INFORMATIONAL HEARING OF BOTH
THE SUCH A BUT SENATE BUDGET
FISCAL REVIEW COMMITTEE.
SUBCOMMITTEE NUMBER THREE ON
HEALTH AND HUMAN SERVICES IN
THE SENATE HEALTH COMMITTEE- ON
THIS HEARING ON OVER MEDI CAL
OVERSIGHT IS A MANAGED CARE
PLAN RESPONSIBILITIES AND THE I
THINK IT'S HOW LAME AGAIN- CAL
AIM PROPOSAL GOVERNOR SAID CAL
AIM IN THE STATE TO STATE
ADDRESS ONLY AS A CAL AIM. SO
WELCOME EVERYONE HERE TODAY- WE
ARE GOING TO BE- COVERING QUITE
A BIT OF GROUND HERE TODAY- IN
THIS HEARING. AND SOMEWHAT
THANK EVERYONE FOR BEING HERE
TODAY. OKAY SO- YOU KNOW- YOU
KNOW MEDI CAL IS A- PROGRAM
THAT COVERS- PRESS MAY THIRD OF
ALL CALIFORNIANS AS A
PEDIATRICIAN AND COVERS HALF OF
KIDS- SO CERTAINLY OF EXTREMELY
IMPORTANT PLAYER IN PROVIDING
AND THE LIVING HEALTH CARE TO-
CALIFORNIANS MEDI CAL MANAGED
CARE PLANS RESPONSIBLE FOR
DELIVERING HEALTH CARE TO TEN
AND A HALF MILLION CALIFORNIANS.
NOW THREE YEARS AGO- THE THIS-
SENATE BUDGET SUBCOMMITTEE ON
HEALTH HUMAN SERVICES HELD AN
INFORMATIONAL HEARING TO
EXAMINE HOW THE CAR HEALTH CARE
SERVICES CONDUCTS RATE SETTING
AND INSURERS NETWORK ADEQUACY
FOR MEDI CAL MANAGED CARE
PLANS. TO ENSURE THAT WE
ACHIEVED THE LEVEL ACCESS- FOR
ALL MEDI CAL BENEFICIARIES-
SINCE THAT TIME WHILE IT'S
CERTAINLY WE HAD SOME VERY
FRUITFUL DISCUSSIONS- WE STILL.
HAVE ACCESS AND QUALITY ISSUES-
THEIR CONTINUES PERSISTS IN
FACT LAST FALL AND TWENTY
NINETEEN- THE SENATE HEALTH
COMMITTEE HELD A JOINT HEARING
WITH THE ASSEMBLY ON TO STATE
AUDITOR REPORTS THAT OUTLINED I
CONTINUE CHALLENGES- BASICALLY
THOSE ARE TO REPORTS- POINTED
OUT THAT- TOO MANY CHILDREN-
WE'RE STILL NOT GETTING THEIR-
REGULAR CHECKUPS- IN FACT. AS
MANY AS HALF A YOU SEE DEPENDS
ON WHICH VISIT SOMETIMES EVEN
MORE AND HALF NOT GET THEIR-
REGULAR- HEALTH SUPERVISION
VISITS AND THEN IN RURAL
COMMUNITIES WHERE- THE PEOPLE
WERE EXPECTED TO EITHER
TRAVELOGUE DISTANCE OR HAVE
CHALLENGES GETTING PARTICULARLY
SPECIALTY CARE. TO HEARING
FOLLOW UP ON BOTH OF THESE
HEARINGS AND- BEGIN DISCUSS
DURING THE CAL AIM PROPOSAL-
THE FIRST HALF THE HEARING IS
GOING TO ADDRESS- THE MANAGED
CARE RATE SETTING AND IT WORK
ATTIC SEEING QUALITY CARE
ISSUES- FOLLOWED BY AN
EXAMINATION OF THE- NEW. MY
RESPONSIBILITIES AND MEDICARE
PLANS WILL BE EXPECTED TO TAKE
UNDER- THE CAL AIM PROGRAM AS
WELL. CERTAINLY WE WILL ENSURE
THAT ALL CALIFORNIANS IN
PARTICULARLY I'M MOST
VULNERABLE WHO ARE IN THE
MEDICARE PROGRAM DESERVE TO GET
THE HEALTHCARE THEY NEED
WITHOUT HAVING TO TRAVEL MILES
AWAY OR WAIT WEEKS FOR THE
CARE. WE NEED TO MAKE SURE THAT
THE PART HEALTHCARE SERVICES-
PROVIDES PLANS WITH THE
RESOURCES. TO DELIVER THE
SERVICES AND WHETHER THEY ARE
FIRST SERVICES ARE NEW ONES AND
ALSO ENSURE THAT THE PLANS ARE
WORKING WITH- THE- PEOPLE
ACTUALLY DELIVERING THE CARE
THE PROVIDERS THE HOSPITALS THE
PHYSICIANS THE OTHER HEALTH
PROFESSIONALS. ON THE FRONT
LINES AND THEN ULTIMATELY OF
COURSE THE BENEFICIARIES AND WE
DO NEED TO HOLD PLANS
ACCOUNTABLE WHEN THEY DON'T
MEET THE NEEDS THAT THEY
FISHERIES AND WE NEED TO HOLD
THE PART HEALTHCARE SERVICES
ACCOUNTABLE. A PARTICULAR WHEN
DOES MEETS NEEDS ARE NOT MET.
SO WITH THAT- WE'RE VERY-
DECIDED TO- HEAD TO WELCOME THE
NEW DIRECTOR OF THE DEPARTMENT
HEALTH CARE SERVICES- DR
BRADLEY GILBERT. AND ALSO TO
WELCOME G. C. COOPER THE STATE
MEDICAID DIRECTOR- AND CHIEF
DEPUTY DIRECTOR OF HEALTH CARE
PROGRAMS FOR THE PART HEALTH
SERVICE ASK YOU TO COME UP. TO
OPEN UP THEIR FIRST PART ONE OF
OUR HEARING ON OVERSIGHT OF
FOCUSING ON THE OVERSIGHT OF
MEDICARE MANAGED CARE
RESETTING. BUT SAFETY NETWORK
OUT OF IN COLLEGE. CARE.
WELCOME THANK YOU SO VERY MUCH
FOR BEING AT LOOKING FOR TO
HEARING YOUR REMARK IN THEM
SURE. YOU I ALONE WILL HAVE
MEDICAL. THANK YOU. SO I JUST
HAVE SOME BRIEF OPENING REMARKS
DOCTOR PAN MEMBERS OF THE
COMMITTEE. I THINK IT'S BEEN A
LITTLE WHILE SINCE YOU'VE HAD A
POSITION AS THE DIRECTOR OF
DEPARTMENT HEALTH CARE SERVICES
I DO WANT TO POINT OUT THIS IS
JUST A TWO POINT SIX FOR ME. SO
I'M JUST STARTING I AM VERY
EXCITED. AND I HAVE I THINK IN
SOME WAYS SOME UNIQUE
EXPERIENCES THAT WILL REALLY
HELP ME IN THE JOB. I HAVE BEEN
A PHYSICIAN FOR MANY YEARS I'VE
WORKED IN JAIL SYSTEMS WORKED
IN A METHADONE CLINIC. I'VE
WORKED IN COUNTY CLINICS DURING
PRIMARY CARE SOLD SO MOST OF
MY- DOCTOR PAN MOST OF MY-
THERE IS A PHYSICIAN HAS BEEN
FOR VULNERABLE POPULATIONS OF
INDIVIDUALS REALLY AT RISK I'VE
ALSO BEEN A PUBLIC HEALTH
OFFICER IN TWO COUNTIES WHICH I
THINK IS A LITTLE DIFFERENT- SO
I REALLY UNDERSTAND PUBLIC
HEALTH AND POPULATION HEALTH
MANAGEMENT ALL OF THOSE PIECES.
AND THEN FINALLY AS YOU KNOW I
WAS THE CHIEF MEDICAL OFFICER
EVENTUALLY THE CEO OF A PRETTY
LARGE HEALTH PLAN. THAT DELIVER
CARE TO MEDICARE BENEFICIARIES
MEDICAL MEMBERS- AND
INDIVIDUALS ARE DULY ELIGIBLE.
I HAVE A RELENTLESS FOCUS ON
TAKING CARE OF THE INDIVIDUALS
THAT ARE PART OF THE TWELVE
POINT NINE MILLION AND- TEN
POINT FIVE MILLION THAT ARE
AND- MEDI CAL THAT. HAS BEEN MY
FOCUS MY ENTIRE CAREER AND WILL
CONTINUE IN THIS JOB. WE'VE GOT
A SUPPORT THE PROVIDERS THE
ONES ACTUALLY TAKING CARE OF
THE MEMBERS IN THE
BENEFICIARIES AND I'VE ALWAYS
BEEN REALLY CLEAR ABOUT THAT
AND- YOU KNOW HAVE. REALLY BEEN
BLESSED WITH GREAT
RELATIONSHIPS WITH PROVIDERS
AND PHYSICIANS THROUGH MY
CAREER. WE'VE GOT A SUPPORT
EVERYBODY RUNS FOR THE COUNTIES
A PROVIDE CARE KIND OF SPORT
FEDERALLY QUALIFIED HEALTH
CENTERS GOING TO SUPPORT THE
PRIVATE PROVIDERS MANY PRIVATE
PROVIDERS OF PROVIDE CARE. TO
WE'VE GOT TO REALLY MAKE SURE
WERE YOU KNOW ATTUNED TO AND
LISTENING TO THE VARIOUS
PROVIDERS TYPES OF PROVIDERS TO
PROVIDE CARE FOR. FOR THOSE
TWELVE POINT NINE MILLION
PEOPLE I ALSO KNOW HEALTH PLANS
SO I LAUGHED WHEN I TALKED TO
THE HEALTH PLANS ARE VERY
EXCITED FOR ME TO BE IN THIS
POSITION BECAUSE I SAID WELL
THE GOOD NEWS IS. I KNOW HEALTH
PLAN THE BAD NEWS IS THAT I
KNOW HEALTH PLANS AND I KNOW
WHAT THEY'RE CAPABLE OF AND
WHAT CAN BE DONE AND- THAT I
THINK CAN CAN REALLY HELP TO
WORK WITH THEM TO GET THE
THINGS DONE THAT WE NEED TO GET
DONE. I AM VERY EXCITED ABOUT
CAL AND WHEN I SAW THE PROPOSAL
COME OUT WHEN I WAS STILL WITH-
HELP WHEN I WAS PREVIOUSLY WITH.
I THOUGHT IT WAS ACTUALLY
PRETTY BOLD- AND I THINK
THERE'S SOME REAL POTENTIAL
THERE TO MAKE A DIFFERENCE FOR
PEOPLE WHICH IS. WHICH IS
REALLY THE WHOLE POINT OF WHY
WE'RE HERE. BUT THERE IS A LOT
OF WORK TO DO. AS A LOT OF WORK
TO DO ON THE DEPARTMENT SIDE
THERE'S A LOT OF WORK TO DO AND
HEALTH PLAN SIDE. TO REALLY
MAKE SURE WE DELIVER THE
PROMISE THAT. THAT HAS BEEN YOU
KNOW PRESENTED BY THE
DEPARTMENT YOU KNOW THOSE THE
SECRETARY IN THE GOVERNOR. SO I
AM I AM REALLY. TO DO THE JOB
FOR TODAY SINCE IS DAY TWO
POINT SIX SEVEN OF JC DO MOST
OF THE- BUT I WILL JUMP IN FROM
TIME TO TIME WHEN I THINK IT'S
HEALTH. FOR REALLY OF J. TO THE
PRESENTE. SO THAT YOU KNOW YOU
GET THE LEVEL OF DETAIL YOU
NEED. TO THANK YOU. YES THANK
YOU GOOD MORNING. SO MY
COMMENTS ARE DONE REALLY GOING
TO FOCUS AROUND TWO MAIN AREAS
FOR THIS OPENING AND THEN-
DISCUSSION WILL FOCUS ON.
OVERSIGHT MONITORING AND THEN
THE PROCUREMENT PROCESS
SPECIFICALLY- SO DCS USES A
VARIETY OF WAYS TO OVERSIGHT-
ARE TO PROVIDE OVERSIGHT
MONITORING TOWARD MANAGED CARE
PLANS INCLUDING NETWORK
ADEQUACY. QUALITY MONITORING.
ANNUAL AUDITS AND- EVALUATIONS
OF. VARIOUS REPORTS APPEALS
GRIEVANCES STATE PLAN HEARINGS.
FOR NETWORK ADEQUACY
SPECIFICALLY- WE DO HAVE A
PRETTY ROBUST MONITORING
PROCESS WHICH INCLUDES AN
ANNUAL AND- NETWORK
CERTIFICATION PROCESS. WHICH
INCLUDES BOTH TIME AND DISTANCE
A PRIMARY CARE AND SPECIALTY-
SEPARATED BY. PEDIATRICS AND
ADULTS. ON IT INCLUDES PRIMARY
CARE AND PHYSICIAN RATIOS- AS
WELL AS VALIDATION. OF THE
MANDATORY PROVIDER TYPES LIKE
FQHCS OR BIRTHING CENTERS- WE
ALSO HAVE AN- ANNUAL TIMELY.
ACCESS STUDY FOR BOTH PRIMARY
AND SPECIALTY CARE APPOINTMENTS
FOR BOTH URGENT AND NON. URGENT
AS WELL AS A DAHLE IN
PEDIATRIC- VISITS- WE DO DO
OUTBOUND CALLS. ON THROUGH OUR
EACH YOU ARE- AND THEN WE
PROVIDE MANAGED CARE PLANS A
QUARTERLY REPORT. OF THOSE
OUTCOMES. SO IF THEY ARE SEEN
DEFICIENCIES IN REGARDS TO
TIMELY. ACCESS IMMEDIATELY
RESPOND TO THOSE DEFICIENCIES.
REACH OUT TO THOSE PROVIDERS TO
ENSURE THAT THEY ARE GETTING
APPROPRIATE ACCESS TO THOSE.
SERVICES THE DEPARTMENT ALSO
HAS BEEN LOOKING AT. OUR
ALTERNATIVE ACCESS STANDARD
PROCESS. AND WE DO KNOW THAT WE
HAVE HAD IN THE PAST A LARGE
NUMBER OF ALTERNATE ACCESS
STANDARDS WITHIN THE DEPARTMENT
WE HAVE SEEN THIS DECLINE. YEAR
AFTER YEAR- AND WE ARE THINKING
WITH THE IMPLEMENTATION OF. AB
SIXTEEN FORTY TWO WE WILL ALSO
SEE SOME ADDITIONAL SCRUTINY.
ON THE ALTERNATE ACCESS
STANDARDS THAT WILL COME FOR TO
THE DEPARTMENT- THERE ARE A FEW
OTHER THINGS WERE DOING IN THIS
AREA. WE WOULD LIKE TO MAKE
SURE THAT YOU'RE AWARE OF. THE
DEPARTMENT WILL BE CLEAR FINING
IN ARE ALL PLAN LETTER MOST.
LIKELY WILL GO OUT TODAY OR
TOMORROW. AND THAT WE WILL BE
LOOKING AT. AND DISTANCE. WHEN
IT COMES TO. YOUR MEANT. I I'M
NO LONGER TIME OR DISK. I'M TO
ENSURE THAT INTO. ARE HOW A PRO
ACCESS TO THIS WILL BE CLEAR.
IN A ALL PLAN LETTER WE HAVE
BEEN WORK WITH CMS IN REGARDS
TO COMPLIANCE WITH THIS
PARTICULAR PIECE- AND THAT WILL
BE PUSHED OUT AND EVALUATED TO
THIS NEXT ANNUAL CERTIFICATION
PROCESS. ADDITIONALLY YOU'LL
SEE THAT BUT BEGINNING IN
JANUARY. OF STARTED JULY OF
TWENTY TWENTY ONE THE
DEPARTMENT WILL REQUIRE THAT
MANAGED CARE PLANS TO CERTIFY
THEIR DELEGATED NETWORKS- SO IN
ORDER TO ENSURE THAT IF THEY
HAVE DELEGATED NETWORK. THAT
THEY ARE MEETING THE SAME
NETWORK ADEQUACY STANDARDS THAT
THE DEPARTMENT HAS PUT ON THE
PRIME PLAN OR THE MAIN
CONTRACTED PLAN. IT WILL BE THE
PLANS RESPONSIBILITY TO DO THAT
CERTIFICATION AND FILE IT WITH
THE DEPARTMENT. AND THEN WE
WILL DO RANDOM AUDITS ON THE
CERTIFICATION SO THAT'S FOR
JULY OF TWENTY TWENTY ONE. ON
THE PLANS ARE REQUIRED IN MARCH
OF TWENTY TWENTY. TWENTY TWENTY
ONE TO SUBMIT A PLAN OF ACTION
TO US TO THE DEPARTMENT. WE
ALSO DO YOU POST ALL OF OUR-
ANNUAL CERTIFICATIONS ON OUR
WEBSITE SO IT IS PUBLICLY
AVAILABLE FOR EVERYBODY- TO SEE
WHAT- IS THE RESULT OF THE
CERTIFICATION PROCESS THESE.
AND OF COURSE WHEN NECESSARY DO
YOU MOVE INTO CORRECTIVE ACTION
PLAN WITH OUR MANAGED CARE
PLANS IF THEY ARE NOT MEETING
THE EXPECTATIONS OF THE
DEPARTMENT IN REGARDS TO-
ACCESS TO APPROPRIATE SERVICES.
ON THE QUALITY SIDE ON THE
DEPARTMENT HAS ALSO MADE SOME
NOTABLE CHANGES IN THE LAST
YEAR- WE HAVE INCREASED- OR
CHANGED OR ARE MEASURES THAT WE
ARE NOW INCLUDING ALL- AT THE
CMS COURSE THAT MEASURES FOR
BOTH CHILDREN AND ADULTS. WE
ALSO HAVE CHANGED OUR MINIMUM
PERFORMANCE LEVEL- FOR
PERFORMANCE FROM 25% TO THE
NATIONAL AVERAGE OF FIFTY
PERCENT. SO YOU SEE THESE
THINGS IN REGARDS TO WHAT WE
CURRENTLY BEEN DOING LOOK AT
NETWORK ADEQUACY WE ARE LOOKING
AT QUALITY WE'VE WE'VE RAISED
THE BAR ANY GUARDS RIGHT
EXPECTATIONS OF OUR MANAGED
CARE PLANS IN THE LAST YEAR.
REALLY HEARING THE FEEDBACK
THAT WE RECEIVED IN REGARDS TO
BETTER OVERSIGHT WITH OUR
MANAGED CARE PLANS AND HOW WE
CAN PUSH THE NEEDLE TO MAKE
SURE PEOPLE ARE GETTING ACCESS
TO SERVICES. I THINK THE NEXT
BIG HING THAT WE LOOK TO AS AN
OPPORTUNITY- IS THE PROCUREMENT
IN FRONT OF US SO THE
DEPARTMENT IS EMBARKING ON. A
MANAGED CARE PLAN PROCUREMENT-
OTHER COMMERCIAL PLANS IN
THIRTY SIX COUNTIES- ON THIS IS
THE FIRST SHERMAN THAT WE HAVE.
GONE THROUGH VERY TIME
CALIFORNIA. AND SO. IN THAT
PROCUREMENT WE'RE GOING BE
LOOKING FOR A NUMBER O THINGS
WE'RE GONNA BE LOOKING FOR A
HISTORY WRITING. WE WANT PLAN
THAT WOULD BE A TO CONTINUE
PROVIDE. HIGH QUALITY CARE AND
IMPROVE THE QUALITY ACROSS THE
STATE OF CALIFORNIA. WE ALSO
WILL BE LOOKING FOR PLANS YOU
CAN ENSURE THAT THEY CAN
PROVIDE AN ADEQUATE NETWORK I'M
TO MEET THE NEEDS OF OUR
BENEFICIARIES. WE WILL FOCUS ON
PREVENTIVE SERVICES IN EARLY
INTERVENTION THAT IS GOING TO
BE VERY IMPORTANT TO US TO MAKE
SURE THAT PEOPLE HAVE A
COMPREHENSIVE PLAN OF MAKING
SURE. ON THE CAN PROVIDE THE
PREVENTIVE SERVICES TO OUR
BENEFICIARIES WE WILL BE
LOOKING AT REDUCING DISPARITIES
ACROSS OUR PROGRAM IN ENSURING
THAT THEY HAVE MECHANISMS TO
IDENTIFY AND REDUCE
DISPARITIES. WE WILL BE LOOKING
FOR COMPETENCIES AND CARE
COORDINATION CASE MANAGEMENT
COMPLEX CASE MANAGEMENT AND OF
COURSE. UNDER CALLIN ENHANCE
CARE MANAGEMENT WILL BE A CORE
FOCUS AS WELL. AS WELL AS-
LOOKING AT THE OPPORTUNITIES
WITH THE STATE'S IN LIEU OF
PACKAGE WILL BE REALLY
IMPORTANT TO THIS PROCUREMENT
PROCESS. AND ALL OF THE CAL IN
THE DIRECTIVES IN GENERAL- WE
ALSO WILL BE LOOKING AT PLANTS
WERE WILLING TO ADVANCE
BEHAVIORAL HEALTH INTEGRATION
THAT IS VERY IMPORTANT TO THE
DEPARTMENT YOU THINK IT'S
CRITICAL ACCESS FOR
BENEFICIARIES TO HAVE ACCESS TO
THOSE PIECES. AS WELL AS LOCAL
PRESENCE IN ENGAGEMENT MAKING
SURE THAT THEY HAVE A LOCAL
PRESENCE IN ENGAGEMENT WITH. ON
THE LOCAL ENTITIES TO MAKE SURE
WE ARE FOCUSED ON THE RIGHT
PIECES. SO GIVEN THIS HE
DEPARTMENT WILL BE POSTING
ACTUALLY ON OUR WEBSITE- EITHER
TODAY OR TOMORROW AN UPDATED
PROCUREMENT TIME PERIOD. I
THINK WE'VE HAD A LOT OF
CONVERSATIONS WITH PEOPLE AND
WE WANT TO MAKE SURE THAT WE
ARE GOING THROUGH A
TRANSPARENT. PROCESS THAT
ALLOWS FOR FEEDBACK AS WELL.
WE'RE GONNA PUSH OUR TIMELINE
SLIGHTLY JUST TO ALLOW FOR- A
FEEDBACK LOOP. ON SO MANY GO
OVER SOME TIME LINES TODAY AND
THEN YOU'LL SEE UPDATED
TIMELINES HAD OUR WEBSITE-
SOMETIME THIS WEEK- SO IN APRIL
OF THE- YEAR THE DEPARTMENT
WILL CONDUCT A STAKEHOLDER
WEAPON ARE- IN REQUESTS NIZHAL
FEEDBACK OTHER PROCUREMENT
ITSELF- AREAS WHERE WE CAN GET
FEEDBACK WHERE PEOPLE THINK WE
SHOULD REALLY FOCUS CHANGES
THEY THINK WE- TO. ZERO IN ON
AS WELL AS THINGS THEY THINK WE
SHOULD BE VALUE WAITING THROUGH
THIS PROCESS. THERE WILL BE A
THIRTY DAY KIND OF COMMENT
PERIOD THAT WOULD BE OPEN FOR
US TO. TAKE THAT FEEDBACK AND
FOR IN TUNE PROCUREMENT AND
THEN AT THAT POINT THE
DEPARTMENT WOULD RELEASE AT THE
END OF THE YEAR BY DECEMBER OF
TWENTY TWENTY. A DRAFT R. F. P.
ON THE IT IS COMMON PRACTICE TO
RELEASE DRAFT ARE PEAS AND RE
RECEIVED COMMENTS- AND THAT
WILL GIVE. PEOPLE AN IDEA OF
THE COMMENTS THAT WE RECEIVED
WHAT WAS INCORPORATED INTO THE
R. P. INTO THE PROCUREMENT
PROCESS THEY WOULD HAVE ANOTHER
THIRTY DAY COMMENT PERIOD FOR
THAT. WE REALLY THINK THE
COMBINATION OF THOSE TWO PIECES
WOULD ALLOW US TO HAVE. SOME
I'M ROBUST CONVERSATIONS AND
STAKEHOLDER ENGAGEMENT BUT OPEN
CONVERSATIONS ABOUT WHAT'S
NECESSARY IN REGARDS TO THAT.
THEN WE WOULD RELEASE. THE
FINAL ARE FEWER SEEMING
SOMETIME IN JUNE. OF TWENTY
TWENTY ONE. PROPOSALS WOULD BE
DUE IN AUGUST OF TWENTY TWENTY
ONE WITH HE HOPES OF ISSUING
AND NOTICES OF INTENT. BY THE
END OF JANUARY TWENTIETH-
STARTED THE END OF- TWENTY
TWENTY ONE DECEMBER TWENTY
TWENTY ONE. SO WE SAY THOSE
THINGS BECAUSE- WE WANTED TO
MAKE SURE WE ARE COMING WITH
UPDATES IN WHAT WE HAVE DONE IN
REGARDS TO MOVING THE NEEDLE
AROUND NETWORK ADEQUACY. AROUND
QUALITY MONITORING AND THEN A
COMMITMENT TO AS WE MOVE
FORWARD- OF SELECTING PLANS IN
THIRTY SIX COUNTIES ACROSS THE
STATE OF CALIFORNIA. GIVING YOU
AN IDEA OF WHAT WE'RE FOCUSED
ON- AND THE IMPORTANCE OF THAT
PROJECT AT PROCUREMENT. THE TO.
COMMENTS SEVEN ONE IS THE PLAN
CERTIFYING THEIR DELEGATED
NETWORKS IS ACTUALLY REALLY
IMPORTANT- IT'S A SIGNIFICANT
LIVE FOR THE PLANS AS A LOT OF
WORK TO THAT. BOARD INSURERS IS
THAT WHEN A MEMBER PICKS. AN
IPA OR PLAN THAT'S A SUB
CONTRACT TO THE PARENT PLAN.
THAT THERE IN FACT GETTING
ADEQUATE NETWORK BECAUSE ONE OF
THE ISSUESCOULD BE. YOU THINK
THAT YOU'RE JOINING THIS PLAN
WITH A CERTAIN NETWORK YOU JOIN
IPA AS PART OF THAT PLAN-
MEDICAL GROUP. AND SUDDENLY YOU
ACTUALLY DON'T HAVE ACCESS AS
MUCH AS YOU WOULD THINK SO
THAT'S- THAT'S PRETTY
SIGNIFICANT AND IS IT IS. YOU
KNOW A FAIR AMOUNT OF WORK FOR
THE PLANS BUT I THINK. IT
REALLY INSURERS A MEMBER THEN.
KNOWS YOU KNOW BASED ON THE
CERTIFICATION THAT THEY'RE
GETTING THAT THEY'RE GETTING A
RESULT OUR- THE SECOND ITEM IS.
THEM THE MINIMUM PERFORMANCE
LEVEL OF A FIFTIETH PERCENTILE
NATIONWIDE IS ACTUALLY PRETTY
SIGNIFICANT I MEAN FIFTIETH
PERCENTILE DOESN'T SOUND LIKE
THAT MUCH. BUT WHAT IT'S SAYING
IS THAT ACROSS THE ENTIRE
NATION LOOKING AT ALL THE
MEDICAID PLANS. THAT EVERY
SINGLE MEASURE THAT THE PLANS
ARE BEING MEASURE AGAINST.
THEY HAVE TO BE BETTER THAN THE
AVERAGE. AND SO I JUST WANNA
LET YOU KNOW YOU KNOW THERE
WILL BE FAILURES I MEAN THERE
WILL BE PEOPLE BELOW BECAUSE-
SO LAW OF AVERAGES FOR ONE
POINT- BUT PLUS IT'S ACTUALLY
PRETTY SIGNIFICANT BAR. I THINK
IT'S OKAY TO HAVE A HIGH BAR-
BECAUSE IT'LL PUSH PLANS TO YOU
KNOW. AND WHAT WOULD BE NICE IS
IF YOU KNOW YOU WE GET
CALIFORNIA UP THERE. SUDDENLY
WERE NOT LOWER THAN THE REST OF
THE COUNTRY. SO I JUST YOU KNOW
WANT TO MAKE SURE. THOSE TWO IN
PARTICULAR BUT MANY OTHER
THINGS THE JC MENTIONED ARE. A
PRETTY SIGNIFICANT. RIGHT THANK
YOU- SO I DO HAVE SOME
QUESTIONS THAT THEY YOU KNOW I
THANK YOU SO MUCH FOR YOUR
PRESENTATION SO FIRST OF ALL I
KNOW THAT. ONE OF THE MAJOR
ISSUES THAT CAME UP THREE YEARS
AGO WAS AROUND- OVERSIGHT FOR-
ESSENTIALLY THE DELEGATED MODEL
THE DELEGATED ENTITIES- EFFECT
I CARED A BILL LAST YEAR. WHICH
ROUGHLY THE GOVERNOR VETOED IT
BUT- HE DID INDICATE IN HIS
SIGNING THAT HIS VETO MESSAGE
THAT. HE DID NEED A LOT OF
DUTIES AND DO WITHOUT A LOT SO.
I'M FINE THAT IS ALL THE GETS
DONE SO I APPRECIATE THAT- YOU
ARE GOING TO ASK- THE- THE
PLANTS TO CERTIFY UNDER
DELEGATED NETWORKS BECAUSE WE
DO NEED TO HAVE OVERSIGHT OVER
THAT- I DID WANT. YES QUESTION
TERMS OF SO. THE SERVER. A
NETWORK- HOW HOW. SO MANY
THAT'S ON THE FRONT AND THING
RIGHT SO YOU APPLY- CERTIFY MY
NETWORKS GOOD WE KNOW THAT
THESE ARE DYNAMIC HER EIGHT- I.
T. A.'S CHANGED PEOPLE COME
INTERNET OUT AND SO FORTH- WELL
I CERTAINLY UNDERSTAND WE
DON'T. OVERLY BURDEN THE PLANS
OF LOTS OF ADMINISTRATIVE
REQUIREMENTS- THIS HOUSE
APARTMENT THINKING ABOUT. YOU
KNOW MONITORING ON AN ONGOING
BASIS THE- THESE DELEGATED
NETWORK SO ARE WE- THAT EVERY
DOWNEY CERTIFYING THEM UP FRONT
WHEN THEY FIRST START IS GOOD.
IS THERE SOME OTHER MECHANISMS-
THAT- EMPLOYED ENSURE THAT THE
STATE WITHIN THE STANDARDS THAT
YOU REQUIRE AND FORTUNE WE DID
HAVE. YEAH WE DID HAVE A COUPLE
CIRCUMSTANCES A FEW YEARS AGO
WHERE. SOME OF THE DELEGATED
ENTITIES- WERE NOT WHAT THEY-
SEEM TO. PRADA SO YEAH I STILL
OF SCORES. SO WOULD IT JUST BE
A ONE TIME CERTIFICATION THE
MANAGED CARE PLANS WOULD
ANNUALLY FROM THAT POINT
FORWARD DEFY ON THEIR THEIR
NETWORK ADEQUACY THE DELEGATED
ENTITIES AS WELL SO. THAT'S WHY
WE'RE GIVING THEM SOME TIME TO
BUILD THE INFRASTRUCTURE PUT IN
PLACE THE SAME MECHANISMS WE
HAVE TO ENSURE NETWORK ADEQUACY
WHICH IS WHY WON'T GO LIVE
UNTIL JULY TWENTY TWENTY ONE
BUT THEN THEY WOULD DO THAT
ANNUALLY. AND THEN THROUGHOUT
THE YEAR AS WE DO TODAY WE HAVE
A LARGE- MEDICAL GROUPS LEAVE
I'M IF IT'S A SET DATE
SUBSTANTIAL NUMBER WE HAVE
MECHANISMS FOR THE MANAGED CARE
PLANS ARE REQUIRED TO REPORT
THAT TO THE DEPARTMENT.
DEPENDING ON THE THRESHOLD WE
WILL REQUIRE NOTIFICATIONS AND
PROCESSES FOR TRANSITIONING
LIVES AND WE WORK VERY CLOSELY
WITH OUR MANAGED CARE PLANS ON
THAT IN IF THERE IS A CHANGE
THAT'S BIG ENOUGH. ON IT OVER A
CERTAIN THRESHOLD WE DO RE
EVALUATE NETWORK ADEQUACY
DURING THE YEAR WE WOULD BE
EXPECTING THAT SAME PROCESS OF
OUR MANAGED CARE PLANS ON THEIR
DELEGATED OKAY. ALL RIGHT SO
BASICALLY ANNUAL CERTIFICATION
WAS SURE HOW FREQUENT SO ANNUAL
CERTIFICATION PLUS NOTIFICAR
NOTIFICATION FOR LARGE. CHANGES
IN THE NETWORK OKAY. EIGHT AND
THEN THE OTHER. I DO APPRECIATE
THE FACT THAT YOU SAID THAT YOU
WE WANT ALL THE PLANS TO BE
ABOVE AVERAGE LIKE LIQUID LIKE
WILL BE GONE RIGHT SO THAT'S
THAT'S THAT'S A GREAT
EXPECTATION- APPRECIATE THAT I
KNOW THAT'S A HIGH BAR- SO I
APPRECIATE YOU RECOGNIZING THAT
TO- I GUESS THE QUESTION EIGHT-
JUST. REALIZING THAT THE WHAT
THE BAR IS AIDED BUT IS WHAT'S
THE CONSEQUENCE FOR NOT MEETING
AT SO- I THINK IN THE PAST-
SOMETIMES THERE'S BEEN SOME
FRUSTRATION AND RECOGNIZES A
HIGH BAR BUT- THAT. THE
RESPONSE A DIFFERENT AGENCY
WHAT WE MONITOR THINGS I SAID
WELL MONITORING IS GREAT BUT
THERE'S GOT TO BE SOME FLOOR
WHERE IF YOU DON'T PERFORM AT
THAT LEVEL SO WHETHER TO FIFTY
PERCENT. SHOULD BE THE FLOOR
NOT. THAT THAT THAT SOME
SIGNIFICANT CONSEQUENCES OCCUR
SO I MEAN I THINK ON ONE LEVEL
YOU KNOW WE- AT I DO LIKE THE
YOU GET A CHANCE TO IMPROVE.
BUT YOU KNOW HOW MANY CHANCES
YET BEFORE LIKE ALL RIGHT WELL.
YOU CAN THEN WE'RE NOT WORKING
OUT SO HOW DO YOU SEE TAT-
MOVING FORWARD IN TERMS OF
GOING BEYOND MONITORING AND
HAVING CONSEQUENCES FOR NOT
HITTING PERFORMANCE TARGETS- SO
WE- WE HAVE A VARIETY OF WAYS
IN WHICH WE DO THIS SO WE DO
HAVE A PROCESS WHERE IF YOU'RE
UNDER CERTAIN THRESHOLD YOU DO
UNDER A CORRECTIVE ACTION PLAN-
WHERE THE PLANS ARE REQUIRED TO
PUT TOGETHER ROBUST PLANS OF
HOW THEY'RE GOING TO MOVE THE
NEEDLE IN IN SEE IMPROVEMENTS.
THERE'S TARGETS THAT ARE
PUTTING THOSE CORRECTIVE ACTION
PLANS OVER MULTIPLE YEARS AND
IF THEY'RE NOT MOVING THEM WE
DO REINFORCE THINGS WE HAVE THE
OPTION TO SANCTION IF WE GO
THROUGH A CORRECTIVE ACTION
PLAN WE SEE CONTINUALLY OVER
TIME THAT THERE'S JUST NO
EFFORT BEING PUT IN. OFTENTIMES
MANAGED CARE PLANS WILL STEP UP
AND THEY WILL REALLY FOCUS ON
THE DEFICIENCIES WITHIN THE
CORRECTIVE ACTION PLAN TO HELP
MOVE THE NEEDLE ALONG THE
DEPARTMENT PROVIDES A LARGE
AMOUNT OF TECHNICAL ASSISTANCE
WE HAVE QUARTERLY MEETINGS WE
HAVE VARIOUS WEBINARS AND WAYS
IN WHICH WE SHARE INFORMATION
WITH. OUR MANAGED CARE PLANS-
WE DO TO TRY TO PROVIDE THAT
ADDITIONAL TECHNICAL ASSISTANCE
WHEN NECESSARY- BUT WE ALWAYS
HAVE THE- THE ABILITY IT
INTERNALLY TO IMMEDIATELY
SANCTIONALSO IF IT'S SO
EGREGIOUS ON ONE END OF THOSE
ARELIBERTIES THE DEPARTMENT
DOES HAVE IT REGARDS TO
EGREGIOUS ACTIONS BUT WE ALWAYS
TRY TO WORK WITH OUR MANAGED
CARE PLANS FIRST TO SEE IF WE
CAN MOVE THE NEEDLE. TO SEE IF
WE CAN MOVE THEM ALONG OVER
YEARS TO SEE IMPROVEMENTS
BEFORE WE MOVED TO SANCTIONS
BUT SOMETIMES DEPENDING ON THE
ACTION IT IS NECESSARY. WHEN A
COUPLE THOUGHTS ONE IS THIS
DOES CHANGE THE GAME ABOUT ALL
OF A SUDDEN THERE'S GONNA BE A
LOT MORE PLANS ARE GONNA BE
INVOLVED IN THAT CORRECTIVE
ACTION PROCESS AND SO REALLY TO
RAISE THE BAR AND RAISE THE
AWARENESS THAT OKAY NOW IT'S
THERE IS YOU'VE GOT IT FIFTY
MPL. SO I THINK THAT IS ONE
WILL JUST BE MORE ENGAGEMENT
AMEND THAT MORE ENGAGEMENT
MEANS MORE PLANS INVOLVED IN
THE DEPARTMENT MORE INVOLVED. I
THINK THE SECOND THING IS THAT
THE DEPARTMENT KEEPS YOU KNOW
CONTINUE TO LOOK AT OTHER
ALTERNATIVES WATER OTHER WAYS
THAT WE CAN MOTIVATE HELL PLAN.
TO DOES THAT BE YOU KNOW AND
NOT I DON'T KNOW THAT WE'VE
COME. UP ANY PARTICULAR SALUTE
OCEAN JET BUT- AS YOU KNOW
THERE ARE A LOT OF DIFFERENT.
TO MOW. PEOPLE WE'VE CORRECT
ACTION PLANS AND SANCTIONS.
OTHER OTHER WAYS TO THINK ABOUT
HOW YOU MOTIVATE. PLANS TO
REALLY PUSH AS HARD AS THEY CAN.
YEAH I THINK THE SHEET THAT I
THINK THAT ONE OF THINGS WE
SHOULD ALSO BE THINKING ABOUT
WE IS SERVE. MINIMUM
PERFORMANCE STANDARDS SO IT'S
LIKE WHAT WHERE'S THE LINE WAY
GETS EGREGIOUS RIGHT- SO
WHETHER IT'S YOU JUST
PERFORMING SO BADLY THAT WE
GOTTA FIGURE OUT SOMETHING YOU
KNOW- OR- YOU SELLING LACK OF
PROGRESS TO A MAYBE NOT AS BAD
SITUATION BUT WE EXPECT TO DO
BETTER AND YOU JUST DON'T WRITE
SO. BE SURE THAT WE THERE ARE
SOME- CLEAR EXPECTATIONS ABOUT
THAT I THINK WHAT. WE DON'T
WANT TO SEE IS THAT YOU KNOW
CORRECTION ACTUAL PLAN AFTER
CORRECTIVE ACTION PLAN THAT
DOESN'T CTUALLY LEAD TO ANY
CHANGE SO I GET OUT THAT'S- A
SO I DO THINK THAT THAT'S THE
OVERSIGHT PART THAT- ZAP WILL
ENSURE IS IN PLACE- THAT-
PEOPLE RECOGNIZE THAT- THERE.
ARE CONSEQUENCES TO NOT AGAIN
YEAH I DO THINK WE NEED TO
THINK ABOUT WHERE WHERE DOES
CONSEQUENCE KICK IN. I DON'T
WANT THE AND REASONABLE BUT
ALSO RECOGNIZING THOSE THOSE
ARE BEEN FISHERIES I MEAN WHEN
THEY'RE NOT DOING WELL. THEN
THAT'S FULLER FALSE AND DIED IN
I THINK ONE OF THINGS THAT- YOU
KNOW WOULD POINT OUT THAT FOR
EXAMPLE- ON THE CAPS SURVEY
GENERALLY. THOSE PLANS DON'T DO
VERY WELL AND THE MEDI CAL SIDE
COMPARED TO UNION CAPS IS
APPLIED ACROSS MEDI CAL
COMMERCIAL MEDICAID PROGRAMS WE
DON'T KNOW WELL SO. WHICH THINK
ABOUT LIKE WHAT WHY IS THAT
WHAT WE- THE END IT'S IT NEARLY
TO COME IT'S A SASSER. SURVEY
WHITE WHITE OR MEDI CAL TO
FISHERIES. THEM NOT FEEL AND
THEIR PLANS ARE SERVING THEM
WELL WHEN. WHEN THAT SURVEY
COMES BACK AND WE GET ONE OR
TWO STARS ON THOSE PLANS ARE
FOR FIVE STARS. SO IT'S
SOMETHING THAT- WE YOU KNOW WE
SHOULD BE. LOOKING AT- AS WELL-
NOW WANT TO TOUCH ON RATE
SETTING- SO- NOW AGAIN THREE
YEARS AGO WE HAD- NODES THE- A
PRESENTATION ABOUT RATE SETTING
I APPRECIATE- AND WE GOT I
THINK WE GOT A- POWER POINT-
ABOUT HOW. THE RATES ARE SET SO
ONE OF THE QUESTIONS I HAD THEN
A GONNA ASK IT AGAIN NOW- SO
FOR EXAMPLE WE HAD AN AUDITOR
REPORT THAT SHOWED.
UNFORTUNATELY AT. HALF OF
CHILDREN IN MEDI CAL WE'RE NOT
RECEIVING THEIR- CHECK UPS
RIGHT THERE TO WELTS THAT THE
RECOMMENDED SUPER WELL
SUPERVISION VISITS TELLS
FASCINATING ABOUT THE AUDIT
REPORT WAS IS THAT. FOR THE
AGES AND WHICH WE WERE ACTUALLY
LOOKING ON THE OUSIDE THE
AUDIT ON A REGULAR BASIS THE
PERFORMANCE WAS MUCH HIGHER.
IDEALS ABOUT 80% OR SO THAT A
RELATIVE THAT WAS AND THEN ON
THE OTHER AGES IT WAS A MUCH
LOWER SO WHICH WOULD INDICATE
TO ME IS THAT IF THEY REALLY
WANTED TO. CONSOLES LOOKING
THEY WOULD BE ABLE TO SAID THIS
SO IT'S AND SO WASN'T IN A
POSSIBLE TARGET BECAUSE IT
SEEMED LIKE IF SOMEONE WAS
COUNTING IT. THEY FOUND A WAY
TO GET IT UP TO A CERTAIN LEVEL
AND WHEN NO ONE WAS WHEN.
PEOPLE WEREN'T LOOKING. IT WAS
DOWN OKAY SO THAT WAS THAT WAS
A LITTLE DISTURBING BUT THE
OTHER THING THOUGH I ALSO
RELATE TO RATE SETTING THOUGH
IS THAT WHEN WE DEVELOPED. THE
SO CALLED TAX SURELY ACCURATE
RATES. DO WE ASSUME. THAT ONLY
50% THE KIDS ARE COMING. IN FOR
THE REGULAR CHECKUPS. WHICH IS
NOT WHAT WE WANT SO WHICH ME
ESSENTIALLY THAT'S WHAT WE-
THAT'S WHAT WE OFFERED TO PAY
FOR. OR DO WE SAY WELL ACTUALLY
WE WANT ALL OF THEM TO COME IN
AND- IF WE REALLY TRIED REALLY
HARD WILL GET 8590% AND THAT'S
WHAT WE SHOULD ACTUALLY PAY
FOR. AND MAYBE YOU DON'T HAVE
TO PERFORMANCE TARGET WE TAKES
MONEY BACK OR SOMETHING OR YOU
KNOW THERE'S OTHER SUBSTANTIAL
SOLUTIONS TO SO. SO ONE ISSUES
THAT I TALKED ABOUT THREE YEARS
AGO BALLOT BRING UP AGAIN IS DO
WE BAKE IN INTO OUR ACTUARIAL
RATES ESSENTIALLY UNDER
PERFORMANCE BECAUSE THAT'S
WHAT'S HAPPENED YEAH THAT'S OUR
HISTORICAL PERFORMANCE RIGHT
SO. ACTUALLY LOOK AT THE
HISTORICAL PERFORMANCE AND SAID
DO WE ACTUALLY BREAK THAT INTO
THE RATES WILL HAVE AS WE SAY
THE RESOURCE WE GIVE YOU IS FOR
WHAT YOU'VE DONE IN THE PAST
NOT FOR IMPROVEMENT IN THE
FUTURE. PARTICULARLY WHEN
THERE'S- WHEN IT LOOKS LIKE
THERE'S AN UNDER UTILIZATION
AND SO I'M NOT INTEREST IN
TEACHING REALIZATION I WANT.
LUSATIAN BUT LET'S JUST SO I
DOES NOT POSE. BECAUSE THAT
QUESTION IN TERMS OF HOW WE
DETERMINE THE RATES THAT WE PAY
PLANS AND IT'LL AND WHAT GOES
INTO THIS ACTUARIAL
ASSUMPTIONS- SO ACTUAR RATES DO
HAVE TO BE PROSPECTIVE. BUT IT
IS DRIVEN BASED OFF OF
HISTORICAL UTILIZATION ON
THROUGH THAT KIND OF ACTUAR
RATE SOUNDING THERE IS
ABILITIES TO ACCOUNT FOR KIND
OF EMERGING OR ANTICIPATED-
EXPERIENCE FOR EXAMPLE- WHEN WE
ROLLED OUT THE VALUE BASED
PURCHASING. INITIATIVE PROFIT
SIX SOON TO THAT THERE WILL BE
AN TWO. LET'S.BECAUSE NOW
THERE WAS. HE PERFORMING
SCENTED. HISTORY PIECES THAT
THAT THE WOULD BE IN IN IN
UTILIZATION SO WHILE IT DOES
HAVE TO BE ACTUAR EARLY SOUND
IT DOES HAVE TO BE REASONABLE
APPROPRIATE ATTAINABLE. NEEDS
TO ACCOUNT FOR THE FACT THAT
PLANTS SHOULD BE PROVIDING
PREVENTIVE SERVICES THEREFORE
THEY SHOULDN'T HAVE. AS MANY
HIGH COSTLY- SERVICES IT HAS TO
ACCOUNT FOR ALL OF THOSE THINGS
THERE ARE TIMES WHEN WE CAN
ACCOUNT FOR IF WE FEEL LIKE IT
WILL HAPPEN IN ACTUAL IMPACT ON
THE RATE- YOU CAN MAKE
ADJUSTMENTS. WE WOULD NOTE THAT
BASED ON THE PREVENTIVE AUDIT
IN THE CURRENT WHAT'S CALLED
THE BRIDGE PERIOD WHICH IS THIS
EIGHTEEN MONTH PERIOD THAT WE
HAVE RIGHT NOW WE DID NOT MAKE
ADJUSTMENTS BASED ON THE
PREVENTIVE SERVICES. AUDIT
HOWEVER THE DEPARTMENT IS
LOOKING IN LIGHT OF BOTH VALUE
BASED AND TO THE ADDITIONAL
AUDIT THROUGH THIS RATE PERIOD
IF WE DO NEED TO MAKE AN
ADJUSTMENT GIVEN THE FACT THAT.
IN IN MARCH OF THIS YEAR WE ARE
GOING TO BE PUSHING SIGNIFICANT
LETTERS OUT TO BENEFICIARIES.
NOTICING THEM OF THEIR RIGHTS
TO PREVENTIVE SERVICES- AND
THAT THEY SHOULD BE ENGAGING IN
SERVICES WE'RE GOING TO EXPECT
MANAGED. PLANS THROUGH THIS
YEAR TO THEN START ON A
QUARTERLY BASIS EVALUATING WHAT
PREVENTIVE SERVICES AND THEN DO
OUTREACH TO PROVIDERS ALL OF
THAT IN RESPONSE TO PREVENTIVE
SERVICES OUGHT. TO THE
DEPARTMENT IS LOOKING INTO
GARCIA SAID THE RATES FOR THE
NEXT YEAR WHAT WOULD BE. BOB WE
NEED IT MAKE BASED ON THE FOR
THAT THERE THE NUMBER. I'M XP
THAT WE POTENTIALLY BE IN. THE
DOES THERE'S A OF AN SERVICE
ALL ADDING. CAN ACCOUNT FOR
CERTAIN THINGS WITHIN THE RIGHT
IF WE SEE IT KIND OF COMING
AHEAD OF US OKAY CAN YOU KNOW
DR THE ITEM IN THE- WHEN YOU
THINK ABOUT YOU KNOW A PLAN
PAYING FOR THINGS IT'S ALL
INTERRELATED SO THEY DO BETTER
BRING IN KIDS FOR PREVENTIVE
SERVICES. THEY RECOGNIZE ASTHMA
EARLIER THEREFORE YOU DON'T
HAVE THE EXPENSES OVER THERE IN
TERMS OF. A CHILD WITH ASTHMA
WHO HAS IN THE COMING IN FOR
PREVENTIVE SERVICES GOING TO
THE ER. SO WHAT I THINK ABOUT
THE RATES ALWAYS THINK OF ALL
THESE INTER RELATED BALANCING
THINGS. BUT ULTIMATELY IT IS
BASED TO SOME EXTENT ON
EXPERIENCE AND SO I TOTALLY
UNDERSTAND YOUR POINT. BUT I
THINK THE PLANS THINK OF IT AS
IF WE DO THOSE THINGS. WERE
BOARDING COSTS OVER HERE WHICH
WE'VE BEEN FULLY PAID FOR SO
IT'S KIND OF. BOTH A LITTLE
FUNNY YEAH AND THAT MIGHT BE A
LITTLE TRICKY. IN TERMS OF-
SAYING THAT TWELVE WE GOT. PUTS
A 80% OF ALL THE KIDS THOUGH
FOR. GETTING TUTORED AT ONE.
WE'D LIKE TO THINK THAT MADE.
THE EYES OF A HOUSE WAS A WOULD
GO DOWN ALTHOUGH ONE COULD
ARGUE THAT PERHAPS WHAT MIGHT
ALSO HAPPEN IS WE'LL SEE AN
UPTICK IN UTILIZATION CERTAIN
OTHER THINGS THE BETTER DENTAL
FIGHT ENTREATED. SO YEAH DOES
THAT ALSO MAKE NOTICE SAM ONE
OF THE MAJOR INITIATIVES THAT
WERE ENGAGED IN IS TRYING TO DO
ASUS SCREENINGS RIGHT AND- WELL
THEY WILL HAPPEN OF RIGHT YOU
DIFFERENT SETTINGS OF CERTAINLY
IN KIDS- ONE OF THE BEST PLACES
TO DO IT STRING WATER WHEN
WE'RE ONLY A 50% IN. YES WERE
MISSING A LOT OF KIDS WE HAVE
OPPORTUNITIES SCREENINGS I MEAN
NOT SAY WE CAN DO SOME OTHER
SETTINGS AND SO FORTH BUT- BUT-
I THINK THAT- THAT'S- THERE'S A
TYPES OF VISITS WERE YOU
REPRESS GOING TO SCREENING AND
EVEN EVEN SOME INITIAL
MITIGATION AND BUT THAT COULD
LEAD TO ACTUALLY FURTHER IF
WE'RE ACTUALLY TRYING TO
ADDRESS THOSE FURTHER VISITS.
THAT AND UP. YOU KNOW SOME
OTHER UTILIZATION BUT WILL SAVE
US MONEY IN THE LONG RUN. SO I
GUESS THE- THE- SO I A HERE
ABOUT THE BACK AND FORTH PRIME
CONCERN IS THAT WELL WE SAY THE
BACK AND FORTH BUT IN THE END.
IF THE PLANS AS WELL WE GO
THERE ARE ACTUAL REPEATS BASED
ON THE ONLY FIFTY PERCENT OF
KIDS COMING AND- I MEAN I GUESS
IS A QUALITY MEASURE. THE DVR
WOULD THAT NOT SAYING THAT THEY
DID THAT'S THE MAIN THING
YOU'RE LOOKING AT BUT IT'S A
IT'S A SOURCE ADDS A LITTLE BIT
OF A WRONG SIGNAL. RIGHT THAT-
THAT IT'S THE RATE ISN'T BASED
ON AND- IT'S HARD TO SAY WELL
IF I ACTUALLY GOT IT FROM 50%
80% THIS MUCH JOHN HAS MORE
THESE CHRONIC DISEASES SO I'M A
LITTLE AFRAID TO SAY WELL
ACTUALLY THAT'S OR WASHES OUT
THAT YOU DO THIS. YOU KNOW
WILL- THAT THAT IN FACT ONE
COULD EVEN ARGUE AND FROM A
POLICY POINT OF VIEW. YOU KNOW
DO YOU BUILD IN SOMETHING LIKE
PREVENTIVE SERVICES THAT.
SHOULD BE ON A REGULAR THING
INTO A TO EVEN A CAPITATION
RATE RIGHT IT'S THE CMS IS
WORRIED ABOUT ALL WE WANT PAY
FOR VISIT BUT DON'T ACTUALLY
HAPPENED. THEN STAY WELL. THIS
CALL. AND WE HAD A VERY REGULAR
SCHEDULE. AND YEAH YOU. CAN'T
DO TWO VISITS IN THE SAME YEAR.
WE ALL PAY FOR ONE. BUT IT'S ON
THE SCHEDULE THAT. YOU KNOW
THAT EVERYONE RECOGNIZES THAT'S
WHAT'S IN THE LAW. OF THE
HEALTHY. THE BRIGHT FUTURE
SCHEDULE AND SAY. COME IN AND
YOU INCENTIVIZE YOU PAID THEY
DON'T DON'T TAKE YOU AT. THAT'S
WHAT YOU GET. PAID AND- WELL.
THE YOU'RE- TO BELIEVE TO GET
THE MEN SO ANYA OF THERE'S A
SORT OF SAW ABOUT IT THAT AND
KNOW I USE MAY CARE AND I TO
MOVE PEOPLE THAT FIRST BUT I
WOULD I IT WAS PEOPLE ARE THAT
SOMETHING LIKE VERTICAL THIS
KIND SERVICE IT MAY MAKE SOME
CHOICES IF YOU DON'T IF YOU'RE
NOT GONNA BUDGET FOR PEOPLE
COMING IN THE START WITHIN THE
ACT OR RATE THAN THAT BECAUSE
YOU'RE WORRIED THAT YOU'LL BE
PAYING FOR PEOPLE WHO STILL
DON'T COME IN. AND TAKE SPEAK
RATE OUT THERE'S NO. YOU KNOW
THE- YOU CAN CONTROL IT SIMPLY
BECAUSE IT'S BASED ON THE A SIX
SCHEDULED THIS IS NOT SOMETHING
SOMETHING THAT YOUR TRADIO.
MEASURE TREATING US. YEAH I
DON'T KNOW IF YOU AND I AGREE I
MEAN I THINK YOU'RE RIGHT IT'S
IN I DON'T THINK PLANTS THINK
OF IT AS AN EXPLICIT TRADE OFF
RIGHT AND I AND I CERTAINLY
DON'T THINK PLANTS THINK OF IT
AS- I'M ONLY GETTING PAID 450%
WELL CHILD SO THEY DON'T. BRING
KIDS IN WE NEED TO JUST MOE
THE PERFORMANCE OF AND I DON'T
THINK I MEAN WITH I DON'T THINK
IT'S AS MUCH THE MONEY IS IT'S
THE PERFORMANCE AT THE BOTTOM.
AND PROPERTY SIXES AS HELL
BECAUSE YOU KNOW WE HAD IT YOU
KNOW YOU HAVE TO THE CODES FOR
THE PREVENTIVE SERVICES WHICH
WHICH YOU KNOW OUR PHYSICIANS
REALLY APPRECIATED. AND THAT'S
IT THAT'S A DRIVER KIND OF TO
ALMOST MITIGATE SOME OF THIS
TRADE OFF SOME OF THE TRADE OFF
ISSUES THAT ARE THERE. BUT I
DON'T THINK I DON'T THINK THEY
THINK LIKE THAT AT ALL WE JUST
HAVE TO DRIVE THE PERFORMANCE
YEAH THE ONLY THING I MEAN I
AGREE JUST BECAUSE THE
UTILIZATION IS WAS DRIVING THE
RAY WITH OTHER ASSUMPTIONS
BUILT IN IT DOESN'T MEAN THAT'S
WHAT WE ARE EXPECTING OF THE
PLANS WE HAVE EXPECTATIONS THAT
THEY PER. PREVENTIVE SERVICES
THAT THE REDUCING HIGH COST
UTILIZATION OF SERVICES IN
GETTING PEOPLE INTO THE
APPROPRIATE LEVEL OF CARE SO I
AGREE ON THAT THOUGH IT THAT
HISTORY IS WHAT KIND OF BILLS
INTO THE RATE. THAT DOESN'T
CORRELATE WITH THE DEPARTMENT
EXPECTATIONS OF THE PLANS AND
OR THE PLANS EXPECTATIONS IN
REGARDS TO GETTING THOSE
INDIVIDUALS AT A SERVICES. THIS
IS A COMMON APPEAR. OPINION
THAT THE AGES ARE SO IT'S
COMPLICATED ABOUT WHICH KIDS
COME IN FOR CARE AND RICH KIDS
DON'T COME IN FOR CARE BUT- YOU
KNOW THE- WELL I DO IT DIDN'T.
YES ABOUT CIVIC NOTE FOR
EXAMPLE WAS- THAT. IF YOU LOOK
AT THE AUDIT THAT ACTUALLY WON
THE AGES FOR YOU SAW THE LOWEST
NUMBER OF VISITS I THINK WAS.
AS H. TWO THREE. WAS AGE TO.
THAT YET THAT'S BAD BECAUSE
THERE'S A LOT OF DEVELOPMENTAL
CHANGES HAD ENGAGED TO AND THEY
WEREN'T LOOKING AT AGE TO SO IS
LOW AND THEN THE ONLY LOOK AT
AGE FOUR AND THAT WAS. GOOD SO-
YEAH THAT OKAY YEAH THAT'S NOT
OKAY ONE OF THE REASONS WHY WE
ADDED ALL OF THE CHILDREN AND
ADULTS CORPS MEASURES TO. NOW
ARE SET SO THAT. IF WE'RE
MONITORING ALL OF IT HOLDING
ACCOUNTABLE TO ALL HOPEFULLY WE
WON'T SEE THOSE HUGE SWINGS
WHERE IF WE'RE NOT MONITORING
IT. THERE'S NO THEM NO ACTION
OKAY I APPRECIATE THAT- IS IT I
JUST EIGHTY AND MY OBSERVATION
IS THAT. WHEN SOMEONE'S LOOKING
THEY SOMEHOW WE WERE ABLE TO
BETTER SO THE NET MUST KNOW HOW
TO DO BETTER. IT'S NOT A MATTER
OF I DON'T KNOW HOW TO DO IT
IT'S LIKE I DOING IT OR NOT. SO
NOW HOW LONG DOES IT TAKE FOR.
TOBY OVER HOPEFULLY WE'RE DOING
THINGS ELEVATORS WE'RE TRYING
TO BUY. AND INSTALL THAT
UTILIZATION BUT SOMETHING'S IN
TERMS OF AGAIN THESE SO YEAH.
TRY TO GO WITH THE ACTUAR- RATE
IS- HOW OLD CITY TAKE FOR
CHANGES IN UTILIZATION TO SHOW
UP IN. THE DATA YET ENCOUNTER
DATA AND IT'S- INTO THE- CATION.
SO I'LL- HAVE TO DO SO WHEN YOU
TO. THE CAP. RATE. FOR THE PLAN.
WHAT'S THE LAG TIME IN AND IF
STILL LIKE TO. SO BASICALLY TRY
TO FIGURE OUT LIKE HOW HOW WE
SHOULD INSTEAD OF. THE PLAN. TO
SERVICE MY- FOR THE RIGHT WORD
HOW DO WE SURE THE PLAN IS
ACTUALLY PAID APPROPRIATELY.
FOR THE THIS IS THEIR
DELIVERING IT UNDER A CAPITATED
RATE DOES SO THERE IS A LAG
BETWEEN DOUBT. THAT WE WANT
THEM TO DO THE RIGHT THINGS AND
YET WE'RE NOT PAYING FOR IT
BECAUSE WE HAVE A WE NOW HAVE A
LACK. SO THERE IS A TWO YEAR
LACK FROM- ENCOUNTER DATA TO
THE UTILIZATION THAT'S BUILT
INTO THE CAPITATION RATE- BUT
AS I WAS MENTIONING EARLIER. WE
DO HAVE PROCESS SEES THROUGH
THE ACTUARIAL SOUNESS WHERE IN
ADDITION TO UTILIZATION WE CAN.
PRIOR TO SEEING IT COMING
THROUGH ON ENCOUNTER LOOK TO IF
WE KNOW WE'RE ROLLING OUT A BIG
CHANGE IN THE FUTURE. WEEKEND
BUILDER FACTOR THAT INTO THE
RATE. ON IT WOULD PROBABLY HAVE
US A LOT OF ASSUMPTIONS BUILT
AROUND IT TO- AND IT WOULDN'T
BE AS IF IT WAS YOU WERE SEEING
IT IN THE UTILIZATION. THEY DO
HAVE THAT ABILITY BUT IT IS A
TWO YOUR LOG IN REGARDS TO
ENCOUNTER DATA COMING IN AND
THEN THAT BILLY BEING BUILT
INTO THEIR- INTO THEIR RATE.
PURSER THE SUPPLEMENTAL DATA
FOR US. THEY'RE VERY FREQUENTLY
WHEN WE SEE CHANGES OCCURRING
IN ANY PARTICULAR BENEFIT OR
ACTIVITY. THE DEPARTMENT ASKED
THE PLAN FOR SUPPLEMENTAL DATA
REQUESTED A ROOM THAT ARE MUCH
MORE FREQUENT THAN. EVERY TWO
YEARS. AND THAT ALLOWS THAN
THOSE FACTORS TO BE TAKEN INTO
ACCOUNT. ON A MUCH MORE I MEAN
REAL TIMES LITTLE HARD BECAUSE
OF THE TIME FRAME TO DO. THE
ACTUARIAL ANALYSIS BUT A MUCH
MORE REAL TIME BASIS THAN TWO
YEARS AND THAT IS WORKED. FOR
CERTAIN THINGS WELL. I THINK
THAT'S WHERE THEY DO TRY TO
MAKE IT ADJUSTMENTS WHERE
APPROPRIATE AND WHERE THERE'S
DATA OR SOME SINCE TO. TO BUILD
ON IT BUT- ON FULL HISTORY
UTILIZATION THERE IS THE LACK.
AND IN RELATION TO FOR EXAMPLE
THE DOING THAT WITH THESE
PURCHASING OTHER TYPES OF
THINGS- IN TERMS OF THE- RISK
FULL RIGHT OF ANNOUNCED THIS
YEAR BECAUSE IT'S ONLY WHEN
PLAN BUT IF YOU HAVE MULTIPLE
PLANS. IN THE COUNTY OR IN A
REGION- AND SUPPOSE SOMEONE
DECIDES A SIDE TO TAKE ON A
VALUE BASED INITIATIVE THEY
ATTRACT MORE OF THE PEOPLE
WITH. A CHRONIC CONDITION TO
THEIR PLAN. IS THEIR INABILITY
TO HOW LONG IT TAKES TO MAKE AN
ADJUSTMENT FOR. CHANGING CASE
MIX. BETWEEN THE- IN AN AREA SO
WE GET THIS GOES BACK TO SAYING
LIKE WE SHOULDN'T BE PENALIZING
PEOPLE FOR. ATTRACTING MORE
PEOPLE CRISES LAWS OF THE TAKE
BETTER CARE OF THEM. SO I DO
BELIEVE IN ME I WOULD WANT TO
GO BACK AND CHECK WITH OUR TIME
TO BE A CERTAIN BUT THEY DO SET
AN ANNUAL RATE FOR THE YEAR AND
THEY DO LOOK AT THAT CASE MAKES
ON AN ANNUAL BASIS IN REGARDS
TO SETTING THOSE RATES BUT- I'D
WANT TO DOUBLE CHECK IN REGARDS
TO HOW THAT'S INCORPORATED-
DON'T SPEAK OUT OF. OKAY NOT BE
CORRECT SO WE CAN GET YOU THAT
A OKAY SO YEAH I'D BE
INTERESTED IN THAT AND ALSO
THINKING ABOUT WHAT MECHANISMS
TO HAVE IN PLACE ESPECIALLY
WE'RE TRYING TO DO TRUE VALUE
BASED PURCHASING AND WE'RE
ACTUALLY TRYING TO. PROVIDE
BETTER QUALITY CARE PEOPLE'S
CHRONIC DISEASES AND YOU HAVE
LET'S SAY MULTIPLE PLANS IN AN
AREA AND ONE PLAN ACTUALLY
STANDS OUT. AND MOST PEOPLE
KNOW THAT PLAN STANDS OUT THEY
WANT TO ACTUALLY SIGN UP FOR
THAT PLAN. AND ASK FOR THE
PLAN. THEY SHOULD BE THE PLAN
SHOULD BE PENALIZED FOR PICKING
UP PATIENTS TO MAY HAVE HIGHER
NEEDS. THOSE ARE THE PEOPLE
CRIED DISEASES IF THEY DO A
GOOD JOB BECAUSE YOU'RE DOING A
GOOD JOB NOW. WE CAN ARGUE
ABOUT HOW PEOPLE. MAKE THEIR
CHOICES AND SO FORTH BUT IT'S I
THINK THAT'S PART OF VALUE
BASED PURCHASING THINGS SO THAT
THEY ACTUALLY PUT IN THE THINGS
IN PLACE TO. MAKE THEMSELVES
BETTER AT DOING AND BECOME MORE
ATTRACTIVE THAN. WE MIGHT WANNA
THINK ABOUT HOW DO WE NOT
PENALIZE A PLAN THAT.
DISPROPORTIONATELY. TRACKS A-
LARGE DON'T. WITH MORE.
EXPENSIVE FOR. YOU KNOW
CONDITION THAT MIGHT. BECAUSE
OUR CASE MAKES A CHAIN RIGHT
THERE IS A RISK ADJUSTMENT
PROCESS IS PART OF THAT YOU
KNOW THE OVERALL RATE
DEVELOPMENT. RIGHT YEAH SO
EXACTLY HOW HOW HOW MUCH OF A
LAGGED THERE'S ON THAT TOO SO.
ALL RIGHT. OKAY. AND THEN- THE
OTHER THING YOU KNOW WE AND
EIGHT YOU SEE WE- WE TALKED
ABOUT- YOU SAID YOU'RE GONNA BE
DOING TIME AND DISTANCE AND- WE
DON'T WE HAVE A AND HAD THE ODD
TO REPORT THAT LOOKED AT- IN
TERMS OF- AND DO TALK ABOUT THE
REDUCTION IN THE DECREASE AND
I'LL SHOW FORGET THE TERM
ITSELF A YES THAT THE ALTERNATE
ACCESS STANDARDS SORRY. AND SO
IN TERMS OF RATE SETTING. THE
HOUSE- HOW DOES THE RATE CITY
ACCOUNT FOR THE PLANS
REQUIREMENTS PROVIDE
APPROPRIATE ACCESS TO CARE AND
PARTICULARS- ZIP CODE SO COUNT
FOR THE NUMBER AND GEOGRAPHIC
LOCATION PLAN AND ALSO AND SO
FORTH SO IT SAID FACTORED IN
INTO THE- INTO THE- RATE
SETTING PROCESS IN TERMS OF-
WELL. YOU KNOW WE NEED TO FEEL
THE CONTRACT WITH CERTAIN
SPECIALISTS THERE IN THE AREA.
AND THAT MAYES SO I MEAN THE
RATES BUILT ON AN EXPECTATION
THAT THEY ARE PROVIDING ALL OF
THE SERVICES WE ARE CONTRACTING
WITH RIGHT FOR AN APPROPRIATE
UTILIZATION BASED ON A NUMBER
OF FACTORS IN AND FORMULAS- AND
THEN BASED ON UTILIZATION
EXPERIENCE FROM THAT MANAGED
CARE PLAN- SO ESSENTIALLY IT IS
SOON AS THOSE THINGS BASED ON.
HISTORICAL PRACTICES NOW IF THE
END IT DEPENDS IN ACCESS TO
SERVICES THAN THAT WOULD SHOW
UP IN FUTURE RATE SETTING BY
GUESS THE QUESTION IS LIKE OKAY
SO WE'RE TRYING TO GET THEM TO
NOT DO AS MANY ALTERNATIVE
ACCESS RATES ON PEOPLE FAR AWAY
BUT THAT'S THEIR HISTORY IN THE
PASSES WERE TRYING TO MOVE THEM
ALONG. AND THEY MAY HAVE I
DON'T KNOW THEY'D BE THERE MAY
NOT HAVE BEEN ABLE TO GET
BETTER RATES BY. FINDING
SOMEONE FARTHER AWAY. THIS IS
THE DOES THAT GET BAKED INTO
THEIR ACTUAR RATE IS THEY'RE
LOOKING AT NOW THAT THEY WERE
TRYING TO MOVE THE FOR AT SO
I'M JUST AGAIN THINKING ABOUT
HOW THINGS MIGHT BE TO GET
BAKED IN OR NOT BECAUSE WE-
YEAH I REALIZE THAT. THE FORTY
WE DON'T HAVE DEAL FALLS
PERSPECTIVES OFTENTIMES WE HAVE
TO LOOK AT. THE DATA STRUGGLE
DATA TO TRY TO FIGURE OUT WILL
HAPPEN IN THE FUTURE BUT SO
I'LL SAY ONE THING THEN YOU. SO
EVEN IF THAT SO EVEN IF IT'S
NOT LIKE IT'S ONLY WITHIN THAT
COUNTY- SPACERS ZIP CODE. THE
PLAN IS RESPONSIBLE OF SERVICES
EVEN IF THEY HAVE COURTNEY SOME
GOING UP YOU KNOW ACROSS THE
STATE OR DROUGHT FAR. THERE
WERE. SERVICES GUARD LESSON SO.
THIS IS THERE A- WOULD BE BILL.
INTO THE RAY. IT EVEN IF THEY-
ULTIMATELY HAD TO PAY A HIGHER
RATE TO MAKE SURE PEOPLE HAD
ACCESS TO THOSE SERVICES. THOSE
WOULD EVENTUALLY BE BUILT IN-
SO IT IS EVERYTHING THEY ARE
RESPONSIBLE FOR WITHIN THEIR
EVEN IF IT'S OUTSIDE OF THAT.
AREA SO YOU HEARD ME SAY. YOU
KNOW YOU DON'T PAY ALWAYS PAY
MEDI CAL TO PROVIDERS BECAUSE
THERE ARE CERTAIN PROVIDERS
THAT YOU NEED. FOR ACCESS THAT
YOU HAVE TO PAY YOU KNOW CLOSE.
MEDICARE SO TO THAT THEN GETS
BUILT INTO THE RATE IT IF THERE
IS A LAG. BUT SO THE WAY I
THINK OF IT IS. THE
DEPARTMENT'S RESPONSIBILITIES
TO MAKE SURE THERE'S THE
ADEQUATE. ACT PASSED. PUSH
PLANS TO DO THAT. PLANS AND TO
DO WHAT THEY- DO. IN TERMS OF.
PAYING THAT ONE PROVIDE THAT'S
GOT A BIT OF A- COUPLE. THE TO.
TACKLE AREA. MORE THAN MEDI CAL
IN THE- GETS OF THE- FLOWS. THE
RATE. YOU KNOW IN TERMS OF THE-
COST. WAS DATE OF. PRESENTED
THE- DEPARTURE. I WOULD NAY
THEM. HEARING THREE YEARS AGO.
GET SEVERAL. HERE AND OF THE
PLAN ARE ACTUALLY. ACTUALLY
MEDIC RATES. ALMOST ALL THE-
AND OTHERS. WEREN'T WERE LIKE.
WHY IS IT IS THIRTY FEET.
DIFFERENT PLANS- IN TERMS OF
THE RATES ARE PROVIDING FOR
WRITERS INSTANT IN THE SAME
MEDICAL PROGRAM WILL RECOGNIZE
DIFFERENT IN DIFFERENT
GEOGRAPHIES ETCETERA. AND WHY
CAN'T WE TRY TO DO IS THAT FOR.
ACROSS THE BOARD MEDI CAL BUT
THAT SOLD. BUT WE'LL JUST LEAVE
THAT THEIR- HERE THAT- NAY THEY
THINK CELL HAS NOW IT'S RIGHT I
THINK YOU WERE. ALL RIGHT- SO
WITH THAT- I WANT THANK YOU SO
MUCH WELL ACTUALLY IF YOU DON'T
MIND ME BILLS HAVE SE
SYNTHESIZER WILL BRING UP THE
NEXT PANEL- AND- NOTICE SEATS
MIGHT BE MORE COMFORTABLE
ALTHOUGH THE CAMERAS MAY NOT BE
AS COMFORTABLE. BUT THAT WE
FOCUS ON THE OTHER PEOPLE
TESTIFYING. ALL RIGHT THANK YOU
SO LET'S BRING UP FOR NEXT
PANEL I WANT TO WELCOME AND
THANK. LESS ABERA EXITING
DIRECTOR FOR ANTHEM BLUE CROSS
IN JERRY MAGUIRE SENIOR
DIRECTOR OF GOVERNMENT
RELATIONS AND SHE DEVELOPED FOR
KERN HEALTH SYSTEMS. WELCOME
AND THANK YOU SO MUCH FOR BEING
HERE AND- SHARING YOUR
EXPERIENCES- WITH MEDIC HOW
RATE SETTING AND- NETWORK
ADEQUACY IN PROCUREMENT SO.
YOUR FIRST. THANK YOU DOCTOR
PATH. THANK YOU DOCTOR FIFTH.
IT'S A PLEASURE TO BE HERE
UNLESS THE BAR EXECUTIVE
DIRECTOR FOR ANTHEM I HAVE
RESPONSIBILITY FOR OUR OVERALL
PROGRAM MANAGEMENT OF THE MEDI
CAL MANAGED CARE. HEALTH PLAN
IT ANTHEM. SO THAT INCLUDES-
ACCOUNT MANAGEMENT WITH OUR
COUNTY PUBLIC AND THEY HAVE A
WHOLE DEPARTMENTS. OUR LOCAL
ENGAGEMENT MODEL OF GENERAL
MANAGEMENT OF OUR- LA CARE
SUBCONTRACTOR AGREEMENT GENERAL
MANAGEMENT OF ARTILLERY COUNTY
LOCAL INITIATIVE AGREEMENTS.
AND I'VE ALSO BEEN SERVING THE
MEDI CAL POPULATION-
MEDICAMENTO CARE POPULATION FOR
TWENTY YEARS WITHOUT THE- I DO
WANT TO JUST MAKE A COUPLE
REMARKS ABOUT OUR COMMITMENT TO
THE MEDICARE POPULATION ACROSS
THE TWENTY NINE COUNTIES THAT
WE SERVE. THAT WEREJUST OVER
ABOUT ONE POINT ONE MILLION
MEMBERS ACROSS THOSE COUNTIES-
A COLLEAGUE OF MINE WILL BE
SPEAKING WITH YOU HERE SHORTLY
WITH REGARDS TO THE HEALTH
HOMES PROGRAM AND SIX OF THOSE
COUNTIES. AND ALSO SERVING NINE
COUNTIES IN THE WHOLE PERSON
CARE PROGRAM IS REALLY WANT TO
EMPHASIZE IT WITH OUR FOOTPRINT
OF THAT. EACH COUNTY THAT WE
SERVICE IS UNIQUE IN TERMS OF.
THE NEEDS OF THOSE POPULATIONS
AND I THINK AS WE'VE- REALLY
LEARNED- YOU KNOW VERY RURAL
AREAS VERY URBAN AREAS- YOU
KNOW WE HAVE TO BE CREATIVE
WITH REGARDS TO FINDING
SOLUTIONS AND TAILORING OUR
PROGRAMS- TO WHAT THOSE NEEDS
ARE. AND SO WHEN WE LOOK AT
THOSE NEEDS- THEY WERE COMING
UP WITH DIFFERENT OPPORTUNITIES
WITH WORKING WITH THE COUNTY
STAKEHOLDERS OTHER. COMMUNITY
LEADERS. AND SERVICES THAT WE
CAN BRING- AS A LARGE HEALTH
ORGANIZATION TO THE COMMUNITY.
AND SOME OF THOSE- CONCEPTS-
HAVE BEEN BORN OUT OF. DISASTER
RELIEF EFFORTS FOR EXAMPLE-
WHERE WE OFFERED KIOSKS LOW FOR
URGENT CARE SERVICES. WE
RECENTLY BEEN REALLY ENGAGED
WITH COUNTIES- STEPPING
BEHAVIORAL HEALTH PATIENTS DOWN
FROM. MODERATE TO SEVERE TO THE
TO THE TO THE MILD TO MODERATE
CATEGORIES USING SOME TELL
HEALTH SOLUTIONS. AND WE
STARTED ROLLING OUT OF TELL
INTERPRETATION SERVICES THAT
SOME OF OUR CLINIC PARTNERS.
SUCH THAT WERE ABLE TO CONNECT
WITH A LIVE VIDEO- TELL
INTERPRETATION- AND PAY FOR THE
PAY FOR THOSE COSTS FOR OUR
MEMBERS. I THINK THAT- AS
RELATES TO ENABLING ACCESS. YOU
KNOW A LOT A LOT OF A LOT OF
WORK IS BEING DONE AT A LOCAL
LEVEL AND I'VE BEEN PERSONALLY
IN CASE. WITH WHAT WITH MY
DIRECT TEAM AS WELL- MEETING
WITH THOSE LOCAL I. COUNTY
LEADERS AND REALLY. PARTNERING
UP ON DIFFERENT PROGRAMS
INCLUDING OPPORTUNITIES FOR YOU
KNOW FUNDING- AS IT RELATES TO
MAKING INVESTMENTS AND-
SOMETIMES IT'S HEALTH SYSTEMS
CLINICS SYSTEMS OR EVEN
COMMUNITY ORGANIZATIONS. THE
COUPLE EXAMPLES OF THAT EVEN
HERE LOCALLY WE ARE PARTNERING
UP WITH THE CLINIC. AS IT
RELATES TO THEIR ELECTRONIC
HEALTH RECORD SYSTEM TO IMPROVE
THE QUALITY PERFORMANCE WE ALSO
HAVE BEEN INVOLVED IN A CAR
AND- EQUIPMENT SUCH AS-
ULTRASOUND EQUIPMENT AGAIN
REALLY TRYING TO ENABLE ACCESS
AND FINDING DIFFERENT
OPPORTUNITIES ARE MORE LOCAL
AND MORE. FOCUSED ON YOU KNOW
WITHOUT AND INDIVIDUAL LEADERS.
THANK YOU WELCOME. OKAY THANK
YOU A CHAIR AND MEMBERS OF FOR
THE OPPORTUNITY TO SPEAK TODAY
OBVIOUS ON TO HAVE IMPORTANT
ISSUES OF NETWORK ADEQUACY AND
QUALITY MEASUREMENTS SOME
GERMAN MCGUIRE SENIOR DIRECTOR
OF GOVERNMENT RELATIONS AND
STRATEGIC DEVELOPMENT FOR
CURRENT HEALTH SYSTEMS AND WE
ARE THE LOCAL PLAN SERVING KERN
COUNTY HOW WE HAVE OVER TO OUR
FIFTY SEVEN THOUSAND MEMBERS
SO. WE ARE THE PLAN CREATED
THROUGH COUNTY ORDINANCE. AND
SO WE ARE PUBLICLY MANAGED TO
SPEAK IN OUR OUR BOARD OF
DIRECTORS IS ASSIGNED BY THE
COUNTY BOARD OF SUPERVISORS AND
SO YOU KNOW THE GIVEN OUR
GEOGRAPHY THE MAIN SEE A CITY
CENTERS BAKERSFIELD AND WE ALSO
HAVE A LOT OF RURAL AREAS IN
OUR COUNTY SO. HAVING THAT
MAKES A WE- HAVE EXPERIENCE
WITH THE YOU KNOW A LOT OF THE
CHALLENGES THAT WE FACE IN
TERMS OF NETWORK ADEQUACY- AND
OF COURSE DESPITE THESE
CHALLENGES WE CERTAINLY TAKE.
TAKE THOSE CHALLENGES SERIOUSLY
REMAIN COMMITTED TO THAT SO I
WANT TO TALK. YOU KNOW IN MY
BRIEF- MOMENTS TO DO A HIGH
LEVEL OVERVIEW OF- THE SOME OF
THE AREAS NETWORK ADEQUACY AND
METRICS THAT WE USE AND THEN.
TALK A LITTLE BIT ABOUT QUALITY
SO. YOU KNOW AT A HIGH LEVEL IN
TERMS OF NETWORK ADEQUACY WE
TAKE THE MENTALITY THAT WE WILL
CONTRACT WITH ANYONE PROVIDER-
WHO MEET STANDARDS OF COURSE
THAT'S IMPORTANT CABBIE OUT WE
WANT THEM TO. PROVIDE QUALITY
CARE WE'RE NOT TRYING TO CREATE
A NARROW NETWORK IN GENERAL. ON
TOP OF THAT WE DO GO FOR
ENHANCED FEE FOR SERVICE
MEDICARE RATES- GENERALLY. SO
THAT'S AN IMPORTANT PIECE AND
TRYING TO ATTRACT A PROVIDERS
INTO THE NETWORK. AND THEN ON
TOP OF THAT WE LATER YOU KNOW
COMMUNITY GRANTS- WHERE WE WILL
FUND CERTAIN INITIATIVES TO
MAKE SURE WE'RE WE'RE FILLING
HOLES- IN THE NETWORK AND OR-
SOMETIMES EVEN PHYSICAL SPACE.
AND WE DO THINGS LIKE A PAY FOR
PERFORMANCE TYPE INCENTIVE
PROGRAMS WHICH I CAN TALK TO A
LITTLE BIT MORE. I'M IN THE
QUEUE IN A AND THEN. WRAPPED
AROUND WITH THINGS LIKE
TELEMEDICINE. AND THEN AND
METRICS IN A HERD OF THE POWER
FROM THE CHEST TALK ABOUT A LOT
OF THE METRICS WE DO. TAKE
SERIOUSLY OF STAFF DEDICATED
YEAR ROUND TO MAKING SURE. THAT
AND IT'S NOT JUST AN ANNUAL
EXERCISE SOME THAT WE'RE
LOOKING AT THOSE VARIOUS THINGS.
SO IN TERMS OF THE QUALITY. YOU
KNOW FIRST THE WHEN THE AUDIT
CAME OUT WE DID TAKE THAT
SERIOUSLY WE REVIEWED IT- WE
LOOKED IT OVER. WE WANT TO MAKE
SURE THAT WE REVIEWED OUR
INTERNAL PROCESSES- AND MAKE
SURE THAT WE ADDRESS WHATEVER
WE NEEDED TO OF COURSE WE WORK
WITH THE PARTNERS A DH CS WHAT
WAS COMING DOWN THE CHANGES
THAT. WENT OUT. AND THEN WHAT
WE CAN GET INTO MORE DETAIL
ABOUT THE EXACT THINGS WE DID
WE YOU KNOW WE REVISE OUR P.
FOR P. PROGRAM TO ALIGN WITH.
YOU KNOW WHAT'S COMING DOWN THE
ROAD. WE DID A LOT OF EDUCATION
TRAINING WHICH WILL CONTINUE TO
BE ON GOING TO HAVE TO OUR
PROVIDER NETWORK TO LET THEM
KNOW WHAT WAS COMING. WE DO
INNOVATIVE THINGS LIKE
PROVIDING REAL. DATA TO OUR
PROVIDERS- SO THAT THEY KNOW
WHO'S MISSING SERVICES BECAUSE
THEY NEED NOT TO KNOW WHEN THEY
NEED HELP. AND OF COURSE IT.
AND UPDATES AND SOFTWARE IT'S
AN- YOU KNOW WE HAVE A- BUS
QUEUE I PROGRAM. QUALITY
IMPROVEMENT PROGRAM. SO ALL
ALSO WAS INFLUENCED BY THIS OF
XIN. AND THEN THE MEMBER
ENGAGEMENT COMMUNICATION SO
THAT'S HUGE- YOU KNOW HOW DO WE
MAKE SURE WE ARE ENGAGING IN
THE MEMBERS TO GET THEM TO
THEIR APPOINTMENTS AS WELL.
STOP THANK YOU THANKS SO MUCH
FOR YOUR PRESENTATIONS-
QUESTIONS. THE OKAY THAT'S
ALRIGHT OKAY WELL I WILL THEN I
JUST I'M SURE PEOPLE AND SO-
FOR SO THANK YOU BOTH FOR YOUR
PRESENTATIONS- IN TERMS OF THE
SO. THE HEALTH V. AND ACTUALLY
SERVICES I KNOW YOU'RE IN KERN
COUNTY RIGHT NOW HOW MANY
COUNTIES IS AND SOME OF THEM IS
IN TWENTY NINE COUNTY MONEY
NINE COUNTIES OKAY. AND LOOSE
ME ON MOST OF THEM ARE- RULE
CORRECT OR DO A TWO YEAR AND
FOUR AND EIGHTEEN RURAL
COUNTIES YEAH OKAY- SEVERAL OR
WERE IN THE BAY AREA SACRAMENTO
COUNTY RIGHT. YEAH AN AIR OF
CENTRAL CALIFORNIA OKAY AS THE
KINGS WITH EVERY TULARE LOS
ANGELES COUNTY AS WELL OKAY SO
BILL BASED ON THE AUDITS FOR
EXAMPLE YOU KNOW WE- WOULD TO
OUT ITS ONE TALKED ABOUT
CHILDREN'S HEALTH CARE AND-
THE- THE RATHER FOR. YOU KNOW
PERFORMANCE THERE- AND THEN-
THE OTHER HAD TO DO WITH AGAIN-
NETWORKS PARTICULARLY AND TO
UNDERSTAND CHALLENGES AND RURAL
COMMUNITIES SO- FROM YOUR
PERSPECTIVE AS A YEAR THE PLAN
NOW YOUR JOB YOU ARE YOUR JOB
IS TO PUT TOGETHER TO NETWORK.
EIGHT WE HAVE WE TALK ABOUT
NETWORK OUT OF SENATOR ANDERSON
THE AGENCIES POINT OF VIEW BUT
THEN YOU'RE TO ONE US THE
RUBBER MEETS THE ROAD RIGHT
TRYING TO PUT THAT TOGETHER-
WHAT WOODY AND- HI SOON YOU'RE
FAMILIAR TO AUDITOR'S REPORT.
SO WHAT. THE. THE BARRIERS TO
TRYING TO GET THE TO BUILD THE
NETWORKS YOU NEED TO BUILD- AND
ALSO TO TRY TO MINIMIZE THE USE
OF- OTHER OF PROVIDE
ARRANGEMENTS WHERE PEOPLE HAVE
TO THAN TRAVEL FARTHER AWAY AND
SO FORTH- AND- ACTUALLY DODGE
DID NOTE THAT TO BE ONE PLAN
THAT SEEMS TO BE ABLE TO
CONTRACT AND THE OTHER PLANNED.
ISN'T SO CONTINUE THE SO MAYBE
FIGHT THE- BILL SPEAKS THAT
CELL YEAH MAKE A FEW COMMENTS
ABOUT. JUST THE CONTRACTING
APPROACH THAT WOULD REALLY
FOCUS ON ENSURING THAT WE HAVE
ALL THE LARGE THE WHITE
HEALTHCARE SYSTEMS. AS WELL AS
THE TERTIARY HEALTH CARE
SYSTEMS AVAILABLE FOR SPECIALTY
CARE EXAMPLES OF THAT COULD BE
UC DAVIS UC SAN FRANCISCO. YEAH
COUNTY SYSTEMS AND CHILDREN'S
HOSPITALS PUTTING THEIR
PHYSICIAN GROUPS- AND REALLY
LOOKING TO MAKE SURE THAT THOSE
ARE ALL AVAILABLE TO OUR
MEMBERS. I THINK WHERE WE YOU
KNOWHAVE CERTAIN AREAS YEAH
LOCAL COMMUNITIES THAT ACTUALLY
MAY ONLY A PROVIDERS MAILING
CONTRACT WITH ONE PLAN. YOU
KNOW WE TYPICALLY- SEE THAT AS
A RESULT OF CAPACITY AT THE
PROVIDER LEVEL- THEY YOU KNOW
SOMETIMES WILL. ONLY BE WILLING
TO OPEN UP TO ONE PLAN OR THE
OTHER BECAUSE OF YOU KNOW THEIR
THEIR CAPACITY- WE TEND OF DEAL
WITH THOSE ISSUES- BY WAY OF
SINGLE CASE AGREEMENT- AS IT
RELATES. TO CASES. BUT WE'RE
CONTINUOUSLY MONITORING
OPPORTUNITIES THE CONTRACT IN
FACT SO ALSO OFFERING AN OPEN
NETWORK MODEL. BY WAY OF
REACHING OUT LEVERAGE OUR
NETWORKS ON THE COMMERCIAL SIDE
AS WELL AND IN TERMS OF THE
RELATIONSHIPS WE HAVE EITHER.
MEDICARE COMMERCIAL. AND LEFT A
INCH FOR THE OFF. ON TRACK FOR
MEDI CAL MANAGED CARE AND YOU
KNOW IN ANY IS IN WERE ABLE TO-
BRING THOSE IN. AND JUST THE
LAST- AMONG REBEL OUT OF FORTY
TWO SPECIALTY. BY LARA ARKHAM
NETWORKS. BUT A- HEARING ABOUT
THAT. AS ECHO ONLY IS NOT GEN
PROVIDE AND NOT EXPECT MEDICARE
TO BE THE GENEROUS. BECAUSE YOU
TALK ABOUT LEVERAGING YOUR
NETWORK AND SO I MEAN I'M A
PHYSICIAN NAY THAT AND THAT WAY
HERE FROM OTHER POSITIONS IS
THAT- OKAY YOU SOMETIMES IT'S
ARE LIKE WELL YOU KNOW YOU TAKE
THE COMMERCIAL THEN WE WANT TO
TAKE THE MEDICAL OR EIGHT IT IS
SO THIS. IS AND SO I DON'T KNOW
HOW MANY PEOPLE YOU ACTUALLY
HAVE ON YOUR MEDI CAL NETWORKS
WHERE YOU DON'T HAVE NOW MAYBE
BECAUSE OF JUST WANT TO TAKE
FROM THE COMMERCIAL OR THE
MEDICARE BY. BUT TO WHAT DEGREE
I GUESS AND EIGHT I GUESS THE
QUESTION IS THAT. THAT PEOPLE
MOST TWENTY THREE ONE DO YOU
SEE PROVIDERS ACTUALLY WILLING
TO TAKE THE MEDIC HOW. A
CONTRACT ON ITS OWN WITHOUT
HAVING TO SAY THAT WELL BECAUSE
WE BUNDLE THAT WAS SOMETHING
ELSE NOW YOU'LL TAKE IT IN THE
LORD'S REPAYING ENOUGH AND THAT
WE PROVIDING A HIGH ENOUGH RATE
SO THAT YOU CAN ACTUALLY TRACK
PROVIDERS. TO ACTUALLY JUST
TAKE THEM CAL CONTRACT WITHOUT
HAVING TO SAY WELL ACTUALLY
WILL YOU ALLOW ONLY TAKE THE
MEDICAL CONTRACTED I GET THE
OTHER CONTRACTS. I MEAN I THINK
IT'S ACTUALLY IT'S COMMUNITY IS
THERE DEFINITELY HAS ITS OWN
NUANCES OF FOR EXAMPLE. YEAH WE
ARE WILLING TO OFFER COMMERCIAL
RATES OR UP TO MEDICARE RATES
IN CERTAIN CIRCUMSTANCES- WHERE
THEY THEY WOULD LIKE TO CONTACT
WITH ALL PRODUCTS AT A AT A
SPECIFIED RATE WE'RE WILLING TO
LOOK AT THAT- ESSENTIALLY
OFFERED THE SAME RATE FOR
EVERYTHING RIGHTS OF YOU SEE
PATIENT IN OUR NETWORK WHAT IS
MEDI CAL MEDICARE OR COMMERCIAL
WE PAY THE SAME RATE AS THAT WE
TALKING ABOUT. IT WE CAN I'M
SAYING IS INDIVIDUALIZED IN
TERMS OF. WHAT WHAT MARK YOU
WHAT WHAT PARTICULAR SPECIALTY-
YOU KNOW WHAT PARTICULAR AREA
THAT WE'RE SERVING- IF THERE
ARE YOU KNOW ANY GAPS IN
SPECIALTY CARE AND WE ONLY
HAVE. YOU KNOW A SMALL VOLUME
SPECIALS THAT EVEN EXIST IN
THAT PARTICULAR COUNTY AT THAT
POINT WE CAN SIT DOWN AND- AND
SOME KIND. OF THE VERY LOW
INCOME. WHERE THEY DON'T HAVE A
COMMERCIAL POPULATION TO SERVE
AND THEY WERE WELCOME HAVING A
MUCH LARGER MIX OF. COMMERCIAL
PATIENTS HOWEVER THEY THEY AND
THEY AREN'T IN THE COMMUNITY.
AND THEREFORE THEY'RE MORE
INTERESTED IN CONTRACTING FOR
THE MEDICAL. OF PRODUCT BECAUSE
THAT'S REALLY WHAT THE
COMMUNITY. THAT THEY'RE SERVING
SO YOU FEEL LIKE YOU'RE ABLE TO
OFFER A SIGNET AT A AT A GOOD
NOT FREIGHT THAT THEY'RE
WILLING TO THAT'S ABOUT THAT'S-
I MEAN. I THINK OUR
EXPERIENCES. HONESTLY IT IS
IT'S LESS ABOUT RATES AND IT
TENDS TO BE ABOUT CAPACITY ON
THE PROVIDER WILLING TO- OPENED
THE DOORS I THINK TO THE MEDIC
CALLED MANAGED CARE POPULATION.
AND HOW YOU KNOW HOW MUCH-
ACCESS THEY'RE WILLING TO
PROVIDE WELL LET ME LEAVE PUSH
BACK ON THAT JUST A LITTLE BIT
AND- LIKE TO PUSH BACK AND
EXPLORE THAT A LITTLE BIT IS
THAT- SO. D. E. AREA FOR WRITER
DATE YOU CAN ONLY SEE SO MANY
PATIENTS RIGHT NOW. THEN THE
QUESTION IS THAT HOW THEY- THAT
AND THE OTHER THING YOU ALSO
HAVE TO DO IS BE SURE THE
PRACTICE MAKES ENOUGH MONEY TO
YOU KNOW THEY HAVE TO PAY THE
RENT DEBTS PAID STAFF STAFF TO
YOU KNOW PAY FOR SUPPLIES AND
ALL THAT OTHER STUFF TOO. SO
WHEN YOU SAY CAPACITY SOMETIMES
THE CAPACITY ISSUES BECAUSE I
LOVE THAT'S RIGHT I MEAN MOST
OF THE SESSIONS I KNOW- DON'T
WANT TO TURN AWAY MEDI CAL
PATIENTS. RIGHT NOW I MEAN
THEY'RE NOT DIDN'T DECIDE TO BE
DOCTORS INTIMACY MEDICAID- BUT
THEY ALSO RECOGNIZE IN ORDER
FOR THE PRACTICE TO BE VIABLE
THEY CAN'T HAVE TOO MANY. IT
WILL BE THE MEDI CAL PROVIDER
AND HAVE IT'S LARGER BECAUSE
IT'S ACTUALLY UNSUSTAINABLE
THIRTY COULD NOT. THE PRACTICE
COULDN'T STAY ALIVE. AND SO.
I'M JUST TRADERS SAY THAT WHEN
YOU'RE HAVING THAT CONVERSATION
AND PERHAPS IT'S ALSO ONE THAT
WE SHOULD HAVE MORE DIRECTLY
WITH THE PROVIDER. IS THAT I
IT THE REASON THEY THEY ONLY
HAVE A CERTAIN AMOUNT OF
CAPACITY FOR THE MEDI CAL
PRODUCT BECAUSE- THAT'S AS MUCH
AS THEY'RE ABLE TO DO. FISCALLY
FURTHER PRACTICE AND STILL KEEP
THE PRACTICE IN BALANCE-
FINANCIALLY OR IS THAT REALLY
THAT CAPACITY THAT THEY YOU
KNOW REALLY HAVE BECAUSE THEY
GOT PAID ENOUGH THEY COULD THEN
TAKE ON NOW THE FORCE DOWN IT'S
A MIX OF DIFFERENT PEOPLE RD
COULD EXPAND AND TRY TO BRING
SOMEONE ELSE ON BORDER. BRING
ON SOME MORE YOU KNOW OTHER
STAFF SAYS THAT THEY CAN
ACTUALLY SEE IF YOU MORE
PATIENCE. I'D I DO THINK IT
VARIES QUITE A BIT I THINK IN
SOME CIRCUMSTANCES ABSOLUTELY
THE FISCAL ISSUES I THINK OTHER
CIRCUMSTANCES A VERY MUCH A
CAPACITY ISSUES ARE. HOW MANY
PATIENTS PARTICULARLY WITH THE
INDIVIDUAL PHYSICIANS. I WE
WE'VE TEND TENDED MORE RECENTLY
THE FOCUS OF ON THE HOSPITAL
SYSTEMS ENSURING THAT WE HAVE
ALL OF THE SPECIALISTS THAT ARE
ADMITTING TO OUR NETWORK
HOSPITALS. AND FOR EXAMPLE IN
RURAL AREAS WE'VE CONTRACTED
WITH EVERY AVAILABLE HOSPITAL.
AND IS PART OF THE SWEEP AND
YOU KNOW THE KIND OF. VIEW OF
HOW WE CAN EXPAND THE NETWORK
REALLY CAN'T EVERYONE THAT HAS
PRIVILEGES TO MAKE SURE THAT
THEY ARE IN THE NETWORK AND
OPEN TO OUR- TO OUR MEMBERS.
THE THOSE ARE YOU KNOW SOME
OPPORTUNITIES WERE KIND OF
LOOKING OVER WE'VE ALREADY. YOU
KNOW TOUCHED EVERY INDIVIDUAL
POSSESS THE PHYSICIAN IN THE
COUNTY AND NOW WE'RE LOOKING.
TO MAKE SURE WE'VE WE'VE
ACTUALLY HAD ALL OF THE DOCTORS
THAT ARE. PRIVILEGES THAT ARE
WORK FOR SO I THINK ALL OF THE
APPROACHES- YOU WITNESSES
SITUATIONS VERY- LIKE I CAN SAY
THAT IT'S OFFICE SCHOOL. OR
IT'S ALL CAPACITY THINK IT'S A
VARIETY DEPENDING ON. YOU KNOW
WHICH PARTICULAR COMMUNITY WERE
WERE DISCUSSING AND FILL ALL OF
THOSE WILL BE GOOD IF WE COULD
FIND SOME WAY TO QUANTIFY
REALIZE YOU MIGHT NOT HAVE THAT
INFORMATION. BUT I MEAN IT'S-
I'M NOT SURE IT IS A MIX THE
QUESTIONS HOW MUCH OF A MEAL.
EXACTLY WHAT IS THAT MIX RIGHT
SIR. AND LIKE I SAID IN SOME
COMMUNITIES I THINK THERE THERE
ARE A LARGE POPULATIONS OF
ADDITIONAL PRODUCT LINES FOR
THEM. AND THERE ARE MARKETS
WHERE THE MAJORITY OF WHAT.
POSITION ARE SERVICING OUR ARE
ACTUALLY ON THE COMMERCIAL
SIDE. BUT THEY ARE WILLING TO
ACCEPT SOME MEDICARE ALL. AND
YOUR POINT ABOUT THE FISCAL
SITUATION- LARGELY THAT THAT
MIGHT BE WHY THEY WOULD. NOT BE
OPEN TO ALL PLANS LET'S SAY IN
A GEOGRAPHIC AS KERR COUNTY FOR
EXAMPLE OR- EVEN ONE. OR THE
OTHER NOT TO MODEL. AND THAT
REALLY IS SOMEWHAT EXTRA.
EASIER YOU KNOW THAT IN ONE
CASE. AND SO FORTH IDEALISTIC
DO WHAT YOU SEE IS THE
CHALLENGES IN TERMS OF. THAT
WELL THE- THE NETWORK ADEQUACY
LIKE THAT WE'RE ALL GOOD
LAWYERS AND YOU'VE AYE ARE ALL
GOOD I'M NOT GUESSING SO.
YOU'RE NOT BUT- TERMS OF WITH
THE CHALLENGES OF MEETING THOSE
STANDARDS AND THE RATES THAT
WERE THAT YOU'RE ABLE TO
NEGOTIATE. YEAH CERTAINLY SO
OBVIOUSLY OUR GEOGRAPHY PLAYS A
BIG ROLE SO THAT IS CHALLENGE
IF YOU'RE LOOKING ZIP CODE BY
ZIP CODE OF COURSE- YOU KNOW IT
AND IN CERTAIN AREAS YOU JUST
RUN INTO. JUST A LACK OF
PROVIDERS AND- FRANKLY A LOT OF
TIMES A LACK OF PEOPLE IN
GENERAL SO. OF COURSE THERE IS
CHALLENGES JUST BASED ON
GEOGRAPHY- WE ALSO DO
EXPERIENCE CHALLENGES BASED ON
CERTAIN SPECIALTY TYPE AND SO.
YOU KNOW TO YOUR PRIOR. COMMENT
ABOUT YOU KNOW RACE WE DO
OFTEN- I THINK. YOU REFERENCE
THE IN THE HEARING THREE YEARS
AGO WERE IN THAT BUT WHERE WE
WILL OFTEN SORT OF TAILOR OUR
RATE BASED ON THAT. THE DEMAND
THAT SERVICE AND THE NEED A
FAST SERVICE SO. YOU KNOW WE DO
FIND OURSELVES PAYING MORE
THAN. THE FEE FOR SERVICE RATE
OFTENTIMES. THE OTHER THING I
WANT TO MENTION HIS YOU KNOW
WHAT A CHALLENGES. PHYSICIANS
WELL WHERE IT'S A FINITE
RESOURCE SO. YOU YOU KNOW WE'VE
DONE SOME CREATIVE THINGS IN
TERMS OF RECRUITMENT AND
RETENTION AND GRANT DOLLARS IN
TRYING TO DRIVE MEMBERS OUR
COMMUNITY BUT WERE OFTEN JUST
TAKEN THEM FROM ANOTHER
COMMUNITY FOR ABLE TO CONVINCE
HIM TO GO SO. IF EVERYONE
ACROSS THE STATE'S DOING THAT
WERE BASICALLY JUST READ FROM
THE SAME PYRITE SO- I DID WANT
YOU KNOW AT LEAST NOTE THAT AND
THEN ON THE LOCAL LEVEL. YOU
KNOW WE DO A GAP ANALYSIS OF
OUR NETWORK I THINK YOU
MENTIONED YOU KNOW COMPARING TO
COMMERCIAL NETWORKS AND- THAT
WE DON'T OFFER A COMMERCIAL
PRODUCT FOR NICE TO MEDI CAL.
PLAN SO WE DO TAKE A LOOK OUT
THERE AND SEE WHICH DOCTORS ARE
IN OTHER NETWORKS THAT AREN'T
IN OURS AND HOW DO WE CLOSE
THAT GAP AND YOU KNOW IT'S AN
INDIVIDUAL CASE BY CASE BASIS.
OFTENTIMES ABOUT. HAPPENS BUT
WE DO WANT TO AT LEAST-
APPROACH THAT. AND HAVE THE
MOST ROBUST NETWORK THAT WE CAN
AND THEN. YOU KNOW THEY'LL
GOING TO MENTION THAT WE DO
HAVE A LARGE MEMBERSHIP OR
COUNTY SO. YOU KNOW IT JUST.
MAKES ARE ABLE TO USE. JUST
THAT THE NUMBER OF MEMBERS THAT
WE HAVE IN OUR SIZE- TO. HELP
US TO NEGOTIATE CONTRACTS
BECAUSE YOU KNOW IF YOU WANT TO
GET. MEMBERS TO THE DOOR WE
HAVE MEMBERS. SO OFTENTIMES ARE
ABLE TO SAY HERE YOU CAN GET
LEASE CAN SEE MEMBERS. ANY
OTHER QUESTIONS OKAY WELL I
THANK YOU BOTH FOR YOUR-
PRESENTATIONS AND FOR THE
ANSWERS TO THE QUESTIONS WE
LOOK FORWARD TO THE YOUNG
CONTINUING WE WANNA MAKE SURE
THAT- EVERYTHING WORKS HERE
AND- YOU KNOW YOU PLAY VERY.
VITAL ROLE AND MAKE SURE THAT
OUR MEDICAL PIECE GET THE CARE
THEY NEED SO THANKS FOR MUCH
THANK YOU THANK YOU ALL RIGHT
SO THE BRING UP OUR NEXT PANEL
WHICH IS OUR MEDICAL PROVIDERS
CONSUMERS AND I WANT TO
WELCOME- KELLY BOMB LEDGE THAT
COULD FOR THE CALIFORNIA
MEDICAL ASSOCIATIONS SAY
ROMANOWSKI CO WITH THIS ACT SAN
FRANCISCO COMMITTEE CLICK
CONSORTIUM. WHEN THE- TO NARROW
LISTS THAT RIGHT OKAY SENIOR
POLICY ADVOCATE TELEPHONE PAN
ETHNIC HEALTH NETWORK AND- MIKE
ODA DIRECTOR OF. HEALTH POLICY
CHILDREN NOW WELCOME SO. ASK
YOU CAN KEEP YOUR MARKS THE
THREE MINUTES AS YOU CAN SEE WE
OFTEN HAVE LOTS OF QUESTIONS SO
THERE'S OPPORTUNITIES FOR EVEN
MORE EXPLORATION. WELCOME GOOD
AFTERNOON CHAIRED MEMBERS
NUMBER- KELLY BEING OF THE
CALIFORNIA MEDICAL ASSOCIATION
REPRESENTING OVER FIFTY
THOUSAND PHYSICIANS ACROSS
CALIFORNIA. I WANTED AYE
STRAIGHT INTO ONE OF THE
QUESTIONS THAT WAS PROVIDE
PRESENTED TO ME- ABOUT THE
CHALLENGES THAT PROVIDERS FACE
WHEN TRYING TO PARTICIPATE.
PARTICIPATE IN MEDI CAL.
CALIFORNIA'S HEAVILY DOMINATED
BY LARGE MANAGED CARE PLANS AND
THE STATE ALLOWS FOR DELEGATE
ARRANGEMENTS WITHIN THOSE
PLANS. AND THIS IS WHERE IT IS
MORE CHALLENGING PROVIDERS TO
SEE REFER AND COURTNEY CARE FOR
THEIR PATIENTS. IF A PATIENT
NEEDS A SPECIALTY REFERRAL THIS
MAY OR MAY NOT BE IN THE
MEDICAL GROUPS NETWORK. THE
PRIMARY DOCTOR MAY FEEL MORE
COMFORTABLE REFERRING TO
SOMEONE THAT THEY KNOW A
SPECIALS THAT IS KNOWN TO THEM.
BUT THAT'S SPECIALIST MAY OR
MAY NOT BE PART OF PLAN OR THE
GROUPS NETWORK. IF A PATIENT
DOES SEE ESPECIALLY PROVIDER
OUTSIDE OF THAT IT'S HARDER FOR
PRIMARY CARE DOCTOR GET FULL OF.
FROM THAT AS IS PLANS TO.
OVERSEEING THE OF PATIENTS AND
SERVING AS A COORDINATED ENTITY
THIS RESPONSIBILITY MAY BE
DELEGATED TO LARGE MEDICAL
GROUPS OR IPA. IN TURN THOSE
MEDICAL GROUPS RIGHT PEAS MAY
ONLY COORDINATE PATIENT CARE UP
TO THEIR FISCAL RESPONSIBILITY.
THE PHYSICIANS I'VE TALKED TO
CALL THIS PING PONG ANG WHERE
THE PLANET DELEGATED ENTITY OR
INTERPRETING THEIR
RESPONSIBILITIES DIFFERENTLY.
SOMEONE AND HE MAY END UP TO
NINE THE SERVICER PAYMENT
STATING THE OTHER IS PRIMARILY
RESPONSIBLE. DEPENDING ON THIS
RESPONSIBILITY THE MEDICAL
GROUP MAY ONLY BE AT RISK FOR
PRIMARY CARE AND LAB
DIAGNOSTICS. THEY WILL HAPPILY
COURTNEY THOSE PATIENTS UP TO
THAT MEETING- SERVICES BUT AS
SOON AS THEY NEEDS SPECIALTY
CONSULTAR DME SO MEDICAL
EQUIPMENT. THE PATIENT GETS TO
FIGURE OUT ON THEIR OWN AND
THEY DO THEIR BEST TO HELP BUT
IT ONLY I MEAN THEY CAN ONLY DO
SO MUCH SOMETIMES. ESSENTIALLY
THE CONTRACT BETWEEN THE PLAN
AND THE MEDICAL GROUP DICTATES
THE PARAMETERS OF THE PATIENT
CARE COORDINATION. WHAT
MEDICARE MANAGED CARE NEEDS IS
SIMPLICITY MECHANICS OF HOW IT
WORKS AS THE PATIENTS WITHIN
MANAGED CARE COMPLICATED ENOUGH
WITHOUT THE PLANS DELEGATING
RESPONSIBILITY ACROSS MULTIPLE
LAYERS OF ADMINISTRATION. THIS
PUTS ADDITIONAL COMPLEXITY
BETWEEN WHAT SHOULD BE A
RELATIONSHIP BETWEEN THE
PHYSICIAN THE MEDIC HOW MANAGED
CARE PLAN AND THE PATIENT.
LASTLY THE MEDICAL POPULATION
IS INCREDIBLY DIVERSE THEIR
CHALLENGES THAT ARE MORE
SIGNIFICANT A PREDOMINANT THAN
IN THE COMMERCIAL MARKET. LOW
INCOME HOUSING INSTABILITY
LANGUAGE OR EDUCATIONAL
BARRIERS. AND HEALTH ISSUES OR
PHYSICAL DISABILITIES THESE
FACTORS MAKE SUCCESSFULLY
MANAGING CARE MORE DIFFICULT
YET MORE IMPORTANT AT THE SAME
TIME AND HIGHLIGHTS THE NEED TO
CUT OUT UNNECESSARY.
UNNECESSARY COMPLEXITY IN THE
SYSTEM. CALIFORNIA PHYSICIAN
STAND READY TO SUPPORT THE
KELLY MINISTRY OF AS IT IS
SETTING A NEW COURSE AND IS A
STEP IN THE RIGHT DIRECTION
INCREASING THE COORDINATION OF
CARE. BUT IT NEEDS TO MOVE
FORWARD UNDERSTANDING AND TAKE
INTO ACCOUNT THE CURRENT
COMPLEXITY CHALLENGES
PHYSICIANS FACE AND CERVANTES
PATIENTS. THANK YOU. THANK YOU
WELCOME. THANK YOU MISTER CHAIR
AND MEMBERS FOR THE OPPORTUNITY
TO SPEAK TODAY I'M SUMMER
METHOXY THE CEO OF THE SAN
FRANCISCO COMMUNITY CLINIC
CONSORTIUM WE REPRESENT ABOUT A
HUNDRED TWELVE THOUSAND
PATIENTS IN THE SAN FRANCISCO
NEIGHBORHOODS WE ARE ALSO A
MEMBER OF THE CALIFORNIA
PRIMARY CARE ASSOCIATION WE
WORK CLOSELY WITH THEM TO
COORDINATE CARE AT THE LOCAL
REGIONAL STATE AND NATIONAL
LEVEL- TO ADDRESS THE NEEDS OF
CALIFORNIA'S MOST VLNERABLE
COMMUNITIES. TODAY COMMUNITY
HEALTH CENTERS SERVE ONE IN
THREE MEDICARE PATIENTS AND
PROVIDE MORE THAN 50% OF THE
MEDICARE OUTPATIENT ENCOUNTERS
WE BEGAN MEETING WITH UCS STAFF
TO DISCUSS OUR THOUGHTS ON HOW
TO IMPROVE THE ACCOUNTABILITY
AND PERFORMANCE OF THE MEDICAL
SYSTEM AND I'M HAPPY TO SHARE
SOME OF THOSE THOUGHTS TODAY.
IN TERMS OF MODELS OF CARE OF
RECENT STATE AUDIT REPORT FOUND
THAT THE REGIONAL MODEL FOR
ROLE EXPANSION AS UNDER
PERFORMING OR REGIONAL HEALTH
CENTERS ARE REQUESTING THAT THE
PARTNERSHIP HEALTH PLAN MODEL
BE ENCOURAGED TO EXPAND TO
COVER THE ENTIRE REGION OUR
HEALTH CENTERS IN BOTH CRIMINAL
AND SAN DIEGO STATED THEY WANT
TO IMPROVE THE GEOGRAPHIC MAJOR
MODEL BUT IT WILL NOT WANT TO
SEE THE MODEL JETTISONED AT
THIS TIME. IN TERMS OF
ENCOUNTER DATA. IN A CAPITATED
ENVIRONMENT AND CANDIDATE IS
THE KEY TO ALL PARTIES
UNDERSTANDING THE NEEDS AND
SERVICES FOR THE MEDICARE
PATIENT STARTING WITH WHAT
HAPPENS IN THE PROVIDER'S
OFFICE THE DATA TRAVELS THROUGH
MULTIPLE PARTIES INCLUDING EYE
PEAS M. ESOS CLEARING HOUSES IT
CETERA YOU MAY EDIT THE DATA-
OR HAVE SYSTEM CONSTRAINTS THAT
ALTER INFORMATION AS IT FLOWS
THROUGH THEIR SYSTEM.
ULTIMATELY RESULTING IN AND-
AND CORRECTOR ON INCOMPLETE
DATA THAT ALTMAN THEIR PARTY TO
THE STATE OR THE PLAN. WE ARE
ASKING THAT PROVIDERS THEREFORE
GET TIMELY REGULAR REPORTS ON
DATA THAT IS ALTMAN ACCEPTED BY
THE PLAN IN ORDER TO IDENTIFY
PROBLEMS ALONG THE TRANSMISSION
PROCESS. ALL PLAN SHOULD HAVE
THE ABILITY TO DIRECTLY PROCESS
TO SUPPLEMENT A FILE THAT
BYPASSES SOME OF THESE
INTERVENING AUTOMATED PROCESS
SEES FOR COMPARATIVE PURPOSES
TO THE WE CAN IDENTIFY GLITCHES
IN THE SYSTEM. ALSO PRIMARY
CARE PROVIDER SHOULD GET DATA
BACK ON UTILIZATION COSTS. FOR
THE ENTIRE COST OF CARE WITHIN
THE SYSTEM BEFORE TO TRULY BE A
PARTNER IN REDUCING OVERALL
COSTS. FOR QUALITY IMPROVEMENT
THERE ARE NUMBER OF BEST
PRACTICES THAT- WE LIKE TO
HIGHLIGHT ONE IS HAVING REAL
TIME SELF SERVICE PORTALS FOR
OUR PROVIDERS BUT THEY KEEP AND
INFORMATION ABOUT PATIENTS GAPS
IN CARE THERE HE DOES NEED. OF
WHAT HAPPENS SOMETIMES IS THAT
THE PLANTS DON'T PROVIDE THAT
INFORMATION UNTIL THE FOURTH
QUARTER OF THE YEAR. PROVIDING
THESE MASSIVE LISTS AND THEN
THAT LAST MINUTE INCENTIVES. TO
TRY AND TRACK DOWN THOUSANDS OF
PATIENTS WHICH IS REALLY NOT AN
EFFECTIVE WAY FOR US TO SERVE.
ON ADDITIONALLY WE HAVE
SITUATIONS WHERE A HEALTH PLAN
SUBCONTRACT WITH OTHER
AGENCIES. WHERE A LAB RESULTS
DON'T COME BACK IN A IN A WAY
THEY CAN BE INGESTED INTO AN
EHR THEY COME BACK AND HAVE TO
BE MANUALLY RE ENTERED INTO THE
SYSTEM. WHICH FOR PRIMARY CARE
PROVIDER THAT'S ALREADY SHORT
ON STAFF THIS IS AN EFFICIENT
ANNA DELAYS ACCESS TO NEEDED
INFORMATION. WE ALSO LIKE A ON
THE ABILITY TO PARTICIPATE IN
Q. RIGHT COMMUNITIES TO BUILD
Q. I PROGRAMS. SO THAT WE CAN
MAKE SURE THAT THEY REALLY MEET
THE NEEDS OF THE COMMUNITY- WE
ALSO WOULD WANT TO SEE HEALTH
PLANS HAVE LOCAL STAFF AND
PRACTICE TRANSFORMATION COACHES
IT CAN WORK IN AREAS. THAT WE
SERVE THANK YOU. DOCTOR PAN AND
SENATOR LEAVE A- MY NAME IS
LINDA TO NARROW ITS NUMBER
SENIOR POLICY ADVOCATE WITH THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK. WE ARE IS STATEWIDE
ADVOCACY ORGANIZATION THAT
WORKS TO ADDRESS HEALTH
DISPARITIES AMONG CALIFORNIA'S
UNDERSERVED COMMUNITIES. WE
APPRECIATE THE INVITATION TO BE
HERE TODAY AND SHED LIGHT ON
THE CONSUMER EXPERIENCE. WITH
THE HEALTH CARE SYSTEM AND
PROVIDE SOME SOLUTIONS AND
OPPORTUNITIES FOR CHANGE AND
IMPROVEMENT. DESPITE GAINES HAD
IN THE NUMBER OF CALIFORNIANS
AND ROLLED INTO HEALTH CARE.
DISPARITIES IN HEALTH OUTCOMES
CONTINUE TO EXIST FOR
COMMUNITIES OF COLOR AND MEDI
CAL. OVER THE PAST YEAR THE PEN
CONDUCTED A NUMBER OF FOCUS
GROUPS. ACROSS THE STATE WITH
THE GOAL TO ENGAGE DIVERSE
STAKEHOLDERS AND CONSUMERS IN
MEANINGFUL DIALOGUE. ABOUT
THEIR EXPERIENCES IN ACCESSING
CARE AN IMPASSE ON THEIR WELL
BEING. OUR FOCUS GROUP FINDINGS
AND COMMUNITY STORIES HIGHLIGHT
STARK DISPARITIES. AND THE
MENTAL BARRIERS IN ACCESSING
CARE. PARTICIPANTS REPORTED
HAVING LONG WAIT TIMES BOTH FOR
APPOINTMENTS AND AT THE
FACILITIES THEMSELVES. THEY
ALSO REPORT A LACK OF ACCESS TO
SPECIALTY CARE AND MENTAL AND
BEHAVIORAL HEALTH.
TRANSPORTATION BARRIERS
ESPECIAL ESPECIALLY IN RURAL
AREAS IS ALSO CONCERNING ONE OF
OUR FRESNO PARTICIPANTS FOR
EXAMPLE WHO IDENTIFIES AS LOT
NEXT FINDS IT CHALLENGING TO
ARRANGE TRANSPORTATION TO MAKE
THEIR APPOINTMENTS. THE OFTEN
GET ASKED FOR RIGHTS FROM ELDER
LEAVE MAKES THAT GOAL-
COMMUNITY MEMBERS WHO ARE
UNABLE OR FREE TO DRIVE- OUT OF
FEAR OF GETTING PULLED OVER THE
POLICE. WE'VE SEEN A GREAT LACK
OF AFFIRMATION OF LANGUAGE
RIGHTS AND INTERPRETATION
SERVICES. TO PARTICIPANTS WHO
IDENTIFIED AS API AND LET NEXT
WERE NOT INFORMED OF THEIR
RIGHTS TO AN INTERPRETER OR
OFFERED THE ASSISTANCE WHEN
THERE WAS A CLEAR NEED. IN THE
TIMES THEY HAVE BEEN GIVEN
ENTER SERVICES THE QUALITY WAS
INCONSISTENT AT FAST. WE KNOW
THAT WHEN IT COMES TO MEDICAL
CARE COMPREHENSION AND
INTERPRETATION IS ESSENTIAL.
LANGUAGE AFFIRMING SERVICES
BUILDS TRUST BETWEEN PROVIDERS
AND PATIENTS AND THIS OFTEN
GOES MISSING. FOR PATIENT
ENGAGEMENT INCLUDING IN
ADEQUATE EXPLANATIONS ABOUT
MEDICATION MEDICAL PROCEDURES
OR HOME CARE INSTRUCTIONS HAVE
LEFT PEOPLE FEELING RUSHED TO
MAKE DECISIONS OR BOMBARDED
WITH PAPERWORK. ADDITIONALLY
PROVIDER STIGMA OR JUST
RESPECTFUL TREATMENT BASED ON A
PERSON'S LANGUAGE RACE SEXUAL
ORIENTATION GENDER IDENTITY
DISABILITY STATUS OR SIZE AND
WEIGHT IS ALSO HARMFUL. AN
AFRICAN AMERICAN PARTICIPANT
WHO HAD COME IN WITH THAT DOWN
ABDOMINAL PAIN DUE TO GASTRITIS
WAS ASSUME TO BE ON OUR CAUGHT
IT. ANOTHER DISABLED
PARTICIPANTS DOCTOR WAS
ASTOUNDED THAT THEY HAD ASKED
FOR AN S. T. D. TASK BECAUSE
THEY HAD ASSUME THAT THEIR
PATIENT COULD NOT BE SEXUALLY
ACTIVE. SEVERAL FOCUS GROUP
PARTICIPANTS HIGHLIGHTED THE
IMPORTANT ROLE THAT COMMUNITY
HEALTH WORKERS AND PURE
ADVOCATES CAN PLAY IN HELPING
INDIVIDUALS UNDERSTAND THEIR
CARE INSTRUCTIONS WHILE ALSO
COMBATING DISCRIMINATION AND
HARMFUL STEREOTYPES. THESE ARE
JUST A HANDFUL OF STORIES THAT
WE WERE ABLE TO IDENTIFY AS A
RESULT OF OUR FOCUS GROUP
FINDINGS HOWEVER PLENTY MORE
EXIST AROUND THE STATE AND
CONTINUE TO STRUGGLE WITH
FINDING. ACCESS TO HEALTH CARE.
HOWEVER WE SEE GREAT
OPPORTUNITIES FOR THE STATE TO
EXECUTE ENFORCEMENT AND ALSO
TAKE THE LEAD ON IMPROVING
QUALITY AND ACCESS. THE CAL AND
PROPOSAL- SEEKS TO TRANSFER NEW
RESPONSIBILITIES TO MANAGED
CARE PLANS FOR IMPLEMENTATION
OF THE NEW ENHANCED CARE
MANAGEMENT BENEFIT PACKAGE. AND
I'M SORRY- WRAP UP- AND IN LIEU
OF SERVICES- WE THINK IN
GENERAL THAT THE STATE CAN
REALLY TAKE A CLOSER LOOK AT
WHAT PLANTS ARE DOING TO REACH
IS. VERY BASIC EXISTING
REQUIREMENTS BEFORE- TASKING
PLANTS WITH MORE
RESPONSIBILITIES- WEEPING FOR
INCENTIVES CAN BE PROVIDED TO
REACHING THOSE GOALS- AND MORE
INFORMATION- CAN BE PROVIDED ON
OUR WEBSITE. THANK YOU. A
OFFICIALS OF VEGETABLE GARDEN
YOU SHOULD THE FOCUS GROUP YEAH
WE LET THE IT LITERALLY JUST
WENT LIVE TODAY SO WE JUST
FINISHED OUR MANY BRIEF SO WE
ARE HAPPY TO. SO ENCOURAGE IT
WOULD CERTAINLY IF UP THE DARK
COMMITTEE AND ALSO WITH THE
FARM IF YOU HAVE THAT DONE SO.
THANK YOU WELCOME. THANK YOU.
GOOD AFTERNOON MICHAEL DAY
DIRECTOR OF HEALTH POLICY
CHILDREN NOW WE'RESTATEWIDE
MULTI ISSUE CHILDREN'S RESEARCH
AND ADVOCACY ORGANIZATION
APPRECIATE THE OPPORTUNITY TO
BE HERE TODAY. AS WE POINTED
OUT IN OUR NEWLY RELEASED-
TWENTY TWENTY CALIFORNIA TROLLS
REPORT CARD KIDS ACROSS THE
STATE ARE NOT GETTING THE
HEALTH SERVICES THEY NEED TO
FIND A LEGAL GUARANTEE. I KNOW
THIS IS A NEW TO THE COMMITTEE
WITH THE I WAS MENTIONED
EARLIER- BUT THE GOVERNMENT
ACCOUNTABILITY OFFICE ALSO
RELEASED REPORT LAST YEAR
SHOWING THAT CALIFORNIA WAS IN
FIFTH PLACE IN TERMS OF. WELL
BABY SCREENING. SO THIS PUTS
OUR KIDS AT RISK ACROSS YOUR
YOUNGEST KIDS AND UNDERMINES
OUR PRESENCE WE MADE AN EARLY
CHILDHOOD. UNDER THEIR MEDICAL
pCONTRACTS HEALTH PLANS ARE
EXPECTED TO PROVIDE CHILDREN
WITH THE REGULAR SCHEDULE
PREVENTIVE SERVICES INCLUDING
WELL CHILD VISITS SCREENINGS
VACCINATIONS. AS WELL AS
TREATMENT THEY TELL ME NEED- IN
COORDINATION WITH CARVED OUT
SERVICES LIKE DENTAL CARE. IN
EXCHANGE TEACH YES WHICH
OVERSEES AND ENFORCES THOSE
CONTRACTS PAYS A MONTHLY
PAYMENT WHETHER OR NOT THE
SERVICES ARE ACTUALLY PROVIDED.
SO WHAT THE CONTRACT AND
PAYMENT SYSTEMS ARE COMPLEX AND
OPAQUE THE OUTCOMES WE'VE SEEN
OVER THE PAST DECADE FOR KIDS
ARE PROBLEMATIC. BUT THE
SOLUTION IS CLEAR WE MUST
CHANGE THE RULES AND BEGIN
PAYING HEALTH PLANS BASED ON
QUALITY AND RESULTS. AS THE
ADMINISTRATION WORKS TO
REDESIGN MANAGED CARE
CONTRACTING AND PROCUREMENT
EACH YES SHOULD RESTRUCTURE THE
MEDICAL PAYMENTS FOR CHILDREN
SERVICES. ENSURE DELIVERY
PREVENTIVE CARE. TO SUPPORT
CARE COORDINATION. AND TO
REWARD PLANS FOR IMPROVEMENTS
INSURANCE ALL OUTCOMES WHILE
ALSO STEP. IN CONSEQUENCE FOR
FIFTH YEAR. FIRST THE BASE
MEDICAL CARE PORTION OF THE
PAYMENT SHOULD REQUIRE A
MINIMUM SPEND THE MINIMUM
PRIMARY CARE SPAN. FOR
PEDIATRIC PRIMARY. AFTER
PREVENTIVE CARE. SO PLANS THAT
DO NOT MEET THIS MINIMUM LEVEL
OF SPENDING ON CHILDREN'S
PRIMARY CARE WOULD BE REQUIRED
TO REPEAT THAT THOSE SOME FUNDS
BACK TO THE STATE. AT SOME. I
FELT. REALLY THE RATE INCLUDING.
FOR CARE COORDINATION. TIED TO.
METRICS THAT MEET THE AND
BEFORE THE NEEDS OF ALL
CHILDREN JUST THE PERCENT KIDS
WHO. HAVE THE MOST INTENSIVE
AND EXPENSIVE NEEDS. AND
FINALLY A PAYMENT STRUCTURE
SHOULD ALSO PROVIDE FINANCIAL
INCENTIVES FOR DEMONSTRATING
YEAR OVER YEAR PERFORMANCE
IMPROVEMENT IN AREAS LIKE
DEVELOPMENTAL SCREENINGS.
CLOSELY PREFER ALL RATES
REDUCTIONS IN RACIAL ETHNIC
DISPARITIES AND INVESTMENT IN
SIR SOCIAL SERVICE SUPPORT FOR
CHILDREN AND THEIR FAMILIES.
THESE REFORMS ARE DESIGNED TO
PROMOTE VALUE QUALITY IN EQUITY
THE VERY GOALS THAT TEACH CS IS
LAID OUT ITS QUALITY STRATEGY.
SO IF WE SAY IT'S IMPORTANT FOR
PLANS TO PROVIDE QUALITY CARE
AND IMPROVE HEALTH OUTCOMES FOR
KIDS IN THE WAY IN WHICH TO PAY
PLAN SORT OF. THOSE PRIORITIES
LOOK FOR TO WORKING WITH YOU IN
THE DEPARTMENT- TO MAKE SURE
THAT ALL CHILDREN RECEIVE AND
THE CARE THAT THEY NEED. THANKS
OKAY THANK YOU THANK YOU SO
MUCH FOR ALL FOR YOUR
PRESENTATIONS QUESTIONS YES SIR
LEYVA. AND OF UP TO SPEED NOW.
THANK YOU. SENATOR PAN THANK
YOU FOR THE GREAT PRESENTATIONS
VERY HELPFUL. I HAD A QUESTION-
FOR KELLY. KELLY IS A BONE.
GAME SORRY ABOUT THE THAT'S
EASY TO REMEMBER THANK YOU FOR.
YOU TALKED ABOUT- CUTTING OUT
THE UNNECESSARY COMPLEXITY IN
THE SYSTEM I COULDN'T AGREE
MORE ANY IDEAS ON HOW WE DO
THAT YOU KNOW WHAT I THINK IT
WOULD GO A LONG WAY TO MAP THE
DELEGATE IN NETWORKS TO KNOW
THAT THE NETWORKS ARE ACCURATE
AND IT'S NOT JUST I WOULD SAY.
LIKE A CRUTCH THAT THE PLANS
ARE ABLE TO CONTRACT WITH THE
DELEGATED ENTITY VERSUS OTHERS
BECAUSE AND WE'RE CONVENIENCE
IF WE DON'T KNOW WHAT'S OTHER
UNDERNEATH I THINK THAT THAT I
WOULD GO A LONG WAY IN
INCREASING TRANSPARENCY AND AT
LEAST- CREATING A MORE
EFFICIENT SYSTEM GOOD SO IF
THEY DO EXIST WE SHOULD JUST
KNOW HOW HOW THEIR EXISTING.
GOT IT THAT MAKES A LOT OF
SENSE YES THINK THE OTHER THING
THAT'S IMPORTANT IS THE PRIOR
AUTHORIZATION. AT SOME OF THE
SITE PIECE HALF BECAUSE DELAYS
CARE INCREASE. YOUR SET TO. I
MAY NOT BE OP. THAT THE NETWORK
IS ADEQUATE BUT THE ABILITY TO
GET THOSE REFERRALS MAY BE
CONSTRAINED THROUGH OTHER
PROCESSES. OKAY YEAH I CAN
AGREE WITH YOU MORE THAT I HAVE
ANOTHER QUESTION FOR YOU. I'M
GONNA SAY THIS WRONG BUT YOU
SAID THAT THE LAB RESULTS ARE
NOT COMING BACK. IN EITHER A
USABLE READABLE FORM. WHO DO
YOU NOT HAVE THE EQUIPMENT I
HAVE WE NOT EQUIPPED YOU WITH
WHAT YOU NEED OR THE LABS NOT
SENDING IT BACK TO YOU IN THE-
CORRECT FORM. SO IN A DELEGATED
ARRANGEMENT AT A PUBLIC
HOSPITALS DOING ON THE LAB WORK
IN THEM THAT INFORMATION FROM
THE PUBLIC HOSPITAL DOESN'T
COME BACK TO THE HOUSE CENTERS.
IN A WAY THAT CAN BE INGESTED
INTO THEIR EHR. SO SOMEONE HAS
TO SIT THERE AND RE ENTER THAT
INFORMATION AT THE PRIMARY CARE
AND- THAT'S JUST UNACCEPTABLE
NO I TOTALLY AGREE SO HOW WOULD
WE FIX THAT- I JUST THINK WHEN
YOU'RE LOOKING AT THESE
DELEGATED OF. MEN'S REALLY
ASKING SOME OF THE- THE SECOND.
QUESTIONS THE THERE ARE THREE.
I PUT. HOW LAB. MISSION IS
TRANCE. BACK WOULD REALLY
HELPFUL YEP I THINK THAT SEEMS
LIKE A PRETTY EASY FIXABLE
THING YES I WOULD SAY THAT SEEM
IS LOOKING AT SOME TRAILER BILL
LANGUAGE THE GOVERNOR POSTED
UNDER THE NEW- I THINK CENTER
FOR INNOVATION. AND IT HAS TO
DO WITH THE INTEGRATION OF EHRS
AND YOU KNOW MAKING THE SYSTEMS
MORE ABLE TO COMMUNICATE SO.
THAT SOUNDS CAN PROVIDE YOUR
OFFICE WITH MORE INFORMATION
I'LL BE GREAT THAT BE VERY
HELPFUL THANK YOU ALL VERY MUCH
THANK YOU MISTER CHAIR. THANK
YOU- SO I COULD BE JUST THE-
SORT OF FOLLOW UP ON THAT AND-
THAT'S WHY IS HE STILL TABLE
HERE SO WE TALKED ABOUT. THAT
OVERSIGHT OVER THE DELEGATED
MODEL APPRECIATE THAT YOU'RE
GOING TO ASK THEM TO ALSO
CERTIFIED OR NETWORK ADEQUACY-
TO WHAT DEGRE E. ARE YOU.
GOING TO ALSO- FOR EXAMPLE
SHOULD THEY- SHOULD ARE YOU
EXPECT THEM TO FOR EXAMPLE
SHARE THE CONTRACT THEY HAVE
THE DELEGATED ENTITY SO YOU
KNOW WHAT THE EXPECTATIONS WERE
SO. WE ARE DEVELOPING PINING.
SO THAT THE- IF YOU GET
COMPLAINTS ARE THERE ARE
PORTERS. IF YOU SEE ACCESS
PROBLEMS. AT THAT. THERE'S
POSTED A IF THERE'S A DISPUTE
BETWEEN V. DELEGATE MODEL ON
THE PLANET TECHNICALLY OF
COURSE YOU HAVE A CONTRACT WITH
THE PLANS OF THE PLAN. YES BUT-
IN TERMS OF HELPING RESOLVE
THOSE THINGS OR- BE ABLE TO. TO
AS AN AGENCY. BE SURE OF THE-
THAT THEY IS RAPID RESOLUTION
AS THESE TYPES OF DISPUTE SO
YOU KNOW HOW PROVIDERS AND
ULTIMATELY SPENT OFFICIERS
GETTING CAUGHT IN THE MIDDLE
WHAT DO YOU THINK ARE SOME OF
THE THINGS THAT THE AGENCY
MIGHT THINK ABOUT. DOING IN
TERMS OF OVERSIGHT OVER
DELEGATED- ENTITIES. TO HELP.
PRESERVE THE RESOLVER OR-
PREVENT THESE ISSUES MAPPING SO
I THINK THE DEPARTMENT IS STILL
LOOKING AT A NUMBER OF THINGS
THAT WE YOU ARE CORRECT WE ONLY
CONTRACT WITH THEM THE PRIME
PLAN RIGHTS ON THE ERM THAT WE
USE- BUT WE DO HAVE WE ISSUED-
AND ALL PLAN LETTER TO ALL OF
OUR MANAGED CARE PLANS IN
REGARDS TO. OUR EXPECTATIONS IF
THEY ARE GOING TO DELEGATE NOT
ALL OF OUR MANAGED CARE PLANS
DELEGATE ON TO THE DEGREE IN
WHICH WE'RE TALKING ABOUT TODAY
BUT THERE ARE POCKETS OF
CALIFORNIA WHERE THERE IS A LOT
OF DELEGATION JUST TO BE CLEAR
AND FAIR TO THE CONVERSATION
AND SO. ON THERE IS A THERE IS
A LETTER WE DO LAY OUT OUR
EXPECTATIONS WE DO EXPECT THAT
ANY OF THE FUNCTIONS THAT THEY
ARE DELEGATING TO THE INTO
BECAUSE THERE'S DIFFERENT TYPES
OF RELATIONSHIPS- THAT THAT
THEY ARE RESPONSIBLE FOR
MEETING ALL OF. THE DEPARTMENTS
EXPECTATIONS SO WHATEVER OUR
CONTRACT WITHIN THOSE
PARAMETERS- DELEGATING THAT.
ENTITY IS RESPONSIBLE COMMUTER
EXPECTED IN THE MANAGED CARE
PLAN IS RESPONSIBLE TO AUDIT
AND OVERSEE THAT INDIVIDUAL AND
SEE. UP THE LAST YEAR'S BEEN
TIGHTENING UP THERE SO ARE OP.
FOR US TO LOOK AT IT CLEARLY
OUR OPTIONS MOVING FORWARD IN
REGARDS TO THE DELEGATED I'M A
NETWORK ADEQUACYOCCASIONS.
WE'LL BE LOOKING AT OTHER TO
NEEDS IN REGARDS TO OVERSIGHT-
BOUNCED TEAM- AS- I. USED AND
TENCHI THREE. PROCESS OF WAYS
IT MADE. TIED UP. IN THOSE.
CONTRACT WILL RELATE. CONTRACT
CLING OUR CALL BACK DOOR
INSTEAD. TO MAKE SURE THAT IS
CLEAR. OVERSIGHT AND MONITORING
OF THOSE DALY INTO. OKAY. AT
THE END OF THE DAY THE ANSWER
FOR ALL SO THERE'S A CAR. OF
WHO RESPONSE FOR THE PAY. OF IN
THAT PROVIDE NEEDS TO PAID AND
SO. YOU KNOW OUR RESPONSE
RELIGIOUS SAY THE PLAN YOU ARE
ULTIMATELY RESPONSIBLE FOR THAT
PROVIDER GETTING PAID.
REGARDLESS YOU KNOW WHETHER
FIGHTING OVER THE DOUGH FOR THE
DIVISION OF FINANCIAL
RESPONSIBILITY AT CETERA. IN
TERMS OF THE ISSUE PRIOR ALSO.
THE DELEGATED ENTITIES ARE HELD
TO THE SAME STATE LAW THE PLANS
ARE ALL TOO. YOU KNOW WHICH IS
FIVE DAY PERIOD DEPENDING ON
WHETHER YOU CAN DO AN EXTENSION
WITH NOTIFICATION TO THE
MEMBER. SO YOU KNOW IT'S THE
PLANT'S RESPONSIBILITY TO
MONITOR THAT THOSE DELEGATED
ENTITIES ARE. PERFORMING THEIR
PRIOR AUTHORIZATION FUNCTION
AND IN THE EXACT SAME TIME
FRAME. AND TO MAKE SURE THEY'RE
REVIEWING YOU KNOW DIALS SO
THAT IS PART OF THEIR OVERSIGHT
PROCESS. TO ENSURE THE NILES OR
IF THERE ARE A NILES THAT
THEY'RE BEING DONE
APPROPRIATELY. SO I THEY YOU.
TO SEIZE POINT I MEAN IT'S OUR
JOB TO ABSOLUTELY MAKE SURE THE
PLANS UNDERSTAND AND THEY DO.
THERE OWN. RESPONSIBLE DON'T
DISAGREE THAT THERE ARE THERE
ARE TING TING IN OVER THE- OF
FNANCE RESPONSE COP BUT SO.
YOU KNOW THEY GOAL OF THIS BUT
AT THE END OF THE DAY I MEAN.
YOU KNOW USE USE THE COURSE OF.
THE CITY. REGIS PEOPLE ARE NOT
GETTING PAID. REMEMBER TO NOT
GET THE CARE THEY BECAUSE THERE
AN APPROACH AND I'LL WHICH- I
MEAN TO BE. THE REFERENCE TO
EXAMPLES OF PROBLEMS WERE THE
THAT WAS ONE OF THE CORE
PROBLEMS. OUT IN A GUESS WHAT
IT SAYS IS THAT. INSANELY TRACY
TO PATIENT OUT IN THE MIDDLE OF
THESE THE SPEEDS WE SHOULD KEEP
FIGHTER OUT IN THE MIDDLE TO
SPEEDS AND- I KNOW YOU MADE
REFERENCE ALSO THE DMA SEE
INSIDE THEY HAVE A ROLE IN
REGULATING PLANS BUT ESPECIALLY
FOR THE- CAL PROGRAM. I HOPE IS
THAT- THAT THE AGENCY WOULD
HOLD PLAN RESPONSIBLE FOR BEING
SURE THAT PROVIDERS FOR SO I
GET TIMELY PAYMENTS OF DOING A
PING PONG THAT PLAN CAN PAYS A-
PROVIDER THEN AND THEN COLLECT
IF THEY FEEL LIKE IT'S NOT.
THEIR RESPONSIBILITY COLLECT
FROM THE DELEGATE AND ANY LIKE
THE TWO OF THEM CAN CONTINUE MY
KEEP BATTLING IT OUT THE BELL
OUT EACH OTHER RIGHT NOW. I
WANT TO THE CONTRACT WITH EACH
OTHER SO. POSITION YET.
THREATEN TO THEIR ORIGINAL
CONTRACT TO FIGURE OUT WHO ENDS
UP HOLE YOU KNOW WHO AND WHERE
THE MONEY. FOR THE MONEY
EVENTUALLY TO AND THEN THE
OTHER PART IS IN TERMS OF THE
PRIOR OFF AND SO FORTH. IS THAT
IF YOU'RE GOING IT'S ABOUT
PRIOR OTT'S FROM PHYSICIANS FOR
MEDI CL FOR. OUR NOSES OTHER
PROVIDERS THAT. BASICALLY THAT
THE PLAN GETS PENALIZED. IF THE
I. T. A. IS. DOING SOMETHING
AND THAT IT'S UP FOR THE PLAN
TO THEN FIGURE OUT HOW THEY IN
THEIR CONTRACT WITH THE I. P.
EIGHTY OR WHATEVER DOWN AGAIN
ENTITIES AND- VIBER PROJECT
VISION THEY HAVE TO COLLECT
THAT PENALTY BACK OF THEY FEEL
IT'S REALLY NOT THEIR
RESPONSIBLY AGAIN BECAUSE YOUR
CONTRACT WITH. THE PLAN BUT WHY
DON'T WANT TO DO IS HAVE A
SITUATION WHERE THE CLINIC IS
SITTING THERE HITTING AT THAT
YOU KNOW BEING YOUNG THE
THERE'S A VIOLATION OF THE LAW
ARE THERE. NOW WITH A SICKLY
NOT RESPONDING- AND THE ONLY
RECOURSE THEY HAVE IS ACTUALLY
TO. AGAIN FIGHT WITH THE IT'S
WHETHER IT'S THE- DELEGATE ANY
OR THE PLAN. AND BASICALLY
STARTS THERE'S STILL NOT
GETTING PAID THAT- THAT AGAIN
DOWN THE PLAN OF THE PLAN TO
DEL AGAIN ANY CAN BATTLE IT OUT
BUT- THE- BUT- BASICALLY. THEIR
X. WITH THAT YOU KNOW THEY'RE
EXPECTED IF THEY DON'T GET THE
FIRE OFF IN THE FIVE DAYS AND
IT'S AUTOMATICALLY AUTHORIZED
AND- THEY DON'T MAKE IT. GEN
AND BOOM SORRY THE PLANS PAYING
FOR THE PLAN CAN COLLECT FROM
DELEGATE ENTITY. THAT EITHER
THAT MAKE A DECISION. RIGHT SO
THAT WE CAN TRY TO KEEP THAT
THE PROVIDERS OUT FROM THE
MIDDLE OF THESE TWO AND THE-
AND ULTIMATELY OF COURSE MOST
IMPORTANTLY THE BENEFICIARY THE
PATIENT TO SOMEONE WHO DOESN'T
NEED TO HAVE A LOOK. CARE I
MEAN THAT'S WHAT WE REALLY WANT
SURE IT HAPPENS THE END. A
QUICK. THING OUT SO I WILL SAY
THE- PHYSICIANS. SPECIALISTS
ARE YOU A LOT MORE. WHEN THEY
TO GO. WITH THE MANAGED CARE.
OR W. AS THE I THINK. THEY ARE
ABLE TO SAY THERE AND THEY- SAY
WELL FOR THIS CERTAIN PROCEDURE
IN ADDITION TO THE RATE I'M
ALSO GOING TO NEGOTIATE I GET
TO FOLLOW UPS THAT ARE INCLUDED
I DON'T HAVE TO ASK FOR PAR
OFF- AND SO I THINK THAT
THEY'RE GETTING MORE SO. COULD
IN THAT REGARD IN THAT BETTER
SERVES XIN AND THEIR- BETTER
ABLE TO. CREATE EFFICIENCY IN
THEIR PRACTICE BUT THEN ALSO
TIMELY AS FOR THE PATIENT
BECAUSE THEY DON'T HAVE TO WAIT
FOR THAT AUTHORIZATION FOR THIS
THIRD. BUT THIS MESSAGE.
COMMENTED SOMETIMES WHAT. WITH
PHYSICAL THIRD IS YOUNG SOME
HAS A SIR. THAT BURKE. A
CONSIST PHYSICAL THERAPY. AND
THEY'LL BE TWO VISITS ARE THREE
VISITS AND SO AUTHORIZED THAT
TIMELY. BUT THEN YOU WAIT
ANOTHER FIVE DAYS AND THEN BY
THE TIME YOU CAN'T GET INTO THE
PHYSICAL THERAPIES OFFICE. IT
WAS ANOTHER WEEK SO YOU'VE GOT
CARE GAPPING CARE CARE GAPPING
CARE. BECAUSE OF THE WAY SOME
OF THESE PRIOR AUST PARTICULAR
FOR THINGS LIKE THERAPY AND OF
HAPPENING. ON IT'S JUST A BUILT
IN DELAY. THAT SLOWS DOWN THE
PROGRESS OF A PATIENT'S CARE.
SO IT'S OF YEN MORE
OPPORTUNITIES FOR OVERSIGHT-
AND- DEL CERTAINLY. NOW I THINK
THEY'LL GET MODEL HAS ITS PLACE
IN MEDI CAL SO NOT OPPOSED TO
DELEGATE MODEL BUT- THE STATE
DELEGATE. DELEGATION SHOULD NOT
THEN RESULT IN MORE OVERHEAD
PAPERWORK FOR PROVIDERS ARE
BEEN. OF RESULT OF THAT THEY
SHOULD THE STANDARD SHOULDN'T
CHANGE THE INTERFACE WITH THE
FIGHTER SO- THEN I GUESS THE
OTHER QUESTION I HAVE SO
ACTUALLY IN TERMS OF ACCESS TO
CARE ONE THE ISSUES I KNOW
THAT'S COME UP IS AN
INTERPRETER SERVICES RIGHT SO
WELL WE'VE- ALL SPEAKING
NUMEROUS LANGUAGES- LIVE
EXPERIENCES MYSELF AS A MEDICAL
PROVIDER AND- IT. GIVE IF
PATIENTS SHOW UP AND BE ABLE TO
GET TIMELY INTERPRETER SERVICES
UNFORTUNATELY ITIS IT HAS
SITUATION WHERE BASICALLY PLAN
SAID WHILE THE PATIENT ACTUALLY
HAD TO SCHEDULE WITH THE
INTERPRETER WITH THE PLAN WE
COULDN'T DO IT OF COURSE NOW
THAT THE PATIENT WHO DOESN'T
SPEAK ENGLISH THAT'S WHAT THEY
NEED INTERPRETER TO FAMILY- LA
IS. THEIR INTERFACING WITH
SOMEWHAT THE PLAN WHO DOESN'T
NECESSARILY SPEAK THE LANGUAGE
OR THE NEXT USE ANOTHER TERM
FOR SERVICE TO TALK TO THE PLAN
PERSON TO STUDENTS SCHEDULED
INTERPRETER. ENOUGH DAYS IN
ADVANCE TO DENSE HOPEFULLY
SHOWS OF THE CLINIC AT THE
RIGHT TIME SO WE CAN ACTUALLY
OF AN INTERPRETER AND THEY
ACTUALLY AND WHEN WE GOT THE
WRONG PERSON WE'LL TRY CALLING
THE CLINICS AND CLINIC. AND
THEY SAID WELL YOU'RE THE
CLINIC YOU CAN'T SCHEDULE
INTERPRETER ONLY THE PATIENT
CAN PART OF PATIENTS FAMILY CAN
SCHEDULE INTERPRETER. SO THAT
BASICALLY CAME ALMOST WASTED
VISIT BECAUSE THE PATIENT WAS
THERE I AM FORTY DIDN'T SPEAK
THAT LANGUAGE. THE ONLY COULD
SPEAK LIMITED NUMBER LANGUAGES
AND- AND SO- WHAT CAN WE DO SO
ANYWAY AND- DO YOU HAVE SOME
THOUGHTS ABOUT AXIS INTERPRETER
SERVICES. YEAH I MEAN THIS IS
JUST BEEN A CONTINUED PATTERN
ON THAT WE'VE SEEN FROM OUR
COMMUNITY PARTNERS AND I THINK
TO THE EXTENT THAT WE CAN MAKE
SURE THAT. YOU KNOW THERE IS A
AN ADEQUATE- WORK FORCE
AVAILABLE TO PROVIDE THESE-
INTERPRETATION SERVICES THAT
ARE SO CRITICAL AND SO TIMELY-
WE WANT TO MAKE SURE TAT ARE
ALL. ARE OF HIGH QUALITY- AND
YOU KNOW HOW THE- THE
VERNACULAR AND NECESSARY TO
COMMUNICATE IS VERY COMPLEX
MEDICAL TERMINOLOGIES- CITY
CENTER WE CAN KIND OF BOOST UP
YOU KNOW THE- WORK FORCE IN AND
MAKE SURE THAT THERE IS YOU
KNOW. FOR ONE THE
INTERPRETATION PHONE LINES ARE
ALSO THERE SOMEONE THERE TO
ANSWER QUESTIONS IN A TIMELY
BASIS- ENSURE THAT PEOPLE CAN
GET THAT CAN ACTIVITY IN REAL.
IS SO I GUESS. FROM MY
EXPERIENCE JERRY THIS IS LOW
ANECDOTAL BUT I MEAN I THINK
THAT THE REASON WE SEXY CENTERS
NOT TRANSLATE THERE'S IS
ACTUALLY YOU DON'T. NEED IT'S
NOT A DIRECT TRANSLATION OF
WHAT THE PERSON SAID UNION
INTERPRETER WHO CAN CONVEY NOT
ONLY THE WORKERS BUT ALSO THE
TONE THE BODY LANGUAGE AND SO
FORTH SO YOU CAN. BUT
ULTIMATELY. SO WHEN WE FIGURE
OUT SO BECAUSE THIS IS ABOUT
ACTON. NETWORK ADEQUACY AND
RATE SETTING THIS SECTION. SO
OBVIOUSLY NOT WELL SO THAT SO
IN TERMS OF MEDICAL
INTERPRETERS HOW DO WE- DOES
THAT FACTOR IN IN TERMS OF. THE
PLANS ARE EXPECTED TO PROVIDE
THEM CORRECT SO. SO HOW DO WE
SEE WHEN WE DO RATE SETTING AND
NETWORK ADEQUACY DO WE HAVE
STANDARDS AROUND THOSE LEVEL OF
INTERPRETING THAT'S- THAT. THAT
TO BAILABLE TO. AND IT. WAS
BELT IN THE- I MEAN THERE'S A
NEW CLASS BECAUSE THEY NEED BE
PAID THEY SHOULD BE PAID.
CONTINUE TO LOOK INTO IT TO
MAKE SURE THAT PEOPLE HAVE EASY
ACCESS TO INTERPRETATION
SERVICES BUT YES IT IS BUILT
INTO THE TO THE MANAGED CARE
PLAN MAKE ON THE ADMIN
COMPONENT OKAY AND I APPRECIATE
TO GO. ALSO IN TERMS OF THE
LEVEL OF ACCESS TO THE INTER-
SO. AND THIS RECOGNIZING THAT-
WHAT WE SHOULD DO IS PUT THE
BURDEN ON THE PATIENT. TO HAVE
TO FIGURE OUT HARD TO PATIENTS
FAIL THE I. T. CARE KIDS OF. TO
THE FAMILY TO HAVE TO SCHEDULE
THESE THINGS. WHEN THEY HAVE A
LANGUAGE BERIA STARTLE HAS
WHICH IS WHY WE NEED
INTERPRETER FIRST PLACE- YES. I
WOULD ALSO JUST ADD TO THE
MPORTANCE OF INTERPRETERS IN
MENTAL HEALTH CARE- THAT IS
PROBABLY THE MOST. CRITICAL
COMPONENT OF ENSURING THAT YOU
KNOW INFORMATION IS BEING
SHARED AND YOU KNOW VERY
SEAMLESSLY- WE KNOW THAT A LOT
OF PEOPLE HAVE ACTUALLY BEEN.
HARMED BY YOU KNOW RECEIVING
MENTAL HEALTH CARE FROM SOMEONE
WHO DIDN'T HAVE LINGUISTIC-
SKILLS OR ON CULTURAL
COMPETENCY AND THEN THAT
PATIENT IS KIND OF FURTHER
TRAUMATIZE AND DOESN'T WANT TO
COME BACK. TO SEE A PROVIDER
SO- ENSURING THAT WERE- BE SURE
WE HAVE CULTURAL COMPETENCE- IN
IN LINE WITH OUR OUR-
INTERPRETING. INTERPRETATION IS
IMPORTANT AS WELL. OKAY ALL
RIGHT AND THEN I KNOW- TODAY
YOU HAD SEVERAL SUGGESTIONS IN
TERMS OF- THE ISSUES AROUND
THE- FEATURE WEAKENED UPPER
PERFORMANCE AROUND THE CHILDREN
GETTING THEIR SCREENING AND
PREVENTIVE SERVICES- INTO
WHETHER ANY ANY THOUGHTS FROM
THE FARM ABOUT SOME OF THE
THINGS HE BROUGHT UP I MEAN I
KNOW WE TALKED ABOUT SOME IT
EARLIER BUT AND THAT MEANS THAT
IN TERMS OF EXPLORING-
DIFFERENT IDEAS TO. I THINK YOU
TALKED ABOUT A SET A SET ASIDE
OR SOME AMOUNT OF FUNDS THAT
THEN WOULD BE IF THEY DON'T
FORM THAT WOULD BE. SO CHORE SO
IT'S A IT'S A COMPLEX QUESTION
FIRST ANSWER TODAY AND THINK
THE DEPARTMENT IS CONSTANTLY
LOOKING AND I THINK A BRIDE
MENTIONED EARLIER DIFFERENT
WAYS IN WHICH WE CAN
INCENTIVIZE OUR PLANS NOT JUST
YOU KNOW THE SANCTIONS AND
CORRECTIVE ACTION PLANS WHICH
ARE VERY NECESSARY SOMETIMES
BUT WE ARE THINKING THROUGH A
VARIETY OF WAYS IN THE FUTURE
TO THINK ABOUT RATE SETTING-
BUT THERE'S A LOT OF PIECES WE
HAVE TO CONTEMPLATE FOR THOSE
TYPES OF DECISIONS. YEAH FULL
DISCLOSURE MY AND I HAD THIS
CONVERSATION BEFORE I BECAME
THE DIRECTOR. OF THIS. SO I
THINK. I THINK THERE'S A COUPLE
THINGS OF IN ONE IS WE'VE GOT
TO SIMPLIFY THE CURRENT RATE
STRUCTURE THE CURRENT RATE
STRUCTURES INCREDIBLY COMPLEX
WITH THOUSANDS OF RATE CELLS. I
THINK WE'VE GOT TO GET TO A
PLACE FOR. PAYING PLANS FOR THE
SAME BENEFITS. YOU KNOW IN A
SIMILAR METHODOLOGY AND THEN
THE NEXT STEP WOULD BE TO SAY.
HOW CAN WE GET CREATIVE ABOUT.
PAY FOR PERFORMANCE INCENTIVE-
PRIMARY CARE SET ASIDE IS
COMPLICATED BUT YOU KNOW I GET
THE POINT- SO I THINK I THINK
THIS IS THE TIME FRAME ISSUE
WE'VE GOT TO GET. WERE WAY TOO
COMPLICATED AT THE MOMENT.
RIGHT WELL LEAD TO HOPEFULLY
DERBY CONTINUE DIALOGUE I KNOW
THERE'S A- THERE'S ALSO A
CHILDREN'S ADVISORY COMMITTEE
FOR MEDI CAL TO- TO GET
SOMETHING TO DO WITH THAT- SO.
HOPEFULLY THEY CAN BE ENGAGE
SOME OF THESE ISSUES AS WELL- I
CERTAINLY UNDERSTAND WHAT
YOU'RE- SAYING ABOUT THE
COMPLEXITY IN SOME SENSES HOW
DO WE SIMPLIFY. FIRST SIMPLIFY
SO THAT WE HAVE CLEAR SIGNALS
ALSO BECAUSE ONCE TOO COMPLEX.
NOW ARE THE SIGNALS THAT WE
SEND TO PLANS AND OTHERS- YOU
KNOW GET LOST IN THE NOISE
RIGHT SO WE CAN WE CAN PROVIDE
MORE. CLEAR DIRECTION AND
INCENTIVES FOR PEOPLE AND IS-
ALSO WITH THAT SIMPLICITY
REDUCE THE OVER BUT THE
OVERHEAD BUT THEN FIGURE OUT
HOW DO WE BUILD AND THINK ABOUT
WHAT MECHANISMS WHO UP IN PLACE
THAT. WOULD BOTH BE
ADMINISTRATIVELY PERHAPS- THIS
STRAIGHT FORWARD AND CLEAR AND
STILL ACHIEVE THE AIMS AIMS
THAT WE WANT BUT CERTAINLY
HOPES WE CAN EXPLORE DIFFERENT
IDEAS AND HOW TO GO ABOUT DOING
THAT. THIS IS NEAR AND DEAR TO
MY HEART. THANK YOU AND YES.
YEAH I WOULD JUST ALSO ADD ONS
THAT IN TERMS OF
CONSIDERATIONS- WE'VE SEEN
GREAT PROMISE WITH THE USE OF
COMMUNITY HEALTH WORKERS AND
REALLY KIND OF UTILIZING THEM
TO BUILD THOSE BRIDGES BETWEEN
THE PLANTS BETWEEN PROVIDERS-
AND REALLY IMPROVING. ON
DISPARITIES IN HEALTH OUTCOMES-
SO WE WOULD HIGHLY RECOMMEND
KIND OF BUILDING THAT INTO THE-
KIND OF THE NATURE OF HOW HOW
CARE IS DELIVERED- AND THEN
ALSO ASKING THE DEPARTMENT TO
RELEASE THAT YOU KNOW
AGGRESSIVE TARGETS FOR.
DISPARITY REDUCTION- AND
UTILIZING THESE CREATIVE MODELS
TO BRING IN COMMUNITY PARTNERS
YOU KNOW LOOKING AT POPULATION
HEALTH MANAGEMENT. IN
COORDINATION WITH LOCAL
STAKEHOLDERS TO FIGURE OUT WHAT
THOSE DEALERS- STRATEGY SHOULD
BE AND THEN. YOU KNOW PROVIDING
BONUSES FOR YOU KNOW GOOD
PERFORMANCE AROUND THOSE. YOU
OKAY WELL THANK YOU ALL OF
THANK YOU SO MUCH ROOMS WHEN
YOU FOR YOUR PRESENTATIONS THE
THREE OF US. THE HEALTH
LAFOLLETTE ALL RIGHT THANK YOU.
OKAY NOW WE'RE GOING TO MOVE ON
TO OVERSIGHT OF PLAN RESPONSE
WAS UNDER THE MEDIC HOW WELL
NOW CAL AIM AGAIN SAYS THEY
SAID SO ALL RIGHT SO YOU'RE
BACK ON THE PODIUM FOR. KELLY
WELCOME. HER EIGHT SO YES I
THINK YESTERDAY WHEN- THE
SECRETARY ANNOUNCED THAT I TOP
THAT IT WAS GOING BACK TO KELLY
KNOWS THE LARGEST HERE THAT WE
HEARD OF. MORNING THEY'RE
CALLING IT NAME GATE APPARENTLY
IT'S A THE THING SO- SO YES
WE'RE CALLING IT CALLIN. OF THE
RECALL THE CAL AIM ND STATUS
STATE ADDRESS I THINK IT WAS
DONE THEN. WE AGREE- SO I
THINK- YOU KNOW WE AT THE
DEPARTMENT HAVE BEEN WORKING ON
CAL AIM FOR ABOUT TWO YEARS NOW
WE HAVE THE OPPORTUNITY IN TWO
THOUSAND EIGHTEEN TO ME
PERSONALLY- GO ACROSS THE STATE
OF CALIFORNIA AND HAVE
CONVERSATIONS. WITH VERYONE WE
LITERALLY WENT FROM- NORTHERN
CALIFORNIA AT THE VERY TOP TWO
I'M SOUTHERN CALIFORNIA CENTRAL
VALLEY THE COAST AND HAD
CONVERSATIONS WITH MANAGED CARE
PLANS WE HAD CONVERSATIONS WITH
PROVIDERS BENEFICIARIES OF
COMMUNITY BASED ORGANIZATIONS
REALLY TO HAVE AN UNDERSTANDING
OF. WHAT'S WORKING AND WHAT'S
NOT WORKING MEDI CAL WHERE
THEIR BEST PRACTICES THAT WE
CAN LEVERAGE AND TAKE TO SCALE-
IT AND REALLY HAVE A
CONVERSATION WITH PEOPLE ON DID
A LOT OF INTERNAL DISCUSSION-
THROUGH- THAT THE
ADMINISTRATION TO FIGURE OUT
WHERE THE PRIORITIES ARE WHAT
WHAT SHOULD WE DO- WHERE HOW
CAN WE MOVE THE NEEDLE WITHIN
MEDICARE. ON AND THAT IS THE
CALLIE PROPOSAL THE DEPARTMENT
IN ADMINISTRATION PUT FORWARD
AT THE END OF OCTOBER. THERE'S
THREE MAN GOALS OF CALLIE AND
THE QUICKLY GET INTO THE PIECES
THEN MANAGE CARE AND THE WITH
UBER COMPONENTS OUR MOVIE
FORWARD SO BUT- I THINK IT'S AN
IMPORTANT KIND OF FOUNDATION
FOR WHAT WE'RE TRYING TO DO.
THIS BECAUSE IT IS BROAD IT IS
ACROSS ALL OF OUR DELIVERY
SYSTEMS IT'S DOCTOR. WITH THE
BREAD BUT MEDI CAL CARE BUT
IT'S REALLY LOOKING AT BY
MEMBER. I IN MANAGING A RISKY
NEED TO RECALL PERSON PURCHASE
AND SOCIAL. OF HEALTH WE REALLY
REALLY MEAN THAT THIS PARTY
PROPOSAL OR WANT TO MAKE. A
STEP FORWARD IN REGARD TO PER%
CENTER. ON IT SURE THERE CAN
CARE. THESE PART SEASON OF THE
IN. THE PROPOSAL'S REALLY IT'S
ON AS WELL AS IN A FINE SOCIAL
THE TERM THE HEALTH. IN MAKING
A PRIORITY TO RID THOSE. FROM
OUR SAYS. AND FOR THAT BENEFIT.
YOU ARE HAVE. A NEXT SCHOOL IS
A AT. MORE CONSISTENT
STREAMLINE SYSTEM SO TO THE CON.
TODAY SOMETIMES WHEN WE TALK TO
OUR PROVIDERS WILL SAY WHEN
THEY SEE A MEDI CAL PATIENT ON
THE AMOUNT OF COMPLEXITY IS
SIGNIFICANTLY HIGHER STACK OF
PAPERS VERSES OTHER PATIENTS.
HOWDO WE LOOK AT THE
COMPLEXITY ACROSS OUR SYSTEM
BOTH FOR BOTH THE STATE ARE
MANAGED CARE PLANS ARE
PROVIDERS AND OR BENEFIT. HERE
IS THAT A MORE SEAMLESS SYSTEM
IN A LOT OF OUR PROPOSALS ABOUT
STREAMLINING AND STANDARDIZING
STATEWIDE REALLY SPEAK TO THOSE
PARTICULAR INITIATIVES. ON TO
HELP IMPROVE INCLUDING OUR RATE
OF DEVELOPMENT REALLY LOOKING
AT HOW DO WE SIMPLIFY OUR RATE
DEVELOPMENT PROCESS THESE. ON
TO MAKE THAT AN EASIER PROCESS
AND THEN LAST BUT DEFINITELY
NOT LEAST IMPROVING QUALITY
OUTCOMES TO DRIVE SYSTEM IS
THIS PETE WHY WE'RE- IT IS A
MORE YEAR AND SO WELL THERE'S A
LOT GOING LIVE OR PROPOSED TO
GO LIVE JANUARY ONE TWENTY
TWENTY ONE. IT IS OVER A SERIES
OF YEARS AT THE AT THIS POINT
WE'RE UP TO ABOUT EIGHT YEARS
ON THE ROAD MAP. OF THOSE
CHANGES UNDER CALLIN AND TODAY
KEEP VERY HIGH LEVEL. AND THERE
IS A VERY LONG. ON OUR WEBSITE
WITH MORE DETAILS- I HAVE BEEN
GOING THROUGH A FOUR MONTH
STAKEHOLDER ENGAGEMENT PROCESS
AT THIS POINT. AND WE HAVE BEEN
TAILORING THE PROPOSAL SENSE
THAT WAS POSTED AND SO THE
DEPARTMENT WILL BE POSTING AN
UPDATED PROPOSAL AT THE END OF
MARCH. TO REFLECT ALL OF THE
STAKEHOLDER ENGAGEMENT. SO
FIRST OKAY OF DO A QUICK RUN
DOWN THE WAIVERS AND THE
TRANSITION THERE A HIGH LEVEL
RUN THROUGH OF THE PROPOSALS
AND THEN OF COURSE OPEN FOR ANY
QUESTIONS YOU MAY HAVE- SO. WE
CURRENTLY HAVE A VERY LARGE
ELEVEN FIFTEEN WAIVER ARE
MANAGED CARE THIRTY AS WELL AS
WELL AS SOME OF OUR OTHER
PROGRAMS LIKE WHOLE PERSON CARE
PRIME. GLOBAL PAYMENT PROGRAM
ARE IN THE ELEVEN FIFTEEN. ON
THIS THE FEDERAL GOVERNMENT TWO
THOUSAND EIGHTEEN RELEASED A
MEMO ON THAT CHANGED THE WAY
BUDGET NEUTRALITY IS
CALCULATED. ON THERE FOR AT
THIS POINT CALIFORNIA WILL NOT
BE MOVING FORWARD WITH IN THE
LAB A LARGE ELEVEN FIFTEEN
WAIVER. MOVING FORWARD BUT WE
WILL HAVE A SMALL ELEVEN
FIFTEEN WAY FOR MOVING FORWARD
WHICH WOULD INCLUDE THINGS LIKE
OUR GLOBAL PAYMENT PROGRAM.
WILL PUT PUT THAT FOR TWO SEE
AS FOR. I'M AS- YES. THIRTY
THREE IN AND SOME OTHER OF
POPPY. PASS THROUGHS ARE
REQUIRED THROUGH IN THE- FIFTY
AND THERE'S NOT A- FOR.
AUTHORITY AND THEN WE PLAN ON A
TRANSITIONING OUR MANAGED CARE
OF FORTY FROM THAT ELEVEN
FIFTEEN TO IN NINETEEN FIFTEEN
BE CURRENTLY OUR SPECIALTY
MENTAL HEALTH WAIVER- IS WHERE
WE- WE ALSO HAVE NINETY FIFTY
BE SO WE PLAN ON BUILDING OUR-
MANAGED CARE PLAN. MENTAL
HEALTH AND SUBSTANCE USE
DISORDER MANAGE CARE FUNCTIONS
IN ONE LARGE CALIFORNIA. A
NINETEEN FIFTEEN BE WAIVER. I
THINK FROM THE DEPARTMENT'S
PERSPECTIVE YOU WILL SEE THIS
REITERATE IS ONE OF OUR GUIDING
PRINCIPLES WITHIN CAL AIMS. I'M
IN ADDITION TO THE PRIMARY
GOALS IS REALLY ABOUT HOW DO
WE- INTEGRATE THE DELIVERY
SYSTEM OUTLINED ARE FUNDING ARE
REPORTING OR QUALITY OR
INFRASTRUCTURE TOWARDS COMMON
GOALS. FOR TOO LONG WE'VE HAD
VERY SILO TO- STREAMS ON AND WE
REALLY WANT TO STEP BACK IN IF
WE BUILD IT TO COMPREHENSIVELY
ACROSS OUR DELIVERY SYSTEM.
LOOKING TO WHERE WE AN ONLINE
TO MAKE SURE THINGS ARE VERY
CALM. TREAT EVEN THOUGH I HAVE
HISTORICAL KIND FUNDING PIECES.
CAL THAT EXIST HOW DO WE MAKE
IT A MORE SEAMLESS SYSTEM FOR
BENEFICIARIES IT IS A VERY.
FOCUSED I WOULD JUST WANT TO
NOTE THAT ALLEY MS LARGEST NOT
EVERYTHING KELLY WILL BE IN. A
WAIVER THERE ARETHINGS HAVE
TO. TO STAY PLANET AND THEN. IT
WILL BE ALL OF IT WILL BE IN
OUR MANAGED CARE PLAN CONTRACTS.
IS ON. THEIR ABILITIES. SO LONG
AS CERVANTES. THE BILL HEALTH
MINISTER DONE PROSPECTIVELY AND
INFORMATION NOTICES THE DOES
PLAN ON POSTING HEM PRETTY
SHORTER CHICHI OF ALL OF TWENTY
SO YOU CAN COME OF SEE WHAT
CITY WHAT FEDERAL AUTHORITIES
WE ARE GETTING A LOT OF
QUESTIONS SO WE DO PLAN ON
PROVIDING A CHEESY FOR PEOPLE
TO BE ABLE TO ACCESS THAT
INFORMATION. SO CALLIN HAS A
TWENTY TWO PROPOSALS- IN IT AT
THIS TIME- AND I'M REALLY GONNA
FOCUS ON THE ONES WITHIN THE
MANAGED CARE SPACE AS WELL AS
THOSE GOING LIVE TWENTY TWENTY
ONE FOR A HIGH LEVEL OVERVIEW.
AND TO GET INTO QUESTIONS. SO
THE TWO BIGGEST PIECES THAT WE
HAVE BEEN HAVING A EXTENSIVE
CONVERSATION ON WITH OUR-
MANAGED CARE PLAN COLLEAGUES
WITH OUR PUBLIC HOSPITAL
SYSTEMS IN OUR COUNTIES OR
WORKGROUP IN OTHER COMMUNITY
BASED ORGANIZATIONS AND
PROVIDERS- IS ENHANCE CARE
MANAGEMENT IN LIEU OF SERVICES.
SO FOR ENHANCE OUR MANAGEMENT
THE DEPARTMENT IS PROPOSING A
STATEWIDE A NEW STATEWIDE
BENEFIT- CALLING HIS CARE
MANAGEMENT. IT IS REALLY TAKING
THE IDEA OF INDIVIDUALS WITH
COMPLEX MEDICAL CONDITIONS
OFTEN THOSE RECEIVING COMPLEX
CASE MANAGEMENT BUYER MANAGED
CARE PLANS TODAY. IN TAKING THE
HIGHEST NEED BENEFICIARIES WHO
HAVE VERY COMPLEX MEDICAL
CONDITIONS BUT ALSO A LOT OF
SOCIAL- OR SOCIAL DETERMINANTS
OF HEALTH. AND GIVING THEM A
HIGHER TOUCH OUTSIDE OF THE
FOUR WALLS OFTENTIMES. IN THE
BEAUTY OF FOR HOMELESS FOR
EXAMPLE WOULD STREET BASED TYPE
ENGAGEMENT. ON VERY HIGH TOUCH.
A LOT OF FACE TO FACE ON IT'S
NOT YOUR BILL IN BETTER. RUN A
LIST. ON THE- CASE MANAGEMENT
IS NOT GOING TO WORK WITH SOME
OF THESE. MORE VULNERABLE
HIGHER TOUCH IN JEWEL'S AND SO
REALLY TAKE THE NEXT LEVEL
ENHANCE CARE MANAGEMENT. FOR
THOSE WHO ARE MOST VULNERABLE
WE'RE TALKING ABOUT INDIVIDUALS
WHO ARE HOMELESS HOW YOU TO
EXERT. IS BEING RELEASED. JAIL
AND THEN ALSO THOSE IN LONG
TERM CARE FACILITIES
TRANSITIONING CHILDREN OF
COMPLEX MEDICAL CONDITIONS. UP
TO COMPLEMENT THAT WE ARE
PROPOSING A THIRTEEN IN LIEU OF
SERVICES- INFLUENCERS IS WHEN
YOU LOOK AT THE END THERE'S TO
KIND OF COMPREHENSIVE BUCKETS.
ON THAT WE ARE TRYING TO
ADDRESS ADDRESS. THERE IS A
HOUSING PACKAGE FOR LACK OF A
BETTER DESCRIPTION WHERE WE ARE
LOOKING AT NAVIGATION SERVICES-
LOOKING AT HOUSING DEPOSITS
HOUSING LIAISON SERVICES OF
WHAT SOMEONE IS HOUSE. MAKING
SURE THAT THEY REMAIN HOUSES A
REALLY IMPORTANT PART OF
GETTING THEM INTO PERMANENT
HOUSING. AS WELL AS HAVING
OTHER STEP DOWN OPPORTUNITIES
CALLIN IS REALLY ABOUT LOOKING
ACROSS THE CONTINUUM OF CARE-
FROM BIRTH TO DEATH BUT MAKING
SURE THAT THERE ARE APPROPRIATE
STEP DOWN OPPORTUNITIES
ESPECIALLY FOR YOUR MOST
VULNERABLE. FOR EXAMPLE IF THE
HOMELESS PERSON IS IN AN
INPATIENT SETTING AN OTHERWISE
WOULD BE OF THE DISH CHARGE%
NORMALLY TO HOME TO BE ABLE TO
HEAL. ON MAY BE NEEDING SOME
WOUND CARE OTHER CLINICAL
SERVICES BUT IF A POSITION
DOESN'T FEEL COMFORTABLE DISH
CHARGING THEM TO THE STREET.
THEY MAY LINGER IN THAT
INPATIENT SETTING FOR AN
EXTREMELY LONG PERIOD OF TIME.
ONE OF OUR INTO OF SERVICES IS
RECRUITED OF CARE WHICH WOULD
ALLOW THAT INDIVIDUAL TO BE
DISCHARGED TO A LOVER LOWER
LEVEL OF CARE MORE APPROPRIATE
LEVEL OF CARE. IN CONTINUE TO
RE SERVICERS IN OUR OPINION
ALSO ALLOW SOMEONE TO COME IN
FROM ENHANCE CARE MANAGEMENT BE
ABLE TO ENGAGE WITH THE
INDIVIDUAL AND HOPEFULLY
CONNECT THEM WITH HOUSING
SERVICES. SO YOU'LL SEE A KIND
OF HOUSING SUITE THERE IS ALSO
A LARGE NUMBER OF IN LIEU OF
SERVICES FOCUSED ON HOME AND
COMMUNITY BASED SERVICES.
ANOTHER A HUGE GOAL FOR THE
DEPARTMENT IS ENSURING THE
INDIVIDUALS- CAN SAFELY RESIDE
IN THE COMMUNITIES OF SOMEONE
HAS BEEN IN A SKILLED NURSING
FACILITY. FOR A LONG PERIOD OF
TIME IT WOULD BE CITY FOR THEM
TO RESIDE IN THE COMMUNITY
ALLOWING FOR THE ADDITIONAL A
WRAPAROUND SERVICES THAT ALLOW
THEM TO. LIVE SAFELY IN THE
COMMUNITY AND OUTSIDE OF A
SKILLED NURSING FACILITY IS
IMPORTANT TO THE DEPARTMENT
THIS IS VERY. TO OTHER. MONEY A-
EASY T. IS ALSO A VERY
COMPLEMENT. OF MANY OF THE HOME
TO ME A SERVICES THAT WE- IN
OUR NINETEEN FIFTEEN C. WAIVERS
THAT YOU MAY BE FAMILIAR WITH.
SO THOSE ARE TWO VERY BIG
PIECES THAT THE DEPARTMENT IS
CURRENTLY WORKING ON. WOULD BE
CONTRACTING WITH THEIR MANAGED
CARE PLANS TO DO. YOU ALSO SEE
IN OUR PROPOSAL- INFORMATION
AROUND REGIONAL RATE AS SETTING
SHARED RISK AND SHARED SAVING-
OPPORTUNITIES IN THE OUT YEARS
OF CAL LAME- YOU WILL SEE THAT
WE ARE PROPOSING SINCE. JANUARY
ONE TWENTY TWENTY ONE TO HAVE A
STANDARDIZED BENEFIT STATEWIDE
SO ALL MANAGED CARE PLANS WOULD
BE REQUIRED TO PROVIDE THE SAME
BENEFIT. STATEWIDE BASICALLY
THAT MEANS THAT WE ARE CARVING
IN LONG TERM CARE STATEWIDE AS
WELL AS TRANSPLANTS. CURRENTLY
LONG TERM CARE IS CARVED IN IN
OUR CCI IN OUR COAST COUNTIES-
SO IT'S REALLY TAKING THE REST
OF THOSE INDIVIDUALS AND
CARVING THAT IN- YOU ALSO SEE
THAT WE HAVE. A KIND OF TWO
PHASED A MANDATORY MANAGED CARE
AND ROLL MEANT TRANSITION. SO
WE HAVE STARTING IN JANUARY ONE
TWENTY TWENTY ONE ALL NON TO
WILL POPULATIONS BECOMING
MANDATORY MANAGED CARE
STATEWIDE. THE TWO EXCEPTIONS
ARE THE FEW EXCEPTIONS ARE-
RESTRICTED SCOPE WOULD REMAIN
IN FEE FOR SERVICE SHARE OF
COSTS. WILL REMAIN IN FEE FOR
SERVICE- WE ARE. ESSENTIALLY
SAYING STATUS QUO WHEN IT COMES
TO FOSTER YOUTH INTEL WE-
FINISH OUR FOSTER. ST WORK. I'M
AND THEN COURSE PRESENTED
ELIGIBILITY REMAIN ENVY FOR
SERVICE THERE ARE FEW OTHER
EXCEPTIONS WE HAVE A PRETTY
HEFTY CHART. ON BREAKING IT ALL
DOWN ON AND THEN IN TWENTY
THREE WE PROPOSE ALL DO A
POPULATIONS MOVE IN. THIS WOULD
INCLUDE THAT WE HAVE CERTAIN
ZIP CODES TODAY THAT DON'T HAVE
MANAGED CARE WE ARE PROPOSING
THAT THOSE THAT CODES WOULD BE.
MANAGED CARE ZIP CODES- AND SO
JUST CLARIFYING THAT AS WELL.
YOU'LL ALSO SEE- A SUITE OF
BEHAVIORAL HEALTH CHANGES I
WON'T GET IN THOSE TODAY SINCE
YOUR MAIN FOCUS IS MANAGED CARE
TODAY. HOWEVER THE DEPARTMENT
IS PUSHING A VERY AGGRESSIVE A
REFORM OF OUR BEHAVIORAL HEALTH
SERVICES- INCLUDING PAYMENT
REFORM INTEGRATION AND CHANGES
TO MEDICAL NECESSITY- FOR
BENEFICIARIES- AS WELL AS
RENEWING OUR DMC ODS-WE ALSO
ARE WORKING TO TRANSITION THE
DENTAL- BENEFITS FROM DTI OUR
DENTAL TRANSFORMATION
INITIATIVE. WE HAVE FOUR PIECES
OF THAT MOVING INTO CAL LAME-
AND THOSE WOULD GO LIVE AND
TWENTY TWENTY ONE. THE LAST
THING THAT I'D MNTIONED IN
REGARDS TO THE PIECES HERE
TOUCHING THE MEASURE PLAN. WE
ALSO ARE LOOKING AT A MAN
DATING- WHEN SOMEONE IS
RELEASED FROM INCARCERATION
THAT THEY BE SCREENED FOR MEDI
CAL- UPON THAT RELEASE- IN
MAKING THAT A MANDATE TO DATE
IS VOLUNTARY WE HAVE SOME GREAT
VOLUNTARY PROGRAMS HAPPENING
STATEWIDE. WE WANNA LESS
LEVERAGE THOSE BEST PRACTICES
AND LESSONS LEARNED. ON AND WE
WANT TO MAKE THAT A STATEWIDE
MANDATE BY JANUARY OF TWENTY
TWENTY TWO. THAT INCLUDES A
MANDATED BEHAVIORAL HEALTH WARM
HAND OFF- FROM INDIVIDUALS WHO
ARE RECEIVING BEHAVIORAL HEALTH
TREATMENT WHILE INCARCERATED-
TO THE BEHAVIORAL HEALTH
DEPARTMENTS. ACROSS THE STATE
OF CALIFORNIA. THERE'S THREE
OTHER PROPOSALS- THAT WE ARE
STILL KIND OF EXPLORE THANK
ALSO JUST ONE TO MENTION AS WE
ARE. AT AND GREAT PLAN. ON A
LOT TO WORK THROUGH THERE WERE.
ENTITY BE RESPONSIBLE FOR THE-
SERVICE ARE. AS OUR SUBTLE FOR
DAY AS WELL AS MENTAL HEALTH
AND AS YOU DE AND POTENTIALLY
ALSO THE DENTALS IN THERE. IT'S
A VERY COMPLICATED PIECE THE
WE'RE CONTINUING THE WORKER
PIECES THERE. I'M WE LIKE TO.
IF YOU. IN THE TO STEVE WE HAVE
FULL IN. SO IT'S TO GO BY WE
HAVE. TACK FOR TWENTY TWO. FOUR
FIFTHS OF. DATE WE ARE ALSO
LAUNCHING I'M IN APRIL A FOSTER
CARE A MODEL OF CARE WORKGROUP
WE REALLY WANT TO STEP BACK AND
THINK ABOUT HOW CAN WE PROVIDE
CARE TO FOSTER YOUTH IN
CHILDREN- BETTER- BECAUSE OF
THE- CLASS CITIES OF BOTH.
PHYSICAL AT THE HAVE THE MAIN
THE BEHAVIORAL HEALTH SERVICES
THAT THEY NEED AND NOT ALL OF
THE SOCIAL SERVICES HAD WE
PROVIDE A BETTER SERVICE FOR
THEM- AND THEN LAST BUT NOT
LEAST THE DEPARTMENT IS LOOKING
AT EXPLORING MENTAL HEALTH
CONTINUE OF CARE WAIVER- WHERE
WE WOULD HAVE THE ABILITY TO
DRAW DOWN FEDERAL FUNDS FOR I
AM THE SERVICES ON MENTAL
HEALTH SIMILAR TO OUR S. U. D.
BUT REALLY WANTING TO LOOK AT
IT MORE AND HOW DO WE BUILD
OUR- OUTPATIENT COMMUNITY
MENTAL HEALTH SERVICES. AND
STILL EXPLORING THE PROS AND
CONS OF THAT CONSIDERATION AS
WE CONTINUE TO DO SOME RESEARCH
SO JUST TO KIND OF- DO ONE LAST
PIECE BEFORE WE TURN IT OVER
FOR QUESTIONS- WE KNOW THAT
THIS PROPOSAL IS BIG. AND IT IS
BOLD- WE DON'T WANT THE POLICY
TO FALL SHORT ON
IMPLEMENTATION. ON THAT IS
SOMETHING WE'RE VERY SERIOUS
ABOUT RIGHT NOW SO WE WILL BE.
IMPLEMENTING FOR BOTH THE
ENHANCE CARE MANAGEMENT IN LIEU
OF SERVICE- PIECES. BECAUSE
WHOLE PERSON CARE AND HELP
HOMES WILL BE TRANSITIONING IN
TO ENHANCE CARE MANAGEMENT AND
INTO OF SERVICES. WE WANT TO
MAKE SURE THAT THERE IS A
ROBUST TECHNICAL ASSISTANCE
PROCESS. ON THAT WE ARE
IMPLEMENTING. SO WE ARE
PROPOSING THAT WILL BE ROLLING
OUT A NUMBER OF WHAT WE'RE
CALLING REGIONAL MEETINGS.
WHERE WE WILL COME TO THOSE
MEETINGS INVITING. ON THE WHOLE
PERSON CARE ENTITIES THE CBC IT
MEANS THE MANAGED CARE PLANS
THE COUNTIES- INCLUDING
BEHAVIOR ALL THE PUBLIC HEALTH
DEPARTMENTS. TO ROLL OVER- TO
GO OVER WERE CALLING TOOL KITS.
WHAT ARE THE THINGS THAT YOU
SHOULD BE CONSIDERING HOW DO WE
TRANSITION THESE BENEFITS INTO
ENHANCE CARE MANAGEMENT. AND
REALLY INCORPORATING ENGAGING
PEOPLE AT THE LOCAL LEVEL.
THROUGH THOSE REGIONAL MEETINGS
AND TOOL KIT SESSIONS WE WILL
ALSO BE IDENTIFYING. AREAS
WHERE WE ARE VERY VULNERABLE IN
THE STATE TO SEND WEBER CALLING
STRIKE TEAMS IN- IN THE STRIKE
TEAMS WOULD GO INTO LOCAL
ENVIRONMENTS HAVE CONVERSATIONS
WITH. BUT THERE'S A MANAGED
CARE PLAN. I HOPE CARE IN. TO
CONVERSATIONS AND HELP
FACILITATE. ON THIS TRANSITION
IT IS A BIG TRANSITION AND IT'S
A LOT OF WORK WE WANT THEM TO
BE SUCCESSFUL- SO AS I
MENTIONED WE DO PLAN ON-
POSTING OUR- FINAL PROPOSALS ON
THE- APARTMENTS. END OF MARCH
EARLY APRIL WE- BE THEN HAVING.
OUR WAIVER PUBLIC HEARINGS IN
MAY- HAS A THIRTY DAY PUBLIC. I
THAT WOULD BE UP DO IT ANYWAY
SUBMIT. WITH THE INTENTION
PUTTING OUR WAIVERS YEMEN IN
JUNE OF THIS YEAR. AND THEN WE
WOULD CAN TO NEGOTIATE THE
WAIVERS WE CMS. THIS YEAR. SO
JUST JUST IN SENATOR TADO. I
WANTED TO INTRODUCE MYSELF I'M
DOCTOR BRAG OVER YOUR NEW DH CS
DIRECTOR FROM THE SALE OF. I
THINK IF YOU THINK ABOUT IT
THERE'S BEEN SOME NICE SUCCESS
WITH THE WHOLE PERSON CARE AND
THE HEALTH HOMES PROGRAMS BUT
THOSE WERE VOLUNTARY IN A SENSE
THERE'S- THERE'S- THEY'RE NOT
IN ALL AREAS. AND THEY'RE A
LITTLE DIFFERENT DEPENDING ON
THE PARTICULAR COUNTY AND WHAT
THE ISSUES WERE WHERE IS
ENHANCE CARE MANAGEMENT NOW
BECOMES A STATEWIDE BENEFIT AND
IT'S IN NOW ALL HEALTH PLANS UP
TO DELIVER THIS LEVEL. OF
ENHANCE CARE MANAGEMENT TO
THEIR MEMBERS AND SO YOU GET TO
THE KEY IS WHERE THERE ARE
WHOLE PERSON KAREN AND
HELPFULNESS PROGRAMS OCCURRING
YOU'VE GOT TO MAKE SURE THAT
TRANSITION WORKS. BECAUSE SOME
OF THEM HAVE HAD SUCCESS OVER
CARING FOR THESE VERY
VULNERABLE POPULATIONS IT ALSO
SIGNIFICANTLY INCREASES THE
POPULATIONS THAT ARE TARGETED
THOUGH. SO WHOLE PERSON CARE
AND HEALTH HOMES FOR HEALTH
THOSE FOCUSED MOSTLY ON THE
HIGH UTILIZED THERE'S CALL
PERSON CARE HOMELESS SOME-
JUSTICE INVOLVED SOMEHOW
UTILIZES NOW IT'S SIX DIFFERENT
YOU KNOW POPULATIONS INCLUDING
CHILDREN WITH COMPLEX ISSUES.
INDIVIDUALS AT REST TO GOING TO
A LONG TERM CARE HELPING
INDIVIDUALS TO GET OUT OF LONG
TERM CARE. THEIR HEALTH PLANS
THAT HAVE HAD TREMENDOUS
SUCCESS ON THAT LAST ONE THERE
COUNTIES THAT HAVE HAD GREAT
SUCCESS WITH WHOLE PERSON CARE.
HOW DO WE MAKE SURE THAT ALL
NOW YOU KNOW GOES TO THIS THIS-
STATEWIDE BENEFT WITH THE WITH
THE CM. AND THEN THE TOOLS OF
IN LIEU OF SERVICES TO ACTUALLY
BE ABLE TO MAKE A DIFFERENCE
FOR SOME OF THESE MEMBERS SO I
THINK. IT'S A LOT OF WORK ON
THE DEPARTMENT'S PART- AND IT'S
A LOT OF IT'S A SIGNIFICANT
LIVE FOR HEALTH PLANS AND
COMMUNITIES AND COUNTIES THAT
HAVEN'T NECESSARILY DONE ANY OF
THIS YET. SO THERE'S JUST GOING
TO BE THAT YOU KNOW THAT
TRANSITION WORK THATWE NEED TO
DO WHERE IT'S WORKING. KEEP IT
GOING WHERE IT HASN'T BEEN DONE
HELP THEM FIGURE OUT HOW TO DO
IT SOLUTIONS THERE'S A LOT OF
WORK TO BE DONE BUT- I THINK
IT'S A REALLY REALLY IMPRESSIVE
EFFORT. OKAY THANK YOU
QUESTIONS. I HAVE A FEW KEY
QUESTIONS HERE- SO AGAIN THANK
YOU SO MUCH FOR THE
PRESENTATION IS A VERY HIGH
LEVEL OVERVIEW IT'S A VERY
LARGE DOCUMENT AND THERE'S A
LOT OF MOVING PARTS- ON THE
ENHANCE CARE MANAGEMENT- YOU
KNOW CERTAINLY MAKES SENSE THAT
WE HAVE THESE VERY HIGH RISK
FOR WILL POPULATIONS- THAT.
NEED ADDITIONAL YOU KNOW HELP
AND FOCUS- BUT SOME OF THE
POPULATIONS THAT NIGHT OF THE
SIX CATEGORIES THEY THEY ALL
NEED SERVICE INTENSIVE TOUCHES
AND SO FORTH BUT FOR DIFFERENT
REASONS AND SO I JUST- SO FIRST
OF ALL IS THAT IN TERMS OF
DEFINING WHO AND WHO WHO WHO
WOULD. LATER GO BACK AS A SO
WHAT WE'RE SAYING IS A STATE
WIDE BENEFIT SO THAT MEANS WERE
CALLING ON. EVERY MANAGED CARE
FOR MEDI CAL MANAGED CARE PLANS
TO PROVIDE THEM. IS THAT HOW
WE'RE DOING IT OR SO IT'S
THROUGH SO IT'S THROUGH THE
MEDICARE OUT EACH OF THE MANTA
CAL MANAGED CARE PLANS WHO
WHICH IF THEY HAVE SOMEONE WHO
FITS AND THE ONE OF THE SIX
CATEGORIES AND THEY'RE
RESPONSIBLE FOR THAT. THE WE
ARE WE WILL BE HOLDING THE
MANAGED CARE PLANS THE MEDICARE
MANAGED CARE PLANS REQUIRED- TO
PROVIDE THIS BENEFIT- FOR
INDIVIDUALS THAT THE WAY THEY
IDENTIFY WOULD BE ELIGIBLE FOR
THIS AND THEN ENGAGING WITH
INDIVIDUAL WITH ENHANCE CARE
MANAGEMENT IT IS GOING TO TAKE
IT IS ONE OF THE THINGS THAT
WILL TAKE A LOT OF ENGAGEMENT
WITH AN INDIVIDUAL TO- TO DO
OUTRAGE I GOT OKAY SO. AND THE
THING IS THAT YOU HAVE SOME.
YOUR PLANS STERN SINGLE COUNTY
OF SOME THEIR MULTIPLE COUNTIES
SUTERA. SO YES OF THE- PETERSON
SO YOU MENTION CHILDREN SPECIAL
NEEDS- CERTAINLY NEIL OUR
SERVICES- AND WE FACT IT'S
LIKELY THE CCS PROGRAM LONG
TIME AGO. BUT I AM VERY
CONCERNED THAT WE EXPECT EACH
INDIVIDUAL MANAGED CARE PLANS
TO BE ABLE TO HANDLE THIS
BECAUSE THEIR BIGGEST ISSUE I
MEAN WONDER ISSUES OF COURSE
CORONATION CARES OF WHAT THE
WONDER BIGGEST ISSUES. IS THAT
THEY NEED PEDIATRIC
SUBSPECIALTY CARE WHICH IS. NOT
PRESENT IN EVERY COUNTY THAT IS
IN FACT ACTUALLY MEAN I MEAN.
YOU KNOW CALIFORNIA BIG STATES
SOMEWHERE IN THE STATE
HOPEFULLY BUT SOMETIMES MAY
EVEN NEED CARE THAT OUTSIDE OF
THE STATE IF THEY HAVE A REALLY
SPECIALIZED CONDITION. AND SO.
THAT SO WE'RE TALKING INTENSIVE
TOUCH WHICH IS PERHAPS A LITTLE
DIFFERENT THAN LET'S SAY
SOMEONE WHO'S HOMELESS. WHO
NEEDS A LOT MORE LIKE SOCIAL
SERVICES AND SO FORTH AND
DAMIANA HEALTH AND SO FORTH
BUT- DEAD BUT THOSE SERVICES
MAY BE MORE AVAILABLE. WITHIN
THEIR GEOGRAPHIC LOCATION AND
THEREFORE FOR A HEALTH PLAN THE
MEDICARE MANAGED CARE PLAN.
CONTRACTING FOR THAT MEAL MAY
INVOLVE CORNY COUNTY AND SOME
OTHER TYPES OF STUFF THE NON
PROFITS. BUT THEY'RE ACTUALLY
WITH ANSWER THE CATCHMENT AREA
THAT THE PLAN. NORMALLY
OPERATES AND SO. NOW THAT MAY
HAVE SO THEIR OWN. IN TRYING TO
PROVIDE THOSE RELATIONSHIPS BUT
THAT'S A LITTLE DIFFERENT THAN
SAYING WELL I A NOW NEED A
CONTRACT WITH THE SPECIALIST AT
TEACHERS REGION ATTIC DISEASE
THAT ONLY EXISTS IN BOSTON AND
SAN FIERRO SAN FRANCISCO. AND
ON THE PLAN. DID YOU KNOW DOWN
AND KERN ERROR UP AND YOU KNOW.
ARE AT THE KERN DOES A GREAT
JOB BUT AS THE DAY WERE HERE
SITES ARE PICKED ON A LITTLE
BIT BUT OUR VIEW NO ONE THE GMC
PLANS IN SACRAMENTO AND BEEN
FORTUNE WE CAN'T PROVIDE IT
THAT'S IT UC DAVIS WHICH IS
STILL TERTIARY CARE CENTER. SO
I GUESS I'M CONCERNED ABOUT NOW
WE FRAGMENTED THIS AMONGST ALL
THESE DIFFERENT PLANS IN EACH
pTRYING TO FIGURE OUT HOW TO
CONTRACT WITH THESE VERY RARE
SUB SPECIALISTS. AND IN FACT
MOST F THE POLICY EXPERTS
WOULD SAY ACTUALLY SHOULD
REGIONALES TO CARE FOR THOSE
PEOPLE SO THAT'S DIFFERENT SO I
WOULD SAY THAT YOU KNOW SO. SO
I'M JUST CONCERNED WERE MIXING
UP OF THIS OF THIS CONCEPT OF
ENHANCE CARE I AM ALL ON BOARD
WITH SOUNDS GREAT. I WILL BE
SURE WITHIN THAT POPULATION ARE
WE PROVIDING THE RIGHT KIND OF
STRUCTURE FOR THAT SO WE'RE
TALKING ABOUT LIKE WE NEED TO
ENHANCE. LIKE PROVIDE
ADDITIONAL SAYS NO BETTER
COORDINATION BETWEEN HEALTH
CARE AND SOCIAL SERVICES AND
HOUSING AND SO FORTH. THE
ABSOLUTE VERSES I NEED HIGHLY
SPECIALIZED- YOU KNOW MEDICAL
CARE- HIGHLY SPECIALIZED
SERVICES THAT ARE IN MY
GEOGRAPHIC AREA BUT NOW WE'RE
GIVING IT UP. THAT'S WHERE
PERHAPS IT MAKES MORE SENSE FOR
THE STATE OPERATE AS A WHOLE
THEN TO FARM IT OUT CONTRACT
OUT TO GUESS WHAT OH BY THE WAY
YOU JUST HAPPEN TO HAVE A KID
BUT THE SPED RAREST. CONDITION.
IT'S YOUR JOB TO TAKE CARE OF
THEM. OKAY NOW I HAVE TO FIGURE
OUT HOW TO. DEAL WITH THIS VERY
UNUSUAL SITUATION SITUATION. SO
WHAT I WOULD DIFFERENTIATE THE
MEDICAL CARE DELIVERY FROM THE
CARE MANAGEMENT SO YOUR EXAMPLE
HAVING SENT SOMEONE TO JOHN SAW
CHILD TO JOHNS HOPKINS FOR
EXAMPLE- CCS PROGRAM DOESN'T
CHANGE OTHER THAN YOU KNOW
WORDS ARE ANY CHANGE IN THE
WHOLE CHILD MODEL. SO FROM THE
MEDICAL CARE PERSPECTIVE OF HOW
YOU HAVE TO PROVIDE CARE TO THE
CHILDREN. NOT REALLY CHANGING
IN THAT SENSE SO JUST TO
CLARIFY SO THIS IS THAT A GOOD
THROUGH SEUSS THREE CCS MOST
CASES THEY WOULD GO THROUGH CCS
THE EXAMPLE I GAVE WAS VERY
COMPLICATED AND THERE WAS HE
SAID YOU KNOW TRY TO FIGURE
OUT. WHAT WE'RE NOW ON THE
CHILDREN AREA IS YOU PROVIDE
THE CARE MANAGEMENT TO MAKE
SURE THAT KID GETS TO THE CARE
WHETHER IT'S CCS WHETHER IT'S
PLAN RESPONSIBILITY SO YOU'D BE
WORKING DIRECTLY WITH THE CCS
AGENCY IF THE CHILD AS SERIOUS
MENTAL HEALTH OR SUBSTANCE USE
ISSUES YOU'RE WORKING WITH THE
COUNTY. SO YOU THAT CENTRAL HUB
AT A VERY FACE TO FACE VERY
HIGH TOUCH MODEL MAKING SURE
THAT THE CHILD GOES WHEREVER
THEY NEED TO GO. THAT RESPOND
THAT FUNCTIONALITY TO SOME
EXTENT IS THE PLANS NOW IS AT A
HIGHER LEVEL BUT YOUR POINT
ABOUT IT THE KIND OF SERVICES
IN THE KIND OF PEOPLE THAT ARE
GONNA PROVIDE SERVICES TO
HOMELESS INDIVIDUAL IS
ABSOLUTELY WELL TAKEN AND
THAT'S THE KEY SO FOR EXAMPLE.
I'M THINKING PLANS TO REALLY
THINK ABOUT HOW THEY'RE GOING
TO RELATE AND TAKE CARE OF
HOMELESS INDIVIDUALS THEY'RE
GONNA TO WORK WITH COMMUNITY
AGENCIES THAT HAVE THAT
EXPERIENCE OF GOING TO THE
STREET HELPING TO FIND THAT
PERSON BUT THEN IT'S GOT IT
THEN YOU GOT TO HAVE THE
INTERFACE RIGHT BACK WITH THE
PLAN TO GET ON THE CARE THEY
NEED. A HAND OR TO FIGURE OUT
YOUR OPTIONS AROUND HOUSING AND
OR TO FIGURE OUT ANYTHING ELSE
OF THAT PERSON NEEDS SO YOUR
POINT IS VERY WILL TELL. EACH
OF THE POPULAR TUNES IS GONNA
TAKE A LITTLE BIT DIFFERENT
WORK IS GOING TO TAKE
SPECIALIZED INDIVIDUALS OR
GROUPS OR ENTITY THESE
PARTICULAR COMMUNITY ENTITIES
OR COUNTIES THAT CAN HELP. BUT
IT DOESN'T FUNDAMENTALLY CHANGE
THE MEDICAL CARE DELIVERY
RESPONSIBILITY. SO YOUR.
EXAMPLE WITH THE CHILD NINE
NINE TIMES OUT OF A HUNDRED BE
A CEASE. KID BUT THE PLAN GOT
THIS CARE MAY. THAT'S MAKE A
SURE WE'RE WITH CITIES US. THE
DUTCH SHELL GETS AT THE NEED.
IT'S A PLAY MEMBER. IT THEY ARE
PLAN MEMBER SORRY SO LATE THEY
JUST THE PERSONAL OCCUR SO YOU
HAVE- SO. SOME COUNTIES ARE
BECAUSE OF THE I. ONE PLANT BUT
MANY COUNTY SOME MULTIPLE
PLANS. AND THE AND AGAIN I DIED
THEY GET I LIKE THE IDEA OF
HAVING THIS ENHANCE THE ABSENT
THE OPERATIONALLY. SO DO YOU.
DO YOU HAVE SOME CONCERNS ABOUT
WITH A DUPLICATION SO WE HAVE
GMC HERE IN SACRAMENTO I MEAN
WE'RE TALKING TO YOU ABOUT HOW
WE MIGHT SIMPLIFY IT REFORM AND
SO FORTH BUT YEAH SO- BUT YOU
HAVE PLANS. NOW WHETHER IT'S-
IN DIFFERENT WAYS OF MULTIPLE-
AND SO ARE WE GONNA. EVER GOT
DUPLICATION BECAUSE EACH PLANS
EXPECTED TO DO THE SAME THING
AND EXCEPT THAT NOW THEY HAVE
THIS POPULATION THAT ONE HAS
THAT PART YOU KNOW THIS MANAGE
YOU KNOW THESE PEOPLE SIGNED.
UP AND SO HOW HOW. THEN YOU
HAVE A KEY THE DROP. WELL THE
BE MOST COUNTIES THAT MEET A
COUNTY AND SO IT'S DOESN'T
MAKE. MORE SENSE FOR EACH PLAN
TO HAVE TO DO THIS SEPARATELY
FOR THE THEIR SUBPOPULATION-
AND IF YOU HAVE. A LOT OF PLANS
AND GET EVEN SUBDIVIDED MORE
VERSES. WHAT'S INTERFACE WITH A
BETWEEN. THE COUNTY WHICH IS A
RESPONSIBILITY FOR A LOT OF
THESE DIFFERENT SERVICES- ON
THE SOCIAL SERVICE SIDE. AND
THE- AND THE PLAN IN TERMS OF
WHO'S- WHO'S- RESPONSIBLE FOR
THE CORONATION THESE VARIOUS-
THE FOR THE ENHANCE CARE
MANAGEMENT SERVICES. FIRST I
THINK THE BIGGEST THING TO
REMEMBER ABOUT ENHANCE YOUR
MANAGEMENT IS ACTUALLY NOT A
FUNCTION WELL WE ARE HOLDING
THE MANAGED CARE PLAN
RESPONSIBLE WE ARE EXPECTING
THEM TO CONTRACT WITH. ENHANCE
YOUR MANAGEMENT PROVIDERS FOR
EXAMPLE THE WHOLE PERSON CARE
PILOTS TODAY OFTEN RUN BY
PUBLIC HOSPITAL SYSTEMS OR
COUNTY ENTITIES WE WOULD STILL
EXPECT THAT. WHILE THEY'RE
DOING THEIR WHOLE PERSON CARE
TODAY THEY WOULD ALSO BECOME
ENHANCE CARE MANAGEMENT
PROVIDERS THE MANAGED CARE PLAN
WOULD BE CONTRACTING. WITH
THOSE INDIVIDUALS AND THAT IT
IT THERE'S TWO PLANS I'M GONNA
KEEP IT SIMPLE AND A TWO TWO
PLANS WHEN COUNTY BECAUSE GMC
IS I AGREE MORE COMPLICATED
WITH ALL OF THE PLANS- BUT- YOU
KNOW. WERE HOPING THAT BOTH
PLANS IN EXAM AND THAT EXAMPLE
ON BOTH PLANS WOULD HAVE A
CONTRACT WITH THAT ENHANCE CARE
MANAGEMENT PROVIDER. WHO HAS A
MODEL OF CARE WHO IS SPECIFIC
TO THE HOMELESS POPULATION OR
THE CHILDREN OR WOOD OR THE
TRANSITIONS OUT OF LNG TERM
CARE SO THEY WILL HAVE A BROAD
BASED. VARIETY OF PEOPLE THAT
THEY ARE CONTRACTING WITH
DEPENDING ON THE EXPERTISE THAT
THEY BRING TO THE VARIOUS TOP
TARGET POPULATIONS- AT AND-
MANAGED CARE PLANS WILL HAVE TO
BE PRETTY INVOLVED INTO SURE
THAT THERE IS A GOOD MODEL OF
CARE IN PLACE- BUT- THAT IS
WHERE WE GET OUR FEDERAL.
AUTHORITY IT'S HOW WE CAN BUILD
INFRASTRUCTURE AND HOW WE- DO
ALL OF OUR BENEFITS RIGHT- AND
SO I THINK THAT- WE JUST WANNA
MAKE SURE PEOPLE UNDERSTAND
WE'RE NOT EXPECTING MANAGED
CARE. LANCE TO BUILD THESE
THINGS OUT THEM. THERE MAY BE
PAID PLACES IN THE STATE WHERE
THAT IS NECESSARY RURAL AREAS
WHERE THERE'S NOT. ENOUGH
PROVIDERS BUT WE DON LEE
EXPECTED THEY ARE GONNA BE
CONTRACTING WITH COMMUNITY
BASED ORGANIZATIONS. WITH
COUNTIES- WITH PUBLIC HOSPITAL
SYSTEMS WITH PROVIDERS IN THE
COMMUNITY TO PROVIDE THIS- TYPE
OF SERVICE. AND THE JUST CLEAR
FIVE AND TERM RECALL SO THE
WHOLE PERSON CARE MODEL WHICH
WERE FOLDING THE SEN YES NOW
WAS ACTUALLY IMPLEMENT IN ANY.
IN ANY NON COULD WAS AT
EMPLOYMENT NON BECAUSE ANY NOT
GIVE ME OF SAN DIEGO. AND THERE
WE ARE HAVING COMMERCE AND IN
SACRAMENTO OF COURSE HAS HOLE
IT BUT A WHOLE PERSON CARE NOT
THE COUNTY SELF BUT THE CITY OF
SACRAMENTO OKAY I'M HAS A WHOLE
PERSON CARE PILOT IS WELL- AND
WE ARE ALREADY WORKING WITH
SANDY YOU- IN REGARDS TO THEIR
UP COMMISSION THAT THEY HAVE
DOWN THERE AND HOW THEY'RE
WORKING ON THIS OF HOW WE CAN
EVEN DO STREAMLINED REVIEWS. ON
OUR SIDE SO FOR EXAMPLE IF A
MANAGED CARE PLAN IS
CONTRACTING WITH THE SAN DIEGO
WHOLE PERSON CARE PILOT. I'M
INSURING THAT WE STREAMLINED
OUR VIEWS SO THERE'S NOT SEVEN
SEPARATE REVIEW OF THE OF A
MANAGED CARE PLAN. IS ON TRACK
THAT OUR EXPERIENCE WITH TRYING
TO DEAL WITH MULTIPLE PLAN YEAH
THE SAME AREA UP IN THE SAME
STATE IN THE GEOGRAPHIC SPACE
SO THE DEPARTMENT IS ALREADY
WORKING WITH- SAN DIEGO THEY'VE
REACHED OUT TO US TO PARTNER IN
REGARDS TO HOW DO WE PROVIDE
TECHNICAL ASSISTANCE TO SAN
DIEGO THE PLANTS DOWN THERE- AS
WELL AS AT THE DEPARTMENT'S
REVIEW TO ENSURE THAT THAT'S A
SMOOTH TRANSITION FOR THEIR
WHOLE PERSON CARE- INTO THE
ENHANCE CAN MANAGEMENT. WE
WOULD BE MORE THAN HAPPY TO
ENGAGE IN THOSE CONVERSATIONS
WITH THE CITY OF SACRAMENTO WHO
ALSO WITH PRIDE BEING JING IN
SIMILAR. CHALLENGES NINE. AND
THEN THE TERM OF. SO YOU TALK
ABOUT FULL INTEGRATION AND THAT
YOU SAID THAT'S A FEW YEARS
AWAY I MEAN ARE YOU LOOKING AT
IF THERE ARE OPPORTUNITIES FOR
PEOPLE ON THE PILOT. TRY TO
PILOT THAT'LL EARLY EARLIER DO
YOU THINK THAT SIDE OF REALIZE
YOU'RE STILL TRY TO WORK A LOT
OF THAT STUFF OUT. I THINK- FOR
WHAT WE'RE TALKING THERE ARE A
LOT OF A REALLY AMAZING
INTEGRATION EFFORTS GOING
ACROSS THE STATE IN THE
DEPARTMENT WANTS TO ENCOURAGE
PEOPLE TO DO IMMIGRATION-
OPPORTUNITIES WHERE WE CAN- WE
THINK IT'S A REALLY CRITICAL
PIECE OF. I WOULD JUST WANT TO
OPEN UP WITH THAT I THINK WHAT
WE'RE TALKING ABOUT WITH THIS
FULL INTEGRATION IS. A TRULY
FULLY INTEGRATED ENTITY- WHERE
WE ARE PAYING ONE CAPITATION.
RATES FOR ALL OF THEIR
SERVICES. OBVIOUSLY IN ORDER TO
DO THAT WITH REALIGNMENT IN THE
STATE OF CALIFORNIA THE COUNTY
WOULD HAVE TO BE WILLING TO DO
THAT- IT IS VERY COMPLEX AND SO
WE DO HAVE KIND OF A- LONGER
RUN WAY FOR. POLICY DECISIONS
FIGURING OUT VERY COMPLEX
FINANCING SITUATIONS- AND THEN
WE WOULD HAVE TO. FIGURE POLICY
SITUATIONS OUT WE'D HAVE TO
SOLICIT SOMEHOW IDENTIFY. WHO
ARE PEOPLE WHO WOULD BE CAPABLE
OF DOING THIS AND IT'S PROBABLY
A PRETTY SHORT LIST OF PEOPLE.
ON CAPABLE OF TAKING ON THE
FULL BREADTH OF THIS UNDER ONE
CONTRACT. ON TO BE ABLE TO HAVE
THE NETWORK WHETHER THAT BE. ON
INCLUDING THE COUNTY BEHAVIORAL
HEALTH- BEING COMPLETELY ON
BOARD WITH THIS. PROPOSAL AND
THEN WE WOULD HAVE TO DO A
PRETTY LENGTHY READY MISS
PROCESS WITH THE DEPARTMENT
WOULD ENSURE THAT THEY HAVE THE
RIGHT POLICIES PROCEDURES IN
PLACE. THE NETWORK IS IN PLACE
TO MEET OUR SATISFACTION ALL OF
THOSE PIECES USUALLY TAKES
ABOUT EIGHTEEN MONTHS OF A
READINESS FOR A NEW PLAN. AND
THAT'S WHY YOU SEE A LONGER
RUNWAY- ON THIS PARTICULAR ONE
JUST GIVEN THE COMPLEXITY OF
THE POLICY DECISIONS. THE
COMPLEXITY OF THE FINANCING
HAVE TO SOLICIT IDENTIFY WHO
WOULD BE ABLE TO DO THIS AND
THAT MAKE SURE THEY'RE READY TO
GO LVE. SO THAT'S WHY YOU SEE
THE LONGER ONE WAY AND WE ALSO
WANT TO ALIGN IT WITH OUR
PROCUREMENT TO GO LIVE- BECAUSE
THAT'S REALLY REALLY CRITICAL-
AND SO. ON WE HAVE A LOT OF
THINGS THIS IS THE FIGURE OUT
IN AND THAT'S WHY YOU'RE SEEING
LONGER TIME PERIOD YEAH SO JUST
SEND IN THE SHORTER RUN-
PILOTS. YOU KNOW LOOKING AT
PLACES THAT REALLY DO WANT TO
GO EARLIER ON A MORE LIMITED
BASIS SO WE START TO LEARN.
WHAT IT MEANS TO BE MORE IN A
RED AND IT'S ALREADY OCCURRING
YEAH. OKAY SO ON AGO JUST
WANTED TO INTRODUCE MYSELF I'M
DOCTOR GO OVER YOUR NEW DH CS
DIRECTOR. THE I APPRECIATE IT.
WELCOME ABOARD. THANK YOU GOOD
TO SEE YOU. THANKS AND WELCOME.
RIGHT IS SO IN TERMS OF. SO WE
KNOW FIRST HALF WE TALKED ABOUT
RATE SETTING HE TALKED ABOUT
HOW HE ESTABLISHED CAPITATION
RATES BASED ON HISTORICAL AND
SOME THE TOWNS WITH THAT AND SO
FORTH- OBVIOUSLY THAT SHOULD
NOT STOP US FROM DOING
SOMETHING NEW BUT HOW DO YOU
PLAN TO ESTABLISH RATES FOR CAL
AMY WERE NOW THE PLANS ARE
TAKING ON THIS. I MEAN ARE WE
GOING TO HAVE SOME SORT OF- ANY
SOME OF THIS IS GOING TO BE A
LITTLE BIT GASSING BECAUSE
WE'RE ASKING PROVIDE SERVICES
AT AND PREVIOUSLY BEEN PROVIDED
BY THE PLANS WE CAN PROBABLY
PRICE OF HOW THEY WERE PROVIDED
BY OTHER PEOPLE ETCETERA I MEAN
ARE WE GOING TO IS TO GIVE ME
SOME SORT OF LIKE SECONDARY
RISK BUFFERING OR RECORDER RAIN
OR SOMETHING LIKE THAT SO THAT-
WE DON'T WANT PLANS BASICALLY
FINDING THEMSELVES. LIKE MISS
GUESSING AND AGREEING TO A RATE
THAT THEN THEY CAN ACTUALLY
DELIVER AND- I MEAN IT BECAUSE
IT'S A REALLY BIG PLAN THEY CAN
DRAW SOMETHING ELSE BUT IT
IT'S- COUNTY PLAN THAT DOESN'T
HAVE ANY OTHER SERVICE LINES
AND WHATHAPPENS THERE STRUCK
STUCK WITH THE LLAMA ABOUT
SAYING WELL WHAT WE TRY TO CUT
CORNERS BECAUSE WE JUST DON'T
HAVE THE MONEY OR SOMETHING SO
HE WHAT KIND OF THINGS DO WE
SEE. IN TERMS OF BOTH
ESTABLISHING RATE. BUT THEN
ALSO. AND AGAIN THE SOME OF
THIS HAS TO DO THE FEDS TO WHAT
THE ALLOWS TO DO BUT BUT I MEAN
IN TERMS OF THE ELDER VIED
LEAST BEFORE WE ROLL IT OUT
SOME BUFFERS TO TAKE CARE OF
LEGITIMATE ISSUES WHERE PEOPLE
MIGHT HAVE. BUILT THE THERE'S A
MISCALCULATION ARE PART THEIR
POWER OR SOMEWHERE ELSE AND
THAT. WITH THAT- BASICALLY WE
WANT ANYONE RUNNING SHORT OF
MONEY MIDWAY THROUGH THE YEAR-
AND TRYING TO VOTE NEW SERVICES
THAT THEY TURNED OUT THAT THEY
FIND CELLS UNABLE TO ACTUALLY
PAY FOR. SO WHAT CAN WE DO TO
TRY TO BUFFER AGAINST A- I WAS
A MISCALCULATION NOW COULD BE
ON THE OTHER END WE MIGHT FIND
WAYS TO DRAW MONEY BACK BUT-
LET'S JUST TALK ABOUT THE FIRST
PROBLEM- SO- ALL KIND OF SET.
UP TO. INTO TWO DIFFERENT
BUCKETS THEN HAS TO MENTION IN
LIEU OF SERVICES. TO THE
DEPARTMENT DOES PLAN ON
LEVERAGING OUR EXPERIENCE WITH
HEALTH HOMES IN REGARDS TO SOME
OF THE ASSUMPTIONS FOR
REBUILDING. BECAUSE IT WAS A
HIGH TOUCH- HIGHER UTILIZING
POPULATION IN REGARDS TO THAT
IT DID HAVE SOME OF THE HOUSING
COMPONENT THAT WE'RE TALKING
ABOUT. TO DO PLAN ON LEVERAGING
UP BUT IT WILL BE DIFFERENT
BECAUSE HEALTH HOMES WAS PAID
ON A SUPPLEMENTAL. BASED ON
UTILIZATION HERE WE PLAN ON
BUILDING THIS INTO THE MANAGED
CARE PLAN RATE AS A SEPARATE
CATEGORY OF SERVICE SO THAT WE
CAN MONITOR IT. ESPECIALLY AS
WE ROLL IT OUT TO MAKE SURE
WERE SEEN TO EITHER. UNDER OR
OR MORE UTILIZATION DEPENDING
ON WHAT WE SEE THERE. ON IS
GOING TO BE VERY IMPORTANT TO
US- IT WILL BE LOSS OF THE
BUILDING OTHER SECTIONS BECAUSE
WHAT WE'RE CURRENTLY ASSUMING
IN THESE. THESE NUMBERS ARE
BEING. KIND OF CHANGE THE DAR
RATE THE DEVELOPMENT TEAM IS.
ACTIVELY WORKING ON A READ
ABOUT SO THAT'S ONE CABBIE OUT
THERE IS THAT WE'RE STILL VERY
MUCH LOOKING AT. HOW ARE WE
GOING TO BUILD THIS IN. BUT IT
WOULD BE A CENTURY READ SAY
ACROSS THE ENTIRE MEDI CAL
pOVERSEE. ABOUT 1% OF THOSE
INDIVIDUALS WOULD PROBABLY END
UP GETTING THIS HIGHER LEVEL
TOUCH ENHANCE CARE MANAGEMENT
BECAUSE IT IS MORE THAN JUST.
OUR STATE WE ACTUALLY. THE
SERVICE BUT THEY WOULD ALSO PAY
FOR MAYBE UP TO THREE OR 5%
WERE YOU DOING OUT REGION
ENGAGEMENT TO THEM BECAUSE
THESE TYPES OF POPULATIONS ARE
USUALLY PRETTY COMPLEX. ON THE
FIRST TIME YOU ENCOUNTER
SOMEONE WHO'S HOMELESS. THEY
DON'T JUST AUTOMATICALLY SAY
YES I WANT TO BE INVOLVED IN
YOUR ENHANCE MERIT YOU KNOW
CARE MANAGEMENT PROGRAM OR GET
ME AND HOUSING. IT'S AN
ENGAGEMENT PROCESS OVER TIME
AND SOMETIMES A VERY LONG. TIME
SAME IF YOU'RE ENGAGING WITH
SOMEONE WHO IS IN A SKILLED
NURSING FACILITY WANTED TO
TRANSITION TO THE HOME OUR
COMMUNITY. THAT DOESN'T HAPPEN
JUST THE FIRST TIME YOU DO OUT
REACH. SO WE WOULD BE
ESSENTIALLY BUILDING IN SOME
OUTREACH AND ENGAGEMENT
PORTIONS. AND THEN OF THOSE
THAT YOU OUT REACHING AGENT
WHAT PORTION OF THOSE WILL
ACTUALLY RECEIVE ENHANCE CARE
MANAGEMENT SERVICES. SO THAT'S
HOW WE ARE LOOKING AT THE
ENHANCE CARE MANAGEMENT
PORTION. WE WOULD BE BUILT IN.
ACROSS THE RATE PROBABLY HAD A
PERCENTAGE IN THAT. PERCENT MAY
VARY DEPENDING ON THE- THE
DIFFERENT CATEGORIES IN IN THE
POPULATIONS THAT WE'RE TALKING
ABOUT- BUT THAT'S APPARENTLY.
WERE THINKING ON THE ENHANCE
YOUR MNAGEMENT. FOR IN LIEU OF
SERVER IS. A LITTLE DIFFERENT.
ON AS ANY OTHER THING I WOULD
SAY IS SINCE ENHANCE YOUR
MANAGEMENT IS DIFFERENT
STATEWIDE SO WE HAVE. A WHOLE
PERSON CARE- IN CERTAIN
COUNTIES AND WE HAVE HELP HOMES
IN CERTAIN COUNTIES AND THEN WE
HAVE CERTAIN COUNTIES WITH
WITH. NEITHER AND SO WE WILL BE
FACTORING THOSE KIND OF- RAMP
UP TIME PERIODS WITHIN THE
RATES APPROPRIATELY WHERE WE
ALREADY HAVE WHOLE PERSON CARE
AND HEALTH HOMES OR BOTH AND
COUNTY. THEY WOULD OBVIOUSLY BE
MORE TO ADD MEDIA- GO LIVE ON
JANUARY ONE TWENTY TWENTY ONE-
INSTEAD OF A PLANNED THIS KIND
OF RAMPING. UP THOSE TYPES OF
FACTORS WILL BE BUILT INTO THE
ASSUMPTIONS. OF THE PENDING ON
WHAT TYPE OF COUNTY.THAT YOU
ARE ALSO PROPOSED EIGHT. I CAN
TO. IMPLEMENTATION SO ANYONE
WITH A WHOLE PERSON CARE HEALTH
COMES WOULD GO LAW. WE WANT. TO
TWENTY. AND THEN. PUT OUT THAT
WOULD GO LIVE LIVE ON TWENTY
TWENTY TO ALLOW FOR THE- ONE
MORE TIME FOR THEM TO BE. THEIR
TO CONTRACT PROVIDER IS REALLY
IMPORTANT KEY- BUT IT ALSO
ALLOWS US TO. TO KIND OF THINK
OF THE ASSUMPTIONS OF THAT RATE
A LITTLE BIT DIFFERENTLY AS
WELL. FOR IN LIEU OF SERVICES
SINCE IT IS TECHNICALLY IN LIEU
OF SOMETHING MORE EXPENSIVE- WE
ARE NOT MAKING REDUCTIONS TO
THE IN PATIENT- ER STAYS. ON
BECAUSE ESSENTIALLY THAT'S WHAT
YOU'RE PAYING FOR THE IN LIEU
OF SERVICES IN LIEU OF THOSE
HIGH COST SERVICES- BUT AS YOU
SAW ON THE BUDGET THERE IS.
THERE IS MONEY SCORED TO-
INCLUDE INTO THE IT THE PLANS
RATES FOR IN THE WEB SERVICES.
AND THAT'S REALLY WHERE WE HAVE
SEEN- IN OUR WHOLE PERSON CARE
PLAYED IT LOTS RECOUP OF CARE
BEDS GO UP- THROUGH A WHOLE
PERSON CARE. I'M SOBERING
CENTERS HAVE COME UP- WE DO
KNOW THAT SOME OF OUR CCI PLANS
PROVIDE- WRAPAROUND SERVICES
FOR INDIVIDUALS IN THAT
PROGRAM. AND SO WE WILL USE
SOME UTILIZATION TO BUILD INTO
THE RIGHT INITIALLY- AND THEN
ONCE THEY START BUILDING
UTILIZATION STATEWIDE THAT IT
WOULD EVENTUALLY BE CONTINUE TO
BE BUILT INTO THE RATE MOVING
FORWARD SO IT'S KIND OF. SOME
UP FRONT WHERE WE DO SEE IT
CERTAIN COUNTIES WHO HAVE TWO
WHOLE PERSON CARE. WHERE WE
HAVE ALL THE ENCOUNTER DATA ON
THAT WE'D BE ABLE TO BUILD IN
UP FRONT- AND THEN OVER TIME IS
PLANS BUILT THE IN IEU OF
SERVICES WE WOULD BUILD THAT
AND FACTORED. INTO THEIR
REGULAR RATE DEVELOPMENT
THROUGH THAT BREAK DEVELOPMENT
PROCESS- THE ONE THING I WOULD-
ALSO. OF FLAG WHEN IT COMES TO
THAT IS WE WILL- PLANS IT'S AN
OPTIONAL BENEFITS SO THEY WOULD
BE TELLING US IN ADVANCE. THEY
ARE OR NOT PROVIDING THE INTO
OF SERVICES. ON IT SOMETHING
THAT PEOPLE SHOULD BE AWARE OF
AND THEN WE WOULD FACTOR THAT
IN IN THE FUTURE AS IT STARTING
TO. RAMP UP THOSE SERVICES. YES
EIGHT APRIL THAT WHAT YOU'RE
TRY TO DO IN THE AGENTS TRIED
TO I GUESS MY CAUTION IS THAT-
THERE'S A LOT OF MOVING PARTS
SO WHAT BECAUSE WE HAVE AND THE
PEN AND WE'RE ALL REST THE
WE'RE ALL EXPECTING THE PLAN TO
DO SO SEVEN I KNOW THAT YOU'RE
YOU KNOW MAYBE WITH SOME PEOPLE
MORE EXPERIENCE WITH THESE WITH
EXISTING PROGRAM THAT'S
RELATIVE SO WE CAN TRY TO GET
SAID SERRA SO. BUT YOU KNOW YOU
GOT WE GOT IN OF THE ENHANCED
CHAIR MANAGEMENT WE GET THE IN
LIEU SERVICES WE'RE GONNA BE
FINANCIALLY FOLDING IN THE LONG
TERM CARE WHICH SOME PLANS MAY
NOT HAVE AND SO AND- THEN
MORAGA NEGOTIATOR RATE FOR
THESE DIFFERENT PIECES RIGHT
AND SO SOMEBODY IN THE BACK
OFFICE AT THE PLAN IS GOING TO
TRY TO FIGURE OUT HOW MUCH THAT
COSTS SO THEY CAN NEGOTIATE.
SIDE YOU'RE GOING TO HAVE YOUR
PEOPLE THAT OUT AND SAID THIS
IS WHAT WE THINK IT'S KIND OF A-
AND IT'S POSSIBLE. EITHER AND I
GUESS IT'S ON THE STATE BECAUSE
IT BUT IT'S POSSIBLE SOMEONE
GUESSED WRONG. RIGHT RIGHT A
DAVID DOWSON SOMETHING HAPPENS
THAT WE DIDN'T EXPECT RIGHT- SO
FOR EXAMPLE- IT. YOU KNOW MAYBE
THERE'S A BACKLOG OF PEOPLE WHO
NEED NURSING HOME CARE THAT
WHAT HAPPENED IS THAT NOW THAT
WE KNOW FULL THEN WE GOT SOME
IN LIEU WE GOT SOME PEOPLE OUT
BUT THEN IT CELLS AND CENTER
AND SO TURNS OUT THE RATE.
BECAUSE THERE IS A SERVICE THE
MAN THAT YOU COULDN'T SEE
BECAUSE THIS IS WASN'T ANY
FACILITY AVAILABLE NOW SO HAS
HE DIDN'T ACTUALLY SCOTT SAVE
MONEY WHAT HAPPENED WAS IS THAT
YOU ACTUALLY TOOK CARE OF MORE
PEOPLE. BECAUSE THERE'S A
BACKLOG OR SOMETHING IT SO I
JUST SOME SO CIRCUMSTANCE SO
WITH THE UNION EXAMPLE WHERE.
SOME THAT SHOULD WORK. BECAUSE
OF THE SAID SITUATION SO- I
UNDERSTAND THAT WAY BACK WHEN
WE TRIED IN ENHANCE PRIMARY
CARE PAYMENT FOR PRANK YOUR
DOCTORS TO BETTER COORDINATE
CARES A MODEL THOSE VERY
SUCCESSFULLY USED IN SOME
STATES LIKE NORTH CAROLINA. BUT
APPARENTLY HERE IN CALIFORNIA
DIDN'T WORK SO WELL. AND I
UNDERSTAND THAT PART OF THE
REASON IT WORKS SO WELL IS
BECAUSE OUR MEDI CAL PAYMENTS
WHICH ARE ONE AMONG THE LOWEST
IN THE WHOLE COUNTRY ARE SO
LOW. THAT INSTEAD OF PEOPLE
TAKING ENHANCE PAYMENT AND
DOING AS MUCH CORONATION CARED
THEY KIND OF TRY TO USE THAT TO
KEEP THE PRACTICE IS GOING
BECAUSE- THE- FEDERAL BUMP UP
RIGHT. AND SO YOU DIDN'T
ACTUALLY GET THE CHANGE OF
BEHAVIOR THAT HAPPENED WHICH BY
THE WAY ALSO TAKES AN
INVESTMENT SO WE WANT PEOPLE TO
DO THINGS DIFFERENTLY. IN THE
VERY BEGINNING THAT MAKES ME
TAKE A LITTLE MORE MONEY BEFORE
THEY FINALLY SWITCH OVER RIGHT
SO YOU KNOW THE HOUSE. NOW THAT
WE CAN DO THE IN LIEU OF IT'S
NOT JUST LIKE SWAPPING
SOMETHING THEY HAVE TO. THINK
COULD ORGANIZE THINGS
DIFFERENTLY AND SO I GUESS THE
QUESTION I WOULD PUT AND AGAIN
I'M VERY SUPPORT OF WHAT YOU'RE
TRYING TO DO- IS TO SAY IS
THAT- I WANT TO BE CAREFUL THAT
HOW WE DEFINE WHAT'S GOING TO
HAPPEN THE FIRST FEW YEARS IN
THE FIRST YEARS A TRANSITION.
THAT WE SET THE RIGHT
EXPECTATION SO LET ME GIVE YOU
ANOTHER EXAMPLE WITH THE ACA.
OF PEOPLE THAT WILL GET MORE
PEOPLE INSURANCE WHICH IS C. E.
R. USE GO DOWN I SAID NO NO.
ACTUALLY HERE IS WILL GO UP
FIRST WHY WHY WHY IS THAT. WE
pPROPER CARETO. IS THAT WHAT
THE PROBLEM IS THAT. IF YOU
WEREN'T INSURED BEFORE. THAT'S
WHERE YOU NORMALLY GO YOU DON'T
HAVE A PRIMARY CARE DOCTOR USE
BECAUSE YOU KNOW I'M SURE CW SO
WHAT HAPPENS IS THAT NOW WHEN
YOU GOT SICK NAY OF INSURANCE
CARD. HE GOT SICK OKAY WELL
WHAT DO I GO. I DO WHAT MY
USUAL THING IS WHAT WE ACTUALLY
HAVE TO DO IS INVEST. SOME
MONEY IN. TEACHING PEOPLE IN RE
DIRECTING THE SHOW FOR THE E.
R. WELL. HERE'S YOUR PRIMARY
CARE DOCTOR YOU SHOULD GO HERE
FIRST NEXT TIME ETCETERA TAKE
SOME TIME FOR PEOPLE AND IS
ALSO BY WE A BACKLOG OF. ON
THAT HEALTH NEEDS THAT THEY HAD
RIGHT BECAUSE THEY WEREN'T SURE
DATE. THE LATE GETTING CARE. SO
NOW YOU HAVE TO. BUMP UP IN
UTILIZATION. AND YOU GO OH WOW
YOU NOW TO FAILURE WE GOT
PEOPLE MORE COVERAGE IS
SUPPOSED TO DECREASE YOUR
STATION THE THEY CHRISSY ARGUES
INSIDE RIGHT NOW I WENT UP. IS
IT WELL THAT'S A TRANSITION
PERIOD BECAUSE THAT'S YOU KNOW
WE'RE TRYING TO GET THE BACKLOG
THEN WE'LL GET TO THE RIGHT
PLACE. SO I JUST WANT TO BE
CAREFUL HOW WE DO THIS WE DON'T
TO CREATE SITUATIONS WHERE. YOU
KNOW AND FIGURE OUT AND AGAIN I
REALIZE SOME OF THIS BECAUSE IT
WORKED FEDERAL GOVERNMENT HOW
THE WAIVERS IT CETERA. HOW WE
PUT IN SOME BUFFERS THERE TO
TAKE. CITY. TO BASICALLY DEAL
WITH. YOU KNOW THE THINGS WE
DON'T TO. WE'D AS HARD RECANTED.
EVERYTHING BUT WE LL KNOW WE
CAN'T PREDICT THE FUTURE AND E
DO KNOW THAT OF. ESPECIALLY
COMPLEX SYSTEMS OF YOUR
EXPECTING PLANS. TO HAVE TO
FIGURE OUT WHAT THE RISK IS. TO
DO. FULL AND HEALTH CARE
MANAGEMENT AND THEN THEY'RE
ALSO GOING TO DO SOME AND LOSE
SERVICES AND THEN OUR AGO ALSO
TO INCLUDE YOUR FULL THEN THE
LONG TERM CARE. WELL YOU WE
JUST THREW IN THREE VERY BIG
MOVING PARTS EVENTUALLY ALL
SORTED OUT. DEL FIGURE OUT WHAT
THE RATE SHOULD BE YOU'LL
FIGURE IT CETERA WILL. GET
ACTUAL SOME REAL EXPERIENCE IN
ANIMALS OR SETTLE DOWN WHAT IT
REALLY SHOULD BE. BUT UNTIL
THEN. SOMEBODY'S GONNA GUESS
TOO HIGH TO LOW IT CETERA. ON
BOTH SIDES AND THEN WE MAY HAVE
SITUATIONS WHERE MIGHT NEED TO.
BE ABLE TO. TO SO THAT. ANY
FISHERIES DON'T GET CAUGHT. IN
THAT SITUATION SO. I JUST. YEAH
I DESERVE. PUT THAT OUT THERE
SERVERS THINKING ABOUT WHAT WE
CAN DO. AS WERE ROLLING THROUGH
EVEN IF YOU'RE WORKING REALLY
pPOSSIBLE ESTIMATES AND SO
FORTH. THAT WE- GIVE OURSELVES
SOME WIGGLE ROOM IF WE CAN. TO
TRY TO DEAL WITH THE
UNEXPECTED- BECAUSE IT AND
BECAUSE I WANT THIS TO BE
SUCCESSFUL I WANT SOMEONE TO
SAY OH WE'RE GOING TO.
CHARACTERIZE THIS TRANSITION BY.
THE THINGS THAT KIND OF WENT.
WRONG SO I MEAN WE SELL. I CAN
I WILL SHARE MORE EXAMPLES. OF
WHAT IT WAS THAT DELAYED THE
UNEXPECTED HAPPEN AND SO PEOPLE
ARE JUST THAT. WHERE WERE
MEETINGS PEOPLE FEEL LIKE
THINGS AND REALLY WORK AS WELL
TERMS OF THERE'S A FEW OF
MOVING PIECES THAT I JUST WANT
TO INSURE YES I THINK WE ONE OF
THE PEACE THAT WE AGREE WITH
YOU 1100% I THINK WE REALLY
WANT TO MAKE SURE THAT- WE KNOW
IT WILL TAKE TIME. WE SAW THAT
THROUGH WHOLE PERSON CARE WHOLE
PERSON CARRYING COME UP THEY
WANT AMAZING IDEAS THAT HAVE
COME OUT OF THAT BUT WE REALLY
HAVE A LOT OF LESSONS LEARNED
BUT US IN HEARING FROM. THE
COLLEAGUES WHO HAVE IMPLEMENTED
A IN REGARDS TO WHAT THAT TOOK
TO GET UP AND RUNNING IT'S NOT
A SHORT RUN WAY IT IS A LONG
RUN MINE SO. YOU HAVE SOME A
PATIENTS THIS WILL TAKE TIME TO
BE WILL WANT PEOPLE TO BE
PATIENT WITH US AS WE'RE
GETTING IT OUT STATEWIDE ACROSS
THE STATE UNFORTUNATELY THE
ELEVEN FIFTEEN WAIVER ENDING WE
NEED TO HAVE A SUSTAINABLE
PATHWAYS. FOR OUR WHOLE PERSON
CARE PILOTS AND SO THAT'S
REALLY CRITICAL KIND OF A
TIMING OF WHY JANUARY ONE IS SO
IMPORTANT FOR THIS PARTICULAR
TRANSITION THE OTHER THING I
WOULD JUST MENTION IS THAT- IN
THE PROPOSAL AND AS SEEN IN THE
IN THE GOVERNOR'S BUDGET IS- A
SIX HUNDRED MILLION DOLLAR
ANNUAL. INVESTMENT IN FOR
INCENTIVES- FOR TWO AND A HALF
YEARS AND WE DO PLAN AND WE ARE
OUT FOR COMMENT RIGHT NOW ON-
IDEAS OF WHAT WE SHOULD BE A
REALLY HONING IN ON FOR THOSE
INCENTIVES TO REALLY DRIVE. AND
BUILD THAT INFRASTRUCTURE
STATEWIDE FOR ENHANCE YOUR
MANAGEMENT IN LIEU OF SERVICES
AND HOW DO WE INCENTIVIZE
ACROSS THE STATE ON TO MOVE THE
NEEDLE OVER THOSE TWO YEARS
BECAUSE WE KNOW IT WILL TAKE
TIME TO BUILD CAPACITY. AND SO
WE REALLY WILL LOOK TO THOSE-
INCENTIVE PAYMENTS TO HELP OUR
MANAGED CARE PLANS AND THEN
ULTIMATELY DOWN TO THE PROVIDER
LEVEL TO BUILD CAPACITY TO
EXPAND WORKFORCE ON TO REALLY
FEEL GAPS WHERE WE SEE A GAPS
WHETHER THAT'S ACCESS TO MORE
RETRIBUTIVE CARE BEDS OR TO
HESE HOUSING HUBS. OF WHATEVER
IT MAY BE A IS A REALLY
CRITICAL PART OF THE PROPOSAL
FOR TO SEE SUCCESS WE ACTUALLY
DID IT THAT WAS A PART OF THE
WHOLE PERSON CARES WELL. ON
VARIOUS PARTS WHERE IT HAD
INCENTIVES BECAUSE THERE ARE
YOU DO YOU KIND OF NEED TO
BUILD SOME INFRASTRUCTURE AND
CAPACITY. FIRST AND WE KNOW IT
WILL TAKE TIME SO WE NEED WE
DON'T. THIS YOU KNOW FALL
INTERPRET. THAT ON JANUARY
TWENTY TWO ONE WE'RE GOING TO
HAVE THIS FABULOUS BENEFITS
STATEWIDE. BUT WE DO HOPE TO
OVER TIME BUILD IT. USING
INCENTIVES TO DRIVE TOWARDS
WHAT'S NECESSARY AND WHAT'S
NEEDED- AND THEN REALLY CV IN
LIEU OF SERVICES BUILT. OVER A
FIVE YEAR PERIOD. PLANS ARE
GOING TO BE ABLE TO DO THEM ALL
DAY ONE WE KNOW THAT- BUT- AS
THE BILL CAPACITY TO BUILD THAT
STATEWIDE- WE'RE REALLY HOPING
IT CAN FILL IN GAPS OVER A LONG
PERIOD OF TIME. YEAH I WOULD
JUST TELL I MEAN I REALLY
APPRECIATE YOUR COMMENTS ABOUT
BEING CAUTIOUS SOME INTO. GREAT
EXAMPLES. ADDITIONAL SPD RATES
WHEN THEY WENT MANDATORY. AN
INITIAL M. C. E. RATES WHEN ACA
HAPPENED. RIGHT RIGHT OUT. SO I
THINK THE NUMBER ONE THE
DEPARTMENT IS MUCH MORE
SOPHISTICATED AROUND RATE
SETTING IN THE PLANS OF REALLY
YOU KNOW NOTICE THAT. YOU
NUMBER TWO THERE IS SOME DATA
TO USE AND IN THE CASE OF YOUR
MEMBER WITH THE ACA THERE WAS
NO DATA RIGHT. TIME WITH THE
SPD'S. MISCALCULATION MIGHT BE
A TERM THAT CAN BE USED- SO I
THINK THERE'S MORE
SOPHISTICATION. THERE IS SOME
DATA THAT THAT CAN BE USED FROM
HEALTH PHONES FROM THE FROM THE
WHOLE PERSON CARE. AND SO I
THINK. YOU KNOW BUT YOUR POINT
IS VERY WELL TAKEN. WE WILL
HEAR FROM THE PLANS OF THEIR
SIGNIFICAN IF THEY'RE
SIGNIFICANT. MAYBE NOT OVER
PAYMENTS FOR CERTAINLY
UNDERPAYMENT SO WE WILL HEAR TO.
I DON'T EXPECT THAT OKAY FOR
THE QUESTIONS. OKAY ALL RIGHT
WELL THANK YOU IT'S HAVE YOU
HERE WILL BRING UP FOR NEXT
PANEL HERE OKAY SO- I'M SURE
WILL HAVE THEIR OWN COMMENTS
ALL RIGHT SO NEXT PANEL IS
ERICA MURRAY PRESIDENCY OF THE
CALIFORNIAASSOCIATION PUBLIC
HOSPITALS AND HEALTH SYSTEMS-
BRAND MARRIED JUNE DS
GOVERNMENT FAIRS ADVOCATE FOR
S. YEAH YOU. CALIFORNIA CITY
COUNCIL BEAU HENNEMAN DAVID
RIGHT KAY- DIRECTOR SOCIAL
PROGRAMS ANTHEM BLUE CROSS-
LEADER COOPS MEN'S- COME
AFFAIRS DIRECTOR LOCAL HEALTH
PLANS CALIFORNIA AND LINDA- WAY
POLICY ADVOCATE FOR WESTERN
CENTER LAW POVERTY WELCOME- I
ASK IF YOU COULD TRY PLEASE
KEEP YOUR REMARKS TO THREE
MINUTES I'M SURE WE'LL HAVE
MORE TIME FOR MORE DIALOGUE
AFTERWARDS. THANK YOU AND
WELCOME. THANK YOU. MY NAME'S
ERICA MARIE AND THE PRESIDENT
AND CEO OF CA PH THE CALIFORNIA
ASSOCIATION OF PUBLIC HOSPITALS
AND HEALTH SYSTEMS WHICH
INCLUDES. KERN MEDICAL
NATIVIDAD MEDICAL CENTER AND UC
DAVIS SELF WE ARE WELL
REPRESENTED HERE TODAY. I WOULD
SAY ON AVERAGE- PUBLIC HEALTH
CARE SYSTEMS. SERVE A VERY
COMPLEX PATIENT POPULATION IS
ALL OF YOU NOW ABOUT HALF OF
THEIR PAYER MIXES MEDI CAL AND
UNINSURED THE OTHER HALF IS-
MEDICARE OFTEN TOOLS AND
COMMERCIAL OFTEN TO THE
EMERGENCY ROOM. AND BECAUSE
THERE'S SO MUCH MEDI CAL AN
UNINSURED CARE PUBLIC HEALTH
CARE SYSTEMS HAVE LONG RELIED
ON SUPPLEMENTAL PAYMENTS TO TRY
TO CLOSE THAT GAP BETWEEN WHAT
THE COST OF THE CARE IS AND LOW
MEDICAL BASE RATES. AND AS HAS
BEEN NOTED THE MOST PROMINENT
OF THOSE A LOT OF THOSE
SUPPLEMENTAL PAY INTERLOCKING
FIFTEEN WAIVERS AND WE NOW HAVE
KIND OF A GREATEST HITS OF
PROGRAMS THROUGH ELEVEN FIFTEEN
WAIVERS WHICH HAVE SUCCESSFULLY
TIED REALLY AMBITIOUS
PERFORMANCE TARGETS TO FEDERAL
FUNDING WHETHER IT'S LOW INCOME
HEALTH PROGRAM. GLOBAL PAYMENT
PROGRAM DISTRICT INTO PRIME WE
REALLY HAVE- DEVELOP DEEP
EXPERTISE IN AND HOW TO DO THAT
AND HOW TO SUCCEED IN IMPROVING
CARE. AND AS JC HAS NOTED THE-
GOVERNMENT HAS FOR CLOSE THE
OPPORTUNITY FOR CALIFORNIA TO
ACHIEVE A NEW IS SIMILARLY
SIZED ELEVEN FIFTEEN LABOR SO
FOR PUBLIC HEALTH CARE SYSTEMS
WHAT CAL AMY IS THAT WE- HAVING
OF ALL FROM A PROVIDE. FOCUSED
WAIVER TWO EIGHT LAND GUEST
WAIVER AND WHAT THE
IMPLICATIONS FOR THAT AND I
WOULD SAY OFFER A LOT OF
OPPORTUNITY BUT IT'S ALSO
FRAUGHT WITH PERIL SO I'LL
START WITH THE PERIL. THREE
REASONS IT IS NOT TOTALLY CLEAR
THAT WE WILL BE ABLE TO REPLACE
ART DOES SUPPLEMENTAL PAYMENTS
EXACTLY IN A ONE FOR ONE OR IN
A SUSTAINABLE WAY- FROM AS YOU
GO FROM ELEVEN FIFTEEN TO
NINETEEN FIFTEEN BE ANOTHER
AUTHORITIES. THIS IS IT'S NOT
KNOWING TODAY WHETHER AND
NECESSARILY OPTIONAL-
OPPORTUNITY THAT PLANS WILL
ACTUALLY TAKE IT AND PROVIDED
IN A WAY THAT TRULY DOES
SUSTAIN THE WORK THAT'S THAT'S
GONE ON IN COUNTIES AND WE'RE
CERTAINLY. HOPEFUL AND A REALLY
APPRECIATE THE INCENTIVES THAT
THE STATE IS OFFERING AND HOPE
THAT THOSE INCENTIVES ARE
STRUCTURED IN A WAY THAT.
FOCUSES ON WHOLE PERSON CARE
SUSTAINABILITY ESPECIALLY
SHARED WITH THE PROVIDERS THAT
WILL HELP ACHIEVE THOSE
PERFORMANCE MILESTONES. THE
SECOND REASON FOR CONCERN IS
THAT. REALLY SIMPLY PUT THE
SUPPLEMENTAL PAYMENTS THAT WE
WILL HAVE ACCESS TO MAY NOT ADD
UP. I'LL GIVE YOU AN EXAMPLE WE
ARE RELIANT ON AND SUPPLEMENTAL
PAYMENTS WE CALL DIRECTED
PAYMENTS AND THOSE HAVE TO BE
FOLDED INTO MANAGED CARE RATES
AND WHEN YOU START TO ADD ON. A
SUPPLEMENTAL PAYMENTS ON TOP OF
LOW PAYMENTS INTO MANAGED CARE
RATES. MORE IN- ACTUARIES AT
THE STATE OR FEDERAL LEVEL MAY
NOT CERTIFY THAT AS ACTUARY LEE
SOUND SO WILL HAVE NEW
LIMITATIONS ON THE SUPPLEMENTAL
PAYMENTS THAT WE THAT WE DO
HAVE ACCESS TO. AND THE THIRD
REASON FOR PERIL IS THE
EXTERNAL POLITICAL ENVIRONMENTS
WE ARE LOOKING AT THE POTENTIAL
OF FINALIZATION OF ADD RULE. ON
PROPOSED BY CMS THAT WOULD
REALLY DECIMATE THE MEDICARE
PROGRAM AND AS YOU SEE NOTED WE
ARE GOING TO BE RELIANT ON THE
TRUMP ADMINISTRATION TO RENEW
THE GLOBAL PAYMENT PROGRAM
WHICH IS A FEDERAL PROGRAM. FOR
CARE TO THE REMAINING AND
SHORT. BUT THERE IS OPPORTUNITY
TO WORK IN A REALLY MEANINGFUL
WAY WITH OUR LOCAL HEALTH CARE
PLANS AND WE REALLY. APPRECIATE
THAT AND KNOW THAT WE WILL WE
WILL ROLL UP OUR SLEEVES
TOGETHER. THANK YOU. DO YOU
HAVE A GREAT THANK YOU THANK
YOU DOCTOR PAN HELLO SENATOR MY
NAME IS AND JDS I'M HERE ON
BEHALF OF SCA YOU CALIFORNIA
STATE COUNCIL AND ARE HAD SEVEN
HUNDRED THOUSAND PRIVATE AND
PUBLIC WORKERS FIRST I'D LIKE
TO DISCUSS THE CRITICAL ROLE OF
COUNTY PROVIDERS IN THE CURRENT
MEDI CAL PROGRAM SECOND I WILL
SPEAK ABOUT CAL A MINUTES
PRESENT FORM THE OPPORTUNITIES
AND SOME OF THE CHALLENGES AS
MYSTERY MENTIONED FROM OUR
PERSPECTIVE AND LASTLY I WILL
SHARE SOME CONCERNS- LARGELY WE
HAVE ON THE MANAGED CARE AS A
WHOLE AND ON THE MEDI CAL
PROGRAM. SO FIRST THE ROLE OF
THE PUBLIC COUNTY WORK FIRST
YOU KNOW VERY WELL THE SCA YOU
REPRESENTS A WIDE RANGE OF
WORKERS IN ALL OF OUR FIFTY
EIGHT COUNTIES ACROSS ALL
COUNTY DEPARTMENTS AS WELL AS
COUNTY PUBLIC HOSPITALS AND
SOME COMMUNITY CLINICS AS WELL
OUR COUNTY PUBLIC WORK FOURS
ARE LITERALLY SOCIAL WORKERS
ELIGIBILITY WORKERS PUBLIC
HEALTH NURSES EMPLOYMENT
SERVICES WORKERS HEALTH CARE
CLINICIANS MENTAL HEALTH
PSYCHOLOGIST MEDICAL CASE
WORKERS AT MANY OTHERS THESE
ARE YOUR- THE- EIGHT COUNTY.
WORK AND HOW SPENT YEAR IN
OFFICE DATE DECADES ON THE
STREET AND IN TENSION AND ON
THE FRONT LINES HELPING LEAD
THE WAY WHEN THE STATE'S FACED
EMERGING- CRISIS AS WELL AS
NATURAL EMERGENCIES. OUR PUBLIC
WORKERS PROVIDE HIGH TOUCH IN
PERSON ASSISTANCE AND REAL TIME
REFERRALS TO CRITICAL SERVICES
LIKE HOUSING MENTAL HEALTH
SUBSTANCE ABUSE TREATMENT. HOW
FRESH HOW WORKS GENERAL
ASSISTANCE LITERALLY ANYTHING
AND EVERYTHING THAT A CLIENT
NEEDS AND IS ELIGIBLE FOR- ON
THE SECOND WE- WANT TO TALK
ABOUT SOME OF THE CALI IMPACTS
ON THEIR CURRENT WORK FORCE.
CONTEMPLATED BY CAL A IT DOES
PROVIDE- SIGNIFICANTLY CHANGE
AND TRANSFERRED THE DELIVERY OF
HEALTH AND SOCIAL SERVICES FROM
COUNTIES TO MANAGED CARE PLANS.
IT'S SIXTY CHANGE LITERALLY HOW
COUNTIES FINANCE BUDGET PLAN
FOR AND POTENTIALLY THE LIVER
HEALTH AND SOCIAL PROGRAMS
SHIFTING A GREATER AT AS YOU
MENTIONED DOCTOR PAN YOU
RESPONSIBILITIES AND FUNDING TO
MANAGED CARE PLANS- THIS WERE
WILL RELY HEAVILY ON CONTRACTS
PERHAPS WITH MANAGED CARE
PLANS. BUT ARE NO. IN NO
OBLIGATION OUR DATA CONTACT
BACK WOULD COUNTIES FOR ENHANCE
CARE MANAGEMENT SERVICES IN
LIEU OF SERVICES AND OTHER
SERVICES THAT HAVE BEEN
TRADITIONALLY DELIVERED BY THE
COUNTIES. WELL WE HAVE BEEN
ENGAGED IN THE LAST FIVE MONTHS
WITH THE DEPARTMENT IN TERMS
OF- MAKING SOME CHANGES TO THE
COW IN PROPOSAL I THINK WE WANT
TO EMPHASIZE THAT. AS IT. IT IS
UNCLEAR TO US- WHETHER THE LEAD
ENTITIES FOR THE WHOLE PERSON
CARE AND HEALTH HOME PROGRAM
WILL BE THE ENTITY THAT THE
MANAGED CARE PLANS WILL BE
REQUIRED TO CONTRACT BACK OUT
TO. AND ALSO WON A HIGHLIGHT
THAT THE BENEFIT THAT IS
ACTUALLY BEING CONTINUE THROUGH
THE CAL A PROCESS. IS THE
INTENSIVE CARE COORDINATION AND
NOT YEAH SERVICE DOES THAT
HOUSE AND YOU SEE THE PACKAGE
THROUGH A I LOW'S ADMIN BUS HOW
QUESTION. MANAGED PLAN WILL.
READY TO THE TO CASE BY CASE
WHAT WHICH I LOW THAT THAT
FISHERY WILL BE LA. FOR AND
LASTLY WE QUESTION THE NEW ROLE
OF MANAGED CARE PLANS IN THE
DELIVERY OF YOU HUMAN SERVICES
WHICH HAS NOT BEEN HISTORICALLY
PART OF THEIR ROLE. AS YOU KNOW
WHAT THIS MEDI CAL PARTICIPATE
FACE TIMELY ACCESS ISSUES AND
ALSO SOME MANAGED CARE PLANS-
DO NOT HAVE NETWORK ADVOCACY
FOR OUR MANY OF OUR CLIENTS TO
ME THIS IS A CRISIS THAT THE
STATE COUNCIL HAS BEEN INVOLVED
IN AND- AS YOU ALSO KNOW THAT.
I SEE AB ONE OF OUR LOCALS AS
WELL AS OTHER CIVIL RIGHTS
ORGANIZATIONS HAVE A PENDING
SUIT AGAINST THE DEPARTMENT TO
ADDRESS THE LARGER MANAGED CARE
TIMELY ACCESS TO CARE ISSUE. SO
WITH THAT SAID I'M HAPPY TO
ANSWER ANY OTHER QUESTIONS ON
ON THE COUCH AIM IN MANAGED
CARE. THANK YOU. WELCOME IF
YOU'RE NOT DEPEND ON MEMBERS OF
THE COMMITTEE- BUT WOMEN
DIRECTORS SPECIAL PROGRAMS FOR
ANTHEM BLUE CROSS THE EXTRA. TO
TALK ABOUT OUR OUR INTEREST IN
EXCITEMENT ABOUT THE WAIVER I
DO SEE THIS IS A IS A GREAT
OPPORTUNITY TO EXPAND ON SOME
OF THE THINGS THAT WE'VE WE'VE
WORKED THROUGH OVER THE PAST
FEW YEARS- DURING THAT TIME WE
HAVE IS AS MY COLLEAGUE
MENTIONED EARLIER WE HAVE SET
UP THE HEALTH HOMES PROGRAM AND
SIX OF OUR COUNTIES. IN SPITE
OF OUR COUNTIES WE DEVELOP
PARTNER TO THE COUNTIES UNDER
WHOLE PERSON CARE AND- REALLY
SEEN A LOT OF POSITIVE CHANGE
TO THOSE PARTNER IT'S WORKING
WITH COUNTIES IN IN A NEW WAY
THROUGH. COORDINATION SERVICES
DATA EXCHANGE. DURING THE ARE
GETTING ACCESS TO THINGS THAT
THEY DIDN'T HAVE ACCESS TO
BEFORE- WE'VE DONE LONG TERM
CARE AND LONG TERM SERVICES AND
SUPPORTS IN TWO COUNTIES
INCLUDING SNIFF TRANSITION-
WORK- AND RELEASED SPENT THE
LAST COUPLE OF YEARS BUILDING
UP SOME SOME OTHER SERVICES AND
PROGRAMS. THAT WILL FALL UNDER
IN LIEU OF SERVICES- AROUND
HOUSING FOOD AND SECURITY
MEDICAL RESPITE A RECOUP OF
CARE AND SO FORTH SO I THINK
THAT. YOU KNOW GOING INTO THIS
WE FEEL LIKE WE HAVE A PRETTY
GOOD STARTING POINT. BUT THIS
WILL TAKE UP A LOT OF WORK TO
STAND UP AND TO IMPLEMENT
STATEWIDE- IS WE WORK TOWARDS
TOWARDS THE IMPLEMENTATION OF
THIS YOU KNOW IT IS. OUR
ANTICIPATION THAT. YOU KNOW WE
WILL NEED TO GET YOU WORKING
CLOSELY WITH OUR COUNTIES IN
WITH OUR COMMUNITY BASED
PARTNERS TO FIGURE OUT. FIRST
AND MOST HOW TO TRANSITION THE
SERVICES OF THE TWO EXISTING
PROGRAMS INTO THIS NEW WAVER
AND ENSURE THAT THERE ARE NO
GAPS IN SERVICES. FOR OUR
MEMBERS AND THAT THERE'S A
SCENE. TRANSITION AND THAT
COULD INVOLVE YET YOU KNOW
WORKING. WITH DIFFERENT MODELS
BASED ON EACH INDIVIDUAL
COUNTIES NEEDS IN SOME COUNTIES
I DO ANTICIPATE THAT WE WILL BE
CONTRACTED DIRECTLY WITH
COUNTIES IN. OTHER COUNTIES YOU
KNOW THEY'RE GONNA BE OTHER
WAYS TO BUILD A CAPACITY I. IT
IT'S NOT BE A ONCE. FITS ALL
MODEL THAT WE WORK TOWARDS TOO
MANY BUT OUR OUR INTENTION.
WORKED THROUGH THAT EVERYTHING
BEING PROVIDE. CARE TODAY DOES
TURN. IT OVER. AND THEN IT
WORKING TOWARDS YOU KNOW WITH
THE IN THOSE SERVICES WORKING
TO MAKE SURE THAT WE ARE
BUILDING OUR CAPACITY TO BE
ABLE TO OFFER ALL THIRTEEN OF
THE IN LIEU OF SERVICES. IN ALL
OF OUR COUNTIES THROUGHOUT THE
STATE BUT IT'S JC MENTION. YOU
KNOW SINCE. CONCERNS THAT CUP.
AROUND THAT I THINK IT IS GOING
TO TAKE A LOT OF TIME TO. TO
BUILD OUT THESE PROGRAMS AND
SERVICES STATEWIDE EVEN IN OUR
COUNTIES WERE DOING HEALTH
HOMES IN WHOLE PERSON CARE
TODAY- I THINK THERE ARE SOME
GAPS WITH SOME OF THE IN LIEU
OF SERVICES THERE ARE SOME GAPS
AROUND THE ENHANCE CASE
MANAGEMENT THAT WE'RE GOING TO
HAVE TO WORK TO BUILD OUT
ADDITIONAL CAPACITY AND- AND
MANY OF THE COUNTIES WHERE
THERE. THERE HASN'T BEEN THIS
INFRASTRUCTURE BUILT FOR THESE
PROGRAMS- YOU KNOW WE'RE REALLY
GOING TO BE STARTING FROM
SCRATCH AND SO IT IS GOING TO
TAKE AN EXTENDED PERIOD OF TIME
AND- EVEN IN THOSE COUNTIES
IT'S GONNA TAKE A LOT OF-
COLLABORATION AND COORDINATION
WITH OUR COUNTY PARTNERS AND
OUR OTHER COMMUNITY BASED
PARTNERS SO. IN OVERALL HAPPY
TO ANSWER ANY ANY QUESTIONS
LATER ON WE DO SEE THIS LIKE I
SAID IS A VERY POSITIVE- SCENE
AND IT'S GOING TO ALLOW US TO
EXPAND ON SOME OF THE GOOD WORK
WE'VE BEEN DOING OVER THE LAST
COUPLE OF YEARS BUT DEFINITELY.
ANTICIPATE SOME CHALLENGES
ALONG THE WAY. GOOD AFTERNOON
AT CHAIR AND COMMITTEE MEMBERS
MY NAME'S ON A COULD MEN'S AND
I'M SPEAKING ON BEHALF OF THE
LOCAL HEALTH PLANS OF
CALIFORNIA. FOLLOWING THE
COMMENTS FROM MY COLLEAGUE FROM
ANTHEM I'D NOW LIKETO GIVE YOU
THE PERSPECTIVE OF THE SIXTEEN
PUBLIC. NONPROFIT HEALTH PLANS.
HOW MUCH COLLECTIVELY COVER
OVER SEVEN AND A HALF MILLION
MEDI CAL MANAGED CARE
BENEFICIARIES. SO AS WE'VE
HEARD THE GOVERNOR AND DH CS
HAVE A BOLD VISION FOR THE
TRANSFORMATION OF MEDIC HOW. TO
REALLY SERVE AS A HUB WHICH
CONNECTS BENEFICIARIES TO A
FULL CONTINUUM OF SERVICES.
LOCAL PLANS ARE REALLY EXCITED
ABOUT THE CALLIN PROPOSAL AND
SEE IT AS A- GREAT OPPORTUNITY
TO IMPROVE CARE AND OUTCOMES
FOR THE BENEFICIARIES WE SERVE.
WE ALSO ACKNOWLEDGE THAT KELLY
MANTRUST HEALTH PLANS WITH
INCREASING RESPONSIBILITY. TO
DELIVER ON THE VISION AND WE
TAKE THIS RESPONSIBILITY
SERIOUSLY. SO IS MISSION DRIVEN
PLANS ROOTED IN INFORMED BY OUR
COMMUNITIES. WE THINK WE HAVE A
REALLY STRONG FOUNDATION THAT
WILL ENABLE US TO MEET THE
OBJECTIVES OF CALLIN. SO TODAY
ALL FOCUS MY COMMENTS OF VERY
BRIEFLY ON THE TRANSITION OF
FULL PERSON CARE AND HEALTH
HOMES. AND TO ENHANCE CARE
MANAGEMENT AND IN LIEU OF
SERVICES. TO LOCAL PLANS REALLY
FEEL THAT THERE ARE FOUR
CRITICAL ELEMENTS AND TO
SUCCESSFUL IMPLEMENTATION.
FIRST STRONG LOCAL
RELATIONSHIPS SECOND BUILDING
ON EXISTING SERVICES
INFRASTRUCTURE. THIRD
MAXIMIZING INCENTIVES AND THEN
FINALLY CONTINUE DH YES
LEADERSHIP. SO FIRST WE REALLY
BELIEVETHAT RELATIONSHIPS ARE
THE FOUNDATION FOR SUCCESS
HERE. SHORTLY AFTER THE COUNTY
PROPOSAL WAS RELEASED- IN THE
FALL LOCAL PLAN STARTED HAVING
CONVERSATIONS WITH THEIR
COUNTIES. WE RECOGNIZE THE
IMPORTANCE OF HAVING
CONVERSATIONS EARLY AND OFTEN
AND THINK THAT THIS WILL SET US
UP FOR SUCCESSFUL- PLANNING
INTO THE TRANSITION INTO
ENHANCE CARE MANAGEMENT AND IN
LIEU OF SERVICES. SECOND
BUILDING FROM EXIST IN EXISTING
SERVICES AND INFRASTRUCTURE. SO
AS WE'VE HEARD EACH PLAN WILL
HAVE A DIFFERENT STARTING POINT
BASED ON THE PROGRAMS AND
SERVICES AND- EXIST IN THEIR
COUNTIES TODAY. BUT I THINK THE
COMMONALITIES THAT ALL PLANS.
REALLY BELIEVE THAT THE
INFRASTRUCTURE THAT'S BEEN
DEVELOPED THROUGH WHOLE PERSON
KAREN HEALTH HOMES. WILL BE
CRITICAL FOR BRINGING THOSE
PROVIDERS INTO THEIR NETWORK
THROUGH SUCCESS OF THESE. AND
IN LIEU OF SERVICES.
ADDITIONALLY IT LOCAL PLANS DO
YOU HAVE EXPERIENCE IN
DELIVERING IN LIEU OF TYPE
SERVICES TODAY. I'M FOR EXAMPLE
KERN HEALTH SYSTEMS TO YOU
HEARD FROM EARLIER THIS
AFTERNOON HAS BEEN FUNDING
MEDICAL RESPITE BEDS. IN THEIR
COMMUNITIES TO FOR HOMELESS
BENEFICIARIES TRANSITIONING
FROM INPATIENT SETTINGS. SO WE
THINK THAT IT'S THESE TYPE OF
INVESTMENTS THAT WILL REALLY
LAY THE GROUNDWORK FOR ULTIMATE
PROVISION OF IN LIEU OF
SERVICES MORE BROADLY. THIRD
AND MAXIMIZING INCENTIVES TO
EXPAND LOCAL SERVICES SO WE'RE
REALLY APPRECIATIVE OF THE
INCENTIVE FUNDS INCLUDE IN THE
GOVERNOR'S BUDGET THIS YEAR-
AND WE THINK THAT'LL BE
CRITICAL FOR BUILDING OUT THE
COMMUNITY BASED A LIVERY
SYSTEMS THAT WE NEED TO BE
SUCCESSFUL. AND ALSO IT
ULTIMATELY ENABLE PLANTS TO
PROVIDE SERVICES SUCH AS
TENDENCY SUPPORT ASSISTED
LIVING AND HOME MODIFICATIONS
JUST TO NAME A FEW. AND THEN
FINALLY- CONTINUE DH CS
LEADERSHIP WILL BE CRITICAL. SO
THIS WILL INCLUDE CLEAR AND
TIMELY POLICY GUIDANCE
TECHNICAL ASSISTANCE AND RATES
WELL IN ADVANCE OF
IMPLEMENTATION. WE'VE BEEN
DISCUSSING ALL OF THESE ISSUES
OF THE DEPARTMENT AND
UNDERSTAND THE WORK IS UNDER
WAY. WE WILL ALSO NEED THE
DEPARTMENT TO CAN YOU CONTINUE
TO BE RESPONSIVE TO CONCERNS
AROUND IMPLEMENTATION
TIMELINES. SO THERE ARE
NUMEROUS CALLIN PROPOSALS WHICH
WILL REQUIRE RESOURCES IN
PLANNING AND PARALLEL TO
PLANNING FOR IMPLEMENTATION OF
ENHANCE CARE MANAGEMENT AND IN
LIEU OF SERVICES SO- WE'VE BEEN
HAPPY TO SEE THE THOUGHTFUL-
ROLLOUT AND FROM. THE
DEPARTMENT BY ADJUSTING
IMPLEMENTATION DATES AND TIMES
THEIR INITIAL OPPOSE ON OCTOBER
UNTIL TODAY- AND THEN JUST IN
CLOSING I WANT TO RE REITERATE
OUR SUPPORT FOR THE KELLY
PROPOSAL. AS WELL AS OUR
COMMITMENT TO WORKING WITH OUR
COUNTY PARTNERS PROVIDERS AND
OTHER STAKEHOLDERS TO. IMPROVE
SERVICES NOW COMES FOR A
BENEFICIARY SO. HAPPY TO TAKE
ANY ANY QUESTIONS AND THANK YOU
FOR INVITING ME TODAY. THANK
YOU WELL GOOD AFTERNOON CHAIR
MEMBERS LINDA WAY WITH WESTERN
CENTER ON LAW AND POVERTY WE
SUPPORT THE GOLDEN VISION OF
THE CAL AIMED PROPOSAL BUT DO
HAVE CONCERNS REGARDING
IMPLEMENTATION AS MUCH OF THE
RESPONSIBILITY FALLS ON MEDI
CAL PLANS WHO HAVE FALLEN SHORT
AS OUTLINED IN THE BACKGROUND
AS WELL AS RECENT AUDITOR'S
REPORT IN ADDITION PLANS ARE
ALREADY RESPONSIBLE FOR CARE
COORDINATION OF CARVED OUT
SERVICES INCLUDING DENTAL AND
BEHAVIORAL HEALTH BUT- DO NOT
EVEN KNOW WHAT MEMBERS ARE
RECEIVING THESE CARVED OUT
SERVICES. THIS RAISES CONCERNS
AROUND MEDI CAL PLANS BEING
GIVEN ADDITIONAL
RESPONSIBILITIES AN EXISTING
OVERSIGHT TO THE CAL AIM GOAL
OF STANDARDIZATION WE'D
RECOMMEND KNOCKS KEEP MANDATORY
KNOCKS KEEN LICENSURE TO ENSURE
THAT ALL MEDI CAL ENROLLEES
HAVE ACCESS TO THE SAME
CONSUMER PROTECTIONS INCLUDING
ACCESS TO AN INDEPENDENT
MEDICAL REVIEW AS WELL AS
OVERSIGHT BY A REGULAR AT
REGULATOR RATHER THAN A PAIR.
IN ADDITION WE DO NOT THINK THE
DEPARTMENT SHOULD BE DELEGATING
OVERSIGHT FUNCTIONS TO A
NATIONAL ORGANIZATION BUT OUR
PLEASE THAT. OTHER THE
DEPARTMENT PROPOSES TO CERTIFY.
DELEGATED ENTITIES WERE ALSO
PLEASE THE CAL AIM INCLUDES
SERVICES TO MEDI CAL ENROLLEES
THAT ARE TRADITIONALLY PROVIDED
THROUGH THE IN LIEU OF SERVICE
PROPOSAL HOWEVER WE'RE
CONCERNED THAT AS AN IN LIEU OF
SERVICE PLANS HAVE THE OPTION
OF WHICH SERVICE TO PROVIDE.
AND ARE FINANCIALLY
INCENTIVIZED TO FOCUS ON HIGH
UTILIZES WHICH MIGHT EXACERBATE
HEALTH DISPARITIES. THE HEALTH
HOLD PROGRAM WHICH WE SPONSORED
PROVIDE HOUSING SUPPORT
SERVICES AS AN ENTITLEMENT SO
ALL IN A ROW LEASE IN
PARTICIPATING CLANS WHO QUALIFY
ARE ENTITLED TO THIS BENEFIT
RATHER THAN AT THE PLANTS
DISCRETION. THE DEPARTMENT
PROPOSES ENDING THIS AS WELL AS
A WHOLE PERSON CARE AND
REPLACING IT WITH IN LIEU OF
SERVICE WHERE'S WE RECOMMEND
MAKING HOUSING SUPPORT SERVICE
A STATEWIDE BENEFIT REGARDLESS
OF WHAT IT'S CALLED. WE ALSO
BELIEVE MEASUREMENTS AND
FINANCIAL INCENTIVES SHOULDN'T
SOLELY BASED ON CALLOUSED
SAVINGS OR CLAIMS. AVOID IT BUT
MILESTONE SHOULD BE PUT INTO
PLACE TO MEASURE THE NUMBER OF
ELIGIBLE AND REALLY SERVE TO
ENHANCE CARE MANAGEMENT AND IN
LIEU OF SERVICES AT THE CHORE
POINTED OUT. WE SUPPORT EFFORTS
TO STRENGTHEN THE PROCUREMENT
PROCESS AND ALSO RECOMMEND AS
PART OF THE PROCUREMENT PROCESS
OF THE CONTRACT BE OPEN TO
STAKEHOLDER INPUT. TO
STRENGTHEN MEASUREMENTS OF WHAT
PLANS ARE HELD ACCOUNTABLE AND
ENFORCEMENT OF THESE PROVISIONS.
TO THE REMAINING WHAT WE THINK
IS 998% NOT COVERED BY THE
ENHANCE. CARE MANAGEMENT OF THE
POPULATION HEALTH MANAGEMENT
PROVIDES OPPORTUNITY BUT
SUCCESS WILL REQUIRE TYING
PAYMENTS TO THE EFFORTS TO.
REDUCE HEALTH DISPARITIES THANK
YOU. THANK YOU VERY MUCH I
QUESTIONS. YES CENTER MONEY
THANK YOU MISTER CHAIR WANT TO
THANK ALL THE PANEL MEMBERS IN
THE DEPARTMENT FOR. HELPING
BRING US UP TO SPEED- ON ONE
DAY ASK MISS WAY ON THE- KNOCKS
KEEN QUESTION ROUGHLY HOW MANY
PATIENTS ARE COVERED BY KNOCKS
KEEN PROTECTIONS OR IF ANYONE
KNOWS. OR AT I DON'T HAVE THE
NUMBER UP WE CAN GET YOU THE
NUMBER THAT ARE IN OUR CLOSE IN
ON THOSE PLANETS APPROXIMATELY
TWO MILLION YEAH AND THEN THE
FOLLOW UP IS WHAT ARE THE
RIGHTS AND REMEDIES FOR THOSE
PATIENTS. IF THEY'RE NOT
PROTECTED BY KNOCKS KEEN. SO
FOR- ON THE DEPARTMENT SAID WE
STILL HOLD ALL OF OUR MANAGED
CARE PLAN- CONTRACTS TO THE
SAME EXPECTATIONS IN REGARDS TO
WHAT'S IN THEIR CONTRACT THERE
IS SOME ADDITIONAL PROVISIONS
UNDER THE KNOX KING CLEARLY-
BUT THERE ARE. A NUMBER OF
THINGS OF NETWORK ADEQUACY IS
THE SAME REGARDLESS. OF WHETHER
THEY'RE KNOCKS KEEN OR NOT TO
THE SAME NETWORK ADEQUACY
STANDARDS THAT WE HAVE FOR A TO
PLAN OUR LOCAL INITIATIVE- PLAN
WOULD ALSO BE THE SAME NETWORK
AS C. ADEQUACY REQUIREMENTS WE
HAVE IN OUR CLOTHES MODEL- AS
WELL. ALL OF OUR STANDARD KIND
OF TURNAROUND TIMES FOR
AUTHORIZATION OR OTHER
MONITORING AND OVERSIGHT WOULD
BE CONSISTENT ACROSS OUR
MANAGED CARE PLANS THERE ARE
DIFFERENCES OF COURSE WITH THE
CLOTHES- I AM MARS AS WAS
MENTIONED. EARLIER BUT WE DO
HAVE PRETTY CONSISTENT
MONITORING ACROSS ALL OF OUR
MANAGED CAREPLANS IN REGARDS
THE CONTRACTUAL OBLIGATIONS. IN
WHEN THERE IS A DENIAL OF
SERVICES IS THERE A- AN APPEAL
RIGHT. TO THE DEPARTMENT. IF
IT'S NOT KNOCKS KEEN. YES SO-
WE DO HAVE THE FAIR HEARING
PROCESS ON THAT IS IN PLACE-
AND- THAT IS AVAILABLE TO
BENEFICIARIES FROM THE PEOPLE
RIGHT. THANK YOU. A JUST A NOTE
ON THE STATE FAIR HEARING THAT
THAT IS AVAILABLE TO ALL IN ALL
THESE REGARDLESS OF WHETHER
YOU'RE NOT SEEN LICENSE OR NOT
THAT IS DONE BY AN
ADMINISTRATIVE LAW JUDGE NOT
NECESSARILY SOMEONE WHO HAS A
CLINICAL EXPERTISE. WHAT AM I
THINK ALL YOU FOR YOUR
PRESENTATIONS. I GENERALLY
AGREE THAT THE PRICE SHOULD
HAVE ALL PLANS KNOCKS KEEN SO
TO SAY THAT RIGHT UP FRONT- SO
FOR THE FOR THE PLANS I GUESS.
SO YOU PRIOR TO SO MY QUESTION
WITH THE AGENCY EARLIER SO WE
GOT A LOT OF MOVING PARTS
YOU'RE GOING TO BE RESPONSIBLE
FOR A LOT MORE STUFF RIGHT. SO.
SO HOW IS A AND I REALIZE IT'S
STILL STILL OF ALL BEING BUT SO
WHEN I QUESTIONS ACTUALLY-
FIRST EMAIL FOLLOW UP WITH THIS
YEAR YOU TERMS OF WHAT IT GIVES
NOW YOU HAD SOMEONE THAT YOU
HAD SOME EXPERIENCE WITH THE
WHOLE TURNOUT ISN'T SO WHAT YOU
SEE IS THE INTERFACE BETWEEN
YOUR PLAN AND ALL THE SERVICES
HERE THAT YOU'LL WELL ACTUALLY
BE SUSPECTED TO DELIVER- AND
THE COUNTIES WHO ALSO ARE IN
CHARGE OF ADMINISTERING. A
WHOLE BEVY OF VERY IMPORTANT
SOCIAL SERVICES THAT ALSO
AFFECTS THE BASICALLY THE
SOCIAL TERMS OF HEALTH TO WRITE
THAT WHETHER IT'S IN. WELFARE
FOOD STAMPS. BUT WE CAN JUST
KEEP GOING ON AND ON SO WITH SO
HOW HOW HOW DO YOU HOW DO YOU
SEE THAT. PLAYING OUT
ESPECIALLY SINCE I GUESS YOU'RE
NOW RESPONSIBLE RECALL
CONTRACTING WITH SOMEONE.
COUNTY NONPROFIT OR SOMEONE TO
UNLESS YOU PLAN TO DELIVER
YOURSELF MINUTE THE THESE THESE
SERVICES SOME OF THEM ARE MORE
KIND OF MEDICALLY ORIENTED BUT
OTHER ONES ARE MORE CERTAINLY
LIKE HOUSING THEY THINK. LIKE
HOUSING VOUCHERS AND SO FORTH
SO HOW DO YOU SEE YOUR ROLE AND
HOW DO YOU INTERFACE WITH THE
OTHER SOCIAL SERVICES WHICH ARE
MAINLY DELIVERED BY. THE
COUNTIES OR- THROUGH- PERHAPS-
SOME NONPROFITS BUT MAINLY TO
COUNTIES. WELL I'LL START AND
SO I THINK- BUT AS I MENTIONED
EARLIER A LOT OF THIS WILL GO
BACK TODAY INTENSIVE PLANNING
THAT- IS OCCURRING AND STARTED
SOON AFTER THE PROPOSAL- OF WAS
RELEASED. AND AS A PART OF
THAT- IT'S REALLY DOING A GAP
ANALYSIS LOCALLY TO LOOK AT-
YOU KNOW WHAT SERVICES ARE
AVAILABLE AND BEING PROVIDED
TODAY WHETHER THAT'S THE WHOLE
PERSON CARE OR HEALTH HOMES.
WHAT IN LIEU OF SERVICES ARE
BEING PROVIDED- TODAY AND THEN
ENSURING THERE'S CONTINUITY OF
THOSE SERVICES UPON THE
TRANSITION AND IN JANUARY. AND
THEN THINKING THROUGH KIND OF
IN THE LONGER TERM WITH THE
MENU OF IN LIEU OF SERVICES I
KNOW. OUR PLANS ARE REALLY
EXCITED ABOUT THEM AND YOU KNOW
IN THE LONG TERM WANT TO BE
ABLE TO PROVIDE ALL OF THEM BUT
IT'S A IT'S ABOUT CAPACITY
INFRASTRUCTURE AT THE LOCAL
LEVEL. SO IDENTIFYING SORT OF A
PLAN FOR BEING ABLE TO BUILD
OUT THAT CAPACITY LOCALLY AND
THAT'S WHERE THE INCENTIVES
INTO PLAY. SITTING UP AGAIN IN
TERMS OF THEN YOU TO YOUR
QUESTION AROUND HOW DO
INTERFACE OF THE SOCIAL
SERVICES THAT PLANS. HAVE NOT
YOU KNOW ARE NOT RESPONSIBLE
FOR AND DON'T DIRECTLY PROVIDE
A THINK. ALSO GOES BACK TO
CONTRACTING WITH COMMUNITIES
ORGANIZATIONS AND THE COUNTIES
WHO ARE EXPERT IN THE AND-
REALLY HAVE THE KIND OF FACE TO
FACE CONTACT WITH THE BENEFITS
OR SOMEBODY BASIS. I'M SORRY I
THINK AGAIN IT'S GOING TO LOOK.
A LOT DIFFERENT FROM COUNTY TO
COUNTY EVEN IN THE COUNTIES
ORDERS WHOLE PERSON CARE TODAY
AND WE'RE FOCUSING ON ON THE
SERVICES THAT THEY'RE PROVIDING
THAT NOW FIT UNDER THE IN LIEU
OF SERVICES BUNDLE OR EVEN THE
ENHANCE CARE MAN MANAGEMENT
BUNDLE- I DO ANTICIPATE THAT
YOU KNOW IN IN SOME COUNTIES.
NOR IN OUR INTENT WOULD NOT BE
TO DISRUPT THE INFRASTRUCTURE
THAT'S BEEN BUILT- WITH ALL
THESE DIFFERENT SERVICE
PROVIDERS AND I THINK IN MANY
COUNTIES WE WILL BE WORKING
DIRECTLY WITH THE COUNTY TO- TO
ADMINISTER THOSE SERVICES THAT
THE WAY THAT THEY ARE TODAY
WITH THE DIRECT CONTRACT WITH
THE COUNTY AND I KNOW THAT IN.
OTHER CUT SOME COUNTIES WITH
ALL PERSON CARE YOU KNOW THE
COUNTY MAY NOT WANT TO TAKE ON
THAT ROLE IN THE MODELS ARE SO
DIFFERENT FROM COUNTY TO COUNTY
IT'S GONNA TAKE A LOT OF HEAVY
ENGAGEMENT OVER THE NEXT FEW
MONTHS TO A TO FIGURE OUT
EXACTLY WHAT THAT RELATIONSHIP
LOOKS LIKE. AROUND THOSE IN
LIEU OF SERVICES BENEFITS- I
THINK BEYOND THAT FOR OTHER
THINGS THAT ARE ARE PROVIDED
THROUGH THROUGH SOCIAL SERVICES
AND THROUGH THE COUNTIES- YOU
KNOW I THINK PART OF THE INTENT
OF THIS IS IT JUST THAT YOU
KNOW WE'RE WORKING WITH THEM
DIRECTLY ON THE SERVICES BUT
WE'RE WORKING MORE CLOSELY WITH
THE COUNTIES TO COORDINATE
THOSE OTHER TYPES OF SERVICES
AS WELL. AND AS WE WORK TO
IDENTIFY YOU KNOW HOW THIS
RELATIONSHIP WITH THE COUNTY IS
GONNA LOOK NOT JUST WITH. WHO'S
PAYING FOR THE IN LUIS MRS BUT
HOW DO WE COORDINATE AROUND
THESE OTHER SERVICES AGAIN
EVERY EVERY COUNTY IS GOING BE
DE BECAUSE THINK YOU MAY CASES.
SOME OF IN LIEU OF SERVICES
BENEFITS THEY'RE NOT JUST LEANS
THAT WHOLE PERSON CARE PAID FOR
THE COUNTY STARTED DOING THIS
AND WE'RE JUST GONNA MOVE IT
OVER RIGHT A LOT OF TIME
SERVICE THERE IN ONE WITH OTHER
MEANS. IS ANOTHER PROBE. AND
WITHOUT THE OUT THAT THAT
INTENSIVE CORE. COORDINATION
STEM FOR STRUCTURE WITH EACH
INDIVIDUAL COUNTY IT'S NOT A
WORKED JUST. OVER A IN THE
HEALTH PLAN BENEFIT. SURE THANK
YOU FOR THE CALL. I THINK I. AS
YOU'VE HEARD FROM. MY
COLLEAGUES UP HERE TO IT IT
WILL DEPEND ON THE COUNTY I'VE
HEARD FROM OUR LARGER COUNTIES
THAT HAVE STRONG RELATIONSHIPS.
SOCIALLY WITH THEIR LOCAL
HEALTH PLANS OR- OTHER
COMMERCIAL PLANS IN THE AREA
THAT. THERE ARE OPPORTUNITIES
THERE. OBVIOUSLY REPRESENT
SMALLER COUNTIES ALSO IN
DIFFERENT PARTS OF THE STATE
WHERE. THERE IS NO EXISTING
RELATIONSHIP WITH THE PLANS.
THERE AND THAT- THAT WE
APPRECIATE THE DEPARTMENT
ENGAGING BOTH PLANS AND THE
COUNTIES ANOTHER PROVIDERS TO
INTENTIONALLY BEGIN THOSE
CONVERSATIONS. BUT I THINK FOR
US IT'S GOING TO TAKE MORE THAN
ENCOURAGEMENT AND MORE THAN-
INJURY MANAGED CARE PLANS TALK
TO THE COUNTY PROVIDERS. FOR US
FOR COUNTIES WHERE IT MAKES
SENSE TO CONTRACT ABOUT
ESSENTIAL OF SOCIAL AND HEALTH
SERVICES BACK TO GET THE
COUNTIES. BUT ONE THING WE'RE
REQUESTING AND FOR THE COUNTIES
THAT WAY DOES NOT MAKE SENSE A
CONTACT BACK OUT TO COUNTIES
LIKE IN SACRAMENTO AND SAN
DIEGO. WHAT WE HAVE- ASKED FOR
IS TO ENSURE TAT. THE MANAGED
CARE PLANS CONTRACT WITH
PROVIDERS THAT MEET. LABOR
STANDARDS QUALITY STANDARDS AS
WELL AS PATIENTSAFETY
STANDARDS TO ENSURE THAT.
MINIMUM THAT THOSE CLIENTS IN
THOSE COUNTIES OUR RESEARCH
BEING THE HIGHEST QUALITY OF
CARE. AND WE'RE TRYING TO
GRAPPLE WITH THE VARIANCES IN
OUR COUNTIES AS WELL BUT AT THE
END OF IT. WHAT I WANT TO LEAVE
YOU WITH IS THAT THAT COUNTY
PUBLIC WORK FORCE ARE THE ONES
THAT ARE ALREADY DOING
INTENSIVE CASE MANAGEMENT. THEY
KNOW IN REAL TIME WHAT HOUSING
AVAILABILITIES THERE ARE IN A
VERY QUICK MANNER AND THEY DO
ALL OF THE IN REACH. OUT AND
OUTREACH WORK TO THE CURRENT
POPULATION AND ALSO TO SOME
EXTENT TO THE AT RISK
POPULATIONS. SO I GUESS I WOULD
NOTE COUPLE OF OBSERVATIONS THE
FROM MY PERSPECTIVE SO ONE IS
THAT- WHEN WE TALK ABOUT THESE
TYPES OF SERVICES. FIRST OF ALL
WHY HERE FROM EIGHT PERHAPS
STILL ALMOST CHILDREN COMPLEX
NEEDS IS THAT THE SOMETIMES THE
PARENTS. THEY WANT THINGS GET-
TURNED OUT SO I HAVE TO. I HAVE
TO CASE AFTER CASE COORDINATE
ALL CASE CORDY HERS RIGHT. AND
SO. YOU HAVE. PEOPLE THE COUNTY
WHO ARE COORDINATING A SET OF
SERVICES AND THEN WE HAVE
ANOTHER SET OF SERVICES HERE-
THAT- THEY'RE SITTING UNDER
THAT THAT THE- MANAGED CARE
PLAN IS IN THE PAYING RELATIONS
THE MASTER PLAN OF THE COUNTY
ARE WE GONNA HAVE. PLANTS NOW
TRYING TO COORDINATE THE CARE
COORDINATORS RIGHT I GOT THE
SET WITH THIS ONE THE SET AND
DAY AND THEY'RE NOT. DEALT SO
SOMEPLACE IN THE- BACKGROUND WE
GOTTA FIGURE OUT HOW TO MAKE
SURE THAT CONNECTS RATE AND
THAT THERE'S AN INCENTIVE TO
MAKE SURE THAT CONNECTS THE
OTHER PART ALSO IS THAT- SO YOU
KNOW DISEASE MANAGEMENT WAS
REALLY SEXY FOR AWHILE- AND
THAT OF THE EIGHTIES. AND WHERE
IT FELL APART WAS IS THAT IT-
WAS BEING DONE STE AWAY FROM
THE FRONT LINES ESSENTIALLY- SO
IT WAS BEING. YOU KNOW WAS. A
HEALTH PLAN HIRED A FIRM TO DO
THIS THAT WAS NOT DID NOT
RELATIONSHIP BUT THE PRIMARY
CARE DOCTOR. ARE THE ARE THE
PROVIDERS THAT THE PATIENT
ACTUALLY INTERACTED WITH THE
REGULAR BASIS RIGHT SO THERE IS
NO TRUST BETWEEN SAY THEY GOT A
CALL FROM A NURSING A YOU NEED
TO GET YOUR HEMOGLOBIN A. ONE
C. OF DIABETES LIKEWHO ARE
YOU. WITH MY DOCTOR I'LL LET
SARAH SO HOW DO WE MOVE THIS
THESE TYPES OF SERVICES IS
CLOSE AS WE CAN TO THE FRONT
LINES THAT'S THE PROVIDERS
THAT'S THE ELIGIBILITY WORKERS
OF THE PUBLIC HEALTH NURSES AT
THE COUNTY. WHO ACTUALLY KNOW
THAT THIS PERSON IS HOMELESS SO
WE WERE PROVIDE. YOU THAT RATE
HOW DO WE'D BE SURE THAT WE
MOVE THAT DECISION MAKING. TO
THE PEOPLE ACTUALLY HAVE THE-
BEST TOHAVE. NOW THE BEST
KNOWLEDGE HAVE THE RELAY. WITH
THE PATIENT CLIENT BECAUSE
THAT'S THE PERSON SO HOW WE BE
SURE THAT HAPPENS AND- SO THAT
WOULD BE SUCCESSFUL AND DOES.
AND BECAUSE AFTER ALL NO THIS
IS ABOUT TRUST IS ABOUT
RELATIONSHIPS AS WELL AS ABOUT
THE SERVICE ITSELF. AND SO I'M
THINKING THAT THIS DALE HOW DO
WE DESIGN THIS IN A WAY. SO
THAT. THIS WILL HAPPEN NOT JUST
HOPE IT WILL HAPPEN AND I'M
SURE THAT CERTAIN PLANS WILL
UNDERSTAND THIS MAKE THIS
HAPPEN BUT THAT WE MAKE THIS
THE STANDARD OF HOW. WE HOW WE
DO THIS AND MAYBE PERHAPS- FROM
OUR PUBLIC HOSPITALS YOUR
EXPERIENCE ABOUT THIS BECAUSE
YOU YOU'RE YOU'RE THE PERSON
THAT THAT YOU'RE IN THE FRONT
LINES RIGHT YOU YOU WOULD WORK
OF PLANS YOU HAVE PATIENTS AT
THE OTHER END AND- YOU'RE
ABSOLUTELY THE RELATIONSHIPS
THAT WE ARE. THAT ARE MOST
IMPORTANT TO US AND SEE THIS AS
THE- A NECESSITY TO MAKE SURE
THAT THE CARE CONTINUES TO BE.
CENTERED AROUND THE PERSON AND
NOT SIMPLY IT COORDINATED
PROGRAMS YOU COULD NOT AGREE
WITH YOU MORE THAT THE MOST
IMPORTANT CONVERSATIONS. THAT
NEED TO HAPPEN AND THE SHARED
DECISION MAKING THAT NEEDS TO
HAPPEN AT THE LOCAL LEVEL
BETWEEN THE COUNTY PROVIDERS.
AND THE PLANS IS EXACTLY AROUND
HOW WE LEVERAGE THE EXISTING
INFRASTRUCTURE WHETHER THAT'S
HUMAN RESOURCES THE PEOPLE WHO
KNOW THESE PATIENTS. OR THE
BRICKS AND MORTAR ALL OF IT I
THINK THE BEST THING WE HAVE
GOING FOR US IN THIS MOMENT IS
THE VERY FACT THAT. PLANTS ARE
BEING ASKED TO DO SO MUCH SO
QUICKLY AND THAT THIS THERE AND
BECAUSE THERE IS ALREADY
EXISTING INFRASTRUCTURE. AND
MORE OFTEN THAN NOT NOT
EVERYWHERE BUT MORE OFTEN THAN
NOT THERE ARE TRUSTED
RELATIONSHIPS I'M AND LOCAL
DIALOGUE AND PEOPLE ARE ALREADY
STARTING TO ROLL UP THEIR
SLEEVES SO. I'M PERHAPS NOT
CONFIDENT BUT HOPEFUL THAT WE
WILL- WE WILL DO EXACTLY WHAT
YOU SAY AND- AND- FIND WAYS AT
THE LOCAL LEVEL TO MAKE SURE WE
ARE NOT LETTING ANYTHING.
SPECIALLY THOSE RELATIONSHIPS
WITH PATIENTS WHETHER ON MINE.
SO IF I DO NOT. HOW WE'VE- WE
MAKE THAT HAPPEN AND ON THEM IN
THE A- IS VERY DIFFERENT THAN
WHEN YOU THINK OF CASE
MANAGEMENT THAT'S BEEN DONE
TRADITIONALLY MOSTLY BY PLANS
TELEPHONIC CASE MANAGEMENT
SEPARATED FROM THE DELIVERY
SYSTEM THE ABSOLUTE EXPECTATION
HERE IS THAT. THESE ENHANCE
CARE MANAGEMENT CAPABILITIES
ARE AT THE FRONT LINES THIRTEEN
THE PERSON'S HOME BUT THERE IN
THE PERSON'S HOME WITH A
TRUSTED INDIVIDUAL THAT THEY
MAY HAVE A RELATIONSHIP WITH IN
THE CLINIC WHERE THERE WERE
THEIR SERVICES ARE BEING
PROVIDED WHETHER THAT'S A
COUNTY CLINIC AN FQHC OR
BEHAVIORAL HEALTH CLINIC WHERE
THE MOST TRUSTED RELATIONSHIP.
IS BETWEEN THAT PERSON AND THE
BEHAVIORAL HEALTH TREATMENT
PLACE THEY ARE NOT MAYBE THE
ONLY PLACE THEY'RE GOING AND SO
THE WHOLE CONCEPT OF AND HEALTH
CARE MANAGEMENT IS REALLY
DELIVERING IT AT THAT LEVEL
WHERE THE INDIVIDUAL IS SO
THAT'S IN THEIR PRIMARY CARE
SIDE THAT'S IN THERE BEHAVIORAL
HEALTH SIDE THAT'S IN THERE IF
YOU DECIDE THAT IN THE PLACES
WHERE THEY ARE. WHETHER THAT'S
YOU KNOW I COUNTY CLINIC
FEDERALLY QUALIFIED ANSEL
CENTER A LARGE PRIVATE PRACTICE
THAT HAS THAT RELATIONSHIP SO I
THINK THAT'S WHERE WE TALK
ABOUT. IT'S REALLY NOT AN
EXPECTATION THAT THE PLAN WILL
BE DIRT CORRECT DIRECTLY
DELIVERING A LOT OF THIS THERE
REALLY IS AN EXPECTATION THAT
THE PARTNERING WITH THE
ENTITIES AND THE COUNTIES IN
THE CLINICS THAT ARE DIRECTLY
PROVIDING THE SERVICES TO MAKE
THAT CONNECTION BUT THIS ALSO
GONNA BE IN THE HOME THIS IS
GONNA BE ON THE STREETS. OF THE
DEPARTMENTS PRETTY CLEAR ABOUT
THOSE EXPECTATIONS IN THE
DOCUMENT AND CERTAINLY IN THE
WORK GROUPS AND WORK THAT WE'VE
DONE- SO EVENTUALLY AND
WHATEVER CONTRACTS IN THE
FUTURE TOO- YES TOO MANY HEALTH
WORKERS COMMUNITY HEALTH
WORKERS ARE AN ABSOLUTE
CRITICAL PIECE OF THIS. AND THE
FACT IS THESE MODELS HAVE BEEN
DONE ALREADY YES TO HEALTH
HOMES THROUGH ALL PERSON CARE.
MANDATE I MEAN ODESSA I LIKE
GOING OUT SO I MEAN TO THE
THINGS THE DEPARTMENT IS DOING-
IS PURSUING IS THAT FOR A WHOLE
PERSON CARE ENTITIES WE ARE
MANDATING THAT THE MANAGED CARE
PLANS- CONTRACT NOW THERE ARE A
FEW. EXCEPTIONS TO THAT LIKE IF
THE WHOLE PERSON CARE ENTITY
DOES NOT WANT TO ACTUALLY
CONTRACT BACK THEY HAVE THE
RIGHT TO. WRITER FOR REFUSAL
FOR LACK BETTER SCRIPT SHIN BUT
ALSO THEY HAVE TO MAKE SURE
THAT THERE IS A CERTAIN EVEL
OF EXPECTATIONS REGARD TO
MEETING ENHANCE CARE MANAGEMENT
BECAUSE WHOLE PERSON CARE VERY
STATEWIDE- ONE OF THE PIECES
THAT THERE ARE GOING TO HAVE TO
TAKE ON THE- THE REQUIREMENTS.
OF THE ENHANCE YOUR MANAGEMENT
BENEFIT- AND MEET THE QUALITY
IN EXPECTATIONS THAT WE PUT ON
THE PLANS WE PUT A LOT OF
EXPECTATIONS ON THE PLANS AS
THEY CLEARLY KNOW. I'M AND THEN
THEY HAVE TO PUT THOSE
OBLIGAIONS ON TO THEIR
CONTRACTED PROVIDERS- SO WE
ARE- WE HAVE- PUT THAT FORWARD
IN OUR PROPOSAL. THE OTHER
THING I WOULD MENTION IS THAT
WE DO PLAN ON HAVING IT AND
BASED ON A LOT OF FEEDBACK FROM
THE WORK GROUP. ON THE
STANDARDIZED- CONTRACT TEMPLATE
FOR ENHANCE CARE MANAGEMENT SO
THE EXPECTATIONS OF THE
DEPARTMENT IS VERY CLEAR- AND
IT IS VERY TRANSPARENT BETWEEN
THE MANAGED CARE PLAN AS WELL
AS THE ENHANCE YOUR MANAGEMENT
ENTITY. WHAT ARE THE EXCEPTION
AT THE EXPECTATIONS OF THIS IS
BEING IN THE HOME BEING ON THE
STREET. AND IN PERSON. AND IF I
MAY JUST AM I THINK GOING BACK
TO. YOUR INITIAL QUESTION
AROUND- HAVING THESE SERVICES
HAPPENED CLOSE TO THE PATIENT
AND KIND OF THE DECISION MAKING
A CAR THERE. I THINK ONE THING
THAT WE'VE IDENTIFIED AS A
NEED. I'M THINKING ABOUT
IMPLEMENTATION IS REALLY.
WANTING TO BRING THOSE
PROVIDERS IN TO OUR NETWORKS-
BUT WANTING TO SET THEM UP FOR
SUCCESS AND ACKNOWLEDGING THAT
A LOT OF TIMES EASIER
NONTRADITIONAL. I'M PROVIDERS
THAT HAVE NOT BEEN IN MANAGED
CARE NETWORKS IN THE PAST.
CERTAINLY A LOT OF TRAINING ON
SORT OF THE- MEDI CAL MANAGED
CARE REGULATORY ENVIRONMENT AND
REQUIREMENTS- JUST. YOU KNOW TO
NAME AN EXAMPLE BEING ABLE TO
CODE AND SMACK ENCOUNTERS
WHICH- AND- AS WE HAD A
DISCUSSION ABOUT AT THE LAST A
WORK GROUP MEETING IS A FEDERAL
REQUIREMENT- SO THOSE ARE THE
TYPE OF THINGS THAT. HAS WERE
THINKING ABOUT PREPARATION-
THAT WE REALLY WANT TO ENSURE
THAT NOT ONLY ARE WE PREPARED
BUT THAT. WE AND OUR AND WE'RE
WORKING WITH THE DEPARTMENT TO
ENSURE THAT OUR PROVIDERS OF
OCCURS WHILE. SO AT THAT A DO
THIS ON A QUESTION OF THE
PLANTS AND SERVE TO TELL ON
SOMETHING I ASKED EARLIER FOR
THE AGENCY SO IN TERMS OF.
YOU'RE GONNA BE EXPECTED YOU
HAVE IN LIEU SERVICES YOU HAVE
YOUNG A- COUNTRY OF LONG TERM
CARE WE'RE DOING THE- THE
ENHANCED CHAIR OF TERMS YOUR
CAPACITY TO. PRICING NEGOTIATED
GET THE RATE YOU NEED TO DO
THIS WELL IS THAT THE WITH THE
DC CHALLENGES WITH DOING THAT.
WELL I THINK THE- THE BIGGEST
CHALLENGES IS REALLY THAT THE
TIMELINESS RIGHT NOW- I KNOW
THE DEPARTMENT IS WORKING HARD
ON TRYING TO FIGURE OUT WHAT
THE RATES ARE GOING TO LOOK
LIKE IN AND WE'VE BEEN GIVEN
SOME TARGET DATES FOR LATER
THIS SUMMER I THINK IS EARLY AS
AUGUST STIR. RIGHT AUGUST
WORKING TO GET AS SOON AS
POSSIBLE SOON AS POSSIBLE- BUT
IT DOES IT DOES RAISE
CHALLENGES BECAUSE LIKE LIKE
YOU MENTIONED EARLIER WE GET
OUR NEW CAPITATED RATE AND WE
HAVE TO HAVE OUR ACTUARY SIT
DOWN AND FIGURE OUT OKAY WELL
HOW DO WE PUT A VALUE ON THE
SERVICES AND HOW DO WE BREAK
THAT INTO THE CONTRACTS AND-
AND EVEN LOOKING AT OUR OUR
EXISTING HEALTH HOMES NETWORK
WHICH WILL BE PART OF OUR
NETWORK FOR ENHANCE CASE
MANAGEMENT. YOU KNOW WE'RE
ALREADY HEARING FROM SOME
PROVIDERS THAT HEY YOU KNOW
WE'VE BEEN DOING THIS FOR
HEALTH HOMES IT HAS BEEN A HUGE
ADMINISTRATIVE BURDEN AND IT'S
BEEN A LOT OF WORK. BUT WE FIND
VALUE IN THIS BUT WE CAN'T EVEN
THINK ABOUT YOU KNOW THIS NEW
PROGRAM IF WE DON'T KNOW THAT
THE RATES ARE GOING TO BE AT
LEAST BE SOMEWHAT SIMILAR. AND
YOU KNOW AS WE ENGAGE I THINK
WITH WITH IN LIEU OF SERVICE
PROVIDERS AND OTHER PROVIDERS
AND START LOOKING AT HOW DO WE
BRING IN- THE WHOLE PERSON CARE
NETWORKS INTO THIS ENVIRONMENT.
YOU KNOW IT IT PUTS IT A TIE A
TIE VERY TIGHT TIME CRUNCH FOR
US TO EVEN YOU KNOW GET THOSE
INITIAL RATES IN SAY AUGUST AND
THEN BE ABLE TO TURN AROUND
HAVE CONTRACTS ESTABLISH THE
NETWORKS BUILT OUT BY JANUARY
FIRST SO I THINK THAT'S- THAT'S
DEFINITELY A BIG CONCERN FOR US
AT THIS POINT. YEAH THE ONLY
THE ONLY OTHER THING I WOULD
ADD IS JUST HAVING CONVERSATION
ABOUT THE ASSUMPTIONS BEHIND
WHAT GOES INTO DEVELOPING THE
RATE SO. ADDITION TO TIMING
KIND OF. WHAT WHAT WHAT'S
BEHIND THE RATE. OKAY NOW LIKE
I GUESS THE QUESTION OF THE
POSE ACT. GIVEN TESTIMONY FROM
LESTER CENTER THAT. THERE ARE
SOME CONCERNS THAT THEM THAT
SOMETIMES THERE ARE SOME PLANS
WHO MAY NOT NECESSARILY-
PERFORM AS WELL AS WE'D LIKE
THEM TO- WHAT KIND OF
ACCOUNTABILITY MEASURES DO YOU
THINK THE- I CAN CERTAINLY ASK
THE AGENCY WHAT THEY WOULD DO
BUT WHAT DO YOU THINK IS THE
PLANS THAT YOU COULD DO THAT
REASSURE ADVOCATES LIKE THE
WESTERN CENTER. THAT WITH THAT-
THAT. THAT THAT. THAT BASICALLY
WHAT WE'LL GET THE EXPECT YOU
KNOW WHAT WE'LL GET THE
SERVICES PEOPLE EXPECT SO- WHAT
KIND OF- ACCOUNTABILITY
MEASURES DO YOU THINK. WOULD BE
APPROPRIATE TO THAT YOU'D SEE
THAT SHOULD BE IMPOSED ON
YOURSELVES THAT WOULD ASSURE
THAT- PATIENTS- WOULD THEY ARE
BUT THEY FISHERIES WOULD GET
THE SERVICES THAT DAY THAT THEY
NEED. AND I'D I THINK IT
PROBABLY AT LEAST. AS FAR AS
WHERE WE ARE NOW WITH IT-
IMPLEMENTATION PROCESS AND
PLANNING I THINK IT IT PROBABLY
IS GOING BACK TO WHAT- WHAT
EXPECTED WHAT ARE THE TO FIND
EXPECTATIONS AND OUTCOMES OF
THE DEPARTMENT IS EXPECTING AND
THEN SORT OF FROM THAT WATER
THE REQUIRED REPORTING TOOLS
ARE METRICS THAT WE'RE GOING TO
HAVE TO REPORT BACK UP AND
THEN. YOU KNOW TRANSPARENCY
AROUND THAT I THINK WERE YOU
KNOW IN SUPPORT OF TRANSPARENCY
AND WANT TO BE ABLE TO PROVIDE
INFORMATION TO ENSURE OUR
PARTNERS AND STAKEHOLDERS THAT
WE ARE ON THE FILLING- THE
OBLIGATIONS THAT HAVE BEEN-
WE'VE BEEN TASKED WITH UNDER
KELLY I'M SO I DON'T KNOW THAT
I HAVE SPECIFIC METRICS TO
SUGGEST AT THIS POINT OTHER
THAN- WE UNDERSTAND THAT THE
NECESSARY PART OF THIS PROCESS
AND PART OF TAKING ON NEW
RESPONSIBILITIES. YEAH YEAH I
MEAN I THINK IT'S GONNA HAVE TO
BE A MULTI TIERED APPROACHES
WERE WERE WORKING TO TRANSITION
EXISTING SERVICES IN THE BUILD
OUT INFRASTRUCTURE IN THE LONG
TERM. I THINK YOU KNOW LOOKING
AT THINGS LIKE HOW MANY PEOPLE
DO SUCCESSFULLY TRANSITION FROM
THE OTHER PROGRAMS INTO THIS
NEW BENEFIT AND HOW MANY
SERVICES. DO WE SUCCESSFULLY-
CONTINUE TO EXTEND THROUGH
THROUGH THESE NEW BENEFITS IS
DEFINITELY CRITICAL I THINK. NO
SUGGESTION OF YOU KNOW HOW MANY
PEOPLE ARE WE ENGAGE IN AND
ROLLING AND ENHANCE CARE
MANAGEMENT MORE DOOR NETWORKS
LOOK LIKE I THINK THAT'S-
THAT'S THINGS THAT SHOULD BE
TAKEN INTO CONSIDERATION BUT
ALSO. YOU KNOW LOOKING AT THE
BROADER CAPACITY IN WHICH- YOU
KNOW FOR SOME OF THESE SERVICES
IT'S YOU KNOW EVEN WITH YOU
KNOW THE HOUSE YOU KNOW THE
RECORD OF CARE SERVICES FOR
EXAMPLE IF WE GO INTO A COUNTY
WHERE THERE'S NO SERVICES THAT
EXIST. IT'S NOT GONNA BE A
MATTER OF WE GO THERE AND SIX
MONTHS LATER WE'VE GOT A
PROVIDER IT'S GOING TO BE A
MULTI YEAR PROCESS AND SO I
THINK. YOU KNOW PART OF THE
OVERSIGHT HAS TO BE LOOKING AT
WHAT WE'RE DOING TO ENGAGE WITH
OUR OUR COUNTIES IN WITH OUR
LOCAL COMMUNITY PROVIDERS TO.
INSURE THAT WE'RE CONTINUING TO
BUILD OUT THAT CAPACITY
THROUGHOUT THE STATE TO PROVIDE
ALL THE SERVICES. ACTUALLY ANY
COMMENTS. NEW AND MAKE. THE.
EASY SO IT'S- CERTAINLY
INTERESTING TO HEAR- FROM FROM
LH PC'S SIDE THE WHAT IT SOUNDS
LIKE IS THAT THEY'D LIKE
GREATER. OVERSIGHT FROM FROM
THE PLANS IS WHAT I HEARD IN
TERMS OF THE ACTUAL
MEASUREMENTS THAT ARE BEING
MEASURED AND SO TO ME- BECAUSE
THERE ARE SPECIFIC REQUIREMENTS
ALREADY IN PLACE THAT AREN'T
BEING MET- TO THAT THE THAT TO
ME MEANS GREATER ACTUAL
ENFORCEMENT OF THOSE
REQUIREMENTS- WHICH- IT SOUNDS
LIKE THAT THE DEPARTMENT IS
LOOKING TO DO MORE OF AND TO
APPRECIATE WITH THE INCREASE IN
THE MINIMUM PERFORMANCE LEVEL.
BUT I THINK THERE ALSO HAS TO
BE A- A PLAN- IT- THE- LEADING
THE WHOLE POINT OF THE CAL AIM
AS WELL AS TO THE RECOGNITION
THAT- BETTER SERVING PATIENTS-
AND I DON'T LIKE TO TALK ABOUT
COST RAVERS NECESSARILY WILL
BUT BUT THAT THAT. AS POINTED
OUT- THIS WILL BENEFIT- IN IN
THE LONG RUN AND SO TAKING THAT
GOT APPROACH MORE- BUT- IF THE
PLANS ARE LOOKING FOR GREATER
MEASUREMENTS AND- ENFORCEMENT
WE CERTAINLY HAVE SOME SOME
THOUGHT. OKAY THE BILL I THINK
YOU KNOW WITH THE NEW PROGRAM
YOU START WITH PROCESS MEASURE
SOMETHING YOU TALK ABOUT SOME
OF THINGS ABOUT TAKED ABOUT IN
TERMS OF. YOU LOOK AT
TRANSITION TO MAKE SURE THAT
INDIVIDUALS BEING SERVED NOW
MOVE OVER YOU LOOK AT NEW
ENROLLMENT YOU LOOK AT HOW MANY
PEOPLE ARE ACTUALLY BEING
SERVED. YOU HAVE TO GET THE
OUTCOME MEASURES EVENTUALLY
THEY'RE NOT JUST FINANCIAL
OUTCOME MEASURES THERE ARE
MEASURES THAT LOOK AT DID YOU
MAKE A DIFFERENCE WITH THAT
PERSON THE REALITY OF THAT THAT
TAKES TIME I MEAN WHEN YOU LOOK
AT A HOUSING PROGRAM FOR
EXAMPLE. YOU HAVE TO STABILIZE
A PERSON IN THE HOUSING YOU
MADE THE POINT THAT OFTEN YOU
THEN GET UNMET NEED THAT COMES
OUT IT'S ALL OF A SUDDEN YOU
NOW HAVE AN INDIVIDUAL THAT
YOU'RE PROVIDING MORE. YOU KNOW
MEDICATIONS TO YOUR PROVIDING
MORE PRIMARY CARE VISITS MORE
SPECIALTY VISITS IT'S GOING TO
TAKE TIME TO REALLY SEE ANY
OUTCOME MEASURES THAT ARE
CERTAINLY BASED ON YOU KNOW
BETTER HEALTH STATUS OF THE
MEMBER. SO I THINK WOULD REALLY
BE STARTING AROUND PROCESS. AND
I THINK YOU KNOW BOTH BOWS
POINT ABOUT. THERE IS THERE IS
THAT HAVE. YOU KNOW NO CAPACITY
AT THE MOMENT SO THE- THE
PROCESS MEASURES. DEVELOPING
CAPACITY. SO I THINK THOSE ARE
THE KIND OF THINGS THAT WE
WOULD BE LOOKING OUT INITIAL.
BUT CERTAINLY I THINK DEAL WITH
THAT PART OF IT IS TRYING TO
SET. EXPECTATIONS INCLUDE
CLINICS THAT EXPECTATIONS
THAT'S WHY WE HAD THE WHOLE
DIALOGUE ALSO ABOUT LIKE. WHAT
WE EXPECT TO HAPPEN DURING THE
TRANSITION MAY NOT BE.
NECESSARY THE SAME AS WHAT WE
ANTICIPATE WILL HAPPEN AT THE
END GOAL BECAUSE IT IS A
TRANSITION AND SO THINGS
HAPPENED DURING TRANSITIONS AND
ALSO HAVING THE FLEXIBILITY OR
TO CAPACITY TO DEAL WITH.
UNEXPECTED THINGS AS WELL
BECAUSE AS MUCH AS WE MIGHT
PREDICT UNTIL WE ACTUALLY TRY
IT SOME THINGS DON'T ALWAYS
TURN OUT THE WAY WE INITIALLY
PROJECT SO- BE SURE WE BILL THE
LITTLE IN THERE FOR THAT AS
WELL. YES I JUST WANTED TO
PROVIDE SOME COMMENTS ON-
CAPACITY AND LACK THERE OF AND-
THIS IS ONE OF THE ISSUES THAT
WE BROUGHT UP AROUND WORK
FORCE. SCA YOU HAVE SEPARATE
BUDGET AND LEGISLATIVE ASK
AROUND TRYING TO THINK. REALLY
CRITICALLY ABOUT HOW WE BUILD
UP OUR BEHAVIORAL HEALTH.
PROVIDERS AND ALSO OUR EXISTING
SOCIAL SERVICES WORKERS YOU'LL
SEE OUR BUDGET LETTER ON THOSE-
TOPICS BUT THEY'RE ALL. ALL
INTERRELATED AND WITHIN THE CAO
AIMS SPACE WE'VE HIGHLIGHTED
THE NEED FOR PROFESSIONAL I
SEEING THE SPACE WEATHER
THROUGH PEER CERTIFICATION ARE
ACTUAL. LICENSING AND SO FOR US
THAT'S- ONE OF OUR TOP
PRIORITIES WE UNDERSTAND THAT
YOU KNOW THE PLANTS CAN'T
PROVIDE SERVICES OR TO COUNTIES
CAN'T PROVIDE SERVICES IF WE
DON'T HAVE ACTUALLY ADVOCATE
WORK FORCE TO BE ABLE TO
PROVIDE THOSE SERVICES. AND SO
WE WANT TO WORK WITH YOU AND
ALSO THAT. TO TRY TO FIGURE OUT
A BETTER WAY OF CERTIFICATION
AND LICENSING AND ALSO
INVESTING ADDITIONAL MONIES FOR
THAT WORK FORCE PIECE. AND
THEN- ONE OTHER QUESTION IN
TERMS OF THE ENHANCE THE CARE
MANAGEMENT BECAUSE WE TALKED
ABOUT WELL THAT'S 1% SINCE THE
BEGINNING OF A REALIZE THAT
CENTER RIGHT BUT BASICALLY. AT
SO- SO I'M ASSETS CERTAINLY THE
A UNDERSTAND MAKES
CONCENTRATE ON THE ALL THAT THE
MOST CHALLENGING AND OFTENTIMES
MOST EXPENSIVE. THAT SWEAR LOG.
AND HOW DO YOU SEE SOME OF THE
THINGS THAT WE'RE PROPOSING
UNDER ENHANCE CARE MANAGEMENT.
PERHAPS THAT AND BEING.
AVAILABLE MAYBE NOT THE RIGHT
WORD BUT THEN INFORMING AND
THEN THAT ALSO DEVELOP A
SERVICES FOR THE REMAINING
POPULATION THAT ACCOUNT RIGHT
SO RIGHT. SO YES I KNOW THIS IS
THE GROUP THAT NEEDS IT THE
MOST AND WE ALSO HAVE AND NOT
EVERYTHING IS ABOUT MONEY TO
BUT IT'S BOTH THE IMPROVED
REYES OPTING FOR QUALITY AND
THE COOK BUT IS ALSO BASS
OPTING FOR SAVINGS AS WELL. BUT
THEN AS WE ARE ROLLING THIS OUT
WE'RE DEVELOPING THE EXPERIENCE
AND SO FORTH SO- AND SOME OTHER
PEOPLE I SAY WELL YOU KNOW WHAT
I HAVE SOMEONE WHO HAS NEEDS
NOT. BUT SINCE THAT PERSON YET
MIKE THIS THIS AND THIS CAN I
GET ONE OF THOSE FOR THIS THAT
WOULD HELP THAT PERSONALIZE A
WHAT WHAT DO WHAT DO YOU SEE-
AND IT AND AGAIN YEAH I DON'T
KNOW HOW THIS INTERFACES WITH
WITH THE WITH THE WAIVER OR
SOMETHING LIKE THAT. SO AND YOU
FRY HAVE NOTHING IT'S JUST
ROUGHLY A ROLL OUT THIS PART
BUT I DID AT THE BT YOU KNOW
PEOPLE SAY IT WILL GO AGO- WELL
YOU KNOW WHAT WHAT ABOUT. NOW I
HAVE SOMEONE WHO'S PRETTY YOU
KNOW THEY'RE NOT THAT 95% THERE
AT THE 90% BASED OFF A LOT OF
NEEDS NOT AS MUCH. BUT AND
MAYBE THEY GOT ONE OF THESE IN
LIEU SERVICES DATE COULD THAT
BE REALLY REALLY HELPFUL FOR
THEM THEY DON'T NEED. THREE OF
THEM ARE FIVE OF THEM AT THAT
THEN YOU SAY WELL BUT YOU'RE
NOT IN THE IN HEALTHCARE
MANAGEMENT DO YOU THE SO WHAT
WHAT HOW. HOW HOW DO YOU SEE
THIS. THERE'S A PIECE IT BEING
ONE OF THE THINGS THAT WE
DIDN'T TALK A LOT ABOUT TODAY
BUT IS IN CAL MS ARE. HEALTH ME.
STRATEGY SEES SO WE WILL
REQUIRE THAT THE MANAGED CARE
PLANS ANNUALLY SUBMIT TO THE
DEPARTMENT. I'M NOW STARTING
JANUARY ONE TWENTY TWENTY TWO
BECAUSE WE ARE TRYING TO
STAGGER BECAUSE WE KNOW THAT WE
I HAVE A LOT OF EXPECTATIONS OR
MANAGED CARE PLANS- BUT- THAT
THAT THE SUBMIT TO US AN ANNUAL
POPULATION HEALTH MANAGEMENT
STRATEGY WITH. IN THAT STRATEGY
THERE ARE A VARIETY OF
COMPONENTS OF WHICH WE WOULD BE
LOOKING AT. ONE IS RESTRAINED
EDUCATION AND LOOKING AT HOW DO
WE IDENTIFY WITH IN OUR
POPULATIONS THOSE WHO ARE. LOW
RISK- THOSE WHO ARE MEDIUM ARE
RISING RISK AND THEN THOSE OR
WHO ARE HIGH RISK. I'M AND THEN
THOSE WHO HAVE NO DATA IN ORDER
FOR US NOT TO KNOW KIND OF WHAT
AND THEN WHAT OUR EXPECTATIONS
OF WHAT PLANS DO AFTER THAT.
THIS KIND OF THREE FOUR KIND OF
MAIN PIECES OF OUR POPULATION
HEALTH MANAGEMENT IS ON THE
BACKBONE OF THE NCQA
REQUIREMENTS TO COMPLEMENT. OF
THOSE PIECES BUT IT REALLY HAS
TO DO WITH STARTING WITH THE
PREVENTIVE SERVICES IN MY ON
THE SERVICES OF. MANAGED CARE
PLANS THROUGH THAT POPULATION
HEALTH MANAGEMENT STRATEGY THIS
GETS TO THE- NINETY NINE OR
NINETY EIGHT YOU KNOW DEPENDING
ON WHICH- PERCENT OF PEOPLE.
HOW ARE YOU MAKING SURE PEOPLE
ARE GETTING PREVENTIVE SERVICES
THEY WOULD BE RESPONSIBLE FOR
TELLING US HOW YOUR MONITORING
THAT. ADDITION TO OUR
REQUIREMENTS THAT MOVIE ROLL
OUT FOR THE AUDIT PROCESS. BUT
THAT IS A CORE COMPONENT OF HOW
ARE YOU KEEPING PEOPLE HEALTHY
HOW YOU BEING PREVENTATIVE. ARE
YOU PUTTING IN EARLY
INTERVENTION SO THAT'S ONE
COMPONENT. THE OTHER IS
IDENTIFYING RISKY NEEDS OF.
USING DATA TO DRIVE AND
IDENTIFY RISKY NEED RATHER
THROUGH MORE COMPLEX READ
AVERAGE STRATIFICATION PROCESS
SEES- USING OUR TIERED
APPROACH- AND THEN BEING ABLE
TO SAY OKAY TO DATE WE HAVE
THIS DIAGRAM THAT WE USE IN OUR
WORK GROUPS WHERE- WE HAVE THE
BOTTOM. OF THE DIAGRAM IT HAS
LIKE PRIMARY CARE SPECIALTY.
HOW EXCEPT. BUT ALSO ALREADY
HAVE TOOL WITH MAN CARE LIKE
THE MAY. LIKE YOUR GINNY END.
YOU KNOW CASE MANAGEMENT CLICKS
CASE MANAGEMENT I THINK AS WE
BUILD OUT POPULATION HEALTH
MANAGEMENT AS WE BUILD UP AND
HAND YOUR MEN. IT START
STRATIFIED POPULATION INTO
PURPOSE POCKETS. HERE AND-
HEALTH. MANAGEMENT NEEDS KIND
OF JUST PREVENTIVE SERVICES
REGULAR OUTRAGE MEMBER
ENGAGEMENT NEWSLETTERS
ETCETERA. WHO NEED SOME CASE
MANAGEMENT. WHO MEETS THE
HIGHER LEVEL COMPLEX CASE
MANAGEMENT HIGHER TOUCH. BUT
NOT NECESSARILY ENHANCE CARE
MANAGEMENT OVER TIME MANAGING
THOSE POPULATION HEALTH
MANAGEMENT STRATEGIES. THROUGH
RICH STRATIFICATION BETTER DATA
ANALYTICS AND PREDICTIVE
MODELING WE ARE HOPING THAT
OVER TIME WE CAN GET TO A PLACE
WHERE WE- ARE I. ABLE TO
IDENTIFY FUTURE GAPS AND THEN
BRING SOLUTIONS TO THOSE GAPS
WHAT WHATEVER THEY MAY BE. A
BUT WE REALLY FEEL LIKE THE
POPULATION HEALTH MANAGEMENT
STRATEGY. IS IT IS THE
FOUNDATION AND THAT ENHANCE
CARE MANAGEMENT IN LIEU OF KIND
OF TUCKED UNDERNEATH THAT.
THERE'S TWO OTHER COMPONENTS
THE POPULATION HEALTH
MANAGEMENT STRATEGY ONE IS
IDENTIFYING AND MITIGATING
SOCIAL DETERMINES OF HELP WHICH
WE FEEL LIKE. THE LIEU OF
SERVICES PACKAGE HELPS BRING-
BUT THAT'S JUST ONE COMPONENT
OF THAT. ON SO WE WILL BE
REQUIRING THAT ARE MANAGED CARE
PLANS ON THROUGH PROVIDERS
IDENTIFIED SOCIAL THE TERMS OF
HEALTH AND REPORT THAT TO ICD
TEN DATA TO THE DEPARTMENT.
WE'VE SEEN. A LOT OF SUCCESS
WITH THIS AND OTHER STATES.
REALLY DO A GOOD JOB OF
IDENTIFYING THAT THE MORE DATA
THAT WE HAVE THE MORE HOT
SPOTTING AND OTHER ANALYTICS WE
CAN LOOK AT TO LOOK AT
OPPORTUNITY STATEWIDE. A FOR
FUTURE INVESTMENTS IN THE
PROGRAM. AND THE LAST BUT
DEFINITELY NOT THE LEAST IS WE
NEED TO DO A BETTER JOB AT
TRANSITIONS ACROSS CARE. ON
BOTH BETWEEN TRANSITIONS ACROSS
OUR DELIVERY SYSTEMS AS WELL AS
WITHIN A DELIVERY SYSTEMS OF AN
IN PATIENT DOES CHARGE A
SKILLED NURSING FACILITY
DISCHARGED. AND ALL OF THOSE
REQUIREMENTS ARE CURRENTLY LAID
OUT IN OUR POPULATION HEALTH.
PROPOSAL ON THOSE PIECES WILL
TAKE TIME TO ROLLOUT BUT THAT
WE REALLY FEEL LIKE IT IS ONE
OF THE FOUNDATIONAL PIECES. TO
BUILD ECM AND OVER TIME UP
THROUGH THE PIECES THAT I JUST
MENTIONED WE WILL BE ABLE TO
IDENTIFY. FUTURE OPPORTUNITIES
AND GAPS TO FILL. SO IT TO. PUT
IN WHAT ONE COULD ARGUE AND I
THINK LINDA'S POINTS IN MJ'S
POINTS ARE ARE LEGITIMATE
ABOUT. CONCERNS ABOUT YOU KNOW
NOT EVERYTHING BEING DELIVERED
THE WAY IT SHOULD. THE PLANS
RESPONSIBLE FOR A 100% OF THE
POPULATION. AND SO. EVEN AS I
THINK ABOUT ECM THAT'S PART OF
A CONTINUUM OF CARE COORDINATOR
XIN BASIC CARE MAY. THERE TO
TERMS YOU CAN USE THAT. COMPLEX
AND ANY CM I MEAN. TO
IDENTIFYING MEMBERS NEEDS IS A
IS A CORE PART OF HEALTH PLANS
AND- MULTIPLE OPENS ARE
INSECURE ACCREDITED THEY
ALREADY HAVE POPULATION HEALTH
MANAGEMENT PROGRAMS. ONE COULD
ARGUE THAT YOU SHOULD DO
POPULATION HEALTH MANAGEMENT
WELL FIRST AND THEN BACK IN BUT
IT'S REALLY A TIMING ISSUE
BECAUSE WE HAD TO BE ABLE TO
MAKE THE TRANSITION FOR ALL
PERSON CARE. TO SOME EXTENT
HEALTH HOMES INTO THE ECM
PROGRAM DELIVER THE IOS. AND
ADDING POPULATION OF MANAGEMENT
ON TOP OF THAT FOR HEALTH PLANS
WOULD HAVE BEEN REALLY REALLY
DIFFICULT. SO YOU KNOW THE
DECISION WAS MADE TO DELAY THAT
A YEAR BUT THE REALITY IS
PLANTS ARE GONNA HAVE TO GO
THROUGH THIS PROCESS THEY'RE
GONNA TO FIGURE OUT WHERE WE'RE
THEIR MEMBERS. LAND TO YOUR
POINT OF YES THIS GROUP IS
INELIGIBLE AND FITS THE
CRITERIA FOR AND HEALTH CARE
MANAGEMENT WELL WE JUST FOUND
THIS OTHER MEMBER THROUGH OUR
PROCESS. THAT IS GOING TO NEED
HELP AS WELL SO EXPECTATION IS
THIRD ANGER HUNDREDS OF THE
PEOPLE THERE'S A SPECIFIC FOCUS
ON IN HEALTH CARE MANAGEMENT
BECAUSE OF THE PROGRAM THE
ROLLING. SO JUST TO CLARIFY IS
BECAUSE WE'RE GOING THROUGH AND
DOING FEEL POPULATION
MANAGEMENT AND SO FORTH IN SAID
IRRESPONSIBLE AND PERCENT OF
POPULATION- EVENTUALLY I MEAN
AS YOU DO REST RATIFICATION.
RIGHT YOU GOING OKAY WE GOT THE
HIGHEST RISK WE GOT THE NEXT
HIGHEST RISK AND SO FORTH. DO
YOU SEE SOME OF THE ECM.
SERVICES BEING AVAILABLE TO
RIGHT NOW WE'RE TALKING ABOUT
TARGETING THE HIGHEST RISK TO
SOME OF THE LOWER RISK YOU
COULD. BE THAT IS THE USE
DESERVE GONNA BE A BARRIER TO
DOING THAT OR DO YOU SEE THAT
HAPPENING EVENTUALLY. AS A
PROVIDE PLAZA PROVIDING RECOUP
PART OF CARE RIGHT NOW OKAY IN
THAT GROUP OF CARE IS FOR. A
PATIENT THAT I MAKE SENSE FOR
THE TECH AND ACUTE CARE
FACILITY RIGHT SO AS LONG AS IT
MAKES SENSE FOR THEM THERE'S NO
BARRIER TO. FOR IBM IS A
SPECIFIC SET OF CRITERIA OF A
POPULATION. BUT NOW IT IT'S OUR
EXPECTATION WOULD BE THAT. A
PERSON NEEDING RECOVERED OF
CARE IS A PERSON IS OKAY I JUST
DON'T KNOW WHAT THEY'RE IN
TERMS OF THE WAIVERS OR
WHATEVER ELSE THAT YOU HAVE TO
APPLY FOR THAT WOULD TREATING
RESTRICTIONS FOR SO IF IT'S IN
THE PROPOSAL THAT'S FOR WE HAVE
AS ECM AND- THIS IS THE GREATER
VCM YOU FALL OUTSIDE THIS
CRITERIA AND THE DEPENDING HOW
TIGHT THE CRITERIA WRITTEN. SO
I JUST THAT'S WHAT JUST
CHECKING ON BIKE SO. WE I MEAN
WE ARE TRYING TO WE ARE TRYING
TO STRIKE THE BALANCE OF
STANDARDIZATION OR- A
STATEWIDE. BUT ALLOWING
FLEXIBILITY FOR PLANS TO MAKE%
DECISIONS ON WHITE BREAD WAS
MENTIONING. BECAUSE I THINK YOU
KNOW WE WANT TO HAVE GENERAL
CRITERIA THE COMPLEXITY THAT
WE'RE TALKING ABOUT ELEVATING
THE- ELIGIBILITY OF WHO SHOULD
BE GETTING THIS TYPE OF
BENEFIT. PLANS ARE REALLY GOOD
HAVE TO MAKE DETERMINATIONS
BASED ON THE INDIVIDUAL IN
FRONT OF THEM. AND WHAT'S THE
BEST. IS IT ENHANCE CARE
MANAGEMENT IS IT JUST COMPLEX
CASE MANAGEMENT. AND MAKE THE
DECISIONS BASED ON THE CASES.
OKAY SO THERE'S THE FLEXIBILITY
TO DO THAT THEN AND WHATEVER
WAIVERS WE'RE GONNA DO. FUTURE
YEAH FROM THE WAIVER POINT OF
VIEW WE WILL DEFINE THE
ELIGIBILITY CRITERIA WHICH WE
HAVE BEEN VETTING TO KIND OF
DEFINE TO CMS. HERE'S WHO WE
THINK WE SHOULD BE GETTING THIS-THIS TYPE OF BENEFIT. IN THE
FACTORS THAT SHOULD BE
EVALUATED FOR WHO GETS IT.
SIMILAR TO BUT SOBRE DIFFERENT.
TCM TYPE SERVICES WE HAVE A
CLEAR DEFINITION OF AN ELIGIBLE
POPULATION. THE TYPES OF
SERVICES THEY SHOULD BE
GETTING- AND THEN THAT'S HOW
YOU'D BE ELIGIBLE TO RECEIVE
THOSE TYPES OF SERVICES. ALL
RIGHT ANY OTHER QUESTIONS. WELL
YOU SO VERY MUCH ONLY FOR YOUR
PRESENTATIONS AND- THERE'S A
LOT MORE I THINK THIS IS JUST-
OVERVIEW. CELL WE A LOT MORE WE
CAN GET INTO AND THERE'S A LOT.
GOING ON SO THANK YOU THANKS
VERY MUCH. OKAY OF NOW. GO
AHEAD WE'RE GOING TO TAKE
PUBLIC COMMENT SO. IN THANK
YOU- SO IF YOU CAN INTRODUCE
YOURSELF NAME ORGANIZATION AND
THEY DO ASK IF YOU CAN TRY
PLEASE KEEP YOUR COMMENTS TO A
MINUTE. OR LESS AND IF YOU HAVE
DDITIONAL MATERIALS PLEASE
SUBMIT TO THE SERGEANT WHO CAN
THEN GIVE IT. WILL GIVE IT TO
THE COMMITTEE SO. FEEL FREE TO
ALSO PROVIDE WRITTEN MATERIAL
OR REFERENCES- TO OUR COMMITTEE
AS WELL SO. THANK YOU WELCOME
THIS IDEA IN. ARNOLD TOUR IS
REPRESENTING THE CENTER BECAUSE
HEALTH NETWORK- INCLUDES THE TO
THE LARGEST- HEALTH CENTERS.
REPRESENTING IN SERVING
FARMWORKERS AND MONTEREY WHICH
IS THE FIFTH LARGEST AND
INVENTOR COUNTY WHICH IS THE-
NUMBER ONE. DELIVER OF CARE TO
FARMWORKERS POPULATIONS. I
THINK YOU'VE DONE A VERY GOOD
JOB. MISTER CHAIRMAN AND REYES
SEEN A NUMBER OF ISSUES. AND I
WOULD ENCOURAGE YOU TO NOT STEP
AWAY FROM THE RESERVATIONS THAT
YOU HAVE. I THINK MISTER
GILBERT AND THE MEDICARE-
MEDICARE ALL DIRECTOR ARE. VERY
WELL INTENTIONED. BUT I WOULD
SAY YOU HAVE SOME VERY
FUNDAMENTAL PROBLEMS HERE IS A
BINDER THAT HAS NINE STUDIES.
ON THE LACK OF SHORTAGES OF
DOCTORS IN THE STATE OF
CALIFORNIA. THEY DON'T EVEN
ADDRESS THE ISSUE OF CULTURAL
LINGUISTIC COMPETENCY YOU RAISE
THAT ISSUE TODAY ABOUT
INTERPRETERS. VERSUS
TRANSLATORS. THE MEDICAL
DIRECTOR SAID THAT WOULD BE AN
ISSUE THAT THEY WOULD GIVE
ATTENTION TO. THAT CAN BE. AN
ISSUE THAT YOU'RE GOING TO GIVE
ATTENTION TO. THAT HAS TO BE
ABOUT NETWORK ADEQUACY THAT HAS
TO BE A FUNDAMENTAL
REQUIREMENT. THAT HAS TO BE A
DELIVERABLE. THIS IS NOT ABOUT
EXPECTATIONS ANYMORE MISTER
CHAIRMAN. THIS IS ABOUT A
PROGRAM THAT HAS BEEN RUNNING
FOR QUITE A FEW YEARS THAT HAS
A NUMBER OF CAPS AND A NUMBER
OF PROBLEMS. AND IF YOU ALL YOU
HAVE TO DO IS LOOK AT HOW THE
DIFFERENT PLANTS ARE RANKED I
KNOW. HOW THEY'RE RANKED- EVERY
YEAR THEY MOVE ALL OVER THE
PLACE. SO WE WERE ENCOURAGE YOU
TO. MOVE IN FACES NOT TO MOVE
IN THE WAY THAT THIS PLAN HAS
BEEN LAID OUT AS A FORMER
LEGISLATIVE ANALYST I AM
TELLING YOU. LOOKING AT THEIR
REPORT WHICH WILL BE COMING OUT
LATER. YOU MUST GO MUCH SLOWER
BECAUSE THERE ARE SO MANY MORE
GAPS LACK OF ACCOUNTABILITY IF
YOU'RE GOING TO DO A BETTER JOB
OF ACCOUNTABILITY. YOU'RE GOING
TO HAVE TO PUT OUT MORE
RESOURCES TO MONITOR THE PLANTS
AND THEIR ABILITY TO DO WHAT
YOU SAID YOU WANTED TO DO.
DELIVERABLES NOT EXPECTATIONS
SIR THANK THANK YOU SIR THANK
YOU. WELCOME GOOD AFTERNOON
MISTER CHAIRMAN MEMBERS I'M
FAIR MCDADE HANG ON BEHALF OF
THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES THANK
YOU FOR HOLDING THIS HEARING
TODAY- AS YOU'VE HEARD CAL LAME
WHICH IS A GREAT NAME. IS AN
AMBITIOUS PROPOSAL THE TWENTY
TWO SEPARATE INITIATIVES- BUT
WE WANT TO COMMENDED CS FOUR
REALLY YOU KNO DOING THE
LISTENING TO OUR LISTENING TO
ALL THE ISSUES TO ADDRESS THE
GAPS. AND MAKE MEDI CAL BETTER
THEY'VE ALSO INCLUDED COUNTIES
AS PARTNERS FROM THE BEGINNING
WHICH WE VERY MUCH APPRECIATE.
AND THEY'VE BEEN NIMBLE AS
WE'VE GONE THROUGH THE
STAKEHOLDER WORKING GROUPS ON
ISSUES THAT HAVE BEEN REYES
THEY'VE LISTENED WELL. AND THE
ATTEMPT TO PROBLEMS ALSO WE'RE
REALLY ENCOURAGED BY THAT WE
ALSO JUST WANT TO EMPHASIZE IN
THE LAST PANEL DID A VERY GOOD
JOB FROM ALL PERSPECTIVES. THAT
CLOSE COORDINATION WITH LOCALS
AND COUNTIES IS IMPERATIVE. AND
THAT THE SOCIAL WORK ASPECT ON
THE HOUSING THE HOMELESS OR SO
ASPECT AND OUTREACH. THAT IS
WHAT COUNTIES TO AND SO WE
STAND READY TO CONTINUE DOING
THAT WE WANT TO WORK CLOSELY
WITH PLANS. AND I THINK WHILE
IT MAY VERY ACROSS THE STATE- I
THINK IT WITH DHS IS
WILLINGNESS TO CONTINUE TO
PROBLEM SOLVE I THINK WE CAN
GET THERE SO. THANK YOU I THANK
YOU. WELCOME GOOD AFTERNOON.
MISTER CHAIR SENATOR MONEY-
CURSING AT THE CALIFORNIA
NURSES ASSOCIATION. SEEN A
HOUSE A NUMBER OF CONCERNS AND
QUESTIONS REGARDING CAL AIM
WHICH I'D LIKE TO QUICKLY
HIGHLIGHT HERE. TRY TO KEEP
THIS UNDER ONE MINUTE.
REGARDING THE POPULATION HEALTH
MANAGEMENT PROPOSAL SEE NAY
BELIEVES DH CS TO DEVELOP A
STANDARDIZED RISK
STRATIFICATION ALGORITHM. AND
IT HAS BEEN SHOWN TO BE
RACIALLY BIASED. AND TO EXCLUDE
INDIVIDUALS WITH GENDER UP WITH
GREATER HEALTH NEEDS WHO ARE
SUPPOSED TO BE. IDENTIFIED BY
RESPECT OCCASION OUR
pRESTORE APPLICATION ME RATE
REALLOCATE THE APPORTIONMENT OF
BENEFITS UNFAIRLY. SUCH THAT
THIS ADVANCED SUBGROUP. OF
BECOMES FURTHER DISADVANTAGED-
THIS IS PARTICULARLY LIKELY
WHEN A CHARACTERISTIC USE FOR
RESTRAINTS VACATION IS A
SIGNIFICANTLY- HOURS A
SIGNIFIER ACTION I SEE A
PREVIOUS DISADVANTAGED OR
VULNERABILITIES SUCH AS RACE
ETHNICITY. INCOME GENDER
HOMELESSNESS EDUCATIONAL STATUS
OR PRIOR INCARCERATION. THE
PROPOSAL INDICATES THE
DEPARTMENT WILL COME WE
CURRENTLY USE THE RESTORE
APPLICATION. FOR REPORTING
PURPOSES ONLY. BUT SEE AN NAY
IS CONCERNED THIS COULD CHANGE
AND MANAGED CARE PLANS COULD BE
PAID AT DIFFERENT RATES.
DEPENDING ON RESPECT OCCASION
CATEGORIES. IF SO WE ARE
ESPECIALLY CONCERNED ABOUT
PLANS GAMING THE SYSTEM TO
INCREASE PROFITS. AND CUT BACK
ON CARE. CNA BELIEVE THE
DEPARTMENT SHOULD REQUIRE
ROBUST MONITORING. AUDITS AND
FINES. OF THE PH EMIT PH M.
PROPOSAL RECOGNIZES THAT THE
DEPARTMENT WILL NEED TO
INCREASE ITS OVERSIGHT BUT
OTHER PROVISIONS IN THE
PROPOSAL APPEAR TO SEAT
OVERSIGHT RESPONSIBILITY TO
NCQA A PRIVATE THIRD PARTY
THANK YOU. THANK YOU AND IT'S
CERTAINLY PLEASE PROVIDE ANY-
WRITTEN COMMENTS TO THE START
OF COMMITTEE THANK YOU. THANK
YOU WHAT AFTER LOCUM. IT
AFTERNOON MICHELLE GIVEN THAT
THE COUNTY HEALTH EXECUTIVES
ASSOCIATION A CALIFORNIA WE
REPRESENT THE LOCAL HEALTH
DEPARTMENTS THROUGHOUT THE
STATE AND AGAIN JUST WANT TO
ECHO- OUR APPRECIATION FOR THE
HEARING IN A LOT OF THE
COMMENTS AND DISCUSSIONS THAT
WERE HAD TODAY. WHEN I TOLD MY
COLLEAGUES FROM C. SACK AROUND
JUST OUR OUR DESIRE TO HAVE
ROBUST PARTNERSHIP IN
COLLABORATION. AS LEAD ENTITY
IS WHAT WORKS OUR LOCAL
DEPARTMENTS WERE AT KEY LEE AND
TO LEAD ENTITIES IN WHOLE
PERSON CARE WHAT WE DO
RECOGNIZE IS NOT JUST THE
CONTINUATION THE COLLABORATION
OR A WHOLE PERSON CARE AT. IT
THAT'S NOT THE ONLY THING TAT
WE WOULD LIKE TO SEE CONTINUE
AT THAT BROADLEAF COUNTIES HAVE
BEEN DELIVERING CARE
COORDINATION FROM THE GROUND
LEVEL AT FACE TO FACE FOR A
LONG TIME IN MANY DIFFERENT
AREAS AND SO TO THE EXTENT THAT
THAT CAPACITY COULD BE LEVERAGE
WE WOULD REALLY APPRECIATE IT.
ALSO JUST WANT TO TAKE A MOMENT
TO TALK ABOUT THE POPULATION
HEALTH MANAGEMENT STRATEGY WE
BELIEVE THAT LOCAL HEALTH
DEPARTMENTS FROM A PUBLIC
HEALTH PERSPECTIVE SHOULD BE
ENGAGING ALSO FROM A STATE
LEVEL THAT PUBLIC HEALTH SHOULD
ALSO BE ENGAGED IN THAT
CONVERSATION. WHEN WE THINK
ABOUT PUBLIC HEALTH WE REALLY
HAVE TO THINK ABOUT OTHER
FACTORS THAT MIGHT BE OUTSIDE
OF JUST HEALTH PLAN UTILIZATION
OR CLAIM TO DATE AND THINGS
LIKE THAT THERE'S THINGS THAT
OUR PUBLIC HEALTH DEPARTMENTS
NO BETTER COMMUNITIES THAT ALSO
NEED TO BE ACCOUNTED FOR AND WE
THINK THERE COULD BE STRONG
PARTNERSHIPS IN THAT AREA AS
WELL. THANK YOU. THANK YOU.
WELCOME HELLO MISTER CHAIR.
SENATOR MINING FRED MAIN. ON
BEHALF OF CAL PACE THE PROGRAM
FOR. ALL INCLUSIVE CARE FOR THE
ELDERLY WHO IS. ALREADY SERVING
DODD TOOLS A NON TOOLS- IN
FULLY INTEGRATED. CARE THAT IS
WHOLE PERSON. CENTERED AS- CAL
AIM. MOVES FORWARD IT'S OUR
UNDERSTANDING THAT PACE WILL.
CONTINUE TO BE- ALTERNATIVE-
CHOICE FOR. THOSE THAT QUALIFY
FOR- FRAIL SENIORS FIFTY FIVE
YEARS AND OLDER. WE DO WANT TO
MAKE SURE IS THE TRANSITION.
OCCURS TO. A MANDATORY- MEDI
CAL MANAGED CARE ACROSS THE
STATE THAT. IS OUT. OF THE
PARTICIPANTS ARE AWARE. OF
PAGE. THAT IT IS A REAL OPTION-
IN MAKING CHOICES AND THEN
FINALLY. I IN THE OPULATION.
MANAGEMENT THAT- THERE'S A
BETTER IDENTIFY. IDENTIFICATION
OF THOSE INDIVIDUALS WHO COULD
BENEFIT. FROM PACE AND THAT
THEY'RE MADE AWARE OF- THE FACT
THAT THEY DO HAVE CHOICES THANK
YOU VERY MUCH. THANK YOU
WELCOME. HI THERE'S ALWAYS THE
COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION- I WOULD
ALSO LIKE TO JOIN MY ARE COUNTY
PARTNERS IN BOTH CELEBRATING
THE STATE AND ALL THE WORK THAT
THEY'VE DONE TO COLLABORATE
WITH COUNTIES AND OTHER
STAKEHOLDERS IN THIS PROCESS.
AND REALLY SEE A LOT OF
TREMENDOUS OPPORTUNITY HERE
INCLUDING LOOKING AT HOW WE'RE
GOING TO DETERMINE MEDICAL
NECESSITY CHANGING THAT SO THAT
WE CAN SAY YES TO MORE
INDIVIDUALS COMING IN FOR
SERVICES AND ROUTE REMOVING
SOME OF THE DIAGNOSTIC CRITERIA
WHERE WE PREVIOUSLY HAD THE
LABEL CHILDREN OR GIVE THEM A
LABEL BEFORE WE CAN PROVIDE
THEM SERVICES. THESE ARE ALL
TREMENDOUS OPPORTUNITIES THAT
WERE REALLY LOOKING FORWARD TO
IMPLEMENTING WE'D ALSO LIKE TO
JOIN OUR COUNTIES AND SAYING
THAT WE DO BELIEVE THAT BECAUSE
OF OUR HISTORY AND OUR
COLLABORATION WITH POPULATIONS
AND OBVIOUSLY FOR US THE
POPULATIONS WITH. SERIOUS
MENTAL ILLNESS SERIOUS
EMOTIONAL DISTURBANCE AND- AND
SAID AND- SUBSTANCE USE
DISORDERS BECAUSE OF OUR
EXPERTISE AND WORKING IN
PROGRAMS THAT ARE SIMILAR TO-
MC AND I LOS LIKE- IMAGE HAS A
FULL SERVICE PARTNERSHIPS WE
REALLY HOPE THAT THE STATE. AND
CONTINUES TO ENGAGE WITH US AND
LOOK AT THAT IS OPPORTUNITY TO
INCLUDE US INTO THAT IN THAT
PROCESS THANK YOU. THANK YOU.
WELCOME THE AFTERNOON. MY NAME
I'M AT A LOT OF THE REBEL KAVA
I AM A RP CAPITAL RESPONSE TEAM
VOLUNTEER. WANT TO THANK YOU
FOR. ALLOWING US TO COMMENT ON
THE CAL AIMED PROPOSAL. WHAT
THE- ARE COMMON IS WITH RESPECT
TO LONG TERM CARE IN THE CAL
AIM PROPOSAL ONE THING THAT WE
DID NOT SEE MENTIONED WAS. THE
ROLE THAT- FAMILY CAREGIVERS
PROVIDE AS YOU KNOW THE
MAJORITY OF LONG TERM CARE IS
PROVIDED BY FAMILY CARE GIVERS.
AND JUST IN CALIFORNIA ALONE
THERE LIKE FOUR POINT SEVEN
MILLION. ACT CARE GIVERS THAT
PROVIDE APPROXIMATELY MORE THAN
FOUR MILLION HOURS AND A RP HAS
ESTIMATED THAT CONTRIBUTION AT
LIKE SIXTY THREE BILLION
DOLLARS. SO WE WOULD LIKE TO
RECOMMEND THAT TO GO FORWARD
WITH THIS PROJECT WITH THIS
PROCESS OF IN- WITH THIS CAL
AIM THAT YOU RECOGNIZE NOT ONLY
RECOGNIZE BUT- ACTUALLY SUPPORT
THESE CALIFORNIA THESE THE CARE
GIVERS. BY INCLUDING SOME
RECOMMENDATIONS WHAT WHAT WE
WOULD LIKE TO RECOMMEND IS THAT
THE MANAGED CARE ORGANIZATIONS
INCLUDE IN THEIR CONTRACTS THE
LANGUAGE THE THIRD FAMILY CARE
GIVERS OF ALL PACKED UP ALL
BEEN FISHERIES HAVE THE
OPPORTUNITY TO PROCESS
PARTICIPATE IN ANY ASSESSMENT
OF NEEDS FOR THEIR FAMILY
MEMBER. THAT FAMILY CARE GIVERS
GET CARE GIVERS RECEIVE AN
INDEPENDENT ASSESSMENT TO
DETERMINE HOW THE MANAGED CARE
ORGANIZATION COULD WORK WITH
AND SUPPORT THE FAMILY CARE
GIVERS OWN NEEDS. THAT MANAGED
CARE ORGANIZATIONS TRAIN THE
CASE MANAGERS ON HOW TO
COMMUNICATE AND WORK WITH
FAMILY CARE GIVERS. MANAGED
CARE GIVERS HAVE REGULAR
COMMUNICATION WITH THE FAMILY
CARE GIVERS REQUIRING HOME HAIR
HOME CARE AND ALSO THAT THEY
PROVIDES WRIST WRIST WRIST BITE
SUPPORT. AND JUST JUST TO
FINISH NEW JERSEY THE STATE OF
NEW JERSEY HAS HAS ALREADY
IMPLEMENTED TWO OF THESE
RECOMMENDATIONS AND SEWER WE
HOPE THAT- CALIFORNIA WILL FALL
STUDENT AND ALSO INCLUDE SOME
OF THESE RECOMMENDATIONS THANK
YOU AND HOPE YOU CAN PROVIDE
THAT IN WRITING AS WELL TO OUR
COMMITTEE. OKAY SO SEE NOLAN
ELSE AT THE MICROPHONE ANY
CLOSING REMARKS OKAY SO I JUST
WANT TO AGAIN THANK. ALL OF OUR
THE TEST A FIRES AND ALL THE
PEOPLE MADE PUBLIC COMMENTS AND
THE ANIMAL I CONGRATULATE DR
GILBERTON AS ROLE IS- AFTER
ABOUT TWO AND A HALF DAYS NOW
TWO THREE AND OUT OUT OF THE
THREE DAYS NOW AT THIS POINT
RIGHT NOW AT THE END OF THIS
DAY- AS DEPARTMENT OF HEALTH
CARE SERVICES AND ALSO WHAT
THANK YOU- IS COOPER AS THEIR
STATE MEDICAID DIRECTOR FOR
SPENDING THIS AFTERNOON WITH US
AS WELL HELPING SIX PLANE THIS
A- VERY IMPORTANT
TRANSFORMATIONAL EFFORT BY THE
FARM HEALTHCARE SERVICES
IMPROVE MEDI CAL AND THEY KNOW
THERE'S LOTS OF MOVING PARTS.
AND WILL BE AS CHAIR OF EVEN
MORE QUESTIONS AS WE ROLL ALONG
BUT THANK YOU VERY MUCH AND
AGAIN THANKS TO ALL THE
WITNESSES WHO ARE HERE AS WELL
SO WHAT THAT- THIS-
INFORMATIONAL HEARING THE
SENATE BUDGET FISCAL REVIEW
SUBCOMMITTEE NUMBER THREE AND
SENATE HEALTH COMMITTEE IS NOW
ADJOURNED THANK YOU.