONDUCT AN AUDIT HAVE THE
ABILITY TO RESPOND IMMEDIATELY
ONCE WE'RE READY TO PUBLISH THE
REPORT. AND THEN AT PRINT
INTERVAL SIXTY DAY SIX MONTHS
IN ONE YEAR SO FOR THIS AUDIT
WE HAVE THE SIXTY DAY RESPONSE
THE SUBSEQUENT AUDIT WILL TALK
ABOUT A LITTLE BIT LATER. WE
ACTUALLY HAVE A SIX MONTH
RESPONSIBLE BY THE STATUS ON IT.
I WILL. DOCTOR DOCTOR PAN IS
RELATED YES- WE REALLY SAW
SIGNIFICANT ISSUES WITH THE
ABILITY OF BENEFICIARIES IN
THESE RURAL COUNTIES TO GAIN
ACCESS TO PROVIDERS WHAT WAS
REFERRED TO AS ALTERNATIVE
ACCESS STANDARD SO THERE WERE
STANDARDS ESTABLISHED MINIMUM
STANDARDS AS FAR AS THE AMOUNT
OF MILES OR THE AMOUNT OF TIME-
THAT WOULD BE A STANDARD TIME
FOR BENEFICIARIES BE ABLE TO
ACCESS A PROVIDER BUT- AS THAT
WAS BEING IMPLEMENTED. CARE
SERVICES UP OUT SOME OF THESE.
FUNDS TO SUGGEST ALTERNATIVE
ACCESS STANDARDS WHAT WE FOUND
WHEN WE LOOKED AT THAT AND THIS
IS CONSISTENT IN BOTH THOUGHT
IT IS. THE NUMBER OF
ALTERNATIVE ACCESS STANDARDS
THAT WERE ACTUALLY GRANTED BY
THE DEPARTMENT OF HEALTH CARE
SERVICES WAS SIGNIFICANT WE
SCK UPWARDS OF TEN THOUSAND
DIFFERENT ALTERNATIVE ACCESS
STANDARDS.THAT WERE APPROVED
BY THE DEPARTMENT HEALTH CARE
SERVICES WITH RESPECT TO THE
REGIONAL MODEL IN THESE RURAL
COUNTIES IT WILL UPWARDS OF
ABOUT A THOUSAND ALTERNATIVE
ACCESS STANDARDS. THE CONCERN
WE HAD WAS MANY OF THESE
ALTERNATE ACCESS STANDARDS
WOULD REQUIRE A BENEFICIARY TO
TRAVEL SOME CASES HUNDREDS OF
MILES TO ACCESS A PROVIDER
WITHIN A KILLER HEALTH PLAN. IN
THE REGIONAL MODEL THERE TO
HEALTH PLAN AND- AND HEALTH AND
WELL- DEPENDING UPON WHICH
PLAN. THE PROJECT BENEFICIARY
PARTICIPATES IN THE PROVIDERS
MAYBE TWO THREE HUNDRED MILES
AWAY AND IN MANY CASES THESE
LOW INCOME INDIVIDUALS DON'T
HAVE THE ABILITY TO DOUBLE EVEN
A- MIDDLE INCOME INDIVIDUAL MAY
NOT WANT TO TRAVEL THREE
HUNDRED MILES- TO SEEK. A CALL
CARE WE REALLY HAD CONCERNS
ABOUT WHY THOSE ALTERNATIVE ACT
STANDARDS WERE I DID- AND UP
TO. LOOK AT PROP THAT HEALTH
CARE SERVICES YOU USE I WE FELT
THAT THERE WERE SOME FLAWS THEY
AT THE PLAN REQUIRED. TO
DEMONSTRATE THAT THEY'VE EXIST.
ALL UP OPTION. ASIAN AS TO WHY
AND IN MANY CASES WE SAW IT WAS
BOILER PLATE FROM ONE ONE
EXPLANATION TO THE NEXT
DEPENDING UPON THE ALTAR OF
ACCESS STANDARDS SO WE DIDN'T
SEE HEALTHCARE SERVICES. REALLY
EXPECTING THE PLANS TO PROVIDE
WRITTEN DOCUMENTATION AS TO
WHAT DUE DILIGENCE THAT THIS
PLAN GO THROUGH TO TRY TO
IDENTIFY PROVIDERS. AND THEN
FINALLY- WITH RESPECT TO THE
ACCESS TO CARE AND THESE
ALTERNATE ACCESS STANDARDS-
HEALTH CARE SERVICES COULD HAVE
USED THEIR CORRECTIVE ACTION
PLANS- AND PUTTING SOME OF
THESE THESE. PLANS ON THAT SO
THAT THE BENEFICIARIES WOULD
IT'LL TEMPORARILY BE ABLE TO
USE OUT OF NETWORK PROVIDERS
THAT PERHAPS WERE MUCH CLOSER
TO HOME. THAN HAVING TO DROUGHT
TO TRAVEL HUNDREDS OF MILES TO
ACCESS CARE- SOME OF THE
REASONS HEALTH CARE SERVICES I
IDENTIFIED AS FAR AS WHY ARE
THERE NOT ENOUGH PROVIDERS. YOU
KNOW CERTAINLY FIRST RATE OUT
ISSUE. THE OTHER ISSUE THAT WE
IDENTIFIED HEALTH CARE SERVICES
ALSO MENTIONED IS SINCE YOU
HAVE TWO PLANS- SOME PROVIDERS
MANY OF THE PROVIDERS ABOUT 70%
WERE ONLY CONTRACTING WITH ONE
PLAN THEY WEREN'T CONTRACTING
WITH BOTH- SO THERE WERE SOME
DIFFERENCES AS FAR AS IN ONE
PLAN AND ACCESS TO PEDIATRICIAN
MAY BE RELATIVELY CLOSE UNDER
ANSEM BUT UNDER HEALTH AND
WELLNESS THAT PERSON MAY HAVE
TO TAKE THEIR CHILD HUNDRED
FIFTY MILES. NOT SO THE ISSUE
IS HAVING TO CHOOSE BETWEEN
PLANS WERE REALLY HAVING TO
MAKE ADDED AT A DECISION AS TO
WHAT TYPE OF CARE DO I REALLY
NEED AND WHICH PROVIDERS GONNA
BE CLOSEST FOR ME BUT BUT IT
WAS CERTAINLY A PROBLEM- WE DID
SOME ANALYSIS USING MEDICAL
BOARD DATA AND OSTEOPATHIC
BOARD DATA TO DETECT ARE THERE
ADDITIONAL PROVIDER IN THE
ROOM. THAT PERHAPS CON THING
WITH THE PLAN WE DID IDENTIFY
ABOUT NINETEEN HUNDRED-
PROVIDERS SO ONE OF OUR
RECOMMENDATIONS THAT MISTER
WE'LL TALK ABOUT IS WHAT THANK
HEALTH CARE SERVICES NEEDS TO
DO MORE NOW THIS OF ALL THE IN
THE CAPITAL WITH EXPECT THESE
TURNED IT STANDARDS BUT HE-
INTO THAT DO ADDITIONAL ALICE
TO. PROVIDE IN THE REGION ARE
RELATIVELY CLOSE TO THE
BENEFICIARIES THERE ARE
PROTESTS BEING IN THE POOL IN
THE PLAN- ARE CONTRACTING WITH
THE TWO PLANS. AND WHAT WE
NEED. TO PROVIDE. SERVICES
COULD TO RIP NOT. TO CARE FOR
BENEFICIARIES SO THAT WAS THE
FIRST ISSUE THAT WE IDENTIFIED.
THE SECOND ISSUE IS WITH
RESPECT TO COMMUNICATION WITH
COUNTIES SO HEALTH CARE
SERVICES AS I'M SURE YOU'RE
AWARE OF FEDERAL AND STATE LAWS
REQUIRE HEALTH CARE SERVICES TO
PROVIDE MONITORING- AND HEALTH
CARE SERVICES DOES DO THAT THEY
MONITOR THROUGH HE THIS- WHICH
I'M SURE YOU'RE FAMILIAR WITH
AND THEY ALSO DO MEDICAL AUDIT
REPORTS- WHICH LOOK AT
UTILIZATION MANAGEMENT CASE
MANAGEMENT. THE AVAILABILITY OF
CARE ACCESS TO QUALITY OF
MANAGEMENT THE ORGANIZATIONAL
CAPACITY- THEY CONDUCT THESE
AUDITS THEY ISSUE THESE AUDITS
BUT THEY DON'T SHARE THE
RESULTS WITH THE COUNTIES THEY
BASICALLY POST POST THE
INFORMATION HEALTHCARE SERVICES
ON THE WEBSITE AND THEN IT'S UP
TO THE COUNTY TO BE PROACTIVE
AND BE LOOKING FOR- CALL
REPORTS A LOT OF REPORTS THAT
MAY BE PERTINENT TO THEIR
PARTICULAR COUNTY. WE THANK
HEALTH CARE SERVICES NEEDS TO
BE A BETTER JOB OF
COMMUNICATING THAT INFORMATION
TO THE COUNTIES PRO ACTIVELY-
AND MORE TOPICALLY WHAT THEIR
DEPARTMENT- WAS DOING. IS WHEN
THEY WOULD COMPLETE MEDICAL
AUDIT REPORT THEN THAT PLAN
WOULD HAVE TO PUT TOGETHER CRAP
CORRECTIVE ACTION PLAN WITH
RESPECT ANY CHOOSE OUR FINDINGS
THEY WOULD WAIT UNTIL THAT
CORRECTIVE ACTION PLAN WAS
COMPLETED BEFORE THE POST THE
MEDICAL OUR REPORT ON THE
WEBSITE WE SHOULD GET THE
MEDICAL OUT REPORT UP THERE AND
THEN WHEN THE CORRECTIVE AT THE
PLANT. THEN YOU CAN ALSO POST
THAT GET THAT INFORMATION OUT
AS QUICKLY AS POSSIBLE ON YOUR
WEBSITE. BUT ALSO BE MORE
PROACTIVE IN COMMUNICATING WITH
THE COUNTIES. WHEN WE TALK TO
SOME OF THE COUNTIES SOME
WEREN'T FULLY AWARE OF ALL THE
DIFFERENT TYPES OF MONITORING
THAT HEALTH CARE SERVICES DOES-
AND CERTAINLY DIDN'T KNOW THAT.
HEALTH CARE SERVICES WAS
CONDUCTING THESE MEDICAL AUDITS
AND THOSE COUNTIES FELT THAT
THAT INFORMATION WOULD BE
BENEFICIAL TO THEM AS THEY TRY
TO ASSIST BENEFICIARIES. WITH
RESPECT TO THEIR RIGHTS
ETCETERA ACCESS TO CARE QUALITY
OF CARE THOSE SORTS OF THINGS.
SO THAT'S THE SECOND ISSUE
REALLY NEED TO STRENGTHEN THEIR
COMMUNICATION WITH THE COUNTIES
WITH RESPECT TO QUALITY OF CARE
AND DEFICIENCIES. THAT THEY ARE
IDENTIFYING WHEN THEY CONDUCT
THESE AUDITS AND CERTAINLY. THE
HE IS RESULTS THOSE.
EFFECTIVENESS RESULTS. THE LAST
ISSUE WAS REAP WITH RESPECT TO.
ASSISTING IN EDUCATING COUNTIES
WHEN THE TRANSITION WAS
HAPPENING SO THIS WAS BACK IN
TWENTY THIRTEEN- WE FELT THAT
THE EVIDENCE DEMONSTRATED THAT
HEALTH CARE SERVICES DIDN'T
REALLY ACTIVELY ENGAGE WITH THE
COUNTIES. NOW THEY DID HAVE
SOME OPEN MEETINGS THEY HAD
SOME DISCUSSIONS WITH THE
COUNTIES. BUT THEY DIDN'T DO
WHAT WE FELT WOULD BE
DEMONSTRATING LEADERSHIP AND
REALLY EDUCATING THE COUNTIES
ABOUT THE POSSIBILITY OF A
COUNTY COAST PLAN OR WHAT WOULD
THE STEPS BE REQUIRED TO DO
THAT WATER ALL YOUR OPTIONS AS
A COUNTY. SOME OF THESE
COUNTIES DIDN'T HAVE.
ESSENTIALLY THE EXPERTISE TO
UNDERSTAND WHAT IS THE BEST
DECISION FOR THE BENEFICIARIES
IN OUR REGION SO WE REALLY FELT
HEALTHCARE SERVICES COULD HAVE
DONE A BETTER JOB SHOULD HAVE
DONE A BETTER JOB. IN
COMMUNICATING WITH THE COUNTIES
EARLY ON SO THAT THEY CAN MAKE
INFORMED DECISIONS AS TO
WHETHER OR NOT A MULTI COUNTY
CODES MADE SENSE- SOME OF THE-
SKEWS ME SOME OF THE COUNTIES
WERE ABLE TO. JOIN PARTNERSHIP
HEALTH WHICH IS. A CODE. THERE
WERE A HANDFUL OF THOSE THOSE
COUNTY ACTUALLY TV DISTANCE
NONPROFIT AND HELPING THEM
UNDERSTAND WHAT THEY NEEDED TO
DO TO APPROACH PARTNERSHIP
HEALTH. AND TO BE ABLE TO
BECOME PART OF THAT CODES BUT
NOT ALL OF THE COUNTIES HAD
THAT KIND OF ASSISTANCE SO WE
FELT THAT HEALTH CARE SERVICES
NEEDED TO BE. DEMONSTRATE MORE
OF A LEADERSHIP ROLE WITH
RESPECT TO THE TRANSITION. AND
THE REASON WE REALLY WANTED TO
EMPHASIZE THIS IS SIMILAR TO
WHAT YOU SAID DR PAN. THERE THE
TWO HEALTH PLANS IN THE
REGIONAL MODEL RIGHT NOW HEALTH
AND WELLNESS IT EXPIRES AND
TWENTY TWENTY SO I KNOW. HEALTH
CARE SERVICES IS AN R. F. P. IN
GOING THROUGH THAT PROCESS-
ANTHEM HEALTH THAT EXPIRES IN
TWENTY TWENTY THREE WHICH A
LITTLE FURTHER OUT. BUT STILL-
IT'S IMPORTANT FOR THE
DEPARTMENT HEALTHCAE SERVICES
STATE OF CALIFORNIA TO REALLY
WORK WITH. THESE COUNTIES
BECAUSE SOME OF THESE CAMPS
HAVE REALLY EXPRESSED INTEREST
IN EITHER DEVELOPING A MULTI
COUNTY. WAS. UP WITH. OUR TYPE
MODEL- BECAUSE WHAT THEY
CURRENTLY HAVE IS JUST NOT
WORKING WITH RESPECT TO ACCESS
TO CARE. AND CERTAINLY NOT
QUALITY OF CARE WHEN WE LOOKED
AT SOME OF THE HEAT IS OUR
RESULTS. SO WE MADE SOME
RECOMMENDATIONS TO HEALTH CARE
SERVICES THAT THEY- THIS TIME
AROUND THEY NEED TO BE MORE
PROACTIVE WORKING WITH. THE
COUNTIES IF THERE'S A NEED FOR
ADDITIONAL FUNDING TO. HAVE
CONVERSATIONS WITH THE
LEGISLATURE BUT REALLY STARTING
NOW. REALLY SINCE ONE OF THE
PLANS EXPIRES ON THE CONTRACT
EXPIRES NEXT YEAR SO I REALLY
STEPPING IT UP AS FAR AS THE
ASSISTANCE TO THOSE THOSE RURAL
COUNTIES- SO THOSE WERE THE
THREE HIGH LEVEL KEY ISSUES-
SUMMER COBBS GONNA STEP YOU
THROUGH. THE MAIN
RECOMMENDATIONS WE HAD SOME
RECOMMENDATIONS OBVIOUSLY
RELATED TO ACCESS TO CARE THOSE
ALTERNATIVE STANDARDS BUT ALSO
SOME OTHER RECOMMENDATIONS WITH
RESPECT TO COMMUNICATION
COORDINATION- ETCETERA SALTER
OVER MISTER COBB. THANK YOU
MICHELLE A GOOD MORNING MISTER
CHAIR MY NAME IS SEAN MACABRE
ON THE SENIOR AUDITOR WITH THE
CALIFORNIA STATE AUDITOR'S
OFFICE- WE HAD FIFTEEN
RECOMMENDATIONS THAT WE MADE TO
THE DEPARTMENT OF HEALTH CARE
SERVICES REGARDING THE THREE
ISSUES THAT THE STATE AUDITOR
JUST DISCUSSED. THE DEPARTMENT
HAS FULLY IMPLEMENTED FOR OF
THOSE RECOMMENDATIONS AGREED TO
IMPLEMENT ANOTHER SIX BUT IT'S
STILL IN PROGRESS. AND HAS
RESPONDED THAT IT WILL NOT AND
IMPLEMENT FIVE OF OUR
RECOMMENDATIONS. I'M GONNA
DISCUSS THE RECOMMENDATIONS IN
THE SAME ISSUE GROUPINGS THAT
THE STATE AUDITOR JUST
DISCUSSED- REGARDING ACCESS TO
CARE. THE DEPARTMENT HAS- MADE
PROGRESS IMPLEMENTING OUR
RECOMMENDATIONS TO VALIDATE
HEALTH PLANS NARRATIVES
REGARDING AND ABILITIES TO MEET
STATE ACCESS STANDARDS- AND
RESPONDED. HOWEVER IT HAS
RESPONDED THAT IT WILL NOT
IMPLEMENT OUR RECOMMENDATION TO
DETERMINE THE AREAS OF THE
REGIONAL MODEL THAT ARE LACKING
SPECIFIC PROVIDERS AND DEVELOP
STRATEGIES TO RETREAT TO
PROVIDE. GHS DESCRIBE THAT DOES
NOT ITS PREVIEW HOWEVER WE FEEL
GIVE. ONE OVERSEEING THE
STATE'S PROVISION OF MEDICAL
SERVICES IT IS WITHIN ITS PEER
REVIEW. ADDITIONALLY THE
DEPARTMENT RESPONDED THAT IT
WILL NOT IMPLEMENT OUR
RECOMMENDATION TO REQUIRE
HEALTH PLANS TO AUTHORIZE OUT
OF NETWORK SERVICE IF THEY
CANNOT DEMONSTRATE THEY HAVE
EXHAUSTED ALL OF THEIR
REASONABLE OPTIONS. TO OBTAIN
PROVIDERS. DHS RESPONDED THAT
IMPROVING ITS ALTERNATE ACCESS
STANDARD REQUEST VALIDATION
PROCESS. HOWEVER THAT RESPONSE
IS NOT ADDRESS HOW IT WILL
HANDLE SITUATIONS IN WHICH
HEALTH PLANS ARE NOT ABLE TO
DEMONSTRATE THAT THEY HAVE
EXHAUSTED ALL OF THE REASONABLE
OPTIONS. TO OBTAIN PROVIDERS.
OUR RECOMMENDATION SPECIFIES
THAT DH CS SHOULD REQUIRE THOSE
PLANS TO AUTHORIZE OUT OF
NETWORK CARE. REGARDING OUR
RECOMMENDATIONS OF THE ISSUE TO
IMPROVE COMMUNICATIONS WITH
COUNTIES- THE DEPARTMENT HAS
FULLY IMPLEMENTED THREE OF OUR
FOUR RECOMMENDATIONS AND HAS
AGREED TO REQUEST FEEDBACK FROM
COUNTIES REGARDING THEIR
EXPERIENCE WITH HEALTH PLANS.
FINALLY THE THIRD ISSUE
ASSISTING COUNTIES THAT DESIRE
TO CREATE OR JOIN OPPOSE. THE
DEPARTMENT HAS MADE PROGRESS IN
PROVIDING BETTER INFORMATION
REGARDING MANAGED CARE BROADLY
AND AGREED TO DEVELOP
INFORMATION THAT WOULD INFORM
COUNTIES OF THE STEPS AND
REQUIREMENTS OF JOINING OR
CREATING ECHOES. ADDITIONALLY
THE DEPARTMENT HAS AGREED TO
DETERMINE THE CAUSES OF THE
REGIONAL MODEL HEALTH PLANS AND
ABILITIES TO MEET THE STATE
ACCESS STANDARDS. THE
DEPARTMENT RESPONDED THAT IT
WILL NOT IMPLEMENT A
RECOMMENDATION TO DETERMINE
WHETHER THE STRUCTURE OF A
CLOSE WOULD IMPROVE THE ACCESS
TO HEALTH CARE AND THE REASON
MODEL COUNTIES. AND TO ASSIST
TOWNIES AND CREATING A BECAUSE
OF THE DESIRE TO DO SO MEANT.
INDICATED THAT IT WOULD
DETERMINE ITS NEXT STEPS
REGARDING. THIS RECOMMENDATION
AFTER DETERMINES THE CAUSES OF
THE REGIONAL MODEL HEALTH PLANS
AND ABILITIES TO PROVIDE CARE
THAT MEETS THE STATE STANDARDS.
HOWEVER AT DHS WOULD BE BETTER
INFORMED HAVING EVALUATED
WHETHER THE CAUSE WOULD IMPROVE
ACCESS TO CARE AND THE REGIONAL
MODEL. AND COUNTIES MAY NOT BE
ABLE TO CREATE A BECAUSE
WITHOUT DHS IS ASSISTANCE.
ADDITIONALLY THE DEPARTMENT
RESPONDED THAT IT WILL NOT
IMPLEMENT OUR RECOMMENDATIONS
DETERMINE WHETHER IT HAS THE
FINANCIAL RESOURCES TO ASSIST
COUNTIES IN CREATING THE CAUSE
OF THE DESIRE TO DO SO. MEN
RESPONDED THAT IT DOES NOT HAVE
THE FINANCIAL REESE'S RESOURCES
TO DO SO. AND THAT COUNTIES-
SHOULD REQUEST THE- FUNDING ON
THEIR OWN IF THEY DESIRE TO GO
HOWEVER BECAUSE THE REGIONAL
MODEL COUNTY- THE REGIONAL
MODEL INCLUDES MANY COUNTIES
THAT MAY DESIRE TO TRANSITION
INTO A SINGLE MULTI COUNTY
BECAUSE WE BELIEVE THAT IT
WOULD BE MORE EFFECTIVE FOR DHS
TO SUBMIT A CONSOLIDATED
FUNDING REQUEST. TO THE
LEGISLATURE AND PLAY A LEADING
ROLE IN THE ESTABLISHMENT OF
THAT PLAN RATHER THAN FOR THE
COUNTIES TO EACH SUBMIT
INDIVIDUAL REQUESTS ON OUR OWN.
FINALLY THE RESPONDED THAT IT
WILL NOT IMPLEMENT A
RECOMMENDATION TO PROVIDE
COUNTIES WITH REASONABLE TIME
TO DECIDE WHETHER. WHETHER TO
CHANGE THEIR MANAGED CARE
MODELS AND ESTABLISH NEW ONES
AND TO ALSO INCLUDE LANGUAGE
AND IT'S TWENTY TWENTY REQUEST
FOR. PROPOSALS TO ALLOW
COUNTIES THAT CAN DEMONSTRATE
THEIR ABILITY TO IMPLEMENT
ECHOES TO OPT OUT OF THE ARE
IFFY. REASONING THAT THE
DEPARTMENT PROVIDE WAS THAT IT
WILL NOT IMPLEMENT THE
RECOMMENDATION BECAUSE THE R.
F. P. IS SPECIFIC TO THE MODEL
TYPE. AND IT WOULD BE WILLING
TO WORK WITH COUNTIES IF THEY
DESIRE TO SWITCH MODEL TYPES
HOWEVER BY IMPLEMENTING A
RECOMMENDATION THE DEPARTMENT
WOULD DEMONSTRATE ITS
COMMITMENT TO HELPING SMALL
ORAL COUNTIES. IMPROVE THE
ACCESS TO CARE FOR THEIR
BENEFICIARIES THANK YOU. THANK
YOU THANK YOU SO MUCH FOR YOUR
PRESENTATIONS. SO FIRST I JUST
WANT TO SEE- FOR THE RECORDS SO
IN TERMS OF THE WORK THAT YOU
DID FOR THIS PARTICULAR REPORT-
DID YOU PRIMARILY LOOK AT JUST
THE MEDICAL SIDE OF THINGS- DID
NEEDED TO YOU KNOW LOOK AT THE
BEHAVIORAL HEALTH- MENTAL
HEALTH CA RALPH WHICH IS
USUALLY. ORGANIZED IN A
DIFFERENT WAY WITH- OF WITH
COUNTY MENTAL HEALTH PLANS THIS
IS THIS IS PRIMARILY ON THE%
PHYSICAL HEALTH SIDE OF HE
MEDICARE PROGRAM GRANT THAT'S
CORRECT DOCTOR PAN THE SPECIFIC
REQUESTS FROM THE MEMBERS WAS
TO LOOK AT PRIMARILY ACCESS TO
CARE AND THEN THIS TRANSITION
THAT OCCURRED TO MANAGE CARE
BACK IN TWENTY THIRTEEN. AND
THE VARIOUS DIFFUSER TWENTY
EIGHT RURAL COUNTIES EIGHTEEN
ENDED UP IN THIS REGIONAL MODEL
BUT IT WAS REALLY LOOKING AT
STRUCTURE ACCESS TO CARE
QUALITY OF CARE WE DID NOT LOOK
AT BEHAVIORAL. HEALTH CARE ALL
RIGHT AND- I REALIZE IS A
LITTLE BIT HISTORICAL AND I
COULD PERHAPS ALSO SPEAKS YES
BUT YOU WERE DOING THIS AUDIT-
THE CHEVY STATION THIS TO WHY
WE- CHOSE I WAS IN THE
LEGISLATURE TO TAX HAVE SOME
IDEAS BUT- WHY. IT WAS DECIDED
TO PURSUE THAT PARTICULAR REACH.
WAS THAT PART OF I DON'T KNOW
WHETHER THAT YOU'RE THAT. WAS
PART OF THE DISCUSSION AS
YOU'RE DOING THE AUDIT OR NOT.
THERE THERE'S AN ONGOING EFFORT
IN THE STATE TO BRING MANAGED
CARE INTO THE MEDICAL PROGRAM
BECAUSE THE STATE'S USE THAT
SEES IT THERE'S A BENEFIT TO IT
OVER THE FEE FOR SERVICE
PROGRAM. OKAY ALL RIGHT IN THE
LAB RATE ANYMORE THAN THAT IS
TO THE REGIONAL BUYER. THIS
WILL CAUSE IS ALSO A MANAGED
CARE MODEL SO I MEAN THERE'S
MULTIPLE MANAGED CARE MODELS.
THAT'S CORRECT AND DOCTOR PAN
AS AS A MISTER MACABRE
INDICATED WE WHEN WE LOOKED AS
I SAID THERE WERE TWENTY EIGHT-
COUNTIES THAT WERE
TRANSITIONING IT WAS PART OF
THE EFFORT TO TRANSITION MORE
AND MORE COUNTIES TO MANAGE
CARE BECAUSE OF THE COST
EFFECTIVENESS OF MANAGED CARE.
AND THEN WHEN WE DO DISCUSS IN
THE REPORT THERE WERE SOME
COUNTIES THAT WERE ABLE TO-
JOINT PARTNERSHIP THERE WERE
TWO COUNTIES THAT IS STEPS
THEIR OWN. CODES BUT THEN THERE
WERE THESE OTHER EIGHTEEN
COUNTIES THAT DIDN'T HAVE THE
ABILITY TO DO THAT SOME OF THEM
TRIED TO JOIN PARTNERSHIP.
PARTNERSHIP REJECTED IT
BECAUSE- IT HAD REACHED
CAPACITY- SO WE WERE TRYING TO
FIGURE OUT OKAY WHY DID THESE
EIGHTEEN AND UP IN THIS
REGIONAL MODEL IT WAS KIND OF
LIKE A LAST. ACT CHOICE OF LAST
RESORT AND THAT BY WE HAVE
CONCERNS. IN THE REPORT ABOUT.
IS PROVIDING THAT YOUR SHIP WE
THINK SHOULD HAVE PROVIDED IN
THE PAST. AND THAT WE THEY
SHOULD PROVIDE NOW AND GIVE
THESE COUNTIES ADDITIONAL
OPTIONS. WITH RESPECT TO
PERHAPS A MULTI COUNTY KOS
MODEL THAT MAY BE BETTER FOR
THE STATE. AND CERTAINLY BETTER
FOR BENEFICIARIES WITH RESPECT
TO ACCESS THE CARE AND QUALITY
OF CARE. SO ONE COULD ARGUE
THAT- AM NINE REPRESENTS A
COUNTY THAT HAS GEOGRAPHIC
MATCH CARE WE HAVE FIVE PLANS.
SACRAMENTO COUNTY. WE CAN WE
WON'T GET INTO THE ISSUES
THERE- BUT. YES ONE QUESTION IS
THAT IT'S- NOT NECESSARILY
INHERENT TO OTHER ECHOES ARE
MULTI PLAN MODEL THAT YOU
NECESSARILY HAVE TO HAVE ACCESS
ISSUES SO I'M PARTICULARLY
INTERESTED IN. THE
RECOMMENDATIONS YOU HAD THAT DH
CS SAID THAT THEY DIDN'T WANT
TO PURSUE REGARDING THE ACCESS
SO I REALIZE THERE'S THE MODEL
PART THAT'S THEIR DIFFERENT
DYNAMICS THERE BUT- IT'S FOR
EXAMPLE ENSURING THAT- PATIENTS
WHO NEEDED. US USUALLY PROBABLY
SPECIALTY CARES MORE LIKELY-
THAT- IF THEY NEED TO GO OUT OF
NETWORK THAT- IF THERE WAS AN
INADEQUATE NETWORK BY THE PLAN.
THAT THE DEPARTMENT WOULD. HELP
FACILITATE THAT- SO CAN CAN USE
CAN YOU SPEAK TO THE- NETWORK
ISSUE SAID YOU SAID YOU LOOKED
INTO FOR EXAMPLE THERE ARE
MANY- PHYSICIANS AND OTHER
PROVIDERS TO DID NOT- WHO ARE
AVAILABLE BUT YET- DID NOT
CONTRACT OR ONLY CONTRACTED
WITH ONE PLAN. AND CAN YOU
SPEAK TO THE LEVEL EFFORT THAT
THE- AGENCY MADE TO TRY TO BE
SURE PEOPLE COULD GET
REASONABLE ACCESS AND TIMELY
ACCESS. AND PERHAPS ALSO TOUCH
ON YOU MENTIONED A NUMBER OF
TIMES THAT THE SORT OF GAVE
ALTERNATE STANDARDS BUT WHAT
PERCENTAGE AND IF THERE'S A
SENSE OF PERCENTAGES LIKE THIS
HOW FREQUENTLY THIS HAPPENED
BEYOND JUST. AS IT IS- IN TERMS
OF THE NUMBER FOR ALL THAT
CENTER. WELL WITH RESPECT TO
THE ALTERNATIVE ACCESS
STANDARDS THAT THE DEPARTMENT
GRANTED AS WE DISCUSS AND IN
THE PREVIOUS AUDIT REPORT- THEY
BASICALLY APPROVED EVERY
ALTERNATE ACCESS STANDARD
REQUEST THAT THEY GOT UNLESS
THE REQUEST WAS INCOMPLETE
WHERE THERE WASN'T SUFFICIENT
DOCUMENTATION OR THEIR IT WHAT
THE APPLICATION WASN'T
COMPLETE. BUT IF THEY RECEIVE A
COMPLETED APPLICATION IT WAS
PRETTY MUCH A THREE HUNDRED AND
RUBBER STAMP OKAY I DON'T SAY
THAT THE REPORT BUT WE SAY THAT
THEY APPROVED ALL OF THE
ALTERNATE ACCESS STANDARDS-
THAT WERE SUBMITTED THAT WERE
DEEMED COMPLETE. AND WE HAD
CONCERNS WITH THAT BECAUSE-
THEY'RE NOT NECESSARILY HOLDING
THOSE PLANS ACCOUNTABLE TO SAY
WHAT DID YOU DO TO EXHAUST ALL
OPTIONS AND AN OPTION IS TO
TEMPORARILY PROVIDE OUT OF. OUT
OF NETWORK. FIGHTERS ACCESS- SO
WE THINK THAT SOMETHING THEY
SHOULD DO AND WITH RESPECT TO
THE ANALYSIS I MENTION THE
NINETEEN HUNDRED PROVIDERS.
WHAT WE DID AND I DON'T KNOW
WHETHER WE SHARE IT WITH YOU
WHEN WE TALK WITH YOU IN THE
PAST BUT- WE ACTUALLY HAVE AN-
I. T. SUPPORT GROUP AND OUR
OFFICE THAT DOES ANALYTICS. SO
WHAT THEY WERE ABLE TO DO-
USING MEDICAL BOARD DATA AS I
INDICATED AN OSTEOPATHIC BOARD
DATA. IDENTIFY PROVIDERS IN THE
RURAL COUNTIES THAT HAD NOT
CONTRACTED WITH EITHER PLANS-
BUT WE ALSO WERE ABLE TO
CREATE- AN INTERACTIVE MAP AS
FAR AS DATA ANALYSIS SO THAT.
IT WOULD BE RELATIVELY EASY FOR
HEALTH CARE SERVICES TO
IDENTIFY WHICH COUNTIES. ARE
THERE ARE THERE ARE SOME
PROVIDERS THAT ARE CONTRACTING
WITH WITH EITHER PLAN REACH OUT
TO THOSE PROVIDERS AND SAY WHAT
IS IT GOING TO TAKE ARE THERE
INCENTIVES. THAT WE CAN PROVIDE.
SIX TO PROVIDE PROVIDERS MORE
WHAT. WE JUST THINK THAT
DEPARTMENT HEALTH CARE SERVICES
COULD BE DOING MUCH MORE
ANALYSIS WE DID IT DURING THE
COURSE OF THE AUDIT SO I THINK
THAT AS AN AGENCY THEY WOULDBE
ABLE TO DO THAT. AS A STANDARD
COURSE OF PRACTICE. AND DID YOU
IN THE PROCESS OF DOING THE
AUDIT. SO THERE'S THE NOW WE
HAVE THE NETWORKS HAVE TWO
PLANS THEY HAVE THEIR EXISTING
NETWORKS- WERE YOU ABLE TO
EXPLORE ARE ENGAGED IN THE
AUDIT. LOOKING AT WHAT- HOW
MUCH EFFORT THE DEPARTMENT
ENGAGED IN AND BE SURE THAT THE
PLANS THEMSELVES ACTUALLY HAD
ADEQUATE NETWORK START WITH SO.
IN THIS YEAH WE TALKED ABOUT
WELL GEE THEY DON'T HAVE ONE TO
GIVE THEM A WAY AROUND. BUT IS
THAT THAT. HOW MUCH DID THE
OVERSIGHT TO THE DEPARTMENT PUT
INTO BEING SURE THAT THE
NETWORK TO START WITH. ACTUALLY
HAD SUFFICIENT. PEOPLE WHO WERE
IN. THE AND IT'S TO BASICALLY
PROVIDE TIMELY ACCESS NOT JUST
SOMEONE WHO IS HUNDREDS OF
MILES AWAY. THE STATE STANDARDS
THAT WE ADDRESS IN THE REPORT
ARE- FAIRLY RECENT STANDARDS I
BELIEVE THEY THEY WERE APPROVED
IN TWO THOUSAND SEVENTEEN AND
BECAME ACTIVE IN TWO THOUSAND
EIGHTEEN. WHICH WAS AFTER THE
STATE- CONTRACTED WITH THE
HEALTH PLANS TO PROVIDE SERVICE
IN THAT REGION. SO THEY WOULD
NOT HAVE BEFORE HAND BECAUSE
THE STANDARDS WERE TO
APPLICABLE THEN OKAY AND HOW
ACCURATE WERE TO PROVIDE A LIST
FROM THE PLANS WHEN YOU WERE
DOING THE AUDIT IS THAT IT TO
ANY ISSUES IN TERMS OF ACCURACY
OF THE PROVIDER. LIST NETWORK
TERMS OF ACTORS THE- DURING THE
COURSE OF THIS AUDIT WE DID NOT
DO THAT TYPE OF ANALYSIS DR PAM
BUT THAT IS AN ISSUE THAT WE'VE
IDENTIFIED IN PREVIOUS AUDITS
AND THE MOST RECENT AUDIT. THE
AUDIT WE'RE GONNA TALK ABOUT A
LITTLE BIT LATER WE IDENTIFIED
THAT AGAIN AS AN ISSUE SOME OF
THOSE PROVIDER DIRECTORIES.
WERE NOT ACCURATE BUT A
PROVIDER MAY HAVE BEEN LISTED
IN THE DIRECTORY BUT IS NOT
TAKING MEDI CAL PATIENTS. OR IS
NO LONGER PRACTICING SO- WE
DID. THEY'RE DOING A BETTER JOB
OF CLEANING UP THOSE
DIRECTORIES- COMPARED TO AN
AUDIT WE DID A YEAR OR TWO AGO.
BUT THAT STILL CONTINUES TO BE
AN ISSUE FOR BENEFICIARIES. ALL
RIGHT THANK YOU- I ACTUALLY.
WANT TO ACKNOWLEDGE IT THANK
YOU CENTER RUBIO FOR JOINING US
AND- AND OF. AS A WEEK WE'RE AT
THE- AUDITOR'S PRESENTATIONS I
KNOW HE HAD SOME REMARKS ARE
USED TO ASK QUESTIONS OF THE
IDEA WELL I DON'T WANT TO BE BY
YOURSELF I DECIDED TO JOIN YOU.
KEEPING EVERYONE THANK YOU ON.
BEING HERE. THE QUESTION I'M
SORRY I WALKED IN AND YOU WERE
SAYING THAT SOME FORGET ME
PHONE. YOU ALREADY STATED. YOU
HAVE. STAFF THAT DOT THE SPIDER
SHOULD BE THANK. DON'T. OFFER
ACCESS SHOULD BE AT LEAST
CONTRACTING WITH. PROVIDE
TEMPORARY. LEAST IDENTIFYING
SOME OF THE ONES THAT ARE NOT
PART OF THE TWO MAJOR ONES. I
IS THAT SOMETHING THAT YOU
SUGGESTED THAT YOU QUESTION I
JUST WANT TO KNOW LIKE ARE THEY
AWARE IS IT SOMETHING THAT.
THEY WERE OPEN TO WIN WILL GIVE
ME A LITTLE BIT OF THE
BACKGROUND. SO HOT THE
DEPARTMENT HEALTH CARE SERVICES
HAS THE ABILITY TO. REQUIRE
HEALTH PLANS TO PROVIDE
TEMPORARY OUT OF NETWORK AS
PART OF A CORRECTIVE ACTION
PLAN SO. IF ALL APPROACH A
HEALTH PLAN IS SUGGESTING WE
NEED AN ALTERNATE ACCESS
STANDARD- AND THAT'S GOING TO
REQUIRE A BENEFICIARY TO TRAVEL
TWO HUNDRED FIFTY THREE HUNDRED
MILES IN SOME INSTANCES I MEAN
THOSE ARE THE MOST EGREGIOUS
BUT- THAT'S STILL SIGNIFICANT
FOR. A LOW INCOME INDIVIDUAL-
HEALTHCARE SERVICES HAVE THE
ABILITY. TO REQUIRE. THESE
NETWORK- CERTIFICATION
CORRECTIVE ACTION PLANS AND AS
PART OF THAT THEY HAVE THE
ABILITY THE PLAN HAS THE
ABILITY- DEPARTMENT HEALTHCARE
SERVICES HAS THE ABILITY
REQUIRE THAT PLAN AT LEAST ON A
TEMPORARY BASIS. UNTIL YOU CAN
GET MORE PROVIDERS TEN CHILE
INTO THE INTO THE NETWORK TO
ALLOW THIS BENEFICIARY TO GO
OUT OF NETWORK THAT MADE
REQUIRE. PAYING MORE TO THAT
PARTICULAR PROVIDER BUT IT'S
LESSENING THE BURDEN ON THE
BENEFICIARY NOW THAT IF YOU'RE
SURE ONLY TRAVEL THIRTY OR
FORTY MILES. AS OPPOSED TO
MAKING A DECISION AS TO WHETHER
NOT TRAVEL TO WANT. TO KEEP AND
CASE THEY WON'T TAKE CARE
BECAUSE. THAT'S JUST TOO FAR
HAS ANYBODY DOING NOW. THIS
TIME. EXAMPLES OF. TO THE
BENEFICIARIES- THAT'S WHY WE
MADE THAT RECOMMENDATION THAT
THERE NEEDS TO BE OTHER PART
HEALTH CARE SERVICES NEEDS TO-
REQUIRE PLANS TO ALLOW THAT TO
THAT OUT OUT OF NETWORK CARE.
THANK YOU FOR THAT WELL I THINK
THAT'S REALLY IMPORTANT TO ME
IF THEY'RE SUPPOSED TO AT LEAST
PROVIDE THE- IF YOU KNOW THE
BASIC CARE AND THEY DON'T HAVE
ENOUGH PROVIDERS. WE NEED TO
TRY TO FORCE THAT IN SOME WAY
THANK YOU SO MUCH FOR EXPANDING
ON IT. THANK YOU. OKAY THANK
YOU SO VERY MUCH FOR YOUR
PRESENTATION AND- AND- IT AND
YOUR PORT AND SO- MODE NOW I'M
GOING TO ASK- THIS DEPARTMENT
HEALTH CARE SERVICES- TO COME
UP SO THANKS VERY MUCH. OTHER
HEALTH AND- THANK YOU MEMBERS
THANKS MUCH. ALL RIGHT SO- NEXT
UP WE HAVE- DEPARTMENT. OF
HEALTH CARE SERVICES WE HAVE-
ACTING DIRECTOR- RICHARD
FIGUEROA AND- CHIEF DEPUTY
DIRECTOR OF HEALTH CARE
PROGRAMS MAIN CAT. CAN'T WELL
WELCOME AND. THE CREE SHEET
HERE. RESPONSE TO THE AUDITOR'S
FINDINGS I KNOW WE HAVE THE
MORE FORMAL RESPONSE BUT MAYBE
A SUMMARY AND MAYBE SOME
DISCUSSIONS ALONG WILL ANSWER
SOME OF THE ISSUES THAT WERE
PERHAPS RAISED IN THE QUESTIONS
AS WELL- THAT WOULD PASS THE
AUDITOR THANK YOU. GREAT AGAIN-
MORNING MR CHAIR AND MEMBERS A
COMMITTEE MADE WHICH FIGARO
ACTING DIRECTOR OF THE PALM
HEALTHCARE SERVICES THE DHS
TAKES THE FINDINGS OF THE
AUTHORS MEDI CAL REGIONAL
REPORT SERIOUSLY IS WORKING
DILIGENTLY NAMEPLATE MOSTLY
ACTION ITEMS AS OUTLINED IN THE
RESPONSES- OUT ALSO NOTE THAT
THE STAFF- RIVER A
COLLABORATIVELY- WITH THE
AUDITORS- STAFF AS WELL AND IN
PRODUCING THIS. I'M JUST SOME
REAL QUICK BACKGROUND CONTEXT
YOU TOUCHED ON THIS A LITTLE
BIT EARLIER- DHS COOLEY
PROVIDES CARED ABOUT THIRTEEN
MILLION CALIFORNIANS THROUGH
SIX DIFFERENT DELIVERY SYSTEMS
INCLUDING MULTIPLE MANAGE CARE
DELIVERY SYSTEM AS YOU NOTED
EARLIER FEE FOR SERVICE DENTAL
COUNTY MENTAL HEALTH DRUG MEDI
CAL ORGANIZED LIVVIE SYSTEM AND
COUNTY SUBSTANCE ABUSE
DISORDERS SERVICES. WE OPERATE
SIXTY FOUR MILES A MANAGE CARE-
AND CONTRACTOR TWENTY FOUR FULL
SCOPE MEDI CAL MANAGED CARE
PLANS 82% OF MEDI CAL ENROLLEES
ARE RECEIVING CARE TO MANAGE
CARE FIND TWENTY THIRTEEN AS
WAS NOTED EARLIER DHS EXPANDED
MATCH CARE TWENTY EIGHT
ADDITIONAL COUNTIES TO CLEAN
EIGHTEEN COUNTIES THAT COMPRISE
THAT WITH CALL THE REGIONAL
MODEL- THOSE EIGHTEEN CANS ARE
GENERALLY THE FOCUS OF THE
AFTER MENTIONED BY THAT ANTHEM
BLUE CROSS IN CALIFORNIA HELP
THE WILL OF THE TO MEDI CAL
MANAGED CARE PLANS ARE. IN THEM
WITH RESPECT THE AUDIT FINDINGS
THEMSELVES IN TIME SAYS TO CARE
AND PROVIDER BEING A REASONABLE
DISTANCE ALL THESE RESIDENT
STATUTORY AND TAX REQUIREMENTS.
COMMENTS HEALTHCARE PLANS. AND
T. H. OF COURSE HAVE CHALLENGES.
I FELT LIKE THAT WAS USUALLY.
HI MARY APARTMENT HEALTHCARE
SERVICES YOU GUYS YOU KNOW I'M
ALWAYS LIKE THIS BUT IT'S GOOD
TO SEE YOU- NOT IT'S BEEN
AWHILE SINCE WE HAVEN'T HAD
BUDGET HEARINGS IN AWHILE BUT
IT'S NICE TO SEE A DOCTOR PAN
AND ALSO SENATOR RUBIO I AM SO
YEAH SO WANT TO USE THE REST OF
MY TIME I KNOW. YOU GUYS HAVE A
LOT TO COVER IN THE AGENDA
TODAY SO YOU KNOW I TRY TO BE
LET GIVE GET YOU WHAT YOU NEED
IN AS AS QUICKLY AS POSSIBLE I
AM SO JUST A COUPLE OF KEY
THINGS TO IDENTIFY- WHERE WE
HAVE MADE PROGRESS AND I THINK
YOU HEARD SOME OF THAT FROM OUR
AGAIN OUT OUR OUR PARTNERS AT
THE CALIFORNIA STATE AUDITOR
WHO AGAIN. JUST A REALLY
APPRECIATE THE TIME THEY WITH
US AS WE TRY TO WORK THROUGH
HELPING THEM UNDERSTAND THE
PROGRAM AND THEN MAKING SURE
ANSWERING THEIR QUESTIONS AND
FELT LIKE WE HAD A GOOD
RELATIONSHIP AND WORKING
THROUGH THAT ANSWERED ONLY
APPRECIATE THAT AND THAT THAT
WAS OVER AT THE DEPARTMENT. IN
TERMS OF. THE VERY SPECIFIC.
FINDINGS ON. WHERE WE.
SIGNIFICANT PROGRESS AS WE
CONTINUE OF COURSE THOUGH TO
HAVE ON GOING IMPROVEMENTS. SO
WITH RESPECT TO THE ALTERNATIVE
ACCESS STANDARDS A PROCESS. WE
HAVE INSTITUTED- ESSENTIALLY A
MORE SPECIFIC A PROCESS BY
WHICH- HEALTH PLANS WOULD BE
ABLE TO REQUEST ALTERNATIVE
ACCESS STANDARDS. BEING VERY
CLEAR WHERE THEY COULD NOT WHAT
THEY HAD TO DO BEFORE THEY
COULD EVEN DO THAT. I KNOW
THERE BEEN QUESTIONS ABOUT HOW
DO WE ALSO MAKE SURE
CONSISTENCY AND STAFF TRAINING
GIVEN. YOU KNOW THE
SIGNIFICANT. AMOUNT OF THINGS
THAT WE GET GIVEN AS YOU ALL
KNOW THE MEDIC HOW PROGRAMS-
SIGNIFICANT SIZE. SO IN TERMS
OF A FEW OF THE THINGS THAT
WE'VE DONE WE'VE ESTABLISHED
PACIFIC REQUIREMENTS AROUND
DETERMINING HOW THE PLAN HAS A-
HOSPITAL. IS NOBLE OPTIONS. FOR
CONTRACTING WITH PROVIDERS
THROUGH THE- EXISTING REGULAR
STANDARD. I WILL. NOTICE THE
DIFFERENCE FROM FROM OUR
PERSPECTIVE IN IN WHAT WHAT
PROPORTION OF. QUESTED
STANDARDS WERE. APPROVED
CERTAINLY SOME OF THEM WEREN'T.
A COMPLETE BUT IT WAS ALSO THEY
WEREN'T COMPLIANCE THEY HADN'T.
ON THE WORK THAT WAS. OF ALL OF
THE REQUEST IN THIS AREA WE
APPROVED FIVE POINT FIVE
PERCENT- I KNOW THAT THE
QUESTION. A DOCTOR PAN TO JUST
ONE AND SERVE TO FLAG THAT FOR
YOU. WE HAVE ALSO ADDED
PURSUANT TO OUR CONVERSATIONS
WITH THE STATE AUDITOR THAT
PLANS MUST DEMONSTRATE ATTEMPTS
TO CONTRACT WITH AT LEAST TWO
CLOSER PROVIDERS WITHIN THAT
PROVIDER CATEGORY. I THINK WE
HAVE THIRTY SIX DIFFERENT
PROVIDER CATEGORIES THAT
OBVIOUSLY WE WORK TO READ THAT
ARE IN THE STATE STATUTE TODAY
SO THEY HAD TO. WORK WITH THOSE
DEMONSTRATE THAT THEY COULD NOT
ACHIEVE REASONABLE CONTRACTS
BEFORE THEY COULD EVEN REQUEST
AN ALTERNATIVE ACCESS.
REQUESTED THAT WAS IN PLACE-
TWENTY NINETEEN AND AN
IMPROVEMENT THAT WE MADE. WE
HAVE- AGAIN IS BIG CREATED AND
IMPLEMENTED THAT NEW PROCESS AS
WELL SOME OTHER THINGS FOR THE
JULY SUBMISSIONS THAT WE DID
FOR THIS YEAR'S- ODD-
CERTIFICATIONS THAT WE SUBMIT
TO THE FEDERAL GOVERNMENT IT IT
INCLUDES US DOING THAT US THAT
SAMPLING OF CERTIFYING THAT
THOSE REASONABLE ATTEMPTS HAVE.
HAVE OCCURRED TO THE PLANS ARE
REQUIRED TO SUBMIT
DOCUMENTATION TO US- AS
MENTIONED THERE ARE LOTS OF
THEM SO WE TO HAVE DONE US A
SAMPLING METHODOLOGY AND IF IN
FACT IT'S DETERMINED EITHER THE
PLAN DID NOT SUBMIT THE
REQUIRED DOCUMENTATION OR THAT
DOCTOR PATIENT ACTUALLY
DEMONSTRATE. A REASONABLE
ATTEMPT TO CONTRACT WITH
ADDITIONAL PROVIDERS WE HAVE
FOUND THOSE PLANS OUT OF
COMPLIANCE THE INSTITUTE OF
FINE SANCTIONS AND ARE
REQUIRING THAT TO PROVIDE OUT
OF NETWORK SERVICE AS. SO WE DO
HAVE SOME OF THAT HAPPENING
TODAY- AND WE DO A COUPLE OF
THINGS TO CONTINUE TO ENFORCE
THAT WE DO SECRET SHOPPING. TO
MAKE SURE THAT IN FACT THE
AVAILABILITY IN THE OFFERING OF
OUT OF NETWORK PROVIDERS IS
BEING GIVEN WHEN SOMEONE IS
CALLING TO TRY TO ACCESS
SERVICES AND WHEN THEY SEE IN
THE PROVIDER DIRECTORY THESE
FURTHER AWAY PROVIDERS THAT
THERE IS KNOWLEDGE PROVIDED TO
THEM. THAT THEY CAN MAKE A
DIFFERENT CHOICE- WE DO ALSO
HAVE IN PLACE. THAT WHAT WAS I.
THAT OUT OF NETWORK YEAH THE
OTHER THING I WOULD SAY I KNOW
WE HAVE A LOT OF CONVERSATIONS
WITH THESE WITH THE AUDIT THE
AUDIT TEAM ON THIS IS THAT
UNFORTUNATELY THEY'RE ALSO
CIRCUMSTANCES WORDS ALTHOUGH
THERE ARE OUT OF NETWORK
PROVIDERS IN THE AREA THEY MAY
JUST NOT BE WILLING TO TAKE
MEDI CAL PROVIDERS WHETHER MEDI
CAL PATIENTSWHETHER IT'S FOR A
GREAT SPACE OR OTHER BASIS WE
KNOW WE DO HAVE PROVIDERS THAT-
THAT JUST USED TO NOT WANT TO
SEE OUR BENEFICIARIES. SO
COUPLE OF THE OTHER CHANGES
THAT I'VE DONE WE DO WE CAN NOW
BEGIN POSTING THE MEDICAL
UPDATES WITHIN A MONTH OF WHEN
THEY'RE ISSUE TO THE PLANS AND
NOT WAITING UNTIL THE
CORRECTIVE ACTION PLAN IS
CLOSED WHAT. DO I DO BY NOW
THROUGH YOU DO BROAD
STAKEHOLDER BY WEEK BY MONTH
LEASE NOT BY FRANKLY BYE BYE
MONTHLY UPDATES THAT INCLUDE A
LOT OF INFORMATION BUT THIS IS
NOW INFORMATION THAT'S INCLUDED
IN THOSE AS WELL AS ANY
INFORMATION ABOUT. QUALITY
DEFICIENCIES ACCESS
DEFICIENCIES ANY. ANYTHING ELSE
ENGINES ARE CORRECTIVE ACTION
PLANS THAT HAVE BEEN TAKEN.
THESE UPDATES DO GO TO A VERY
BROAD ARRAY OF. OF STAKEHOLDERS
AND I'M GUESSING THE STAFF UP
THERE ALL GET. WE GET THESE
PROBABLY REGULARLY- ANYONE CAN
SIGN UP. BUT TO REALLY RESPOND
TO HOW DO WE MAKE SURE OUR
COUNTY PARTNERS ARE ARE GETTING
THIS INFORMATION GETTING IT IN
THIS TIMELY WAY. WE HAVE WE DO
HAVE GOOD PARTNERSHIPS THOUGHT
THE COUNTY ASSOCIATIONS BUT THE
SECOND SHE ACT. WHO WE WORKED
WITH AND THEY'VE AGREED TO HELP
MAKE SURE THAT THE COUNTY
EXECUTIVE IS ANOTHER COUNTY
ENTITIES REALLY KNOW THAT THIS
THIS PROCESS. THIS INFORMATION
IS AVAILABLE AND A SIGN UP SO
THAT THEY. CAN GET THAT ON THE
REGULAR BASIS. THERE ARE ALSO
QUESTIONS ABOUT HOW DO WE MAKE
SURE COUNTIES IN PLANS AND
OTHER INTERESTED. ENTITIES
REALLY UNDERSTAND WHAT ARE THE
DIFFERENT MODEL TYPES AND HOW
COULD I COUNTY OR A PLAN CHANGE
MODEL TYPES WE DO HAVE SOME OF
THAT INFORMATION ON OUR WEBSITE
TODAY. BUT WE ARE COMMITTED AND
TAP PROVIDING EVEN MORE OF THAT
IN MORE DETAIL AND HAVING THAT
POSTED TO OUR WEBSITE BY THE
END OF THIS YEAR. AND SOME WILL
DEFINITELY MAKE SURE TO. TO
MAKE SURE THAT BOTH OBVIOUSLY
THE COMMITTEES HAVE THAT AS
WELL AS OUR OUR OUR COLLEAGUES
AT THE STATE AUDITOR'S OFFICE.
WE ALSO ARE- AS DISCUSSED SORT
OF IN THE BEGINNING PROCESS OF
AN ARE A FEW THAT WILL BE
RELEASED NEXT YEAR. AND WE WILL
BE LOOKING TO MAKE SURE THAT
PLANS AND COUNTIES. ARE AWARE
OF WHAT'S GOING ON THROUGH THE
ARE FEW PROCESS. AND IF THEY
WISH TO CHANGE PLAN MODEL YPES
TO LET US KNOW SO THAT WE CAN
UNDERSTAND HOW THAT MIGHT
IMPACT THE R. F. P. OR EVEN
DURING OUR- PROCESS HOW CHANGES
COULD BE MADE ABOUT WHO'S
APPLYING TO DO WHAT KIND OF.
WHAT KIND OF PLAN AND IF WE ARE
MADE AWARE OF REQUEST I KNOW
WE'VE WE'VE HAD SOME MEETINGS
WITH SPECIFIC COUNTIES WHO HAVE
HAD THIS INTEREST- WILL
CONTINUE TO WORK WITH THOSE.
THOSE COUNTIES AND THOSE PLANS
ON ON ON NECESSARY STEPS FOR
THAT AND HOW THAT HOW THAT
MIGHT PLAY OUT. I'M AS I WAS
IDENTIFIED IN THE AUDIT REPORT
THERE WERE SPECIFIC INSTANCES
OF ACCESS CONCERNS THAT WERE
RAISED AND SO WE HAVE
CONTRACTED. ADDED TO OUR
CONTRACT WITH OUR EXTERNAL
QUALITY REVIEW ORGANIZATION ARE
EACH YOU ARE. TO REALLY DEVELOP
AND VALIDATE WHAT WERE THOSE
ACTIVE SITE. ISSUES IDENTIFIED
WHAT COULD BE THE POTENTIAL
CAUSES FOR THOSE. IS IT RELATED
TO THE ALTERNATE ACCESS
CONCERNS OR OTHER OTHER ISSUES
THAT ARE GOING ON. SO THAT WE
CAN THEN. HAVE ADDITIONAL
INFORMATION TO INFORM HOW WE
MIGHT BETTER. STREAMLINED AND
HELP PROVIDE TECHNICAL
ASSISTANCE ENCOURAGE OTHER WAYS
THAT WE CAN MAKE SURE THAT
WE'RE HAVING APPROPRIATE ACCESS
FOR OUR BENEFICIARIES. NO YOU
ALSO HAD- A QUESTIONS ABOUT THE
GROUPING OF THE EIGHTEEN
COUNTIES AND REALLY WHERE THAT
CAME FROM. I WILL SAY. I WAS
NOT DEEPLY PERSONALLY INVOLVED
IN THAT DECISION MAKING AT THE
TIME. BUT KNOWING FROM TALKING
TO THE STAFF THAT WERE HERE.
AND MY UNDERSTANDING OF IT
THERE REALLY A FEW REASONS. ONE
BEING THAT WE DID HAVE THESE
TWENTY EIGHT COUNTIES THAT ARE
LOOKING. MOVE INTO MANAGED
CARE. THERE WERE EIGHT THAT
PARTNERSHIP HEALTH PLAN WAS
INTERESTED IN PUTTING IN. YOUR
DESK AT THAT TIME. THE OTHER
OFFICE WERE NOT THEY'RE NOT
CONTINUE SO. OR THEY OR THEIR
FATE OR THAT THAT CODE THAT. WE
THEN OF THE OF MEANING THESE
TEAMS ARE CONTINUOUS SO IT
REALLY PROVIDED A WAY TO. ADD A
REGIONAL LIES MODEL. THAT ONE
WOULD MAKE SURE THAT HEALTH
PLAN TO CHOSE WHO CHOSE TO TRY
TO ENTER INTO THIS AREA WOULD
HAVE SUFFICIENT POPULATION. TO
REALLY MAINTAIN THE AND
ADMINISTRATIVE INFRASTRUCTURE
AND THE NETWORK IN THE SERVICE
DELIVERY THAT THEY NEED AS WELL
AS FROM THE STATE
ADMINISTRATIVE SIDE OF
DEVELOPING RATES. WE'VE HAD YOU
KNOW DOCTOR CAN I KNOW YOU AND
I TALKED A LOT ABOUT RATE
SETTING IT IS COMPLICATED AND
THE SMALLER THE NUMBERS OF
INDIVIDUALS IS REALLY HARD TO
THEN GET ACCURATE RATES. SO IT
WAS A COMBINATION OF THOSE
THINGS- AND THEN REALLY WITH
RESPECT TO OUR UPCOMING PLAN
REFER CHAIRMAN I TOUCHED ON IT
EARLIER. BUT WE ARE AS HAS BEEN
DISCUSSED WILL BE RECURRING. RE
PROCURING ALL OF OUR-
COMMERCIAL MANAGED CARE
CONTRACTS. AND SO THAT'S WHAT
WE- THAT ARE RELEASED IN THE
SECOND HALF OF TWENTY TWENTY IT
AFFECTS THIRTY SIX COUNTIES
SEXUALLY ANY NON COAST COUNTY.
RIGHT THERE'S A COMMERCIAL PLAN
IN EVERY ON BECAUSE COUNTY. AND
SO THAT THAT WILL BE RELEASED
IN IN THE SECOND HALF OF NEEDS
HE- CERTAINLY. ISSUES OF
QUALITY AND ACCESS ARE CRITICAL
COMPONENTS OF WHAT THAT ARE OF
PEOPLE BE LOOKING. LOOKING AT
HOW CAN WE EVALUATE OUR PLANS
ABILITY TO HAVE CONTRACT. AND
WHETHER AND DO THEY NEED TO BE
DOING OF NETWORK. BUT SHE. DOES
NOT SERVICES COULD YOU TELL
HEALTH WHICH. CORD IMPORTANT
THANK YOU FOR THEIR CONTRACT
WITH OUR SAFETY NET EDITORS ARE
ARE FQHCS ARE ARE EACH SEASON
ARE. OUR TRIBAL PROVIDERS WHO.
ARE IN SOME OF THESE PLACES
LIKE THE KEY CORE COMPONENT OF
WHERE PEOPLE CAN PROVIDE GET
ACCESS. TO THOSE WILL CERTAINLY
BE KEY ELEMENTS. WE ARE STILL
IN THE DEVELOPMENT OF THE R. F.
P. DOING A REALLY REALLY A
WHOLE REASSESSMENT OF THE
ENTIRE MANAGED CARE CONTRACT.
IT HASN'T HAD THAT SORT OF FULL
LOOK WE'VE HAD WE'VE HAD THINGS
ADDED IN BUT IF YOU ACTUALLY
READ THROUGH IT SOMETIMES
THINGS SEEM TO BE IN WEIRD
PLACES SO PART OF ITS CLEANING
THAT UP SO. IT'S MORE
UNDERSTANDABLE NOT JUST TO US
IN OUR PLANS BUT TO THOSE OF
YOU WHO ARE INTERESTED LOOKING
AT WHAT THE REQUIREMENTS ARE.
AS WELL AS THE REQUIREMENTS
THAT WE THINK WE NEED TO BE
ADDING. UP BOTH JUST FROM OUR
OWN EXPERIENCE BUT CERTAINLY
TAKING INTO ACCOUNT ANY AUDIT
FINDINGS THAT HAVE BEEN
OCCURRING OVER THE LAST SEVERAL
YEARS. AS WELL AS WE HAVE HAD
INPUT FROM SEVERAL. COLORED
ORGANIZATIONS WHO HAVE ALREADY
BEEN PROVIDING. INPUT AN
INSIGHT INTO WHAT THEY WOULD
LIKE TO SEE. AND THEN OF COURSE
WE DID I'M SURE YOU HEARD ABOUT
OUR RELEASE OF CAL AIM. LAST
WEEK WHICH IS OF COURSE A VERY
BROAD PROPOSAL ON THE MEDIC HOW
PROGRAM BUT ANY. FINAL
DECISIONS ON WHAT WILL BE IN
CALLING AIM AND HOW THEY AFFECT
MANAGED CARE PLANS THOSE WOULD
ALSO GO INTO THE NEW CONTRACTS
AS WELL- PRIOR TO THE- EAST.
THE R. F. P. SO REALLY WERE
WERE TARGETING THE FIRST
QUARTER OF TWENTY TWENTY. TWO
TO RELEASE OUT TO FOLKS. A LIST
OF THE SUMMARY OF THE CHANGES
WHETHER THAT'S- MODIFICATIONS
DELETIONS MOSTLY ADDITIONS. NOT
SO MUCH OF THE REGION'S UNLESS
THEY'RE NO LONGER RELEVANT. SO
THAT THE STAKEHOLDER COMMUNITY
AND LEGISLATURE CAN HAVE CAN
HAVE THAT CHANCE REALLY PROVIDE
US INPUT ON OTHER THINGS THAT
ARE MISSING THINGS THAT WE
SHOULD BE IMPROVING SO THAT WE
CAN. TAKE THAT ACTON
INCORPORATED INTO THE FINAL ARE
A FEW. THAT AS I SAID WILL BE
RELEASED AT THE END OF TWENTY
TWENTY. I AM I KNOW THERE WAS A
QUESTION YEAH THE ISSUE OF
DIRECT PROVIDER DIRECTORIES
WITH WAS REYES HERE AT. IT IS A
QUESTION IN THE LATER SECTION
AS WELL BUT I FIGURED I WOULD
JUST. DO THE ANSWER NOW SO WE
DO HAVE WE HAVE MODIFIED OUR
CONTACT WITH ARE YOU Q. RO. TO
BE TO BE DOING PROVIDER
DIRECTORY VALIDATION THEY WILL
BEGIN DOING THAT IN JANUARY AND
WE'RE LOOKING AT BEING ABLE TO
HAVE SOME OF THOSE INITIAL
RESULTS IN THAT FIRST QUARTER
OF TWENTY TWENTY. AND THEN HAVE
THAT HAVE HAVE THEM DOING THAT
ON GOING SO THAT WE ARE
IMPROVING AND HAVING PEOPLE
HAVE A PROVIDER DIRECTORY THAT
ACCURATELY REFLECTS WHO THEY
CAN THEY CAN SEE. SO I THINK
WITH THAT ALL AND I KNOW. GOT A
LOT OF TRYING TO. KEEP WITHIN
MY TIME. I WILL JUST FINALLY
SAY THAT YOU KNOW NOT TO
SPEAKING FOR MYSELF AND FOR THE
DIRECTOR BUT FOR THE TEAM
THAT'S HERE IN THE TEAM THAT
WORKS ON THIS. WE DO THESE JOBS
BECAUSE WE CARE ABOUT THE MEDI
CAL POP YOU CAN AND- WANT
PEOPLE TO HAVE ACCESS TO
SERVICES THAT THEY NEED. AND
HAVE THAT BE QUALITY AND
TIMELY. AND SO WE ARE
COMPLETELY PASSIONATE AND
COMMITTED TO CONTINUING TO DO
THAT. AS MUCH AS WE POSSIBLY
CAN. YOU KNOW THERE ARE
CHALLENGES AND A BIG PROGRAM
AND- MEANING AND ALL OF THOSE
TYPES OF THINGS THAT EXISTS
BUT- BUT YOU. COMMITMENT FROM
AUSTIN ALL OF US BACK IN THE
DEPARTMENT WHO. WHO WE DO THESE
JOBS BECAUSE THIS IS WHAT WE
CARE ABOUT DOING SO WITH THAT
I'M- HAPPY TO TAKE QUESTIONS OR
HAVE THE DIRECTOR ANSWER
QUESTIONS WHATEVER. WHATEVER
WORKS FOR YOU GUYS. THANK YOU
SO MUCH FOR YOUR PRESENTATION-
JUST THE CLIP AT THE TECHNICAL
QUESTION TO CLARIFY. THAT IS
THAT YOU MENTIONED AT ALL THE
COMMERCIAL PLANES. ARE UP FOR
OUR P. IN TWENTY TWENTY BUT
DODD OR MENTION ANTHEM ISN'T UP
TO TWENTY TWENTY THREES.
CONTINUE CLARIFIES SURE YEAH.
SO THAT WE'RE RELEASING THE R.
F. P. IN TWENTY TWENTY. FOR ALL
THIRTY SIX COUNTIES THE
EFFECTIVE DATES OF WHEN THOSE
NEW CONTRACTS WOULD GOING TO
PLEASE. US OUR TWENTY TWENTY
THREE IN SUMMER TWENTY TWENTY
FOUR JUST DEPENDING ON THE
CURRENT CONTRACT PLANTS BUT
WE'RE TALKING ABOUT. OKAY SO
THE OUR FEES GOING OUT SO
EVERYONE KNOWS WHAT THE ACTUAL
CHANGE RIGHT BECAUSE READING OF
SELECTION AND READY NESS AND
ALL OF THAT NEEDS TO HAPPEN
OKAY SO YES IT WILL TAKE A FEW
THE ACTUAL. IMPLEMENTATION OF
NEW PLANS WON'T HAPPEN UNTIL
TWENTY TWENTY TWENTY TWENTY
FOUR OKAY IT'S MY CLEAR FIGHT
YES CENTER RUBIO. THANK YOU. I
BELIEVE YOU STATED EARLIER
WITHOUT- YOU'VE ALREADY MADE
SOME CHANGES BASED ON THE ON A
RECOMMENDATION. AND DIE YOU
STATED THAT NOW. YOU HAVE A
SAMPLE SAMPLING METHODOLOGY TO
IS TO ENSURE THAT PEOPLE ARE
MAKING. SENATE WHAT TENDS TO
ATTRACT OUT NOT TELL ME ABOUT
THE- METHODOLOGY WHO CREATED
THAT IT. YOU'RE GETTING A
LITTLE MORE DETAIL THAN THAT I
MIGHT HAVE I HAVE FOR YOU FOR
USE LET ME FOLLOW BACK UP WITH
THAT IT REALLY IS GIVEN THE
BREADTH OF. THE NUMBER OF PLANS
WE HAVE NUMBER OF COUNTIES THAT
BEING ABLE TO REVIEW EVERY
SINGLE ONE IS A CHALLENGE AND
SO WE I I'D HAVE TO CHECK BACK
WITH MY STAFF ON. WHAT WAS A
SEPARATE SAMPLING METHODOLOGY
WE USED- AND OF COURSE OPEN TO
REFINEMENTS THAT TO MAKE SURE
THAT WE'RE REALLY CAPTURING AN
APPROPRIATE SAMPLE SO THAT WE
KNOW IF THERE ARE LARGER
PROBLEMS THAT EXIST BUT LET ME
GET BACK TO YOU ON THE SPECIFIC
DETAILS OF THAT METHODOLOGY.
CAN'T THINK I LOOK FORWARD TO
HEARING YOUR- HE ALSO STATED
THAT- NOW YOU'VE TAKEN- SOME OF
THE RECOMMENDATIONS IN YOUR
POSTING. THE AUDIT BEFORE
CORRECTION ACTION IS TAKEN- IS
THERE A AN ESTABLISHED TIMELINE
TO POLLSTERS AUDIENCE OR YOU'RE
JUST. SURE YES SO YES SO WE- WE
ARE POSTING THEM WITHIN THIRTY
DAYS OF ISSUING THEM TO THE
HEALTH PLAN. THANK CANCER
THAT'S SOMETHING. THANK YOU AT
SEVERAL QUESTIONS ABOUT SOME
SPECIFICS- REGARDING YOUR
PRESENTATION- SO FIRST OF ALL
YOU MENTIONED AND THE
ALTERNATIVE ACCESS STANDARD
PROCESS THAT- THERE CERTAIN
REQUIREMENTS YOU JUST MENTIONED
REQUIREMENTS CAN YOU MORE%
REQUIREMENTS- THAT ARE NEEDED
FOR. THE A TO RECEIVE AN
ALTERNATE. I GUESS AN ALTERNATE
ACCESS STANDARD SURE WHAT WHAT
DO YOU HAVE TO MEET IN ORDER TO
JACQUI BE GRANTED ONE SURE SO
THE TO VERY SPECIFIC ONES THAT
I KNOW OFF THE TOP OF MY HEAD.
ONE IS THE REQUIREMENT TO
SUBMIT DOCUMENTATION ON THE
EFFORTS THAT WERE MADE TO
CONTRACT. THE SECOND BEING THAT
THEY HAVE TO DEMONSTRATE AYE
EVEN BEFORE THEY SUBMIT AN
ALTERNATIVE ACCESS REQUIREMENT
THAT THEY HAVE IN FACT TRIED TO
CONTRACT AND WHAT WERE THE
REASONS WHY THAT CONTRACT COULD
NOT BE AFFECTED WAITED WITH A
PARTICULAR PROVIDER AN AT A
MINIMUM TO WITHIN EACH.
CATEGORY OF THE THIRTY SIX OR
HOWEVER MANY DIFFERENT PROVIDER
TYPES WE HAVE THAT THAT THAT
THAT DEMONSTRATION HAS BEEN
DONE AND THE REASONS WHY THAT
CONTRACT WAS NOT ABLE TO BE
ENTERED INTO. OKAY THAT STILL
SOUNDS A BIT VAGUE- SO WHAT
KIND OF REASONS ARE ACCEPTABLE
WHAT KIND OF REASONS WOULD NOT
BE CONSIDERED ACCEPTABLE SO THE
PERSON REFUSE IT. SAID TO GIVE
REASONS THAT'S FAR BUT WHAT
REASON SO IT JUST SAY YOU KNOW
WE OFFERED THEM THE STANDARD
MEDI CAL RATE AND THEY SAID WAS
TOO LOW SAID ACCEPTABLE. OUR
KIDS ARE YOU ARE YOU REQUIRED
TO OFFER A HIGHER RATE LIKE-
FOR EXAMPLE AT LEAST MEDICARE
OR ABOVE RIGHT I MEAN. WE'RE
TALKING ABOUT SO AT IT SO WHAT
OR REASONS HOW MUCH WHAT KIND
OF EFFORTS DO YOU ACTUALLY HAVE
TO USE THE SAY THAT YOU
ACTUALLY TRIED SUFFICIENTLY.
WELL SENT THEM A LETTER DATED
ANSWER I MEAN THAT TO ME WOULD
BE THAT WOULD NOT BE REASON
YEAH. CAN YOU GIVE ME SOME
EXAMPLES OF THINGS YOU ACTUALLY
HAVE TO SHOWN YOU'VE DONE THAT
DOCUMENT. THAT I WE TRIED A. B.
C. AND D. AND. TELL ME WHAT
KIND OF THINGS. DO THEY
ACTUALLY HAVE TO TRY THAT ARE
CONSIDERED FOR THE REVIEWERS
SAY- THEY ACTUALLY REALLY TRIED
VERSES WELL YOU KNOW THAT WOULD
NOT BE SUFFICIENT. SURE SO LET
ME. JUST MAKE SURE WHAT I HAVE
THE ANSWER THAT- AND THEN IF WE
NEED TO AND I KNOW THERE WAS A
REQUEST FOR OR THE PROCEDURES
THAT WERE USING WE CAN PROVIDE
THOSE TO YOU WE HAVE SOME
COPIES WE CAN GIVE YOU TODAY
BUT ALSO SEND USE THAT ALL THE
MEMBERS HERE. I THINK I THINK
THAT YOU KNOW CERTAINLY
PROCEDURES SYSTEM SOMETHING WE
WANT TO BE VERY INTERESTED BUT
ALSO THE STANDARDS RIGHT THE
MINIMUM STANDARDS PEOPLE ARE
SUPPOSED TO MEET AND ARE FOR
THEM TO BE ABLE TO SENSE AGAIN
NOW THAT'S WHAT WE'RE SAYING SO
WHAT WHAT IS IT THAT YOU
ACTUALLY HAVE TO DO. BEFORE.
PART IN SAYS OKAY WELL USED.
LOOKS LIKE WE ARE AT AN IMPASSE
AND THE ARE ONLY ALTERNATIVE IS
TO SAY ONE TWO HUNDRED MILES OR
THREE HUNDRED MILES AWAY SURE
SO THE THINGS THAT I CAN SPEAK
TO MORE DIRECTLY AND THEN AGAIN
I THINK HAPPY TO HAVEOF RATES WERE OFFERED WE DON'T
HAVE A SPECIFIC STANDARD ON IT
HAS TO BE THIS KIND OF RATE OR
THAT THAT NOT. AS YOU KNOW
GREAT. FOR SERVICE AMERICA AND
THEIR CAP DID SO A COMPARISON
TO OTHER RATES- CAN BE A
CHALLENGE BUT BUT REALLY
LOOKING AT WHAT OTHER WHAT
TYPES OF RIGHT. THEY ARE ARE
THEY OFFERING WHAT THE RATE.
DID THE- IF. OTHER IN THE
COUNTY. DETAILS BUT WOULD BUT
LET US HAVE THE PEOPLE WHO KNOW
THAT BETTER THAN ME- THAT AND
THEN WE CAN HAVE A FOR A
FURTHER CONVERSATION OKAY SO.
THAT'S PARTICULARLY IMPORTANT.
IS WELL WHAT. I DID RATES SEND
A COW AND WE HAD THE RATE
SETTING HEARING AND HE KNOWS
THE SAMPLE COSTA TESTIFIED
TODAY PAID MEDICARE RATES WERE
WHEN I THINK WAS ANTHEM WHO
CAN'T OURS. DALY SAID THAT.
SOMETIMES HAS TO DO WITH THE
LEVEL OF- ESSENTIALLY OVERHEAD
HIM MISS MEAN BURDEN ABSOLUTELY
THE PLAN EXPECTS. OF THE SO
WHICH OF COURSE RAISES THE COST.
AT THAT CAN BE AN ISSUE AS WELL
THERE'S OTHER REASONS AS WELL
SO I THINK IT'S IMPORTANT THAT
WE NEED- WHAT HURTS WERE TAKEN
TO TRUST RATES ADDRESS. YES AND.
JEFF IS THAT PREVENT PEOPLE
FROM CONTRACT WITH THIS PLAN SO
I THINK THOSE MINIMUM STANDARDS
ARE GOING TO BE IMPORTANT LIKE
HOW IT ASIDE FROM JUST THE
PROCESS HOW THE PEOPLE REVIEW
IT WHAT. THIS S. A FOR NOW YOU
COULD DO MORE. YOU TALKED ABOUT
A REASONABLE CONTRACT. THE END
A DEFINITE REASONABLE SO WHAT
IS CAN YOU PROVIDE MORE
SPECIFICITY IS TO WHAT'S
REASONABLE AT A AT A L. I THINK
WE HAVE ESTABLISHED IN THE
STATE STANDARDS FOR ACCESS TO
CARE AT THAT WORKS CLEARLY THE-
REASONS. THAT'S THAT. THE STAND
ESTABLISH REASONABLE HI. YEAH
AND CERTAINLY I MEAN OBVIOUSLY
THE ABILITY TO ALTERNATIVE
ACCESS ALSO PART OF THE STATUTE
IT RECOGNIZING THAT THERE ARE
GOING TO BEAT THAT MAY NOT BE
POSSIBLE TO BE MAD AND I THINK
THAT AGAIN CONTINUING IMPROVE
NGUYEN BUT HOW HOW MORE OFTEN
DO WE REQUIRE. OUT OF NETWORK
ACCESS AND THEN. BURKE ACCESS
ARE THOSE. DID YOU IN SO ALL
ALL TOTALLY APPROPRIATE
QUESTIONS EIGHT I DO THINK
WE'VE MOVED WE'VE MOVED TO THE
LINE AN IMPROVED IT BUT WE WANT
TO CONTINUE TO IMPROVE IT AND I
WOULD LOVE TO HAVE A
PARTICULAR. IS WITH YOU I THINK
YOU CAN REALLY THINK ABOUT WHAT
I THINK SHOULD BE HOW DO WE BE
MORE SPECIFIC- I'M IN FROM AN
ANALYTICAL PERSPECTIVE AND LESS
OF THE SUBJECTIVE PERSPECTIVE
SO I. SHEET THAT IN AND HAPPY
TO CONTINUE. ANYTHING RESULT
IMPORTANT FOR THE PLANS AND
THAT'S ABSOLUTELY. THE
CONTRACTS ARE THEY HAVE TO KNOW
WHAT THEY'RE WHAT IT'S BEING
EXPECTED OF THEM AS WELL AND-
AND TO WHAT DEGREE THAT THEY
MAY BE EXPECTED TO HELP CREATE
THE KIND OF NETWORKS THAT. WE
WANT THEM. THE THAT'S TIED INTO
COMMENTS THAT WERE WILLING TO
PAY AS WELL SO- THAT'S
SOMETHING VERY IMPORTANT WHEN
THE THINGS THE OTHER ALSO
POINTED OUT WAS IN TERMS OF THE
ACCOUNT COMMUNICATIONS A PRE
SHEET DISEASE. YOU'RE PUTTING
OUT THE- WHILE THE FINDINGS OF.
WE SHOULDN'T PRIOR TO DOING
CORRECTIVE ACTION PLANS- WHAT
ELSE I MEAN. IT I THINK THAT
WHAT THE CHALLENGES OKAY THAT
WE HAVE IS THAT- YEAH COUNTY.
IN CALIFORNIA WE EXPECT THE
COUNTIES SO DURING THE BUDGET
SUBCOMMITTEE WE EXPECT THE
COUNTIES TO BASICALLY BE ON THE
FRONT LINES THEY'RE THE ONES
WHO ARE YOU KNOW AND ROLLING IN
ELIGIBILITY AND FOR YOUR OFTEN
TO PULL WHO. IF YOU FACE TURNED
TO HELP FOR VISITS TO THE HAD
THE CONTACT WITH THE THAT. AND
SO WHAT KIND OF SAUCE. APPS ARE
YOU PS TAKING TO TRY TO IMPROVE
THAT PARTNERSHIP WITH THE
COUNTY SO THE COUNTY CAN BE
BETTER SO. YOU KNOW PLAN TYPE
WE'LL GET TO THAT. BUT JUST THE
COUNTY BEING ABLE TO. HELP.
CONSTITUENTS WHO ARE ALSO OUR
BENEFICIARIES TO PROVIDE BETTER
SERVICES FOR THEM SO- IS BEYOND
WHAT WE'RE DOING NOW I MEAN I
HOPE THIS TRUE FATHER OF ART IS
THAT IT IS. WELL ENCOURAGE THE
DEPARTMENT TO ENGAGE AND
PERHAPS SOME ARE PROACTIVE IN
ROBUST PARTNERSHIP WITH
COUNTIES PARTICULARLY A RURAL
COUNTY SWITCHER SMALLER HAVE
FEWER. RESOURCE ITSELF TO BE
ABLE TO DO THIS SO. FOR MORE ON
THE STATE AND- COUNTY THAT'S UP
TO TAKE A MORE SLACK ON THEIR
OWN SO WHAT IS WHAT ARE SOME
THE THINGS THAT THE EIGHTY S.
IS CONSIDERING IN TERMS OF
MOVING THAT. WITH SEVERAL
COUNTIES. SURE. SORT OF MORE
BROADLY- WORKING WITH OUR
COUNTY ASSOCIATIONS WITH BOTH
THE SECOND SHE ACT ON HOW DO WE
BETTER REACH THE COUNTY
EXECUTIVE. AND THAT OUR
BUSINESS AT AT HI TOWNIES.
SHOUT YES WE HAVE HAD THOSE
DISCUSSIONS WANT TO PROVIDE
THAT TECHNICAL THE STATE. IN
THINKING WHAT WHAT. THE OP WHAT
THE CHALLENGES ARE. AND HOW WE
MOVE FORWARD FROM THAT SO OF I
WILL SO IF I WAS SOMEONE AND
ROLL COUNTY. THE EXACT BUT THE
PERSON WHO DID OVERSEE OUR
HEALTH AND HUMAN SERVICES- IS
THERE A PARTICULAR PERSON I
SHOULD REACH OUT TO INDEED CS
TO TALK ABOUT MY CONCERNS ARE
THINGS I NEED HELP WITH IT
FOURTH THAT WHO THAT PERSON.
SURE IT'S CERTAINLY ME MYSELF
COULD BE THE DIRECTOR OR OR OR
STE BROOKS. THREE OF US WOULD
BE THE MOST APPROPRIATE CONTACT.
ALL RIGHT WELL YOU KNOW THAT
ALL OF YOU ARE VERY BUSY
THERE'S A LOT GOING ON. YES BUT
I MEAN I. THE MORE PROACTIVE
THAN SIMPLY. FOR YOU CALL US
WHEN YOU NEED US I MEAN. I'M
THINKING THAT PARTICULARLY WITH
PEARL COUNTIES WHERE THERE'S
FEWER STAFF. THERE'S PERHAPS
RIGHT. THE MAYBE PEOPLE WERE
VERY PLEASURABLE ABOUT THIS
PROCESS BUT THAT GIVEN THE FACT
THAT THEY USE OFTEN HAVE FEW
RESOURCES OR LESS ABLE GET
CONSULTANT STIR LIST ABLE THEY
MAY NOT THEY MAY NOT NOW. TWO
YES I HAVE AS MUCH EXPERIENCE
POSSIBLY MAYBE NOT. ASSISTANCE
THIS GUY AND WHAT HAPPENS IS
THEY'RE NOT RUNNING THE THEY'RE
NOT A BECAUSE THEY'RE NOT
RUNNING THEIR OWN SYSTEM THEIR
INTERFACING WITH MANAGED CARE
PLANS TO THANK. AM TO GET THE
CONTRACTS. TODAY THEY DON'T
HAVE TO WRITE THEN I HAVE TO
TYPE IT IT'S NOT LIKE THE
COUNTY AS A SIGN UPS AS YET.
AND WITH UPPER NO NOT RATE
CORRECT. FOR DETAILS TO BE MORE
PROACTIVE IN GETTING THEIR
INPUT AND ALSO NOT JUST WAIT
FOR THEM TO REACH OUT BUT ALSO
SAY. WHAT ARE SOME OF THE
ISSUES WHAT CAN WE DO TO HELP.
OUT TO BE SURE THAT THE PLAN.
EXPECT THEM TO. YOU HAVE A
MINUTE TO DO THAT. ALL RIGHTS
AND- I CERTAINLY LOOK FORWARD
TO HEARING FROM ANY RURAL
COUNTY TO FEEL. DONE AND
HOPEFULLY WE CAN WORK IN
PARTNERSHIP BE SURE THEY'RE
BETTER. I REALLY UNDERSTAND THE
QUESTION. FOR INFORMATIONAL
PURPOSES- I BELIEVE IN THE
AUDITOR'S REPORT TO CONCLUDED
THAT THE REGIONAL MODEL
BENEFICIARIES WOULD HAVE BETTER
ACCESS TO MANAGED CARE THE
TRANSITION OVER TO A COUNTY
ORGANIZED HOLD SYSTEM
EXPLAINED. CHECK YOUR ISSUE IF
YOU AGREE WITH THAT. I MEAN I
THINK A AYE AYE AYE. POSSIBLE I
THINK THERE ARE DIFFERENCES
BETWEEN THE AREAS OF THAT WERE
BEING COMPARED TO IN IN IN SOME
DIFFERENT WAYS TERMS OF WHAT
SHIP. DOES AND HAS BEEN DOING
AND WHAT THE TEAM'S. THAT WERE
OUT LATE JOINT PARTNERSHIP
MODEL. FROM THE PARTNERSHIP
PERSPECTIVE- SO- EIGHT I DON'T
NECESSARILY IF SUBSCRIBE TO THE
IDEA THAT A PARTICULAR MODEL IS
THE BEST ONE I THINK IT'S
REALLY MAKE SURE WE HAVE PLANS
WHO ARE MISSING IS THAT THEY
NEED TO DO I THINK ALL OF THE
WORK WE'RE DOING OR WERE. YOU
IN CAL ABOUT THING THAT AND SO
THAT YOU AREN'T SEEING
DIFFERENT IS A OF THESE PLAN
MODEL TYPES- SO A. B. YOU KNOW
I WOULDN'T NECESSARILY SAY THE
CODES MODEL IS ALL THE. BEST MY
I THINK WE DO OTHER MODEL
SUPPER BETTER. ALL COAST PLANS
ARE SOME OF OUR BETTER PLANS WE
ALSO DEFINITELY HAVE OTHER
LOCAL PLANS WE HAVE KAISER WE
HAVE OTHERS ALSO PROVIDE
SIGNIFICANT ACCESS AND SO. I
DON'T. REALLY YOU KNOW
PRESCRIBE THAT ONE PARTICULAR
MODEL IT'S HOW WE ASSESS WHAT
THE NEEDS OF THAT REGION ARE.
AND HOW WE ALSO HAVE PLANS THAT
ARE INTERESTED. IN DOING WORK
IN THOSE REGIONS AND THEN HOW
TO BE HOLD THEM ALL CAN. BE
ACCOUNTABLE TO THE STATE THAT
WE'VE ALL SAID ARE NECESSARY
FOR BENEFICIARIES. WELL.
SUGGESTIONS ON HOW WE CAN
IMPROVE SERVICES. WHAT WOULD BE
YOUR TOP. TAKE BACK. I THINK
GEN AND I CAN WE CAN MAKE SURE
THAT YOU GET A COPY OF THE CAL
A PROPOSAL WHICH WAS RELEASED
LAST TUESDAY I THINK GENERALLY
AT THE HIGHEST LEVEL I THINK
THE WAY THAT WE'RE TRYING TO
TAKE MEDICAID OR MEDICARE ON
CALIFORNIA'S. PACIFIC OKAY MORE
BROUGHT. ARE YOU WITH. HI JUST
AS THE BALL. POPULATIONS
CHILDREN WITH SPECIAL NEEDS THE
HOMELESS- AND PERSONS THAT THAT
UTILIZE EMERGENCY DEPARTMENTS A
LOT AND TRYING TO FIGURE OUT
HOW TO ADDRESS THE HEALTH THE
HEALTH SYSTEM CAN'T COVER IS
NOT EVERYTHING A CAN'T BE
EVERYTHING WITH ME DOING A LOT
MORE THAN THIS RIGHT NOW IN
TERMS OF LINKING. PEOPLE THAT
HAVE HEALTH ISSUES TWO OTHER
SERVICES LIKE THE WHOLE PERSON
CARE A WHOLE PERSON CAUGHT
BOTTLE SO I THINK ONE THING FOR
SURE WE- EXPAND OR- CHANGE
AMERICA PROBLEM IS THEY HAVE A
MORE WHOLE PERSON APPROACH. AND
LOOK AT THE SOCIAL. MAKE SURE
THEY HAVE ACCESS TO- A FOOD
RESOURCES FOR EXAMPLE MAY. HELP
DIGITAL SYSTEMS THINGS THAT ARE
GONNA HELP STABILIZE THE MORE
BROADLY THAT THEN IMPACTS OUR
HEALTH POSITIVELY SO I THINK WE
TRY TO TAKE A BROADER LOOK. AT
AT HEALTH BEING JUST NOT THE
CARD. ITSELF BUT THE KIND OF.
BACK THAT PERSON'S LIFE THAT
AFFECT THEIR HEALTH THAT'S ONE
THING. THAT WE'RE LOOKING AT.
CONTACTS AND SOMETHING THAT
YOU'RE GOING TO BE SEEING-
COMING TO LATER THIS YEAR WE
ARE WE'VE ALREADY RELEASED THE
LEAD SELF WAS OBVIOUSLY AND
MAIN LEGISLATION AND YOU'RE
POPPING HAVE A MEASURE WHERE
MORE SPECIAL HEARINGS I'M
GUESSING ON THIS. GOING TO BE
ABLE TO. YEAH. IT'S A KIND OF
MORE BROADLY MANY DIFFERENT EL.
THURMOND THOSE THINGS WE HAVE
BEEN ABLE TO DO. FOR A GRAY
ASSEMBLY OF BROUGHT ACROSS THE
COLD MEDI CAL- THAT WOULD LIKE
TO ADD THAT WE'D LIKE TO
INCORPORATE MORE AND I WOULD
ADD TO THAT I THINK THE POLICE
WHERE WE HAVE THAT LEAST OF
THAT TODAY JUST GIVE IN
WEARABLE PERSON CARE. HAS BEEN
WHERE THE MONEY BEEN FOR THAT
OBVIOUSLY IN THE- BUDGET. THE
HUNT DOLLARS FOR. SERVICES THE
HOUSING SERVICES. HAVING PLACES
FOR RECRUITMENT OF CARE
SOBERING CENTERS- HOW DO WE DO
BETTER TRANSITIONS OUT OF. OUT
OF NURSING FACILITIES OR OTHER
INSTITUTIONS. BUT AS IS BASIC
INFRASTRUCTURE THAT THAT WE-
HAD IT. AGAIN IS PROPOSED IN
THE CAL AIM PROPOSAL AND WHY IT
WILL NEED. ABOUT UP FROM A
BUDGETARY AND LEGISLATIVE
PERSPECTIVE HOW DO WE MOVE THAT
NEEDLE. WE FOR TO BUILD. STRONG
THERE REALLY IS NECESSARY OF
THOSE COUNTY. NOT AS MUCH AND
NOT AS MUCH CAPABILITY SO HOT
FROM REGIONALIZATION OR OTHER
THINGS THAT WE CAN DO AND THAT
WE CAN SUPPORT AT THE STATE
LEVEL TO HELP THEM. WE THEN
HAVE THOSE BEST PRACTICES WE'VE
SEEN. SMALLER COUNTIES PLASTER
COUNTY IS ONE OF OUR TOP THE
WHOLE PERSON CARE ENTITIES
WHO'VE DONE A LOT GOT CUTS YOU
KNOW SIGNIFICANT NUMBERS OF
PEOPLE FROM THEIR POPULATION
INTO SUPPORT OF HOUSING SUPPORT
OF SERVICES THAT IN THE END IS
GOING TO IMPROVE THE QUALITY OF
LIFE. THAT TALKING ABOUT. THAT
THE FUTURE OF WHAT WE'RE TRYING
TO GET TO IT IS BIG BROAD AT
THAT HAS STATUTORY IN BUDGETARY
CONSIDERATIONS THAT WILL ALL
NEED TO HAVE THOSE
CONVERSATIONS ABOUT BUT IT IS
SOMETHING WE- EXCITED ABOUT
ANYTHING. GET THE KNACK. OF A
MEDICAL PROGRAM IT IS MORE WE
WANT IT TO BE REALLY FILLING IN
THOSE GAPS THAT EXIST TODAY. IS
THE CAL GAME ALL RIGHT ONLINE
OR DO YOU NEED TO PROVIDE. IT
IS THERE'S A WEBSITE. YOU HAVE
A AS ABOUT HOLD AID ON TELLING
HIM THAT WE DID SHARE OUT BOTH
WITH OUR LEGISLATIVE STAFF AS
WELL AS THE BROADER
STAKEHOLDER- WE DID HAVE OUR
INITIAL KICK OFF SO THERE'S A
LONG PAPER IF YOU WANT TO.
UNDER NEW PAGES SETS ON THE ON
THE. PROVIDE WHATEVER
ADDITIONAL INFORMATION. TO YOU
ALL AS AS NECESSARY AND
APPROPRIATE I KNOW WE DID. SO
ONE WITH WITH THE STAFF- ON
MONDAY WE DID HAVE OUR LARGER
STAKEHOLDER MEETINGS THAT WE
BOTH HAVE A OVERALL ADVISORY
COMMITTEE AND A BEHAVIORAL
HEALTH FOCUS STAKEHOLDER
ADVISORY COMMITTEE WILL THAT BE
RELEASED AND HAD WE WALK
THROUGH. HOURS OF CONVERSATION
WITH THEM AND THEN WE'VE KICKED.
THE MULTI. WE HAVE LIKE A SIX A
TWELVE PAGE WILL MAKE SURE YOU
GET. ORDER READER SO USERS.
REMIND THE HUNDRED PAGE IF YOU
CAN. AND ALL OF THEM. AT ALL
THANK YOU THAT'S IT THANK.
THANK YOU SENATOR RUBIO I
APPRECIATE THE VISION- AND
CERTAINLY- SUPPORTIVE OF THAT
SOMEONE WHO IS THE BACKGROUND
PUBLIC HEALTH AND CERTAINLY-
APPRECIATES THE SOCIAL TERMS
HEALTH. WHICH BUT ALSO MEANS WE
NEED TO GET THE FUNDAMENTALS
RIGHT- SO RIGHT AND SO WE HAVE
A LOT OF WORK TO DO- WE NEED TO
BE SURE PEOPLE CAN GET ACCESS
SO YES. ACCESS TO HEALTH. ANY
PERCENT WE HAVE ANOTHER. IT'S
REALLY IMPORTANT WHEN YOU
REALLY NEED IT. CAN'T GET IT
WHICH IS THE ISSUE THAT WE'RE
DEALING WITH IN THE AUDITOR'S
REPORT OF THE NEEDS OF
SPECIALTY CARE TO CAN'T GET IT
THE PRIMARY CARE TO CAN'T GET
AT THAT'S A PROBLEM- WE HAVEN'T
TOUCHED ON BE. SO THAT'S WITHIN
THE DOMAIN OF THE EIGHTY S.
RIGHT AND WE'VE HAD IS HEARINGS
AROUND THAT AND THEN WE TO MORE
TALK ABOUT SUBSTANCE USE
TREATMENT ACCESS AS WELL SO.
EVEN WITHIN THE REALM OF HELP.
WE STILL HAVE A LOT. THIS IS
PARTICULARLY CUTE IN A RURAL
COUNTY SWITCHES ARE WHAT THIS
AUDIT REPORT. STILL WITH I
WOULD MAKE NOTE THAT-
APPRECIATE- YOU'RE SHARING THE
TIMELINE THAT- WE DO PLAN TO
HAVE ANOTHER INFORMATIONAL
HEARING TO TALK ABOUT. WHAT'S
GOING ON WITH MANAGED CARE IN
THIS REVIEW OF THE R. P. AND SO
FORTH AT THE BEGINNING OF THE
YEAR- SO WE LOOK FORWARD TO
HEARING FROM STAKEHOLDERS AND
ALSO GIVING YOU. SOME OF OUR
THOUGHTS RELATION TO- TO THE
PART IS GOING FORWARD WITH- THE
OTHER THING I. WANT TO TOUCH-
IS THAT AS I KNOW THE STREET
PUTTING TOGETHER THE BUDGET-
FOR NEXT YEAR- WE TALKED IT OUT.
REPORT REFER TO DIFFERENT
MANAGED CARE MODELS I KNOW
DIRECT. SIX MADE REFERENCE TO
THAT WELL I DON'T THINK THAT
NESTLE CHANGING MODELS. SOLVES
ALL THE PROBLEMS- I DO THINK
THAT COUNTIES COULD USE SOME
ASSISTANCE AND THINKING ABOUT
DIFFERENT MODELS- SOME WHICH I
UNDERSTAND THE PERHAPS REQUIRED
LEGISLATION IF WE WANT TO
EXPAND KOS BUT THERE'S ALSO
OTHER. IS AS WELL. AND EVEN WE
STAYED WITH A HE'S NOT. PLAN
WHAT. ARE SOME OF THE
CHARACTERISTICS- SO EVEN WITHIN
EACH MODEL REALLY WHAT THE
DIFFERENT CHARACTERISTICS ARE
PERHAPS PROVIDING MORE
TECHNICAL ASSISTANCE TO COUNTY
SO THEY CAN HAVE MORE GUIDANCE-
IN IN THAT IS DO YOU SEE THAT
AS BEING SOMETHING THAT THE
PART HEALTHCARE SERVICES WILL
BE ASKING IN THE BUCKET TO SOME
FUNDING BY PLEASE WITH CLOSEST
FOR. ARE FOUND OUT BE ABLE TO.
EXAMINE OUR EVEN WORK WITH THE
MODELS THAT THEY ARE CURRENTLY
DEALING WITH- IN TERMS OF BEING
YOU CAN BE ABLE TO WORK MORE
EFFECTIVE. IN MAKING MEDI CAL
WORK FOR THE RESIDENTS OF THEIR
COUNTY I WOULD SAY THAT I MEAN
WE OBVIOUSLY TOOK. AT OF THE
RECOMMENDATION I THINK-
SOMETIMES. I WISH THEY HAD A
YES NO MAYBE SO BOX TECH- AND
THE OTHER WAY WE RESPOND THE
OTHER RECOMMENDATIONS BUT- I'M
WE HAVE TAKEN NOTE OF THAT- I'M
GONNA. THE OAKS ARE POOR OF IN
TERMS OF THE LEGISLATURE'S IN
THE HONORS INTEREST IN SEEING
THOSE SPECIAL RESOURCES ARE
AVAILABLE. COMMA BUT YOU KNOW
WHAT THE GOVERNOR IS GOING TO
DO. OWNERS OFFICE TO DO BUT
IT'S REALLY CAMINO WE CERTAINLY
HAVE NOTED THAT IT'S IT WAS A
REQUEST AND SOMEONE TAKE A LOOK
AT INTERNALLY. ALRIGHT WELL I
WILL URGE I THINK THE OTHER
RECORDS HAS POINTED OUT INDEED
FOR THE S. AND I WOULD URGE
THAT. SOME RESOURCES AS PRIDE
PRIZE A PERCENTAGE THE ENTIRE
MEDI CAL BUDGET RIGHT ABA LEAKY
MUCH MUCH MUCH LESS THAN THE
ANNUAL VARIATION THAT MEDI CAL
EXPERIENCES FROM YEAR TO YEAR
ALTHOUGH I KNOW WORKING HARD TO
TRY AND THEIR OF THAT- BUT I
THINK THAT. GIVEN SOME OF THE
FINDINGS AND THE TWO AUDITS
FORGET DOING AT A GIVEN THE
NATURE OF AND I APPRECIATE THAT
YOU'RE ACTUALLY TAKING THIS ON
WERE LET'S LOOK AT THE WHOLE
MEDI CAL PROGRAM AND HOW DO YOU
PROVE IT YOU'RE REVIEWING ALL
THE OUR FEES. WE NEED TO BE
SURE THE PEOPLE ON THE GROUND
TO. YOU KNOW- ACTUALLY FACING.
BEEN FISHERIES OF THE OTHER
DAY- ROLLING NUMBER GIVING
ASSISTANCE. HAVE SOME HELP IN
BEING ABLE TO BETTER UNDERSTAND
AND ALSO PERHAPS. HAVE A BIT
MORE SAY IN. THE FUTURE OF
MEDICARE HOW THAT'S INTERCOUNTY
SO. LET'S PUT IT THAT WAY.
THANKS FOR HAVING THAT
DISCUSSION IN BUDGET.
SUBCOMMITTEE AS WELL OKAY SO
THERE YOU GO ALL RIGHT ANY
OTHER QUESTIONS. OKAY I THANK
YOU FOR YOUR PRESENTATIONS
WE'RE GONNA DO IS WHEN I BRING
UP OUR NEXT PANEL BUT FOR THE
Q. NA BECAUSE IT MAY INVOLVE
YOU WILL ASK IT ALSO FOR THE
QUEUE IN A FOR THE NEXT PANEL
YOU CAN STAY UP HERE IF YOU
WISH- WE JUST WE JUST NEED FOR
CHAIRS FOR THE- NEXT PANEL SO
YOU CAN JUST GO AND STAY UP
HERE. QUESTION WILL BRING UP
THE- SPEAKERS OKAY THE SPRING
OF OUR NEXT. ONCE WE HAVE DR-
BAR SOME STARKEY THAT PRONOUNCE
THAT CORRECTLY. CASIRAGHI ABOUT
IT IS THAT CALIFORNIA MEDICAID
PRESENT ANTHEM BLUE CROSS- ABBY
TOTENMEDI CAL PROGRAM OFFICER
CALIFORNIA HEALTH AND WELLNESS
AB- TURNIP SEED SENIOR DIRECTOR
OF EXTERNAL REGULATORY AFFAIRS
OF PARTNERSHIP HEALTH PLAN AND
JIM MILLER DOCTOR INTO MILLER
BUTTE COUNTY HEALTH OFFICE. AND
DO WE HAVE ENOUGH ROOM HERE YES.
THE. CAN SOMEONE IS SERGEANTS
CAN HELP ASSIST WITH THE.
STEVIE SURE OF MICROPHONES FOR
ONE HERE. WE HAVE FIVE PEOPLE.
OKAY I THINK ZERO ONE PERSON I
DID INTRODUCE HERE I INTRODUCED
FOR PEOPLE ONE TWO THREE. SO WE
HAVE TACTICS BECAUSE SORRY
SORRY I SORRY. DAVIS SOMEONE
HERE I GOT FIVE. JACQUES
HORRIBLE WELL I THINK YOU'RE
THE DIGITAL ALL IN EXPAND OKAY
SORRY ALL RIGHT THERE YOU GO I
THOUGHT YEAH IT'S FOR PEOPLE ON
THIS OKAY THANK YOU DOCTOR
ABOUT. I KNOW I'VE USED FOR THE
NEXT. SO LET'S GO AHEAD AND TO
BEGIN IN THIS ORDER SO. ANTHEM
BLUE CROSS WELCOME AND- KEEP
YOUR REMARKS TO THREE MINUTES
IN A TO ELABORATE SO. CHECK NO
RUBIO MY NAME IS A DOCTOR BY
SOME CUTS ROBBIE I'M UPSET
PRESIDENT OF ANTHEM MEDICAID
I'M A FAMILY PHYSICIAN- THEN
WITHOUT THEM THIRTEEN YEARS
ALSO THE MASTERS IN PUBLIC
HEALTH- THAT A LOT OF HEALTH
POLICY RESEARCH AND PUBLIC
HEALTH RESEARCH IN THE PAST
ANTHEMS BEEN IN MEDICAID SINCE
NINETEEN. I'M A VERY PROUD OF
THE LAST TWENTY YEARS RECENTLY
WE'VE WE RECEIVE FOR QUALITY
AWARDS FROM THE H. YES IN THE
PAST FIVE YEARS SO WE REALLY
TAKE QUALITY ACCESS SERIOUSLY
AT OUR PLAN. WE'VE BEEN AT THE
REGION IN THE REGIONAL MODEL
SINCE TWENTY THIRTEEN- I KNOW
THE AUDIT WAS FOCUSING ON
ACCESSING QUALITY SO I WANTED
TO REALLY SPEAK TO THOSE THOSE
COMPONENTS- DEFINITELY HAVE A
LOT OF WORK IN THE LAST FIVE
SIX YEARS IN A ROW COUNTIES
MEETING WITH THE COLDER.
BALLING UP TOP I SENT THE FIRST
TO ROLL OUT WITH NO COPAY TELL
ALL I'M THERE'S A CROSS
CALIFORNIA BUT PARTICULARLY THE
RURAL COUNTIES WE ARE WE
WORKING WITH IPADS IN THE
CLINICS- GIVEN ACCESS TO CARE
UNIT WHICH IS A CLINICAL YOU AT
THAT COORDINATES ACCESS TO CARE
WHERE THERE IS NO PROVIDER- IN
THE LAST YEAR WE'VE POINTED AT
SIX HUNDRED THIRTY SPECIALIST.
OUT OF WORK- SO WE'LL FOCUS ON
ACCESS AND QUALITY BUT WE DO A
LOT OF WORK AROUND MAXIMIZING
OUR ACCESS IT IS THE BEST
INTERESTS OF THE CHIN AS A PLAN
TO MAKE SURE THAT MEMBERS GET.
IT IS NOT IN OUR BEST. TO NOT
JUST. HAAS SEE THERE. PROVIDE
SERIOUSLY I WANT TO MAXIMIZE
ACCESS- I CAN TELL YOU LOOKING
AT MY STAFF WE'VE NEVER
REJECTED A CONTRACT FROM A
PROVIDER IN THE ROLE COUNTIES
BECAUSE OF RATES- WE GO ALL THE
WAY UP TO ALMOST 2100% OF MEDI
CAL WE LOOK AT OUR COMMERCIAL
NOT WORK IN THE IN THE WORLD
COUNTY. SO WE MAKE EVERY EFFORT
WHETHER IT'S LOOKING AT.
PROVIDER THAT WE HAVE A SINGLE
CASE AGREEMENT AGREEMENT.
NUMBER ACT I MEDI CAL MEMBER-
PROVIDER WITH WITH ANTHEM. SO
WE'VE DONE AS MUCH AS WE THINK
WE HAVE. BEEN ABLE TO
ACCOMPLISH AS FAR AS GETTING
MAXIMUM ACCESS. TO OUR MEMBERS
FROM OUR FOR SUMMER KANSI
LOOKING AT. MAXIMIZING THAT I
KNOW THE AUDIT HAD SAID WE HAVE
THIRTY SEVEN HUNDRED PROVIDERS
AND WE HAVE TO REMEMBER THESE
ARE EIGHTEEN INDIVIDUAL UNIQUE
COUNTIES- THE NINETEEN HUNDRED
THAT WE- HAVE NOT. CONTRACTED
WITH I ACTUALLY LOOKED AT THE
BOARD WEBSITE TODAY. TO TRY TO
LOOK AT LIKE INYO COUNTY HOW
MANY PROVIDERS ARE IN THERE. IT
IS VERY DIFFICULT TO KNOW IF
THOSE PROVIDERS TO MEDIC NOW.
IF THEY ARE ACTUALLY HOSPITAL
IS PROVIDERS VERSES SPECIALIST.
I WOULD LOVE TO SEE A LIST OF
THOSE NINETEEN HUNDRED. CONTACT
I THEN I CAN GUARANTEE. YOU CAN
LOOK AT. BUT BUT AGAIN TO IT TO
MAKE SURE THAT WE UNDERSTAND
THAT AND MY- TO BE THAT THOSE
NINETEEN HUNDRED. A WILL TAKE
MEDI CAL HAVE AN OPEN PANEL ARE
SPECIALISTS VERSUS PATHOLOGIST
VERSES RADIOLOGISTS. SO SOME
ADDITIONAL WORK ON THE ON THE
AUDIT AND I KNOW IN TABLE.
THREE IT DOES LOOK AT QUALITY.
QUALITY OF CARE AND I STILL
WANTED TO UNDERSCORE THE TABLE
THREE THAT- AS FAR AS HE TO
SCORES GO TO TWENTY TWO SCORES
THAT THE A CS HOLD US
ACCOUNTABLE FOR. ANTHEM HAVE
THE LOWEST NUMBER OF MEASURES
THAT WERE. BELOW MINIMUM
PERFORMANCE SOME OF IT FOR HE
TO STAMP POINT OUT THEM IS
ACTUALLY. A BETTER PERFORMING
QUALITY THAN PARTNERSHIP AND
HEALTH AND WELLNESS. THAT WERE
WERE BEING COMPETITIVE BUT I DO
THE HIGHLIGHT. QUANTIFIABLE HE
THIS. PERFORMANCE WHICH IS WHAT
I'LL TO ACROSS THE STATE.
SCORES ARE ON PAR WITH OTHER
PLANS IN IN THE LOCAL MARKET SO
I STILL QUESTION THE FACT THE
QUALITY OF CARE IS NOT
ADEQUATE- WITH OUR PLAN- WHEN
IT COMES TO ACCESS I DO WANT TO
HIGHLIGHT YOU KNOW THE
ALTERNATE ACCESS STANDARDS WITH
SUBMITTED TWO HUNDRED SEVENTY
OF THEM. AND THAT AFFECTS ABOUT
5% OF THE MEMBERS IN THE RURAL
COUNTY. DESPITE CENTER VERY
IMPORTANT AND CRITICAL BUT I DO
WANT TO MAKE A POINT THAT IT'S
NOT THAT EVERY PROVIDE ON EVERY
MEMBER IS. IT THE- ACCESS THE
STANDARDS I MEAN ONLY ONLY DO
REALLY REALLY DON'T HAVE ANY
OTHER QUESTIONS ABOUT AS FAR AS
AN ALTERNATE ACCESS. THERE IS A
TABLE TO HEAR THAT HAS ME UP
WHICH MY PLAN SO I WANTED TO
KIND OF UNDERSCORE THAT INYO
COUNTY FOR US IS ONE OF THE
MOST CHALLENGING COUNTY. SO I
KNOW THAT WERE WHAT KIND OF.
PARENT EIGHTEEN COUNTIES.
COMPARED TO ALL THE. YOU WANT
TO RECOGNIZE THE COUNTY IS VERY
UNIQUE AND DIFFERENT. AND IF WE
DO TAKE OUT INYO COUNTY FROM
THE NUMBERS ARE AVERAGE ACCESS
REQUEST IS ABOUT FORTY FIVE
MILES. AND A MAXIMUM ACCESS
MILEAGE IS NINETY NINE ALSO IN
YOUR COUNTY HAS BEEN A
CHALLENGE FOR US AND WE'D BE.
HAPPY TO PARTNER WITH I'M- WITH
THE DEPARTMENT AND OTHER PLANS
TO MAKE SURE WE ADDRESS THE
NEEDS OF IN YOUR COUNTY THAT IS
ONE THAT'S THAT STANDS OUT BUT
THAT THE TROUBLE WITH THE- THE
TABLE THAT IT IT'S BY SPECIALTY
SO. ONE CAN ONLY A FIVE. MOTOR
VESSEL TEASE. THEM BY READING
IT YOU MIGHT SAY THAT EVERY YOU
KNOW EVERY QUE. CHALLENGES WERE
WON A MEMBER EIGHTEEN COUNTY SO
IT IS NOT. NECESSARILY THAT SB
MILEAGE AFFECTS EVERY COUNTY. I
DO WANT TO GET THAT EVEN THOUGH
THE MODELS IMPORTANT WE DO WANT
TO STRESS YOU KNOW PHYSICIAN
RECRUITMENT IN THE FACT THAT
THE PHYSICIANS ARE THE
PHYSICIANS IN THESE COUNTIES
AND SO. LOOKING AT OTHER
OPTIONS. AND THAT THE A CS HAS
DONE A LOT ON PHYSICIAN
RECRUITMENT AND LOAN REPAYMENT.
BUT MAKING SURE WE ADDRESS THE
OTHER NEEDS OF THESE COUNTIES.
THAT REGARDLESS OF THE MODEL
THE PHYSICIAN ACCESS IS STILL
AN ISSUE ACROSS ACROSS THESE
EIGHTEEN COUNTIES. INCLUDING I
WOULD SAY THAT YOU KNOW ANTHONY
COMMITTED TO THESE COUNTIES WE
WORKED HARD WITH LISTEN TO
COUNT. WE MEET QUARTERLY WITH
EVERY COUNTY. EVERY ONE OF THE
EIGHTEEN COUNTIES WHETHER IT'S
PUBLIC HEALTH WE HAVE A HOUSE.
WE'VE HEARD AND CUT REVISED OUR
APPROACH AND IMPROVED OUR-
PARTNERSHIP WITH THE I'M SO WE
LOOK FORWARD. TO WORKING WITH
YOU IN THE FUTURE. THANK YOU
MISTER. THE STORK SO GOOD
MORNING AND THANK YOU FOR THE
OPPORTUNITY TO BE HERE MY NAME
IS ABBY TOTTENHAM THE MEDIC
HELP PROGRAM OFFICER FOR THE
COMBINED HEALTH NET IN
CALIFORNIA HEALTH AND THIS
MEDIC HEALTH PROGRAM IN ESSENCE
THAT MEANS I'M RESPONSIBLE FOR
OUR PROGRAM ACROSS TWO MILLION
MEMBERS IN A VERY UNIQUE AND
DIVERSE SET OF GEOGRAPHIES I'M
HERE TODAY SPECIFICALLY TO
SPEAK TO OUR PERFORMANCE IN
RURAL NORTHERN COUNTIES.
CALIFORNIA HEALTH WELLNESS I
CAME TO BE THIRTEEN ONLY KNOCKS
KEEN LIFE HEALTH AND REALLY
WHAT THAT MEANT AS WE AT THE
BASE FOR FIREMAN'S ACCORDING TO
STATE LAW BUT THAT DOESN'T MEAN
WE STOPPED SINCE THE INCEPTION
OF PLAN WE'VE INCLUDED HAND.
NETWORK ALMOST FOURTH HOUSE IN
NEW QUIRK. TODAY OVER THREE
THOUGHT SINCE SHE WAS NETWORK
WITH IN THE WRONG NORTHERN
SERVICE AREA AS WELL AS AN-
TWELVE THOUSAND SPECIALISTS.
THAT ARE- IN THE SURROUNDING
GEOGRAPHIES BECAUSE WE KNOW
THAT ACCESS IS LIMITED WITH IN
THE RURAL NORTH WE REALLY HAVE
TO LOOK OUTSIDE OF THOSE
COUNTIES TO MAKE SURE WE HAVE
ROBUST SPECIALTY ACCESS TO
CARE. NOW THE MERGER BETWEEN
OFF THAT IN CALIFORNIA HEALTH
ANALYSTS GAVE US A UNIQUE
OPPORTUNITY AS A HEALTH PLAN TO
LEVERAGE HEALTH NET STATEWIDE
PRESS AND EXPAND ACCESS. A
REALLY KEY EXAMPLE IS OUR-
BACKROOM COUNTY WITH USE DAVIS
A WE WERE ABLE THROUGH HEALTH
THAT. NOT ONLY EXPAND ACCESS
FOR SACRAMENTO MEMBERSHIP TO UC
DAVIS IS BOTH THE PRIMARY AND
SPECIALTY CARE PROVIDER. WE ARE
ALSO TO BE ABLE TO PROVIDE A
DIRECT REFERRAL PATHWAY FOR ALL
OF OUR MEMBERS WITHIN THE
CALIFORNIA HEALTH AND WELLNESS
SERVICE AREA. IN REALITY
PROVIDER RECRUITMENT CAN TAKE
MANY FORMS IT'S NOT JUST
THROUGH OUR RELATIONSHIP WITH
HEALTH NET IT'S A CONTINUE AN
ON GOING PROCESS- WE ACTUALLY
DO NOT USE NICKEL BOARD DATA
WE'VE FOUND THAT THE MEDICAL
BOARD IT IS NOT ACCURATE IT
DOES NOT. REFLECT PROVIDER
ACTUALLY AVAILABLE FOR HEALTH
AND CONTRACTING IT'S LICENSED
IN. EXAMPLE A KAISER IN SERVICE
AREA THAT MEANS THOSE POSITIONS
INCLUDED IN THE MEDICAL BOARD
DATA. INSTEAD WE USE A VARIETY
OF OTHER SOURCES INCLUDING
PROVIDER DIRECTORIES GOOGLE
SEARCHES SUGGESTIONS FROM DH
CS- WE ALSO HAVE A SIDE VENDOR
WE USE THAT DOES LARGE SCALE
ANALYSTS TO IDENTIFY PROVIDERS
THAT ARE AVAILABLE POTENTIALLY
FOR CONTRACTING. WE WILL
CONTRACT WITH ANY PROVIDER THAT
MEETS THE STATE'S CREDENTIALING
STANDARDS AND HAS A HIGH ENOUGH
QUALITY OF CARE AS WELL AS
MEETING- OUR CONTRACT WHERE
MEN'S GENERALLY. ABOUT THE
CONTRACTED RATE REALLY IN THE
ROLE SERVICE IS ABOUT CAPACITY
WHEN YOU CONSIDER THE SMALL
NUMBER OF SPECIALISTS IN
PARTICULAR IN THOSE SERVICE
AREAS AND THE FACT THAT THEY
HAVE ALL LINES OF BUSINESS TO
SERVE. LARGELY WHEN THEY SAY
THEY WANT A CONTRACT IT'S
BECAUSE ALREADY INDICATED WITH
MORE REQUESTS THAN THEY ARE
ABLE TO SERVE. AND AS A RESULT
IF THEY DON'T WANT TO CONTRACT
AND OPEN TO ALL MEMBERS AND
OPEN IN OUR PROVIDE DIRECT.
THEY WORK WITH US AND SINGLE
CASE AGREEMENT AND SINGLE CRAZE
AGREEMENTS ESSENTIALLY MEANS
THAT MEMBERS RECEIVE ACT TO
THAT PROVIDE EVEN THEY'RE NOT.
OUR PROVIDE DIRECT. LOOK TO THE
OLD ACT STANDARDS. NOTED THAT-
IN MANY CASES ALTERNATE ACCESS
STANDS THAT ARE PROVIDED ARE
REPRESENTATIVE NOT OF A
SPECIFIC INDIVIDUAL NEED OF
ACCESS TO CARE BUT RATHER ARE
OF A POTENTIAL ACCESS ISSUE FOR
EXAMPLE IN INYO COUNTY IN THE
CODE FOR NINE THREE FIVE TWO
SEVEN WHERE WE HAVE AN
ALTERNATIVE ACCESS STANDARD FOR
A PEDIATRIC CARDIOLOGIST. IN
REALITY THERE ARE NO CHILDREN
WITHIN THAT ZIP CODE WE CURRENT
IS ONLY ONE ADULT BUT WERE
FIRED BY STATE LAW TO HAVE THE
ALTERNATE ACCESS STANDARD IN
ORDER TO PROVIDE. POTENTIAL SO
JUST EXT. WHAT ARE SOME SAID AS
WELL AS IT ISN'T JUST WATER
NETWORK DIRECTORY SAYS BUT THE
ADDITIONAL SERVICES THAT WE ARE
ABLE TO PROVIDE FOR EXAMPLE WE
HAVE ONE STOP CLINICS WHERE WE
BRING IN SUSAN G. KOMEN FOR
MAMMOGRAPHY WE HAVE A PROGRAM
FOR IN HOME SERVICES FOR OUR
HIGHEST RISK MEMBERS WE
REMEMBER CONNECTIONS PRO GOES
TO THE HOME TO ENSURE THE-
RECEIVING IT ON VISITS AT THIS
TO CARE NOR HAVE. DISH ON THE
ON A WIDE ARRAY OF OTHER
SERVICES WE PROVIDE. THANK YOU
MISTER MC. GOOD MORNING MY NAME
IS AMY TURNIP SEED AND THE
SENIOR DIRECTOR OF EXTERNAL AND
REGULATORY AFFAIRS AT
PARTNERSHIP HEALTH PLAN.
PARTNERSHIP IS A COUNTY AS
HEALTH SYSTEM OR CODES IN SHORT
WHICH MEANS MAJORITY OF MEMBERS
AND ROLLED A MEDIC CAL ARE
SIGNED A PARTNERSHIP AS WE ARE
THE SINGLE MEDI CAL PLANT IN
OUR COUNTIES. CURRENTLY
PARTNERSHIP SERVES FOURTEEN
COUNTIES WHICH INCLUDES FIVE
HUNDRED AND FORTY THOUSAND
MEMBERS. TODAY I'M GOING TO
BRIEFLY DISCUSS PARTNERSHIPS
EXPERIENCE WITH THE ROLE
EXPANSION WHAT MAKES THE CODES
MODEL UNIQUE AND THEN SHARE
SOME OF THE SPECIFIC WORK
PARTNERSHIP IS DOING TO
INCREASE ACCESS AND QUALITY.
INCLUDED ARE PROVIDE A
RECRUITMENT PROGRAM.
TRANSCRIPTION HELLO HOW WHEN
THE STATE AUTHORIZED THE ROLE
OF IN TWENTY TWELVE A SUBSET OF
THESE COUNTIES WORKED WITH
THEIR BOARD OF SUPERVISORS AND
LOCAL HEALTH CARE PROVIDERS TO
LOBBY THE STATE AND PARTNERSHIP
TO JOIN THE CODES MODEL IN
ADDITION MANY OF THESE COUNTY
SET UP MEETINGS WITH OUR PLANS
LEADERSHIP TEAM TO DISCUSS THE-
FEASIBILITY. OF JOINT
PARTNERSHIP HEALTH PLAN. IN
TWENTY THIRTEEN PARTNERSHIP.
YES CAME TO A MUTUAL AGREEMENT
ON THE EIGHT COUNTY SELECTED TO
JOIN THE CODES MODEL AS PART OF
FOR EXPANSION. WHAT MAKES THE
COAST MODEL UNIQUE THE CODES
ARE COMMUNITY BASED NOT FOR
PROFIT MISSION DRIVEN HEALTH
PLAN THAT EMPHASIZES
TRANSPARENCY. WE HAVE A STRONG
FOUNDATION AND THE COMMUNITIES
WE SERVE MAINTAIN STRONG TIES
TO LOCAL PROVIDERS AND OUR
MEMBERS. BEING THE SINGLE MEDI
CAL PLAN IN OUR COUNTIES ALLOWS
US THE UNIQUE OPPORTUNITY TO BE
CLOSELY CONNECTED TO OUR SAFETY
NET PROVIDERS. PARTNERSHIP IS
GOVERNED BY A THIRTY TWO MEMBER
BOARD OF COMMISSIONERS THAT
INCLUDE AT LEAST ONE PRESENTED
IT FROM EACH COUNTY DOMINATED
BY THE- SUPERVISORS AS WELL AS
TO. PARTNERSHIPS MISSION IS TO
REMEMBER AND THE COMMUNITIES WE
SERVE. WE LIVE OUR MISSION
THROUGH OUR STRONG COMMITMENT
TO IMPROVING QUALITY AND ACCESS
FOR OUR MEMBERS. OUR MISSION
CAN BE SEEN IN A NUMBER OF
PROGRAMS BUT IT'S LIKE TO
HIGHLIGHT THREE. THE FIRST
BEING PROVIDER RECRUITMENT. WE
HAVE A LONG HISTORY OF
CONTRACTING WITH EVERY WILLING
AND ABLE PROVIDER AND OUR
SERVICE AND SURROUNDING AREAS.
AS THE ONLY MEDI CAL PLAN IN
OUR COUNTIES WE BELIEVE THIS IS
ADVANTAGEOUS IN THE CONTRACTING
PROCESS. HOWEVER HAVING A PER
ACT ADAM BUT PROVIDER NETWORK
ESPECIALLY IN OUR WORLD.
CONNECT ON THESE IS NOT WITHOUT
ITS CHALLENGES. IN MANY OF OUR
IS IT. THE ISSUE IS NOT
CONTRACTING WITH THE PROVIDERS
IT IS AT THAT PROVIDERS IN THE
AREA. THE SHIP IS DEDICATED OF
MILLION FIRST PROVIDER. AND
SINCE TWENTY FIFTEEN WE'VE BEEN
ABLE TO RECRUIT THREE HUNDRED
AND TWENTY FOUR PROVIDERS FOR
FOURTEEN COUNTIES. SECOND
TRANSPORTATION WE DO OUR BEST
TO ENSURE OUR MEMBERS HAVE
ACCESS TO MEDICAL CARE
INCLUDING PROVIDING
TRANSPORTATION ARE NON MEDICAL
TRANSPORTATION BENEFITS HAVE
INCREASED OVER 3100% SINCE
INCEPTION IN JANUARY TWENTY
EIGHTEEN. WE STILL NOT SEEN AND
EXPERIENCED A BALLOT SCENE OF
UTILIZATION AND MEMBERS
CONTINUE TO SEEK TRANSPORTATION
TO THE VISITS. THIRD TELEHEALTH
THERE SHOULD BE ACTIVELY
WORKING ON WAYS TO EXPAND
TELEHEALTH SERVICES TO OUR
MEMBERS AND OUR PROVIDER
NETWORK ARE TELEHEALTH PROGRAM
CURRENTLY LIVES IN TWENTY TWO
LOCATIONS HAS COMPLETED OVER
THIRTEEN THOUSAND VIDEO
CONSULTATIONS AND NEARLY TWENTY
FIVE HUNDRED ECON. OUR TOP
THREE TELEHEALTH SPECIALTIES.
ALLERGY RHEUMATOLOGY AND
PSYCHIATRY. IN CONCLUSION WE
APPRECIATE THE STATE AUDITOR'S
REPORT IN SUPPORTING THE
CLOTHES MODEL AND IT KNOWLEDGE
IN OUR COMMITMENT TO IMPROVING
QUALITY IN ACTS FOR OUR MEMBERS
FOR PARTNERSHIP THE CAUSE MODEL
IS THE PREFERRED. H. CARE MODEL
SENATOR PAN SENATOR RUBIO THANK
YOU FOR YOUR TIME TODAY I'M
HERE TO ANSWER ANY QUESTIONS
YOU MAY HAVE. THANK YOU. DOCTOR
MILLER. GOOD MORNING THANKS FOR
HAVING ME TODAY MY NAME IS ANDY
MILLER AND THE BIãU COUNTY
PUBLIC HEALTH OFFICER. AND I
SIT HERE TODAY AS A
REPRESENTATIVE OF THE GROUP OF
COUNTIES. WHO WORK TOGETHER
HOPING TO HAVE A VOICE IN THE
WAY THAT- MEDIC MEDIC COW WILL
BE IMPLEMENTED IN THEIR
JURISDICTIONS. THE PROPERTY
HOPE OF COUNTIES. IS TO WORK
WITH THE H. C. S. TO MOVE TO A
COUNTY ORGANIZED HEALTH- SYSTEM
OR KOS MODEL. CURRENTLY THE
GREAT MAJORITY IF NOT ALL OF
THE EIGHTEEN COUNTIES INCLUDING
THE CLINICS HOSPITALS. OF
PERMITS BEHAVIOR DEPARTMENTS OF
THESE CHARACTERS DESIRE
EXPLORING THIS MOVE. WE'VE BEEN
IN DISCUSSIONS AMONG OURSELVES
AND WITH DH CS FOR ALMOST THREE
YEARS NOW. SO WHY DO WE WANT
THIS CHANGE A IT'S NOT A
SURPRISE TO YOU ALL THAT RURAL
COUNTIES HAVE AMONG THE POOREST
HEALTH INDICATORS. I SOME OF
THESE ARE PROBLEMS OF GEOGRAPHY
AND OF WORK FORCE THAT ARE
DIFFICULT CHALLENGES FOR ANY
MEDI CAL MODEL. GET THESE
CHALLENGES SHOULD REALLY BE AN
EXCUSE TO ACCEPT THEY SUGGEST
THE NEED FOR A MODEL THAT
MAXIMIZES ACCESS AND QUALITY.
AND ACCORDING TO THE AUDIT AND
TO SOME CALIFORNIA HEALTHCARE
FOUNDATION DOCUMENTS OVER THE
YEARS. OF THE REGIONAL MODELS
HAVE NOT RECEIVED THIS
ACCEPTABLE LEVEL OF CARE. WE
SEE MANY POTENTIAL BENEFITS FOR
A KOS- AND LET ME COVER A
COUPLE. BECAUSE GOVERNOR. I
INCLUDES LOCAL ENTITIES. THEY
HAVE A PLACE ON THE BOARD OF
DIRECTORS AND ENSURE THE LOCAL
PRIORITIES ARE OUR ADDRESS.
DOES HAVE A HISTORY WORKING IN
PARTNERSHIP WITH WILL. TO
ADDRESS IMPORTANT PUBLIC HEALTH
AND GENERAL HEALTH CONCERN LIKE
OPIOIDS EXPANDING- DRUG MEDI
CAL ADDRESSING HOMELESSNESS
THROUGH THE WHOLE PERSON CARE
AND TARGETING CHRONIC DISEASES
THROUGH HEALTH HARMS. CLOSE
SHOULD HAVE SHOWN INCREASED
POTENTIAL TO CREATE A BROADER
PHYSICIAN NETWORK AND RURAL
COUNTIES AS WE'VE BEEN TALKING
ABOUT AND AS THE AUDIT SUPPORTS.
UN KOS HAVE A SATISFACTION
AMONG KEY STAKE HOLDERS
INCLUDING HOSPITALS CLINICS
HEALTH DEPARTMENTS BEHAVIORAL
HEALTH DEPARTMENTS FOR EXAMPLE
THE EIGHT COUNTIES THE JOINT
PARTNERSHIP IN TWO THOUSAND AND
THIRTEEN ALL OF THEM ARE SET BY
THE WITH KOS INNER HERE-
TALKING ABOUT THAT. AND YET THE
GREAT MAJORITY OF NOT ALL
COUNTIES IN THE REGIONAL MODEL
HAVE TOGETHER WITH THIS CONCERN.
BUT A CLOSE MAY HAVE A GREATER
OF RESOURCES TO DEDICATE TO
LOCAL PRIORITIES NO PORTION OF
THAT CAPITATION IS PAID TO
SHAREHOLDERS AND HENCE IS
AVAILABLE TO ADDRESS PRIORITIES
SUCH AS PROVIDE A RECRUITMENT
WHICH WE JUST HEARD ABOUT. SO
FOR FROM OUR STANDPOINT THE
DESIRED. OUTCOMES WOULD BE
pTHE H. C. S. R. TO PUT IN PLACE
A TRANSPARENT PROCESS COUNTIES
TO EITHER MOVE. TO AN EXISTING
GOES TO IMPLEMENT A CUP. THE
OTHER OUT THANK IS WHICH IN THE
OF UPCOMING R. F. THAT WOULD
ALLOW REGIONAL MODEL COUNTIES
TO DEMONSTRATE THEIR ABILITY TO
IMPLEMENT ECHOES OR JOIN AN
EXISTING BECAUSE IN THEIR
COUNTY BY TWO THOUSAND TWENTY
THREE. IN ORDER TO OP. SS THANK
YOU SO MUCH. THANK YOU. SO
THANK YOU SO MUCH FOR YOUR
PRESENTATIONS AT. JIM WOOD.
YEAH ALL RIGHT- SO- I
UNDERSTAND FROM- THE
PRESENTATION FROM ANTHEM THAT-
DE SICKLY ONE OF THINGS THAT
YOU DO IS YOU HAVE PEOPLE WHO I
GUESS YOU HAVE EXISTING
CONTRACTS WITHIN YOUR ASSN AND
UP FOR THE MEDI CAL PROGRAM I
DON'T KNOW I WAS FOR CALIFORNIA
HEALTH AND WELLNESS BECAUSE
YOU'RE YOU'RE JUST. REALLY JUST
THE MEDI CAL PLAN. WELL YOU
HAVE HEALTH THAT TOO RIGHT SO
WITH THAT YEAH WITH THEM WE
HAVE BOTH THAT CALIFORNIA'S
MOST AND HEALTH NET AND WHAT
WE'VE DONE IS WERE ACTUALLY
LEVERAGING THE HEALTH THAT
CONTRACTS WITH SO. OKAY SO I
GUESS THIS IS YOUNGER. OKAY
WELL KELLY DAY QUESTION THEN IS
WHAT DO YOU DO BEYOND. THE
PEOPLE YOU HAVE YOUR COMMERCIAL
CONTRACT. TO REACH OUT TO
PEOPLE WHO MAY NOT HAVE A
COMMERCIAL CONTRACT WITH YOU.
ASKED THEM TO CONTRACT ON THE
MEDI CAL AND- YOU MADE MENTION
OF LIKE 2100% OF MEDI CAL RATES
WELL THAT'S STILL NOT VERY
HIGH. HOW ARE YOU WILLING TO GO
IN ORDER TO SURE THAT SOMEONE
CONTRACT SO YES I AGREE. THEN
THERE ARE A LOT OF PHYSICIANS.
THEY MAY BE A LITTLE TAPPED OUT
ARE MAXED OUT BUT ALSO FRANKLY
WHEN THEY LOOK AT THE LIST
THEY'RE LOOKING AT. PLANS THAT
THEY CAN. THAT THEY CAN BE
RELIABLY NOW THE PLAYED RIGHT
RATE BUT THEY CAN BE RELIABLY
PAID- BECAUSE SOMETIMES YOU'LL
GET PAID ON TIME- THAT THEY
DON'T OCCUR INCREASED COSTS FOR
HAVING A CONTRACT WITH THEM
BECAUSE THEY PUT IT THROUGH THE
WRINGER- TERMS. GET ANY FUNDING
L. A REIMBURSEMENT SO THE THING.
APPROACH THAT DOES PROVIDE
THOSE PHYSICIANS AND OTHER
PROVIDERS TO SHOW THAT DAY YOU
THAT THIS IS A SUPERIOR PLANNED
THE CONTRACT WITH THEY MAY NOT
HAVE AN EXISTING COMMERCIAL
PLANNED BUT THAT YOU WILL
ACTUALLY DELIVER FOR THEM TO
MAKE IT WORTH YOUR WHILE TO
ACTUALLY. CONTRACT KLAY
SPECIALISTS. NOTHING SO WE DO
THANK YOU KNOW WE GO ALL THE
WAY UP TO EVEN COMMERCIAL RATES
AND MEDICARE RATES SO. THE
REASON I'M SET THAT EXAMPLE.
THERE'S NEVER BEEN AN TIME WITH
THAT I WAS AWARE OF THAT WE
HAVE NOT CONTRACT WITH A
PROVIDER BECAUSE OUR RATES BUT
YOUR QUESTION ADDITIONAL TO
RATES. IN ANYTIME WE HAVE A AS
ABBY MENTION A SINGLE CASE
AGREEMENT. OR AGREEMENTS THAT
COMES AND WHERE WE SAY NUMBER
NEEDED A PROVIDER THAT LOCAL.
ENGAGE THAT PROVIDER AND SAY WE
WOULD LIKE TO BRING YOU A WIDE
NETWORK LET'S LET'S START
DISCUSSING- THAT POSSIBILITY
BUT- I WOULD I WOULD THINK
AGAIN UNDERSCORE THAT A LOT
THOSE FACTORS. ARE CAPACITY
THERE EITHER ANALYSTS.
COMMERCIAL BEARS- THE THERE'S A
LOT OF WORK WITH MEDICAID. A
LOT OF ADDITIONAL COMPONENTS
WHETHER IT'S YOUR HEATER SCORES
WEATHER'S DOCUMENTATION
FACILITY CITED THE AND HE TO
SUPPLIES I MEAN HE IS NOT
SPECIFIC MEDICAL CORRECT. THE
IT'S NOT SYMPTOMATIC SHOP AT
THE MEDICAL PROVIDER IS BEING
HELD TO A SPECIFIC HE TO SCORES
THAT ARE NOT THE SAME AS
COMMERCIAL PROVIDERS. SO THERE
ARE IS A LOT MORE OVERSIGHT AND
FRANKLY. WE WILL PUT THE ITEMS
ON FOR THAT HE MATCH. CATION
THAT'S WHAT PROVIDERS SO
DEFINITELY AS A MEDICAL
PROVIDER YOU ARE EXPERIENCING
AT THE- OVERSIGHT- RIGHTFULLY
SO FAR MEMBERS BUT IT IS IT IS
VERY DIFFERENT THAN A
COMMERCIAL PROVIDER EXPERIENCES
AND THE SAME. IN THE SAME
COMMUNITY SO A LOT OF TIMES
THEY'LL THAT. IT TAKE FIVE TOP
PROVIDERS FIVE FIVE MEDI CAL
MEMBERS. TEN THEY STILL HAVE TO
GO THROUGH A FACILITY SITE
REVIEW SOME ADDITIONAL
COMPONENTS. THAT IF THEY WERE
JUST TO TAKE A TOLL WOULD NOT
NECESSARILY BE NON AMASSING
THAT'S THE MAIN REASON OR THE
ONLY REASON. BY THAT IS A PART
OF THE REALITY OF. THIS. CAL
BUT I WOULD JUST ADD WHEN
YOU'RE LOOKING AT A PARTICULAR
ON SPECIALTY PRACTICES THERE
ARE WAYS TO LOOK AT CREATIVE
CONTRACTING OPPORTUNITIES WHERE
DIRECT FEE FOR SERVICE CONTRACT
PER SE BUT WHERE WE CAN FOR
EXAMPLE LEASE A PERIOD OF TIME
WITHIN THEIR OFFICE TO USE AND
IT'S NOT NECESSARILY I'M GONNA
PUT YOU IN MY DIRECTORY BUT IT
ALLOWS FOR. OUR MEMBERS. SO SIR.
HOW WE WORK WITH SOME OF OUR
PROVIDER AND YOUR INCENTIVE
BASED CONTRACTING IF YOU'RE
ABLE TO HIT CERTAIN HE DOES
METRICS YOU GET ADDITIONAL
BONUSES WHICH THEN MAKES
PROVIDERS MORE WILLING TO SEE
THE MEMBERS- WE ALSO LOOKED AT
AND WITH SOME OF OUR HOSPITAL
PARTNERS. ACTUALLY PUTTING
WITHIN THE CONSTRUCT OF THEIR
CONTRACTS RECRUITMENT AND
RETENTION BONUSES SO THAT NOT
ONLY ARE THEY AS A HOSPITAL
SYSTEM ALREADY PLANNING TO
RECRUIT FOR SOME OF THESE
PROVIDERS BUT WE'RE ADDING
SUPPLEMENTAL FUNDING. TO MAKE
IT A SUSTAINABLE PRACTICE MODEL
FOR THEM AND THAT'S HELP TO
WELL WE DON'T HAVE NECESSARILY
A FUN BUT IS CIVIC FOR PROVIDER
RECRUITMENT WE DO PROVIDE
FUNDING TO SOME OF OUR
HOSPITAL. IS BECAUSE THEY ARE
THE LARGEST SPECIALTY CARE
WITHIN THE RURAL AREAS. I WOULD
ALSO MAKE NOTE- THAT- THAT
WE'RE DOING THE LOAN REPAYMENT
PROGRAM- WE TALK ABOUT NOT
ENOUGH. MEDI CAL PROVIDERS-
THAT PROGRAMS OVERSUBSCRIBED.
CORRECT. YES WE CERTAINLY HAD
MORE APPLICANTS THAN WE THAT WE
ARE ABLE TO FUND AND QUITE
HONESTLY WE EXPECT FOR THIS
NEXT ROUND FOR THAT TO GRANT SO
FOR SURE. YEAH SO I WOULD.
HYPOTHESIZE THAT IF GIVEN THE
OPPORTUNITY THE SUFFICIENT
PAYMENT THEY'LL MAKE IT
SUSTAINABLE UNPAYABLE. THAT YOU
WILL GET THE PROVIDERS BECAUSE
THERE WILL EAT SO
OVERSUBSCRIBED PEOPLE OR ELSE
EVEN IF WE STEP UP AND PROVIDE
THEM WITH WHAT THEY NEED TO
MAKE A LIVING. AND THEY WILL
COME. YOU DISAGREE. OKAY ALL
RIGHT SO THAT'S ALL WE NEED TO
DO CORRECT. OKAY SO HOPEFULLY
WE CAN WORK THIS OUT AND GET
SUFFICIENT RATES AND THEN
YOU'LL FIND ENOUGH PROVIDERS TO
CARE FOR PATIENTS CORRECT. OKAY
THANK YOU I APPRECIATE THAT
NOW- EIGHT YOU KNOW I THINK-
KOS IS A PARTICULAR MODEL AND
DAY APPRECIATE AS MANY UP
PERHAPS. DOCTOR MILLER- I KNOW
THAT YOU'RE SPEAKING ON BEHALF
OF THE CONSORTIUM- ASIDE FROM
YOU KNOW YOU TALK MORE
SPECIFICALLY ABOUT ECHOES WHAT
ARE THE CHARACTERISTICS. THAT
CLOSER OTHERWISE BECAUSE WE
DON'T KNOW WHERE THIS WILL GO
WHAT KIND OF THINGS DO YOU LIKE
YOU HEARD ME ASK THE QUESTION
OF THE EIGHTY S. BEFORE WHAT
KIND OF THINGS THAT. THE COUNTY
IS ONE IS FROM THE STATE IN
REGARDS TO HELP WITH THAT A CAL
AND HELPING COUNTIES PROVIDE
BETTER. ACCESS TO PEOPLE IN
COUNTY WHETHER IT'S A COULD BE
A CAUSE BUT IT COULD ALSO BE L.
IT. THE WHAT THE REGIONAL MODEL
LIKE WHAT. WHAT WHAT WHAT ARE
SOME THE THINGS THAT YOU SEE-
DEFICIENCIES THAT WE NEED TO
STEP UP AND DOING YEAH SO. I AM
I'M TEMPTED TO TRY TO ANSWER
THE QUESTION IT FROM A PUBLIC
HEALTH STANDPOINT BUT I THINK
THAT REALLY THE MOST IMPORTANT
THING THAT WE DID WHEN WE
STARTED LOOKING AT THIS AS A
COUNTY. AND I THINK OTHER
COUNTIES HAVE DONE WAS TO TALK
TO OUR HEALTH CARE PARTNERS THE
PEOPLE THAT DELIVER THE CARE.
AND THAT ARE REALLY THE CORE IN
THE IMPORTANT PART OF THIS
INFRASTRUCTURE. AND WE DO WE
WANT TO AND SAID HEY YOU KNOW
THIS CONTRACT BE UP IN THE NEAR
FUTURE- WHY DON'T YOU. LOOK AT
WHAT WHAT YOU GET IN AND WHAT
YOU WHAT YOU DO. THINK ABOUT
THE PROGRAM THAT YOU'RE IN
TOCHTER ASSOCIATIONS TALK TO
YOUR- COLLEAGUES IN NEARBY
COUNTIES- MANY OF THEM ACTUALLY
RAN. OPERATIONS IN MULTIPLE
COUNTY SINCE A WORKED UNDER
BILL MODELS. AND SO- I THINK.
THAT THAT'S IT'S NOT AS MUCH.
OKAY SO I'M START. AND I THINK
ALL THE THINGS THAT LIKELY YOU
HAVE HEARD. IT'S ABOUT- BEING
ABLE TO CONTRACT. THE RATES OF
CONTRACTING GETTING PAID- HOW
DIFFICULT ALL THOSE THINGS ARE.
HI SO IT'S KIND OF THE CORE
BUSINESS OF YOU KNOW WHAT DH CS
DOES AND WHAT THESE PROVIDERS
PROVIDE. NO MORE SPECIFICALLY
IF YOU START TALKING ABOUT
PUBLIC HEALTH AND BEHAVIOR
HEALTH. WE GET INTO LOTS OF
AREAS SPECIFIC AREAS- YOU KNOW
THEIR INTERACT WITH SIDE
CALIFORNIA CHILDREN'S SERVICES
THEIR INTERACTION WITH ADULTS
HI. DAY CARE CENTERS- THEIR
INTERACTION WITH BEHAVIORAL
HEALTH. AND AGAIN COMING BACK
TO- TO PROVIDE A FOR PROVIDER
PANELS. BUT IT IT'S THOSE
CONVERSATIONS THAT HAVE LED TO
THE- VERSION I DESCRIBED AND
NOT JUST OP COUNTY IN MULTIPLE
CAT. YEAH JUST. GIVE MULLIN
SAID YOU KNOW WHAT IS IT WHAT
YOUR CONCERNS. HELLO AND WE
WENT THROUGH WITH THE DH CS
STAFF THE BOILER PLATE
CONTRACTORS AS A WE HAVE A
PROPERLY DON'T THE ACTUAL
CONTRACTS AND SO WE WENT
THROUGH WE THESE AREN'T SO BAD
IT'S ACTUALLY KIND OF LIVING UP
TO THEM. THAT'S DIFFICULT SO I
THINK THAT THE COPS THEMSELVES
WHAT WE WANT FROM THE STATE I
THINK THERE'S A LOT THAT'S IN
THERE IT'S JUST BEEN HARD TO
ACTUALLY. LIVE UP TO THOSE. SO
BASED ON YOUR TESTIMONY AND I
REALIZE THAT YOU DON'T ACTUALLY
HAVE THE ACTUAL CONTRACT BUT-
IF IT JUST COULDACTUALLY
ENFORCE THE STANDARDS IN THE
CONTRACT THAT YOU THE BOILER
PLATE CONTACT YOU RECEIVE THAT
THINGS WOULD BE MUCH BETTER
WELL I MEAN IT I THINK THE YES
AND I THINK THAT ONE OF IS THIS
DISCUSSION ABOUT THE- THE
ALTERNATIVE ACCESS STANDARDS I
THINK THAT IT'S REASONABLE AND
I'VE IN THE RESPONSE DH CS
PROTECTION AGAINST UNREASONABLY
HIGH RATES ANYTHING THAT NEEDS
TO BE THERE BUT I DON'T SEE
ANYTHING IN THERE THAT TALKS
ABOUT STANDARDS PROTECTING.
THEY THE BENEFICIARIES FROM
UNREASONABLY LOW RATES I DON'T
KNOW WHAT THAT IS I DON'T SEE
THAT BUT I DON'T SEE THAT IN
THE DISCUSSION AT ANY POINT- IN
RESPONSE AND SO I THINK THAT
TOO THAT'S WHY WE ARE THE ONLY
WAY TO CATCH ARE THESE TIME
SINCE HER MAN. SO YOU HAVE TO
BE. REALLY CAUTIOUS AND CAREFUL.
HOW WE ARE HOLDEN TO THOSE
STANDARDS WERE NOT WHEN THOSE
EXCEPTIONS ARE MADE. WELL
COMMENTS FROM THE DEPARTMENT TO
PUT OUT ABOUT THIS SURE SO
WHETHER AND IF WE WEREN'T CLEAR
CERTAINLY IF WE WERE SEEING
UNREASONABLE LIKE YOU KNOW NOT
THAT I THINK THE FOLKS AT MY
TABLE WOULD BE LIKE YOU'LL BE
PAID TWO DOLLARS OR SOMETHING-
IT IS THAT BALANCE OF IS IT
REASONABLE COMPARED TO WHAT IT
EITHER CAL PACE TODAY WHETHER
THAT SUFFICIENT OR NOT
OBVIOUSLY A CONVERSATION. WHAT
IS AND AGAIN WHEN YOU HAVE TWO
PLANS WHAT IT PLAN PAYING WHY
IS THAT WORKING HOW DO WE LOOK
AT STANDARDS LIKE. YOU KNOW
COMPONENTS OF MEDICARE OR I
THINK REALLY AND I THINK THIS
IS THE WORK THAT OUR PLANS HAVE
BEEN DOING THAT WE ARE
ENCOURAGING MOVING AWAY FROM
THIS CONSTRUCT OF SORT OF
PAYMENT FOR SPECIFIC SERVICES
BUT HOW DO WE- SERVE. AND ALL
THAT IN A WAY IT HAVE THESE
SENT ARRANGEMENTS AS WELL. AS
NOT JUST A SERVICE WAS PROVIDED
WHICH IS IMPORTANT BUT IF IT'S
NOT A SERVICE THAT'S ACTUALLY
SIR THE PERSON OR ADDRESSING
ALL OF YOUR NEEDS. AND THE
OUTCOMES ARE GETTING BETTER HOW
TO COME THOSE IS TO USE IT TO
MAKE SURE. MEMBERS PROVIDE.
COMPANY ALL OF AND THAT'S
REALLY. WORK HAVE BEEN DOING
OBVIOUSLY WE HAVE THE ELEMENTS
THAT WE'VE BEEN PUTTING IN WITH
RESPECT TO PROP FIFTY SIX. AND
THEN AGAIN REALLY I WAITED TO
HEARKEN BACK TO. A LOT OF THE
ISSUES AND SUGGESTIONS YOU SEEN
OUR CALLIN PROPOSAL AS WAYS
EVEN FURTHER DRIVE. AND REALLY
REALLY HAVE THAT REAL
OPPORTUNITY A AND SUBJECT
BUDGETARY CONVERSATIONS WE'RE
GOING TO HAVE. BUT WHERE
COULDN'T. OR IS THE BEST WAY
FOR US TO INVEST MONEY. THAT
REALLY DRIVES THOSE CHANGES IN
OUTCOMES IMPROVEMENTS IN NOT
JUST THE QUALITY OF THEIR
PARTICULAR HEALTH SERVICES BUT
THEIR OVERALL QUALITY OF LIFE
AND THAT. THAT'S WHAT WE'RE
TRYING TO FOCUS AYE AND I THINK
OUR PLAN THERE'S ARE ARE VERY
SORT OF ON BOARD WITH THAT
SUPPORTIVE OF THAT. WE WILL
CONTINUE TO DO THAT SO IT IT IS
ALSO. SOME LOOKED TOTALLY
UNREASONABLY SO THAT WE WOULD
REJECT AN ALTERNATIVE ACCESS
REQUIRE. LESS BUT WE ALSO DO
YOU HAVE. TO YOU KNOW AS FISCAL
AGENTS OF STATE. WHAT I MEAN SO
IT'S NOT A BALANCE OF BOTH
MAKING SURE IT'S NOT. TOO LOW
BUT ALSO RECOGNIZING WHAT IS
REASONABLE FROM A MORE TALKING
ABOUT I THINK IN THE COMP I
THINK THAT COMES BACK TO A
PREVIOUS KIND PATIENT ABOUT
WHAT ARE THE STANDARDS YEAH AND
THE AND THAT'S FAIR AND THEN.
WHAT WE SHOULD DEFINITELY HAVE
THAT CONVERSATION. AND THEN THE
OTHER QUESTION I HAVE. THE
REFERENCE IS MADE TO TABLE
THREE AND THE HE THIS
PERFORMANCE. AND I WON'T. I'M
NOT GONNA GO BETWEEN THE
DIFFERENT PLANS BUT HOW. SO YOU
KNOW WE HAVE HERE NUMBER
MEASURES TWENTY FIFTEEN TWENTY
TO THE TERROR OF THE HOUSE AND
THEN WE HAVE THE NUMBER OF
AVERAGE NUMBER IF YOU JUST
MEASURES BELOW MINIMUM
PERFORMANCE LEVEL SO THESE ARE
ALL BELOW MINIMUM PERFORMANCE
LEVELS. AND SO GOOD THING IS
THAT TWENTY EIGHTEENS LOOKS
BETTER IN THE PRIOR YEARS. HOW
THIS COMMERCIALLY COMPARED TO A
TYPICAL COMMERCIAL PLAN. SO IS
THIS IS IT THE NUMBER OF THE
LOW PERFORMANCE LEVELS THIS
TYPICAL FOR THAT COMMERCIAL
PLAN WILL NORMALLY HAVE THIS
MANY BLOW PERFORMANCE LEVELS IS
WE'RE SEEING I'M NOT GONNA PICK
ON ANY PARTICULAR PLAN HERE BUT
WE CAN SEE THEIR- HOUSES. YEAH
WITH THAT I THINK I MEAN I USED
TO COME FROM THE COMMERCIAL
SIDE A FEW YEARS SO I
DEFINITELY THINK THE PATIENT
POPULATION IS VERY DIFFERENT.
THAT'S NOT MY QUESTION I
UNDERSTAND THAT THAT IS SO IS
THIS IS THIS ACCEPTABLE WARS
THE SERVICE NATIONALLY AND
PROVIDED THIS AND SAID WE WERE
BELOW OF THIS MANY LEVELS WITH
THAT THE- IS THAT TYPICAL. IT'S
NOT ACCEPTABLE I CAN TELL YOU
COMMITTED TO. THE SCORES OF THE
S. S. AS A LOT TO A PARTNER
YES. ON ON IMPROVE WE'VE WE'VE
ACTUALLY. FOR MOST IMPROVED
AWARD IN THE LAST FIVE YEARS IT
IS A LOT OF MEASURES IT'S AT A
LOT OF- EXCHANGE OF DATA. AS
WELL AS ACCESO HE THIS IS VERY
COMPLEX AND I WE HAVE A I DON'T
BELIEVE ME I. DEFINITELY NOT
WHAT WE WANT TO BE I THINK
1100% THAT THE TOP TIER AND WE
ARE. COMMITTED TO THAT WHETHER
IT'S FOR THE PHYSICIAN AND
SENATE'S WHETHER IT'S DATA
SUPPORT WHETHER IT'S- NURSES IN
THE OFFICES OF PROVIDERS WHICH
HAVE. WHETHER IT'S GOING TO
MEMBERS HOMES THERE'S A
DIFFERENT WAYS TO IMPROVE YOUR
SCORES QUE- BUT I THINK WE
WOULD LIKE TO HAVE ZERO BELOW A
100% ALL RIGHT THAT IS ACTUALLY
THE REQUIREMENTS AS WELL. HELLO
WELL I WE JUST MAKE NOTES I
WOULD ALSO NOTE THAT. HE'D S.
WHICH IS BASED ON MINISTRY OF
DATA ALSO. TENDS TO FOCUS ON
ITEMS THAT HAVE LARGER PATIENT
BASIS BECAUSE OTHERWISE YOU
WON'T HAVE ENOUGH NUMBERS SO.
WELL HE THIS IN ITSELF IS
HELPFUL AND USEFUL- I WOULD
ALSO MAKE NOTE THAT HE THIS
THAT BY ITSELF IS INSUFFICIENT
EVEN IF THEY WERE ALL ZERO RATE
THAT'S GOOD BUT THAT DOESN'T
MEAN YOU'VE DONE A GOOD ENOUGH
JOB BECAUSE AS A PHYSICIAN WE
ALSO TAKE CARE OF PATIENTS WITH
RARE CONDITIONS. YOU DID MAKE
NOTE THAT YOU KNOW YOU HAVE
SOMEONE AT CHAVEZ CHEN HEART
DISEASE THEY'RE NOT GONNA HAVE
A HE THE SCORE BECAUSE IT'S NOT
ENOUGH SO- WE CAN'T LEAVE
PEOPLE BEHIND EITHER- BUT BUT
AWESOME EVEN THOUGH IT IS
SCHOOLS WE COULD DO BETTER
SOMETHING. I AGREE. I THINK
THAT'S A RUBIO. PRETTY MUCH
ASKED OTHER QUESTIONS BUT I TO
HAVE SOMETHING THAT YOU
MENTIONED IN PASSING. FOR A
MISTER CUSS ROBBIE I HOPE I'M
PRONOUNCING THE CORRECT AS
WELL- YOU TALKED ABOUT-
DISAGREEING WITH THE AUDIT SOME
JUST LOOK HERE IS HE SAID THAT
YOU WERE CURIOUS ABOUT THE
NINETEEN HUNDRED PROVIDERS THAT
WORK. LIKE DAD AND THAT IT
DEPEND ON WHAT SPECIALTY WAS
WHETHER SPECIAL TO YOU. AND
THANK YOU SO ON BUT BUT ALL
AGES CAN YOU SHARE WITH ME.
WELL FURTHER HOW THAT SKEWS THE
AUDIT FINING. I THINK I WAS
MAINLY SAYING THAT WE CONTRACT
WITH THIRTY SEVEN OVER THIRTY
SEVEN HUNDRED SPECIALIST
CURRENTLY IN THE IN THE WORLD
REGIONAL MODEL. THIS NINETEEN
HUNDRED WE WOULD LOVE TO SEE
THE SPECIFICS OF- YOU KNOW
WHAT'S PROVIDERS THEY THEY ARE
BECAUSE SOME. THAT BUT BUT
BECAUSE IT'S BASED ON THE BOARD
WEBSITE AND I DON'T HAVE THE
DETAILS OF THAT THIS THING. BUT
IT COULD BE THAT OF THEM ARE
EITHER HOSPITAL BASED
PHYSICIANS. JUST OTHER
SPECIALISTS THAT MAYBE DON'T.
EITHER A FOR AN OPEN PANEL OR
THEY'RE NOT ABLE TO SEE IT MEDI
CAL MEMBER SUGGEST BECAUSE
THERE'S AN AND NINETEEN HUNDRED
OUT THE REST AS ABBY WAS
SAYING. IT DOESN'T MEAN THAT
THE POTENTIAL. IS FOR US THE
CONTRACT. BUT WE WILL GET THAT
LIST ENGAGE US PROVIDERS
TOMORROW. BUT I JUST WANT TO
CAUTION THAT THAT NINETEEN
HUNDRED SEEMS A LOT- BUT WHEN
YOU LOOK AT IT ALSO IN THE
COUNTY SPECIFIC DETAILS FOR
EXAMPLE I LOOK. THIS MORNING AT
THE BOARD WEBSITE INYO COUNTY.
THERE'S FIFTEEN SPECIALIST IN
IN YOUR ACCOUNT. BUT WEBSITE
KNOW WHETHER THEY TAKE THEIR
SHOW WHETHER THEY TAKE MEDI CAL
I TRIED. IT WITH THAT THERE'S
AN INTERACTIVE TOOL. THERE'S A
LOT THAT'S NOT. CLEAR AND THE
WEBSITE ON THE BOARD WEBSITE
THAT'S WHY ATTY WITH PENSION
AND WE USE OTHER TYPES OF
DIRECTORIES. WE YOU KNOW WE USE
THAT REAL LIFE EXPERIENCE THE
LAST FIVE YEARS WHERE MEMBERS
HAVE ASKED US THAT THERE'S A
THERE'S A CARDIOLOGISTS NEXT
DOOR I WANT TO GO TO THE
CARDIOLOGISTS WE GIVE THEM A
SINGLE CASE. AGREEMENT AND THEN
WE ENGAGE THAT CARDIOLOGISTS TO
SAY WE SEE MATT MEMBERS YOU
KNOW THAT'S THAT'S HAD A- RIGHT
AND A MAJORITY THE TIME IF NOT
ALL IT'S EITHER THEIR FULL BY
THE ONLY ONE I SEE COMMERCIAL
AND THEY MADE IT. A UNIQUE
SITUATION FOR THIS ONE MEMBER.
I'M SUCH THING WE REALLY NEED
TO KNOW. IN NINETEEN HUNDRED S.
AND BUT THERE REALISTICALLY
ABLE TO TAKE MEDI CAL MEMBERS
REGARDLESS OF THE RATE LET'S
PUT THE RATE AT THAT IF THEY
HAVE THE CAPACITY. TO SAVING
CAUGHT. AND THE DIFFERENT TYPES
OF POSITIONS AND ON THIS. CAR
JUST. AS WE LIKE TO WHAT. WHAT
TYPE POSITION THEY ARE. FOR
THAT. AUDITOR'S CAN. IS THERE
ANY WAY TO LIKE INTO A TEN HAVE
AN ACCURATE MEASURE OF. WHAT
YOU'RE SAYING. ACTUALLY NOW
WITH AUDITOR'S HERE IN THE
AUDIENCE DO YOU MIND COMING UP
THEN PERHAPS ADDRESSING CENTER
RUBEUS QUESTIONS MAY NEED A
LITTLE. I'M SORRY. OKAY. SO THE
NINETEEN HUNDRED- IS IT AGAIN
WE DID USE MEDICAL BOARD DATA
AND OSTEOPATHIC BOARD DATA AND
LOOK AT THE VARIOUS REGIONAL
COUNTIES THOSE RURAL COUNTIES-
SO WE DIDN'T GO IN AND
SPECIFICALLY IDENTIFIED BY
SPECIALTY OR TYPE OF POSITION
POSITION BUT WHAT WE WERE
TRYING TO DATE IN THE REPORT
WHICH I THINK WE WERE
SUCCESSFUL. BASED ON WHAT.
MONEY I'M HEARING IS. IDENTIFY
TOOLS IS THAT THE DEPARTMENT
HEALTH CARE SERVICES CAN DO AN
ANALYSES OF EIGHT USING DATA
FROM THE MEDICAL BOARD AND THEN
NOW YOU HAVE NINETEEN HUNDRED
THAT POTENTIALLY IF YOU PICK UP
10% OF THOSE THAT'S NINETY NEW
PROVIDERS SO WHAT ARE POINT IN
THE AUDIT REPORT WAS. NEEDS TO
BE MORE ANALYSIS. UNTIL
PROVIDERS TO TRY TO GET. I DO
APPRECIATE WHAT WHAT- ANTHEM IS
SUGGESTING AND HEALTH AND
WELLNESS BUT IN LISTENING TO
THEIR TESTIMONY THERE THEY ARE
REACTING TO A BENEFICIARY
SAYING I WANT TO TAKE MY CHILD
TO THIS CARDIOLOGISTS THEY
AREN'T NECESSARILY WORKING WITH
HEALTH CARE SERVICES OR HEALTH
CARE SERVICES ISN'T NECESSARILY
PROACTIVELY SAYING. HAVE A
CARDIOLOGISTS IN THE INYO
COUNTY THAT'S NOT PART OF A
MEDIC CAL LET'S REACH OUT TO
THAT CARDIOLOGISTS AND SPEED
ARE YOU WILLING TO PARTICIPATE
SO LET'S NOT RELY ON FISCHERI
TO SUGGEST I WANT TO TAKE MY
CHILD IS CARDIOLOGISTS. SO I
UNDERSTAND NOT ALL NINETEEN
HUNDRED POTENTIALLY WILL
PARTICIPATE IN MEDI CAL WILL BE
WILLING TO BE PROVIDERS WHAT WE
WERE TRYING TO DEMONSTRATE AS
THE STATE DEPARTMENT HEALTH
CARE SERVICES DOING MORE
ANALYSIS. TO TRY TO IDENTIFY
INDIVIDUALS EITHER BY SPECIALTY
BY LOCATION LOOK AT THOSE
DIFFERENT COUNTIES AND SEE
WHERE THERE ARE- GAPS IN THE
NUMBER OF PROVIDERS AVAILABLE
TO BENEFICIARIES AND TRY TO
CLOSE THOSE GAPS USING
INFORMATION LIKE. THE EMPHASIS
WE DID DURING THE COURT THE
AUDIT. THAT ANSWERS YOUR
QUESTION WHAT IT DOES AND THE
REASON I WANTED TO FIND THAT
INFORMATION BECAUSE RICH. OF
PROBLEMS HERE TRYING TO BE MORE
PROACTIVE IN TRYING TO ENSURE
ONE HAS ACCESS AND WHEN THERE
IS A DIFFERENCE OF OPINION I
JUST KINDA WANT TO CLARIFY
BECAUSE- IT'S A BIG DIFFERENCE
POWER. ON BUT I WILL. A CHANCE
TO MONTICELLO I'M HEARING THAT
DOWN. YOU KNOW I'M SERVICES
LIKE UP CARDIOLOGISTS BUT YOU
MAY NOT BE ENGAGING THEM SO
WHAT YOU HAVE TO SAY TO. STATE
IT SO I THINK THAT THE WHAT
YOU'RE HEARING HERE IS THAT
THERE IS NOTHING MORE WE CAN DO
WE LOOK AT THE A CS DIRECTORY
WE LOOK AT OTHER MEDICARE
DIRECTORIES- WE ARE VERY
PROACTIVE- WHEN WE FIRST MOVED
INTO MANAGED CARE WE LOOK AT
THE BY TOP PROVIDER THAT WAS
FOR SERVICE BEFORE THEY WENT
INTO MANAGED CARE AND REACHED
OUT TO THEM FOR CONTRACTS. SO I.
IN THOSE COUNTIES NOW WHETHER
REALISTICALLY HEY WE HAVE HEAVY
ALREADY ENGAGE THEM AND THEY
SAID NO. ANY OF THIS IS A
RESEARCH PART OF ME RESEARCH
APARTMENT COMING OUT BUT-
WHETHER WE WRITING IS AND THEY
SAID NO WHETHER THEY TAKE
MEDICARE I'LL- WHETHER THEY ARE
IN THE SPECIALTY THAT IS
IDENTIFIED IN TABLE THREE- I
ACTUALLY SAVINGS TABLE TO-
THOSE ARE THINGS I THINK WE
SHOULD CONTINUE TO WORK ON.
THAT TOGETHER PARTNERING WITH
PLANS WITH THE H. YEAH. TO I
DON'T KNOW IF THIS EARLY THE
DIFFERENT MODELS WITH. THAT I
THINK IT'S MORE ABOUT. ACROSS
MAYBE CROSS REFERENCING THAT
BOARD DATA WITH THE DH CS DATA
WITH. DATA THAT EACH PLAN MIGHT
HAVE THAT THAT'S ALREADY
CONTRACTED TO MAKE SURE WE HAVE
EVERY AVAILABLE PROVIDER IS A
GOAL FOR US. IS TO MAXIMIZE
ACCESS THERE'S NOT THERE'S NOT
IN OUR BEST INTEREST TO MAKE UP
A MEMBER. GO FIVE HUNDRED MILES
TO SEE A SPECIALIST BECAUSE AT
THE END UP IN THE HOSPITAL.
IT'S GOING TO BE IN THAT BAD
EXPERIENCE FOR EVERYBODY SO WE
WILL DO WHAT IT TAKES. AND WITH
THE STATE. PARTY WITH PLANS. TO
IMPAIR. IF THERE'S A WILL. WHEN
THE CONTRACT AM I JUST WANTED
TO SAY THAT THAT EIGHTEEN
HUNDRED AS AS A VERY IT'S A-
KIND OF A START. HERE'S
NINETEEN HUNDRED PHYSICIANS
THAT LIVE IN THESE COUNTIES AND
HAVE A- ACTIVE LICENSE FROM THE
BOARD. WHETHER THEY TAKE
MEDICARE WHETHER THEY'RE IN
THEIR SPECIALIST WHETHER THEY-
HAVE AN OPEN PANEL WHETHER
WE'VE ALREADY REACHED OUT TO
THEM AND THEY SAID NO. AGAIN
CHALLENGES WITH DIRECTORIES AND
LISTS. IT'S A LOT OF MORE
LETTERS UNDER THERE THAT WE
JUST NEED TO WORK THROUGH. SO I
JUST DON'T WANT. THE COMMITTEE
TO ACT TO- LARGE NUMBERS KING.
ASSUMING THAT THE NINETEEN
HUNDRED ARE ONES THAT. WHETHER
IT IS A MODEL NINETEEN WHO
WOULD BECOME INTO MANAGED CARE
TOMORROW BECAUSE I JUST WANT TO
CAUTION THAT. ON THE LAST SIX
YEARS OF EXPERIENCE MYSELF AS A
PHYSICIAN GOING OUT THERE.
MEETING WITH PHYSICIANS THAT
THAT ARE WITH WITH THE
CONTRACTING WITH US AND. AND
ONCE THAT DOWN. IT'S NOT
NECESSARILY THAT BLACK AND
WHITE. ANOTHER. IT'S DIFFICULT
TO MAKE DETERMINATIONS BASED ON
DIFFERENCES IN OPINION BUT YOU
KNOW TO. YOU KNOW YOU JUST WANT
TO GIVE US A SAMPLE WHAT THAT
LOOKS LIKE. IS THERE ARE
MANDATES AND RECORD KEEPING FOR
EXAMPLE HOW DO WE MOVE FORWARD
WITH DOUBT IF WE DON'T
UNDERSTAND SOMETHING GIVEN
EXAMPLE OF COURSE I'M
EXAGGERATING BUT YOU'RE SAYING
THAT YOU MAKE EVERY EFFORT TO
ENGAGE THESE BOOKS TO ENSURE
THAT THEY WANT TO PARTICIPATE
IN THAT THEY DON'T. SO HOW DO
WE KNOW WHAT LOOKS LIKE TO YOU
BY REACH OUT ONE TIME TWICE
HOW. WE MAKE THIS BETTER LET ME
ASK THE OTTER. QUESTION DO YOU
HAVE A MANDATE TO. KEEP RECORDS
OR WHAT CAN WE DO. WELL I THINK
THAT'S SOMETHING THE DEPARTMENT
HEALTH CARE SERVICES NEEDS TO
DO AND THAT'S PART OF WHAT WE
HAVE RECOMMENDED TO THE
DEPARTMENT SO IT SHOULDN'T BE A
ONE AND DONE IT SHOULD BE
PERIODICALLY THEY NEED TO BE
LOOKING AT- ACCESS TO CARE WHEN
THEY'RE WHEN THEY'RE
CONSIDERING THE ALTERNATIVE
ACCESS STANDARDS IN DETERMINING
WHETHER THEY'RE GONNA PROVE ANY
ADDITIONAL STAND ADICIONAL
ALTERED TAXES UNDER. THEY NEED
TO BE ASKING THESE KINDS OF.
AND THE THINGS WE HAD IN THE
REPORT IS. I MEAN A PLAN WOULD
SUGGEST WE DON'T HAVE ANY
PROVIDERS IN THE REGION SO WE
NEED AN ALTERNATE ACCESS
STANDARD THAT'S GOING TO
REQUIRE UNFORTUNATELY OUR OUR
BENEFITS YOUR TO DRIVE A
HUNDRED FIFTY MILES WHAT WE
WEREN'T SKIING HEALTHCARE
SERVICE IS DOING IS CHALLENGING
THAT PLAN AND SAYING.
DEMONSTRATE TO US WITH DOCUMENT
GEN WHAT TYPE HOW MANY YEARS
DID YOU REACH OUT TO WHERE ARE
THEY LOCATED WHAT TYPES OF
PROVIDERS ARE THEY SO WE
BELIEVE THE DEPARTMENT OF CARE
SERVICES NEEDS TO DO THAT ON A
PERIOD. AWARE THAT THE COURT
PLEASE YEARLY- I THINK THAT'S
SOMETHING THAT THAT. SERVICES
WE NEED TO DETERMINE BUT THAT
WAS ONE OF THE KEY ISSUES WE
HAD WITH RESPECT TO. THEIR
DECISION MAKING IN APPROVING
ALTERNATE ACCESS STANDARDS THEY
WEREN'T CHALLENGING THE PLANS
AND ARE YOU SEEKING.
SUFFICIENTLY FOR THEM TO BE
ABLE TO DEMONSTRATE WITH
DOCUMENTATION AND WRITTEN
JUSTIFICATIONS AS TO WHY IT
FELT THEY NEEDED THESE
ALTERNATE STAND. I THINK MY
QUESTION MAYBE A LITTLE
REDUNDANT. ASK ABOUT A
REASONABLE RIGHT REASONABLE
REASONABLE TâM SO I GUESS
THAT'S WHERE WE'RE GOING TO
HAVE TO FIGURE THIS OUT YOU
KNOW BECAUSE I WITHOUT HAVING
YOU KNOW DOCUMENTATION A
WRITTEN INFORMATION IT'S
DIFFICULT BUT- YOU KNOW FORGIVE
ME IF THIS UP A LITTLE
REDUNDANT I JUST REALLY WANT
UNDERSTAND THAT THANK YOU YOU.
ANSWER QUESTIONS THANK YOU.
THANK YOU I A THAT WE I LOOK
FORWARD TO SHARING WITH YOU SEE
RUBY ON REST OF THE COMMITTEE
THE ANSWERS FROM THE PARK
HEALTHCARE SERVICES AS TO
WHAT'S REASONABLE DEFINITION. I
JUST HAVE ONE- BRIEF QUESTION
AND THEN I KNOW WE'RE RUNNING
BEHIND TIME IN REGARDS TO
BUILDING PROVIDER NETWORKS AND
MAYBE I'LL START WITH ACTUALLY.
DOCTOR MILLER AND PARTNERSHIP
FOR THIS WAY. TO WHAT DEGREE HE
DOES AND AGAIN I'M GAS FOR VERY
BRIEF EITHER YES NO OR VERY
BRIEF EXPLANATION OUT TO WHAT
DEGREE DOES. DOES THE HEALTH
PLAN WORK WITH THE COUNTY TO
HELP GET. PERHAPS TO GET
PROVIDERS THEIR PHYSICIANS TO
PARTICIPATE THE PLAN BECAUSE
AFTER ALL MOST OF THESE
POSITIONS ARE PART OF THE
COMMUNITY AND IF THEY FEEL THAT
THEIR LOCAL COMMUNITY NOT JUST
SOMEONE DISTANCE TRYING TO
CONTRACT WITH THEM. SOME TO
STEP UP. EXPERIENCE I'VE BEEN
OUT JUST WAITED DOCTORS THAT
TAKE PLANS- THAT DEBTS THAT
OFTEN CAN CAN HELP SO. AND
BUTTE HAVE YOU SEEN PLANS THEN
BUTTE COUNTY GO AND ACTUALLY
ENGAGED TO COUNTY AND SAID HEY
WE NEED SOME PEOPLE SOME
PARTICULAR- PHYSICIANS OR
PHYSICIAN SPECIALTY CAN YOU
HELP US WITH TRYING TO IDENTIFY
SOME WHO MIGHT BE WILLING TO
HELP US OUT. HOW LONG. YES OR
NO OR- YES. SO I AM NOT SEEING
A I'M NOT SURE THAT THE
COUNTIES BE WELL POSITIONED TO
HELP THAT WAY EVEN IF THEY DID
OKAY WE HAVE WORKED ON OTHER
THINGS START NOT THAT ISSUE
OKAY AND PARTNERS ANY
EXPERIENCE. THAT YOURSELF OR DO
YOU AND- YOUR FOR. THERE'S A
COUPLE THE PAYMENT WE HAVE. A
LOCAL REPRESENTATIVE FOR. LEASE
ONE ON OUR BOARD GOVERNOR ON
OUR BOARD OF COMMISSIONERS. BUT
WE ALSO REACH OUT OUR MEDICAL
DIRECTORS REACH OUT WITH THE
PROVIDERS IN THE COMMUNITY AND
WE SEE WHAT THEIR NEEDS ARE WE
TRYING TO FIGURE OUT WAYS TO
BRING PROVIDERS ARE DOING GAUGE
PEOPLE AT THE LOCAL LEVEL. OKAY
YEAH WE'RE VERY SIMILAR
APPROACH WE ACTUALLY ALSO HAVE
OF. FOR HEALTH AND WELLNESS
THAT DOES INCLUDE A PHYSICIAN
FROM THE LOCAL COMMUNITY WHO
EACH OF THE COUNTIES THAT NO
JUST FROM IT'S FROM OUR LARGEST
HEALTH SYSTEM WITHIN VIEW. DO
YOU COUNTY AMPLA THEY SAID HE
SAID OUR BOARD AND- WE ONLY FOR
BUTTE THEN HE DOES BI YUBA
AND SUTTER OKAY BUT THE OTHER
COUNTIES TRAFFIC YOU DON'T HAVE
SOMEONE LIKE WE DO HAVE LOCAL
OUR. LIVES WITH EACH COUNTY AND
THEY DO ENGAGE WITH PHYSICIANS.
ALSO ONLY IN THE COUNTY AT
LEAST ON A QUARTERLY BASIS AND
ALL OF THEIR- LEADERSHIP WITHIN
THAT THE LOCAL PROVIDER
COMMITTEE ON MY PERSONAL CELL
PHONE SO THEY ARE ALWAYS
WELCOME TO. CALL ME AT ANY TIME
IF THERE'S ANY PARTICULAR ISSUE
THAT THE ADDRESSED IN THE-
MISSION WE NEED TO ME QUITE THE
WITH EVERY COUNTY AND IN THOSE
MEETINGS. TAKE ME WITH THE
COUNTY WILL TALK ABOUT COUNTY
GOVERNMENT THAT YOU HAVE A
HEALTH. THE PUBLIC HEALTH
DEPARTMENTS ALL THE DEPARTMENTS
WITHIN THAT COUNTY THAT ARE
INVOLVED IN THE HEALTH CARE-
LISA AND IN THE BACK IS THE ONE
THAT THAT MEETS SO WE GET INPUT
FROM THEM IN THAT IN THAT
REGARD WE WORK WITH THEM. WHEN
IT COMES TO- PROVIDE A RECRUIT
WE WORK A LOT WITH THE HOSPITAL
COUNCIL AND- DIFFERENT.
ORGANIZATIONS THAT ARE MORE
ALIGNED OR AN INTEGRATED WITH
THE PROVIDER. SPECIAL COUNSEL
ON THE ALL THE CEOS OF THE
MAJOR SETTLES ACROSS- THE WORLD
COUNCIL SOCIETIES- YES MEDICAL
SOCIETIES BUT MY I THINK FOR
THE MEDICAL THAT CAN DEFINITELY
NOT THE CMA BUT THERE ARE
DIFFERENT TYPES OF
ORGANIZATIONS COUNTY MEDICAL
SOCIETIES YEAH YEAH SIMILAR
SYSTEM OF THOSE.YOU CAN YAK.
YES WE WORK WITH THEM AS WELL-
ACTUALLY BEEN FINDING SOME OF
THEIRPROJECTS WE WORK WITH
THOSE TYPES ORGANIZATIONS THAT
ARE MORE CONNECTED WITH. WHAT
THE PROVIDER COMMUNITY OKAY
ALRIGHT WELL I'M TRYING TO
THINK ABOUT ORDERED MORE THINGS
ESPECIALLY WHEN YOU TALKED
ABOUT. THE DANCE OF THOSE WORDS.
ON'T BUT THERE ARE SOME
ADVANTAGES TO DOING THAT CELL.
OKAY WELL I WANT TO THANK THANK
YOU OFFER PRESENTING ANIMAL THE
AND THAT YOU YOU MUSCLE STATE
GOOD ZERO FOR THE NEXT PANEL.
SO THANK YOU VERY MUCH FOR YOUR
TESTIMONY AND. APPRECIATE THE
ALTHOUGH I ALL THE WORK THAT
YOU DO I KNOW IT CAN BE
CHALLENGING IT IS A DIFFERENT
POPULATION I DON'T LIKE NOR
THAT IT CAN BE CHALLENGING TO
PROVIDE ACCESS AND- RURAL
COUNTIES AND- DOUBLE. DIAMOND
CALIFORNIA THE WELLNESS IS
DOING THAT AREA AS WELL THANK
YOU. OKAY SO WE'RE GOING TO
MOVE ON TO THE NEXT REPORT. I
THINK I GUESS YEAH YOU HAVE- SO
THANK YOU VERY MUCH. AN AUDITOR
AND- YOU'VE IT'S A MISTER
COOPER IS THAT THE FIRST ON
THIS ONE OKAY SO THIS IS THE
RECOMMENDATIONS ON THE
CALIFORNIA- DON'T SPREAD OF
HEALTH SERVICES AND THIS MONTH
RT IMPLEMENTATION PROGRESS
REPORTS OF THANK YOU AND
WELCOME ME. THANK YOU CHAIRMAN
PAN SENATOR RUBIO. AND MY NAME
IS ELAINE HOW CALIFORNIA STATE
UNDER WITH ME IS JOSHUA HOOPER
JOSH WAS THE TEAM LEADER ON
THIS PARTICULAR PROJECT THIS IS
AN AUDIT THAT WE WERE ASKED TO
DO- LATE LAST LATE AND TWENTY
EIGHTEEN SHOULD DEPORT IN MARCH
OF TWENTY NINE AND AS YOU
INDICATED DOCTOR PAN ARE WE
HAVE. SIX RESPONSE AND I WILL.
SAID OF MY LEG. AND THEN MISTER
HOOVER WELL STEP THROUGH.
EMENDATIONS THAT WE'VE MADE AND
AGAIN WE HAVE A SIX MONTH
RESPONSE- SO HE WILL. DISCUSS
WITH THE COMMITTEE. THE
VARIOUS- STATUSES OF EACH OF
THOSE RECOMMENDATIONS. AT LEAST
GROUPING MA'AM BYE BYE SUBJECT
AREA SO THE FIRST AREA I'M NOT
GONNA DIE IN TWO AND A LOT OF
DETAIL BECAUSE THIS IS- THE
CAR. OVER ISSUE THAT WE HAVE
FROM THIS. NOT AND THE REPORT
WE SPOKE ABOUT. THIS LATE WITH
RESPECT TO ACCESS TO CARE
APPROVAL OF ALTERNATIVE AND
STANDARDS I WANTED TO PROVIDE A
LITTLE BIT OF CONTEXT HOWEVER.
THIS AUDIT REALLY FOCUSED ON.
SERVICE HOLDREN AND MEDI CAL AS
YOU SAID DR PAN THERE ARE. A
SIGNIFICANT NUMBER OF CHILDREN
IN CALIFORNIA NEARLY HALF OF
CALIFORNIA'S CHILDREN RECEIVE
THEIR MEDICAL SERVICES THROUGH
MEDICARE ALL. 90% OF THOSE KIDS
ARE IN AND AT PROVIDE RECEIVING
SERVICE THROUGH A MANAGED CARE
PLAN. WE ALSO LOOK UTILIZATION
RATES ACROSS THE COUNTRY BASED
ON PERMISSION. FEDERAL OUR
PROGRAM MEDICID PROGRAM
PROVIDES AND CAL UNFORTUNATELY
RANKS RELATIVELY LOW AND HAS
FOR A LONG TIME- AT THE POINT
IN TIME WE LOOKED AT FEDERAL
FISCAL YEARS.TWENTY SEVENTEEN
DATA CAL YOU'RE RANKED FOR
FORTIETH AMONG STATES. ENTRY AS
FAR AS ASIAN PREVENTIVE
SERVICES FOR CHILDREN ARE YOU.
RATE AS A STATE- HAS BEEN BELOW
50% FOR THE LAST FIVE FISCAL
YEARS WHEN WE CONDUCTED THE
AUDIT. SO CLEARLY AN ISSUE THAT
CALIFORNIA NEEDS TO FOCUS ON-
WITH RESPECT TO ACCESS TO CARE
AGAIN I'M NOT GONNA GO INTO ALL
THE DETAILS WE HAD THE SAME
ISSUES IN THIS REPORT. THIS WAS
ACTUALLY THE FIRST REPORT WHERE
WE ISSUED. FINDINGS AND
CONCERNS ABOUT THE HEALTH CARE
SERVICES DECISION MAKING WITH
RESPECT TO APPROVING
ALTERNATIVE ACCESS STANDARDS-
OR REQUESTS AND- OF THE TEN
THOUSAND THAT I MENTIONED
EARLIER ABOUT SIXTY EIGHT
HUNDRED OF THOSE WERE FOR.
FIGHTER PROVIDE. IS TO. A LOT
STANDARD WERE RE APPROVED ARE
FOR PROVIDERS IN THE- MANY OF
THESE PLANS WE ACTUALLY DUG A
LITTLE DEEPER AND DETERMINE
WHAT WAS THE UTILIZATION RATE
FOR THESE PLANS AND THE
UTILIZATION RATE FOR CHILDREN
FOR THESE PLANS THAT WERE
ASKING FOR THESE ALTERNATE
ACCESS STANDARDS. WAS AGAIN
BELOW 50% SO THOSE ALL
IDENTIFIED ISSUES FOR US WITH
RESPECT TO ACCESS TO CARE AND
CERTAINLY WE HAVE
RECOMMENDATIONS WITH RESPECT TO
OUR DEPARTMENT CARE SERVICES IN
THEIR DECISION MAKING WITH
RESPECT TO OUR APPROVING.
ALTERNATE ACT THE STANDARDS.
THE OTHER TWO THAT WE LOOKED AT
WITH RESPECT TO THE DEPARTMENT
OF CARE SERVICES AND ITS
RESPONSIBILITIES- IS IT'S
OVERSIGHT AND- THE FACT THAT
THE CONCLUSION WE RATE IS WE
FELT THAT THE DHS WAS.
DELEGATING A LOT OF ITS
RESPONSIBILITIES TO THE PLANS
AND THE REASON WE SAY THAT IS
THERE ARE SPECIFIC REQUIREMENTS
IN FEDERAL LAW THAT CHILDREN
RECEIVE EARLY PERIODIC
SCREENING DIAGNOSTIC AND
TREATMENT TREATMENT. DEPARTMENT
HEALTH SERVICES BACK IN TWENTY
FOUR IN ADOPTED THE AMERICAN
ACADEMY OF PEDIATRICS THE
BRIGHT FUTURES SCHEDULE
ESSENTIALLY A SCHEDULE OF
SERVICES PREVENTIVE SERVICES
THAT SHOULD BE PROVIDED
CHILDREN- SO WE WERE EXPECTING
THAT HEALTHCARE SERVICES WOULD
HAVE VERY SPECIFIC EXPECTATIONS
OF. THE PLAY TIMES TO MAKE SURE
PROVIDERS WERE MY NAP IF YOU
THEIR SCHEDULE- AND
UNFORTUNATELY WHEN WE LOOKED AT
CONTRACTS BETWEEN HEALTH CARE
SERVICES AND THE PLANS THOSE
CONTRACTS WERE NOT CLEAR AS TO
WHAT. THE ACT RECALL WERE AS
FAR AS WHAT THE EXPECTATIONS.
OF PROVIDERS IN BEING ABLE TO
PROVIDE SERVICES TO CHILDREN
THAT ARE ON THIS BRIGHT FUTURES
ALL THESE PREVENTIVE SERVICES
THAT WOULD BE BENEFICIAL TO
CHILDREN WE WEREN'T SEEING WE
DIDN'T THINK THOSE CONTRACTS
WERE STRONG ENOUGH WE DIDN'T
THINK THAT DEPARTMENT OF CARE
SERVICES WAS REALLY CLEARLY
COMMUNICATE TO THE ENDS AND
THEREFORE THE PLANS WERE NOT
INDICATING TO PROVIDE WHAT THE
EXPECT HIS WORK BACK TO.
PROVIDE SERVICES FOR CHILDREN.
OTHER SIMILAR TO THAT WHERE
YOU'RE LOOK AT MORE. AND SO
TYPICALLY THE ADAGES IF YOU
MEASURE SOMETHING AND YOU
MEASURE AGAINST SOMETHING
PEOPLE ARE GOING TO PERFORM AND
SO WE LOOKED AT PERFORMANCE
TRICKS- FOR THE BRIGHT FUTURE
SCHEDULE SO THERE ARE A VARIETY
OF DIFFERENT TIME FRAMES AND
THE TIME FRAME THAT HEALTH CARE
SERVICES WAS HOLDING. UP PLANS
ACCOUNTABLE TO WE SAW HIGH
UTILIZATION RATES AND THAT WAS
AGES THREE TO SIX TIPPER
UTILIZATION RATES FOR CHILDREN
AND THOSE AGE GROUPS BETWEEN
SIXTY AND SEVENTY CENTS. AS A
LOT OF THE OTHER AGE GROUP
ALTHOUGH AGES EIGHT TWENTY
DROPPED OFF SIX. BILLION IN
CASE THEIR WORK. SIGNIFICANTLY
BELOW THE 50% OR THE AVERAGE
FOR THE STATE OF CALIFORNIA SO.
WE FELT THAT THE DEPARTMENT OF
CARE SERVICES NEEDS TO MAKE
SURE THAT AGAIN THE PLANS
UNDERSTANDING THEY NEED TO
FOLLOW THE RIGHT FEW SCHEDULE.
WE NEED TO MAKE SURE THE
PROVIDING THE SERVICES TODAY
FROM THE FROM INFANCY ALL THE
WAY UP THROUGH AGES EIGHTEEN TO
TWENTY. WHICH IS INCLUDED ON
THAT BRIGHT FUTURES PLAN.
SCHEDULE EXCUSE ME. INTO THAT
WE WERE LOOKING AT THE MEDICAL
AUDITS THAT I REFERRED TO
EARLIER AND WHETHER OR NOT
THOSE MEDICAL ARTS WE'RE REALLY
FOCUSING ON. THE PREVENTIVE
SERVICES FOR CHILDREN- AND WE
DIDN'T SEE A LOT OF INFORMATION
IN THE AUDITS WHERE THEY WERE
REALLY DRILLING DOWN TRYING TO
IDENTIFY ISSUES WITH RESPECT TO
HOLDEN RECEIVING PER OF
SERVICES FROM PROVIDERS AND
PLANS I'M SURE. I'LL SERVICES
WERE AVAILABLE MITCHELL AND
BETTER. SPECIFICALLY ALSO
LOOKING AT DOCTOR BUT WHEN HE
REQUESTED US TO DO THIS WORK HE
WAS ALSO INTERESTED IN LOOKING
AT CULTURAL AND LINGUISTIC
ISSUES. ARE IS HEALTHCARE
SERVICES PROACTIVE DRESSING
CULTURAL DISPARITIES ARE TRYING
TO MAKE SURE THAT.
BENEFICIARIES HAVE INFORMATION
IN THE LANGUAGE THEIR PRIMARY
LAST SPOKEN LANGUAGE RATHER
THAN JUST ENGLISH ARE ARE THEY
ENSURING THAT THEY'RE DOING
ANALYSES OF VARIOUS REGIONS TO
SEE ARE THERE CULTURAL
DIFFERENCES AND ARE THERE.
INDIVIDUALS FROM DIFFERENT
DIFFERENT ETHNICITIES THAT ARE
NOT YOU WILL YOU USING
PREVENTIVE SERVICES FOR THEIR
CHILDREN AND WHAT ARE THE
BARRIERS WHAT DO WE NEED TO DO
AS A STATE HAT IS HEALTH CARE
SERVICES NEED TO DO AS FAR AS
REQUIRING. THIS TO ME SURE AT
UNDERSTAND WHO THE FISHERIES
ARE THERE ARE CULTURAL BARRIERS
AND LINGUISTIC BARRIERS YOU TO
DEAL WITH WE NEED TO ADDRESS
THOSE AND WE DIDN'T THINK
HEALTH CARE SERVICES WAS DOING
AT A JOB THAT COULD SHOW UP. TO
MAKE SURE. AND FOR THE
PROVIDERS. FULL WHAT WE DIDN'T
SEE IS- HEALTH CARE SERVICES
MAKING SURE THAT THEY WERE
SHARING ALL OF THE INFORMATION
NOT JUST WITH RESPECT TO THE TO
THE INCENTIVE PROGRAMS BECAUSE
THOSE HAVE BEEN SUCCESSFUL.
OTHER ISSUES WHERE PLANS HAVE
ADDRESSED SOME CONCERNS THAT
HAVE BEEN RAISED BY HEALTH CARE
SERVICES WE WOULD EXPECT TO SEE
SHARING ESSENTIALLY BEST
PRACTICES OR STRATEGIES THAT
ARE THAT. VARIOUS PLANS WERE
USING TO TRY TO GET REALIZATION
RATES UP. WE SAW THAT THEY HAD
SOME PERIODIC CALLS QUARTERLY
CALLS QUARTERLY PROGRESS
REPORTS BUT AGAIN WE THINK
THOSE COULD BE MORE
COMPREHENSIVE AND MORE
BENEFICIAL TO. THE VARIOUS
PLANS TO MAKE SURE THAT THEY
WERE AWARE OF ANY STRATEGIES
THEY COULD USE TRY TO INCREASE.
THE AND EDUCATE THE FISHER
ABOUT THE ABILITY TO GET AND IF
SERVICES FOR THEIR CHILDREN.
AND THEN THE LAST FEW WAS
RELATED. ON THESE EXTERNAL
QUALITY REVIEWS ARE THERE ARE
RECOMMENDATIONS THAT HE Q. R.
E. Q. R. OVER HIS MAKING THEIR
EXTERNAL QUALITY OUR REVIEW
ORGANIZATION VARIETY OF
DIFFERENT RECOMMENDATIONS WITH
RESPECT TO ACCESS WITH RESPECT
TO QUALITY OF CARE WHEN WE LOOK
AT SOME OF THOSE
RECOMMENDATIONS. WE SAW THAT.
THE OF THOSE RECOMMENDATIONS
NOT BEEN FULLY AMPLE I
HEALTHCARE SERVICES SO. WE MAY
STATIONS THAT YOU NEED TO
REALLY FOCUS ON THESE
RECOMMENDATIONS AND TRY TO GET
THEM IMPLEMENTED QUICKLY AS
POSSIBLE. AND YOU KNOW THAT EXT
ONLY REVIEW VERY SPECIAL WE'VE
GOT A FOLLOW THROUGH. AND DOES
RECOMMEND. SO I'M VERY HIGH
LEVEL THE KEY ISSUES IDENTIFIED
IN THE REPORT AS I SAID WE ARE.
IN MARCH OF NINETEEN WE DID
RECEIVE US A SIX MONTH RESPONSE
FROM THE DEPARTMENT OF CARE
SERVICES SO MISTER HOOPER WILL
STEP YOU THROUGH AND IN THE
VARIOUS BUCKETS- WHAT ARE KEY
RECOMMENDATIONS WERE AND WHAT
THE STATUS IS AS FAR AS
DEPARTMENT HEALTH CARE SERVICES
PROGRESS. IN IMPLEMENTING THOSE
RECOMMENDATIONS. FOR THE RECORD
MY NAME IS JOSH COOPER I WAS
THE TEAM LEAD ON THIS AUDIT. AS
THE STATE AUDITOR SAID ARE OUT
IT LOOKED AT- THE DELIVERY OF
PREVENTIVE SERVICES TO CHILDREN
AND MEDI CAL. TO THAT END WE
HAD FOURTEEN RECOMMENDATIONS
FOR DH CS- DHS IS SAID THAT IT
WILL NOT IMPLEMENT ONE OF THOSE
FOURTEEN. BUT THAT IT IT HAS IT
WILL IMPLEMENT THE OTHER
THIRTEEN. WE ISSUED THIS REPORT
IN MARCH OF THIS YEAR- AND SO
IN SEPTEMBER DE ACS ISSUED AT
SIX RESPONSE. AT THAT POINT- IT
HAD NOT FULLY IMPLEMENTED ANY
OF THE RECOMMENDATIONS FAR FROM
OUR REPORT. I'M GONNA GO OVER
THOSE NOW- WE HAVE THOSE
FOURTEEN RECOMMENDATIONS BROKEN
DOWN INTO FOUR CATEGORIES- THE
FIRST IS ACCESS THE SECOND IS
OVERSIGHT- THE THIRTY SHARE.
AND THE FOURTH- IT HAS TO DO
WITH UTILIZING THOSE AYE
EXTERNAL QUALITY REVIEW
ORGANIZATION TOOLS THAT THEY
HAVE. THE FIRST RECORD ASIAN IN
THE ACCESS CATEGORY. WAS THE DH
CS SHOULD IDENTIFY AREAS WHERE
MORE PROVIDERS WERE NEEDED- AND
THEN TO RECRUIT MORE PROVIDERS
IN THOSE AREAS- USING-
REQUESTING FUNDING IN INCREASES
AS NECESSARY. THIS IS THE
RECOMMENDATION THE DE CSS SAID
IT WITH MY EMPLOYMENT DHS IS
POINTED TO ITS LOAN REPAYMENT
PROGRAM HOWEVER WE. WE FOUND
THAT DH CS COULD. SHOULD NOT
LIMIT WHAT IT DOES TO JUST THAT
ONE SINGLE PROGRAM. THE SECOND
ACCESS RECOMMENDATION HAD TO DO
WITH- CLARIFYING ITS CONTRACTS
THAT THERE THE PLANS ARE
REQUIRED TO EAT DELIVER BRIGHT
FUTURES. DC HAS INDICATED IT
FULLY INTO THAT-
RECOMMENDATION- BUT IT HAS NOT
YET UPDATED THE CONTRACTS. THE
THIRD RECOMMENDATION WISE- THAT
IT SHOULD UPDATE IT'S WRITTEN
MATERIALS- TO TWO MEMBERS- AND
DHS IS NOT YET IMPLEMENTED THAT
RECOMMENDATION. IN THE
OVERSIGHT CATEGORY- AGAIN DHS
IS NOT YET IMPLEMENTED ANY OF
THESE RECOMMENDATIONS THE FIRST
WAS TO UTILIZE THE PERFORMANCE
MEASURES THAT THE STATE AUDITOR
MENTIONED- TO- IN CAPS LATE ALL
AGES AND NOT JUST CHILDREN IN A
CERTAIN AGE GROUP. THE SECOND
WAS TO IMPLEMENT AUDIT
PROCEDURES- THAT ARE SPECIFIC
TO UTILIZATION OF CHILDREN'S
PREVENTIVE SERVICES. THE THIRD
WAS TO. IS IT TAKE TO USE ITS
UTILIZATION MANAGEMENT PROGRAM
TO ADDRESS UNDER UTILIZATION-
SPECIFIC TO CHILDREN'S
PREVENTIVE SERVICES. THE FOURTH
WAS THAT IT SHOULD- ENSURE
BETTER ACCURACY AND PLAN
PROVIDER DIRECTORIES. THE FIFTH
IS THAT IT SHOULD USE ITS
HEALTH DISPARITY STUDY- TO
DRIVE TARGETED INTERVENTIONS-
WHEN THERE ARE- HEALTH
DISPARITIES BETWEEN CHILDREN OF
DIFFERENT ETHNIC BACKGROUNDS IN
LANGUAGE NEEDS. AND THE SIX IN
THE OVERSIGHT CATEGORY WAS THAT
DH CS SHOULD USES. SHOULD
REQUIRE PLANS TO USE THE GROUP
IN THE NEEDS ASSESSMENT
REPORTS- TO ALSO FOLLOW UP. TO
ADDRESS FINDINGS THAT STEM FROM
THOSE REPORTS. IN THE SHARING
CATEGORY THERE WERE TWO
RECOMMENDATIONS THAT WE MADE TO
DH CS THE FIRST IS THAT IT
SHOULD IDENTIFY EFFECTIVE
INCENTIVE PROGRAMS IN IN THE
VARIOUS PLANS AND THEN SHARED
THOSE- HOSE EFFECTIVE
INCENTIVE PROGRAM. ALL OF THE
PLANTS. DHS IS SAID THAT IT.
THAT RECOMMENDATION- BUT IT IS
NOT YET. GOTTEN AROUND TO IT
THE SECT SHARING RECOMMENDATION
HAD TO DO ASSURING THE RESULTS
OF SEX- SUCCESSFUL STRATEGIES
FROM ITS CORRECTIVE ACTION
PROGRESS- PROCESS THE PLAN TO
STUDY ACT PROCESS- DCS HAS
BEGUN COLLECTING CAM SUCCESSFUL
STRATEGIES BUT IT HAS NOT YET
SHARED THOSE. THE PLANTS. AND
IN THE LAST CATEGORY HAD TO DO
WITH BETTER UTILITY. A REVIEW
OR TOOLS- WE HAD
RECOMMENDATIONS THAT DH CS-
SHOULD USE MORE RECENT DATA AND
MORE OFTEN- TO VALIDATE THE
DATA THAT IT HAS- WE HAD A
RECOMMENDATION- THAT IT SHOULD
USE THAT HE GROWS- THEY SHOULD
IMPLEMENT THE EQUALS REP
RECOMMENDATIONS RELATE TO
CHILDREN PREVENTIVE SERVICES.
AT A RECOMMENDATION DCS. IN
ASSESSMENT OF THE PLANT THE
ACTIONS THAT PLANTS HAVE TAKEN
TO ADDRESS THE EGRESS
RECOMMENDATIONS I IN ALL THREE
OF THOSE HAVE NOT YET BEEN
FULLY IMPLEMENTED. OKAY THANK
YOU. QUESTIONS JUST TO. ONE
QUESTION- SO IS YOU MAY NOTE IN
THE REPORT THEAGE RANGES ON
WHICH THE DTS ACTUALLY MONITORS
PERFORMS MUCH BETTER THAN THE
OTHER AGE RANGES. THAT'S
CORRECT SO THAT TO ME IMPLIES
THAT IF PEOPLE REALLY WANTED TO
THEY COULD AT LEAST PERFORM AS
WELL AS THAT. WE SHOULD STILL
PERFORM BETTER BUT THEY COULD
AT LEAST PERFORM AS WELL AS
THOSE AGE RANGES WHERE SHE
BASICALLY- UP AROUND BETWEEN
6275% VERSES ARE. TURN AVERAGE
OF BELOW 50% I GUESS FORTY NINE
PERCENT. DID YOU- IDENTIFY IN
THE AUDITS- THINGS THAT WERE
DONE DIFFERENTLY FOR THOSE AGE
RANGES ASIDE FROM THE
MONITORING- WATER PENALTIES
ASSOCIATED WITH NOT HITTING
PERFORMANCE TARGETS ARE IT IT
DIFFERENCES FOR THAT IS AGE
RANGES BAND FOR THE OTHER- AGES
AND WHICH DIVERSE. BE ASIDE
FROM THE OTHER TRADE
CONSEQUENCES RELATED TO THAT.
YES DR AS YOU MENTIONED-
BECAUSE IT WAS A PERFORMANCE
BECAUSE IT WAS SOMETHING THAT
THEY WERE HOLDING THE PLANS
ACCOUNTABLE FOR WE FOUND THAT.
THE REALIZATION RATES WERE MUCH
HIGHER IN THOSE AREAS- THEY
WERE NOT HOLDING PLANS
ACCOUNTABLE FOR PERFORMANCE FOR
DELIVERING PREVENTIVE SERVICES
FOR THE- THE H. ONE AND TWO
YEAR OLDS AND FOR THE CHILDREN
WHO ARE OVER SIX RESULT. SO
THERE WAS A DIFFERENT. HAVE
SOMEONE DIDN'T HITTER
PERFORMANCE MEASURE ON AGES
THEY WERE MONITORING DID.
THAT'S THAT'S DO YOU HAVE AN
ANSWER FOR THAT I CAN ASK EACH
YES. YEP WE ACTUALLY DID REVIEW
THAT WE FOUND THAT- DHS
MENTIONED WHEN THEY WERE UP
HERE BEFORE THEY MENTIONED THAT
THEY HAVE. WAYS TO HOLD AND
ACCOUNTABLE- THEY DO. HAVE A
PROCESS FOR ISSUING SANCTIONS
BUT WE FOUND IN OUR REPORT-
THEY HADN'T DONE THAT THEY HAD
ACTUALLY ISSUED SANCTIONS- UP
UNTIL THE POINT WHEN WE STARTED
OUR REPORT. AFTER WE STARTED
OUR REPORT WE NOTED THAT THEY
DID- IT THAT- METHOD OF HOLDING
THE PLANS ACCOUNTABLE. OKAY Q.
AND I HOPE THAT WE SHOULD REDO
THE SUDDEN FIGHT IN A FEW YEARS
AND SEE WHERE WE ARE. OKAY
THANK YOU VERY MUCH FOR YOUR
PRESENTATION. OKAY AS THE PART
HEALTHCARE TO COME BACK UP. I
SHOULD PERHAPS DISCLOSE- THAT I
AM A MEDIC HOW. POSITION TO
PROVIDES WELL CHILD CARE SO I
HAVE DIRECT PERSONAL EXPERIENCE.
I'LL JUST PUT THAT OUT THERE.
WELL WHERE'S. I LOOK FOR
SERVICEMEN. THIS AGAIN SHERMAN
AND ANSWER RUBIO- THE DH CS IS
WHAT WAS WHAT IMPACT THEIR WE
KNOW IS A VERY SUBSTANTIAL-
NUMBER RECOMMENDATIONS I KNOW
THERE WAS A HEARING ON THIS
EARLIER IN THE YEAR WITH SOME
OF THESE THINGS WERE DRESSED
BUT AGAIN JUST TO REPEAT WHAT.
WAS SAID BEFORE. DHS TAKE
FINDING SERIOUSLY A AND THE AND
I BELIEVE TAKE. CONCEPTS
IMPLEMENT A COMPREHENSIVE
ACTION PLAN IN RESPONSE TO IT-
DSS RECOGNIZES THE STANDS
BEHIND THE IMPORTANCE OF KIDS
OR CHILDREN OF THE SEATING.
APPROPRIATE PREVENTIVE.
SERVICES AND THE RIGHT SETTING
UP PLACE AT THE RIGHT TIME- WE
DID RECENTLY SUBMIT A OR SIX
MONTH RESPONSE TO THE AUDIT-
AND LIKE TO KIND OF THIS ROLE
AT A HIGH LEVEL COVER JUST A
COUPLE OF A FEW OF THE- YEAH.
ACTION ITEMS ARE COMPLETED AND
THEN AND THEN MAY WHAT KIND. SO
WE HAVE CHANGED CAL MANAGED
CARE PLAN ACCOUNTABILITY
MEASURES TO ALIGN WITH FEDERAL
COURSE THAT MEASURES WHAT THE
SAME TIME INCREASING THE
MINIMUM PERFORMANCE LEVEL FOR
THESE MEASURES. WE ARE ISSUING
UP A REVISED EARLY AND PERIODIC
SCREENING DIAGNOSTIC AND
DIAGNOSTIC AND TREATMENT EPS TO
TEASE IS KNOWN ALL PLAN LETTER
AND EVIDENCE OF COVERAGE. BOTH
OF WHICH BETTER DELINEATE
HEALTH PLAN RESPONSIBLE IS
PERTAIN TO THESE SERVICES. ANNA
SHARING BEST PRACTICES AMONG
HEALTH PLANS INTO THE PROJECT
DST SERVICES. IN ADDITION IS
COMPLETED ITEMS THE DEPARTMENT
IS ENGAGED IN AND OUT WHICH
PLAN WHICH WILL TOUCH ALL
BENEFICIARIES AND THE AGE OF
TWENTY ONE. A REMINDER OF THE
IMPORTANCE OF RECEIVING THESE.
INDIVIDUALS MAY BUT ACCESS THEM.
THE FARMERS OF MANY A NEW
HEALTH DISPARITIES REPORTING
REPORT A PREVENTIVE SERVICES
UTILIZATION REPORT ONGOING
ENCOUNTER DATA VALIDATION
STUDIES AND NEW HEALTH PLAN
CONTRACT LANGUAGE PERTAIN TPS
ET. I'M AGAIN- MERRY HERE'S AND
TALK ABOUT THESE THINGS AND
MORE DETAIL BUT THOSE ARE SOME
OF THE HIGHER LEVEL THINGS I
THINK THAT WOULD BE THE
COMPLETED OR ONE OF THE
HIGHLIGHT FOR THE COMMITTEE
MAJOR STEPS FORWARD SO SURE
THING. YEAH WELL THE PERMIT
HEALTHCARE SERVICE TO GO INTO A
BIT MORE DETAIL ON OF THOSE-
AGAIN TAKEN A LOT OF ACTIONS.
RELATED TO AUDIT BUT ALSO JUST
UNDER THE GENERAL DIRECTION OF
THE GOVERNOR AND HIS FOCUS ON
EARLY CHILDHOOD REALLY REALLY
WANTING TO MAKE SURE WERE. WERE
DOING BETTER AND STARTING TO
HIT THE MARK MORE ON ON WHAT'S
NEEDED SO WITH RESPECT TO THE
QUALITY METRICS I KNOW YOU HAD
A QUESTIONS FOR THE AUDITOR'S
ABOUT THAT. CHANGES THAT WE
HAVE MADE AS- WE PREVIOUSLY HAD
US UP YOU KNOW ESSENTIALLY.
THAT THE CORE MEASURES AS WHERE
WE WERE HOLDING PLANS
ACCOUNTABLE- AND THAT'S WHERE
WE WOULD HAVE CORRECTIVE ACTION
PLANS AND THE POTENTIAL FOR
FINANCIAL SANCTIONS. DIDN'T
START IT IS CURRENT REPORTING
HERE SO THIS YEAR THEY WILL BE
BEING HELD ACCOUNTABLE TO ALL
OF THE CMS CORE MEASURES NOT
JUST FOR CHILDREN BUT ALSO FOR
ADULTS. AND AS MENTIONED HAVE
INCREASED MINIMUM PERFORMANCE
LEVEL TO BE THE AT THE NATIONAL
MEDICAID FIFTIETH PERCENTILE. I
WILL SAY AND I THINK I'VE I'VE
SHARED. HE'S ON THIS WITH WITH
YOU DOCTOR PAN AS WELL AS
OTHERS THERE THERE ARE ALSO
SOME. THE ART OF HOW SORT OF
NAZARIAN COME MEASURING
PERFORMANCE BASED ON JUST
COMPARED OF NEST TO OTHER PLANS
RIGHT SO BEING AT THE FIFTIETH
PERCENTILE MEANS YOU'RE SORT
OF. ABOUT THE MIDDLE OF ALL
PLANNED ALL NATIONAL MEDICAID
PLANS IT DOESN'T ACTUALLY SPEAK
TO WHETHER ANY OF THE PEOPLE AT
THE TOP ARE ACTUALLY DOING A
GREAT JOB OR THE PEOPLE AT THE
BOTTOM REALLY DOING A GOOD JOB
SORT OF PARTICULARLY WHEN SOME
OF THOSE MEASURES THAT ARE SORT
OF. PRETTY CLOSE. I THINK YOU
KNOW THE LARGER. METHODOLOGY
WITH THE STANDARD WAY THAT.
HEALTH QUALITY HAS HAS BEEN
MEASURED IS REALLY THAT ISSUE
OF IF EVERYBODY'S DOING BAD.
THE BEST OF THE BAD IS STILL
NOT GOOD ENOUGH I THINK YOU SEE
THAT PARTICULARLY WITH THE WITH
MEASURES AROUND KIDS. AND
UNFORTUNATELY IN THE SUCH. AN
OUT SCREENING MEASURES- BELIEVE
THE NATIONAL MEDICAID-
IMMEDIATE AS LIKE 12% OR EIGHTY
IT'S SOMETHING LESS THAN 20%
WHICH IS NOT DOES NOT OKAY. AND
SO WHAT WE'VE ALSO IMPLEMENTED
THAT MATT THAT IT. HAS BEEN
THEY HAVE. BEEN SO REGARDLESS
OF WHERE YOU FALL NOT SOME TILE
THIS IS REALLY WHERE YOU NEED
TO BE SO WE- JUST INTO THE
FIFTIETH PERCENTILE MEASURES
ADDED FOR THOSE MEASURES BUT
THAT THESE EXIST. THESE
ABSOLUTE BENCHMARKS AND THAT IS
FOR THIS REPORTING YEAR AND
PLANS WILL BE HELD ACCOUNTABLE
TO BOTH OF THOSE THINGS SO THEY
MAY PASS FIFTIETH. NET NATIONAL
MEDICAID PERCENTILE PERFORMANCE
BUT ACTUALLY PASSED THAT SALUTE
BENCHMARK THAT THAT I
PERSONALLY FEEL IS A BETTER.
NEED TO BE DOING THERE ARE
MEASURES UNFORTUNATELY THAT
DON'T HAVE THOSE WORKS TODAY
AND WE'VE BEEN WORKING THROUGH
HOW DO WE ESTABLISH THOSE SO
THAT WE CAN HAVE THAT ACROSS
THE BOARD IN. HAVE BOTH THIS
COMPARATIVE PERCENTILE
METHODOLOGY BUT ALSO ABSOLUTE
BENCHMARKS AND SO WERE WE ARE
HOPING THAT WE CAN INSTITUTE
THOSE FOR THE TWENTY TWENTY
YEAR BUT WANT TO MAKE SURE
THAT. THAT THAT WOULD ESTIMATE
THAT ME AND- HOW WE BY MEASURE.
FOR PLANS THAT DO NOT MEET
WHETHER IT'S THE FIFTIETH. L.
AND OR THE ABSOLUTE BENCHMARK-
OUR CURRENT PROCESS NOW IS TO
INSTITUTE IMMEDIATE FINANCIAL
SANCTIONS JUST FOR FAILING TO
MEET THAT. AS WELL AS UP PUT
THEM INTO A CORRECTIVE ACTION
PLAN WHERE WE CAN THEN WORK AND
PROVIDE TECHNICAL ASSISTANCE
WHAT'S HAPPENING. ARE THERE
SERVICE IS WHAT ARE THE TELL
SERVICES AND OR CHALLENGES.
BECAUSE OBVIOUSLY ADDRESS HOW
MUCH WHAT WE'RE LOOKING AT AND-
ITS LACK. OF THAT THAT IS
CUTTING SOME OF THESE ISSUES SO
WE WOULD HAVE CORRECTIVE ACTION
PLAN WORK WITH MY TONE. AND
THEN THERE IS THE POTENTIAL FOR
ADDITIONAL FINANCIAL SANCTION.
PLAN ISN'T COMING. TO COME AND
REALLY MEETING THOSE CORRECTIVE
ACTION MILESTONE IF SET UP. WE
HAVE AS THE DIRECTOR MENTIONED
UPDATED OUR FACILITY SITE
REVIEW WHICH WAS ONE OF THE
RECOMMENDATIONS FROM. FROM THE
AUDITOR'S AS WELL AS HAVE
UPDATED AND IS CURRENTLY IN USE
THE AUDIT PROCEDURES FOR THE
MEDICAL RECORD REVIEW SO THAT
WE ARE SEEING MUCH MORE
ALIGNMENT AND MEASUREMENT OF
WHAT THE BRIGHT FUTURES
REQUIREMENTS ARE IDLE HANDS ARE
AND SEEING WHERE PLANS ARE
FALLING WITHIN THAT AND AGAIN.
THESE ARE IDENTIFIED WE HAVE
THIS IT. CAN BE THE SAME.
CORRECTIVE ACTION AUSTIN I'M WE
RESPECT TO YOU THAT YOU KNOW
PART OF PART OF THE WORK ON OUR
END IS ALSO TO ENHANCE OUR
SYSTEMS AND DATA CAPABILITIES
WE'VE HAD A LOT OF
CONVERSATIONS ABOUT SOMETIMES
THE CHALLENGES THAT WE HAVEN'T
EVEN PROVIDING ALL OF THE
INFORMATION THAT YOU'RE LOOKING
FOR AS WELL AS THE IN XIN THAT
WE REALLY NEED TO DO A BETTER
JOB OF MONITORING IS THAT THERE
ARE LIMITATIONS IT SYSTEMS
INSTRUCTOR CAN BE CHALLENGING.
SO WE ARE IN AND SEARS TEAM
REALLY QUITE HONEST DONE
INTENSE AMOUNT OF WORK AND
IMPROVE NOT ON THE PROVIDER
PROVIDER SIDE AND WHO WHO
ROLLED IN ALL OF THE BUT CAN TO
IMPROVE TO CURRENTLY ON THE
ENCOUNTER DATA SIDE WILL BE
THAT HELLO DATA ABOUT WHAT
SERVICES ARE BEING PROVIDED
THAT MORE DETAILED GRANULAR
LEVEL SO WE KNOW WHAT'S
HAPPENING IN A VISIT AND- NOT
JUST. TO VISIT. BUT IN THE
PREVIOUS TESTIMONY FROM. WE ARE
WE HAVE DRAFTED AND WORKED ON
THE NEW CONTRACT LANGUAGE WITH
RESPECT PARTICULARLY TO THE E.
PST T. IN BRIGHT FUTURES
REQUIREMENTS THAT IS LANGUAGE
WE HAVE BEEN SUBMITTING TO CMS-
THE PROCESS FOR CONTRACT
AMENDMENTS WITH THE MSL SAY IS
NOT ALWAYS THE FASTEST AND-
THERE'S LOTS OF THINGS THAT
HAVE TO BE GOING ON BUT THOSE
THOSE ARE AND THOSE ARE IN.
PLACE AND WILL BE IN EFFECT FOR
THE NINETEEN TWENTY CONTRACTOR
THAT YEAR THAT WE ARE IN
CURRENTLY. WITH RESPECT THE
QUESTIONS ABOUT THE HEALTH TO.
NAY NO AGAIN WE'VE HAD MANY
CONVERSATIONS ABOUT THIS WE
HAVE BEGUN UP REPORTING ON THAT
HEALTH DISPARITIES REPORT THAT
WE THAT WE BUT WE HAVE TALKED
ABOUT. WE ARE EACH YEAR AT A
NEW MEASURES. AND WE IN INTO
NOW THAT WERE GETTING TO THE
PLACE OF HAVING THREE YEARS.
ALSO ADDING THREE YOUR FRIEND.
SO THAT WE CAN SEE WHAT'S
CHANGING HOPEFULLY THE CHANGES
ARE THAT THINGS ARE GETTING
BETTER. BUT IF THEY'RE NOT HOW
DO WE THEN SIR IMMEDIATELY
ACTIVE. AND END AND LOOK AT
WHAT WHERE WE- CHANGE. EITHER A
MONITORING REQUIRE MEN OR- THAT
ARE. ON THAT. ONCE YOU CONTINUE
TO WORK WITH OUR STAKEHOLDERS
WE HAVE SEVERAL STAKEHOLDER
WORK GROUPS AND PARTICULARLY
ARE MEDI CAL MANAGED CARE
ADVISORY GROUP WERE HOW DO WE
CONTINUE TO HAVE ONGOING
ENHANCEMENTS TO THAT EXPANSIONS
OF THOSE REPORTS REALLY HAVING
MORE GRANULAR DETAIL SO THAT
EVEN IF IT LOOKS STATEWIDE THAT
WE ARE IMPROVING IN CERTAIN
AREAS WE KNOW THERE ARE
POPULATIONS WHERE THEY'RE NOT
THAT NOT THE CASE AND WE DON'T
WANT THAT TO GET HIDDEN FOR.
BREAKING INTO THE BRAND. THAT
THAT WE NEED TO BE LOOKING. THE
BASIC THE OUR RECOMMENDATION
ESTABLISH A NEW REQUIREMENT
THAT THE PLANS UTILIZED THE
HEALTH DISPARITIES DATA AS WELL
AS THE CONSUMER SATISFACTION
FROM THE CAPS SURVEY TO DEVELOP
A POPULATION NEEDS ASSESSMENT
WHICH REALLY WAS AT THE CREATE
A LITTLE BIT OF DIFFERENT WORDS
BUT WAS WAS REALLY THE
RECOMMENDATIONS OF THE AUDITOR.
AND SO THEY'D HAVE TO NEEDS
ASSESSMENT REALLY LOOKS. ALL
BUT AT THESE MORE GRANULAR
LEVEL OF LOOKING AT SPECIFIC
POPULATIONS AND THAT THEY WOULD
HAVE TO SUBMIT OF THAT
POPULATION NEEDS ASSESSMENT TO
THE DEPARTMENT AND THEN HAVE AN
ACTION PLAN TO ADDRESS THOSE
AREAS WERE CLEAR THAT THAT
THINGS ARE NOT WHERE THEY NEED
TO BE IT WE DO ANTICIPATE THAT
FIRST REPORT TO BE DUE TO.
TWENTY TWENTY. WHERE I FEEL
LIKE THAT'S- REALLY ONLY ONCE.
ALSO AND I KNOW CONVERSATIONS
WE'VE HAD WITH THE DOCTOR PAN
ABOUT INCREASING THE FREQUENCY
OF THE CAPS SURVEY SO WE ARE
MOVING THAT FROM EVERY THREE
YEARS TO EVERY TWO YEARS- AND
NOT IN A STARTING NOW SO THAT
WE CAN HAVE THAT MORE REGULARLY.
AGAIN ANOTHER PLEASE WE'RE WERE
FOLLOWING THE RECOMMENDATIONS
IS REALLY HAVE WORKING WITH OUR
EACH YOU ARE ROAD TO DEVELOP A
PREVENTIVE SERVICES REPORT THAT
WILL USE OUR ENCOUNTER DATA TO
LOOK AT WHAT IS USUALLY WHAT IS
UTILIZATION HAPPENING AGAIN
BROKEN DOWN AN APPROPRIATE
CATEGORIES AND SEEING WHERE
THERE ARE LAPSES AND THEN HOW
TO WEAVE CONTINUALLY FOLLOW UP
WITH OUR PLAN AND OUR PROVIDERS
AND AGAIN THROUGH THE BREACH
CAMPAIGN THAT YOU HEAR ME
DISCUSSING A LITTLE BIT MORE
DETAIL. GET THOSE. BUT WE- WITH
OUR STAY COOL AND ARE EACH YOU
ARE- TO FINALIZE THE
METHODOLOGY OF THE METRICS FOR
THAT REPORT WANT TO MAKE SURE
THAT WE'RE REALLY CAPTURING
WHAT IT IS PEOPLE THINK WE
SHOULD BE LOOKING AT HOW WE CAN
MAKE IT MOST USEFUL NOT JUST
FOR US BUT FOR YOU AND ARE
STAKEHOLDER GROUPS THAT REALLY
OPEN FORM WHAT POLICY. CHANGES
AND OTHER THINGS WE MAY NEED TO
SEE. A MINORITY MENTIONED.
PROVIDER DIRECTORY VALIDATION
ON THE LAST SECTIONS ALL OF US
GET OVER THAT EVEN THOUGH IT
WAS RELATED TO THIS AUDIT- AND
THEN REALLY THE LAST THING THAT
REALLY CAME OUT OF OUR THINKING
ABOUT HOW DO WE DO BETTER IN
SPOTS THE AUDIT IS THAT
STATEWIDE OUTREACH PAIN- WHAT
THE THINGS WE ARE PLANNING- ONE
IS JUST A STATEWIDE LETTER
MAIL. WELL HOW OLD TO HAVE
CHILDREN NEWS UP TO THE AGE OF
TWELVE GIVEN THE. HE UP AND AGE
EXPLAINING WHAT SERVICES ARE
AVAILABLE AND HOW DO THEY
ACCESS THEM WE ALSO ARE LOOKING
TO DO A TARGETED CAMPAIGN FOR
THOSE HOUSEHOLDS WHERE THERE
ARE CHILDREN AND YOUTH UP TO
TWENTY ONE WHO HAVE AND- TEST
THOSE PREVENTIVE STE. IS IN THE
LAST TWELVE MONTHS. I'M AND
REALLY FOCUS ON THAT WE DID SEE
A LOT OF SIX THAT. WE'VE TALKED
ABOUT HERE THAT WHEN WE DID
THIS ON THE DENTAL SIDE WE SAW
VERY SIGNIFICANT TAKE UP OF
KIDS WHO HADN'T BEEN SEEN
GETTING STE IN IT IS SORT OF IN
THAT YEAR AND REALLY BUILD OFF
OF THAT AND- ARE WE WE'VE DONE
IT MUCH MORE. NOW DENTAL
OUTREACH WITH THEIR SMILE
CAMPAIGN THAT IT CAN WE
CONTINUE TO SEE A LOT OF
BENEFITS FROM AND SO REALLY
TRYING TO BUILD OFF THAT
SUCCESS- BUT WANTING TO OF
COURSE ALSO CONTINUE. GAUGE
STAKEHOLDERS ON ARE THOSE
HITTING RIGHT MARKS WHAT HOW DO
WE DEVELOP THOSE MATERIALS IN A
WAY THAT OUR READERS. THE BALL
AT AND CAN LEAD. YOU TO HELP
OUR PARENTS OR OTHER. WITH
CHILDREN USE THAT UP TO THE AGE
OF TWENTY ONE- THE BENEFIT OF
REALLY HAVING THE PLANS DO THIS
IS THAT OUR INTENTION ARE
REQUIRED. IN THEM WILL NOT TO
JUST HAVE IT BE A GENERIC CALL
WHERE THEY SAY THE SAME THING
TO EVERY HOUSEHOLD THAT THEY
CALL. BUT IN FACT GIVEN THE
DATA THEY HAVE ABOUT WHAT
SERVICES HAVE OR HAVE NOT BEEN
ACCESS REALLY TARGET THAT
CONVERSATION. THOSE HOUSEHOLDS
SO THAT THEY KNOW. YOUR CHILD
HAS GOTTEN THIS OR HASN'T
GOTTEN THIS HOW CAN WE HELP YOU
SCHEDULE YOUR APPOINTMENT WITH
YOUR PROVIDERS IN ORDER TO GET
THOSE SERVICES. I ALSO JUST
WANT TO BRIEFLY TOUCH ON SOME
OTHER THINGS THAT ARE SPECIFIC
TO THE RESPONSES TO THE AUDITS
BUT THAT WE'VE ALSO BEEN
ENGAGING IN AND OBVIOUSLY A LOT
OF. A LOT OF THINGS HAVE GONE
THROUGH THAT. BUDGET IS WHERE
FIVE THINGS. THE VALUE BASED
PAYMENT PROGRAM I KNOW YOU'RE
GONNA ASK ABOUT IT SO IT JUST
STARTED JULY ONE AND WE DO HAVE
SPECIFIC MESSRS EARLY CHILDHOOD
WE DON'T HAVE RESULTS AND IT
JUST STARTED I WOULD SAY YOU
KNOW A YEAR OR SO AND WE CAN
HAVE THAT. THE ON PROPOSITION
FIFTY SIXTY MINUTE MAN SOME OF
WHICH ARE VERY SPECIFIC.
TARGETED CHILDREN. SERVICE RG
UPCOMING JANUARY IMPLEMENTATION
OF THE TVPA SCREENINGS AND THE
DEVELOP SCREENINGS. AND THEN
AGAIN I WOULD REFER BACK TO
THAT CALLIE IN PROPOSAL AND A
LOT OF PLACES WERE TRYING TO
AFFECT KIDS I THINK SOME OF THE
ISSUES THAT. TOUCH ON THAT
WEREN'T SPECIFIC TO THIS AUDIT
BUT IT. SIGNIFICANT SUGGESTED
ENGINE. PARTICULARLY ON THE
BEHAVIORAL HEALTH SIDE. TO
IMPROVE STREAMLINED AND MAKE
SURE KIDS HAVE ACCESS TO THOSE
SERVICES AND AREN'T FALLING
THROUGH THE CRACKS BETWEEN THE
MULTIPLE DELIVERY SYSTEMS. SO I
WILL STOP THERE. THANK YOU
THANK YOU SO MUCH FOR YOUR
PRESENTATION I WANT TO WELCOME
AS CHAIR OF THE SENATE HEALTH
COMMITTEE- BACK TO WOOD- IF YOU
WANT TO TAKE A BREATHER I CAN
START WITH SOME QUESTIONS. TO
ROUTE OR IF YOU WISH. REMARKS
SO YOU DO THAT. OKAY THANK YOU
SIR RUBIO. I JUST A REAL
QUICKLY. YOU MENTIONED THE
PERCENTILE VERSUS THE ABSOLUTE
BENCH MARKET AND TRACKS YOU'RE
SAYING YOU'RE GOING TO DEVELOP
THAT ARE THAT'S ALREADY BEEN
DEVELOPED SO WHEN WOULD WE SEE
THOSE METRICS. SURE SO I AM.
TRADITIONALLY IT'S ALL BEEN
PERCENTILE BASE TO DO WE
INCREASE THAT MINIMUM
PERCENTILE THAT'S REALLY A
COMPARISON. RIGHT HOW DO PLANTS
COMPARE TO OTHER AND MEDICAID
PLANS NATIONALLY FOR THE
ABSOLUTE BENCHMARKS THERE ARE-
FROM THE- NATIONAL COMMITTEE ON
QUALITY ASSURANCE SINCE I ONLY
EVER SAY THE ACRONYM. THERE ARE
FIRST MOVE THOSE CMS MEASURES
OF THOSE ABSOLUTE BENCHMARK SO
WE'VE IMPLEMENTED THOSE. THEN
THERE ARE SOME THAT DON'T SAT
AND THAT'S THE ONES WERE TRYING
TO DEVELOP AND MAKE SURE THAT.
WHAT IS THE BEST WAY TO DO THAT
WHAT'S AN APPROPRIATE AND THAT
THEN WE WOULD BE ADDING IN
ADDITION TO THE THINGS THAT
WE'VE ALREADY PUT IN DOES THAT
MAKE SENSE YES. THANK YOU FOR
THEIR- AND TO THINK. THIS IS
THE BENCHMARK THEN THE APPS.
FOR ALSO PROVISIONS SCREENING
FOR CHILDREN. YOU KNOW I DON'T
KNOW THAT AFTER. MY I WE WILL
GET BACK TO YOU WITH EVERY
ABSOLUTE BENCHMARK THAT WE HAVE
THAT WE ARE MEASURING OF FOLKS
WITH I KNOW THE TEAM KNOWS THAT
I. OKAY MANY THINGS I KEEP IN
MY HEAD AND THAT THAT'S ONE.
WELL SINCE THAT'S THE TOPIC OF
THIS. AUDIT BUT I APPRECIATE
OKAY BACK TO ME ON THAT CAN YOU
REPEAT THAT THE NATIONAL
ORGANIZATION THAT YOU GET THE
BENCHMARKS FROM QUITE. CONCEDED
RIGHT THE LAST PART NATIONAL
COMMITTEE ON QUALITY ASSURANCE.
IN SECURE TESTING MY ACRONYM
KNOWLEDGE DO OKAY SO. SO YEAH I
APPRECIATE GETTING THE ABSOLUTE
BENCH RIGHT SO. I KNOW THIS MAY
SEEM A LITTLE TANGENT DO YOU
KNOW WHAT YOU DO YOU KNOW THE
HISTORY THE TSTT PROGRAM AND
WHY WE HAVE IT. DO I LIKE
DANGER I MEAN IT'S OF INTEREST.
WHY WHY CONGRESS PASSED IT. NO
I DON'T OKAY I JUST SAY BRIEFLY
IT WAS PASSED ACTUALLY AS A
RESULT OF A VALUATION OF
DRAFTEES FOR THE VIETNAM WAR
THEY MADE NOTES AS DATE DRAFTED
YOUNG MEN TO FIGHT IN THE
VIETNAM WAR THAT MANY OF THEM
WHO COULD NOT QUALIFY FOR
MILLER SERVICE HAD PREVENTABLE
CONDITIONS. THAT THEY WERE ONLY
PICKED UP IN CHILDHOOD NOW I
WILL SAY THAT'S NOT MY MAIN
PURPOSE FOR TRYING TO DO THIS
BUT IT WAS A NATIONAL SECURITY
ISSUE. AND THAT'S WHY CONGRESS
PASSED THE PS TWO. WE MAKE HERE
IN CALIFORNIA WHERE THINGS WERE
TRYING TO ACHIEVE FOR EXAMPLE
IS- TRAUMA INFORMED CARE WE'RE
GOING TO SCREEN FOR ASUS. BUT
IF ONLY LESS THAN HALF OF ALL
THE CHILDREN ARE SHE COMING IN
FOR- HEALTH SUPERVISION THAT
MEANS RUNNING A BE SCREENING
HAVE TWO KIDS THAT SAY THEY
COULD BE SCREEN AND SOME OTHER
VISITS BUT- THIS IS THOSE
THAT'S THE PLACE TO BE
SCREENING SELF. TO ME THIS IS
VERY TIGHT END WITH OTHER AT
THAT WE'RE DOING. THE OTHER
THING I WOULD MAKE NO TO SAY
LOOK AT OTHERS CHART- SO WE DO
EMPHASIZE THAT THE YEARS IN
WHICH THEY AT WHICH THEY ARE
MONITORED FOR MUCH BETTER
SWITCH WOODS SAYS TO ME THAT.
WE CAN DO BETTER. WITHOUT THAT
WE CAN DO EVEN BETTER THAN THAT
BUT EVEN JUST WHAT WE'RE DOING.
ACTUALLY FOCUSED BUT WHAT WAS
PARTICULARLY SCARY HE WAS IS
THAT. THE NUMBER OF VISITS FOR
ONE YEAR OLDS. OKAY THINK ABOUT
ALL DEVELOPMENTAL CHANGES THAT
HAPPEN IN THAT FIRST THAT SO WE
WILL TALK ABOUT AUTISM. OTHER
DEVELOPMENTAL CONDITIONS. IS
AROUND. LOW ABOUT 40% AND THEN
TWO YEAR OLD AGAIN SPEECH DELAY
YOU KNOW WE TALK ABOUT ALL THE
EXPENSE WE SPEND ON THINGS LIKE
SPECIAL EDUCATION. OTHER PARTS
OF THE BUDGET DID THEY DID THAT.
KIDS BEING BEHIND FOR THEIR
STARTING SCHOOL SOCIAL
DEVELOPMENT. WE ARE LIKE 25% I
MEAN THAT'S A HUGE MISSED
OPPORTUNITY. YEAH I THAT THAT
THAT I MEAN THAT THAT THAT'S A
TRAVESTY. I THINK THAT THAT IS
MISS CAVELL NINETEENTH WHEN THE
REASONS WHY WE NEED TO HAVE A
VERY STRONG OUT REACH PROGRAM.
NO I DON'T THINK I. DID THE
OTHER THING I WOULD MAKE NOTE
AND I APPRECIATE THAT THOSE THE
DEPARTMENTS IS SENDING LETTERS
AND THE PLANS. THE OTHER PEOPLE
WE NEED TO AND- IS THAT
ACTUALLY THE RELATIONSHIP THE
PATIENT SHOULD HAVE THIS WITH
THEIR- PHYSICIAN AND OTHER
PROVIDERS AND THAT. WHEN THEY
GET THE LETTER FROM THEM. NOW I
WOULD ALSO NOTE THAT YOU KNOW
I'M A PROPONENT MANAGED CARE I
GET FOR MEMBER PER MONTH BUT-
THESE ARE PREVENTIVE SERVICES
THAT EVERY CHILD YET. RIGHT I
MEAN THERE'S NO REASON THEY
SHOULDN'T GET IT. I ASSUME
THERE'S NO DISAGREEMENT ON
THAT. I SO IN MANY WAYS ONE
COULD ARGUE THIS IS NOT
SOMETHING THAT YOU CAPITATE
THIS IS LIKE OKAY YOU KNOW WHAT
YOU HAVE THIS MANY KIDS IN YOUR
PLAN. IF YOU PROVIDE THEM. YOU
GET PAID IF YOU DON'T YOU DON'T
GET PAID. BECAUSE THE YOU ACTED
TO EVERYONE WHO DOESN'T GET THE
VISIT WHY ARE THEY BEING PAID
FOR IT. THEY SHOULD NOT BE ABLE
TO PAY THAT OFF OF NOT
PROVIDING CARE. I MEAN THIS IS
NOT ONE OF THESE WELL WE'RE
MANAGING THE CARE MAYBE THEY
SHOULD HAVE COME FOR THAT
VISIT. CORRECT I MEAN DO YOU.
IS THERE DISCRIMINANT. OKAY SO
WE TALK ABOUT FINANCIAL
CONSEQUENCES WHEN IT COMES TO
HEALTH SUPERVISION PREVENTION
LIKE THIS. THE EXPECTATION
SHOULD BE EVERY CHILD WHO YOU
ARE RESPONSIBLE FOR SHOULD GET
THEIR VISIT ON SCHEDULE AND IF
THEY'RE NOT. WHY WE PAY YOU FOR
THAT. RIGHT. THAT SHOULD BE THE
EXPECTATION IT DEFINITELY IS
THE EXPECTATION I THINK YOU
KNOW THAT THE COMPLEXITIES OF
HOW TO DO THAT PARTICULAR I GET
IT FROM AN ACTUARIAL RATE PER
UNIT YOU AS WHAT WE WE'VE HAD A
LOT OF RATE RIGHT CONVERSATIONS
IS ALSO SO. I JUST. NOW AFTER
WE TALK ABOUT. EIGHT NINETEEN.
THE EXPECTATIONS SHOULD BE YOUR
PLAN AND YOU ACTUALLY GET ALL
YOUR KIDS AND YOU SHOULD NOT BE
PENALIZED FINANCIALLY FOR THAT
MOST ACTUARIAL RATE SHOULD NOT
BE ONE OR EXPECT THEM TO FALL
OFF. ON THE FLIP SIDE IF
THEY'RE NOT HITTING THAT. HE
GET PAID FOR THAT EITHER RIGHT
I MEAN THIS IS THIS IS WHAT
THESE IS THAT THE LITTLE
DIFFERENT THAT WELL YOU KNOW
YOU HAVE A COLD. DID YOU BRING
INTO THE ARE NOT OKAY. RIGHT WE
DON'T KNOW IF IT'S REALLY COLD
OR SOMETHING MORE SERIOUS I
MEAN THERE'S A LOT. I GET THAT
FOR THE MAD YOU KNOW THE
MANAGED CARE PART OF IT BUT
WE'RE TALKING ABOUT PREVENTIVE
SERVICES. THE STANDARDS PRETTY
CLEAR RIGHT. SO THAT SO
HOPEFULLY WE THAT THERE SHOULD
BE SOME CONVERSATIONS ABOUT
THAT WHEN IT COMES VERY
SPECIFICALLY TO THIS TYPE OF
SERVICE CORRECT. OKAY. RIGHT
DID YOU AT SOME REAL BUT THAT
THE CHAIR WOULD IT JUST I JUST-
PERSON FOR SMALLER APOLOGIZE
FOR MYTARDINESS BUT I'D I WANT
TO FOLLOW UP ON THAT BECAUSE I
THINK THAT THE CONSEQUENCES OF
THESE KIDS NOT GETTING THE CARE
AT THE RIGHT TIME. IS POTENTIAL
BIGGER EXPENSE ON THE OUT IT
IT'S JUST WHAT HE'S TALKING
ABOUT AND THAT'S AND I THINK TO
ME THAT'S ONE MORE SHOCKING
PARTS OF THIS IS LIKE WHOA WAIT
A SECOND HERE IT'S A MISSED
OPPORTUNITY. TO INTERVENE EARLY
AND PROTECT THESE KIDS GOING
FORWARD SO- I'D I HAVE BEEN
HERE FOR ALL THIS OBVIOUSLY BUT
I JUST THE I THINK THE NEXUS
BETWEEN. BIGGER OUT THAT COSTS
IN THE IN THE OUTLYING YEARS.
AND THE MISSED OPPORTUNITY TAKE
CARE OF KIDS- THERE OUGHT TO BE
ACCOUNTABILITY ON BOTH. WITH
THE PLANS AND WITH US FOR NOT
MAKING IT HAPPEN. AND I THINK
THE OTHER PART YOU KNOW WOULD
WE AND I THINK IT'S ALSO
IMPORTANT AND THEN DELVES MUCH
INTO IS THAT MY GUESS IS THAT
WHEN YOU LOOK AT THE
PERCENTAGES THE PEOPLE AREN'T
GETTING IT. YOU KNOW WHO ARE
THEY- WHY ARE THEY NOT. YOU
KNOW WE SEE THE DISPARITIES OF
PEOPLE SPEAKING DIFFERENT
LANGUAGES AND- AND SO FORTH SO
YOU KNOW THAT'S- THAT AS WELL
SO WE GOT TO FIGURE OUT HOW WE-
SET THAT LEVEL ACCOUNTABILITY
AND BUT ALSO YOU KNOW ARE WE.
HOW WE DESIGNED THE SYSTEM IN A
WAY THAT MAY NOT NECESSARILY
YOU KNOW YOU MENTIONED ACTUAR
EARLY AND LEAVE ME I UNDERSTAND
THAT WE NEED A LOT OF THINGS
ACTUAR EARLY YEAH. BUT IN THE
END SOMETHING LIKE THIS THIS IS
THIS IS A LITTLE DIFFERENT
PREVENTIVE SERVICES A LITTLE
DIFFERENT. THAN SOME OF THE
OTHER FORMS IN TERMS OF HOW YOU
MIGHT WANT THINK ABOUT PAYMENT
BECAUSE YOU DON'T WANT TO
DISCOURAGE PEOPLE FROM GETTING
THE SERVICES. AND YOUR REWARD
PEOPLE FOR NOT PROVIDING THEM
RIGHT AND SO- THERE'S A LITTLE
LESS. I THINK UNCERTAINTY AS TO
WHERE TO JUDGMENT FALLS. YES
JUST FOLLOW UP AND THEN NOT
JUST NECESSARY MEDICAL EXPENSES
BUT YOU KNOW THAT FALLS INTO
THE EDUCATIONAL SYSTEM AND
SCHOOLS TRY TO FIGURE OUT WHAT
TO DO WITH THESE KIDS WILL HAVE
EITHER TO LASER THAT ANY HELP
THANK YOU SO MUCH FOR YOUR
TESTIMONY. EXCUSE MYSELF I HAVE
ANOTHER MEETING BUT THANK YOU
THANK YOU VERY. TODAY OKAY.
THANK YOU SO. FOUR TWO AND I
APPRECIATE THAT- YOU PERSONALLY
PRESENTED SEVERAL DIFFERENT
THINGS THAT- THE DEPARTMENT IS
DOING AND I THINK. THAT'S
IMPORTANT MOVING FORWARD- I
UNDERSTAND THE AUDITOR'S- YOU
KNOW- CONCERNED ABOUT. THE CS
SAYING THAT- IT. ONE
RECOMMENDATION BUT ULTIMATELY
IT'S REALLY ABOUT. HOW WE SURE
THE KIDS GET THE CARE SO- I
KNOW THERE ARE STE VARIOUS
STEPS THAT YOU'VE DESCRIBED
THAT WE'RE GOING TO TRY TO
ACTUALLY INCREASE PROVIDER
ENGAGEMENT. POSITION NUMBER
SERVE OFTEN MEDI CAL WE NEED TO
CONTINUE TO WORK ON THAT WE
PRESS TRAPS AND RURAL
COMMUNITIES WE STILL I MEAN.
THIS TAX TOGETHER THESE WHERE
WE MIGHT WANT TO WEAR THE I
THINK WHAT THE HONOR REYES IS
THAT WE SHOULD BE LOOKING AT
SEEING YOU KNOW ARE THERE
POCKETS THAT WE HAVE ISSUES
WITH IN TERMS OF HAVING KNOWS
IT FULLER WE JUST HEARD ABOUT
FULL CAPACITY IT CETERA THAT
MAYBE IS THAT WHAT'S STOPPING.
GETS FROM GETTING THEIR- THEIR
HOUSE A PROVISION VISITS AND WE
NEED TO BUILD SOME PROVIDER
CAPACITY THERE- RIGHT AND AGAIN
WE DO HAVE EXISTING PROGRAMS
THAT YOU POINTED OUT THAT CAN
HELP US DO THAT BUT THAT MADE.
PERHAPS MORE TARGET EFFORTS IN
THAT REGARD. JUST GONNA THANK
THE CHAIR- FOR YOUR ASSISTANCE
DURING THE LAST BUDGET PROCESS
OF. ANY ADDITIONAL RESOURCES
FOR THE DEPARTMENT IN THIS AREA
AS WELL THAT THAT'S NOT REALLY
TOUCHED. ON HERE BUT THAT WAS A
DIRECT OUTGROWTH OF BOTH THE
AUDIT AND THE SUPPORT OF THE
COMMITTEES AND LEGISLATURE LAST
YEAR SO WE'LL BE PUTTING THOSE
RESORT OBVIOUSLY. THE POSITIONS
IS KIND OF PROVE THEM WE HAVE
TO HIRE THEM AND THINGS LIKE
THAT BUT AGAIN THAT I THINK
THAT WAS A- VERY COLLABORATIVE
EFFORT ON TRYING TO MAKE SURE
THAT THE PROBLEM HAS THE
APPROPRIATE RESOURCES TO. MAKE
SURE MAKE THE CHANGES THAT
YOU'RE SUGGESTING. WE WANT YOU
TO BE SUCCESSFUL. WE DO TOO.
BECAUSE AS YOU SAID. IT'S ABOUT
CAN'T WELL YOU SAID YOU'RE NOT.
YOU YOU'RE DOING THIS JOB
BECAUSE YOU'RE TRYING TO HELP
PEOPLE. A 100% SO WE WANT TO
HELP YOU HELP PEOPLE. I MISS.
OKAY OKAY WELL WE'RE GONNA
BRING UP A PANEL I THINK THE
ONLY THREE SEATS OVER THERE I
DON'T STAY UP HERE. SO YEAH
MOVE OVER JUST SO THERE OKAY
MOVE OVER. SO I WANT TO.
WELCOME WE HAVE- STEPHANIE
SUNSHINE- CO THE CENTRAL
CALIFORNIA ALLIANCE FOR HEALTH-
MIKE THE DATA HEALTH POLICY
DIRECTOR FOR CHILDREN NOW AND-
DOCTOR JACK CORBEAU- FROM THE
AMERICAN CARRY PEDIATRICS
CALIFORNIA DISTRICT WELCOME AND
PREP SO JUST GO AHEAD HAVE YOU
TESTIFIED THAT ORDER ASKED TO
TRY TO KEEP YOUR TESTIMONY
THREE MINUTES. AND. I'M SURE
WE'LL HAVE MORE TIME TO
LEVERAGE Q. AND A THANK YOU
WELCOME. I STEPPED INSIDE THE
EAR FOR CENTRAL CALIFORNIA.
ALLIANCE FOR HEALTH CAN YOU
HEAR ME OK GOOD OKAY US TO WORK
COUNTY ORGANIZED HEALTH SYSTEM
SERVING PEOPLE WITH MEDIC CAL
IN SANTA CRUZ MONTEREY AND
MERCED COUNTIES WE HAVE AROUND
THREE HUNDRED AND THIRTY
THOUSAND MEMBERS 47% OF WHOM
ARE CHILDREN. WE'VE BEEN
OPERATING FOR ALMOST TWENTY
FOUR YEARS AND- RECOGNIZING OUR
TEN AND TWENTY YEAR ANNIVERSARY
IS AND- MERCED AND MONTEREY
COUNTIES THIS YEAR. OUR MISSION
IS ACCESSIBLE QUALITY
HEALTHCARE GUIDED BY LOCAL
INNOVATION WE TAKE OUR
COMMITMENT TO QUALITY SERIOUSLY
AND HAVE DEMONSTRATED RESULTS
IN ALL THREE COUNTIES IN WHICH
WE SERVE. SANTA CRUZ IN
MONTEREY COUNTY IS OUR
PROVIDERS TYPICALLY PERFORM AT
THE NINETIETH PERCENTILE ACROSS
MOST OF THE PEDIATRIC EXTERNAL
ACCOUNTABILITY SET MEASURES.
AND IN MERCED COUNTY TWO OF THE
FIVE MEASURES- THAT WE FOCUS ON
FOR KIDS IN THE PAST HAVE BEEN
AT THE NINETIETH PERCENTILE. IN
TWENTY EIGHTEEN WE WERE ABLE TO
EXCEED THE MINIMUM PERFORMANCE
LEVEL ACROSS THE BOARD. I'M
SORRY TWENTY EIGHTEEN. THE
ALLIANCE TOOK THE FINDINGS OF
THE AUDITOR VERY SERIOUSLY AND
I'VE TAKEN A NUMBER OF ACTIONS
IN THE PAST YEAR TO IMPROVE THE
DELIVERY OF PREVENTIVE SERVICES
TO OUR KIDS. WHILE ALSO
CONTINUING MANY EFFORTS THAT
WERE ALREADY UNDER WAY TO
ADVANCE PREVENTION OUR REGION.
THE BARRIERS TO INCREASING THE-
OF PREVENTIVE SERVICES. HAVE
LARGELY TO DO WITH PROVIDER
WORKFORCE PROVIDER AVAILABILITY
IN CAPACITY. AS WELL AS MEMBER
AWARENESS AND CONFIDENCE AND
ACCESSING SERVICES WE ALSO
SIGNED FIND SOME CHALLENGES
WITH REGARDS TO DATA COLLECTION
AND SHARING AS YOU'VE NOTED.
WITH REGARDS TO THE NETWORK WE
HAVE HISTORICALLY- ENHANCED
PAYMENT FOR PEDIATRIC
PREVENTIVE SERVICES PAYING
2100% OF THE MEDICARE FEE FOR
SERVICE SCHEDULE FOR ALL C. H.
T. P. SERVICES IN ADDITION TO
CAPITATION TO PRIMARY CARE
PROVIDERS. IN ADDITION WE HAVE
OF FOCUS TO SOME OF OUR
INCENTIVE PROGRAM MEASURES ON
PEDIATRIC- MEASURES- OUR
INCENTIVE PROGRAM AWARDS
PERFORMANCE ABOVE THE FIFTIETH
PERCENTILE AND SHARE SAVING
BACK WITH PROVIDERS FOR THEIR
PERFORMANCE. IN ADDITION WE'VE
PROVIDED ADDITIONAL TOOLS FOR
OUR PROVIDERS TO IDENTIFY THOSE
CHILDREN IN THEIR PRACTICES
HAVE NOT RECEIVED IMMUNIZATIONS
AND WHILE THE SETS WE'VE ALSO
PROVIDED EDUCATIONAL OFFERINGS
REGARDING PEDIATRIC SERVICES
WE'VE INCLUDED PEDIATRIC
PREVENTIVE SERVICES IN ALL OF
OUR PROVIDER BULLETINS IN THIS
PAST YEAR. AS WELL AS AN OLIVER
PROVIDER WORKSHOPS AND ALSO IS
THE FOCUS OF PRACTICE COACHING
THAT WE DO WITH PRIMARY CARE
PRACTICES. TO ADDRESS PEDIATRIC
CAPACITY IN OUR REGION WE
FOCUSED ON PEDIATRIC SERVICES
IN OUR MEDIC CAPACITY GRANT
PROGRAM THIS INCLUDED FUNDING
FOR CAPITAL PLANNING FOR
PEDIATRIC CLINIC EXPANSIONS THE
RECRUITMENT OF EIGHTEEN
PHYSICIANS TO OUR SERVICE AREA.
GRANTS TO ORGANIZATIONS THAT
ADDRESS FOOD AND SECURITY FOR
SPECIFIC PEDIATRIC POPULATIONS
AND TECHNICAL SUPPORT BETTER
INTEGRATION OF CHILDREN'S
BEHAVIORAL HEALTH SERVICES. TO
A MEMBER AWARENESS AND
CONFIDENCE IN ACCESSING
SERVICES WE'VE REVIEWED AND
IMPROVED REMEMBER ON BOARDING
PROCESS WE'VE PRIORITIZE
MESSAGING REGARDING PREVENTIVE
SERVICES DURING OUR COMMUNITY
OUTREACH EVENTS. WE SPENT SENSE
PACIFIC MAILERS TO MEMBERS
REGARDING THE EPS D. T.
BENEFIT. WE'VE ALSO SURVEYED
OUR MEMBERS WITH REGARDS TO
THEIR PERCEIVED BARRIERS AS TO
IMMUNIZATION PROVIDED OUT REACH
LETTERS O PARENTS OF CHILDREN
WHO HAVE NOT HAD IMMUNIZATIONS
ARE WELL VISITS. AND ARE ALSO
IN THE PROCESS OF MAKING OUT
REACH CALLS TO FAMILIES HAVE
NOT HAVE IMMUNIZATIONS ARE WELL
CHILD VISITS- I WOULD JUST
CLOSE BY SAYING THAT. AS I
MENTIONED BEFORE 40% OF OUR
MEMBERS ARE CHILDREN AND- NO
AMOUNT OF IMPROVEMENT THAT'S
ENOUGH SO. REALLY PROP THE
RESULTS THAT YOU THE CHEAP SO
FAR AND WILL CONTINUE TO FOCUS
ON ADVANCING PREVENTION OUR
AREA. THANK YOU THANKS FOR MUCH
YESTERDAY. HELLO MY NAME'S
MICHAEL DAY DIRECTOR OF HEALTH
POLICY CHILDREN OUR NONPARTISAN
POLICY RESEARCH AND ADVOCACY
ORGANIZATION- I'D LIKE TO THINK
THE COMMITTEES FOR HOLDING THIS
HEARING AND ESPECIALLY
KNOWLEDGE DOCTOR WOULD FOR YOUR
LEADERSHIP IN SECURING THIS
AUDIT- SO THE COMPANY
HEALTHCARE FOUNDATION RE
RELEASED A REPORT RECENTLY THAT
SHOW THAT THINGS LIKE CHILDHOOD
IMMUNIZATIONS AND AYE AYE
CHILDREN'S ACCESS TO PRIMARY
CARE PHYSICIANS HAVE ACTUALLY
BEEN DECREASING BURSTING
STAGNANT OVER THE LAST DECADE.
AND SO CHILDREN ACCESS CARE
MEDI CAL HAS BEEN A LONG
STANDING PROBLEM THAT BENEFITS
NEITHER KIDS NOR TAXPAYERS- BUT
PERHAPS IN THE SYSTEM IS
PRODUCING THE- THE OUTCOMES WAS
DESIGNED TO SO WHEN HE TOOK
OFFICE GOVERNOR NEWSOME
INHERITED- MEDICAL MANAGED CARE
DELIVERY SYSTEM THAT WAS PLAYED
AYE CONTRACTS THAT WERE NOT
DESIGNED. TO IMPROVE QUALITY
CARE FOR KIDS. AND. SUFFER FROM
INCONSISTENT INEFFECTIVE
CONTRACT OVERSIGHT AS THE
AUDITOR'S REPORT SHOWED. SO
IT'S UP MINISTRATION TO PROVIDE
THE LEADERSHIP WE NEED TO TURN
IT AROUND AND MAKE SURE THE
KIDS ARE GETTING THEIR HE PST
T. SERVICES. SO TO DO THIS THE
ADMINISTRATION SHOULD UNDERTAKE
MEDI CAL CONTRACT IN PAIN
REFORMS NEXT YEAR THAT
DEFINITIVELY PRIORITIZE. THE
PST T. CARE FOR KIDS AND WE
STAND READY TO SUPPORT THE
STATE NETWORK. SO WITH THAT I
WANTED TO- EXPRESS OUR
APPRECIATION FOR DCS STAFF IN
ALL THEIR HARD WORK DRESSING
AUDITOR'S RECOMMENDATIONS. AND
I BRIEFLY ONCE WANTED TO TOUCH
ON TWO OF THOSE ACTIVITIES. ONE
WAS AROUND HE NOTICED. CONSUMER
IS THAT DE CSS. REALLY
APPRECIATE THEIR WILLINGNESS TO
WORKS COLLABORATIVELY WITH
STAKEHOLDERS TO MAKE SURE THAT-
THE FINAL NOTICE IS DONE
EFFECTIVELY IN AN
UNDERSTANDABLE AND RESPECTFUL
WAY TO PARENTS WE HAVE A COUPLE
EXAMPLES ONE IS FROM SMALL
CALIFORNIA ON THE MEDICAL
DENTAL BENEFITS THE OTHER ONE
IS A COLORFUL FAMILY FRIENDLY
PAMPHLET THAT THE WISCONSIN
MEDICAID AGENCY PUT OUT SO IF
THE MODELS OF WAYS TO DO THIS
WELL. NEXT I WANT TO TALK ABOUT
THE- REPORT THAT TEACHES IS
WORKING ON AROUND THE BRIGHT
FUTURES PREVENTIVE SERVICES. WE
KNOW THEY'RE WORKING ON AND WE
URGE YOU TO WE URGE THE
DEPARTMENT TO RELEASE THIS
REPORT- SOONER GIVEN THE
PERSISTENT REQUEST FROM-
STAKEHOLDERS IN ADVISORY PANEL
MEMBERS SO WE HOPE THAT WE CAN
GET A PRELIMINARY DRAFT OF THAT
REPORT BY THE END OF THIS YEAR
TO MAKE IT TO CONTINUE THAT
CONVERSATION. AND WE THINK IT'S
IMPORTANT BECAUSE IF WE'RE
GOING TO ESTABLISH FUTURE
PERFORMANCE MEASURES- WE IT
THROUGH MANY MEDI CAL CONTRACTS
AND PAYMENTS WE WANT THAT WANT
THAT TO BE DONE HOLISTICALLY
KID FOCUSING AND OUTCOMES BASED
WAY THAT REALLY LEVERAGES THE
MANAGED CARE BUSINESS MODEL. SO
TO BE CLEAR THE STATION
ESTABLISH AND ENFORCE CONTRACTS
THAT ALIGN THE ACCOUNTABILITY
MEASURES WITH FINANCIAL AND
OTHER INCENTIVES TO REALLY
DRIVE IMPROVEMENT AND WOULD
PROMOTE DISPARITIES REDUCTIONS
FOR CHILDREN- ONE IDEA IS THE
STATE COULD CONSIDERING THE
RATE SETTING METHODOLOGY THAT
REQUIRES A MINIMUM SPENDING
LEVEL ON PRIMARY CARE SERVICES
FOR CHILDREN. IT IS AND
APPROACH ORGAN AND RHODE ISLAND
HAVE TAKEN SO CALIFORNIA COULD
SIMILARLY EXPLORE SUCH A THING.
SO IN CLOSING I'LL JUST OFFER
THAT MANAGED CARE PROCUREMENT
PROCESS NEXT YEAR REALLY
REPRESENTS AND- REAL
OPPORTUNITY TO RECTIFY THE
ACCESS ISSUES IDENTIFIED IN THE
I DIDN'T TO MAKE A POSITIVE AND
LASTING IMPRINT ON THE WAY THE
STATE PAYS FOR DELIVERS.
SERVICES FOR KIDS AND MEDI CAL
THANK. YOU PERFECT HAPPINESS
REHEARSED THANK YOU. PRACTICAL
EXCUSE ME THANK YOU FOR THE
OPPORTUNITY TO BE HERE MY NAME
IS SHOCKED COR VOCAL I'M A
PEDIATRICIAN AND PRACTICING
PEDIATRICIAN AND CO CHAIR FOR
THE STATE GOVERNMENT AFFAIRS
COMMITTEE OF THE AMERICAN
ACADEMY OF PEDIATRICS IN
CALIFORNIA WHERE NONPROFIT
REPRESENTING ABOUT FIVE
THOUSAND PEDIATRICIANS HERE IN
CALIFORNIA- AND THE IS THANK
YOU TO DOCTOR WOULD DOCTOR PAN
DISTINGUISHED- COMMITTEE
MEMBERS FOR HAVING US HERE AND
SPEAKING ON THIS IMPORTANT
ISSUE. WE AS PEDIATRICIANS ARE-
ALARMED CONCERNED DISMAYED THAT
THAT- THAT PREVENTIVE SCREENING
IN CALIFORNIA IS SO LOW FOR
CHILDREN WE- AND I HOPE AND
THAT THAT EVERYONE HERE CAN
FEEL LITTLE BIT LIKE A
PEDIATRICIAN TODAY IN THE SENSE
THAT WE'RE ALL A BIT OBSESSED
AND IT'S IN MANY WAYS A
THANKLESS JOB AND THAT YOU KNOW
WHEN'S THE LAST TIME YOU DIDN'T
GET TETANUS- YOU KNOW ONCE LAST
TIME YOU DIDN'T GET LEAD
POISONING- BUT- BEING AT PEACE.
WHERE A LITTLE BIT INFORMED BY
A AS THE TRUMP TO BE HONEST. IF
YOU CENA MOM LOSE A CHILD. ON
THE WAY HERE I'M A GROWN MAN
BUT- I ACTUALLY STARTED CRYING
A LITTLE BIT BECAUSE I'VE SEEN
SEVERAL MOM LOSE LOSE BABY TO
YOU KNOW WE CALL IT SUFFOCATION
NOW BUT SUCH SUDDEN INFANT
DEATH. AND IT'S TOTALLY WELL
NOT TOTALLY THERE'S LITTLE BEEN
UNKNOWN BUT LARGELY
PREVENTABLE. SO YOU KNOW JUST
THE BACK TO SLEEP CAMPAIGN
SAVES TWO THOUSAND LIVES IN
THIS COUNTRY A YEAR. AND DON'T
HAVE. WE NEVER KNOW AT THE END
WINS LAST TIME YOU. DIDN'T DIE-
SYSTEM SOLELY IMMENSELY
IMPORTANT AND I SHOULD I SHOULD
THINK THE DEPARTMENT I SHOULD
THANK EVERYONE WHO'S HERE TODAY
BECAUSE- WHAT YOU DO WILL SAVE
FIVE. AND I'M IMMENSELY
THANKFUL AND I HOPE YOU FEEL
LITTLE OF THAT OBSESSION TO DO
FOR OTHER PEOPLE THAT YOU'LL
NEVER MEET AND THEY'LL NEVER
KNOW- THAT YOU HELP THEM. AND
THANK YOU AND I I'LL SWITCH IT
SHOULD THANK MICHAEL DAY AND
ALL OF OUR PARTNERS- FOR THE
IMPORTANT WORK YOU'RE DOING IN-
HOPING PEDIATRICIANS DO A WE DO
AND HELPING- CHILDREN OF
ACHIEVERS SUFFICIENCY OF
OPPORTUNITY. HEALTH AND
PREVENTION OF CONDITIONS LIKE
DIABETES- YOU KNOW INTERVENTION
FOR EARLY INTERVENTION FOR
DEVELOPMENTAL DISORDERS ALL THE
ALL THE THINGS THAT THAT.
CHILDREN REALLY NEED TO THRIVE
IN AND- AND BECOME WHAT THEY
THEY'RE DESTINED TO BE. THANK
YOU. THANK YOU QUESTIONS. THANK
THANK YOU- COUPLE- RESPOND I
MAKERS TO HEAR THE IMPROVEMENTS
AND IN YOUR IN YOUR PROGRAM- IS
THE CENTRAL CENTRAL CALIFORNIA
WINES FOR HEALTH INSURANCE BIG
MOUTHFUL- BUT- HOW HOW HAVE YOU
REACHED OUT TO PROVIDERS AND-
AND- BENEFICIARIES. AND WHAT
WHAT STRATEGIES IF YOU EMPLOYED
AND. SOMEWHAT TARGETED OKAY
THINKING WE'VE BEEN- IT'S BEEN
VERY BROAD THIS YEAR IN TERMS
OF THE VOLUME OF COMMUNICATION
SO AS I MENTIONED WE FOCUSED ON
PREVENTIVE MEASURES IN EACH OF
OUR THEIR BULLETINS ON A
QUARTERLY BASIS WE SEND A BILL
IT'S NOT TO THE ENTIRE NETWORK-
WE REALLY EMPHASIZED EFFORTS IN
MERCED COUNTY WHERE WE HAVE THE
LOWEST RATES OF PERFORMANCE AND
SO WHEN I TALK ABOUT THAT WE'RE
TALKING ABOUT WORKSHOPS WITH
THE PROVIDERS WE HAVE A QUALITY
IMPROVEMENT TEAM THAT GOES OUT
IN. PRACTICE CATCHING. THAT
INCLUDES PROVIDING. WORK HARD
TO THOSE PRIME. IS THE LET'S
THE PRACTICE KNOW WHERE THEY'RE
FALLING IN TERMS OF THEIR
MEMBERS ARE NOT RECEIVING
SERVICES AND THEN TALKING THEM
THROUGH WHAT OPPORTUNITIES THEY
MIGHT HAVE WITHIN THEIR OFFICES
TO HELP IMPROVE PERFORMANCE IN
THOSE AREAS AND THEN WE'VE
HEARD THAT WITH MEMBER
COMMUNICATIONS AS WELL. SO HAVE
YOU RECEIVED ANY GUIDANCE. DH
CS THREE JUST TO CERTAINLY
THEY'VE ISSUED A P. L.'S THIS
YEAR AND THIS IS BEEN A TOPIC
OF CONVERSATION AT EACH OF THE
CEO MEETINGS THAT EACH CSCO
MEETINGS FOR THE HEALTH PLANS
AND SO THIS IS BEEN PRETTY
ACTIVE IN TERMS OF THE DIALOGUE
I THINK INITIALLY- AS WAS
MENTIONED PREVIOUSLY YOU KNOW
UNDERNEATH SOME CERTAINLY CAME
OUT VERY STRONG AND EMPHASIZING
PREVENTION FOR KIDS WHICH IS
SOMETHING WE WERE EXCITED TO
SEE IF THE HEALTH PLAN. IT'S
SOMETHING WE'VE BEEN TALKING A
CARDBOARD OVER THE PAST YEAR
MANY OF THE HEALTH PLAN HAD
FOCUS ON COMPLEX ADULTS AND
RIGHTFULLY SO WITH THE ACA
EXPANSION IN TWENTY EIGHTEEN WE
REALLY LOOK AT WHAT'S NEED TO
CHANGE AND IT'S THIS ISSUE IT'S
WE NEED TO DO A BETTER JOB OF
PREVENTION FOR KIDS RIGHT.
WHERE WE FOCUSED AND LINE.
PRESS THAT. WANT TO BE GOING.
AND SO WE HAVE A- THAT THE FEET
THAT WE'VE- BEEN UP. AND WILL
CONTINUE TO WORK WITH THE
DEPARTMENT. LOCAL PROVIDER
STUDENTS CARE. THANK YOU.
MISTER DAY YOU MENTIONED-
WANTING TO SEE HOPEFULLY A
DRAFT- BY THE END OF THE YEAR-
NOT FAMILIAR WITH WHAT THE
ACTUAL TIME LINE WAS SUPPOSED
TO BE ON THAT. WHAT IS THE TIME
AND IS THAT POSSIBLE. YEAH WELL
THAT THAT'S A POSSIBILITY THAT
THAT DROPPED MY EMAIL HERE. SO
THE TIME LINE THAT WE HAD
INDICATED IN THE AUTO RESPONSE
WOULD BE TWENTY TWENTY- AND A
LARGE PART OF THAT QUITE
HONESTLY IS SO THAT WE CAN WORK
WITH MIKE AND OTHERS ON MAKING
SURE THAT WHAT'S GOING TO BE IN
THAT REPORT HAS THE MEASURES.
AND THE METRICS OF THE
METHODOLOGY OF HOW YOU DO THAT
SO THAT THAT IS WHAT OUR
INTENTION ANTI MY IS EIGHT A
CERTAINLY CAN TAKE BACK WITH
THE TEAM AND THINKING ABOUT. IS
THERE SOME. IS THERE SOME DRAFT
WHAT WE'RE THINKING ABOUT THAT
THEN COULD. ON THAT I JUST YOU
KNOW WE WANT TO MAKE SURE IT'S
MEANINGFUL AND SO WE OFTEN FIND
THAT'S MOST USEFUL WHEN WE WHEN
WE WORK WITH OUR PARTNERS AND-
YOU KNOW SOMETIMES THAT ALSO IS
RELATED JUST OUR OVERALL
CAPACITY. OF A DEPARTMENT OF
THE THINGS THAT WERE WORKING ON
AND I THINK AS AS YOU KNOW THE
CALIBER PROPOSAL THAT WE RECENT
RELEASED HAT HAS TAKEN A
SIGNIFICANT AMOUNT OF OUR TIME
AND SO. NO THESE ARE ALL HIGH
PRIORITY. TIMES. ONCE THAT CAN
TAKE THAT BACK THE TEAM IN AND
CHECK IN WITH MIKE ON. ON HOW
CAN WE THINK ABOUT AN
INTERDEPENDENT EACH MEANT TO
MAKE SURE THAT. IT'S CLEAR WE
ARE WORKING ON THESE THINGS AND
HOW DO WE DO THAT IN A WAY
THAT'S AS TIMELY AS POSSIBLE
AND MAKING SURE WE'RE GETTING
THAT. MEANT SO WE CAN TAKE THAT
BACK AND- FOLLOW BACK UP WITH
HIM SO TWELVE TWENTY SIX.
THAT'S A BIG BROAD. IT IS-
SOMETIME IN TWENTY TWENTY FIVE
DON'T HAVE THAT OFF THE TOP OF.
BUT I WILL ABSOLUTELY COMMIT TO
GETTING BACK. ON THAT AND THEN
HOW WE CAN POTENTIALLY MOVE
THAT UP FOR WHAT. IT COULD BE
EARLY I DON'T ACTUALLY JUST
KNOW THAT OFF THE TOP OF MY
HEAD. AND BROUGH- FROM YOUR
PERSPECTIVE. IN YOUR MEMBER AND
TENURE PROVIDERS HOW'S THE OUT
REACH BEEN AND HOW IT'S BEING
RECEIVED BY PROVIDERS. IT'S
INCONSISTENT SO WE REACHED OUT
TO OUR LEADERSHIP AND SOME HAVE
HEARD FROM THEIR HEALTH PLAN
SOME HAVE NOT THERE THE KEY. IS
FOR OUTREACH AND FEEDBACK FROM
FROM THE HEALTH PLAN- TORY- YOU
KNOW CAPABILITIES WITHIN THE
MEDICAL GROUPS TO. TRACK AND
GET OUT TO MEMBERS IS VARIABLE
SO. THERE'S A LOT OF. DIFFUSION
OF RESPONSIBILITY I GUESS
BETWEEN BETWEEN ALL THE PARTY
SCENE WITH A SELF PLAN THE
STATE IN THE AND PROVIDERS I
THINK THERE NEEDS TO BE A MORE
COHESIVE PLAN. ARE THERE SOME
AREAS OF THE STATE THAT ARE
DOING BETTER IN THAT
COMMUNICATION ANOTHER- ARE HARD
TO SAY IN OUR IN OUR IN OUR
SURVEY IT'S IT. IT DOESN'T SEEM
TO BE A SPECIFIC PATTERN. WHAT
DO YOU THINK INCREASES
PREVENTIVE SERVICES IN YOUR
VIEW WHAT WHAT IS WHAT IS WHAT
IS THE- I'M NOT LOOKING FOR A
MAGIC BULLET. BUT I AM KIND.
YEAH BECAUSE WHAT IS IT THAT
WHAT IS IT THAT INCREASES
ACCESS TO PREVENTIVE SERVICES.
I THINK IT'S A EMINENCE SYSTEMS
RIGHT SO- YOU KNOW I THINK HIM
IMPROVE REIMBURSEMENT- FOR
AREAS WITH WITH LOW PROVIDER-
RATIOS YOU KNOW AND I THINK
THERE'S OTHER STATES THAT HAVE
SHOWED. INTENDED BASED PAYMENTS
TO BE EFFECTIVE IN INCREASING-
THE AVAILABILITY- I THINK
THERE'S A LOT WE CAN DO AS FAR
AS DATA IN IN IMPROVING HOW WE
DISSEMINATE AND TRACK DATA. IN
INFRASTRUCTURE YEAH SO THERE'S
A LOT OF THINGS AND I THINK OF
OUR PARTNERS AND THE AUDIT
REPORT ITSELF OF HAVE MADE A
LOT OF RECOMMENDATIONS THAT ARE
GOOD. GOOD WAY TO GO. I CAN.
THANK YOU- JUST TO FOLLOW UP ON
THAT. AND DAY APPRECIATE THE
VARIOUS EFFORTS- FROM FROM YOUR
PLAN AND OTHER PLANS TO TRY TO
AND IN THE STATE BUT HOW ARE WE
DOING TO- A AS I MENTIONED IT'S
THE RELATIONSHIP BETWEEN THE
PATIENT OR FAMILY WITH THEIR
PHYSICIAN THAT OFTEN IS THE
MOST AFFECTED IN TRYING TO GET
PEOPLE TO SHOP FOR VISITS AND
SO FORTH. WHAT ARE YOU DOING TO
BUILD CAPACITY AND PRACTICES TO
DO THIS I THINK THERE'S TWO
AREAS I WANTED PARTICULARLY
TOUCH ON ONE IS THAT HOW LONG
DOES COULD- RELATIONSHIPS ARE
ALSO ABOUT TOP SELLERS IF YOU
HAVE A LOT TURN OVER. THE
PROVIDERS STAND PEOPLE ARE
DEVELOPING ONGOING
RELATIONSHIPS YOU KNOW THEY
WERE CAUGHT YELLED AND FAMILY
GETS BOUNCED AROUND DIFFERENT
PLACE ALSO BY WAY BECOMES A
CHALLENGE TERMS OF DATA
TRACKING TO- GAIN ACCURATE DATA
SO WE'LL BE LOOKING AT- SOME
THE LONGEVITY OF HOW LONG
PARTICULAR FIRES ARE IN
NETWORKS- AND HOW THAT TIES TO-
PERFORMANCE. AND IN THE OTHER
PART IS THAT THESE ARE
PRACTICING ARCHER SO. IT'S YOU
KNOW A REMINDER SYSTEMS AND
THINGS LIKE THAT- PAGE
REALIZING THAT YOU USE THAT
SOMEONE NEEDS TO DO THAT COSTS
MONEY THAT TAKES UP THE THAT
THAT SOMETHING THAT WOULD BE
THAT. AS OUR ENTERED TO HAVE
THEIR SOME FUNDING THAT ALLOWS
THEM TO DO THAT WHETHER IT'S
YEAH REMINDER SYSTEM OUR NURSE
COORDINATOR WHO CAN HELP OUT
WITH THESE TYPE OF THING AND
THEN ALSO THE FOLLOW THROUGH BY
THE WAY YOU COME IN FOR WELL
CHILD. YOU DO THE SCREENING AND
SOMETHING COMES BACK POSITIVE.
AND SO STONE'S HELP YOU TRY TO
CONNECT UP WITH THE ALL THE
REGIONAL CENTER FOR EARLY
INTERVENTION SERVICES IT'S WITH
THE SCHOOL DISTRICT SPECIAL
EDUCATION RIGHT. IT'S OF THE
AUDIOLOGIST FOR THE HEARING
SCREENING IT'S WITH YOU KNOW
SPECIALIST THAT THERE'S
WHATEVER SO THAT THE P. S. IT'S
THE- THE- T. T. AT THE END.
OKAY ALL. RIGHT SO IT'S NOT
SCREENING IT'S THE DIAGNOSIS
AND TREATMENT. AND SO THE T.
PART AT THE END. SO WHAT ARE WE
DOING IN THAT RATE- TO TRY TO
PROVIDE THE TO BUILD THAT
CAPACITY IN IN AND THE AMONG
THE- PHYSICIANS AND OTHER
PROVIDERS SO I THINK THAT'S
BOTH KIND OF A. QUESTION FOR.
THE CS BUT ALSO QUESTION FOR
THE PLANS- CONTRACTING WHO ARE
HAVING TO DIRECT CONTRACTS WITH
THE POSITIONS ON PROVIDERS. TWO
AGO SERVER. SO AS I MENTIONED
BEFORE JUST WITH REGARDS TO THE
PREVENTIVE SERVICES THIS IS
SOMETHING THAT WE'VE DONE- FOR
A NUMBER OF YEARS NOW JUST IN
TERMS OF PROVIDING FEE FOR
SERVICE REIMBURSEMENT FOR WHAT
WE PREVIOUSLY FOCUSED ON A C.
H. T. P. WHICH CURRENTLY THE-
THE BRIGHT FUTURE SUITE OF
SERVICES NOW FOR MEMBERS JUST
TO BE. SURE THAT OUR PROVIDERS
ARE ARE KNOWING THAT WERE
PUTTING AN EMPHASIS ON THIS FOR
FAMILIES AND FOR ITS- WE ALSO
INCLUDE THOSE MEASURES IN OUR
INCENTIVE PROGRAM. THAT
MEASURES PERFORMANCE WITH LIKE
PROVIDERS OR PEDIATRICIAN. IN
OTHER COMPETING WITH THEIR
PEERS AND THAT'S MOTIVATING TO
PEOPLE. THAT WITH QUARTERLY
REPORT CARDS TO THE PROVIDERS
AND I'VE GONE TO LEVEL THIS
YEAR REALLY PEDIATRIC FOCUS
REPORT CARDS AND THEN FOR THOSE
PRACTICES THAT SEEM TO BE
STRUGGLING GOING IN AND HAVING
OUR Q. I STAFF WORK WITH THEM
ON A PSA PROCESS. THINK ABOUT
WHAT'S HAPPENING IN THE OFFICE
THAT COULD BE SHIFTED. THE
PROVIDER BETTER- AND BETTER
OUTCOME- WE ARE ALSO AS I
MENTIONED- PROVIDING PROVIDER
EQUIPMENT GRANTS TO RECRUIT NEW
PROVIDERS TO THE AREA WE ALSO
HAVE TECHNICAL ASSISTANCE
GRANTS AVAILABLE SO FOR
PRACTICE WANTED TO BRING IN A
NEW SOFTWARE SYSTEM. IF THEY
WANTED TO HAVE SOME TYPE OF-
PRACTICE ASSESSMENT AND FIGURE
OUT WHAT THEY COULD DO
DIFFERENTLY. THERE'S ALSO THAT
RESOURCE AVAILABLE TO THEM- ONE
OTHER THING THAT I WOULD
MENTION IS WE BEEN. HAVING
DIFFERENTKINDS OF
CONVERSATIONS WITH ALL
STAKEHOLDERS OUR CUSTOMER
SERVICE THERE YEAH WE'RE LUCKY
IN OUR THREE COUNTIES BECAUSE
THERE ARE. FORUMS WERE ALL
HEALTH CARE LEADER. EARLIER
BEFORE WE BASIS IN SOME
INSTANCES WHERE THE SCHOOL
DISTRICTS MIGHT BE PRESENT AND
DIFFERENT DEPARTMENTS IN THE
COUNTY SO THAT WE CAN START
TALKING WITH OTHERS WHO ARE
ALSO PROVIDERS OF SERVICE TO
CHILDREN. TO THINK ABOUT HOW
CAN WE WORK IN A MORE
INTEGRATED WAY ACROSS ALL THE
SYSTEM- IF THE FAMILIES ARE
GETTING THE SAME MESSAGES IN
THE SCHOOLS AND ANOTHER SERVICE
AS AS THEY ARE FROM PLANT. FROM
THE WRITERS HELPS THE PROVIDERS
OUT IT CAN'T JUST BE THE
PHYSICIAN'S JOB TO BE THE ONE
POINT OF CONTACT WITH THE
FAMILY. OBSERVER REPAIR LOOKING
AT WHAT OFFER TO DO WE HAVE TO
BETTER INTEGRATE COMMUNICATE
ACROSS THE SYSTEM. ADD ON TO
THINK THERE. ARE A FEW THINGS I
THINK ONE. THAT I'VE- IT'S
POSSIBLE THE TEAM HAS DONE THAT
I IT. NOT AWARE OF IS REALLY
LOOKING AT THIS ISSUE OF. OUR
OUR CHILDREN AND FAMILIES
STAYING WITH THE SAME PROVIDER.
OVER TIME. IS THERE A WAY TO
REALLY LOOK AT SOME OF THE
INCENTIVE CONCEPTS AGAIN THAT
HAVE BEEN PROPOSED THROUGH
CALLIE AIM. TO REALLY REINFORCE
THAT WE'VE DONE THAT ON THE
DENTAL SIDE I THINK. HAVEN'T
DONE IT AS SPECIFICALLY ON ON
ON THE PHYSICAL HEALTH SIDE I
DO KNOW. OBVIOUSLY OUR PLANS DO
THEIR OWN INCENTIVE PROGRAMS
AND THAT'S WHERE. SHARING THEIR
BEST PRACTICES ABOUT HOW DO WE
MAKE SURE FOLKS. WE HAVE A
HOME. AND NOT SORT OF GOING
AROUND. AT YOUR POINT. DOES
IMPROVE JUST THE DATA
COLLECTION AND THE TRACKING OF
WHAT SERVICES ARE BEING
PROVIDED IN WHO'S DOING THE
REFERRALS. I'D ALSO- POINT TO
SOME OF THE CONCEPTS IN CALLIE
ABOUT. REALLY PUTTING EVEN MORE
EMPHASIS. ON HEALTH PLAN BUT
NOT NOT REALLY THE HEALTH PLAN.
SERVICE IT'S BUT SORT. LOW A
LOT. OF CARE BOARD. OWNERS THE
OTHER AND THEN AGAIN SOME OF
THOSE OTHER SOCIAL SERVICES YOU
KNOW WHO ARE THE FOUR OR THE
FOOD INSECURE OR THEIR HOUSING
ISSUES THAT WE NEED TO BE.
ADDRESSING AND SO THAT'S REALLY
A LOT OF WHAT WE'RE LOOKING AT
IN OUR IN OUR CALLIE MORE TO.
TO REALLY HAVE THAT BE A FOCAL
POINT AND NOT HAVE SOMEONE
WHO'S HAVING TO CALL SIX
DIFFERENT. PLACES BECAUSE
THEY'RE SIX DIFFERENT CARE
COORDINATORS TO DO THAT- ON THE
FOLLOW THROUGH. PEACE I THINK
AND SUPERCRITICAL FIRST FROM A
PRODUCTIVE IN UTILIZING DATA
ANALYTICS ABOUT WE SEE A
SCREENING HAPPEN. WHAT HAPPENS
AFTER THAT AND YOU KNOW WE'VE
PARTICULARLY WITH THE TRAUMA
SCREENINGS YOU KNOW THING
THAT'S GOING TO GO INTO PLACE
IN JANUARY WE REALLY WORKED
WITH THE SURGEON GENERAL ON-
DIFFERENTIATING LIKE. SOMEONE
YOU KNOW ESSENTIALLY SPLITTING
THE CODE INTO TWO SO ONE THAT'S
MAYBE LOWER RISK- AND THEN
WHERE ARE THE HIGHER RISK WHERE
THERE SHOULD BE REFERRALS. THE
TEN FOR MENTAL SERVICES BUT
ALSO IN A FINE WHAT TYPES OF
PHYSICAL HEALTH PROVIDERS CAN
REALLY PROVIDE THOSE SERVICES
IN A TRAUMA INFORMED WAY- THE
CHALLENGES OF GOING TO. A
PHYSICIAN WHEN YOU'VE
EXPERIENCED TRAUMA IS
SIGNIFICANT AND- AND SCARY AND
SO A LOT OF TIMES YOU SEE THAT
SORT OF THE UNWILLINGNESS OF
WANTING TO GO INTO THAT OFFICE
BECAUSE OF FEAR AND SO HOW DO
WE REALLY TRACK THOSE AND-
REALLY THOSE ARE THE THINGS
WE'RE LOOKING AT PARTICULARLY
ALSO WITH THE DEVELOPMENTAL
SCREENINGS OF. OF GREETING
HAPPEN. NOW IT'S GOING. WITHIN
THE PURVIEW OF THE MANAGED CARE
PLAN TO BE PROVIDING THAT
FOLLOW UP SERVICE BUT IT IS
THEIR RESPONSIBILITY. AND AGAIN
THAT SORT OF MORE PROVIDER
BASED ON THE GROUND PERSON TO
PROVIDE THE APPROPRIATE
REFERRAL AND THEN MAKING SURE
WE'RE CONNECTING THAT DATA.
REFERRAL HAPPENED MAYBE DID IF
THAT DIDN'T THAT'S A PROBLEM IF
THE FOR ALL HAPPENED NOTHING
HAPPENED FROM THAT REFERRAL HOW
DO WE ALSO ADDRESS THAT SO I
THINK. A LOT OF THOSE THINGS
ARE ARE ARE WHAT WE'RE TRYING
TO LOOK AT AND THE DATA IT
IMPORTANT IN BEING ABLE TO
ASSESS THAT. I WOULD ALSO SAY
ALTHOUGH IT HADN'T BEEN A
PARTICULAR. PIECE THAT YOU
HEARD ME MENTION ON THE
OUTREACH SIDE. BUT HOW DO WE
NOT JUST HAVE THE PLAN TO BE
DOING OUTREACH BUT HOW PUSH
THAT DEBT TO THE PROVIDER LEVEL
MAKING SURE THEY HAVE THE
INFORMATION THAT MADE THAT MAY
NEED TO REACH. OUT AND I SAVE.
THE SORT OF WHEN YOU. IN MY
LOOK. WHY IS THE CHALLENGES
THAT WE HAVE WITH. ACCURATE
CAUGHT HIM FOR MISSION FOR
FAMILIES AND MEDI CAL AND-
KNOWING THAT THE PROVIDER LEVEL
TYPICALLY HAS THE BEST PLANS
HAVE THE NEXT BEST. BUT IT'S
NOT OFTEN CONSISTENT AND NOT
OFTEN EASILY SHARED BECAUSE OF
OUR DATA SYSTEM LIMITATIONS
AND- REALLY LOOKING FORWARD TO
WORKING WITH FOLKS ON. HOW DO
WE OBVIOUSLY MAINTAIN THE
PRIVACY THAT NEEDS TO BE
MAINTAINED. BUT MAKE SURE THAT
OUR HEALTH PLANS ARE PROVIDERS
ARE COUNTY BEHAVIORAL HEALTH
FOLKS ALL HAVE THE INFORMATION
ON HOW TO ACTUALLY REACH.
BENEFIT WHETHER. WHAT I'M OUT
HERE FOR KIDS BUT EVEN ADULTS
WE CAN'T IF WE DON'T IF THEY
CAN'T BE LOCATED BECAUSE OUR
DATA JUST ISN'T BEING UPDATED
APPROPRIATELY THAT'S A HUGE
PROBLEM AND SO. I WOULD SAY
AGAIN THAT'S ANOTHER AREA WHERE
I THINK IF WE CAN IMPROVE THAT
AND FIND A MORE STREAMLINED WAY
TO DO THAT. IT WILL HELP
IMPROVE SERVE THESE WERE ALL
RESULTS OF YES MAYBE ONE THING
HAPPENS BUT THE FOLLOW THROUGH
DOESN'T. THANK YOU ARE. YOU
JUST TOUCH ON ISSUES RUN
HOMELESSNESS ARE PEOPLE OF
UNSTABLE HOUSING EXACTLY
ADDRESSES THINGS LIKE THAT- I
APPRECIATE THAT- YOU- THAT- THE
SUNSHINE TALKED ABOUT THE IDEA
ABOUT ACTUALLY EVEN PAYING FEE
FOR SERVICE FOR. PREVENTION
THAT GOES BACK TO YOU KNOW THIS
IS ONE OF THESE THINGS THAT
WELL EITHER YOU'RE ON THE
SCHEDULE IT'S NOT THAT I'M
GONNA SEE EXTRA VISITS YOU'RE
NOT GOING TO PROVE THAT BUT YOU
KNOW THERE YOUR- PEOPLE KNOW
THAT IF I GET THAT I'VE SEEN
PATIENT ON THE SCHEDULE I'M
GOING TO GET PAID- AND THAT.
THAT COMES REPORT I APPRECIATE
ALSO WE SAID ABOUT CONTINUITY-
GIVE YOU THE WORK ON PRIMARY
CARE BY OUR FEELS WORK AND WHAT
MAKES PRIMARY CARE HIGHER.
QUALITY LOWER COST ETCETERA
IT'S ACTUALLY ABOUT THE
RELATIONSHIP. SO WHEN PEOPLE
JUST. CHURNING THROUGH-
PHYSICIANS OTHER PROVIDERS THAT
ACTUALLY YOU THE BENEFITS. OF
THAT SO IT'S BEING OF THE BUILD
THAT RELATIONSHIP- SO I THINK.
CERTAINLY AND WE NEED TO DO
MUCH BETTER AND MAKE NOTE THAT
IOWA. THAT THEIR NUMBER ONE
HERE BUT DAY PERFORM BETTER
THAN OUR BEST PERFORMANCE. FOR
ANY YEAR. PERCENT IT'S 49%
NATIONAL AVERAGE IS 50% THAT'S
THE AVERAGE WE CAN DO BETTER
AVERAGE AND I THINK IF WE WANT
TO CARRY OUT THE GOVERNOR'S
VISION THEN WE NEED TO KNOW
YOU. BETTER THAN AVERAGE SO I
LOOK FORWARD TO HEARING MORE
SPECIFICS ABOUT HOW WE'RE GOING
TO GO ABOUT DOING THIS- BEFORE
I LET YOU ALL GO I DO WANT TO
RAISE AN ISSUE- SPECIALLY.
SINCE CHAIR WAS HAVE BEEN
HAVING TO DEAL WITH THIS- BUT
YOU KNOW WHAT IT DOES INTERFACE
WITH THESE TWO OUT REPORTS TO.
WHAT ARE WE DOING TO BE SURE
THAT PEOPLE HAVE ACCESS TO CARE
WHEN WE HAVE THE POWER GOING
OUT WE HAVE FIRES GOING ON. OUT
TO BE RECENTLY READ ARTICLE
ABOUT THE CHALLENGES THIS IS
FACING FOR PRACTICES. OF CAN
YOU PERHAPS THE JUST COULD
SPEAK A LITTLE BIT OF WHAT'S
YOUR INTERACTION WITH WHETHER
IT'S WITH ELLIE S. OR OTHER
AGENCIES TO ENSURE THAT PEOPLE
CONTINUE TO GET ACCESS TO CARE.
WE'RE NOT JUST TALKING ABOUT
YOU KNOW THERE'S A FIRE PEOPLE
OUT THE BACK TO IT WE'RE
TALKING ABOUT POWERS GOING OUT
PEOPLE STILL CATION THERE'S NO
REFRIGERATION HOSPITALS RUN ON
GENERATORS FOR DAYS ON END WHEN
THOSE GENERATORS ARE DESIGNED
AROUND FOR THAT LONG. BOB OR
MEDI CAL CAN YOU JUST PERHAPS
TOUCH ON SOME OF THE THINGS DH
CS IS DOING AND WE'RE HEARING
FROM BG AND HE'S CEO THAT IS A
TEN YEAR NORMAL OR ABNORMAL SO
THIS IS NOT SO WHERE THINGS
THAT WE'RE THINKING ABOUT FOR
MEDI CAL POPULATION IN THESE
COMMUNITIES. SO I CAN IS TOP.
LEVEL NUMBER MERRY CHIME IN
LEBANON FROM THE SPECIFIC STUFF
SO- AT THE AGENCY LEVEL THEY DO
THEY ARE AT THE ARE AT THE
JOINT OPERATION CENTER- WITH
ALL THE OTHER WITH ALL THE
OTHER MAJOR AGENCIES- THE LEADS
WITH AND- HEALTH AND HUMAN
SERVICES AGENCY- ARE PRIMARILY
DSS BECAUSE THEY DO LOTS OF.
HOUSING SUPPORT ACTIVITIES-
EMSA WORKS ON MEDICAL CAPACITY-
AND THEN- PUBLIC HEALTH-
BECAUSE THE LICENSING
CERTIFICATION AREA THAT THAT
THEY WORK IN AN ENVIRONMENTAL
HEALTH. SO THE. THREE LEADS WE
ARE REPORT. TO THE. HE JUST.
HAD A BREAK IN A VERY HIGH
LEVEL- DURING THE MOST RECENT-
INCIDENT WE'RE HAVING CALLS AT
LEAST TWICE A DAY- AT AGE TO
LEVEL TO MAKE SURE THAT WE WERE
THAT WE WERE COORDINATED. THEIR
PARTICULAR AREAS AND AGAIN
AMERICAN TITLE BUT MORE THIS
BUT THEY WERE THERE- THINGS
THAT WERE BEING RAISED UP IN
TERMS OF THE NEED FOR
MEDICATIONS WHICH PHARMACIES OR
OPEN WHICH PROMISES ONE OPEN-
NEED FOR REFRIGERATION- IN A
NUMBER OF CASES WE HAVE- PEOPLE
FOR EXAMPLE THAT. ARE YOU KNOW
WE'RE PRO AM SAID LIKE PRESENT
TENSE AND VENTILATORS OR C. PAP
OR KINDS OF MACHINES THAT ARE
TO KEEP BY. THAT WE ARE
CONSTANTLY CHECK IN ON- WHAT
CAME. OUT OF THE MOST RECENT
INCIDENT AGAIN AT A HIGH LEVEL
WAS THAT. NEEDED TO GET SOME
SENSE RIGHT WHERE FORMER
DRUMMER FOR EXAMPLE- AND SO-
THE ADMINISTRATION. ASSET
APARTMENTS HEALTH CARE TO
ESTABLISH A SPECIAL HOTLINE.
THAT WE THEN MADE AVAILABLE YOU
KNOW TO THE PUBLIC AND TO OUR
AND TO THE HEALTH PLANS- FOR
PEOPLE TO BE ABLE TO CALL AND
IDENTIFY SPECIFIC NEEDS OF THE
MAKE OF AND HIS TEAMMATES C.
REGULATES MOST OF THE PLANS
RIGHT NOW BUT THEY HAVE. A CALL
CENTER THERE BUT KNOWS WHEN AND
RATE THE H. WILL HELP THE KIND
OF THING. SO WE- WHAT WE COULD
DO TO LEAN FORWARD USING THE
EXISTING INFRASTRUCTURE. THAT
WE HAVE. TO SET UP. A HOTLINE
FOR AND. TO BE A CALL AND THEN
WE WORKED WITH THE AGENCY- ON
VERY SPECIFIC- DIRECTION TO THE
PLANS. ABOUT WHAT THEY WERE TO
DO I'M REALLY TO MEDICATIONS
ALL IT MAY TALK ABOUT THAT
PROCESS. I FEEL LIKE A COVERED
A LOT OF IT BUT- I THINK I GOT
A FEW VERY SPECIFIC THINGS
OBVIOUSLY WE HAVE GREAT PLAN
PARTNERS TO GET WHO CARE VERY
MUCH ABOUT THEIR POPULATIONS
AND SO. WHAT WE SAW AND WHAT
OUR DIRECTION WAS IS
PARTICULARLY ON THE
PRESCRIPTION DRUG SIDE- YOU
KNOW PEOPLE MIGHT NOT HAVE
THEIR SCRIPT THE MIGHT HAVE
LEFT IT AT YOU KNOW WHATEVER IT
IS. OPENING UP AND NOT HAVING
TO TREAT. THE REQUIREMENTS SO
THAT PEOPLE COULD HAVE BOTH
EMERGENCY SUPPLIES BUT IF. IF
IT'S NEEDED LONGER TO DO THAT
WE OBVIOUSLY RECOGNIZE IF YOU
DON'T HAVE ACCESS. AND YOU
DON'T ACTUALLY HAVE YOUR
MEDICATION. WHAT MIGHT HAPPEN
IS YOU KNOW COULD BE.
ULTIMATELY DYING AND
PARTICULARLY WHEN YOU THINK OF
SOME OF YOU KNOW THE MORE
CHALLENGING THE CHALLENGING
POPULATIONS WE DO DO DALY
FACILITY CHECK IN SO ANY OF THE
FACILITIES IN THE AREA WHETHER
HOSPITALS. OTHER LONG TERM
INSTITUTIONAL OTHER TYPES OF
THOSE THINGS WE DO CHECK IN
WITH THOSE IF THAT WAS HAVING
TO TRANSFER PATIENTS WE
ASSISTING AGAIN WHETHER IT'S
WITH HEALTH PLAN OR SPONSOR.
YOUR OR IN FEE FOR SERVICE WE
DO HAVE A PROCESS THAT TO
REALLY HELP PEOPLE TRANSITION.
I THINK WE HAVE YOU KNOW.
UNFORTUNATELY BUT IN THE CASE
OF NOW HAVING LEARNED FROM THE
FIRES IN A COUPLE OF YEARS
REALLY THINKING ABOUT HOW TO
WORK WITH FEDERAL GOVERNMENT
MAKING SURE THAT WE HAVE. THE
ABILITY. NOT ONLY FOR US AS A
STATE TO PROVIDE SERVICE THAT
AT THE STATE BECAUSE- WE CAN
GET FEDERAL FUNDING FOR WHEN
SERVICES MIGHT NEED TO BE
PROVIDED AN ALTERNATIVE
LOCATIONS AND- CONTINUE TO WORK
WITH THEM ON ON THOSE ISSUES-
YOU KNOW WHETHER THERE ARE
THINGS HAPPENING IN SHELTERS OR
JUST A DIFFERENT. DIFFERENT
LOCATIONS- AND THEN I AS AS
THE- MENTIONED- WE ALSO HAVE
WITH OUR WEAVER- PROGRAMS WE DO
EITHER DIRECTLY WHERE THEY'RE
MANAGED BY US OR WITH OUR CARE
MANAGEMENT ENTITIES. HAVE THERE
HAVE THAT DIRECT OUT REACH.
EACH YOU KNOW ARE YOU SAFETY
UNIQUE THING. BUT WE ARE
LOOKING AT IN THE FUTURE- YOU
KNOW NOT IN FUTURE NOW FOR
FUTURE SITUATIONS IS THIS ISSUE
OF A. OUR Q. AND PEOPLE HAVE.
BOTH DURATION IF YOU MEANT.
JUST FOR CREEK BUT ALSO PEOPLE
WHO SURVIVE ON THINGS THAT ARE
POWER ELECTRICITY AND TYPICALLY
HAVE SOME LEVEL OF BACK UP YOU
KNOW YOU PS STUFF THAT CAN
OPERATE FOR HOURS SPENT WHAT
WE'VE BEEN SEEING WITH THESE
POWER SHOT OFFICES HOURS ISN'T
IS NOT WHAT'S HAPPENING AND SO
HOW DO WE THINK ABOUT FROM A
FEDERAL MEDICAID PERSPECTIVE.
IS THE POTENTIAL FOR REAM.
GENERATORS AND OTHER THINGS
LIKE THAT SO WE ARE LOOKING
INTO THAT THAT IS SORT OF A NEW
IS NEWER ISSUE FOR US WITH
THESE. SORT OF PS PS THINGS
GOING ON FOR DAYS BUT
DEFINITELY SOMETHING ON OUR
LIST TO CONTINUE TO LOOK AT
OBVIOUSLY THE- THESE ARE PEOPLE
WHO WE WANT TO TAKE CARE OF. WE
DON'T WANT TO SEE THEM HARMED
OR OR WORSE PARTICULARLY WHEN
IT. OUR OUR- AND THERE IS
SOMETHING THAT WE CAN DO ABOUT
IT. YEAH I WOULD I WOULD JUST
END BY SAYING YOU KNOW WE ARE
NOT THE LEADER THAN AGENCY BUT
WE WERE ACTIVELY ENGAGED. I
THINK IT'S FAIR TO SAY WILL BE
A VERY- ACTIVE AND ROBUST-
AFTER IN CENTER AFTER EVENT.
ANALYSIS TO SEE EXACTLY WHAT WE
MORE- YOU KNOW OBVIOUSLY IS AN
ISSUE NOTED IT DOES APPEAR
THESE LOCKER. THE SERVER IN A
VERY SHORT TERM ON A MORE OFTEN
THAN ANYBODY BUT LIKE SO. YEAH
JUST JUST JUST. UP AS SOMEONE
WHO'S FRESH OFF OF SOME OF
THESE EXPERIENCES- IT WAS IT
WAS HAPPENING LIVE WHEN I WAS
VISITING WITH YOU IN OFFICE
LAST WEEK. WAS A MATTER OF
FAITH. I THINK- IT ONE OF THE
CONCERNS I HAVE IS THE LONG
TERM- FOR EXAMPLE- AND CITY
SANTA ROSA VISTA CLINIC- JUST
RE OPENED- AFTER TWO YEARS
BEING CLOSE SPEAKS OF THE TOP
FIVE- AND THEN WAS AND THEN WAS
THREATENED AGAIN BY THE CAN
KICK FIRE. SO YOU KNOW I THINK
THEY'RE GONNA HAPPEN YOU KNOW.
HOUSE THERE'S AND THINGS ARE
GOING GOING TO HAVE CHALLENGES
BUT I THINK. IN THE LONG RUN-
DUMBARTON ARE MORE VULNERABLE
DESPITE POPULATION ARE GOING TO
BE DISPLAYED I'M WERE SEEN SEE
CAN SOME. AMOUNTS OF FOOD IN
SECURE. AS PEOPLE OF LOST MAYBE
JUST ONE BUT TWO. ENTIRE
REFRIGERATORS FULL- AND SO I
THINK THAT'S WHERE THE OUT
REACH. IN SOME. FIRE IMPACTED
AREAS ARE GONNA NEED TO BE RE
DOUBLE BECAUSE THE LAST THING
ON SOMEONE'S MIND IS LIKE.
GETTING THERE TO PREVENTIVE
VISIT THAT THEY MAY NOT EVEN
KNOW EXISTED THEY DIDN'T EVEN
KNOW THEY TO DO THAT. AND I DO
HAVE I DO HAVE SIGNIFICANT
CONCERNS BECAUSE- WHAT MOST
PEOPLE IN THIS ROOM PROBABLY
DON'T KNOW UNLESS YOU LIVE YOUR
LIVING AT- IN IN A SIGNIFICANT
SECTION OF ONE OF MY COUNTIES.
THEY DON'T EVEN HAVE ASKED BACK
YET. SO YOU TALK ABOUT YOU KNOW.
YEAH TAKING CARE OF EQUIPMENT
AND THINGS AND ONE PHARMACIST
IN THE WEST PARTISAN AS CINEMA
COUNTY- COULDN'T GET IS GAS
TURNED ON BECAUSE YOU HAD TO BE
THERE IN PERSON AND HE WAS
TAKING CARE OF PATIENTS WHO
NEEDED MEDICATIONS SO WHEN
EXTRA. NIGHTS WITHOUT HEATING
IN HIS HOUSE SO THESE ARE THESE
ARE BIGGER PICTURE ITEMS THAT
NONE OF US EXPECTED TO HAVE TO
DEAL WITH WE'RE TRYING TO
INCREASE- ACCESS FOR KIDS AND
ENSURING THAT HAPPENS BUT BUT I
THINK IT IS SOMETHING THAT'S
GOING TO HAPPEN IN OTHER PARTS
THAT EIGHT AND WE NEED TO WE
NEED TO WEAR THAT WHEN YOU HAVE
A PLAN THAT. THAT THAT KIND
ABOUT. IN AREAS THAT ARE TO BUY
THIS STRIPS. I GOT. HE SAID
THAT. IN IN ALMOST EVERY.
PUBLIC VENUE WITH THE GOVERNOR
IS AND YOU SAW SECRETARY GALLEY
AT HIS SIDE I THINK IT WAS IT
WAS- THAT WAS ON PURPOSE.
BECAUSE THE VERY LARGE ROLE OF
HEALTH AND HUMAN SERVICES.
PLAYS I GUESS OUR SISTER
APARTMENTS PROMESAS SERVICES BY
THE RAISING OF A CONTROL I
MEAN- YOU KNOW- DSS FOR EXAMPLE
EVEN THEM. EVEN THOUGH I TO
THIS IS A MEDICAL BENEFIT WE
DON'T. ACTUALLY OPERATED THAT
WAY IT'S MORE DSS BUT THEY WERE
VERY ACTIVE ENGAGE ON THE CARE
GIVER SIDE. I YOU. OFFER TEMPLE
THE PROGRAM ARE THEY ASK
FEDERAL GOVERNMENT. YOU CAN DO
A ONE TIME BASIS YOU CAN PLACE.
CALPERS I'M IN THE LAST WEEK WE
SELLERS SAYING WELL ENOUGH AS
YOU ARE THINK ABOUT ME IT'S
GOOD IT'S CHANGE RULES LAW
BECAUSE THE SITUATION MISTER
WHAT WAS JUST INDICATING.
DIDN'T HAPPEN ONCE IT HAPPENED
TWICE WILL. UNDER THE RULES
ISN'T EQUIPPED FOR THAT MAYBE
IT'S NEVER HAPPENED THE WORD
ABOUT A ONE TIME FLOOD. OR
HURRICANE OR SOMETHING THAT
DOESN'T HAPPEN EVERY OTHER WEEK
OR TWO THREE TIMES IN A SEASON
SO AGAIN IS THE KIND OF THINGS
AND OF THE SECRETARIES VERY
CONCERNED ABOUT HE'S ASKED US.
TO EMPLOY A LEAN FORWARD
STRATEGY WHICH WE'VE BEEN
TRYING TO DO AN END USER MAY
TALK ABOUT SOME OF THE RICHEST
IN. EXPECT TO THINK ABOUT HOW
MUCH HAPPIER OVER LONGER
PERIODS OF TIME AND SO WE'RE
WE'RE OBVIOUSLY GOING TO DO
THAT. JUST A FINAL FOLLOW UP
HERE IN THIS IS REGARDS AND
THINKING ABOUT TRAUMA AND KIDS-
THESE FIRES AND THESE POWER
OUTAGES AND THINGS- I DON'T
KNOW HOW THEY FALL INTO YOUR
DEFINITIONS AND WE'RE LOOKING
TO LOOK AT THAT. BUT IS
TRAUMATIC. I WILL TELL YOU ON
THE NIGHT THAT THE FIRE STARTED
THE CAN KATE FIRE STARTED- IT
WAS LIKE SOMEBODY FOR SWITCH ON
AND ALL OF A SUDDEN WE HAVE
THESE IS. AMAZING WINS. I
LOOKED OUT MY FRONT DOOR AND- I
SAW SOME OF MY NEIGHBORS
LEAVING- THEY LEFT BECAUSE I
BELIEVE THAT THEY EXPERIENCE
THE FIRES. IN TWO THOUSAND
SEVENTEEN IN THE SAME AREA AND-
FLAP THAT NIGHT. AS WELL AND SO
YOU KNOW THESE ARE FOR AND WAS
WITH CHILDREN AND- THE KIDS ARE
AFFECTED IT AFFECTS THEIR
SCHOOL- PERFORMANCE AND IT
OKAY. IN SOME CASES THERE THEIR
FAMILIES THAT HAVE SOURCES BUT-
WHAT A CASE. FAMILIES THAT
DON'T COMMON OUT ON. FACT NOW
YOU'VE. GOT SOME THESE MONIES
WERE THE PARENT COMMITTEE. FOR
AND NOW YOU HAVE ADDITIONAL
STRESSORS OF POTENTIAL TRIAL
YES SO I WOULD JUST SAY ON THAT
WE EVERY DAY. KELLY IN
CALIFORNIA FOR AND OUR OFFICE
WAS CALLING EVERY COUNT EVERY
AFFECTED COUNTY ASKING IF THEY
NEEDED ADDITIONAL ASSISTANCE-
WE ALSO I WAS ON A ON A CALL
PHYSICALLY TOGETHER WITH C.
SACK CA S. C. C. B. H. D. A.
AND SHE ACT WE WERE KIND OF
GOING OVER WHAT IS THE BEST
POINT OF CONTACT HOW WE MAKE
SURE THERE ARE. ENOUGH MENTAL
HEALTH PROFESSIONALS A
PARTICULAR TO MY DO THESE ARE
MORE IS MORE ON THE SHELTER
OPERATION SIDE BECAUSE WE WERE
EMERGENCY EVACUATION. MODE WILL
HAVE TO GO WE'LL HAVE TO SEE
OBVIOUSLY. INTO THEIR HOMES
WHEN YOU PROBABLY GONNA SEE
EXACTLY A BIGGER OF SO WE ARE
WE ARE WATCHING THAT CAREFULLY
AS WELL BUT JUST KNOW THAT WE
ARE VERY. ENGAGE WITH POLICY
PHD A CHECK AND SEE SECOND
JOINTLY AND TRY TO FIGURE OUT
WHAT IS THE BEST APPROACH NOT
JUST FROM EVACUATION. CENTER
POINT OF VIEW- IN FACT WE WERE
FAVOR OF BUGGING THEM TOO MUCH
BY CALLING EVERY DAY THE SECOND
IS THAT YOU WILL CALL EVERY
DAY. WE DID CALL EVERY DAY
ANALOG CASES YOU KNOW SOME OF
THE- WE AT THE TUITIONS FOR
EXAMPLE WERE WE HAD COUNTY
OPERATIONS AND- CAN. SEE UP.
DON'T EVEN. PLACE OVER THERE A
SINGLE CHECKING ALL WHOLE BUNCH
A COUNTIES AROUND HERE JUST TO
SEE ANYONE ANYWHERE WHERE
THERE'S A P. S. P. S. UNIT WAS
A PUBLIC HEALTH EMERGENCY. WE
ARE STILL CALLING AND CHECKING
IN WOULD BE EXPECTED TO CAN IT
TO DO SO WE'RE VERY PROACTIVE.
IN THAT PARTICULAR AREA- AS
WELL AS TAKING WITH OUR HEALTH
PLANS SO AGAIN WE WERE. WAS A
TWENTY FOUR SEVEN THING. I'M
MORE SABATINO OFFICE WAS
STAYING OPEN WHICH MAKES THESE
OUTBOUND CALLS- IN TERMS OF
WHEN IT. TRIES OUT WERE
EXPRESSING HOME- THAT'S WHAT.
WE HAVE HOSPITAL'S. KAISER
PARTICULAR. WHO WAS. IN MOVING
PEOPLE FROM THE SANTA ROSA
CENTER TO. DO SELF DISCO. WENT
DOWN TO SAN MATTEO WHICH WE AYE
WERE OTHER BIT. PEOPLE SO. I
WAS VERY. ENGAGE ENVIRONMENT
THAT UNFORTUNATELY WE ARE ARE
ARE LIKELY TO. AND I THINK OF I
THINK YOU RESERVE PARTICULARLY
GOOD QUESTION ABOUT THE
SCREENING AS WE DO FOR TRUMP
TRUMP OBVIOUSLY THE SORT OF THE
BENCHMARK AND WHAT WE'RE
PROPOSING TO USE IS YOU KNOW
REALLY THE PEARLS AND THE ACES
THAT THAT IT THINGS. THAT WE
ALL KNOW OR SUPER TRAUMATIC BUT
I THINK THIS NEW WORLD OF-
BECAUSE IT'S REALLY ACES ARE
GETTING AT INSTABILITY FEELING
A- FEELING LIKE YOU DON'T HAVE
FOOD NOW THOSE. ELECTIONS ARE
ARE MORE TIED TO OTHER TYPES OF
THINGS THAT I THINK IT'S A
VERY. QUESTION ABOUT WHETHER WE
NEED TO BE THINKING ABOUT
EXPANDING THE WAY WE DEFINE
THAT BECAUSE LACK OF STABILITY
OR LACK OF FEELING SAFE IN ITS
IN A CHILD REGARDLESS OF
WHETHER IT'S- THE THINGS THAT
ARE MENTIONED CURRENTLY IN THE
ACES YOU KNOW BECAUSE OF
INCARCERATION OR- NO DRUG.
OTHER THING JUST REALITY LIVING
IN A PLACE WHERE. WE WEEKS
HAVING POWER TO OFFER YOUR
HAVING FIRES HAVE EXCELLENT
QUESTION IN SOMETHING-
CERTAINLY WILL ENGAGE WITH THE
SURGEON GENERAL ON ON HOW DO WE
ACTUALLY EVEN THINK ABOUT THESE
NEW TYPES OF TRAUMAS THAT MAYBE
HAVEN'T EXISTED IN THE SERVE
REPETITIVE NATURE THAT THEY'RE
HAPPENING NOW THAT I THINK VERY
MUCH FALL IN LINE WITH THE SAME
TYPE IMPACTS USE IT FROM THAT
LACK OF STABILITY IN YOUR HOME
LIFE AS A AS A CHILD SO I THINK
IT'S A GREAT AND IN SOME WE-
CAN THINK OF HOW TO. ADD AS
WELL I FEEL ONE. COMING UP.
THEY'RE JUST A VERY BRIEF
QUESTION. SIR IT'S NOT GOOD FOR
OF THE VALUE BASED PURCHASING
IS THERE ARE YOU INCLUDING THE
PREVENTIVE SERVICES ISSUE AND
YOUR VALUE BASED PURCHASING
CELL OF THE FILE THAT IS
CORRECT YES OKAY WILL FOLLOW UP
ON THAT YES WE CAN DEMONSTRATE
THE SPECIFIC METRICS FOR USING
AND- THAT ALL REALLY IS
INCENTIVES TO THE PROVIDERS
PROVIDING THOSE SERVICES THEY
DO. THROW THROUGH THE PLAN BUT
IT'S NOT THE PLAN ACTUALLY
GETTING THE BENEFIT IT IS
GETTING THAT DOWN TO OKAY SO
WILL OFTEN HAVE FOLLOW UP OKAY
WITH THAT- I THINK WALL FOR
YOUR TESTIMONY AND- SO WE'LL GO
AHEAD AND TAKE. PUBLIC COMMENT
NOW. SO I ASK. KEEP YOUR MARKS
TWO MINUTES OR LESS. THIS PASS
UP THE SERGEANTS ANY WRITTEN
MATERIAL YOU HAVE AS WELL- THIS
TESTIMONY SO WELCOME AND PLEASE
INTRODUCE YOURSELF FIRST THANK
YOU SO MUCH KELLY BEING ON
BEHALF OF THE CALIFORNIA
MEDICAL ASSOCIATION WE COVERED
A LOT TODAY- SOULS THE MOST
RECENT JUST ONE LET YOU ALL
KNOW THAT WE ARE COLLABORATING
WITH THE GOVERNOR'S OFFICE AND
PUT OUT A CALL TO. ACTION TO
OUR VISIT. I'M ALL TEARING THE
AFFECT AREAS AND- OPPORTUNITY
SO WE'RE LOOKING FORWARD TO
THAT- WE'VE ALSO BEEN WORKING
THAT THE REPORTING REQUIREMENTS
FOR THESE NEW MEASURES ARE NOT
SO ONEROUS AT THE TIME STAFF
REQUIRED TO ACCURATELY REPORT
THEM AND PUT ON THE FUNDS
GOBBLES UP THE PRACTICES
ABILITY TO USE THE PAYMENTS FOR
FOLLOW UPS AB. FAMILIES AND
ALSO WANTED TO KNOW WE ARE
CURRENTLY WORKING WITH PARTNERS
SPRING TECHNOLOGY AND TOOLS TO
MORE PROVIDERS THROUGHOUT THE
STATE. SIMILAR TO THE EFFORTS
THAT CENTRAL CALIFORNIA COAST
MENTIONED SO PRACTICE
TRANSFORMATIONS DIFFERENT
REPORT SO THEY CAN PULL DOWN
AND SEE WHO THEY NEED TO FOLLOW
UP WITH. I'M KIND OF ON THE
RIGHT HERE IS TO HEAR MY
COMMENTS BUT. CONTRACTING
THROUGHOUT THE STATE IS A
RELATIVE BLACK BOX ARMS WERE
LOOKING FORWARD TO HEARING- THE
DEBATE ADDITIONAL INSIGHTS AND
WITH THE IMPLEMENTATION OF AB
SIXTEEN FORTY TWO WILL BRING.
WE ALSO AGREE WHOLEHEARTEDLY
THAT RATES ARE NOT THE ONLY
CONSIDERATION WHEN CONTACTING
ITS ADMINISTRATIVE BURDEN AND
COST TO THE PRACTICE OF TAKING
COMMERCIAL AND MEDI CAL.
PATIENTS WITHIN ONE PLAN OR
CONSIDERING WORKING WITH TO
MEDI CAL MANAGED CARE PLANS AND
THEIR COMMERCIAL PLANS AND A
LOT MORE COMMENTS BUT ALSO MET
THEM TO YOU THANK YOU THANK YOU
VERY MUCH. WELCOME GOOD
AFTERNOON LINDA WAY WITH
WESTERN CENTER ON LAW AND
POVERTY WE APPRECIATE THE
AUDITOR RAISING CONCERNS
NETWORK ADEQUACY CONCERNS IN
RURAL AREAS AND THE DOCTOR
WOULD SAY BE SIXTEEN FORTY TWO
IS A STEP IN THE RIGHT
DIRECTION BUT THINK MORE NEEDS
TO BE AND- SPECIFICALLY. TWENTY
ACCOUNTABILITY AND ENFORCEMENT
IN CONTRACTS AND STAKEHOLDER
PROCESS. ARE OF P. RICK
PROCESS WE APPRECIATE THE
OPPORTUNITY TO PROVIDE INPUT ON
THE UPDATED CONTRACT AND ASKED
THAT THAT STAKEHOLDER PROCESS
TRULY BE A STAKEHOLDER PROCESS-
IN ADDITION WE RECOMMEND
GREATER OVERSIGHT OF NETWORK
ADEQUACY INCLUDING WHEN TIMES
SUB CONTRACT- DELEGATE
RESPONSIBILITY TO
SUBCONTRACTORS. A RECENT I
CALIFORNIA HEALTHCARE
FOUNDATION REPORT ON MEDI CAL
PLANS QUALITY SHOWED LOCAL
INITIATIVES OUTPERFORMING A FOR
PROFIT PLANNED SO MAY CONSIDER
LOCAL INITIATIVES IN ADDITION
TO THE COKE BOTTLE IN THE
CURRENT FORM CLOTHES ARE NOT
REQUIRED TO BE NEXT KEEP
LICENSE AND SO CODES ENROLLEES
HAVE LESS CONSUMER RIGHTS
SPECIFICALLY THE RIGHT TUNING.
AND IT MEDICAL YOU AND IN OUR
VIEW BY DEPARTMENT OF HEALTH
CARE. LATER ANOTHER PAIR OF
HEALTH PLANS THANK YOU. THANK
YOU. HI WHERE YOU JOHN WAS
CALIFORNIA PAN ETHNIC HEALTH
NETWORK I'M GONNA TRY TO DO
THIS IN ONE MINUTE- SO AS WE
ALL KNOW MEDI CAL- COFFERS
MEDICAL POPULATION IS VASTLY
DIVERSE 80% OF THE POPULATION
ARE COMING OF COLOR AND- HOLE
FOR OFF I'M DISPROPORTIONATELY
AFFECTED BY PREVENTIVE HEALTH
**** PREVENTABLE HEALTH
CONDITIONS LIKE ASTHMA AB IS A
MANAGED CARE PLANS ARE REQUIRED
TO CONDUCT A PUBLISHER HOLES
NEED THIS MAN. PNA EVERY FIVE
YEARS TO ENSURE THE RACIAL THE
A DIVERSE POP INCLUDING LIMóN
PUSH PROFICIENT THE DOORS ARE
ABLE TO ACCESS SERVICE SO I
WOULD LIKE TO JUST THE GETTING
STRESSED OUT INTO MARCH AUDIT
REPORT. THEY OUGHT HER SON DIED
EACH SI ESTAS OVER SOCIAL
SHORE- AND MAKING SURE. HOST
PLANS ARE EFFECTIVELY REDUCING
DISPARITIES. PREVENTIVE
SERVICES THROUGH PAEAN PEONIES
AND THAT DH CS IS DONE
LITTLETON'S SURE THAT FAMILIES
HAVE ACCESS TO ORAL
INTERPRETATION. SO AS TO
MINIMIZE THE USE OF CHILDREN AS
INTERPRETERS. SO AS A RESULT
THE AUDITOR INCLUDED A
RECOMMENDATION THAT EACH CS
UPDATER PNA REQUIREMENTS- SO
THE AUDITOR'S FINDINGS ACTUALLY
COMPARE WITH A C. PENS OWN
FOCUS GROUP FINDINGS THIS YEAR
WE FOUND THAT. CONSUMERS EVEN
IF. THEY HAVE HEALTH COVERAGE.
AND THE OFTEN UP STORIES. IN
ACCESSING ARMED SERVICES.
ESPECIALLY IN TERMS OF- YOU
KNOW ACCESS TO LANGUAGE
INTERPRETATION SO WHERE WHERE
THAT DH CS HAS TAKEN STOPS. TO
STRENGTHEN THE PNA REQUIREMENTS
AND WE- SINK THE DH CS STAFF
FOR HER WORK AND THIS IS A YOU
KNOW IMPORTANT FOR STOP HELLO
WE AGREE WITH THE PARTIAL-
COMPLIANCE THAT. THE AUDITOR
HAS FOUND SO- WE'RE CUTTING.
DIE YOU KNOW DH CS. THAT YEAR
OVER YEAR TARGETS FOR MANAGED
CARE PLANS. THANK YOU YEAH
THANK YOU SO MUCH. CAN THIRD
YOU CAN TURN THAT INTO WRITING
ALSO THANK YOU. ALSO CHAIR TONY
TRIGGER ON BEHALF OF THE
CALIFORNIA. THE BRAVE WITH
BREVITY I JUST WANT TO ALIGN
MARKS WITH THE REPRESENTATIVE
FROM THE ATTRITION SO WE WANT
TO THANK BOTH THE CHAIR OF THE
SENATE AND ASSEMBLY HEALTH FOR
THE HEARING IN THEIR WORK ON
THIS. IMPORTANT ISSUE AND C. T.
MEANS COMMITTED TO INCREASE
PREVENTIVE CARE FOR CHILDREN
AND THE ROLE THAT SCHOOLS PLAY
WITH BOTH FOR YEARS AND PLANS
IN DELIVERING THOSE SERVICES SO
WE HOPE WE CAN BE OF ASSISTANCE
GOING FORWARD THANK YOU. THANK
YOU THANK YOU SO MUCH WELCOME.
GOOD AFTERNOON JUST AROUND OF
THE CHILDREN'S PARTNERSHIP. I
WOULD GREATLY APPRECIATE THE
COMMITTEES CONTINUED ATTENTION
TO THE AUDITOR'S REPORT ON MEDI
CAL CHILDREN'S HEALTH IMPROVING
MY CALLS PRIMARY CARE FOR KIDS
IS A NECESSARY STEP IN
ADDRESSING HEALTH DISPARITIES.
THIS IS IMPORTANT MORE
IMPORTANT THAN EVER SINCE
CHILDREN ARE FACING. CHARGES IN
CALIFORNIA WITH WHEN INTO
CHILDREN COMING FROM AN
IMMIGRANT FAMILY. BECAUSE OF
THE STOMACH PAIN THAT I OWE MY
PRESENT HIS OFFICE MIGHT BE I'M
DEAR TOXIC STRESS TO THE NOT
KNOWING IF THE PARENT IS GOING
TO START FROM SCHOOL ARE GONNA
BE DETAINED OR DEPORTED IN THE
MEANTIME. ENSURING THAT OUR
SYSTEM. THE MOST VULNERABLE
CHILDREN WE NEED MEDI CAL
MANAGED CARE PLANS TO STEP UP.
FAMILIES IN THEIR PROVIDERS
WHERE IS THE SERVICE IS
AVAILABLE TO THEM AND CONNECT.
TO THAT CARE THAT IS A FULL. AS
SELECT. ANTI TO APPRECIATE
YEARS IN THE MEDICAL CHILDREN
SUCH AS ACES AND DEVELOPMENTAL
SCREENING SCREENINGS IT IS THE
NEXT STEP THE REFERRAL TO THE
NEEDED SUPPORT THAT IS THE
ULTIMATE PURPOSE OF IDENTIFYING
RECEIVED THIS READINGS THE CAL
IN PACKAGE HAS AMBITIOUSAND
BOLD REFORMS HOWEVER CHILDREN'S
PRIMARY CARE DOES NOT SEEM TO
BE ONE OF THE REFORM AREAS OF
FOCUS WE LIKE TO REITERATE THAT
WE NEED TO FULLY IMPLEMENT EPS
D. T. AND WELCOME FOR THE
CONVERSATION AND- POLICY
VESTMENTS THANK YOU. THANK YOU.
WELCOME AND MICHELLE GIVEN THE
HELP EXECUTIVE ASSOCIATION OF
CALIFORNIA FIRST AND FOREMOST.
YOU FOR THE CONVERSATION THE
DISCUSSION THAT HAPPENED HERE
TODAY ON TWO VERY IMPORTANT
ISSUES- IN REGARDS TO THE
DISCUSSION AROUND THE REGIONAL
MODELED AT ANI'S WHICH- ARE
REALLY THANKFUL FOR THE
OPENNESS THAT. THE DEPARTMENT
EXPRESSED TODAY IN TERMS IN
TERMS OF BEING IN CONTINUING
CONVERT WITH COUNTIES. IT
DOCTOR MILLER HAD STATED OVER
EARLIER THIS IS A CONVERSATION
THAT WE'VE BEEN TRYING TO HAVE
OVER THE COURSE OF THE LAST
THREE PLUS YEARS- AND I THINK
WHAT COUNTIES WOULD LIKE TO SEE
AT THIS POINT IS I'M REGULAR AN
ONGOING DISCUSSION ABOUT. WHAT
THE STEP FORWARD COULD BE. AND
CHECK ALSO COMMITTED TO
ASSISTING IN THAT PROCESS AND
ASSISTING IN THE PROCESS OF
CONTINUING DISCUSSIONS WITH
THEIR CURRENT PLANS BECAUSE
THINGS DO WE CAN'T WAIT DESPITE
WHATEVER HAPPENS- IN TOTAL.
TWENTY THREE TWENTY TWENTY FOUR
FOR THINGS TO IMPROVE AND SO WE
ARE OPEN TO BUILDING THAT
COMMUNICATION WITH THE HEALTH
PLANS IN THE COUNTIES TOGETHER
SO WHATEVER WE CAN DO TO ASSIST
IN THAT AREA WHERE WE'RE
PLEASED TO DO THAT. THE ONLY
THING I SINCE THE CD SHUTDOWNS
WHERE WERE MET. EARLY THAT I.
CONVENING HEALTH. RECTOR I TO
DO SO. OVER THE COURSE OF THE
LAST COUPLE WEEKS AND WE'RE-
REALLY INTERESTING TO. ISSUES
THAT HAVE COME UP. THAT I
THINK- OVER THE COURSE OF THEIR
COUNTY COLLEAGUES AND WITH THE
ADMINISTRATION THAT WE CAN
REALLY. THINK ABOUT TROUBLE
SHOOTING FOR THE FUTURE AND
SET. OUT WE APPRECIATE THE
ENGAGEMENT THAT THE
ADMINISTRATION IT HAD A- ISSUE
THEY HAVE BEEN VERY HELPFUL AND
WE LOOK FORWARD TO CONTINUING
HOW WE CAN IMPROVE FOR THE
FUTURE. THANK YOU. OKAY THANK
YOU. IN THE CLOSING REMARKS.
JUST OF PERSONAL THANK YOU TO
EVERYONE WHO WHO CAME TODAY I
DO APOLOGIZE FOR BEING LATE-
THE ONE OF THE REASONS
OBVIOUSLY I THINK THE CHAIR
PROBABLY MENTION THAT- WE HAD
MEETINGS RELATED TO THE FIRES
BUT A PARTICULAR OF INTEREST TO
ME WAS AROUND- SOME WORKFORCE
AND SPECIFICALLY SOME OF OUR
MOST VULNERABLE PEOPLE IN OUR
COMMUNITY MANY OF WHOM HAVE
CHILDREN. AND SO I HAVE A VERY
BIG IS BECAUSE IF YOU WHAT THAT
POTENTIALLY FOR A LOT SEND
THEIR ACCESS TO OF CARE- WE
DON'T KNOW WHAT THE FUTURE
HOLDS SOME WE HAVE LESSONS
WE'VE LEARNED FROM TWO THOUSAND
SEVENTEEN ON A VARIETY OF
THINGS WHAT'S DIFFERENT ABOUT
THIS PARTICULAR- INCIDENT
WHAT'S THAT HAD A FIRE THE
PERFECT SMALL. PORTION THE
COMMUNITY BUT WE HAD. YES PETE.
EVACUATED A HUNDRED AND EIGHTY
EIGHT THOUSAND PEOPLE FROM OUR
CAT THE FIRE BUT THE ENTIRE
COUNTY WAS AFFECTED BY THE P.
S. P. S. AS WELL. AND THAT
WHICH IS ONE OF THE CAT IS A
REPRESENT. MY FOR MY CONCERN
WILL BE LONG TERM. AREAS
BECAUSE WE HAVE WE HAVE
FLOODING A PART OF MY DISTRICT
LAST YEAR WE'VE NOW HAD ANOTHER
FIRE EVENT WE HAD TWO THOUSAND
AND SEVENTEEN- FIRES SO I'VE MY
CONCERN OVER THE LONG HAUL IS
IN AREAS THAT HAVE SPECIFIC
DISASTERS WHAT IS THAT DO WHAT
WHAT TO HOW DOES THAT CHANGE
THE SNAPSHOT OF X. KIDS GOOD
GET PREVENTIVE SERVICES. AND
WHAT OF THE- PUBLIC. COMES OF
THAT. AS WE OPPOSITE. QUITE
FRANKLY AS WELL THANK YOU
THANKS AND THANKS FOR YOUR
PATIENCE CHECK. AND OUT ALSO
WANT TO THANK EVERYONE FOR YOUR
PARTICIPATION THIS HEARING WITH
THINK- CHAIR WAS FOR HIS
LEADERSHIP AND NOT WORKING WITH
THE- MEDIAN OF ARRANGING AND
ORGANIZING THIS YEAR THANK THE
OTHER- SO MUCH FOR YOUR WORK IN
THE TWO OUT REPORTS- THAT-
HIGHLIGHTS A VERY IMPORTANT
ISSUES WE NEED. TO US AND TO
IMPROVE. GRAHAM THAT AGAIN
THERE'S A THIRD. AND HALF OF
ALL CHILDREN. I WANT TO THANK
THE PART HEALTH CARE SERVICES
FOR BEING HERE AND THE WORK
THAT YOU'RE DOING A LOOK THE
FOLLOWING THERE'S A LOT OF
FOLLOW UPS- THAT CAME UP THAT
WE LOOK FORWARD TO FOLLOWING UP
AS I MENTIONED EARLIER. WE ARE
PLAYING DO AND THE OTHER
OVERSIGHT HEARING LOOKING AT
THE MANAGED CARE CONTRACTS AS
YOU'RE GOING FORWARD. AND THAT
REGARDS AS WELL I WANNA THANK
ALL THE WITNESSES AS WELL FOR
TRAVELING AND SPEAKING AND-
PRESENTING AS WELL YOUR TIME
BUDDY SO EXTREMELY IMPORTANT
FOR US AND- OUR- OVERSIGHT. OF
MEDICARE PROGRAM AS WELL SO
AGAIN. ALTHOUGH THIS IS A CAME
TO TESTIFY IN IN I THINK
EVERYONE WHO CAME TO LISTEN TO
THIS HEARING IS. A LOT OF WORK
TO DO. IT'S A VERY IMPORTANT
PROGRAM THAT IS DOING A LOT OF
GOOD FOR A LOT OF PEOPLE BUT
CAN DO BETTER AND- SO THAT'S
WHY WE'RE COMMITTED TO DOING.
AND WITH THAT. IF THERE'S NO
THE FOR THE REMARKS- THIS
INFORMATIONAL HEARING OF THE-
SENATE HEALTH AND ASSEMBLY
HEALTH COMMITTEE. ACCESS TO
CARE AND REGIONAL MODEL CHILLS
PREVENTIVE HEALTH SERVICES
ALGER THANK YOU