OUR. THE SENATE COMMITTEE ON
HEALTH IN THE SENATE BUDGET
FISCAL REVIEW SUBCOMMITTEE
NUMBER THREE WILL COME TO ORDER
. GOOD AFTERNOON IN RESPONSE TO
THE COVE IN NINETEEN EMERGENCY
TO PROTECT THE PUBLIC
LEGISLATORS AND EMPLOYEES WE
MUST LIMIT NONESSENTIAL
GATHERINGS AND IT HERE TO SOCIAL
DISTANCING FACE COVERING
GUIDELINES. COMPLIANCE WITH
THOSE ORDERS THE SENATE HAS MADE
NECESSARY ADJUSTMENTS THE NORMAL
PRACTICE IS TO ENSURE THAT THE
PUBLIC CONTINUES TO HAVE ACCESS
TO THE LEGISLATIVE PROCESS.
TODAY WE ARE HAVING- BUT WE HAVE
REPRESENTATIVES FROM THE
DEPARTMENT HEALTHCARE SERVICES
KAISER PERMANENTE A LOCAL HEALTH
PLANS COMMITTEE CLINICS IN
CONSUMER REPRESENTATIVES WHO ARE
PARTICIPATING REMOTELY. FOR
REMOTE PARTICIPANTS PLEASE MUTE
YOUR PHONES OR COMPUTERS. WHEN
YOU ARE TALKING THIS WILL
GREATLY AID IN ELIMINATING ANY
PHYSICAL FEEDBACK. BASKET EVERY
TIME YOU WISH TO BE RECOGNIZED
THAT USED TO RAISE YOUR HAND
FEATURE IN THE PROGRAM AND I'LL
BE WATCHING ON THE MONITOR HERE.
EACH TIME YOU ARE RECOGNIZED TO
SPEAK A POP UP WINDOW WILL
APPEAR ASKING IF YOU WISH TO ON
MUTE. PLEASE SELECT A MUTE
BEFORE BEGIN BEGIN BEFORE YOU
BEGIN SPEAKING. IT PERSONNEL PUT
YOU BACK ON MUTE WHEN YOU ARE
DONE. ONCE RECOGNIZED TO SPEAK.
PLEASE MAKE SURE YOU CAN BE SEEN
ON THE SCREEN STATE YOUR NAME
AND THAT YOU'RE READY TO ADDRESS
THE COMMITTEE. TO ALLOW THE
PUBLIC ACCESS WE'VE ADMITTED
MEMBERS OF THE PUBLIC TO THIS
HEARING ROOM TWELVE HUNDRED TO
THE EXTENT THAT SOCIAL
DISTANCING REQUIREMENTS ALLOW
WILL BE USING A TELECONFERENCE
OR MISS FOR THOSE INDIVIDUALS
WHO WISH TO TESTIFY. TODAY
REMOTELY. FOR ALL INDIVIDUALS
WISHING TO PROVIDE PUBLIC
COMMENT THE PARTICIPANT TOLL
FREE NUMBER AND ACCESS CODE IS
POSTED ON OUR COMMITTEE WEBSITE
IT WILL BE DISPLAYED ON THE
SCREEN AND I WILL ANNOUNCE IT
NOW. TODAY'S PARTICIPANT NUMBER
IS. EIGHT FOUR FOUR. TWO NINE
ONE SIX THREE SIX FOUR. AND THE
ACCESS CODE IS. ONE FOUR ONE.
ONE ONE FOUR ZERO. FOR DETAILED
INSTRUCTIONS ON HOW THE
TELECONFERENCES SOME WORKS
PLEASE REFER TO THE SENATE AND-
COMMITTEE WEBSITE. FOR TODAY'S
HEARING WILL BE HEARING ALL THE
PANELS OF WITNESSES ON THE
AGENDA PRIOR TO TAKING ANY
PUBLIC COMMENT WHAT WE HAVE
HEARD ALL OF THE WITNESSES WE
WILL HAVE A PUBLIC COMMENT
PERIOD FOR THOSE WHO WISH TO
COMMENT ON THE TOPICS OF TODAY'S
AGENDA. PLEASE NOTE IN ORDER FOR
US TO HEAR YOU CLEARLY AND AVOID
ACOUSTIC FEEDBACK. YOU MUST MEET
THE DEVICE YOU'RE WATCHING THE
HEARING ON PRIOR TO GIVING
TESTIMONY OVER THE PHONE. IT'S
IMPORTANT THAT WE HEAR FROM YOU
AND WE THANK YOU FOR YOUR
PATIENCE. I ALSO MAKE NOTE THAT
GIVEN- TIME LIMITATIONS THAT IF
YOU ARE PARTICIPATING BUT LEE-
PROVIDED TO PUBLIC- COMMENT YOU
CAN ALSO SUBMIT A MORE DETAILED
COMMENTS. VIA OUR- BY IN WRITING
THROUGH OUR COMMITTEE WEBSITE. I
WILL MAINTAIN DECORUM DURING THE
HEARING AS IS CUSTOMARY IN AN
INDIVIDUAL WHOSE DESTRUCTIVE MAY
BE REMOVED FROM THE REMOTE
MEETING SERVICE OR HAVE A
CONNECTIONS MUTED. SO IN TERMS
OF THE HEARING WE WILL BEGIN
WITH A PRESENTATION BY OUR
HEALTHCARE SERVICES WE WILL THEN
FOLLOW THAT. WITH COMMENTS FROM
OUR STAKEHOLDER PANEL. ACTIVES
AND THEN WE WILL- THEN TAKE A
MEMBER QUESTIONS AND COMMENTS
AFTER THAT AND- AND- HERE
ANSWERS FROM OUR- DISPENSE. THE
PURPOSE OF THIS HEARING IS
BECAUSE OF THE PART OF HEALTH
CARE SERVICES IS PROPOSING A
DIRECT STATEWIDE CONTRACT WITH
KAISER PERMANENTE A TO PROVIDE
HEALTHCARE SERVICES TO MEDICARE
RECIPIENTS. EARLY SERVICE ALMOST
NINE HUNDRED THOUSAND MEDICARE
RECIPIENTS WITH EITHER THE
PRIMARY HEALTH CARE. I AM VERY
HEALTHCARE SERVICES PLAN IN SOME
COUNTIES FORCES SUBCONTRACTED
HEALTHCARE SERVICES PLAN AND A
NUMBER OF OTHER COUNTIES. KAISER
IS NOT OPEN TO ALL MEDICAID
ENROLLEES BUT TO THOSE WHO
RECENTLY HAD KAISER WHO HAD
IMMEDIATE FAMILY MEMBERS IN
KAISER. THIS PROPOSAL WOULD ALSO
OPEN KAISER TO FOSTER AND FORMER
FOSTER YOUTH AND PEOPLE ARE DULY
ELIGIBLE FOR MEDICARE AND
MEDICARE. GLAZER WOULD ALSO
ACCEPT SOME NEW COULD BEEN
RELEASED THROUGH THE FAULT ROMAN
AS LONG AS KAISER DOES NOT
EXCEED A PROPOSED 25% GROWTH IN
MEDICAL AND ROWLEY'S. THE PART
OF HEALTHCARE SERVICES IS
PROPOSING TO MAKE THESE CHANGES
THROUGH A BUDGET TRAILER BILL
LANGUAGE. AN AGENCY GUIDANCE.
ASSEMBLY MEMBER ARAMBULA IS
AUTHORING ABC TWENTY SEVEN
TWENTY FOUR AS A POLICY VEHICLE
FOR THIS PROPOSAL. THE PURPOSE
OF TODAY'S HEARING IS TO EXAMINE
THIS PROPOSAL WE ARE NOT
FORMALLY HEARING THAT BUILT
TODAY BUT WE ARE HEARING THE
PROPOSAL. FIRST AND FOREMOST IS
THIS PROPOSAL IN THE BEST
INTEREST OF MEDICARE
BENEFICIARIES. FOR MORE MEDICARE
BENEFICIARIES HAVE ACCESS TO
BETTER QUALITY CARE OR MERIT
MEDICAL PROVIDERS. SECONDLY
SHOULD KAISER BE TREATED
DIFFERENTLY THAN OTHER MEDICARE
MANAGED ARE PLANS REQUIRED TO
ENROLL ANY MEDIC CAL THE FISHERY
THAT USES OUR PLAN OR WHO MAY
WISH TO RESTRICT OUR NETWORK TO
ONLY CERTAIN HIGH QUALITY
PROVIDERS. IN ADDITION TO KAISER
WOULD BE THE SOLE STATEWIDE-
HEALTH PLAN CONTRACTED HEALTH
PLANS FOR US OTHER HEALTH PLANS
UP. WOULD BE CONTRACTING FOR
EITHER A COUNTY OR GROUP OF
COUNTIES. THIRD WHAT KAISER HAVE
ADEQUATE LOCAL RELATIONSHIPS TO
ENSURE THAT MEDICARE
BENEFICIARIES ARE CONNECTED TO
OTHER SERVICES IN THE THEIR
COMMUNITIES. AND DOES THIS
CHANGE THE UNIQUE MODEL OF.
COUNTY ORGANIZE HEALTH SYSTEMS
WERE MEDIC CAL IS PROVIDED
THROUGH A SINGLE PLAN IN A
COUNTY OR A GROUP OF COUNTIES.
FINALLY WILL BOTH KAISER AND
OTHER MEDICARE MANAGED CARE PLAN
RATES ACTUALLY COMPENSATE PLANS
FOR THE COST OF PROVIDING CARE
TO MEDICARE RECIPIENTS.
PARTICULARLY IF THERE'S A
DIFFERENCE IN CASE MIX IN THE
BENEFICIARIES WHO ARE SIGNED UP
FOR EACH PARTICULAR PLAN. WILL
THAT BE REFLECTED IN RATES SO
THAT THERE IS FAIRNESS AND
PAYMENT. SO THESE ARE SOME OF
THE QUESTIONS THAT- HOPEFULLY
WILL BE ADDRESSED- IN THE
PRESENTATIONS AND THAT WILL BE
FOUGHT THAT- THE MEMBERS OF OUR
COMMITTEE BE FOLLOWING UP ON.
AND WITH THAT I WOULD NOW LIKE
TO INVITE CENTER EGGMAN- CHAIR
OF THE SENATE SUBCOMMITTEE-
BUDGET SUBCOMMITTEE ON HEALTH
AND HUMAN SERVICES BUT- THAT.
THE CHAIR OF THE TICKET BUDGET
SUB COMMITTEE ON HEALTH AND
HUMAN SERVICES TO GIVE HER
OPENING REMARKS THANK YOU. THANK
YOU VERY MUCH DR PAN IT'S NCE
TO BE HERE TODAY TO SEE HERE
THIS IMPORTANT ITEM. WE HAVE
TALKED ABOUT A LOT WITH THE WITH
THE BUDGET. A SUB COMMITTEE WE
HAVE WHEN WE WHEN WE MET WITH
THE DIRECTOR BASS WE'VE MET WITH
KAISER WE MET WITH- THE
DEPARTMENT- AND THE IN THE
ADMINISTRATION IN A LOT OF THIS
BUT WE THINK IT IS IMPORTANT. TO
PUT AS MUCH DAYLIGHT ON THIS AS
WE POSSIBLY CAN WE KNOW A LOT OF
FOLKS HAVE KAISER AND OUR- AND
ENJOY THEIR PLANS AND WOULD LIKE
TO BE ABLE TO KEEP IT AND WE
ALSO UNDERSTAND- ARE BLOOD THE-
OTHER LOCAL PLANS- FEELINGS
THAT. THAT THEY MAY NOT ALWAYS
BE TREATED. LIKE EVERYBODY ELSE
SO WE UNDERSTAND THAT KAISER IS
BOTH A PROVIDER AS WELL AS A
PLAN. WHICH PUTS THEM IN A
UNIQUE CATEGORY- SO WE WANNA YOU
KNOW WE WANT RESPECT AND HONOR
THAT SO I'M GLAD TO BE HERE
TODAY I'M GLAD WE'RE GOING TO
BE- MY COLLEAGUES WILL BE ABLE
TO ASK MORE QUESTIONS AND WILL
BE ABLE TO THINK ABOUT OUR OWN.
ON TO MAKE SURE THAT
CALIFORNIANS GET THE BEST
BENEFITS POSSIBLE THANK. THANK
YOU SO MUCH CARE EGGMAN ORDER.
OTHER MEMBERS THE COMMITTEE
WHICH TO MAKE AN OPENING COMMENT
BEFORE THE END. AS SAYING NONE-
WILL FIRST BEGIN WITH THE
PRESENTATION FROM THE DEPARTMENT
HEALTH CARE SERVICES. A DIRECTOR
BASS THANK YOU FOR JOINING US
TODAY- OF. WE LOOK FORWARD TO
YOUR PRESENTATION WELCOME.
AFTERNOON THANK YOU AYE CHAIRS
AND MEMBERS OF THE OF THE
COMMITTEE AND SUB COMMITTEE I
REALLY THANK YOU FOR THE
OPPORTUNITY TO DISCUSS THIS
PROPOSAL. WE ARE PROPOSING IN
BUDGET TRAILER BILL LANGUAGE TO
DIRECTLY CONTRACT WITH KAISER AS
A MEDIC CAL MANAGED CARE PLAN
STARTING IN TWENTY TWENTY FOUR
AND THIRTY TWO COUNTIES ACROSS
THE STATE. WE CAME TO THIS
PROPOSAL WITH THE GOAL OF
IMPROVING THE EXPERIENCE FOR
MEDICARE BENEFICIARIES WE WANT
OUR MEDICARE BENEFICIARIES TO
EXPERIENCE LESS DISRUPTION IN
CARE AND MORE ACCESS TO QUALITY
PROVIDERS AND WE THINK THIS
PROPOSAL DOES THIS. ONE OF THE
QUESTIONS WE ARE GETTING IS WHY
SHOULD DH CS TREAT KAISER
DIFFERENTLY. AS ALLUDED TO
EARLIER KAISER IS DIFFERENT FROM
OUR MEDICAID MANAGED CARE PLANS
IN THAT IT'S AN INTEGRATED
SYSTEM IS BOTH A PLAN AND A
PROVIDER. AND RELIES ON ITS
BRICK AND MORTAR FACILITIES TO
PROVIDE CARE. KAISER DOES NOT
EXPAND ITS NETWORK BY
CONTRACTING OUT WITH PHYSICIAN
GROUPS FOR EXAMPLE LIKE OTHER
MEDICAID MANAGED CARE PLANS.
THEY'RE INTEGRATED AND SELF
CONTAINED SYSTEM IS UNIQUE.
BECAUSE OF THIS KAISER HAS NOT
BEEN SUBJECT TO THE TRADITIONAL
MEDICAL PLAN CHOICE METHODS
WHERE THEY WOULD HAVE GENERAL
EVERYONE WHO SELECTS KAISER. THE
ENROLLMENT ROADWAYS WOULD FAR
OUTPACE ITS PHYSICAL CAPACITY.
KAISER IS ALSO UNIQUE BECAUSE
IT'S SYSTEM INCLUDES ACCESS TO
THE SAME PROVIDERS FOR THEIR
COMMERCIAL MEDICARE EXCHANGE A
MEDIC CAL POPULATION. THERE IS A
HIGH QUALITY PROVIDER KAISER
CONSISTENTLY SCORES ABOVE 90% IN
OUR AGGREGATED QUALITY FACTOR
SCORES WHICH IS A QUALITY SCORE
THAT ACCOUNTS FOR PLANT
PERFORMANCE IN COMPARISON THE
WEIGHTED AVERAGE OF OTHER
MANAGED CARE PLANS IS ABOUT 65%
ADDITIONALLY KAISER SCORES
HIGHER ON INDIVIDUAL FACTORS
RELATED TO CHILDREN PREVENTIVE
CARE AND MATERNAL CARE. KAISER
IS THE HIGHEST AMONG THE HIGHS
FOR QUALITY SCORES FOR FOLLOW UP
CARE FOR CHILDREN PRESCRIBED
ADHD C. MEDICINE- DEPRESSANT
MEDICATION MANAGEMENT
CONTRACEPTIVE CARE TIMELINESS A
PRENATAL CARE RESIDENTS ARTICLE
CANCER SCREENING AS WELL AS
CHILDHOOD IMMUNIZATION STATUS
FOR EXAMPLE. WE WANT TO GROW
THEIR PARTICIPATION IN THE
MEDICAL SPACE UNDER THIS
PROPOSAL THEY WILL GROW MEDICARE
ENROLLMENT 25% OVER THE FIVE
YEAR CONTRACT THIS EQUATES TO
ABOUT TWO HUNDRED THOUSAND NEW
MEMBERS OVER FIVE YEARS ACROSS
THE THIRTY TWO COUNTIES. THIS
MEANS THAT THEIR MEDICAL GROWTH
WILL BE AT A FASTER RATE THAN
IT'S PROJECTED GROWTH FOR
COMMERCIAL AND MEDICARE THIS
MEANS THAT MORE MEDICARE
BENEFICIARIES WILL HAVE ACCESS
TO THIS HIGH QUALITY PLAYER.
THIS INCREASING CAPACITY TO
SERVE ADDITIONAL MEMBERS WOULD
OCCUR NOT QUITE KINDS ARE
CONTRACTING OUT WITH PHYSICIAN
GROUPS ARE CLINICS. RATHER THIS
INCREASING CAPACITY WOULD OCCUR
BY KAISER HIRING MORE CLINICIANS
TO WORK IN THEIR CLOTHES
INTEGRATED LOCATIONS ENTERPRISE
ABILITY NOT NEW FACILITIES. HI
THERE WILL NOT BE SHIFTY ACCESS
AWAY FROM OUR SAFETY NET
PROVIDERS THEY WILL BE ADDING
CAPACITY INTO THEIR INTEGRATED
SYSTEMS AND WE WILL MONITOR THIS
TO OUR NETWORK CERTIFICATION
PROCESS. NEW KAISER ENROLLEES
WILL GET YOU SEE KAISER DOCTORS
THIS IS BEING MISREPRESENTED SO
WHY BE VERY CLEAR ON THIS.
ADDITIONALLY THIS PER. THE
MEDICAL PROGRAM IS GETTING MORE
FROM KAISER UNDER THE CURRENT
ARRANGEMENT TODAY. THIS IS
BETTER THAN THE STATUS QUO FOR
OUR BENEFICIARIES M. PROGRAM.
TODAY KAISER IS ALLOWED CERTAIN
EXEMPTIONS FROM PLAN
REQUIREMENTS SUCH AS EXEMPTIONS
FROM FACILITY SITE REVIEWS AND
MEDICAL RECORD REVIEW PROCESSES.
UNDER THIS PROPOSAL THESE TYPES
OF EXEMPTIONS WOULD NO LONGER
APPLY. WOULD BE SUBJECT TO ALL
OF THE SAME REQUIREMENTS AS ARE
OTHER MEDICAID MANAGED CARE
PLANS. TODAY HI SUSAN ROMAN IS
ONLY THROUGH CONTINUITY AND
FAMILY LINKAGE THAT IS A PERSON
IS ABLE TO SELECT KAISER AS
THEIR MEDICAID MANAGED CARE PLAN
IF IN THE LAST SIX TO TWELVE
MONTHS THEY HAD HISER. SO FOR
EXAMPLE IF A PERSON HAS EMPLOYER
SPONSORED KAISER AND LOSES THEIR
JOB THEY COULD SELECT KAISER AS
THEIR MEDICAL PLAN. UNDER OUR
PROPOSAL IN ADDITION TO
CONTINUITY AND FAMILY LINKAGE
THEIR ENROLLMENT WILL GROW BY
AUDI DAHLE ELIGIBLES THOSE
ELIGIBLE FOR BOTH MEDICARE AND
MEDI CAL I'M INDIVIDUALS WITH
GENERALLY HIGH COMPLEX. NEEDS
AND CONDITIONS SO FAR PERSON
SELECTS KAISER FOR THEIR
MEDICARE THEIR MEDICARE
ENROLLMENT IN KAISER WOULD BE
ALIGNED PURSUANT TO STATE LAW.
AND ANOTHER OPTION IS FOR OUR
FOSTER YOUTH WE KNOW THAT ARE
OFTEN OUR FOSTER YOUTH MOVE
ACROSS COUNTY LINES AS
PLACEMENTS CHANGE. THIS WOULD
PROVIDE OPPORTUNITY FOR FOSTER
YOUTH HEALTH INFORMATION TO
SEAMLESSLY TRANSFER POSITION
ACROSS COUNTY LINES SO THERE
PROVIDERS HAVE THEIR HEALTH
RECORDS FROM ANY DUPLICATE
IMMUNIZATIONS. AND ENSURING THAT
IMPORTANT INFORMATION
INFORMATION SUCH AS HISTORY OF
ALLERGIC REACTION TO MEDICATION
MOVES WITH THE USE. THESE
OPTIONS ARE ALL BASED. ON CHOICE
OF THE BENEFICIARY. AND YOU THE
FEET ON OUR ORIGINAL PROPOSAL
THAT THIS ALLOWS OR TWO JERRY
PICK WE'VE EXPANDED OUR PROPOSAL
TO ALSO INCLUDE GROWTH FROM A
RANDOM MIX OF MEMBERS THROUGH
THE DEFAULT ENROLLMENT PROCESS.
THIS IS WHEN WE ASSIGN A PLAN TO
AN INDIVIDUAL IF THE PERSON DOES
NOT SELECTED PAN AYE AND DURING
THE ENROLLMENT PROCESS. WE WILL
WORK WITH KAISER ON DETERMINING
THIS DEFAULT NUMBER PER COUNTY
BASED ON THEIR CAPACITY TO
PROVIDE HERE IN EACH COUNTY.
VERY IMPORTANTLY IN ALL OF THESE
PATHS OF ENROLLMENT KAISER WOULD
NOT BE ALLOWED TO DECIDE THE
NIGHT OR DISCONTINUE A MEMBER. I
WOULD ALSO NOTE THAT KAISER'S
CASE MIX IS RELATIVELY
REFLECTIVE OF THE STATEWIDE CASE
MIX. FOR EXAMPLE THEY HAVE ABOUT
THREE POINT SEVEN SIX- SENIORS
AND PERSONS WITH DISABILITIES
AND THE STATE WHY NUMBERS ARE AT
THREE POINT FOUR FIVE PERCENT.
ADDITIONALLY I WOULD NOTE THAT
IN SACRAMENTO AND SAN DIEGO
WHERE WE HAVE A DIRECT CONTRACT
WITH KAISER. KAISER'S MEMBERSHIP
IS PROJECTED TO BE HIGHER RISK
THAN THE COUNTY AVERAGE FOR
CHILD AND ADULT POPULATIONS AT
LOWER RISK FOR SENIORS AND
PERSONS WITH DISABILITIES. TO
THE MARK I DIRECT INSIGHT INTO
WE HAVE TO KAISER THE MORE WE'RE
ABLE TO AFFORD THESE TYPES OF
ANALYSIS. TODAY HI A PARTISAN.
IN CAL TWENTY TWO CARRY. THE
DEPARTMENT DIRECTLY CONTRACTS
WITH KAISER IN FIVE COUNTIES AND
KAISER PARTICIPATES IN THIS AS A
SUBCONTRACTOR WITH TWELVE LOCAL
PLANS IN SEVENTEEN COUNTIES.
UNDER THIS PROPOSAL KAISER WOULD
PARTICIPATE IN THIRTY TWO
COUNTIES AND IN SOME OF THESE
COUNTIES THE PARTICIPATION WOULD
BE BASED ON THE ZIP CODES WHERE
THEY MAINTAIN A NIGHT LIGHT
KNOCKS KING LICENSE WITH THE
DEPARTMENT OF MANAGED
HEALTHCARE. AND THIS WOULD BE IN
IN THOSE COUNTIES WHERE THEY
HAVE ANY LINE OF BUSINESS AND IN
ALL INSTANCES KAISER WOULD
DIRECTLY CONTRACT WITH THE
STATE. THIS IS BRINGING
ADDITIONAL ACCESS AND CAPACITY
FOR THE MEDICAL PROGRAM IN TEN
COUNTIES. THIS PROPOSAL GIVES
THE STATE DIRECT OVERSIGHT OF
KAISER AND A THIRTY TWO COUNTIES
AND ALLOWS US TO PUSH KAISER'S
AND WAYS WE HAVE NOT DONE BEFORE
AS WE WILL HAVE A DIRECT
OVERSIGHT- AND KIND OF DIRECT
CLARITY AND TRANSPARENCY WITH
REGARD TO OUR AND PROVISION OF
OVERSIGHT. THIS IS A STEP
FORWARD IN THE PAST THE SIMPLE
**** SIMPLIFICATION OF COVERAGE
IN THE STATE AS IT REDUCES I'M
NAY I NEEDED LAYERS OF
ADMINISTRATION AND BUREAUCRACY
BY ELIMINATING THE TWELVE
SUBCONTRACTS AND COURSE BY NEED
ADMINISTRATIVE OVERHEAD BETWEEN
KAISER AND OTHER MANAGED CARE
PLANS. ELIMINATING CONSUMER CAN
VIEW REGARDING SOME CON. OR
ARRANGED BETWEEN KAISER AND THE
OTHER MANAGED CARE PLANS. AND
AGAIN ALLOWS DH CS TO HAVE
DIRECT OVERSIGHT OF. THE CARE OF
ABOUT A COSTA MILLION
BENEFICIARIES. TODAY HI THERE IS
NOT REQUIRED TO PARTNER WITH
COMMUNITY HEALTH CENTERS FOR
EFFORTS RELATED TO POPULATION
HEALTH MANAGEMENT ECON SALT-
INPATIENT SPECIALTY ACCESS.
UNDER THIS PROPOSAL KIZER HAS
AGREED TO TERMS ON THESE
PARTNERSHIPS IN PARTICULAR WE
ARE GETTING THEM TO PARTNER WITH
FEDERALLY QUALIFIED HEALTH
CENTERS ARE NON KAISER MEMBERS
TO ADD SPECIALLY ACCESS CAPACITY
THEY DO NOT DO THIS TODAY. ONE
OF OUR GOALS IS SEEK TO CREATE
IS TO SEEK TO CREATE
PARTNERSHIPS THAT PROVIDE
MEDICARE BENEFICIARIES THE MOST
POSSIBLE AND WE HINK
PARTNERSHIPS BETWEEN OUR FAQS
AND KAISER. ON SPECIALTY CARE IS
AN EXTRAORDINARY OPPORTUNITY
THIS IS GETTING THE DID YOU HAVE
TO DO MORE EMBEDDED CAL EVEN FOR
NON KAISER MEMBERS. I KNOW THERE
ARE QUESTIONS RELATED TO HELP
PLAN RATES AND HOW THEY WILL BE
A TRUSTED TO ACCOUNT FOR BE IT
AT THE ACTUAL ACUITY RISK. OF
EACH PAGE HI AND AGREEMENT TO
ENSURE VERY IN PAY. CAP RATES
WILL COUNT MEMBERS SHOULD
MEMBERSHIP SHIPS TO THIS. THE
WILL DRAW THE PLAN SIX. TO
REMOVE MEMBERS WORK LOW SO TO
ACCEPT. TO KAISER AS WELL AS THE
GLOBAL SUB CAPITATION COSTS FOR
THESE MEMBERS. WHAT MEMBERS WHO
ARE SUBJUGATED KAISER ARE
REMOVED FROM THAT DIRECT PLANS
ENROLLMENT. THIS CAPITATION
COSTS REVIEWS MEMBERS WILL BE
REMOVED AS WELL. IN OTHER WORDS
WE WILL REMOVE THE COST FOR
KAISER AS A DELEGATE AND NOT
ASSUME THAT THE TRANSITIONING
KAISER MEMBERS COSTS THE SAME AS
THE DIRECT PLANS AVERAGE NUMBER.
CONSEQUENTLY THE RATES WILL
RECOGNIZE THE SHIFT A MEMBER AND
MEMBER MIX AND COSTS. JUST FOR
BACKGROUND CAPITATION RATES ARE
DEVELOPED TO BE SUFFICIENT TO
COVER THE REASONABLE APPROPRIATE
AND ATTAINABLE PROJECTED COST OF
PROVIDING COVERED SERVICES TO
ALL POPULATIONS DURING THE
RATING PERIOD. RADIAN IS RATE
SETTING IS INFORM THE- PRIMARILY
BY HISTORICAL EXPERIENCE AND
ADJUSTED TO ACCOUNT FOR THE
APPROPRIATE POPULATIONS AND
SERVICES. DURING THE DURING THE
RATING PERIOD. I CAPITATION
RATES ARE FURTHER SEPT TO HEALTH
BASED RE ADJUST PROCESS. WHICH
IS A PROCESS USED TO REMEMBER
OUR PLANTS BASED ON HEALTH
STATUS OF THE POPULATION. WE
ALSO HEARD THE CONCERN THAT
PLANS WOULD HAVE TO WAIT TWO
YEARS TO RECOGNIZE THIS
ADJUSTMENT TO THE RATES. LOCAL
PLANS WILL NOT NEED TO WAIT TWO
YEARS TO WRITE RECOGNIZE THIS
ADJUSTMENT AS JUST NOTED THE
RATES ARE DEVELOPED ACCOUNT FOR
THESE CHANGES PRIOR TO THE START
OF THE RATE YEAR. WE ALSO THINK
IT IS VERY IMPORTANT FOR KAISER
TO MAINTAIN AND BUILD LOCAL
RELATIONSHIPS. TO ENSURE THAT
THEIR MEDICARE MEMBERS ARE
CONNECTED TO ALL THE SERVICES
THEY NEED IN THE COMMUNITY-
THAT'S REQUIRED BY CALTRAIN. AND
AS REQUIRED BY JUST OUR GENERAL
PRINCIPLES OF THE SOCIAL DRIVERS
OF HEALTH REALLY RECOGNIZING
THEIR VALUE ON HEALTH OUTCOMES.
KAISER IS COMMITTED TO USING
COUNTY DEPARTMENTS PUBLIC
HOSPITALS AND HEALTH SYSTEMS AND
COMMUNITY HEALTH CENTERS TO
DELIVER OUR CAL AIM ENHANCE CARE
MANAGEMENT BENEFIT AND COMMUNITY
SUPPORT SUPPORTS. KAISER HAS
ALSO COMMITTED TO BROUGHT UP
TATE OF COMMUNITY SUPPORTS
CONSISTENT WITH OTHER MEDICARE
MANAGED CARE. MANAGED CARE PLANS
WILL IMPLEMENT AT LEAST THE SAME
NUMBER OF COMMUNITY SUPPORTS AS
OTHER PLANS IN THE AREA.
ADDITIONALLY WE THINK ALL OF OUR
MANAGED CARE PLANS COMMERCIAL
KAISER AND LOCAL PLANS SHOULD
BUILD OUT THE RELATIONSHIPS WITH
COUNTY DEPARTMENTS AND LOCAL
PARTNERS. AS SUCH OUR NEW
MANAGED CARE CONTRACT TO GET A
PLACE TO ALL OF OUR PLANS AND
GOES LACKS TWENTY TWENTY FOUR.
INCLUDES REQUIREMENTS FOR PLANS
TO HAVE MO USE WITH COUNTY
SOCIAL SERVICES DEPARTMENTS
CHILD WELFARE PROBATION
CONTINUES OF CARE AREA AGENCIES
ON AGING FOR EXAMPLE. PLANS WILL
BE REQUIRED TO FACILITATE WARM
HAND OFFS AND CLOSED LOOP
REFERRALS OF MEMBERS TO THE
LOCAL COMMUNITY RESOURCES. THESE
M. O. USY OUTLINED POLICIES AND
PROCEDURES BETWEEN THE PARTIES
REGARDING SCREENS. CLOSE LOOK
REFERRALS COORDINATION DATA
EXCHANGE DISPUTE RESOLUTION
MEETING FREQUENCY QUALITY
IMPROVEMENT ACTIVITIES FOR
EXAMPLES. LOCAL ENGAGEMENT IS A
FUNDAMENTAL PRINCIPLE BEYOND
THIS PROPOSAL THAT THE
DEPARTMENT RECOGNIZES IS
CRITICAL IN ADDRESSING THE
SOCIAL DRIVERS OF HEALTH AND
DELIVERING SERVICES OUTSIDE OF
TRADITIONAL HEALTH CARE
SETTINGS. THIS APPLIES NOT JUST
TO KAISER. BUT TO ALL OF OUR
MANAGED CARE PLANS. QUESTIONS
HAVE ALSO BEEN REYES REGARDING
COMMITMENT BE ABLE SERVICES AND
COLLABORATION WITH COUNTY
BEHAVIORAL HEALTH DEPARTMENTS.
UNDER THIS PROPOSAL WE WILL HAVE
DIRECT OVERSIGHT AND INSIGHT
INTO KAISER'S PROVISION OF
BEHAVIORAL HEALTH SERVICES.
CURRENTLY THIS INSIGHT IS
INCORRECT AND MOSTLY VIA THE
PRIME PLANS THIS DIRECT
RELATIONSHIP WILL IMPROVE OUR
ABILITY TO HOLD THEM ACCOUNTABLE
ACCOUNTABLE. ADDITIONALLY WE
KNOW THAT ALL OF OUR MANAGED
CARE PLANS CAN DO BETTER WITH
REGARD TO THE PROVISION OF
BEHAVIORAL HEALTH SERVICES ONE
OF THE TOP THREE CLINICAL
FOCUSES IN OUR NEW COMPREHENSIVE
QUALITY STRATEGY IS BEHAVIORAL
HEALTH INTEGRATION. WE KNOW THAT
ADDRESSING BEHAVIORAL HEALTH
TODAY WILL REDUCE CHRONIC
DISEASES AND SERIOUS ILLNESSES
IN THE DECADES TO COME AND FOR
THE FIRST TIME EVER WE ARE
INCLUDING METRICS RELATED TO
BEHAVIORAL HEALTH AND SPECIALTY
SERVICES AS PART OF OUR QUALITY
STRATEGY. IN CLOSING THIS
PROPOSAL GETS AS MORE FOR OUR
MEDICARE BENEFICIARIES DOING
NOTHING IS WORSE THAN THE STATUS
QUO. WE WANT TO GROW ACCESS TO
QUALITY PROVIDERS FOR MEDICARE
BENEFICIARIES AND THIS IS AN
OPPORTUNITY TO CRAFT DIFFERENT
APPROACHES TO WORK WITH KAISER
DIFFERENT PARTNERSHIPS TO EXPAND
THEIR CONTRIBUTION TO THE
MEDICAL PROGRAM. AGAIN OUR GOAL
IS TO PROVIDE CHOICE AND
CONTINUITY FOR OUR MEDIC HEALTH
BENEFICIARIES ACROSS PAYER
SOURCE ACROSS COUNTY LINES TO
INCREASE ACCESS TO SERVICES AND
QUALITY CARE. THIS PROPOSAL
BRING SIGNIFICANT VALUE TO OUR
MEDICARE BENEFICIARIES THANK YOU
. THANK YOU DIRECTOR BUS- WILL.
EFFECT INCLUDE A PRESENTATION
FOR THE PART HEALTHCARE SERVICES
THEN- I WILL MOVE ON TO OUR
STAKEHOLDER PERSPECTIVES AND
THEN AFTER THAT WE WILL HAVE
OUR- WILL HAVE QUESTIONS FROM
COMMENTS FROM MEMBERS. SO THE
NEXT SPEAKER- LEADING OFFICE
STAKEHOLDER PERSPECTIVES IS A
REEF- SHAKE BELIEVE HOPEFULLY
LIKE OF A PRONOUNCE IT CORRECTLY
HIS DIRECTOR OF CALIFORNIA
MEDICAID OUT AND STATE SPONSORED
PROGRAMS AT KAISER PERMANENTE.
WELCOME THANK YOU- DOCTOR CAN A
GOOD AFTERNOON SENATORS MANY
MISS ARCHIE AND I AM THE
DIRECTOR OF CALIFORNIA MEDIC
KALLEN C. SPONSORED PROGRAMS
HERE BECAUSE- I WOULD ALSO LIKE
TO MENTION THAT I'M CHOI. BY DOC
BECAUSE SHE WAS IT'S OR CHIEF I
CRIED. IN BEHAVIORAL HEALTH
BETTER AND ALSO THE OF. MENTAL
IN THIS. BECAUSE SHE WOULD BE
AVAILABLE TO ANSWER THE
QUESTIONS RELATED TO THE ROCK
SERVICES OKAY I HAVE ON BEHALF
OF KAISER PERMAN. I AM TO SHOW
OUR STRONG SUPPORT FOR THE
ADMINISTRATION BUDGET PROPOSAL
TO ENTER INTO A SINGLE. DIRECT
MEDI CAL CONTRACT WITH KAISER
PERMANENTE A STARTING JANUARY
FIRST TWENTY TWENTY FOUR. HI
COMMITTEE HAS PROBABLY
DISSIPATED MEDICARE FOR YEARS AS
A NONPROFIT HEALTH CARE
ORGANIZATION WITH THE MISSION TO
PROVIDE HIGH QUALITY CARE
ENCOURAGING TO IMPROVE THE
HEALTH OF OUR COMMUNITIES. HI
COMMITTEE CURRENTLY PROVIDES
HIGH QUALITY CARE-HIS DIRECTOR
BOSS MENTIONED TO OVER NINE
HUNDRED THOUSAND MEDICARE
BENEFICIARIES IN TWENTY TWO
COUNTIES FOURTEEN CONTRACTS
LOCAL PLANS AND GMC COUNTIES. A
SINGLE DIRECT CONTRACT ALLOWS
KAISER PERMANENTE DE TO INCREASE
ITS PARTICIPATION IN MEDICARE
WITH MANAGEABLE GROWTH THAT
WOULD IMPROVE MEDICARE
BENEFICIARIES ACCESS TO CRITICAL
PROVIDERS AND QUALITY HEALTHCARE
SERVICES WITHOUT NEGATIVELY
IMPACTING THE ESSENTIAL ROLES OF
THE LOCAL HEALTH PLANS AND.
SIGNAL PROVIDERS. TRANSITIONING
INTO A DRAW MEDI CAL CON TO SEE
. HOUSE THE FOLLOW BENEFITS. IF
YOU HELLO EQUITY HI PERMANENTE A
WILL. MORE INVOLVED POPULAR.
WITH NEEDS SO AS FOSTER. TO
MEDICARE THE MEDICARE SENIOR IN
OTHER LOW INCOME. IT INCREASE
ACCESS QUALITY CARE HI IS A
PERMANENT AS BY TO IS HIGH
QUALITY RATED THE ACCOUNT PLAN.
HAS PERMANENTLY WILL ALSO EXPAND
ITS MEDICAID A MOMENT TO TEN AND
DIGITAL COUNTIES FOR A TOTAL OF
THIRTY TWO COUNTIES ACROSS
CALIFORNIA. THIS ALLOWS CRISIS
COMMITTEE MEMBERS TO KEEP THEIR
SAME DOCTORS THERAPISTS
HOSPITALS ELECTRONIC HEALTH
RECORDS ETCETERA NO MATTER WHAT
COUNTY RESIDING RATHER THAN
HAVING TO NAVIGATE A WHOLE NEW
SYSTEM OF HEALTH CARE AN ALREADY
STRESSFUL TIMES IN THEIR LIVES.
IT REDUCES IMAGE COMPLEXITY
INCREASES STATE OVERSIGHT AND
ENFORCEMENT. A DIRECT CONTRACT
WILL REMOVE ADMINISTRATIVE
LAYERS MAKING THE MEDICARE
PROGRAM EASIER TO ACCESS FOR
MEMBERS AND WILL STREAMLINE THE
STATE OVERSIGHT AND
ACCOUNTABILITY OF THE CONTRACT.
AND FINALLY T RESPECTS LOCAL
CONTROL HI COMMITTEE WILL HAVE
NO USE WITH COUNTIES AND WILL
COLLABORATE WITH LOCAL HEALTH
PLANS COUNTIES AND THE SAFETY
NET I'M DETERMINING IN ROMAN
GROWTH IMPLEMENTATION OF CALLING
BECAUSE HE'S AND DELIVERY OF
COMMUNITY SUPPORTS. THIS
PROPOSAL IS A CAREFULLY BALANCED
APPROACH THAT WILL ALLOW KAISER
PERMANENTE A TO INCREASE ACCESS
TO HIGH QUALITY CARE. FOR A
BROADER NUMBER OF MEDICAL ISSUES
IN A WAY THAT IS INTENDED TO
COMPLEMENT LOCAL HEALTH PLANS
AND SEEKING A DELIVERY SYSTEM.
WE LIKE TO THINK YOU'RE A DOCTOR
PATTEN SENATOR EGGMAN YOU'RE TOO
MANY STAFF. HOLINESS
INFORMATIONAL HEARING FOR THE
BACKGROUND INFORMATION THAT WAS
PROVIDED. DURING IS AN IMPORTANT
PART OF THE EXTENSIVE PUBLIC
DISCUSSION THAT HAS TAKEN PLACE.
ON THIS PROPOSAL OVER THE LAST
SEVERAL MONTHS. WE ALSO
APPRECIATE THE OPPORTUNITY TO
SPEAK WITH MANY STAKEHOLDERS AND
LONGTIME PARTNERS ACROSS THE
STATE ABOUT THIS PROPOSAL OVER
THE LAST SEVERAL MONTHS. WE KNOW
THAT THERE IS A SIGNIFICANT
AMOUNT OF INTEREST IN THIS
PROPOSAL AND WE VALUE YOUR
INPUT. WE WELCOME FURTHER
CONVERSATION AND LOOK FORWARD TO
CONTINUING TO WORK WITH ALL
STAKEHOLDERS AS PROPOSAL MOVES
FORWARD. AGAIN DOCTOR BECAUSE
SHE AND I ARE AVAILABLE TO
ANSWER ANY QUESTIONS THAT THE
COMMITTEE HAVE. THANK YOU THANK
YOU AND- GET WILL TAKE QUESTIONS
AFTER WE FINISH OUR STAKEHOLDER
PERSPECTIVES SO APPRECIATE YOU-
BEING HERE'S STAYING ON AN ENTRY
THIS QUESTIONS. WILL NOW MOVE ON
TO THE NAY A KOOPMANS- IT CO THE
LOCAL HEALTH PLANS A CALIFORNIA
WELCOME. EIGHT GOOD AFTERNOON
CHAIRED PLAN EGGMAN AND MEMBERS
OF THE COMMITTEE. THANK YOU FOR
INVITING ME TO SPEAK TODAY AND
FOR THE DISCUSSION ABOUT THE
SIGNIFICANT PROPOSAL. I MONEY
COMMITTEE OVER THE LOCAL HELP
AND THE CALIFORNIA. GP
REPRESENTS SIXTEEN CANYON BASED
LOCAL PLANS THE STATE WHICH- FOR
OVER PERCENT OF MY- AND CARE AND. HE HAS THEY ARE. TO THE- FOR
EACH AND INTO WIDE HOW COME. THE
TIGER. NOW IN EARLY FEBRUARY.
CITING THINKING IN FOR THE NOT
HELPFULLY AS AND I. CONSEQUENCE
THAT NOT AND BY THE
ADMINISTRATION. AND PUBLIC. THAT
PARTNER WITH HOSPITALS AND- THE
ENSURE ALL HELD YOUR RECEIVE
THEIR- LOCAL ARE PART OF THE
BACKBONE OF THE NIGHT. THE AT.
THE PROPOSAL A ROAD CAL HEALTH
PLAN MY WHICH HAD BEEN. IN
MEETING NEEDS OF LOCAL MEDIC HOW
BENEFITS YOU. FOR DECADES. I
WILL THREE KEY CAN.
DELIVER CARE LOCALLY AND SUPPORT
THE THINKING AT. BEST MODEL
EXPANDED OVER THE SUBSEQUENT
DECADES AND IN TWENTY TWENTY
FOUR THERE WILL BE A PUBLIC PLAN
AND FORTY NINE COUNTIES ACROSS
THE STATE. IN EACH OF THESE
COUNTIES LOCAL STAKEHOLDERS WENT
THROUGH A PUBLIC PROCESS WHICH
CULMINATED IN THE PASSAGE OF
COUNTY ORDINANCE SAYS. THE
DALLAS OR JOIN A PUBLIC LAND. I
FOUNDATIONAL PART OF THE LOCAL
PLAN MODEL IS THAT LOCAL PLANS
AND THEIR STAFF ARE LOCATED IN
THE COMMUNITIES THEY SERVE. I
HAVE LOCAL ACCOUNTABILITY AND
GOVERNANCE. THE CONNECTION TO
COUNTY PROVIDERS AND THE
COMMUNITY CANNOT BE REPLICATED
BY IMPOSING REQUIREMENTS TO
ESTABLISH. RELATIONSHIPS THEIR
GRIEVANCE. THE PROPOSAL FOR A
JACK DIRECT STATEWIDE CONTACT IS
PRETTY. PROUD FOR MEDIC CAL AND
RELEASED- BY COUNTY ORGANIZED
HEALTH SYSTEMS. ARE THERE IS ONE
PUBLIC PLAN THAT COVERS ALL
MEDICAL MANAGED CARE ENROLLEES.
BECAUSE THERE IS A SINGLE ENTITY
ORGANIZING CARE THERE IS A
UNIQUE ENVIRONMENT OF
COLLABORATION AMONG PROVIDERS
HOW MANY. AS A RESULT. HAVE BEEN
LEADER IN MEDIC HOW PILE
INNOVATIVE NEW PROGRAMS ANY
INTEGRATING. THEY HAVE LONG SO
THAT ARE NEW LEADING CARD OTHER
PLANS ALLEN. HAS BEEN A BIG IN.
PROGRAMS SERVICE NOT ANOTHER
COUNTY BECAUSE THEY ARE THE
SINGLE CAR CARE AND ACCOUNT.
BURKE OF THE NUMBER OF MY SURVEY
HI THERE THIS PURPOSE.
EFFECTIVELY AND THE CODE FINAL.
MISSION USING NETBANKING. NOT
JUST THE ON PRINTER BUT IT'S THE
FRAGMENT CARE FOR MEMBERS. AND
DISRUPT THE HEALTH EITHER. BY
INTERVIEW AND INSTEA OF A
COLLABORATOR. BUT FOR THE WHITE
ALSO ENTERED EVERY FOR MANY
BENEFITS BUT ALSO IN THE END HAS
. THE PROPOSAL DOES NOT GET.
THAT THEIR CARE WILL BE. THROUGH
CREDIT NUMBER OF PROVIDE. IF AND
IF ARE ELDERLY TO ENROLL IN
KAISER WE THEY SHOULD BE. ACCESS
THE SAME KIND OF PROVIDERS THAT
ARE SERVING I DO COMMERCIALLY.
ENROLLEES THE FACT THAT QUE
CONTRA NINE PROVIDERS
PARTICULARLY FOR PRIMARY CARE
THIRD. IT'S NOT A CALENDAR WE
ARE NOT GETTING ACCESS TO
CLOTHES NETWORK WHICH IS THE
BASIS FOR THIS PROPOSAL.
ADDITIONALLY IF EITHER CONTACTED
COMMUNITY CLINICS OR OTHER
MEDICAL PROVIDERS IN THE
COMMUNITY IT IS NOT CREATING NEW
ACCESS FOR MEDICARE MEMBERS. IN
ASSEMBLY REDUCING ACCESS FOR NON
PAY THEIR MEDICAL AND RELIEF. I
KNOW DIRECTOR ROSTERS TO THIS
ISSUE AND INDICATED HI THERE
WILL NOT IN FACT CONTRACTED OUT
TO THIRD IN MEMBERS HOWEVER.
WITHOUT STATUTORY PROTECTION WE
DO NOT BELIEVE HE HAS THE IN FOR
A THIRTY. PERCENT COURSE THAT.
FINALLY THE IN ROMAN RULED OUT
IN THE- ARE BY DEATH.
EXCLUSIONARY I DIDN'T. WILL
PRIMARY BE INTO THE TO RE LOST
THEIR COVERAGE COVERAGE. A
POPULATION THAT IS GENERALLY HOW
AND HOW FEWER NAY. RELATED TO
CLOSE INTERNET AND OTHER HOW AND
REALLY. THIS IS A NATIONAL FOR
MEDICARE MEMBERS INCREASE
LOPSIDED ENROLLMENT BETWEEN
NINETY MANAGED PLAN. AND COUNTY
WERE LOW PLANT TO PRESENT TODAY
. THE LOCAL PLAN FOR MARC HUGHES
FIRST POP. AND THE OTHER PLAN
THEIR CAP. THIS IS ALL TRUE
LOCAL THAT THE CATER. DIFFERENT
HAS IN. FOR MEDICARE PROVIDER
AND THEN. SPEAKING AT PROVIDERS
WHICH SOMETIME CAN HIDE THAN
HALF OF LOCAL FANS I AM RIGHT
NOW. WILL CARE FOR SICKEST
MEMBERS AND BOTTOM MEDICAL
BENEFITS YOUR LOOKING TO RELY ON
THE- THAT ARE CARE. WITHOUT A
CERTAIN THAT THE RATE PAID THE
PLAN WILL ADD CREATE FOR MEMBERS
IN THE RESULT MAY BE A- BONUS
FOR THE PLAN SERVING. AND IN ON
IN PUN. FOR THE PLAY ARE GOING
ENROLLEES. THE DOWNSTREAM. IN
THAT THE RATES PROVIDER SERVING
THE COMPLEX STATION. CAN TURNS
AND THEIR THE- TO DELIVER HIGH
QUALITY. ONE THING WE DO NOT
BELIEVE THIS PROPOSED THERE'S A
AND ANGLE HAS BEEN NAY ON THE-
FOR THE MEDIC HOW. SYSTEM AND
THE BENEFITS TO RELY ON IT. BUT
WE CONTINUE TO- URGE ALLEGED
DURING THE RECALL. JENNIFER THEY
BELIEVE THE AT ABOUT LINE AND I
CAN. MUST BE A IN FACT YOU. WE
PROVIDED SUPPOSE THE NUMBER THAT
IF THAT NECESSARY PART. AND OPEN
DISCUSSION WITH A LOT. ABOUT
EARLY. THANK YOU. THANK YOU VERY
. OUR NEXT DAY CALL. IS ANDY.
PATTERSON FOR THIS VICE
PRESIDENT CALIFORNIA CARE
ASSOCIATION WELCOME. RIGHT YOU
SO MUCH. BYE THANK YOU MISS
CHAIR MADAM CHAIR MEMBERS OF
BOTH- AS DOC BEEN DISTORTED MY
NAME IS ANNE MARTINE PATTER AND
I'M THE SENIOR VICE PRESIDENT
FOR THE CALIFORNIA PRIMARY CARE
ASSOCIATION AND THEIR AFFILIATE
CALIFORNIA HEALTH ADVOCATES.
CBSA REPRESENTS MORE THAN
THIRTEEN HUNDRED COMMUNITY
HEALTH CENTERS IN CALIFORNIA THE
PROVIDE HIGH COMPREHENSIVE HIGH
QUALITY CARE TO SEVEN POINT TWO
MILLION PEOPLE. RESHAPE THE
DIALOGUE SPURRED BY THIS
PROPOSAL ALL OF THE STAKEHOLDERS
HERE TODAY ARE COMMITTED TO
CREATING A MEDICAL PROGRAM THAT
DELIVERS ROBUST SERVICES WITH
EXCELLENT QUALITY. BUT WE HAVE
NOT TAKEN AN OFFICIAL POSITION
ON THE ADMINISTRATION'S TRAILER
BILL LANGUAGE OR THE BILL THAT
HAS BEEN INTRODUCED IN THE
ASSEMBLY WE DO HAVE CONCERNS
ABOUT THE PROPOSAL THAT WE ASK
THE ADMINISTRATION AND THE
LEGISLATURE TO CONSIDER. THE
GREATEST RACE WE SEE FROM THE
DEVELOPMENT OF AN ATS PETE IS
INADVERTENTLY CREATING A TWO
TIERED MEDIC CAL PROGRAMS. WE
UNDERSTAND THAT THIS IS NOT THE
INTENT OR IS ABOUT OF THE
MEDICAL PROGRAM BUT WITHOUT
CAREFUL CONSIDERATION IT IS
POSSIBLE THAT SUCH A PROPOSAL
WILL DESTABILIZE THE LARGER
MEDICAL PROGRAM. AND UNDERMINE
THE ORIGINAL INTENTIONS. WHAT
KINDS ARE PERMANENT IS NOT
EXPRESSLY MENTIONED IN THE
PROPOSED LANGUAGE WE KNOW THAT
THEIR THE PLAN TARGETED BY THIS
PROPOSAL. KP HAS LONG BEEN A
PARTNER TO MEDICARE ALLEN CBC
AND HEALTH CENTERS WE RESPECT
AND ADMIRE THEM. BUT WE ALSO
HAVE ALWAYS KNOWN THAT THEIR
CORPORATE AND FINANCIAL
STRUCTURE ENABLES THEM TO
UNFAIRLY COMPETE WAS PRINCIPALLY
THE SHOWS UP IN WORKFORCE.
COMMUNITY HEALTH CENTERS HAVE
FOR YEARS STRUGGLE TO MAINTAIN
ADEQUATE STAFFING STRUCTURES WE
SIMPLY DO NOT HAVE THE RESOURCES
KP DOES TO RECRUIT AND RETAIN
PROVIDERS. THEIR COMMERCIAL
LINES OF BUSINESS PROVIDE A
REVENUE SOURCE THAT NONPROFIT
HEALTH CENTERS DON'T HAVE. I
CANNOT TELL YOU HOW MANY TIMES
I'VE HEARD STORIES LIKE THIS ONE
WE JUST FINISHED TRAINING A NEW
TEAM ABOUT MAYES LAST YEAR IN
THE LAST THREE MONTHS TEN OF
THEM WERE ALL HIRED BY KP. OR
I'VE PROVIDER JUST FINISHED HER
RESIDENCY IN KP OFFERED HER A
TWO HUNDRED THOUSAND DOLLAR
SIGNING BONUS AND ALL WE COULD
OFFER WAS TWENTY FIVE THOUSAND.
THIS HAPPENS ALL THE TIME ALL UP
AND DOWN THE STATE. AND WE IN NO
WAY BEGRUDGE KP FOR INVESTING IN
THEIR WORKFORCE THEY HAVE
EXCELLENT PROVIDERS AND STAFF.
OUR CONCERN IS THAT WE HAVE NO
VIABLE MECHANISM TO KEEP UP AND
THUS ARE LEFT CONSTANTLY
UNDERSTAFFED THE CONSEQUENCE OF
THIS IS A TWO TIERED MEDICAL
DELIVERY SYSTEM. IF YOU MEDICARE
BENEFICIARIES CAN RECEIVE
COMMERCIALLY SUBSIDIZED
INSURANCE AND CARE WHILE THE
RESTAURANT A SYSTEM NOT BY
DEFAULT NOT BENEFITTED FROM
COMMERCIAL INVESTMENT. THE
LEGISLATURE CAN HELP US SOLVE
THIS CONUNDRUM. ALL OF US HERE
WANT MEDIC HELL TO BE THE BEST
HEALTH INSURANCE FOR ALL
RECIPIENTS ACROSS THE STATE NO
MATTER WHERE THEY LIVE. WE DON'T
WANT THAT FOR JUST A FEW. HOW
CENTERS HAVE INVESTED DECADES IN
THEIR COMMUNITIES WITH OVER
THIRTEEN HUNDRED SITES ACROSS
THE STATE A MULTITUDE OF
SERVICES PRIMARY CARE BEHAVIORAL
HEALTH. DENTAL OPTOMETRY
ACUPUNCTURE WE HAVE BUILT TRUST
WITH OVER SEVEN MILLION PEOPLE
WE HAVE ALL OF THIS IN PART
BECAUSE OF OUR UNIQUE PAYMENT
MODEL IN PPS BUT ALSO. IN SPITE
PPS. UBS RATE SIX. CANNOT BE RAY
WILL COME FOR SO. INCREASES WE
HAVE AN INFLATION INDEX KNOWN AS
MEDICARE ECONOMIC INDEX BUT IT'S
BETWEEN. SOMETIMES A CLOSE 2022%
A YEAR AND MANY HEALTH CENTERS
WILL TELL YOU THEIR RATES ARE AT
LEAST 20% OUT OF LINE WITH
MARKET SALARIES. IF THE
LEGISLATURE CAN HELP US ADDRESS
THIS MATTER THAN HEALTH CENTERS
CAN BE STRENGTHENED AND WE CAN
LEVEL THE PLAYING FIELD. WE CAN
HELP TO ENSURE IN EVERY CORNER
OF THE STATE MEDICARE
BENEFICIARIES HAVE ACCESS TO
EXCELLENT QUALITY CARE. FULLY
STAFFED BY EXPERT PROVIDERS AND
STAFF. WE ALSO HAVE A FEW
LOGISTICAL ISSUES OF CONCERN. TO
RAISE MORE GENERALLY. WE'RE
CONCERNED ABOUT NETWORK
DISRUPTIONS BY KP GROWTH WE DO
NOT WANT TO SEE THE 25% GROWTH
CAP OVER FIVE YEARS. DO ANY
UNDUE HARM IN ANY ONE COMMUNITY.
5% OVER THE TOTALITY OF CAPE OF
THE KP SERVICE AREA IS UNLIKELY
TO BE HARMFUL. TO THE HEALTH
CENTER DELIVERY SYSTEM BUT IF A
DISPROPORTION ABOUT OCCURRED IN
ANYONE ZIP CODE IT COULD
INADVERTENTLY TO STABILIZE THE
HEALTH CENTER. WITH A LONG
HISTORICAL PRESENCE. TO MITIGATE
BEST WE DO BELIEVE THERE SHOULD
BE AN ADVISORY BODY CLOSELY
MONITORING THE GROWTH. AND THAT
SUCH A BODY SHOULD INCLUDE
REPRESENTATIVES FROM THE HOUSE.
THIS IS PARTICULARLY A CONCERN
FOR THE ZIP CODES AND COUNTIES
WERE KP DOESN'T ALREADY OFFER
MEDICAL. LASSEN REGARDS TO
SPECIALTY CARE ACCESS WHICH WE
APPRECIATE BEING A COMPONENT OF
THE ADMINISTRATION AND THE
AUTHOR'S INTENT. WE WANT TO SAY
THAT WE ABSOLUTELY NEED MORE
ACCESS TO SPECIALTY CARE AND
WE'RE EXCITED TO SEE A MORE
CONCERTED EFFORT AND WILLINGNESS
FROM CAPE K TO LEAN IN HERE.
THAT SAID WE KNOW THAT KEEP YOU
CANNOT BE THE ANSWER STATEWIDE
BOTH BECAUSE OF THEIR STAFFING
GEOGRAPHIC LIMITATIONS.
FURTHERMORE WE KNOW SPECIALTY
ACCESS IS COMPLICATED HENCE WHY
IT HAS BEEN A CHALLENGE FOR SO
LONG. AS PART OF OUR WORK WITH
THE STATE AND KAISER I'M
POPULATION HEALTH MANAGEMENT ONE
OF THE AREAS OF FOCUS ON THAT
WE'VE BEEN GETTING UNDERNEATH IS
pWANT TO ACKNOWLEDGE THAT THERE'S
BEEN A DEEP AMOUNT OF WORK IN
DATA. THAT HAS GONE INTO THIS AT
THAT POINT WE ARE NOT PREPARED
TO OFFER SOLUTIONS AS WE BELIEVE
THAT WORK BUT WE BELIEVE THAT
WORK SHOULD CONTINUE IN EARNEST-
AND FIND THE BEST SOLUTIONS. WE
WANT WE JUST NEED A LITTLE BIT
MORE TIME TO GET IT RIGHT- BUT
ARE INVESTED TO BE SAID IN OUR
HELP AND OUR MEMBERS. OF THE
CONTINUING THOSE DISCUSSIONS AND
FINDING AN APPROPRIATE SOLUTION
. HOW CENTERS LOCAL HEALTH PLANS
KAISER IN THE STATE ALL DESIRE A
STRONGER QUALITY ORIENTED
MEDICAL PROGRAM. FOR THAT TO
HAPPEN THE LEGISLATURE IN THE
STATE MUST CAREFULLY CONSIDER
THE PROVISIONS. PUT FORWARD IT
BY THE ADMINISTRATION AND BY THE
AUTHOR TO ENSURE ALL THE
REQUIREMENTS FOR PLANS AND
PROVIDERS IN MEDIC CAL. ARE
EQUAL AND FAIR AND THAT
BENEFICIARIES. HAVE A WONDERFUL
COMPREHENSIVE QUALITY ORIENTED
EXPERIENCE ACROSS THE STATE OF
CALIFORNIA THANK YOU SO MUCH.
THANK YOU VERY MUCH AND FAILURE
LAST STAKEHOLDER FOR- AND OUR
PANEL IS HAS A TAURUS- CASOULOS
UP ALL SEAMLESSLY ADVOCATE FOR
HEALTH ACCESS CALIFORNIA WELCOME
. THANK YOU GOOD AFTERNOON-
CHARTER MEMBERS CAN EVERYONE
HEAR ME. YES PLEASE BEGIN THANK
YOU OR IS WITHOUT TAXES
CALIFORNIA STATEWIDE HEALTH CARE
CONSUMER ADVOCACY COALITION
HEALTH ACCESS HOUSING SUPPORT IF
AMENDED POSITION ON THE DIRECT
CONTRACTING PROPOSAL WITH KAISER
PERMANENTE BEING HEARD IN
TODAY'S INFORMATION HEARING THE
DEPARTMENT OF HEALTH CARE
SERVICES. AS MENTIONED ALREADY
INTENDS TO ENTER INTO A DIRECT
CONTRACT WITH KAISER AS A
MEDICAMENTO PLAN IN CERTAIN
GEOGRAPHIC AREAS OF THE STATE
HEALTH ACCESS IS GENERALLY
SUPPORTIVE OF THE VARIOUS GOALS
IN THE PROPOSAL TO PROVIDE
PATIENTS AROUND THE STATE WITH
CONTINUE YOUR CARE. IF THEY HAD
PRIOR COVERAGE WITH KAISER AND
NOW BECOME ELIGIBLE FOR
MEDICARE. IF THIS WORKS AS
INTENDED MORE CALIFORNIA
PATIENTS IN MARIN COUNTY'S WILL
HAVE THE ABILITY TO KEEP THEIR
BECAUSE OUR DOCTOR AND NOT HAVE
THEIR CARE INTERRUPTED. IT WOULD
GIVE PATIENTS MORE OPTIONS AND
MAKE EXISTING OPTIONS CLEAR TO
THEM. RIGHT NOW EVEN IN COUNTIES
WHERE KAISER IS A MINUTE CAL
IT'S NOT CLEAR TO PATIENTS WHAT
PLAN THEY SHOULD CHOOSE THAT
POTENTIALLY HAS A SUBCONTRACT.
THAT WOULD ENABLE THEM TO STAY
WITH THEIR DOCTOR. WE ALSO
SUPPORT EXPANDING THE OPTION OF
KAISER COVERAGE TO THE
VULNERABLE POPULATIONS OF FOSTER
CHILDREN AND TO A LEGIBLE
SENIORS. AND PEOPLE WITH
DISABILITIES. GETTING KAISER TO
DO MORE OF ITS FAIR SHARE AND
MEDICARE NOW HAS THE POTENTIAL
TO IMPROVE THE CAPACITY AND
QUALITY AND ACCOUNTABILITY IN
THIS KEEP PROGRAM. GIVEN THE
DOCUMENTED ACCESS ISSUES AND
MEDICARE- BRINGING IN KAISER'S
NETWORK OF DOCTORS HOSPITALS AND
SPECIALISTS SHOULD HELP ADDRESS
THE NEEDS OF THIS PROGRAM THAT
SERVES OVER THIRTEEN MILLION
CALIFORNIANS. THE IMPLEMENTATION
OF THIS CONTRACT SHOULD ENSURE
THAT KAISER'S ADDITIONAL%
CAPACITY IS ADDITIVE RATHER THAN
REPLACING OR COMPETING WITH
CRITICAL SAFETY NET HOSPITALS OR
CLINICS. COMPARED WITH MANY
OTHER PLANS KAISER DOES
RELATIVELY WELL ON MANY QUALITY
METRICS SO THAT THEIR EXPANSION
IS LIKELY POSITIVE FOR IMPROVING
QUALITY AND MEDICARE FIVE. BUT
THERE IS STILL MUCH ROOM FOR
IMPROVEMENT ON THE RECORD
QUALITY IN EQUITY ESPECIALLY
WITH AND BEHAVIOR HEALTH. A
DIRECT CONTRACT BETWEEN DCS AND
KAISER WOULD BE A STEP IN THE
RIGHT DIRECTION FOR THE STATE.
TO HAVE A GREATER AND MORE
DIRECT OVERSIGHT OF KAISER TO
BETTER MONITOR ACCESS TO CARE
AND ENSURE PATIENT PROTECTIONS.
WELL WE SUPPORT THE BROAD INTENT
OF THE PROPOSAL WE WANT TO
ENSURE THAT THE INTENDED GOALS
AND COMMITMENTS ARE CODIFIED TO
BEST BENEFIT MEDICARE
BENEFICIARIES. AND THAT THERE IS
ACCOUNTABILITY WITHIN THIS
CONTRACT WITH KAISER AS A
MEDICAMENTOS CARE PLAN. WE THINK
THE COMMITTEES AND THE
DEPARTMENT FOR WORKING WITH US
TO ADDRESS OUR CONCERNS. SEVERAL
OF OUR AMENDMENTS SEEK TO
CLARIFY AND CODIFY WHAT THE
DEPARTMENT IN KAISER HAVE
ALREADY PUBLICLY COMMITTED TO.
WHICH WOULD PROVIDE GUARANTEES
AND ASSURANCES AGAINST
MISUNDERSTANDINGS. THE FULL LIST
OF OUR AMENDMENTS CAN BE FOUND
IN OUR LETTER SUBMITTED TO THIS
JOINT INFORMATIONAL HEARING. ONE
OF OUR BROADER ASK IS THAT WE
ENSURE THAT KAISER ENTERED INTO
A MEMORANDUM OF UNDERSTANDING
WITH THE COUNTY THEY ARE LOCATED
IN. TO BEST COORDINATE THE CARE
TO MEDICALLY NECESSARY CARE FOR
MEDICARE BENEFICIARIES. FOR
EXAMPLE SOME OF THE WHOLE PERSON
CARE GOALS OF COUNTY TEAM OUR
BEST FULFILLED BY COUNTY SOCIAL
SERVICES AND OTHER COUNTY
SERVICES. IN ORDER TO MEET THESE
AND OTHER POPULATION HEALTH
GOALS WE WANT TO ENSURE THAT
KAISER ESTABLISHES A
RELATIONSHIP WITH THE COUNTY AND
RELATED ORGANIZATIONS. TO BETTER
CORNY PUBLIC HEALTH. SERVICE IS
EXPANSION EARLY. WE SUPPORT THE
GREATER KINDLY BACK HOME WITH
STATEWIDE. BUT WE THINK THAT IS
A TO ME. THE INPUT RELATIONS.
THIS IS IMPORTANT GIVEN THAT
KAISER COMES TO THIS FROM A
DIFFERENT STARTING PLACE THAN
THE PUBLIC HEALTH PLANS CREATED
BY COUNTIES. FINALLY WE
APPRECIATE THAT KAISER WILL TAKE
ON MORE OF ITS SHARE OF THE
STATE'S MEDICAL PUBLICATION
WHILE ALSO GROWING ITS BUSINESS.
NO LONGER AS A SUBCONTRACTOR
UNDER OTHER PANS TAKING AN
ADMINISTRATIVE FEE. IN THIS
CONTEXT WE'D URGE KAISER TO
COMMIT TO SPECIFIC WAYS. IT WILL
INCREASE ITS STATE WIDE AND
LOCAL COMMUNITY INVESTMENTS AND
IMPROVING MEDIC COW. THE HELP
LOW INCOME COMMITTEES AND TO
INCLUDE THOSE COMMITMENTS IN
STATURE AS MUCH AS POSSIBLE. WE
DO THINK EITHER FOR WORKING WITH
US ON A DRESSING OUR CONCERNS
AND FINDING A PATH FORWARD IN
THIS PROPOSAL. AGAIN CONTACTS
CALIFORNIA IS TAKING A SUPPORT
OF AMENDED POSITION ON THIS
DIRECT CONTRACTING PROPOSAL.
ALTHOUGH WE DO HAVE QUESTIONS ON
HOW THIS PROPOSAL WAS ORIGINALLY
RELEASED. AND THE LACK OF
TRANSPARENCY IN THE INITIAL
PROCESS WE DO THINK THE CHAIRS
AND MEMBERS HERE IN THE
STRUCTURE MISSION OF HEARING.
FOR WORKING WITH US ON OUR
CONCERNS AND DO LOOK FORWARD TO
CONTINUING THIS WORK. BECAUSE AT
THE END OF THE DAY WE WANT TO
MAKE SURE THAT THIS PROPOSAL
BEST BENEFITS MEDICARE
BENEFICIARIES AND STATE. THANK
YOU. HI THANKS VERY MUCH. WE NOW
WITH THOSE PRESENTATIONS WILL
BRING IT BACK TO THE COMMITTEE-
OKAY. THE SERVICE CENTER RUBIO
AND THEN- SERA. THANK YOU MISTER
CHAIR MADAM CHAIR- WELL WHERE TO
BEGIN THERE'S SO MUCH THAT WAS
DELIVERED TO US RIGHT NOW SO I'M
GONNA TRY TO NOT COMPREHENSIVE
WAY- ASK MY QUESTIONS- I WANT TO
START WITH- YOU KNOW I HAD MET A
FULL DISCLOSURE I HAD MET
EARLIER TODAY- WITH THAT
MICHELLE BASS AND I HAD HEARD
YOU KNOW I HAVE MY QUESTIONS
AND- ADEQUATE ANSWERS BUT THEN
AS FOR HEARING THE OF THE
TESTIMONY. YOU KNOW BROUGHT MORE
QUESTIONS UP THE ONE ISSUE THAT
I'M HAVING TO CONTEND WITH AND I
WANT CLARIFICATION SO I CAN HEAR
BOTH SIDES. IS THAT WHEN YOU
KNOW I HEAR FROM- FROM THE
ADVOCATES. THAT ARE IT'S NOT
GOING TO DISADVANTAGED. BY THEIR
HEALTH PLANS I'M SORRY OTHER
HEALTH CLINICS AND NOT IT'S NOT
GONNA TAKE THE SICKEST PATIENTS
AND THAT'S NOT GOING TO TRICKLE
DOWN TO SUBSTANDARD- YOU KNOW
OUR SERVICES BUT THEN. WHEN I
HEARD THE LAST PANELISTS AND I
BELIEVE THAT THAT WAS- IT COULD
HAVE BEEN AND D. R. WHO SET THIS
FOR MAYBE A REFER THEY TALKED
ABOUT AGAIN THEY'RE GONNA LEAVE
US WITH THE SICKEST PATIENTS SO
I'M HERE IN THIS CONFLICTING
SORT OF TESTIMONY WHERE ONE SAYS
NO THE OTHER ONE SAYS YES SO I'D
LIKE TO GIVE THEM BOTH THE
OPPORTUNITY JUST ON THAT ISSUE.
WE CAN CLARIFY BECAUSE I WANT TO
HEAR FROM BOTH THAT STANCE AGAIN
ONE BELIEVES THAT IT WILL LEAVE
THEM WITH THE SICKEST PATIENTS
AND THE ANALYSIS NOW I JUST WANT
THAT ISSUE SEPARATED AND- AND
BROUGHT FORWARD IF THAT'S OKAY.
OKAY SO- MAYBE WELL DO IS- AS
DIRECTOR FOR US IS- CAN EIGHTY
FIRST ADDRESS THAT ISSUE AND
THEN AGAIN SENATE RUBIO IF I
HAVE THE WRONG PERSON CORRECT ME
SO WHOEVER YOU ARE LISTEN TO BUT
MAYBE IT WILL HAVE- LIMIT
KOOPMANS FROM THE LOCAL HEALTH
PLANS AND RESPOND. AND THEN AND
IF YOU ALSO WANT THE PRIMARY
CARE ASSOCIATION AS WELL SINCE
YOU KNOW NOT JUST SO YOU KNOW
OKAY SOMEONE AND FAVOR SOMEONE
IN THE APPLICATION SITE SO I
JUST WANT TO RECONCILE THOSE TWO
STATEMENTS AND IT JUST SEEMS
THAT PEOPLE BELIEVE. AND WHEN I
HEAR THE TEST YOU MAKES SENSE
BUT YOU KNOW WHAT THEY'RE
READING ALL THAT WAS SAID I JUST
WANT TO SEPARATE THIS ISSUE AND
GET TO THE BOTTOM OF IT A VERY
AYE PRICES SUGGEST THAT PERHAPS-
AND AGAIN IT'S OTHER PEOPLE IN
AFTERWARDS BUT WE WILL START OFF
WITH THE ACTOR DIRECTOR BOSS
FOLLOWED BY. LAMEA KOOPMANS FROM
THE LOCAL HEALTH PLANTS IT SO
DOCTOR BOSS DO YOU WOULD YOU
MIND. TO IT ADDRESSING THAT
ISSUE. OR STAY YOU FOR THE
QUESTION. SO TODAY. HIS ROOM IS
B. ON. ALONE SO WITH PROPOSAL WE
ARE AT ACTUAL MORE. MORE HIGHER
. MORE HIGH ACUITY. TO THEIR
MEMBERS. BY HAVING THE OPTION OF
THE JEWEL ELEGY. WHICH GENERALLY
KNOW AND ELDER FOR BOTH MEDICARE
AND MEDICAID. AND THEN OUR
FOSTER YOUTH AND THEN THROUGH
THE DEFAULT ENROLLMENT
ASSIGNMENT ALSO A RANDOM MIX OF
MEMBERS TO KIND OF REFLECT. THE
PROPRIETY OF A CUTIE THAT MIGHT
BE REFLECTIVE. OF THE MEDICARE
POPULATION SO IN PARTICULAR IN
COMPARISON TODAY ACTING KAISER
WILL BE GETTING A MORE RANDOM A
MORE. DIVERSE MIX OF MEMBERS-
COMPARED TO WHAT HEY HAVE.
TODAY AND I JUST DIDN'T REALLY.
ALL UP ON OF THE POINT ABOUT WE-
CAN. PLANS DO GET PAID BE ON
THEIR QUEUE THE MIX THE WORD
EXPECT PLAN TO DO MORE WITH
LESS. IT HAVE IT HIGHER GDP. AND
SO JUST I THINK THOSE TWO ARE
VERY CRITICAL IN TERMS. THAT HOW
THIS FOR IS THAT A BETTER INTER
OF MEN MAKES VOICE AT HIGHS ARE. SO NOW WE CAN HAVE THE
OPPOSITE RESP TO THIS. YES YES
HAVE A- KHOO. FROM THE LOOKS
HEALTH PLANS. YEAH ADD MONEY TO
MEN'S AND ACTUALLY LET ME GET TO
THE REPEAT I'M GOING TO
INTRODUCE MY COLLEAGUE JENNIFER
LOPEZ TO THEIR DIRECTOR POPPED
AND FINANCING BUT- TO START WITH
RESPONDING TO THE QUESTION
ABOUT. THE SO. I THINK FIRST
STARTING WITH THE ENROLLMENT
RULES. SHE KNOWS THAT MEDICARE
BENEFICIARIES. WHO HAVE NOT HAD
PREVIOUS INVOLVEMENT THROUGH
CONTINUITY OF CARE. THAT WOULD
RUN HOUSES- WHO RE ENTERING FROM
THE CRIMINAL JUSTICE SYSTEM WILL
NOT QUALIFY TO ENROLL IN KAISER.
I THINK IT STARTS THERE AND THEN
BASED ON CURRENT ENROLLMENT- IT
WOULD NOTED EARLIER THAT TWELVE
OUR LOCAL PLAN SUBCONTRACTED
WRITER TODAY. SO WE'RE ABLE TO
SEE WHAT SHE REALLY LOOKS LIKE
BETWEEN OUR DIRECT NUMBERS AND
THOSE THAT ARE ASSIGNED HI
THERE. AND SO ON AVERAGE OUR OUR
DIRECT NUMBERS WERE SENIORS AND
PERSONS WITH DISABILITIES ARE
50% HIGHER IN ACUITY COMPARED TO
THOSE BETTER SURVIVE HEY THERE.
OF COURSE IT IS VERY SCANTY TO
COUNTY BUT THERE WE HAVE NOT
SEEN SOUND LIKE HE THERE'S- FOR
OUR DIRECT NUMBER ARE. TO ONE
HUNDRED AND TEN PER. MORE EXCUSE
THANK HATERS NEVER SHIPPED. IN
HER OF THE GNU POPPY. HAS TO BE
. ON THE FOR. I JUST NOW THAT
WITH WITH THE- ALTHOUGH THEY ARE
A MARBLE POPULATION. AND THEIR
COSTS AND THEY'RE CARED REALLY
FOR ON THE- SIDE NOW ON THE
MEDICARE SIDE BUT THERE'S A THE
THING AND PART OF THE THINGS
THERE- AND WITH FOX YOUTH THERE
. YOU AND LONG POPULAR. BUT MORE
IN OF SOCIAL AND THE HEALTH
NEEDS NOT NOT THE- YOU KNOW FROM
A MEDICAL- NEED FIRST AS- AND
THEN FINALLY ON FOURTH BEFORE IT
. I DO WANT TO TRY TO THE
DENTIST TO THE RATE ISSUES- THAT
WERE REFERENCE. DESIGN VETO AND
FINE. I THINK WE DON'T HAVE THE
DETAIL I MIGHT BE IN THE NEXT
THAT FOR. I YOU KNOW WE BEEN
HOLE THAT IT ACTUALLY BE. I
THINK OF. SMALL AMOUNT. OF THEIR
OF CARE MEMBER SO DON'T THINK IT
WILL ACTUALLY ACTUALLY CHANGE
THE NEXT MEMBERS HEY THERE WILL
BE- BUT AGAIN. THERE'S NO DETAIL
THAT THAN FOR THE UNTIL THE
POINT. SO IT YOU DON'T MIND AND
ME INTRODUCING LOPEZ AND HER
THOUGHT THE ROOF ISSUES THAT
WOULD GREAT YES. PLEASE PLEASE
WE ARE ON. GET OUT. HIGH LOW
WITH LOCAL HEALTH PLAN. WELL WE
DON'T GET. PLAN GET PAID ON A
CHEERLEADING. NEAREST IS THE
CURRENT RATE CRACK. PRACTICE DO
NOT ACCURATELY AND JUST FOR ME.
SHEILA E. FIFTY. MEMBER DURING
THE HELP. MM WHO ARE THE HIGH
NEED OUR ISSUE IS NOT THE OP. OF
BRICK CONTROL. WERE OUT. WHAT
MEANS. FOR THIRD HIGHER. OF
HEALTHY MEMBERS THEY- WITH THESE
KIND OF FLY RISK OUT. RECEIVE ON
IN. BUT FIRST. HELPING MEMBERS
WELL PLAN WHO ARE LAST THIRTEEN
THE MORE HIGHER. MEMBERS OR- GET
AND- HANDLED AND REYES ATTY. WE
FEEL THE BITE. OF THE IN RAW X.
OUTLINED THE KAISER. I'M IN THE
END HI WILL SERVE. HEALTH
MEMBERS AND IF RISK JETS OUTPUT
ARE NOT CORRECT IT HI THERE WILL
INDEED RECEIVE AN UNINTENDED.
FOR SERVING HOW. MEDICARE MA'AM
. WELL NOT PAID HEALTH PLANS
WILL CONTINUE TO RECEIVE A- IN
THE- THREE IN THE MOST FRAIL.
OUR IN THAT REQUIREMENTS THE
RATE FOR. ARE TO ENSURE PLAN ARE
PAID. RATE I THE PROPOSAL BEFORE. THANK YOU WELL CLEARLY THERE
IS SOME TWO MESSINA BELIEVE-
THEY MENTION THAT THEY HAVE AN
GONE EVERYTHING THAT THAT THEY
NEEDS TO EXPLORE THE FULL IN
ROME. AND THE DETAILS SO I GUESS
WE TO MAKE SURE THAT THEY GET
THEY- SO WE CAN. ACCEPT IT
FURTHER BUT YEAH I WANT TO MOVE
ON TO ANOTHER ISSUE- IT WORRY
ME. IS ACTUALLY RUBIO- CAN I PUT
QUICK PAUSE YOU KNOW MY- I THINK
STATURE EGGMAN DID HAVE A FALL
TO YOUR FIRST QUESTION SO WE CAN
DO THE FALL UP IN THOSE ACTIVE.
AND SO JUST A DIFFERENCE TO MY
FUTURE VACANT I THINK HER UP
THANK YOU VERY MUCH IS A JUST
DIRECT RELATED SAID I LOSE MY-
DENT. NO NO WENT- SO IT'S US SO
THAT WE'RE- TO DO. THINGS
BECAUSE ONE OF WHEN THE PROPOSED
FIRST CAME OUT. THERE WAS A LOT
OF CAN. THAT IT WAS. GOING TO.
ADVERTISER PEOPLE THERE ALREADY
. SO ONE OF THE CAN WAS TO COAX
ME THE PIE- TO BE ABLE TO HAVE
THIS THIS DEFAULT AS WELL. BE
ASSIGNED. BUT PERMITS LIMON I
FEEL LIKE I'M TO THINGS. IRMA'S
COOPS AND I'M- IT IN A
NATIONALLY WASN'T INCLUDED IN
THE PLANS WERE SAYING THAT'S
TERRIBLE DO YOU HAVE TO INCLUDE.
YOU KNOW SOME DEFAULT SO NOW THE
PLAN INCLUDES DEFAULT BUT IT
SOUNDS LIKE NOW YOU'RE STILL
SAYING. IF YOU DON'T LIKE THE
DEFAULT AND THE DEFAULT ITSELF
WILL FURTHER DESTABILIZE THE
PROVIDER NETWORK IS THAT WHAT
I'M HEARING. YES LET ME CLARIFY
AND I THINK THE CONCERN AGAIN IS
THAT THE ENROLLMENT RULES THAT
ARE INCLUDED IN THE PROPOSAL.
WILL MEAN THAT ONLY CERTAIN
BENEFICIARIES QUALIFY CAN ROLE
IN TIGHTER AND BOTTLES WELL THAT
PEOPLE PROPOSAL HAS BEEN SHARED
BY THE GAS AT A HIGH LEVEL- WE
DON'T HAVE ANY DETAILS IN FORM-
EVALUATE HOW WILL ACTUALLY
IMPACT THE PROPOSAL. AND-
SERVITE HIGH THEIR BIRTH IS JUNE
THIRD BY THE LOCAL PLAN AND
THINKING THAT PROVIDERS- SO I
THINK IT'S A MATTER OF- NEEDING%
ADDITIONAL INFORMATION TO
EVALUATE THAT. AND THEN.
ADDITIONALLY QUESTIONS AS TO IF
KAISER WAS GOING TO GROW BY 25%
OVER A FIVE YEAR CONTRACT FIRM-
I TO THE D. PROPOSAL BEING.
ANNOUNCED HOW DO THAT HOW DOES
THAT GET FACT IN I THINK WE
PROBABLY HAVE LOT OF OPEN
QUESTION ABOUT WHAT BEING
PROPOSED IN THE HOW ACTUALLY
IMPACT WILL BE SERVED HI THERE-
VERSUS THE OTHER PLANS OKAY
THANK YOU AND SO IT SOUNDS LIKE
THE DEPARTMENT WOODS AND NEED
WORK ON. ON THAT ISSUE AND I
WOULD JUST I WOULD JUST MAKE
NOTE THAT THE OTHER ISSUE THAT
THAT YOU WERE TALKING ABOUT THE
RATE SETTING FOR QT IS REALLY
NOT AS RELATED TO THIS PLAN AS
YOUR OVERALL ISSUES WITH. RATE
SETTINGS FOR QT. SO THERE IS A
DIRECT LINKAGE BETWEEN THIS
PROPOSAL AND ARE CONCERNED SO.
YOU'RE RIGHT THAT THE CONCERNS
THAT WE HAVE. PROCEED THIS
PROPOSAL AND OUR BROADER
CONCERNS ABOUT THE RATE SETTING
PROPERTY TODAY AND THE FLAWS
THAT WE- SEE IN THAT PROCESS.
BUT THE PROPOSAL WILL EXACERBATE
THOSE ISSUES. BECAUSE IT REMOVES
A HEALTHIER SUBSET. OF MEMBERS
BEING SERVED BY LOCAL PLANS OR
THROUGH KAISER AND BY CATER TO
LOCAL PLAN. AND LEAVE LOCAL
PLANTS WITH THAT EVEN MORE DISK
. I YOU POPULATION. BUT I THINK
IT REALLY MEANS THAT WE NEED-
GUARDRAILS. IF THAT WAS A
PROCESS BY WHICH HE YES ENSURE
THAT THE REFACTORED CONSIDERED.
ADEQUATELY AND APPROPRIATELY IN
THE RESETTING PROCESS. OKAY SO.
WHAT I'M GONNA DO IS NOT UNLIKE
TO GO AHEAD CENTER- I A N. AND
THEN BUT DON'T FOR YOUR
THOUGHTS. RIGHT AND OUT THAT ONE
GET TO YOU YOU CAN YOU CAN
ALWAYS COME TO THE TOP AS WELL
OKAY CENTER. YEAH AND THINK YOU-
TO MADAM AND WRAPPED UP SEE IT'S
VERY TO CONTINUE THE COME.
BECAUSE I AM HEARING THAT THE UP
BY. THAT NSS AND DON'T ASSIST
OPPOSE THE JUST HAVE THE- TO
HAVE ITS REALLY HIGH TO GET
TAKEN CARE CONGRESS. BECAUSE
IT'S A MATTER OF GETTING IN TO
SEE IF THEY ACTUALLY OPPOSED
ONCE THEY SEE THE DETAILS ALL
RIGHT NOW WE'RE GONNA HAVE TO AT
LEAST ME PAS ON THAT ISSUE. BUT
ANOTHER QUESTION THAT I HAD JUST
INITIALLY WAS. GIVEN THAT WE'RE
HEARING FROM JUST EVERY INDUSTRY
HOW OTHERS WORK FOR SHORTAGES
HOW ARE YOU GONNA. FILL THE SEAT
HELD A POSITION SAID THERE'S AN
INFLUX OF ENROLLEES BUT THEN.
OUR IS- SOMEWHAT SADDENED WITH
WHAT I HEARD IN TERMS OF HOW
THESE OTHER FACILITIES TRAIN
PEOPLE AND THEN THEY END UP
LEAVING AND- THEN EVEN COMPETING
WITH- SIGNING BONUSES AND- AND I
THINK THAT THAT IS SOMETHING
THAT DOES GIVE ME GREAT PAUSE
BECAUSE WHEN WE TALK ABOUT AS-
THEY- FACED AT THAT. TO TEACH
MEDICAL SYSTEM. WE WHEN THERE
ARE RECRUITING. TOP NOTCH. AND
GIVING THESE YOU KNOW BIG
BONUSES. THEY ARE TAKING QUALITY
PROVIDERS AWAY FROM THE SMALLER
FACILITIES AND I THINK THAT
SOMEWHERE IN THERE WE HAVE TO
EXPLORE THE ABILITY TO MAYBE.
CAPS IN ABILITY TO THE TO RECOUP
FROM. THESE FACILITIES AT.
PERSONNEL AND NOW THEY LOSE IT
IS THAT CAN MORE IN I THINK THAT
WE AS A- OR TO THAT. IF WE ALLOW
THE TO MOVE THE WAY. AT IT IS.
I'D LIKE I WOULD TO SEE. IN
THERE ARE A LEAST CONTINUE TO
COME. ON DO WE- LEVEL THE
PLAYING FOR WHETHER IT BE.
CAPPING SOME KIND OF
RECRUITMENT. YOU KNOW DOLLARS SO
THAT YOU KNOW SMALLER FACILITIES
CAN ALSO COMPETE IN TERMS OF
QUALITY. YOU KNOW PERSONALITIES
NOT WE ARE CREATING THIS TO
SYSTEM OR THEY MAY HAVE THE-
THE- BETTER QUALIFIED
INDIVIDUALS IN THE SMALLER
FACILITIES ARE BEING ARE LEFT
WITHOUT. WELL THAT THEY KEEP
TRACK AND SO ALSO. SOMETHING
THAT I'D LIKE TO SEE EXPLORE I
GET I DON'T HAVE THE SOLUTIONS
BUT I REALLY JUST WANT TO PUT IT
OUT THERE THAT IS A CONCERN FOR
ME. AND I WOULD LIKE TO SEE THAT
EXPLORED A LITTLE FURTHER THANK
YOU. OKAY THANK YOU THANK YOU
CENTER RUBIO- MAYBE A QUICK
COMMENT ON THAT WOULD BE AS WE
RAISE MEDI CAL RATES MAYBE.
FACILITIES THAT TAKE CARE OF
MAJORITY MEDI CAL PATIENTS COULD
BE MORE COMPETITIVE IN HIRING
BUT- WHAT WILL EXPLORE THAT
LATER. SO WE'LL GO CENTER ROCKS
AND THEN- FOLLOWED BY OKAY
AGAINST LIMO ACCIDENTS OUT LEYVA
. ALL RIGHT AND THEN AND THEN I
HAVE MY QUESTIONS. OKAY CENTER
ROTH. IS TO TRY TO GET A GROUP
OF THE CHURCH NOT CAPPING THE
RECRUIT. IT'S PUTTING. FUN INTO
THE MEDIC- SO THAT THE- RATE TO
RING. AND SO THE- THAT. PROVIDE
MEDICAL SERVICES HAVE THE MONEY
NECESSARY TO PAY. AND TO COMPETE
WITH THOSE IN THE COMMERCIAL
MARKET PLACE WHICH WILL BE
DIFFICULT IT'S CERTAINLY. AN
ISSUE THAT WE'VE BEEN STRUGGLING
WITH. SINCE I CAME UP HERE
ALMOST TEN YEARS AGO. BUT WITH
SOMETHING WE NEED TO PURSUE AND-
CENTER RUBIO I CERTAINLY AGREE
WITH YOU. I'M TRYING TO. I'M
TRYING TO UNDERSTAND AND
RECONCILE THE OPPOSITION. WITH
THE PROPOSAL. AND WHAT I HEARD
FROM. THE DIRECTOR WAS. WITH
REGARD TO FQHCS I WAS TOLD THAT
ONE OF THE CONCERNS WAS THAT
THIS PROPOSAL WOULD ALLOW KAISER
TO START. BOOKING SLOTS SO TO
SPEAK OR TAKING- TAKING
POSITIONS- AND HAVING TO KAISER
PATIENTS BECAUSE OUR MEDICAL
PATIENTS CARED FOR AN FQHC
FACILITIES. AND WHEN I HEARD WAS
NO THE PROPOSAL'S GONNA. LIMIT
THE USE OF FACILITIES IN THIS
CASE A PROPOSAL TO KAISER BRICK
AND MORTAR FACILITIES NOT. FQHCS
SO THAT WOULD SEEM TO ONE
ADDRESS THAT ISSUE. I WAS TOLD
WERE CONCERNED ABOUT THE FACT
THAT- LET THE LOCAL PLANS ARE
GONNA BE LEFT WITH THE SICKEST
PATIENTS WILL HVE A I HAD A
COUPLE A COUPLE ISSUES THURMOND
SEEMS TO ME THAT. WITH KAISER
CURRENTLY SUBCONTRACTING IT
TWELVE WHAT. TWELVE PLANS IN
SEVENTEEN COUNTIES SUBSTANTIAL
NUMBER OF COUNTIES I GUESS MY
QUESTION IS ISN'T KAISER
TREATING THE SAME PATIENTS TODAY
THAT KAISER WILL BE TREATING.
TOMORROW IN THE IN THE AT LEAST
IN SOME SENSE OF THE WORD AND
HOW DOES THAT LEAVE THE LOCAL
CLANS WITH QUOTE THE SICKEST
PATIENTS. IN IN THIS CASE THE
CASE IS GOING TO BE TRUE THEIR
LIMITS ON. THE NUMBER OF
PATIENTS THAT- AND WHO THE
PATIENTS ARE THE TRANSITION TO
KAISER IN THE MEDICARE PROGRAM.
AND THE 25% INCREASE OVER FIVE
YEARS IS REALLY NOT MUCH OF AN
INCREASE IN MY GUESS IS A
SUBSTANTIAL PORTION OF THE 25%
WILL BE. THOSE KAISER COMMERCIAL
PATIENTS WHO BALLOTS FROM THE
COMMERCIAL PLANS TO THE MEDICAL
PLANS. OVER THE FIVE YEARS WHO
WOULDN'T BE GOING TO. THE LOCAL
PLANS ANYWAY SO IF YOU HAVE A
LIMIT ON FQHC USAGE AND YOU
HAVE. TO PROVIDE FOR RISK
ADJUSTED CAPITATION AND
OBVIOUSLY THERE'S SOME.
MATHEMATICS THAT NEEDS TO GO
INTO THAT TO MAKE SURE IT WORKS
OUT. AND YOU HAVE A LIMIT ON
MEDICAL PATIENTS MEDICAL
PATIENTS ELIGIBLE FOR KAISER
ENROLLMENT- WHAT'S LEFT IN TERMS
OF THE OBJECTION. TO THIS
PARTICULAR PROPOSAL OTHER THAN.
I GUESS THAT IF LOCAL PLAN
SUBCONTRACT WITH KAISER FOR
KAISER TO TREAT FORMER KAISER
PATIENTS UNDER MEDICAL YOU'RE
RIGHT THERE'S GOING TO BE SOME
SECURITY DIFFERENCE THERE THAT
NEEDS TO BE ACCOUNTED FOR THE
LOCAL PLANS WON'T GET TO TAKE
CREDIT FOR THE CARE THAT KAISER
PROVIDES. THESE PATIENTS AND WE
PROBABLY NEED TO TAKE CARE OF
THAT IN THE RISK ADJUSTMENT. FAN
OF COURSE SINCE ALL THIS COMES
DOWN TO MONEY USUALLY IN THE
HEALTHCARE FIELD. THERE IS THE
225% ADMINISTRATIVE FEE. BUT
LOCAL PLANS HAVE BEEN ABLE TO
RETAIN AND MAYBE WE NEED TO.
PROVIDE SOME SORT OF HOLD
HARMLESS AGREEMENT OVER SOME
PERIOD OF TIME WHETHER IT'S ONE
YEAR TWO YEARS THREE YEARS OR
FOUR YEARS TO ALLOW. LOCAL PLANS
TO RELEASE SOME OF THEM. THE
TIME TO TRANSITION OFF OF THE
ADMINISTRATIVE FEE FROM. A
FINANCIAL STANDPOINT. HAVE I
MISSED ANYTHING. SO SHE WOULD
DIRECT THIS AT THE FOURTEENTH
ANY OF ANY ANSWER ON WHO WANTS
TO TAKE IT MAYBE WE'LL HAVE THE
LOCAL HEALTH ITS FIRST ADDRESS
IT SEEMS LIKE THAT'S THAT'S THE
THRUST OF YOUR QUESTIONS AND
OTHERS WHO WISH TO ADDRESS THAT-
POINTS PROFIT CENTER ROTH SO
PEOPLE START WITH ONE EQUIPMENT
. THANK YOU FOR THE QUESTION
AND- I THINK TO START WITH ONE
OF THE ISSUES YOU RAISE WHICH
IS. HAIDAR CONTRACTING WITH
ATHLETES EITHER NON PAY THEIR
PROVIDERS. I WILL SAY THIS IS
THE FIRST TIME WE'VE HEARD THAT
CLARIFICATION MADE- SO I THINK I
WANT TO START WITH THAT- ALSO. I
THINK TO GO BACK THEIR MARKETING
MY TESTIMONY- IF THAT'S THE
INTENT OF THE PROPOSAL. THERE
SHOULD BE LANGUAGE IN STATUTE
ADDRESSING AND THAT INCLUDED IN
THE AMENDMENTS WE SHARED SO
WOULD WELCOME FURTHER
pCONVERSATION AND CONSIDERATION
OF THOSE. AND AGAIN WITHOUT
LANGUAGE IN STATUTE. WE DON'T
ACTUALLY THINK THAT'S AND
FORCIBLE. I'M ASSUMING. LET ME
JUST. LET ME JUST STOP YOU
ASSUMING. THAT THE PROPOSAL
CONTAINS LANGUAGE WHICH REQUIRES
KAISER IS A CONDITION OF
PARTICIPATING IN THE MEDICARE
PROGRAM IN THIS REGARD. THAT
KAISER PROVIDE SERVICES ENTIRELY
WITHIN THE KAISER SYSTEM. BRICK
AND MORTAR SYSTEM IN THE STATE
WILL THAT SUFFICE. TO ADDRESS
THAT PARTICULAR OBJECTION. IF
LANGUAGE IS ADOPTED ON THAT
PARTICULAR ISSUE I THINK IT
WOULD ALLEVIATE THAT SPECIFIC
CONCERNS THANK YOU I WILL SAY
OUR CONCERNS ARE MUCH BROADER
THAN MASSES SPEAKING A COUPLE OF
THE OTHER ISSUES. RAISED
SENATOR- I THINK GOING BACK TO
SOME OF MY REMARKS ARE MY
TESTIMONY ABOUT THAT
FUNDAMENTALLY CHANGING THE LOCAL
FAN MODEL. A WE DO HAVE CONCERNS
ABOUT THE CHANGE THAT THAT
CREATE A LOCAL LEVEL IN TERMS OF
LOCAL GOVERNMENT. AND LOCAL
DECISION MAKING- THAT THAT I
DON'T THINK CAN BE REPLICATED.
BY REQUIRING AND THE USE- AND
THEN ON ON THAT OF THE CLASS ARE
. HI THERE AT BEING LAX WITH THE
HELP WITH LOCAL BANDS BEING LEFT
AT THE SECOND. AND HIGH EITHER
TO HOW MA'AM. AND THE NEXT BEST
WITH THE RATE. I THINK AGAIN
WE'RE ASKING FOR APPROPRIATE
GUARDRAILS IN STATUTES THAT WILL
ENSURE THAT THE RAPE
APPROPRIATELY REFLECT. THE REST
OF THE RESPECTIVE MEMBERSHIP
THAT WE SERVE- SO AGAIN IT'S
LANGUAGE AROUND PROCESS. TO
ENSURE THAT THE RATE YOU IN FACT
MATCH THE REST WHICH LEAVES YOU
NOT TODAY. SO IF WE IN FACT
WE'VE FOOD IF WE IN FACT GET IT
RIGHT WITH RESPECT TO THE RISK
ADJUSTED CAPITATION FORMULA. TO
PROPERLY ACCOUNT FOR WHO'S
TREATING- IN. TERMS OF ACUITY.
THAT SHOULD SAY. THAT PARTICULAR
ISSUE CORRECT. YES I THINK IF WE
HAVE PROPOSED PACIFIC LANGUAGE
ON THAT AND SHOULD THAT BE
INCLUDED IN THE TRAILER BILL OR
POLICY BILLS- I THINK THAT WOULD
ALLEVIATE THE CONCERNS AROUND-
THE RATE ISSUES GIVEN THAT THERE
WOULD BE TRANSPARENCY AND A
PROCESS- SO AGAIN ANYTHING IT
GOES BACK TO THE AMENDMENTS THAT
WE PROPOSE AND THOSE BEING
CONSIDERED AND ADOPTED. RIGHT
LET ME AS ONE OF THE THING AND
NOBODY'S I DON'T THINK ANYBODY
SPOKEN ABOUT IT BUT THIS
ADMINISTRATIVE FEE WHERE THERE'S
CONTRACTS IN THEIR SUBCONTRACTS
BECAUSE IT SEEMS TO ME THAT WHAT
WE'RE DOING IS WE'RE SHIFTING
FROM A SUBCONTRACTING MODEL TO
IT THE CONTRACT MODEL SO INSTEAD
OF A LOCAL PLAN HAVING
RESPONSIBILITY AND THEN SUB
CONTRACTING BECAUSE YOUR CARE
FOR KAISER RELATED PATIENTS
CAUSES GETTING THE CONTRACT
DIRECTLY. SO LET'S TALK ABOUT
THE ADMINISTRATIVE FEE DO WE DO
WE NEED TO ADDRESS THIS
ADMINISTRATIVE FEE IN THE
PROPOSAL THE LOCAL PLANS NEED TO
HAVE TIME TO WEAN THEMSELVES THE
PLANS OFF OF THE. ADMINISTRATIVE
FEE WHATEVER IT IS. SO I'D SAY I
MEAN AT FIRST ON THE
ADMINISTRATIVE FEES ARE
DEPENDENT I THINK A LOT OF.
MISCONCEPTIONS ABOUT THEIR- AND
I THINK IT'S BEEN YOU KNOW THE
AMOUNT THAT IS RETAINED BY LOCAL
PLAN HAS BEEN MISSTATED. AND SO
JUST TO CONFIRM LOCAL PLANS
TODAY RETAIN 2% AS YOU
INDICATED- AND AN ADMINISTRATIVE
RATE- TO THE EXTENT THAT ANY
ADDITIONAL. COSTS ARE NOT
PASSED. HI THERE BECAUSE HI
THERE IS NOT- PROVIDING CERTAIN
SERVICES THAT ARE COVERED BY
MEDICARE OUT OF THAT ADDITIONAL
FUNDING ACTUALLY GOES TO
SERVICES FOR TO GIVE A FEW.
EXAMPLES LONG TERM CARE MAJOR
ORGAN TRANSPLANT EATING DISORDER
SERVICES. SO I JUST WANT TO
CLARIFY THAT OUT OF. THE GATE
BECAUSE THERE'S BEEN A LOT OF
QUESTIONS AND CONCERNS ABOUT IT.
IN TERMS OF YOUR SPECIFIC
QUESTION AROUND BEING HELD HARD
LINE. I THINK ON THE THAT THE
RACE ISSUE. AND FINANCIAL SIDE.
EIGHT OUR LANGUAGE. AGAIN
REFERENCING WE PUT IN IN OUR
PREFER THE NUMBER. LEAVE ADDRESS
THE ISSUE OF ENSURING THAT THERE
GREAT ADDED. THAT'S NOT PROPOSED
UP OLD HARMLESS IT'S ENSURING-
THAT RATES ARE AT RELEASED AND
ACCOUNT FOR NUMBER RENT BOTH AT
THE HIGH END AND THE LOW END WE
DO NOT AND THAT WITH THE
SCENARIO THAT MY COLLEAGUES
UNDESCRIBED WHERE THE PLAN FOR
BEING TO HELP YOUR NUMBERS. IT'S
AN UNINTENDED BONUS SO YOU ARE
YOU ARE YOU SUGGESTING THAT
UNDER THIS BECAUSE PROPOSAL THAT
THERE ARE. HEALTH CARE BENEFITS
MEDICAL BENEFITS THAT WILL NOT
BE PROVIDED BY. KAISER UNDER THE
PROPOSAL LONG TERM CARE AND
OTHER ASPECTS THAT OTHER
BENEFITS THAT ARE CURRENTLY
BEING PROVIDED BY LOCAL PLANS TO
MEDICARE BENEFICIARIES AND IF
THE ANSWER IS YES HOW DOES THAT
WORK IN WHO PROVIDES THOSE
BENEFITS GOING FORWARD. IF THE
KAISER PROPOSAL IS ADOPTED. I
WOULD DEFERRED THE- ABOUT- THE
INTENT OF THE QUESTION ABOUT THE
FUTURE BUT TODAY THAT IS TRUE
THAT CRATER DOES NOT COVER ALL
MEDICARE COVERED SERVICES. IN
OUR SUB CONTRACTED RELATIONSHIP
AND IT IT VARIES DEPENDING ON
GEOGRAPHY OKAY WELL I'M NOT
GOING TO HOG THE MIKE HERE I'M
GOING TO STOP TALKING AND MAYBE
SOMEBODY ELSE WILL FOLLOW
THROUGH ON. WHAT'S COVERED AND
WHAT WILL BE NOT COVERED IN THE
UNDER THE PROPOSAL I JUST WANT
TO SAY I'M TRYING TO PUT THE
PIECES TOGETHER HERE I'M NOT
BEING CRITICAL IN THAT. I DON'T
HAVE A- ONE SIDE OR THE OTHER I
JUST WANNA MAKE SURE THAT WHEN
WE HAVE- A CONTRACTING
ARRANGEMENT THAT WE PROVIDE
APPROPRIATE MEDICAL BENEFITS TO
THOSE WHO. BADLY NEED THEM THANK
YOU MISTER CHAIR. ACTUALLY SO
YOU DON'T MIND I AS THE ACTUALLY
TO SERVE FOR LIFE FINISH YOUR
LAST QUESTION- PERHAPS- CAN. CAN
DIRECTOR BOSS OF OR HEALTHCARE
SERVICES ADDRESS THE POINT THAT
WAS JUST MADE BY THE LOCAL
HEALTH PLANS THAT CURRENTLY THE
KAISER SUBCONTRACTORS. ARE
PROVIDING ALL THE COVERED
SERVICES AND WHAT THE
OBLIGATIONS OF KAISER WILL BE IN
TERMS OF COVERING ALL THE
MEDICAL SERVICES AND THERE TO
STATEWIDE CONTRACT SO- DIRECT
BUS DO YOU MIND ADDRESSING THAT
PARTICULAR POINT. YES I DREADED
THE PROPOSAL AND UNDER THE NEW
CONTRACT THAT WOULD GO LIKE
TWENTY TWENTY FOUR KAISER WOULD
BE RESPONSIBLE FOR PROVIDING ALL
OF THE RELEVANT. MANAGED CARE
BENEFITS THAT ARE NOT CARVED OUT
OF A CANDIDATE THE BANDAGE CARE.
PLAN AND I WOULD KNOW YOU KNOW
AS AS I WAS GIVEN UP LOADED TO
IN THE KAISER'S RELATIONSHIP
WITH FIND PLANS VARIES ACROSS
THE STATE AND IN SOME INSTANCES
THOSE LOCAL PLANTS DO NOT. I
REFUSE TO CONTRACT WITH KAISER
FOR SOME OF THESE SERVICES SO
UNDER THIS PROPOSAL KAISER WOULD
BE RESPONSIBLE. FOR ALL ALL OF
THE PLAN BENEFITS. WHAT THE HELL
CENTER OFF YES OKAY. THANK YOU
RIGHT- CEREMONY. THANK YOU. AND
I APPRECIATE THE PRESENTATION
AND ON AND THE ONGOING
DISCUSSIONS I'VE HAD SEVERAL
DISCUSSIONS WITH A SEVERAL FOLKS
I'M ABOUT THIS PARTICULAR ISSUE
AND- YOU KNOW I THOUGHT A LOT
ABOUT WHAT THIS MEANS FOR
DIFFERENT COUNTIES- AND
CERTAINLY AS THESE IDEAS COME
FORWARD. I HAVE A THINK ABOUT
THE FACT THAT- AT YOU KNOW I
REPRESENT INTER COUNTY IN SANTA
BARBARA COUNTY WHY. HAVE
INTERCOUNTY WITH. EIGHT IN
SUMMER WITHOUT A KAISER. BUT I
THINK. AS A LAW OF THESE EIGHTY
COME. THROUGH THE- OF A LEAD.
WHO HAS. FOR YOU- ARE COMMUNITY
PIECE TOGETHER. WHEN WE DON'T
HAVE ACCESS TO SOME OF THE BIG
NAME WHEN WE DON'T HAVE ACCESS
TO THE SERVICE TO THE
SPECIALTIES AND THE LIST GOES
ON. AND WHAT I'VE LEARNED IS
THAT WE HAVE TO- CERTAINLY YOU
THINK ABOUT THE TRUST THAT'S
BUILT WITH THE COMMUNITY WE HAVE
TO THINK- ABOUT HOW WE ACCESS
CARE IN FIFTY EIGHT DIFFERENT
COUNTIES. AND SO. THE LENDS IT A
LOOK AT THIS WITH IT IS ONE OF
FROM MY COUNTY THAT'S TRULY
STRUGGLED- TO BRING IN HEALTH
PROVIDERS A COMMUNITY THAT HAS
STRUGGLED TO FIND THE SPECIALTY
NEEDS. A COMMUNITY THAT'S BEEN
TOLD IF YOU DRIVE YOU KNOW
ANOTHER FIFTY SIXTY SEVENTY
WHATEVER MILES YOU CAN GET X.
CARE. ACT IN SO WITH THAT LIVES
IN MINE I APPROACH THIS
PARTICULAR PROPOSAL. M. WITH
CONCERNS- AND I THINK THE
CONCERNS ARE BASED ON SOME OF
WHAT I'VE HEARD OTHER COLLEAGUES
. MENTIONED THAT THERE IS NOT
THAT THE CLEAR CLARITY THAT
PROVIDES CONFIDENCE AND TRUST
FOR LOCAL COMMUNITIES AND I
DON'T THINK THAT THAT'S A
FUNCTION OF- WRONG INTENTIONS I
THINK THAT THAT'S JUST IT'S A
BIG PROPOSAL AND ITS NEW- AND
SO. IT SEEMS THAT YOU KNOW ONE
OF ONE OF THE PIECES THAT UP FOR
ME IS IMPORTANT IS SINCE TO
SUSTAIN AND FIND WAYS TO
AGGREGATE RATE- AND TO ADD TO
THE CARE THAT WE HAVE IN OUR
COMMUNITIES KNOWING THAT WE ME-
BUT YOU KNOW WE MAY OR MAY NOT
BENEFIT FROM A PLAN LIKE THIS.
AND WHILE THE STATE BENEFITS-
YOU KNOW I DO WONDER WE AND WE
TALKED ABOUT FIVE COUNTIES THAT
ARE CURRENTLY. YOU KNOW THAT
KAISER HAS THAT ARE DIRECT.
CONTRACT AND THEN ANOTHER
SEVENTEEN THAT'S TWENTY TWO THAT
STILL LEAVES THIRTY SIX
COUNTIES- WHICH IS WHICH ARE A
LOT AND I UNDERSTAND THAT
PERHAPS THIS THIRTY SIX COUNTIES
DON'T RUFFLE REPORT THAT REFLECT
THE MAJORITY OF THE POPULATION
THE STATE BUT I STILL THINK ARE
VERY IMPORTANT COUNTIES. WITH
VERY DIFFERENT COMMUNITY
STRUCTURES. OF CARE THAT ARE
INTO GOING TO POTENTIALLY BE A
PART OF THIS SO ONE OF THE
QUESTIONS I ASKED AND THIS IS
FOR THE DIRECTOR- IS WHY NOT
JUST EXPLICITLY. EXEMPT THEM AND
SAY THAT THEY ARE NOT PART OF
THIS AND THE ANSWER THAT THAT I
RECEIVED AS WELL BECAUSE IT'S
IMPLIED. BUT IT TURNS OUT THAT
IN A SYSTEM OF CARE- DISRUPTING
EVEN IF THE DISRUPTION HAS A
POSITIVE OUTCOME- EATING CAUSES
A MOMENT OF CONCERN AND-
CERTAINLY CONFUSE YOU KNOW A
LACK OF CLARITY SO I WANT TO
RECAST THAT. WHY NOT JUST
EXEMPTS. CLUB COUNTIES THAT
WOULD NOT BE DIRECTLY IMPACTED
BY THIS AND THIS IS FOR DIRECTOR
BASS. THANK YOU FOR THE QUESTION
AND AS I MENTIONED- IN OUR
CONVERSATION OUR FACT SHEET THAT
LISTS THE COUNTIES THAT THIS
APPLIES TO YOU THE CLIP THE
COUNTIES WERE KAISER HAS A
COMMERCIAL OR MEDICARE LINE OF
BUSINESS SO. IT WOULD BE
EXPANDING AS WE TALKED ABOUT THE
TWENTY TWO THIS WOULD BE THE
ADDITIONAL TEN- SO FOR A THIRTY
TWO COUNTIES IN TOTAL THAT THIS
THIS CONTRACT WOULD APPLY TO.
YOU KNOW IN IN IN CONVERSATIONS
AND KIND OF TRYING TO. WORK
WITH- AT WORK WITH THE
LEGISLATURE AND ADVOCATES AND-
AND THE PLANS THE IN TERMS OF
PROVIDING MORE CLARITY WERE
HAPPY TO CREDIT ENGAGE IN THOSE
CONVERSATIONS TO CONSIDER HOW TO
PROVIDE THAT. BUT INTERACTION WE
DID LOOK ALL OF THE COUNTIES
THAT THE SUPPLY STILL. CORRECT
AND I GUESS THAT IS IT'S THAT
AND BEGIN. THAT A IT'S CREATING
A- OF THE MISTRUST RIGHT- THAT
IF COMMUNITIES AND COUNTIES FEEL
THE NEED TO BE EXPLICITLY TOLD
YOU'RE NOT IN. JUST BECAUSE IT
SAYS YOU'RE NOT ON THE LIST
DOESN'T ACTUALLY IMMEDIATELY
EQUATE TO YOU'RE NOT AND BECAUSE
YOU COULD BE IT IN THE FUTURE.
IF THIS- IF THIS SETS A
PRECEDENT FOR OTHER TYPES OF
MODELS- I THINK COMMUNITY SHOULD
BE AWARE WHETHER EACH YOU KNOW
IT COULD POTENTIALLY IMPACT
THEM- SO. FOR ME THAT
DISTINCTION AS MEANINGFUL- TO
STATE WELL YOU'RE NOT ON THE
LIST IS NOT THE SAME DISTINCTION
THE SCENE. YOU'RE EXPLICITLY
EXEMPT FROM THIS PARTICULAR
PROJECT- OR PROGRAM. SO YOU KNOW
I A THROW THAT OUT THERE- THE
NEXT PIECE THAT I HAVE IS IT IN
THIS IS- FOR ALL REALLY INVOLVED
AND WHOEVER WANTS TO JUMP IN. WE
ARE NOT SEEN A DIRECT BILL IN
FRONT OF US HOWEVER WE KNOW THAT
THERE'S TWO PATHS THAT ARE BEING
EXPLORED A DIRECT BILL- THAT'S
COMING THROUGH THE ASSEMBLY. AS
WELL AS CONVERSATIONS IN THE
BUDGET. AND WE OFTENTIMES IN
THIS COMMITTEE. LOOK AT BILLS
AND TALK ABOUT AMENDMENTS AND
WHERE IS THE NEGOTIATION AND HOW
FAR WEAK. AND TRULY THAT HAS NOT
HAPPENED WITH THIS. IT HAS NOT
HAPPENED AND I AM CURIOUS WHAT
ARE. WHAT'S THE PROCESS FOR
AMENDMENTS ARE WE REALLY. TO
MOVE SOMETHING FORWARD- WITHOUT
TAKING THIS INPUT AND SOMEONE.
DELIBERATELY TELLING US WHERE WE
ARE WITH AMENDMENTS- THEY'RE
JUST IN THIS CONVERSATION
THERE'S BEEN SUGGESTIONS FOR
MULTIPLE TYPE OF AMENDMENTS IN
THE FORM OF CLARITY. WHEN ARE
THOSE GOING TO GET IN A BILL OR
WHEN OTHER WINNERS LANGUAGE
GONNA BE PROPOSED FOR THAT
THAT'S AGREED UPON. SO I'M
HOPING THAT SOMEONE CAN TELL US-
WHAT THE NEGOTIATION PROCESS IS
LIKE- AND WHEN WE- MIGHT AS
LEGISLATORS EXPECT TO SEE.
LANGUAGE WITH AMENDMENTS. WELL
MAYBE I'LL TRY TO. ADDRESS THAT
QUESTION FIRST AND THEN I. DON'T
KNOW IF OTHERS SPEAKERS WANT TO-
REPORTS THAT WHY THIS IS A
JOINT. OF THE BUDGETS OF ON
HEALTH AND HUMAN SERVICES AND
THE HEALTH COMMITTEE- SO WE
DOCTOR ARE USED AS POINTED OUT
BEFORE. THERE'S CURRENTLY A
VEHICLE IN THE ASSEMBLY- IN FACT
WHEN THE PROPOSAL CAME OUT FROM
THE GOVERNOR'S OFFICE- BOTH THE
ASSEMBLY THE SENATE TALKED ABOUT
THE NEED FOR A POLICY VEHICLE
GIVEN THE EXTENSIVE POLICY
ISSUES THAT RELATED TO THAT OF.
THE US- SO MEMBER AND LET HIS
AUTHORED SUCH A VEHICLE SO IT'S
OVER IN THE ASSEMBLY. BUT ALSO
OF COURSE WE'RE HEARING THAT
THIS MAY BE PART OF BUDGET
PROCESS. AND SO THE NATURE OF
THE NEGOTIATIONS OF COURSE IS
THAT- WHAT WE'RE DISCUSSING HERE
GETS INCORPORATED INTO THAT WE
HAVE BUDGET STAFF HERE- IN THE
AUDIENCE AS WELL AS COMMITTEE
STAFF HERE WOULD THEY'RE THEY'RE
TAKING NOTES AND LISTENING AND-
SO. THAT WILL HELP SHAPE- WHAT
WE WILL BE- AS THE SENATE AND
THEN OF COURSE THE ASSEMBLY DO
THEIR OWN PROCESS AND- TELL THE
WHOLE BUDGET PROCESS WHERE
DISCIPLINE CENTER TOGETHER AND
THEN. WE TALK TO THE GOVERNOR
RIGHT AND SET SO THE THREE
PARTIES. SO. THAT NEGOTIATION.
WILL HAPPEN IF IT'S A BUDGET.
BILL AS IF IT'S THAT WE'RE NOT
DO IS BY TRAILER AGAIN WE THE
LATEST. GET THE DECIDE BECAUSE
WE DON'T PUT IN THE BUDGET.
HAPPEN RIGHT- SO THAT IN WHICH
CASE WE SAY THAT'S THE VEHICLE
THAT OF COURSE IT WOULD THE BILL
WOULD FORMALLY COME TO THIS
COMMITTEE AND- THE OPPORTUNITY
AS WELL THIS COMMITTEE TO A
MEN'S AS WELL- SO- EVEN THOSE
INFORMATIONAL HEARING I THINK
WHAT YOU'RE- THE QUESTIONS YOU
RAISE ANY ISSUES RAISED HERE
TODAY- WILL. HELP INFORM THE
TYPES OF CHANGES THAT WE- MAY
SEE AND A OF ITS BUDGET TRAILER
BILL- OR- AND THEN OF COURSE IF
IT COMES HERE TO FORMAL. THAT
THE RAMBLER BILL COMES YOUR
FORMALLY A FEW OF THE NUMBERS
OFF TOP OF MY HEAD THEN WILL
HAVE A CHANCE AS WELL. NOW THIS
A SERVER ADMIN DID YOU WISH
ALSO. ON JUST I WOULD SAY THE
SAME THAT THE THINK. THERE IS A
VEHICLE ON IN THE OTHER HOUSE.
THE OF THIS IS REALLY BE HERE.
CONCERN SO NO MATTER NO MATTER
HOW OR IF THIS MOVES FORWARD ALL
OF OUR INPUT WOULD BE.
INTEGRATED INTO THE FINAL. YEAH
AND WE WANT TO BE SURE WE DID
THIS BEFORE. THE THAT THAT MAY
REVISED SO THAT IF IT'S TRUE IT
IS BUDGET TRAILER BILL. BECAUSE
WE DON'T HAVE THE VEHICLE YET IN
OUR HOUSE THAT- THAT WE'RE
HAVING THIS DISCUSSION. SO THAT
PROCESS UNDERSTOOD AT A THINK
I'M STILL NOT CLEAR ON HOW THE
CONVERSATIONS ARE GOING IN
REGARDS TO AMENDMENTS BECAUSE
DISCUSSIONS. AND CONVERSATIONS
RELATED TO AMENDMENTS- ARE. ARE
PART OF THIS EQUATION AND YOU
KNOW AND I JUST WANT TO SAY THAT
EVEN THOUGH THERE'S INFORMATION
OUT THERE- WHETHER IT'S A
FACTUALLY OR INFORMATION OUT
THERE OR EVEN PROPOSED
AMENDMENTS NONE OF THAT IS LAW.
IT'S NOT LONG UNTIL IT'S IN A
YOU KNOW IT'S IN A TRAILER BILL
LANGUAGE OR- IN. THE BILL ITSELF
AND SO FOR ME WITHOUT SEEING ANY
MOVEMENT ON EITHER OF THOSE I
DON'T KNOW. WHERE WE ARE AT WITH
THAT AND- IN IN THIS
CONVERSATION ALONE THERE'S A LOT
OF VERBAL AGREEMENTS ON POINTS
THAT COULD BE CLARIFIED BUT I'VE
NOT YET SEEN THOSE PUT INTO
EITHER FORM OF THE LAW. AND
PERHAPS THEY WON'T SEE THOSE ANY
TIME SOON- BUT I JUST WANT TO
ENCOURAGE US TO NOT RELY ON
INFORMATION FOR FACT SHEETS
BECAUSE THAT IS NOT THE
EQUIVALENT OF A LAW- IN TERMS
OF. YOU KNOW WHERE THESE
NEGOTIATION GOES- AND FINALLY
ALL JUST SIT YOU KNOW AND IF
SOMEONE WANTS TO MENTION THE CAB
AT ALL CLOSE WITH. JUST
GENERALLY SAYING THAT TO ME THIS
IS NOT. I WOULD BE RAISING THESE
ISSUES WHETHER OR NOT IT WAS
KAISER PERMANENTE HEY SO THIS IS
TO ME IS NOT ABOUT KAISER
SPECIFICALLY AND- THERE'S NOT A
LACK OF TRUST WITH THAT THE
ENTITY. THIS IS SIMPLY RIFAT
REFLECTING THE PERSPECTIVE OF A
LEGISLATOR WHO HAS HAD TO PIECE
TOGETHER HEALTH CARE- AND WHO
AND WHEN YOU BRING IN MODELS
THAT COULD POTENTIALLY DISRUPT
THAT- YOU. END UP WITH PEOPLE
WHO DON'T HAVE CARE. AND THAT'S
TO ME AT THE CORE OF WHERE THESE
COMMENTS COMMENTS ARE COMING
FROM- I ALSO YOU KNOW WE OFTEN
SEE VERY WELL INTENTIONED- BILLS
AND IDEAS COME FORWARD- BUT I
THINK IT'S UPON US TO JUST MAKE
SURE THAT FOLKS DON'T FALL
APART- IT YOU KNOW. AND
COMMUNITIES DON'T END UP WITH
GOOD INTENTIONS THAT TRANSLATE
TO. SOMEONE NOT GETTING THE CARE
THEY NEED BECAUSE THEY COULDN'T
SEE SOMEONE OR BECAUSE THE
MODELS CHANGE- BECAUSE
REIMBURSEMENT RATES ARE. ARE
SUCH THAT. IT'S NOW CAUSED
ACCESS ISSUES SO- YOU KNOW THOSE
ARE MY COMMENTS AND I WANT TO
THANK EVERYONE EVERYONE HAS BEEN
ON ALL SIDES OF THIS HAS BEEN
INCREDIBLY- HELPFUL THEY'VE BEEN
RUDE PROACTIVE IN REACHING OUT-
AND I WANT TO COMMEND FOLKS FOR
ALLOWING US TO REALLY. DIG DEEP
INTO THIS PARTICULAR ISSUE.
THANK YOU SIR LIMÓN. I WOULD
MAKE NOTE- DATS- COURSE PERHAPS
THE OTHER PARTY SHOULD JUST
MENTION IS I THINK YOU BROUGHT
UP CEREMONY IS THAT YOU HAVE THE
PORTION THAT ACTUALLY WERE
PUTTING INTO CODE. SO WHAT SO
WHAT I BUDGET TRAILER BILL A
BILL AND THEN THERE'S OTHER
PARTS IT SEEMS LIKE IT'S MORE OF
AN AGREEMENT IS GONNA BE DONE IN
OTHER WAYS BUT YET IT'S NOT AND
LAW AND I THINK CERTAINLY SOME
PEOPLE RAISE THE QUESTION OF.
HOW FORCIBLE IS THAT RIGHT IT'S
ADDRESS SO- SO ONE OF THINGS
THAT WE MAY NEED TO LOOK AT IS
WHAT WE ACTUALLY ARE PUTTING
CODE WHAT HOW MUCH OF THE
PROPOSAL IS NOT BEING PUT IN
TRUST ME YOU KNOW WHAT'S BETTER.
OKAY IF I JUST AS- B. CENTER
LAMONT JUST FOR MY OWN. TO SO I
CAN UNDERSTAND GOING. INTO
TAKING THIS FORWARD- YOU'RE
CONCERNED ABOUT IF THE COUNTY IS
NOT IT DOES NOT HAVE A KAISER.
BRICKS AND MORTAR AND OR PART OF
THAT. THAT IF THE COUNTY IS NOT
INVOLVED HELP ME UNDERSTAND HOW
HOW YOU FEEL LIKE THAT THAT THEN
IMPACTS THEIR LOCAL CARE SYSTEM
IS IT ON THE BORDER ISSUES OR IS
IT ON SO IT COULD BE I MEAN IT
COULD BE AND I THINK EVERY
COUNTY IS VERY DIFFERENT- RIGHT
YOU HAVE DIFFERENT EMPLOYERS
WITH DIFFERENT PROVIDERS THAT DO
MULTI COUNTY WORK- AND SO WHEN
YOU HAVE. ANY LIKE SANTA BARBARA
COUNTY THAT HAS NO KAISER PER SE
IS NOT IS GOING TO BE EXEMPT IS
NOT GOING TO BE INVOLVED FOR A
SONG CAL LOCAL SYSTEM- BUT THEN
YOU HAVE INTERCOUNTY I MEAN I
HAVE HIGH COMMUTER SO ALL OF
THIS STARTS TO GET INTERTWINED
VERY QUICKLY RIGHT IN TERMS OF
WHERE YOU LIVE AND WHERE YOU
WORK FROM YOUR EMPLOYER IS.
WHERE YOU HAVE ACCESS THE
PROXIMITY OF MILES- AND SO FOR
ME I THINK ONE OF THE PIECES OF
CLARITY THAT I'M LOOKING FOR IS
IF THIS APPLIES TO- IF THIS
DOESN'T APPLY TO A COUNTY
PLEASED TO SAY THAT- AND DON'T
SAY WILL IT ONLY APPLIES TO ACTS
SAY IT DOESN'T APPLY TO Y. I
THINK THAT THAT'S PARTICULARLY
IMPORTANT BECAUSE THAT HELPS US
UNDERSTAND. WHAT CARE IS
AVAILABLE OR WHAT IS NOT A MAN
WHO THIS PARTICULARLY MAY OR MAY
NOT DISRUPT. THANK YOU. AND JUST
. SIR DID YOU HAVE TO VERY
RELATED TO THIS BEFORE THE A
LABEL HEALTH OKAY ALL RIGHT SIR
LEYVA. THANK YOU MISTER CHAIR-
WELL OKAY THERE'S A LOT HERE SO
I WOULD SAY THAT- I LEARNED A
LONG TIME AGO THAT WE PICK
WINNERS AND LOSERS IT GENERALLY
DOESN'T WORK AND I WOULD SAY
THAT CLEARLY HERE PEOPLE FEEL
THAT KAISER IS A WINNER AND THAT
OUR LOCAL PLANS ARE THE LOSERS
WHETHER OR NOT THAT'S TRUE IT
SEEMS THAT THAT SEEMS TO BE THE
FEELING. ALSO PEOPLE DON'T FEEL
LIKE THEY'VE BEEN HEARD IS WHAT
IT SEEMS TO ME AS WELL AND WHEN
YOU HEAR PEOPLE SOMETIMES YOU
FIND OUT THAT MAYBE WHAT YOU
THOUGHT WAS RIGHT ISN'T RIGHT
AND MAYBE WE CAN FIND A WAY TO
RESOLVE ISSUES OR AT LEAST MAKE
PEOPLE FEEL LIKE THEY HAVE AN
OPPORTUNITY TO VOICE THEIR
CONCERNS I WANT. AT EVERYONE'S
OPEN TO TALK BUT I FEEL LIKE
BOTH SIDES ARE STILL COMPLETELY
IN THEIR OWN CAMPS AND NEITHER
SIDE WILL PACERS HAPPY BUT I
DON'T FEEL LIKE OUR LOCAL PLANS
ARE HAPPY OR FEEL GOOD ABOUT
THIS PROCESS ONE AND I DON'T
THINK ANY OF US FEEL I CERTAINLY
DON'T FORGET ABOUT THE PROCESS
ONE THING YOU WAKE UP ONE
MORNING AND FIND AT THESE
NEGOTIATIONS HAVE BEEN GOING ON
AND THEN YOU'RE JUST TOLD- THAT
THIS IS WHAT'S GOING TO HAPPEN.
TO CEREMONIES POINT WE HAVE
NOTHING IN THE LAW WE HAVE
NOTHING THAT THE LEGISLATURE CAN
DO TO TRY AND MAKE IT BETTER OR
TRY AND GET TO A POINT WHERE
EVERYBODY'S A LITTLE HAPPY AND A
LITTLE UNHAPPY. SO I HAVE A
COUPLE QUESTIONS- THE FIRST ONE
IS FOR YOU- DIRECTOR BASS
YESTERDAY WHEN WE MET YOU SAID
KAISER DOES NOT CROP CONTRACT
OUT TODAY. EXCEPT FOR MAYBE
TRAUMA. SO MY QUESTION IS THAT
IS THAT ACTUALLY TRUE BECAUSE
THEN I'VE ALSO HEARD FROM LOCAL
PLANTS THAT KAISER CONTRACTS OUT
ALL THE TIME. BECAUSE I THINK
MIKE MY ORIGINAL QUESTION WAS-
WHY IS IT THAT MORE PEOPLE CAN'T
BE OPEN. TO BEING ENROLLED AT
KAISER IF YOU HAVE MEDICARE WHAT
IS IT ONLY HAVE TO BE- SOMEONE
WHO IS ALREADY HAS TIES OR IS A
MEMBER OF THE FAMILY. AND THEN
THE RESPONSE WAS IT BECAUSE IT
DOES NOT CONTRACT OUT EXCEPT FOR
MAYBE TRAUMA. SO DOES CALL IT
KAISER CONTRACT OUT FOR
SERVICES. OTHER THAN TRAUMA. I
THINK THAT QUESTION YESTERDAY
REALLY. THE DO CONTRACT THAT WE
KNOW THE CONTRACT FOR TRAUMA
HOSPITAL SERVICES I THINK THAT
THE POINT. COM ABOUT. CARE AND
EAT THE TEACHER THE BABY'S TAKE
A PRIMARY CARE WITHIN THEIR
THEIR FACILITIES BUT THEY DO WE
KNOW IN SOME OF THE- WERE
PLANTED. AT IN WHERE THEY HAVE
GROESCHEL AND MEDICARE OF THAT
YOU CONTRACT WITH WITH HOSPITALS
TO ENSURE THAT THEY HAVE THE
CAPACITY. SO THAT IS THE POINT
OF CLARIFICATION. OKAY SO. YOUR
CALL. OUT FOR EVERYTHING EXCEPT
PRIMARY CARE. I MEAN IF YOU WANT
A COMPLETE LISTING OF HOW THE
OPERATE THEIR LINES OF BUSINESS
IS IF I CAN TELL YOU WE WOULD BE
HAPPY TO PROVIDE THAT
INFORMATION BUT I THINK
GENERALLY SPEAKING AND THE
REASON WHY WE ARE APPROACHING
THEM DIFFERENTLY IS BECAUSE FOR
THEIR THEIR INTEGRATED CARE
THEIR PRIMARY CARE. IS IN HOUSE
. OKAY I THINK THAT'S A LITTLE
BIT MORE CLEAR YESTERDAY IT
SEEMED LIKE THEY DIDN'T CONTRACT
OUT FOR ANYTHING- BUT SOUNDS
LIKE THEY DO SO WHEN WE TALK
ABOUT CONTINUITY OF CARE. IN
FACT IF YOU ARE A KAISER
SUBSCRIBER YOU. MIGHT BE
CONTRACTED OUT FOR A PARTICULAR
SERVICE THAT KAISER. DOES NOT
OFFER IN THE BRICK AND MORTAR.
SO OKAY- AND THEN MY OTHER
QUESTION IS- I THINK IT WAS
JOSE- FROM HEALTH ACCESS SAID
THAT HE WOULD LIKE TO SEE AN MO
YOU WITH EACH COUNTY IS THAT
POSSIBLE. THE POSSIBLE FOR
KAISER TO DO AN MO YOU WITH EACH
COUNTY AND JOSE HOPE AYE MISTER
CÁC S. I HOPE I'M- ACCURATELY
STATING WHAT YOU SAID. I CAN
SPEAK TO THAT- BUT HAS ANYONE
HAD ANSWER FIRST. YES THANK YOU
SENATOR FOR THE QUESTION SO- IN
ESSENCE YES AND THAT'S WHAT WE
WERE ORIGINALLY WANTED TO DO AND
SO WE WANT TO MAKE SURE THAT
KAISER PARTNERS WITH THE LOCAL
COUNTY SO THAT MAKE MAKING SURE
THAT WE DO PROVIDE THAT FOCUS ON
WHOLE PERSON CARE IT M. AND THEN
A DAY SOME OF THE BEST SERVICE
SOME OF THE SOME OF SPECIFIC
SERVICES ARE BEST PROVIDED. BY
COUNTIES AND WE WANT TO MAKE
SURE THAT THERE IS NO
RELATIONSHIP BETWEEN KAISER AND
THE EXISTING COUNTIES- THAT THEY
WILL BE IN OKAY SO KAISER IS
THAT POSSIBLE THAT YOU COULD DO
IT MO YOU WITH EACH COUNTY.
ABSOLUTELY IT'S IN FACTORY- SO I
THINK AT- I SEE I'M SEE DIRECTOR
BOND STREET YOU'RE ABSOLUTELY
GREAT BECAUSE- WOULD REQUIRE. TO
COMPLY WITH ALL OF THE NEW
REQUIREMENTS INCLUDING CALLAHAM
SPECIFIC REQUIREMENTS. I AND I
CAN CERTAINLY SEE THAT KAISER
PERMANENT DAY IS COMMITTED TO
MEETING ALL THE REQUIREMENTS
WHICH INCLUDES. I'M HAVING AND
WILL USE WITH ALL THE COUNTIES
AND WHICH OPERATE AS WELL AS
OTHER PROVIDERS. I'M FOR EXAMPLE
TO ARRANGE FOR PROVIDING YOUR
COMMITTEE SUPPORTS- WHICH ARE
WHICH ARE PART OF CALTRAIN STOPS
ITALY I THINK- AND EVERYTHING
THAT I COULD SHARE IS THAT IN
CURRENT STATE THAT'S WHAT WE DO-
DIRECT. THESE TURN IN OUR TRACK
COUNTY YOU HAVE AND WILL USE.
THAT A RISK. BUT ALSO. JUST TO
BE QUITE FOR IT'S THE BEST WAY
TO PROVIDE CARE BECAUSE WE
CAN'T. PROVIDE CARE FOR MEMBERS
IN THE BEST WAY POSSIBLE WE
DON'T HAVE AGREEMENTS. WITH FOR
EXAMPLE COUNTY AGENCIES TO
COORDINATE CARE FOR EXAMPLE IS
SPECIAL T. MENTAL- PUBLIC HEALTH
AND OTHER OTHER EXAMPLES. LIKE
THAT'S ABSOLUTELY WE DO IN
CURRENCY- YOU KNOW WITH OUR
TRADE CONTRACT THAT WILL BE
EXPANDED- YOU KNOW IF THE
PROPOSED CONTRACT GOES TO AN ALL
THIRTY TWO COUNTS ACROSS STATE.
BUT AND ALSO DO ABBAS HAND IF J.
F. YOU. PROCEED YOU. I WANTED TO
. BE EMPHASIZE OF THAT WAS MADE
EARLIER IN. OUR NEW CAR. THE IS
A- PRINCIPLE THAT ONE OF. TO ALL
OF OUR MEN CARE FOR OKAY. OUR
NEW COMMERCIAL PLAY AND THE-
PLANS. THESE MO YOU WITH CHILD
WELFARE. COULD OF CARE. WHAT
PROGRAMS. EIGHT FOR AGING. ALL
OF THESE REALLY. FUNDING QUE.
BASE WORK. AND LOCAL K.
DEPARTMENT. ARE I'M FOR MARCUS.
THE TERMS OF ADDRESS SOCIAL
DRIVERS OF AND SO. WITH OUR NEW
. ALL OF OUR- PLANS WILL BE
REQUIRED HAVE THESE. YOU OKAY.
THANK YOU WILL AT THAT WE'RE-
PROGRESS ALL MAYBE. THE EVERYONE
CAN AGREE ON WE'RE GETTING
THERE- OKAY. THE OTHER TWO
QUESTIONS I HAD. WERE DOES THIS
AGREEMENT. GIVE OVERLY BROAD
AUTHORITY TO DH CS. SO DH CS
COULD MAKE CHANGES. TO ITS
CONTRACTING ARRANGE WITH KAISER
WITHOUT ANY CORRESPONDING
CHANGES IN STATUTE. AND THUS
WITHOUT CONSULTATION OF THE
LEGISLATURE. COUNTIES LOCAL
PLANTS AND OTHER MEDICAMENT. CAL
STAKEHOLDERS IS THAT ACCURATE.
IS THE QUESTION TO ME IT ANYBODY
IF I JUST WANT OF WHAT I SAID
WAS ACCURATE SO WHOEVER. WANTS
TO ANSWER. WELL MAYBE WHAT THE
DIRECTOR START AND THEN WILL
FOLLOW THE LOCAL HEALTH PLANS
OKAY. DR I AM MAKING OUR ARE WE
HAVE A STANDARDIZED CONTRACT
THAT WE ARE APPLYING TO ALL OF
OUR MEDICAID MANAGED CARE PLANS
AND SO THAT CONTRACT WOULD BE
THAT WOULD BE THE SAME FOR ALL
OF OUR MEDICAL MANAGED CARE
PLANS AND WE DO ANNUAL UPDATES
TO THAT PLAN WE DO ACROSS.
ACROSS THE STATE SO IT IS THE
SAME PROVISIONS FOR ALL. FOR YOU
COULD MAKE CHANGES WITHOUT ANY
CONSULTING- THE LEGISLATURE OR
ANYONE ELSE BECAUSE THERE IS
NOTHING IN THE STATUTE OR LAW.
AT PRACTICE TODAY EVEN BEFORE
THIS KAISER PROPOSED PROPOSAL I
THINK THAT IS IT'S JUST THE WAY
THAT THE CONTRACTING ARRANGEMENT
IS BETWEEN THE STATE AND THAT.
OUR MEDICAID MANAGED CARE PLANS
ANYTHING JUST TO. ARE YOU KNOW
PART OF DISAGREEMENT WITH KAISER
SOME OF THE TERMS WILL BE A
PUBLIC MO YOU THAT- WILL BE%
PUBLIC INTEREST IN TIME IN TERMS
OF HOW WE TO SENATOR PAN'S POINT
EARLIER SOME OF THESE PIECES
WILL BE CODIFIED SOME OF THESE
WILL BE. IN IN FOR SPEED AND-
YOU BECAUSE WE DON'T KNOW FOR
EXAMPLE THE ENROLLMENT NUMBERS
WE DON'T KNOW WHAT THE
ENROLLMENT NUMBERS WILL BE
JANUARY ONE TWENTY TWENTY FOUR
AND WE WOULD WANT TO BE VERY
CLEAR IN IN TERMS OF OUR AMMO
YOU WITH HIGHS ARE ON THAT. ONCE
WE HAVE THOSE MOMENTS WE HAVE
THAT INFORMATION OKAY AND I
THINK MAYBE WE'RE LOOKING AT
THIS A LITTLE MORE CLOSELY JUST
BECAUSE THE PROCESS OF GIVING
KAISER THE CONTRACT WAS NOT OPEN
AND TRANSPARENT. SO DID YOU WANT
TO LOOK AT THE PLANS ALSO JUST
SAID YES OKAY YES IF WE CAN ALSO
HAVE LANIER KOOPMANS ALSO
ADDRESSED THE QUESTION OF
CERTAINLY THOSE. THANK YOU FOR
THE QUESTION. AND I THINK I
WOULD ANSWER THAT QUESTION THAT
QUESTION IS YES LEAD WE DO THINK
THAT THAT'S GOOD AT LEAST AS
CURRENTLY DRAFTED. GRANT OVERLY
BROAD AUTHORITY TO BE YES. I
THINK YOU HEARD THE CONVERSATION
EARLIER- YOUR QUESTION FROM
FEDERAL AMOUNT. ABOUT WHERE THE
PROPOSAL APPLIES AND DOES NOT-
CURRENTLY THAT INFORMATION IS
ONLY IN A FACT SHEET. WE THINK
IT SHOULD BE EXPLICIT IN THE
STATUTE. SIMILARLY WITH RESPECT
TO CATER GROWTH. I THINK WE'VE
HEARD THAT- THAT YEAH IT WILL BE
TWENTY FIVE PERCENT. OVER THE
CONTRACT TERM. THERE'S NOTHING
IN THE STATUTE THAT SEEKS TO
GROW THROUGH THE NUMBER OF OTHER
YOU KNOW. ISSUES THAT. WE THINK
SHOULD BE EXPLICITLY ADDRESSED
IN STATUTE- THAT HAVE BEEN TO- I
CONTACT. THAT ARE NOT REFER. AND
WHAT BEING PROPOSED BY THE
DEPARTMENT OF A THREE THE LINK.
GREAT THANK YOU LAST THANK YOU
FOR AND ALL MISTER CHAIR SO MY
LAW QUESTION IS DOES THE- FOR A
NO BID STATEWIDE KAISER CONTRACT
SUPPORT THE INTERESTS OF A
COMMERCIAL HEALTH PLAN. AT THE
EXPENSE OF THE PUBLIC MEDICAL
DELIVERY SYSTEM AND THE
BENEFICIARIES IT SERVES. I I'M
GUESSING THAT THE DEPARTMENT
THINKS NO IT DOESN'T AND THAT
THE PLANS THINK YES IT DOES. I
WOULD JUST NOTE HEISER IS A NON
PROFIT JUST LIKE OUR LOCAL PLANS
AND JUST LIKE OUR LOCAL PLANTS
DID NOT HAVE TO BID FOR A
CONTRACT THIS IS YOU KNOW
SIMILAR AND NOT BEING THE OLD.
SO I THINK THAT IT I WOULD JUST
MAKE THOSE TWO POINTS. THANK YOU
- THIS COOPER TO JOIN ALSO
ANSWERED A QUESTION I SEE
SHOWING UP. THANK YOU YEAH IF I
A MAYES FIRST BY AND YEAH THERE
RIGHT RIGHT PLACE. YEAH WE'RE A
DIFFERENT PLACE THE DEPARTMENT
TERMS OF OUR- PERSPECTIVE ON
PROPOSAL AND IT'S AN ON AND
COULD INTO IT'S A- BUT THAT THE
- TO DIRECTOR COMMENTS- AROUND.
MAKING PERIL BETWEEN THE LOCAL
PLAN AND HOW. I WOULD JUST NOTE
THAT LOCAL PLAN THE LOCAL
EDITION AND COUNTY GUYS HELP
SYSTEMS ARE PUT AND- THAT HAVE
GOVERNANCE. HE COST AND
LEADERSHIP AS WELL AS HOW
SUPERVISOR. ON THE BOARD. SO
THERE ARE SIGNIFICANT
DIFFERENCES AND WELL AS WE-
COUNTY OREGON. I THINK THE
COMPARISON TO BE ON A I FEEL
LIKE A IT'S AGAIN. GREAT THANK
YOU VERY MUCH AND I ALSO ON TO
REITERATE WITH SAID LIMÓN SAID I
WOULD BE OUT THESE. IF IT WAS
SOME APPROACH OTHER THAN CUT-
WHEN I TO GO. A MEDICAL BENEFITS
FOR WORKERS WE ALWAYS MADE SURE
WE KICKING BANK. UP HIGHS ARE
PROPONENT BECAUSE- MANY FOLKS
REALLY LIKE THAT MODEL ONCE WE
ALWAYS WANT TO MAKE SURE THAT WE
CONTINUE THAT. I JUST WANT TO
MAKE SURE THAT WE ARE NOT
DISADVANTAGING ONE GROUP OVER
ANOTHER- ONE HEALTH PLAN OVER
ANOTHER. AND I HOPE I REALLY
HOPE THAT WE GET SOMETHING IN
STATUTE AND THAT WE CAN LOOK AT
THE BILL THAT'S WORKING ITS WAY
THROUGH. AND MAYBE COME UP WITH
SOMETHING AS I SAID EARLIER
WHERE EVERYBODY'S A LITTLE HAPPY
AND A LITTLE UNHAPPY THANK YOU
MISTER CHAIR. THIS LEYVA IT
PLEASE. OKAY YEAH I THINK I JUST
A QUICK POINTS OF. JUSTER AROUND
I GUESS. WHO BENEFITS ARE PART
OF I THINK. I THINK WHAT'S
WHAT'S- FROM THE PROPOSED AND
HOPEFULLY- HOPEFULLY WITH SHARED
SOME OF THE- I DIDN'T THINKING.
IT IS I REALLY GOING BACK TO THE
CALL. SHE HAS YOUR DAYS THE
HIGHEST QUALITY PERFORM. MEDICAL
PLAN STATE ACCOUNT I THINK
THAT'S A SENATOR THERE'S A
COUPLE CASH FOR THAT THE- HOW.
THAT SHOWS THAT- REALLY I THINK
- THE BENEFIT REALLY. FOR ME- I
THINK THAT'S REALLY THE
IMPORTANT POINT THAT I THINK I
WANT TO HIGHLIGHT IS THAT HAS
YOU COMMITTEE. I WILL NOT.
PROPOSAL I WILL BE GETTING RATE
I'M- MEDIC CALLOUS INDIFFERENCE
AND LOSS IN FACT- COMMITTEE.
NEARLY TWO. DOLLARS A YEAR-
ANNUALLY IN MEDIC. THIS
PROPOSAL- MAKING EVEN MORE
COMMITMENTS TO THE MEDICAL DRUG
PROGRAM AND DESPITE THESE
LOSSES- WE'RE SIMPLY- COMMITTED
TO OUR CORE MISSION IS THE RIGHT
THING TO DO- FOR PREVENTING CAL
MEMBERS AND ALSO FOR THE ENTIRE
MEDICARE PROGRAM SINCE WHEN THAT
PILOT THAT POINT TO. IN TERMS OF
YOU KNOW- YOU KNOW WITH WHO
BENEFITS FROM THIS REALLY AYE
AYE I THINK FROM THE KAISER
COMMITTEE PERSPECTIVES FOR THE
MEDIC CAL. PROGRAMS AND LISTEN
FOR THE. BENEFITS YEARS. THANK
YOU I'M- THAT I JUST KNOW THAT
MY FIRST. WITH I TOLD THAT
BECAUSE- FROM KAISER THAT THE DO
NOT MAKE MONEY ON MANTA. ALL AND
I SAID YOU HAVE TO A- TO IN INTO
THE A- IT IT'S- TO BEEN A-
KAISER IN SOME WAY YOU TO NOT.
ENTER AGREEMENT AND TO PROP OR
NOT. IF IT'S NOT GOING TO BE
BENEFICIAL SO MY QUESTION WAS IF
YOU'RE NOT GOING TO. MONEY ARE
YOU GOING TO LOSE. MONEY AND I
MONEY SO THAT IS A BENEFIT IF
YOU'RE LOSING MONEY YOU'RE GONNA
LOSE LESS. THAT'S A BENEFIT SO
THANK YOU MISTER CHAIRMAN THANK
YOU FOR INDULGING ME OKAY. OTHER
QUESTIONS BEFORE OKAY CENTER
RUBIO. THANK YOU MISTER CHAIR
AND THIS IS REALLY NOT FOR- THE
LOCAL HEALTH PLANS WERE CRIES
RATING TO ME YOU KNOW I THINK I
SHARE THE CONCERNS OF MY
COLLEAGUES WERE- YOU KNOW WE'RE
DISCUSSING THIS. KIND OF CAT I
WOULD AS HE CASUALLY BUT YOU
KNOW I PERSONALLY LIKE TO SEE
ALSO SOMETHING IN PRINCETON. YOU
KNOW I THOUGHT WE WERE GOING TO
BE DISCUSSING IT AND THEN SEEN
THESE IMPRENTA BUT- NO JUST
GOING BACK TO THE INITIAL NOT.
COMMONER QUESTION WHERE SHE- ONE
SIDE DOESN'T HAVE THE FULL
INFORMATION SO. WHAT'S GOING TO
HAPPEN ONCE THEY DO HAVE THE
PHONE PERMISSION THAT BECOMES
ANOTHER ISSUE TO DISCUSS LATER
BUT- I PERSONALLY AGAIN IT'S
JUST PROCESS IN GENERAL WOULD
LIKE TO SEE SOMETHING IN PRINT
BEFORE WE JUST SE IT ON A
TRAILER BILL. AND I DON'T KNOW
IF WE CAN. ACCOMPLISH THAT GIVEN
THE YOU KNOW THE TIMELINE BUT-
THERE'S A LOT OF. QUESTIONS IN
AND THAT'S YOU KNOW REALLY
SOMETHING THAT CONCERNS ME BUT-
I'LL JUST LEAVE IT AT THAT AND
HOPEFULLY WE CAN FIGURE OUT A
WAY THAT WE CAN. COME TOGETHER
OR IS SOMEHOW GET SOMEBODY
AMENDMENTS. I HAVE ONE MORE
QUESTION AND THAT'S BASED ON. A
MEETING THAT WE HAD- WITH THAT
LOCAL HEALTH PLANS. I KNOW THAT
THE BILL IS ARAMBULA ON THE ON
THE ASSEMBLY SIDON. AND SO I
GUESS AT THIS POINT I WANT TO
ASK YOU KNOW WHO HAS FINAL
DECISION MAKING POWER IN HERE
BECAUSE I THINK- I WAS- TOLD OR
SHARED WITH MY OFFICE THAT. ARE
YOU KNOW SOME OF THE AMENDMENTS
IN CONCERT. FOR SURE WITH THAT
MR ARAMBULA BUT THEY HAVEN'T
NECESSARILY HAD A- QUALITY
ENGAGEMENT SO IF YOU GUYS CAN AT
LEAST EDUCATE ME ON. HOUSES
INFORMATION GONNA BE CONVEYED
AND HOW ARE OR THE FINAL
DECISIONS. POINT TO BE MADE THAT
WOULD BE GREAT THANK YOU. WHAT
OF AGAIN- I WOULD JUST SAY AND
THEN OUT OF. A TRADE MENTAL
ALSO- AND- ALSO ANSWER A
QUESTION IS AGAIN WHAT. THE
REASON FOR THIS INFORMATIONAL
HEARING. AS WE WANTED TO HEAR
FROM ALL OF YOU. YEAH YOU HAVE A
CHANCE TO HEAR FROM THE STATE.
TO HEAR YOUR- AND THEN-
DEPENDING ON WHATEVER THAT WE
CAN A CORPORATE THAT INTO-
MOVING FORWARD SO WE'RE HEARING
WHAT YOU'RE SAYING ABOUT. WELL
THERE IS A LANGUAGE ON CERTAIN
THINGS IT'S AN AGREEMENT THAT OF
COURSE ALSO IT'S COMING BACK FOR
THE DESTRUCTION AS WELL- WE FOR
YOU KNOW WE'RE WE'RE LISTENING
TO ALL THE THREE. POINTS BEFORE
BRINGING UP AND THEN THAT
CERTAINLY THAT MEANS OUR STAR
STAFF KNOWS THAT THESE ARE
CONCERNS OF THE COMMITTEE. AND
WILL- AND TRY TO CORPORATE THAT
WHETHER IT'S BUDGET TRAILER
ORDERS THE RENTAL BILL COMES
OVER. AND THAT'S BECOMES THE
MAIN VEHICLE- SO ACTUALLY I
TREATMENT. YEAH I WOULD JUST-
WITH DOCTOR PAM THAT'S- AS- AS
WE ALL KNOW WHEN WE SEE
PROPOSALS COME OUT. AT LEARN
ABOUT THE ONE IT REALLY IT IN
THE P. WHICH IS THE BEST WAY FOR
US TO LEARN ABOUT THINGS.
BECAUSE IT MAKES US HAVE A LOT
OF QUESTIONS WHEN WE LEARN ABOUT
THINGS IN THE NEWSPAPER- AND WE
CERTAINLY EXPRESSED OUR CONCERN
EARLY ON I CERTAINLY DID. AND WE
DID NOT JUST LET THIS FLY
THROUGH THE BUDGET AS WELL AS-
THE TEA. I THINK THE DESIRE- AND
SO WE'VE BROUGHT IT BACK UP FOR
THIS VERY PURPOSE THIS- DIDN'T
THERE IS. THE YOU KNOW. ANYTIME
THERE ARE. BUDGET NEGOTIATIONS
WITH A WITH AN ENTITY IS LARGEST
IN IN CALIFORNIA THERE'S GOING
TO BE A LOT OF VERY HIGH LEVEL
NEGOTIATIONS PART OF THAT PART
OF THAT PROCESS IS HEARING FROM
ALL OF US RIGHT HERE RIGHT NOW
AND SO AND WE HAVE OUR BUDGET
STAFF IN THE IN THE BACK OF THE
ROOM WAS CAREFULLY TAKING NOTES-
AND- CALL. WE AND WE WILL DO OUR
BEST TO INCORPORATE EVERYTHING
THAT WE'VE HEARD AND- AN ACT. I
DON'T THINK ANYBODY SITTING HERE
RIGHT NOW KNOWS THE FINAL END
PRODUCT BECAUSE IT'S IT IS IN
PROCESS. OR JUST FOR THAT ALONE
I NEEDED THANK YOU I KNOW THAT A
LOT OF TIMES WE GET IT. ALMOST
LAST MINUTE SO I HAVE TO DO FOR
THEM I THINK BOTH OF YOU FOR
JUST EVEN BRING US TOGETHER I.
LEARNED A LOT TODAY AND- THERE'S
LIKE I SAID A LOT OF UNANSWERED
QUESTIONS BUT UP. AT IT YOU WILL
THAT OUR CONCERNS ARE EX WE HAVE
DONE OUR VERY BEST TO MAKE THIS
NOT JUST BE RUBBER STAMPED AND
TO BRING IT. CAUGHT BACK IF YOU
WILL TO MAKE SURE THE
LEGISLATURE IS ABLE TO FULLY
ENGAGE WITH THE PART WITH THE
PROPOSAL. SERA THANK YOU MISTER
CHAIRMAN THIS WAS AN- IN THE-
QUESTION ANSWER SEGMENT ON- IMHO
USE BUT MANY OF A CERTAIN THESE
DAYS ARE CONCERNED ABOUT MENTAL
HEALTH AND MENTAL HEALTH CARE
FOR- TO THE STATE INCLUDING ARMS
SPECIFICALLY INCLUDING OUR
MEDICARE BENEFICIARIES. SO WITH
REGARD TO MENTAL HEALTH CARE
SOMEONE SUGGEST THAT KAISER AT
LEAST SOME PORTIONS IN SOME
SEGMENTS OF KAISER'S STRUGGLED
WITH PROVIDING MENTAL HEALTH
CARE FOR ITS ENROLLEES.
CERTAINLY IN THE PAST SO IF THIS
PROPOSAL OPTED WITH RESPECT TO
MENTAL HEALTH CARE. WHAT HAPPENS
THERE BUT IF I HEAR THE LOCAL
PLANS CORRECTLY THEY'VE SUGGESTS
THAT- SOME CARE PERHAPS MENTAL
HEALTH CARE IS COVERED. THROUGH
THE ADMINISTRATIVE FEE AND
OTHERWISE WHEN THEY SUBCONTRACT.
SERVICES TO CAPTURE FOR MEDIC
SINCE WHEN THE SUBCONTRACT GOES
AWAY. AND KAISER IS EXPECTED TO
PROVIDE THE FULL SCOPE OF
MEDICAL BENEFITS WHAT HAPPENS IN
THE MENTAL HEALTH ARENA. MAYBE
I'LL START WITH- DIRECTOR BUS
YES PLEASE. SO I WOULD DEFER TO
MS COMMITMENT IN TERMS OF- IF
PRIME PLANS ARE. CARBENE OUT
MENTAL HEALTH SERVICES IN TERMS
OF THE RELATIONSHIP WITH KAISER
THAT'S NOT MY UNDERSTANDING- BUT
IN TERMS OF YOU KNOW KAISER'S
COMMITMENT TO BEHAVIORAL HEALTH
SERVICES. AND YOUI THINK AS WE
WILL HAVE A DIRECT OVERSIGHT OF
KAISER AND THEIR UTILIZATION AND
THEIR THEIR PROVISION OF
SERVICES ON THE B. HERE ON SITE
AND I THINK THAT THE ABILITY TO
HAVE THAT DEREGULATION SHOULD
WILL HELP US BE ABLE TO HOLD
THEM MORE ACCOUNTABLE. AND I
AGAIN WOULD KNOW THAT ALL OVER
MEDICARE MANAGED CARE PLANS CAN
DO BETTER WITH REGARD TO THE
PROVISION OF BEHAVIOR HEALTH
SERVICES AND THAT'S WHY WHEN
IT'S ONE OF THE CLINICAL FOCUS
AREAS FOR COMPREHENSIVE QUALITY
STRATEGY- AND SO. THE FIRST TIME
EVER WE WILL BE INCLUDING THAT
IT'S RELATED TO BEHAVIORAL
HEALTH ESPECIALLY SERVICES AS
PART OF OUR QUALITY STRAP AND
PART OF HOW WE WILL PAY OUT
PLANS IN THE FUTURE. THANK YOU
AND THE DEMOCRATS WE ALSO DID
LYNETTE COOKMAN ONE- ADDRESS
THAT AS THE TWELFTH DISTRICT
MENTIONED THAT IN TERMS OF WHAT
THE- THAT'S. PROJECT IS A BIT
DON'T SUBCONTRACT MENTAL HEALTH
PORTION. I THINK YOU DOCTOR CAN
. SO I THINK WE HEARD FROM SOME
OF OUR PLAN AT THE PUMP K. TODAY
THAT CATER PROVIDE MENTAL HEALTH
SERVICES BUT THERE ARE SOME THAT
THEY JUST DON'T PROVIDE AND THAT
THE LOCAL PLANT AND- NEED TO
STEP IN AND PROVIDE THOSE
PROVIDER MEMBERS AND THE EXAMPLE
THAT I HAVE HEARD IT FOR CERTAIN
SERVICES RELATED EATING
DISORDERS. OKAY OKAY THANK YOU
AND THEN MY A AND ACTUALLY IF
YOU DON'T MIND CENTAMIN YOU HAD
A BRIEF COMMENT YOU WANTTO. I
JUST WANT TO MAKE THE COMMENT
THAT MY UNDERSTANDING IS THAT IT
THEY DON'T ALWAYS HAVE SOME
INPATIENT ACUTE IT IS WHICH I
THINK THE DIRECTOR JUST REFER
TO. THE BUT I GET THE THING I
THINK WE ALL HERE IS A THERE
THERE ARE NONE I'M NOT ENOUGH
PROVIDERS AND WHEN WE TALK ABOUT
KAISER NOT HAVING ENOUGH
PROVIDERS THEN I JUST THINK WE
NEED TO BE VERY CAREFUL THAT WE
DON'T ENCOURAGE THEM TO POACH
EVEN MORE FROM THE LOCAL PLANS
JUST BECAUSE THEY'RE THEY'RE
ABLE TO HAVE MORE PROVIDERS
BECAUSE THEY'RE ABLE TO PAY A
LOT MORE WORK. WE ARE MY OF MY
NEXT AND HOPEFULLY FINAL
QUESTION HAS TO DO WITH LOOKING
READING THE MATERIAL AND I GUESS
THIS GOES TO THE DIRECTOR TO
CONTRACT REQUIREMENTS AND RE
PROCUREMENT IN A RESTRUCTURED
MANAGED CARE CONTRACTS A FOR THE
MEDICAL SERVICES- POORLY PLANS
ARE EXPECTED TO MEET OR EXCEED
BENCHMARKS OR FACE SANCTIONS. IF
LOCAL PLANS- ARE CURRENTLY
CREDITED WITH THE LOWER ACUITY
OF- KAISER MEDICARE PATIENTS
BECAUSE OF THE SUBCONTRACTING
ARRANGEMENT WHEN THAT
SUBCONTRACTING ARRANGEMENT GOES
AWAY. WHAT HAPPENS WITH RESPECT
TO THE LOCAL PLANS VIS A VIS
THIS NEWLY RESTRUCTURED MANAGED
CARE CONTRACTS. CALL MET. THANK
AND IS THERE SOME ADJUSTMENT FOR
THAT. SO WE'VE BEEN VERY CLEAR
WITH OUR COVERAGE OF QUALITY
STRATEGY ON THE METRICS THAT
PLANS WILL BE HELD ACCOUNTABLE
TO YOU AND THAT WILL FLY ACROSS
ACROSS ALL DELIVERY SYSTEMS AND
ACROSS THE ENTIRE CROSS THE
STATE AND SO COME TWENTY TWENTY
FOUR PLAYERS WILL KNOW WHAT WE
WILL BE RIGHT. TWENTY TWENTY.
WELL AS DIFFERENT QUALITY CARE
TARGET HELP BENEFICIARIES
RECOGNIZING THAT- YOU KNOW WE'RE
GIVING THEM SOME TIME TO
UNDERSTAND WHAT THESE METRICS
ARE AND THAT WE WANT TO REFLECT
HOW WEAK WE ENGAGE WITH OUR
PLANS AND HOW WE PAY OUR PLANTS
IN TERMS OF THE QUALITY. AND
EXPECTATIONS WE EXPECT FOR OUR
MEDICARE. WELL OF COURSE YOU
KNOW KAISER. IF IN FACT BECAUSE
YOU PATIENTS ARE LOWER CUTIE
HEALTHIER PATIENTS AND WE SHIP
FROM A SUBCONTRACTING- TO
ACCOUNT DIRECT CONTRACTING MODEL
IN THE LIGHT SWITCH IS FLIPPED.
THAT CHANGES IMMEDIATE DOES THAT
ALSO MEAN THAT THERE IS AN
IMMEDIATE CHANGE FOR THE LOCAL
PLANS AND HOW WITH THE LOCAL
PLANS BE ABLE TO. TRANSITION IF
THE IMPLEMENTATION IS. FOR
EXAMPLE AND ARE THEY IN FACT
LEFT IN THIS CASE WITH SICKER
PATIENTS WHICH COULD BE
ACCOUNTED FOR I GUESS IN YOUR
RISK ADJUSTED CAPITATION PAYMENT
BUT IF THEY'RE BUILT QUALITY
BENCHMARKS THAT HAVE TO BE MET
BY THE LOCAL PLANS WITHOUT
CREDIT FOR THE CASE YOUR
PATIENCE ISN'T THAT GOING TO
HAVE AN IMMEDIATE IMPACT IF
THEIR SANCTIONS IT RESULT FOR
FAILURE TO MEET BENCHMARKS
REGARDLESS OF THE MONEY THAT
THEY GET IN THE RISK ADJUSTED
CAPITATION AM I MAKING SENSE I'M
A LITTLE OUT OF MY SANDBOX HERE
BUT- EVEN IN ALL OF THESE
CHANGES ARE VERGE. TWENTY FOUR
BUT I WILL I TURN IT OVER TO AT.
COOPER OUR STATE MEDICAID
DIRECTOR AND CHIEF DEPUTY JUST
TO GET IS THAT YOU CAN GET INTO
A LITTLE BIT MORE OF THE
TECHNICAL DETAILS THANK YOU
MA'AM- JESSICA. EAGLE YES HI.
I'M SO AND I'LL START WITH THE
RATES AND THEN I WILL MOVE OVER
INTO THAT THE QUALITY SUPPORT
SO- WE WOULD BE ADJUSTING BOTH
THE LOCAL PLANS AND KAISER IN
REGARDS THE IMPACT ON MEMBERSHIP
. I TO THE- FOR. YOU SO. IT'S
WILL ACCOUNT FOR MEMBERSHIP-
SHIFTS- AND- THE YOU KNOW WHEN.
OF WHO A QUOTE AT OF A- SO
DELEGATE TO. OUR ROOM. FROM THE
DRAFT IN ALL- THE GLOBAL KIND OF
KAPPA. BECAUSE FOR THE NUMBERS
WILL ALSO BE FOR. I THOUGHT WE'D
BE A TAKING ACCOUNT FOR THAT I'M
IN THOSE TWO. AND WE HAVE ALL OF
THAT INFORMATION AND DATA. FROM
OUR MANAGED CARE PLANS TODAY ALL
THE MEMBERSHIP OF THE SAME THING
ON THE RISK ADJUSTMENT SIDE WE
WOULD BE- ANTICIPATING- THAT
MOVIE WOULD BE. RE ADJUSTING THE
CALCULATION. BASED ON THE RISK
ADJUSTMENT AND WE ARE HAVING
EXTENSIVE CONVERSATIONS EVEN
OUTSIDE OF THIS HI THERE. A
CONVERSATION WITH THE MANAGED
CARE PLANS IN REGARDS TO HOW WE-
GET TO THAT RISK ADJUSTMENT TO
MAKE SURE THAT IT IS. A
ADEQUATELY ADJUSTING FOR. ACROSS
THE VARIOUS PIECES WHEN. IT
COMES TO THE- WORST BUT YES TO
BE WOULD BE AS WE WOULD BE
GETTING. SCHOOL PLEASE FOR ALL
THEIR TWO K. ONCE THEY AND WHY
IN THE TEN NEW COUNTY BECAUSE
YOU DO HAVE TO HAVE A START
NUMBER OF LIVES FOR. IN QUALITY
MEASURES I DO. AN ALBUM.
REQUIREMENTS BUT THOSE WOULD BE
REPORTED DIRECTLY- AND THEN DID
QUALITY SCORES THAT ARE
CURRENTLY BEING RECORDED SO I'VE
HAD A VERY HIGH QUALITY SCORES
AS- INDICATED BY THEM EARLIER. I
MEAN BY DEMONSTRATED ON OUR
QUALITY OF REPORTS ONLINE. BUT
THOSE WOULD BE REMOVED FROM THE
LOCAL PLAN. IN THIS WOULD BE
DIRECTLY ORIENTED JUST TO KAISER
AND THEREFORE A DEPENDING ON HOW
THOSE BOARDS ON AVERAGE HITTING
OF THE LOCAL PLANS- THEY COULD
SEE A DECREASE- REGARDLESS OF
THAT THE- PLAN WOULD BE
RESPONSIBLE FOR. ALL OF THE
LIVES THAT THEY'RE UNDER THE
QUALITY SCORES AND IF THEY ARE
BELOW A CERTAIN LEVEL I WOULD BE
HOLDING THE MANAGED CARE PLAN
ACCOUNTABLE. FOR THE QUALITY
SCORES OF THE DAY ARE SUBMITTING
TO THE DEPARTMENT WHICH CAN
RESULT IN CORRECTIVE ACTION PLAN
OR SANCTION. DEPENDING ON WHAT
WE ARE ARE ARE TALKING ABOUT- IT
pLOCAL PLANTS DO YOU HAVE A SEAT
BENEFIT FROM. THE KAISER QUALITY
SCORES BECAUSE OF THEY ARE AND
HOW HIGH THEY ARE. CONTINUE TO
WORK WITH- PLANS. IN REGARDS TO
THAT ****
TRACTION OF THE KAISER PATIENTS.
KAISER RECEIVES NO ADVERSE
IMPACT OF COURSE BECAUSE OF
PREVENTATIVE CARE AND THE WAY
THEY'VE DESIGNED KAISER'S
PROGRAM. LOCAL PLANS HAVE BEEN
BENEFITING FROM THE KAISER
PATIENTS BECAUSE THEY'VE BEEN
THE PRIME CONTRACTOR.
SUBCONTRACTING TO KAISER WE'RE
GOING TO REMOVE THAT THE LIGHT
SWITCH GETS FLIPPED OFF. THE
QUALITY MEASURE SCORES GO INTO
THE TANK. AND WHAT. WHAT'S THE
TRANSITION PLAN FOR THE LOCAL
PLANS. IN OTHER WORDS TAKE IT TO
TAKE THAT INTO ACCOUNT AND TO
GIVE THE LOCAL PLANTS THE
OPPORTUNITY. TO SOME HELP
IMPROVE BUT QUALITY IMPROVE
QUALITY MEASURES AND PERFORMANCE
VIS A VIS THE BENCHMARKS THAT
ARE SET AND FRANKLY FROM OF
NOTHING'S FAIR CERTAINLY NOT IN
SACRAMENTO AND CERTAINLY NOT
UNDER THE DOME BUT I THINK WE
NEED TO APPLY SOME FAIRNESS
MEASURE TO THIS AND HAVE SOME
SPOOL UP OF THIS PARTICULAR
ASPECT OF THE PROPOSAL IN ORDER
TO GIVE LOCAL PLANS THE ABILITY
TO MEET THE TEST. AND IF YOU
KNOW IF THIS PROPOSAL GOES UNITS
INTO EFFECT ON JANUARY ONE OF
TWO THOUSAND TWENTY THREE WERE
JULY ONE OF TWO THOUSAND TWENTY
THREE THAT'S PROBABLY ENOUGH
TIME NOT ENOUGH TIME RATHER NOT
ENOUGH TIME TO TURN THE TITANIC
HERE SITES I WOULD JUST POINT
OUT ONE THING ALSO SO- IT WOULD
BE ONE IT UP FOR JANUARY ONE OF
TWENTY FOUR TO THAT LEVEL MORE
TIME TWO THINGS THE LOCAL PLANTS
CURRENTLY NO I WHAT THEIR
QUALITY SCORES ARE WITH AND
WITHOUT HEISER TODAY SO THAT
WOULD HAVE THE INFORMATION TO BE
ABLE TO- TO WORK TOWARD SOME OF
THOSE- IMPROVEMENTS I THINK. OF
THE THING I WOULD SAY IS HI
THERE COULD ALSO BE A
SIGNIFICANTLY IMPACTED RIGHT NOW
THEY ALSO FOUGHT SUBMIT ALL
THEIR SCORES AND WHILE THEY ARE
A HIGH SCORE IN CERTAIN MEASURES
AND METRICS WITH THE DEPARTMENT
THEY COULD BE UNDER A CERTAIN
THRESHOLD- NOW THAT THEY ARE
THEN DIRECTLY CONTRACTED WITH AT
THE STATE. MEASURES. ENTER
ACCOUNTABLE ALL- IF THEY ARE LOW
IN SEARCH MEASURE BUT THE LAW
THE FIFTY FOR. WE WILL ALSO BE A
DAY WOULD BE EXPOSED NEW CRAP
ACTION AND- SAYING. IMMEDIATELY
I JUST LIKE ANY OF OUR OTHER
DIRECT CONTRACTORS AREN'T THEY
ALSO GET THE BENEFIT WITH ARE
NOT EXCEEDING UNDER THE
SUBCONTRACT BECAUSE WE HOLD THE
PRIVATE PLAN. A GLOBAL SO IT
GOES BOTH WAYS I THINK YOUR
POINT IS NOTED IN REGARDS TO THE
TRANSITION AND HOW WE ARE
FACTORED THOSE THINGS IN. A TO
ALLOW FOR ALL INTO T. UNDERSTOOD
. THREE AND ASSUMED AS MOVING
FORWARD WELL I. WELL I THINK
IT'S LIKE THAT USED TO BE IS
ADVERSELY IMPACTED AS A LOCAL
PLANS ARE I GUESS IT IS
CONCEIVABLE THAT KAISER WILL
ALSO SUFFER SOME ADVERSE IMPACTS
WELL INCLUDE KAISER IN MY- IN MY
REQUEST IT SEEMS TO ME THAT WHEN
WE'RE IMPOSING A CHANGE LIKE
THIS. IT CAN BE SIGNIFICANT AND
MY ONLY CONTEXT IS HAVING BEEN
ON HOSPITAL BOARDS WHERE WE'VE
DEALT WITH QUALITY MANAGEMENT
BENCHMARKS AND PERFORMANCE AND
CERTAINLY FROM THE SEVERAL
HOSPITALS AND I'VE- BEEN
INVOLVED WITH IT IT'S IT DOESN'T
HAPPEN OVERNIGHT TO GO FROM RED
TO GREEN. AND SO MY QUESTION IS
HOW MUCH TIME YOU GIVING LOCAL
PLANS AND I'LL INCLUDE KAISER IN
THE STATEMENT. TO IMPROVE TO GO
FROM RED TO GREEN IN THE CERTAIN
AREAS AND I DON'T THINK IT
SHOULD BE JANUARY ONE OF TWO
THOUSAND TWENTY FOUR FOR JUST
TALKING ABOUT IT TODAY THE FACT
THAT PLANS ARE ABLE TO SEPARATE
OUT. THE NON KAISER PATIENTS.
WHEN IT COMES TO QUALITY.
IMPROVEMENT BENCHMARKS IN THE
PROCESS DOESN'T REALLY DO IT.
FOR ME. SO I'M ASKING I GUESS
YOU AND WE WILL DECIDED HERE
TODAY. THE WHEN WE'RE MOVING
THIS PROPOSAL FORWARD THAT WE
GIVE SOME THOUGHT. AT LEAST IN
THIS AREA TO PROVIDING. SOME
STRING. ON THE LOCAL PLANS
ENCOURAGE YOUR TO COME INTO
COMPLIANCE WITH THIS NEW THE
RECONFIGURED- MANAGED CARE
CONTRACT AND THE PROPOSALS
RELATED TO QUALITY AND BENCHING
. SURE WILL DEFINITELY TAKE THAT
BACK IN THINK THROUGH HOW WE CAN
DO THAT WE WOULD ALSO NEED TO
CONSULT WITH OUR ALLIES CMS
POTENTIALLY AS WELL YOU KNOW
THEY HAVE BROUGHT EXPECTATIONS
IN REGARDS TO TRANSPARENCY
AROUND THESE THINGS AND
OFTENTIMES. A DELEGATION AS WERE
FAIRLY TALKING ABOUT THAT STATE
CAN IN BOTH WAYS JUST TO BE
CLEAR- NOT ALWAYS PAINT THE FULL
PICTURE OF THE DIFFERENT PIECES
BUT WE WILL DEFINITELY TAKE THAT
BACK UNDER CONSIDERATION. IN
REGARDS TO HOW DO WE HAVE A
SMOOTH TRANSITION OF BROADLY
WITH THE MANAGED CARE
PROCUREMENT WE ARE DOING A LOT
OF FOCUS GROUPS AROUND HOW DO WE
DO THAT MAKE A TRANSITION WILL
DEFINITELY TAKE THIS UNDER
CONSIDERATION TO ENSURE THAT WE
TAKE ALL THESE FACTORS. THANK
YOU THANK YOU VERY MUCH AND
THANK YOU FOR PUTTING UP WITH ME
APPRECIATED THANK YOU MISTER.
THANK YOU APPRECIATE AND- NOW
IT'S MY TURN TO ASK QUESTIONS OF
I WOULD MAKE NOTE- CENTER UP A
FAVORITE FEATURE WHAT- YOU YOU
BRING UP ALTHOUGH I WOULD ALSO
MENTION THAT- I REMEMBER BRING
UP QUALITY MEASURES FOR.
MEDICARE MANAGED CARE PLANS A
DECADE AGO AS CHAIRED THE
ASSEMBLY HEALTH COMMITTEE SO
I'LL JUST MENTION THAT THEY HAD
A DECADE TO FIX IT AND- SO THEY
HAD PLENTY OF TIME- BUT ANYWAY.
WELL THE THAT THAT BUT I
CERTAINLY APPRECIATE WHAT YOU'RE
SAYING IF YOU TAKE THE KAISER
OUT HOW THAT MIGHT AFFECT AND
THE PLANS. IN TERMS OF THEIR
OVERALL RATING AND ALSO FOR
KAISER ITSELF BECAUSE NOW
THEY'RE PICKING UP A PIECE THAT
MAYBE THEY DIDN'T HAVE TO DO IS
A SUBCONTRACT- SO THE QUESTION
SO I HAVE CITY SEVERAL
QUESTIONS- THE- THAT I CLARIFIED
. ON THE TWO. CARE HERE TO GET I
REALLY- PABLO THE TEACHER AND
RECTIFY WITHOUT IMPACTS ON
CONVERSE I ALSO MET KAISER. AND
ALSO MET WITH THE LOCAL HEALTH
PLANS AS WELL ABOUT THEIR
CONCERNS- AND IT ALSO NOTE THAT
I REPRESENT TO COUNTIES ONE IS-
SACRAMENTO COUNTY. MANAGED CARE
SO THERE IS A KAISER DIRECTOR
THE GUY CONTRACT WITH KAISER IS
DIRECTLY CONTRACT WITH THE
STATE. FOR THAT- SO- READY HAVE
THAT IN MIND AND ONE COUNTY AND
THE OTHER IS ACTUALLY BECAUSE
COUNTY- WITH PARTNERSHIP HEALTH
PLAN- YELLOW COUNTY- SO WHICH-
SO CERTAINLY HEARING IT FOR US.
I HAVE A CEMEX ON ON SERVICE TO
ENDS OF- A MEDIC CAL IN TERMS
OF- CONTRACTING HEALTH PLANS. SO
THE FIRST CUT IS THE QUESTIONS I
HAVE THIS REGARDS ACTUALLY- THE-
RATE SETTING AND RISK ADJUSTMENT
SO I DO NOT START WITH THE LOCAL
HEALTH PLANS SO. MEN YOU
TESTIFIED HERE TODAY ARE LEAST
UP AND THEN I FORGOT WHO THE
OTHER PERSON YOU BROUGHT ON FROM
YOUR TEAM- THAT. THE DHS DOES DO
RISK ADJUSTMENT BUT SOUNDS LIKE
YOU'RE VERY CRITICAL OF THE RISK
ADJUSTMENT METHODOLOGY AND YOU
YOU DID MENTION THAT THERE WERE
PROTECT THIS PARTICULAR LANGUAGE
YOU YOU ARE SUGGESTING. REGARD
THAT SEEM TO ADDRESS RISKY JOB.
THE POSTMAN MEDS- IN AN ANSWER
THAT YOU GAVE TO WHAT MIGHT ONE
OF THE MEMBERS OF THE COMMITTEE.
CAN YOU PERHAPS GIVE US A HIGH
LEVEL DESCRIPTION OF EXACTLY
WHAT THAT MEANT IT IS AND WHAT
IS WHAT IS THE ISSUE WITH THE
WAY TO THE ATS CURRENTLY DOES
RISK ADJUSTMENT THAT CONCERNS
YOU. ARE THAT YOU SAY IS NOT
ACCURATE TO OUR DOESN'T- I DON'T
THE WORDS IN YOUR MOUTH BUT
SOUNDS LIKE IT DID NOT THE YET
CONCERT THAT BASICALLY SAID THE
WAY THAT DETAILS CURRENTLY DOES
RISK ADJUSTMENT DOESN'T
ACTUALLY- WELL. IT IS. A INFILL
WAS WAS PARTICULARLY ACCURATE I
GUESS IF I'M USING THE RIGHT
WORDS SO KEEP KEEP PLEASE
ADDRESS THAT. THANK THANK YOU
FOR THE BEST CENTER PAN AND I
WILL AND ASK MY COLLEAGUE
JENNIFER LOPEZ. TWO LANES HERE
AS WELL THANK YOU ANSWER THE
QUESTION AROUND OUR AMENDMENTS
AND HOW IT ADDRESSED THE ISSUE-
YOU'RE RIGHT IN CHARACTERIZING-
YEAH BY TESTIMONY IN RESPONSE
THAT. WE BELIEVE THAT THE RISK
ADJUSTMENT METHODOLOGY CURRENTLY
USED BY THE DEPARTMENT. IS
FLAWED. IN THAT IT DOESN'T
ADEQUATELY ADDRESS RATE FOR THE
HIGHEST NEED. NOR THE LOWEST
NEEDS MEMBERS. EACH DAY. THING I
DOLLARS OCCURRING. THAT WOULD BE
EXACTLY BY THE PROPOSAL IF THOSE
ISSUES ARE NOT ADDRESSED. GEN
CONFIG MORE TO THAT. BUT THERE
ARE AT IN LIFE. I'M HERE AT FOR
A CROSS. AND THEN I TIMELINE.
FOR DEEP YEAH TO ADDRESS ISSUES
THERE ARE TECHNICAL WORK THAT WE
INCLUDE. YEAH IN OUR. A WELL
IT'S MEMBERS AND SOME OF THE
OTHER THAT BEEN YES LONG PAIN
POINTS ARE ALSO DIRECT RELATED
TO THIS BUT I WANT TO ADD ASK
JENNIFER LOPEZ- LAPD'S DIRECTOR
CALL AND FINE THE TOP A BIT
ABOUT MORE ABOUT RISK ADJUSTMENT
AND AN ORCHESTRA OKAY. JENNIFER
LOPEZ PLEASE. HI THERE SO I KNOW
I ON THE RISKY SOFTWARE THAT
ISSUES RELATED THIS IS A TO THE
TAIL THING YOU'RE HOW FOLK AND-
BRITAIN'S HERE YOUR HIGH ME-
YOU'RE GONNA AT YOU FULL REFUND
OF THE HELL. AND UNDER FUNDING
OF THE MOST FRAIL AND YOU KNOW
THIS IS A SUPPORTED BY STUDY
THAT WITH BY THE SOCIETY ENACT
ON ACTOR ON AVERAGE COULD NOT.
SO ARE. EIGHT BROMATE RULES
FORTH IN THE PROPOSAL AND BY
PRODUCT DISCUSS WILL SERVE
HEALTH POP. REALLY HAVE A HIGHER
PER. OF A HEALTHIER MEMBER SINCE
. TO THE LOCAL PLAN AND BECAUSE
THE THESE UNDER FIVE. THAT MEANS
HI WOULD A- GREAT SETTING AND WE
WOULD SITTING YEAH. OKAY SAYS
CERTAIN THAT. APPRECIATE THAT
MAYBE I'M GONNA YELL INTO THE
WEEDS LITTLE TECHNICAL. BECAUSE
YOU TELL ME ABOUT EPIC OF THAT
BUT THAT THE HSS AT IT IS THAT
UP TO RECENTLY IS USING A RISK
ADJUSTMENT DOLLARS G. BASED ON I
THINK PHARMACY USE. BUT I ALSO
UNDERSTAND THAT THEY ARE MOVING
BEYOND THAT AND USING A MORE
SOPHISTICATED FORM RISK
ASSESSMENT DATA RATES OTHER DATA
LEFT DIAGNOSES AND SO FORTH. ARE
YOU REFERRING TO THEIR CURRENT
THAT PREVIOUS RISK ADJUSTMENT
ARE YOU ALSO REFERRING TO- THERE
THE FUTURE ADJUSTMENT METHOD.
THAT THE STATE. THE DAILY WITH-
YES WITHOUT IT WOULD BE MORE
ACCURATE. THANK YOU FOR YOUR
QUESTION I AMBER TO BOTH THE FAR
READ ADJUSTMENT INCOME OR ACT-
WHICH IS DEVELOPED BY SEE DIEGO
AND THEY THE MOVE IN CALENDAR
YEAR TWO THREE BE TO. EIGHTEEN
PLANTS ARE AT WHICH HE POINT AND
I DIAGNOSTIC CODE BOTH OF THE
MODELS HAVE THIS AND THAT IS BAY
FROM STUDY- AS POINTED OUT BY
THE AN ACTUAL WAY. OVER FIVE
HEALTHIER HER UNDER FIVE THANK.
AN ISSUE WITH YOU HAPPEN JUST
FOR. SHARE THANK BEING BY SINGLE
OKAY AND THE LEAVE THAT THAT IS
THAT IS IT SINCE. THE ISSUE AND
THE CONCERN OKAY HI DON'T SERVE
HOW. AND MORE MONEY THAT YOU
CANNOT GET THAT IS OUR TIME AND
GETS I GET SO HAVE THE BUT SO. A
GUESS MY OTHER THAN MY FATHER UP
QUESTION IS TE- IS THERE A
SOLUTION TO THIS YOU A ARE YOU
ARE YOU JUST. IT'S SO YOU KNOW
YOU'RE ME THAT IT'S NOT GOOD AT
TALESE'S IS THERE A RISK.
METHODOLOGY THAT- YOU IT ALL
INTERNET YOU WANT TO GO THAT
WOULDN'T HAVE THE PROBLEM YOU AS
A- RISK. METHODOLOGY IS HOW THIS
PROBLEM. I THINK I WOULD SAY
THAT THE CAKE CAL. MEDICAID
BECAUSE ANOTHER. TO COUNTY
REGIONAL STARTING VERY NOT A-
DIFFERENT BASED ON THE NUMBER
MIX. FROM TO PLAN. IT'S REALLY.
SPECIFIC ISSUE. WE HAVE FORTY
NINE. I'M DATING COOPER ENDED
THAT AND HER CAST. THAT HAD BEEN
KEPT. RECOMMENDATIONS HOW
CORRECT THE NOT UTILIZED OR
ISSUE. WE ARE WE TO HEAR FROM
THE STATE LOOK FOR TO HAVING
THOSE THE FACTIONS. REGARDING
THE HOW YOU RIGHT- THERE ARE A
VARIETY OF. THAT CAN BE EMPLOYED
THAT COULD BE AND YOU ATTENTION
AND MAKE A RISK ADJUSTMENT
REALLY OFFICE REDEVELOPMENT
SMART. FOREST PRODUCTS SOMETHING
LIKE A HIGH. FOR HI BUILDER BUT
- POLICE- YOU KNOW I DON'T TO
GET. RATE SETTING COMPLEX AND-
WITH THAT AT ALL. IT IS. WHERE
DID YOU MEET HOW FOR UNLIKE
OTHER MEN THE STATE HAS
DESPERATE SHE OF THE MAY. THAT
COURAGE FROM PLAN TO PLAN WE CAN
- THESE. ANYWAY JEFF.
METHODOLOGY THAT WE WOULD ACCEPT
I THINK WE KNOWLEDGE THAT NO
SINGLE METHODOLOGY IS GOING TO
BE A 100% ACCURATE BUT MY
UNDERSTANDING IS THAT IT IS
COMMON PRACTICE. TO MAKE
ADJUSTMENTS TO THAT THE CORRECT
FOR FLOOD AND THAT IS WHAT WE'RE
ASKING FOR OKAY ALL RIGHT THAT
THAT'S HELPFUL TO KNOW I WOULD
MAKE NOTE THAT CALIFORNIA'S A
FAIRLY LARGE STATE SO WE'RE THE
MOST POPULOUS IN THE COUNTRY FOR
I THINK WE HAVE THE LARGEST
MEDICAID POPULATION OF ANY- ANY
STATE- AND SO. IN SOME WAYS AT
LEAST WE HAVE BIG NUMBERS ON OUR
SIDE TERMS TO BE ABLE TO MAKE
CORRECTIONS AND SO FORTH- MAYBE
OUT THERE AND- ALSO NOW ASK.
WELL MAYBE I'LL ASK A DCS TO
RESPOND I DON'T KNOW SIR I DO
SEE COOPER WANTS ME TO ONCE IT'S
MORE TECHNICAL QUESTION VERSES
ARE DIRECTOR WILL SAVE HER FROM
HAVING TO ANSWER THIS TECHNICAL
QUESTIONS SO. J. C. I GUESS
YOU'RE YOU'RE NOT STUCK WITH
ANSWERING THE TECHNICAL QUESTION
ON METRIC METHODOLOGY.
ADJUSTMENT YOU IN ORDER. AND ARE
PAN AM AS SO YOU BUT I WOULD SAY
IS. WE ARE CONTINUE CONVERSE.
WITH PLAINTIFFS WE HAVE HAD- A-
DAY THIS. WITH ALL OF THAT.
OTHER LOCAL HEALTH PLANS THIS
YEAR THAT THEY HAVE ASKED HER TO
READ. YOU YOUR CONTINUE TO IN.
IN I MISS LOPEZ. REGARDS TO OUR
CURRENT MESSAGE. ON MEDICARE
AXIS CORRECTING THEM BUT WE ARE
CURRENTLY PROPOSING. AND WE'VE
HAD MANY DISCUSSIONS WITH THE
PLANS IN REGARDS TO THAT. BUT IT
ALSO SAY IS THAT WE ARE LOOKING
AT A QUALITY- IT WITHIN THE RATE
YOU'RE LOOKING AT THE
UTILIZATION SCORES- AND WE ARE
LOOKING AT- SAFETY NET. YES- YOU
KNOW IN IN YOU KNOW INVESTMENT
PIECES. ARE ON THE TABLE ALL. WE
ARE ACTIVELY ENGAGING WITH- MANY
THINGS THAT ARE IN THEIR COURT%
REGARDS TO GETTING BACK TO THE
DEPARTMENT ALSO FOR THESE
CONSIDERATION IN PIECES. BUT
ALSO SAY IS WE ARE ALSO USING A
BROAD ASSUMPTIONS THAT WILL BE
APPLIED ACROSS ALL PLANS WE ARE.
LOOKING PASSED. I'M MAKING THIS
WORK FOR ONLY LOCAL. PLANS ARE.
YEP ROB- ACTUAR- APPROPRIATE
ADJUST WITHIN OUR RATES- THAT
CAN BE A- BY BOTH CMS. AND THAT
CAN ASSERT- IN OFTEN. SEEN THAT
ESPECIALLY WITH SOME OF THE
UTILIZATION PROPOSALS BEING PART
THERE'S NOT AN ACTUAL DIFFERENCE
BETWEEN LOCAL PLANTS IN THEIR
COMMERCIAL PLANTS. IT IT BURIES
A CROSS OF WHAT WE'RE LOOKING AT
IS WE'RE TRYING TO WORK TOGETHER
BROADLY AT TO FIND A WAY TO.
APPROPRIATELY ADJUST BY QB WE
THINK THAT IS IMPORTANT. WE ALSO
WANT TO MAKE SURE THAT WE ARE
BUILDING IN. A FOR HIRE CUTIE.
COPULATION THAT THAT WILL TAKE
MORE WORK ON QUALITY THOSE ARE
THINGS THAT WE'VE ALSO SHARED
WITH THE LOCAL PLANS. IN REGARDS
TO HOW WE WANT TO MAKE THESE
ADJUSTMENTS BECAUSE WE KNOW WITH
THE HIGHER QB POPULATION.
ACHIEVING EQUALITY SCORES IS
CHECK MORE CHALLENGING AND WE
ARE MAKING. A DOES IT. MEAN
THOSE RESERVATIONS WITH THEM SO
I THINK. THE DEPARTMENT IS VERY
COMMITTED TO. MAKING SURE THAT
THE X. YOU DID JUST MENTION THE
RISK ADJUSTMENTS WITHIN OUR RATE
SETTING IS APPROPRIATE. AS YOU
CLEARLY HEARD- THIS IS SOMETHING
THAT ALL MEDICAID UP PLANS TO
HAVE TO JUST FOR WHAT I WOULD
JUST SAY IS CALIFORNIA'S NOT. HI
MEDICAID OTHER MANY OTHER STATES
THE DO AS WELL- SO JUST POINT
THAT OUT AND AT HIGHS ARE SMALL
IT'S A SIMILAR ACROSS ON THE
OTHER THING I WOULD SAY IS WHEN
WE LOOKING AT OUR STAFF AND SAN
DIEGO COUNTIES WHERE HI THERE IS
A DIRECT CONTRACTOR TODAY HI
THERE'S BEEN PER SHIP IS
PROJECTED TO BE HIGHER RISK THAN
THE COUNTY AVERAGE FOR CHILDREN
AND ADULT POPULATIONS AND THEIR
COUNTERPARTS BUT I WOULD KNOW
THEIR LOWER RISK FOR SENIORS AND
PERSONS WITH DISABILITIES SO WE
ARE DEFINITELY LOOKING AT. ALL
YES THERE'S A- WE- APPROPRIATELY
THOSE IN THE WAY ARE. RAY IN THE
FUTURE IN ADJUSTING. THOSE
PARTICULAR PIECES YEAH WELL I
APPRECIATE THAT- AND- YOU ALSO
WANNA COURAGE THE DEPARTMENT
THAT LOCAL HEALTH PLANS TO
CONTINUE TO WORK TOGETHER ON
RISK ADJUSTMENT I MEAN
ULTIMATELY. EIGHT I WILL TALK
ABOUT KAISER CONTRACT I THINK
IT'S MANY LIKE IS THAT THIS
ISN'T MUCH ABOUT THE SPECIFIC
PLANS WANT THAT WHATEVER PLANS
ARE BEING TREATED FAIRLY THEY
HAVE THE RESOURCES THEY NEED TO
TAKE CARE OF THE PATIENTS RIGHT.
THAT WE'RE NOT HAVING THESE.
AVERTED PLANNED- THIS IS- THAT
TAKES CARE OF A LOWER JUDY SAID
AND- AND- AND HIS STUFF. UP BUT
THIS IS GETTING DISPROPORTION
ABOUT OF THE FUNDING AND
THEREFORE DISADVANTAGING- NO
SICKER PATIENTS SO- IT IN MY IN
MY MIND. BE SURE THAT WE HAVE AN
APPROPRIATE- DISTRIBUTION L.
RACE RISK ADJUSTMENT IS GONNA BE
REALLY IMPORTANT AND- I KNOW
THAT DEPARTMENTS AS ARE WORKING
ON IT. I HEAR FOR THE LOCAL
HEALTH PLAN SAID. IF THERE IS A
YOU KNOW DISTORTION AT THE
TAILS- AND VOTE IS IF WHAT WE
CAN TRY TO CORRECT FOR. BUT
HOLDEN AND- BUT CERTAIN DOES
INDICATE. THAT- GIVEN SOME OF
THE RESTRICTIONS ON WHO CAN ROLL
THE KAISER KAISER PERHAPS AND
ALSO HISTORY. THAT KAISER
PERHAPS WOULD HAVE A HEALTHIER
POTENTIALLY HEALTHIER POPULATION
IN THE END WE WANNA BE SURE THAT
ANY PLAN WHETHER IT'S KAISER. AS
A THROUGH STATEWIDE CONTRACTOR
LOCAL HEALTH PLANS. GETS
APPROPRIATE RISK ADJUSTMENT SO
THEY HAVE THE RESOURCES TO GET
OUR PATIENTS- THE- SO DOES
FOLLOWS ON TO A RATE SETTING- SO
WHEN THE QUESTION SO OF COURSE
WE'RE MOVING TO REGIONAL RATE
SETTING HUNDRED A NEW
PROCUREMENT. RIGHT SO IN TERMS
IT. IS GONNA STATEWIDE CONTRACT
DIRECTLY AND NOT UNDER THIS
PROPOSAL. SO IN TERMS OF THE
RATE THAT KAISER GETS PAID IS
THAT LIKE A SIMULATION OF THE-
VARIOUS LOCAL WITH A RISK
ADJUSTMENT VENTURA- THAT JUST.-HOURS AT A STATEWIDE SAME RATE
ACROSS THE WHOLE STATE BECAUSE-
EACH LOCAL HEALTH PLAN. IS HAVE
YOU KNOW GONE HAVE THEIR RATES
SET BASED ON WHERE THEY ARE IF
THE LOCALITY IN. WHICH REGION
THERE IN BECAUSE OUR STATEWIDE
SO HOW ARE YOU UNDETERMINED.
RATE IS IT GOING TO BE. BUILT
WELL I GUESS ONE COULD ARGUE
THAT IF THEY JUST GET ONE
STATEWIDE RATE THAT'S NOT QUITE
THE SAME AS- SAYING THAT WELL
ACTUALLY YOUR RATES CAN BE BASED
ON YOU HAVE X. NUMBER OF
ENROLLEES IN THIS AREA IN THIS
REGION AND THAT'S REGIONALLY IN
THIS AREA AND THAT'S A THREE
GENERATION CELLS. SO IN CASE YOU
HAVE A SHIFT AND- AND WHERE YOU
KNOW WHERE YOUR PATIENTS ARE SO
FORTH THAT SHOULD BE REFLECTED
IN THE ULTIMATE AND READY TO GET
PAID. POLICE FOR THAT LOCAL
ANOTHER. STATEWIDE CONTRACT IS A
GONNA HAVE ESSENTIALLY SUB RATES
BASED ON YOUR REGIONAL RATES AND
THE NUMBER FOR LEASE IN EACH
REGION. VERSUS A ONE STATEWIDE
RATE WHICH COULD TURN OUT TO BE
ADVANTAGES FOR CERTAIN REGIONS.
MAYBE THIS ADVANTAGES IN OTHER
REGIONS SO CAN YOU TO SERVE-
PERHAPS- CLARIFY HOW RATES ARE
GOING TO BE SET. AND
PARTICULARLY OUR RATES COULD BE
SET FOR KAISER WHICH IS GOING TO
HAVE A STATE WIDE CONTRACT THE
ONLY PLAN WITH STATEWIDE
CONTRACT. THE WHAT I WOULD SAY.
IS THAT WE HAVE A HANDFUL OF.
YOU KNOW. HEALTH PLANS WHO HAVE.
A BLUEPRINT IN MULTIPLE COUNTIES
I THINK THE HELP THAT ARE TODAY
FOR EXAMPLE. THIRTY TWO. OR
THIRTY THREE COUNTIES ACROSS THE
STATE OF CALIFORNIA- I- I DON'T
KNOW WHAT I WOULD NEED TO.
CONSULT WITH OUR OUR OUR RATES
TEAM SPECIFICALLY IN REGARD TO
WHAT WE'RE THINKING FOR THE
CHANGE OF WHERE WE HAVE THE FIVE
DIRECT. AND I KNOW THERE'S STILL
A LOT OF I THINK YOU'RE GOING
AND WHAT I WOULD SAY THOUGH. ON
WHETHER WE HAVE- YOU KNOW TO.
AND NORTHERN CALIFORNIA.
CALIFORNIA. WORK I WITH BE
FACTORED IN AND THEIR MAKE YOU
FEEL YOU TALK ABOUT BEFORE
THERE'S ALWAYS BASE RATE AND
THEN THERE'S TO BE LOCAL
ADJUSTMENTS IN REGARDS TO HOW WE
DO IT AFTER IN THOSE REGIONAL
FACTORS AND THAT WILL STILL COME
INTO PLAY HERE THE OTHER THING I
WOULD PUT THAT CAPITATION RATES
ARE BASED ON GROUPS OF Y. KIKO
CORRECT- WHICH WE WILL. YOU KNOW
RATE CELL THAT I WANNA GET TO
TECHNICAL BECAUSE I DON'T THINK
THAT'S HELPFUL FOR THE PURPOSES
YEAR BUT REALLY NEAT WE BUILD
THE RATES BASED OFF OF FOR
EXAMPLE THE FOLLOWING
ACCUSATIONS WILL HAVE CHILDREN
WILL HAVE THE DOGS WILL HAVE THE
EXPANSION SPVS S. B. DUAL LONG
TERM CARE SO WE ARE ALREADY
BREAKING DOWN RATES YOU. FOR A.
I'M AS WE CONTINUE TO CUT BUILD
OUT THAT ARE REGIONAL. GREAT
THAT HE PROCESS WE WILL MAKING A
NUMBER OF IT JUST. IN REGARDS TO
HOW FACT. HI INTO. A THOSE RATES
ARE OVER. IS WELL AS WE BE DOING
WITH KIND OF. ALL OF OUR- THREE
BEINGS- IN. WE ARE FORWARD WITH
REGIONAL RATE SETTING IN TWENTY
TWENTY FOUR. YEAH AND I THINK
FOR PURPOSE OF FAIRNESS AND
ABOUT GETTING INTO ALL THE
COMPLEXITY ADDITION FOR THE
CELLS THAT THEIR PRICE ON
GEOGRAPHICALLY ELECTED.
REFLECTION OF WHICH- THE AGHA
FEES. THEIR ROLE LEASE ARE AND
RIGHT BECAUSE OTHERWISE LATER.
IF YOU DON'T THAT ISN'T
REFLECTED BANDIT YOU KNOW THE
PLAN COULD BE POTENTIALLY
ADVANTAGE OR EVEN DISADVANTAGED
ACTUALLY. MANY ON THE- YOU'VE
ESTABLISHED OTHER ARE NOW.
FACING THEIR RATES ON- VERSES-
YEAH KAISER BEING BASS ON A-
THAT YOU KNOW THAT SET OF. ARE
SO FORTH SO- IT JUST JUST ONE
YOU MENTIONED THAT- THE OTHER
QUESTION I HAVE IS- ACTUALLY.
ONE OF THE PARTS OF THE PROPOSAL
IS WELL ACTUALLY I JUST GOT IT
COUNTY MO YOU SELL. YOUR
REQUIRING AT KAISER OF A AND
WILL YOU WITH EVERY COUNTY AND
REALLY APPRECIATE AGAIN THE
DESCRIPTION OF THAT- BECAUSE
THIS IS THE- AND AGAIN. THIS IS
WHAT. WE ARE EIGHT THAT. DTS OF
DIRECTLY HOLD THE CONTRACT FOR
EVERY SINGLE HEALTH PLAN
DIRECTLY WITH THE STATE SO I
JUST THE DOUBT. WE KNOW THAT. IN
TIME- IN TERMS OF ACCOUNTABILITY
FOR SO IT'S AN L. KAISER AND
ALSO EVERY OTHER HEALTH PLAN SO
HAS HAS A- YOU WITH THE COUNTY.
WHO HOLDS THE PLAN INCLUDING
KAISER WHICH NOW HAS A STATEWIDE
CONTRACT. ACCOUNTABLE FOR
FOLLOWING THEM TO YOU AND IF
THEY DON'T FOLLOW THE MO YOU.
DOES IT IS IT GOING TO HAVE TO
BE DH CS THAT. THOSE THAT THE
DAY OF THE DAY COUNTY HAS
APPEALED TO DHS FOR CONSEQUENCES
ORDERS TO COUNTY IT WITHIN EMMA
USER TO COUNTIES ALLOWED TO HAVE
ANY- I GUESS AND LOCAL AUTHORITY
BUT- RECOURSE TO ADDRESSING IF
THERE IF THE ABLE YOU IS NOT
FOLLOWED- SO- CONTINUED K. DRESS
THAT SO GREATTHEY DON'T COME UP
WITH THE NUMBER YOU. ETCETERA
BUT OF COURSE WE KNOW ANIMAL USE
JUST THE STARTING POINT AND THEN
THE QUESTIONS THE PEOPLE FOLLOW
SOMEONE DOESN'T FOLLOW THROUGH
ON WHAT'S WHAT THEY AGREE TO ANY
OF THE YOU. AND WHO WHO WHO WHO
CAN HOLD THEM ACCOUNTABLE. PART
WOULD HOLD. THAT THE HEALTH OF
KERR ARE. CANNIBAL FOR ME THAT
COULD OF THE CONTRACT AND THAT
INCLUDES AND DEMO USING THOSE ML
USE WE WILL HAVE KIND OF THE OF
THE PARAMETERS OF WHAT SHOULD BE
INCLUDED IN THOSE AND I THINK
PART OF THAT DOUBT IS THE
DISPUTE RESOLUTION HOW THE TWO
PARTIES WILL COME TO AGREEMENT
AND IF THE PROCESS IS NOT CALLED
WHAT ARE THE NEXT STEPS INTO YOU
KNOW I THINK IT'S A- I'M- IS AND
THE PLANTS. IN THREE WITH
PROCESS MIGHT BE IN TERMS OF
THESE OF THESE REAL. BUT THEN
ULTIMATELY THE DEPARTMENT WOULD
HOLD. ACCOUNTABLE IF AN AMMO
REVIEW WAS NOT AGREE TO OKAY IS
THE- CERTAINLY APPRECIATE THAT
THE TEACHERS WOULD BE THE
ULTIMATE. ACCOUNTABILITY BUT AT
SOME POINT YOU KNOW THERE'S SO
THAT EVERYTHING DOESN'T HAVE TO
ALWAYS FLOATED THE DH CS. RESITA
THERE SINCE. YOU KNOW MY ON A
STANDARDIZED MAY NOT BOAST SOME
. AND THAT SO THAT. AGAIN KAISER
AND WHATEVER OTHER HEALTH PLANS
ARE IN THE REGION. THERE ARE
SIMILAR PROCESS SEES FOR YOU
KNOW EITHER DISPUTE RESOLUTION
OR OTHER THINGS THAT MAY
HOPEFULLY NOT LEAD TO FINALLY-
YOU KNOW ANYBODY CAN HAVING. THE
END AGAIN THAT YOU KNOW THAT THE
TO TRY TO TRYING TO BE SURE MAKE
THINGS FOR PEOPLE TO VALLEY
FORGE WE GO EMMA YOU THEN- BE
SURE THERE ACCOUNTABILITY FOR
EMMA YOU- AND THEN- AND THEN THE
OTHER. I HAVE IS GOING TO TALK
ABOUT WHEN ONE COMPOUNDED THIS
AGREEMENT IS. PROVIDING
SPECIALTY ACCESS FOR FQHCS.
THROUGH KAISER IN MAYBE THE
QUESTION MORE DIRECTLY FROM
KAISER. NOW OF COURSE KAISER'S
MODEL IS THIS IS ACTUALLY CLOSE
SYSTEM THAT'S MORE EFFECTIVE
EFFICIENT YOU HAVE
COMMUNICATIONS AND SO FORTH. HOW
HOW WOULD THAT WORK IF YOUR
PRIMARY CARE SITE IS AND IF YOU
SEE THAT'S NOT PART OF THE
KAISER SYSTEM- SO I'D BE CURIOUS
THE- MINIMUM. FROM KAISER LIKE
HOW ARE YOU GOING TO. WHAT IS
GOING TO BE THAT RELATIONSHIP
WITH THAT THE FAQS AND KAISER
FOR THE SPECIALTY ACCESS. AND SO
HOW'S THAT GOING TO WORK AND
WHAT KIND OF TREATMENTS ARE
NECESSARY AND THEN I ALSO WANT
TO HEAR FROM THE PRIMARY CARE
ASSOCIATION ABOUT THAT. SO THAT
YOU KNOW IT IS SO THAT SAMPLES
IS GOING TO BE I WENT TO
UNIVERSITY LEVEL DAHLE IF USING
THEIR OU OPERATE AND HOW DO YOU
DECIDE HOW MANY SPECIALTY
REFERRALS AND STUFF YOU'RE GOING
TO GET. SURE I THINK THE
QUESTION. IS WHAT. I THINK WITH
THE- TO THAT THERE'S A COUPLE
THINGS HERE. I COMMITMENTS
OCCURRED SESSIONS ACCESS MEDICAL
- FOR HI COMMITTEE MEMBERS
SOMETHING WE'RE WE'RE WITH THAT
ON. AS SOON AS A VALUE TO YOUR
TO ABLE TO RESOURCES TO THE
COMMUNITY- ESPECIALLY WHERE
THERE'S PROVIDER SHORTAGES
RIGHTS I THINK THAT THAT'S
THAT'S KIND OF ONE ONE CHILLER
OF THAT AND THAT COMMITMENT IS
TO SPECIALTY ACCESS FOR KAISER
INFERRED ON HYGIENE. ONE THING I
LOOK. THE OTHER THING TO POINT
OUT IS I'M GONNA THIS WAS THIS
WAS TIME ABOUT REALLY- THAT
WOULD REGARDS TO PRIMARY- OUR
MEMBERS ARE QUESTIONS. AS YOU
MENTION WILL ALWAYS HAVE ACCESS
TO BECAUSE MANY DAY. PCPS WHO.
TRIED TO ATTACK THAT DOES NOT
CHANGE. AT ALL YES I THINK- THE
PARTNERSHIP WITH THAT FEW WEEKS
HE'S REALLY- YOU KNOW WHAT'S IN
THE BEST INTERESTS OF THE
COMMUNITIES FOR EXAMPLE- YOU
KNOW- BEST PRACTICES AROUND
POPULATION HEALTH MANAGEMENT-
ACCESS TO SPECIALTY HEALTH
CENTER. SO I THINK I THINK
THAT'S KIND OF ONE FORTY NINE IS
THAT- YOU KNOW THE KAISER
PERMANENTE A MODEL INMATE
DELIVERY SYSTEM THE RIGHT TO
ACCESS OKAY. YES CHANGE YEAH I
KNOW NINE OTHER DOESN'T SEEM SO
THAT'S THAT'S A CHALLENGE FOR IT
SO I SEE THE PROPOSAL THEY'RE
SAYING THAT. KAISER WILL OFFER
SUBSPECIALTY ACCESS TO FAQS WHO
ARE TAKING CARE OF NON KAISER
PATIENTS BECAUSE YOU SAID IF
THERE ARE TIES ARE PATIENT AND
MEDICARE. BE GOING TO YOUR
PRIMARY CARE DOCTORS. AND AS AND
- ALERT. SO IT USED TO THINGS A
CERTAIN PLACE. SUDDENLY YEARS.
METALLIC STEEL PITOT EVER. AND I
GETTING THESE REFERRAL FROM
THESE BECAUSE DOCTOR AT F. Q.
RIGHT AND THE YEAH. AND ABOUT
WAY THEY DON'T. YEAH THEY MEDIA
DIFFERENT EHR STAY. I AND SO THE
BECAUSE IS HOW. ARE YOU REALLY
TO BE TO THESE F. AND THEIR- FOR
REFERRAL ESPECIALLY SINCE YOU
KNOW ARE YOU ARE REQUIRED THEY
HAVE TO BE ON THE SAME EHR
SYSTEM. ARE YOU GOING TO PUT. A
WHAT KIND OF BARRIERS MIGHT BE
PUT UP THERE ARE YOU KNOW HOW
OPEN ARE YOU GOING TO BE- TO
THESE EFFORTS TO THE F. CUES IN
THEIR PROVIDERS TO THE SUB
SPECIALTY REFERRALS- ESPECIALLY
SINCE YOU USED TO OPERATING AS A
CLOSE SYSTEMS AND ALL YOUR-
SPECIALTY. FOLKS IN OAKLAND FROM
THE CLERKS THE DOCTORS THE
NURSES HAVE TO DEAL WITH PEOPLE
WHO AREN'T PART OF THE KAISER
SYSTEM. HERE NOW ARE SHOWING UP
AND SAY HEY I'M A MEDICAL
PATIENT INEED THE L. E. N. T.
SIR- BUT YOU DON'T USE. EHR YOU
DON'T WHATEVER. SO HOW WE
SUPPOSED TO. WORK WITH YOU ON
THAT. SURE I'M QUITE A SENIOR
THAT DRUG BOSS ON POPPED UP
MOSTLY WANT TO TRY IN BUT I ONE
THING I CAN IS THAT IF AT WITH
TO SPECIALTY ACCESS I SEE THAT
REALLY IT'S DOWN A CALL YOU ACT
. FOR MEMBERS OF THE COMMUNITY
NOT NECESSARILY SOME NOTES TIED
TO THE CASUAL COMMITTEE SYSTEM.
US I THINK THAT'S ONE THING I
LIKE TO THINK EVERYTHING OUT
SHARED- IS THAT- TYPE OF- SAYS
IN TERMS OF HOW THAT WORKS NO WE
IS KAISER WE WILL WORK
COLLABORATIVELY WITH. DTS ALSO
WITH THE ASSOCIATION I TO MAKE
SURE THAT OKAY THAT WORKS WORK
FOR THE COMMUNITIES IN WHICH
WILL SERVE SETS IT'S DEFINITELY
SOMETHING THAT WE NEED TO WORK
THROUGH BUT IT WILL BE DONE
COLLABORATIVELY WITH PEACE OKAY.
ALSO THE CLINICS ALL RIGHT WELL
I APPRECIATE IT WILL BE A VALUE
ADD IF IT ACTUALLY HAPPENS SO
I'M NOT SAYING THAT YOU'RE NOT
GONNA RY TO MAKE IT HAPPEN I
AFTER THAT I HAVE I. AM THEY
HAVE SINCE. I WAS A SKEPTICISM
RIGHT WHERE BUT YOU KNOW THERE'S
A LOT. ISSUES TO MAKE IT.
BECAUSE KIND. SYSTEM IS ABOUT
THE- TO BE A- AND NOW WE'RE
OPENING A- WERE UP. PART OF
SYSTEM. AND SO IT'S GONNA
REQUIRED NOT ONLY OF COURSE
SOMEONE NIELSEN ADMINISTRATORS
GONNA REQUIRE EVERYBODY FROM YOU
KNOW THAT THE- FIRST TO THEIR TO
THEIR SUPPORT STAFF AND I WANT
TO SAY WE ARE GOING TO DO THIS.
OTHERWISE IT'S SO EASY FOR THEM
TO CLOSE A VALLEY QUE YOU KNOW
WHAT YOU DIDN'T SEND THE FORM
THE RIGHT WAY WERE USED TO
EATING USE OUR SYSTEM IT'S
ADDRESS. AND NOTHING AND THEN
BASICALLY PEOPLE ACTUALLY GET
ACCESS- IF YOU DON'T MIND- IF
THE- LET ME LET'S GO TO THE-
PRIMARY CARE ASSOCIATION AND-
YOU WANT. TO ADD ON TO THAT- IF
YOU DON'T MIND. SO
ARE YOU SEE THIS WORKING. YES
THANK YOU SENATOR PAN- I AM
GOING TO JUST DID- WHAT YOU SAID
IT'S REALLY COMPLICATED- AND WE
KNOW THIS WE'VE BEEN ASKING FOR
KAISER OPEN UP SPECIALTY FOR
YEARS AND YEARS AND YEARS AND
YEARS AND- IT'S A BIG MOVES THAT
THE PERMANENT TAKE GROUP AND I
WANT TO JUST THANK THEM FOR
BEING WILLING TO DO THIS AT ALL
THINKING ABOUT THIS WITH US. WE
STARTED EXPLORING WHAT THIS
WOULD LOOK LIKE LAST ABOUT LAST
SUMMER I GUESS WE REALLY STARTED
DIVING INTO IT LAST FALL I'M AT
IN OUR POPULATION HEALTH
MANAGEMENT WORK AND I JUST WANT
TO UNDERSCORE IT IS REALLY
COMPLICATED THERE'S BEEN A
SPECIALTY GROUP OF KAISER
PERMANENTE DOCTORS AND
FACILITATORS AND-
REPRESENTATIVES FROM THE HEALTH
CENTER SYSTEM TO REALLY DIVING
INTO DATA BECAUSE WE'RE REALLY
TRYING TO. WHERE THE- NEED. ARE
BY ZIP CODE BY SPECIALTY BY
ACUITY AND WHAT'S THE BEST WAY
BECAUSE THERE ISN'T WE JUST DO
NOT HAVE. THE PHYSICAL HUMAN OUR
TO. FILL ALL THE SPECIALTIES SO
HOW ARE WE GOING TO DO THAT SO
THEY'VE JUST WANT TO COMMEND
THERE'S BEEN A GROUP OF PEOPLE
REALLY FOCUSED ON THIS AND HAVE
I MENTIONED THIS TO MY TESTIMONY
WE DON'T HAVE. WE HAVEN'T SPENT
ENOUGH TIME TRYING TO FIGURE IT
OUT AND I DO BE UNIQUE BY COUNTY
BY PLAN BOB AND ONE OF THE-
THINGS WE ENCOUNTERED WAS IN ONE
OF THE PLANTS IN THE AREAS THAT
ONE OF THE COUNTIES WHERE WE'RE
WHERE WE REALIZED THAT THERE WAS
A HUGE SPECIALTY NEED AND WE
STARTED TO DIVE IN. IT WAS A
PLAN THERE THAT THEY HAD ALREADY
STARTED WORK ON SO WE SO PART OF
WHAT WE'RE TRYING TO DO IS
KAISER IS NOT THERE TO NECESSARY
THEY'RE NOT THERE TO DISRUPT THE
SYSTEM THAT THEY'RE TO BE A
VALUE ADD SO PART OF THE LEVEL
OF COMPLICATION AS WELL AS PLANS
ARE ALSO THINKING ABOUT THIS AT
THE LOCAL LEVEL TWO. AND SO
WE'VE GOT TO DO THIS BY COUNTY
IN SOME CASES AND BY SPECIALTY
INSECURITY AND NEEDED SUPPOSED
SO IT JUST HAS MULTIPLE LAYERS
OF COMPLEXITY BUT WE'RE HAPPY
THAT WE ARE DIVING IN AND I
WOULD NOT SLOW THAT DOWN AT ALL
AND JUST CREATING SOMETHING IN
THE PROCESS IN THE LANGUAGE AND
I APPRECIATE ALL THE PIECES OF
WHERE'S THE LANGUAGE. PATIENT
TRAILER BUT WE JUST NEED
SOMETHING TO KEEP IT GOING AND
THE PRESSURE ON HERE BECAUSE
THIS PROBLEM HAS BEEN GOING ON
FOR SO LONG WE NEED TO KEEP
KAISER AT THE TABLE WITH US
THINKING ABOUT THIS AND FINDING
A WAY TO BRIDGE THE GAPS AND
SPECIALTY CHEN OKAY AND DRUG
BUST YOU ONE SAY SOMETHING TO
THIS NO I WAS JUST GOING TO. BE
COVERED A LOT OF WHAT I WAS
GONNA SAY THERE'S BEEN A LOT OF
FOR A LOT OF DATA TO IDENTIFY
WHERE SOME OF THESE AREAS AND
WATER AT SOME OF THE
PARTNERSHIPS THAT MIGHT OCCUR-
AND JUST TO BE FULLY TRANSPARENT
BEING GIVEN KIND OF SOME OF THE
OPPOSITION ON THIS ENTIRE
PROPOSAL IS PUT A LITTLE BIT OF
A PAUSE ON THAT WORK I'M JUST
REALLY NOT INTENDING TO RUFFLE
FEATHERS ANY WORK I'M BUT I
THINK WE VALUE THAT WE KNOW WE
NEED MORE. ESPECIALLY CARE
ACCESS WE KNOW WE NEED TO ENGAGE
AS MANY ARE PROVIDERS AT IT AT
THAT CITIZENS ARE GOING TO HELP
TEACHERS. FROM PERSPECTIVE WE-
EXCITING ARE TO OF MATCH
DIFFERENT- DIFFERENT ENTITIES
THAT MAYBE HAVE A PARTNER TO
THIS WAY AND REALLY INTO BEING
TRYING TO THROUGH HOW WE CAN
MORE SO. OKAY THANK YOU- JUST
MAKING AND A BEFORE FINISH AND
THEN WE'RE GOING TO SENATE
AGREE. THAT AFTER YEAH I'M I'M A
PRIMARY CARE TO DOCTOR TO
ACTUALLY THAT AS IT KAISER SO- I
AM BE. MAY NOT BE THE LET'S NEXT
YEAR MAYBE COMING BACK TO MY
COLLEAGUES AND SAYING HEY THIS
IS MY EXPERIENCE AND IT DIDN'T
WORK OR DID WORK OR SOMETHING
SO- I'M LOOKING FORWARD TO.
SPECIAL ACT. THE ACCESS BUT-
SOMETIMES- IS IT PEOPLE ARE
NECESSARILY COME CHANGING WAITED
THINGS AND THIS IS GONNA REQUIRE
SPECIALIST AT KAISER TO DO
THINGS DIFFERENTLY IF THEY'RE
ACTUALLY GONNA OPEN UP TO- NINE
KAISER PATIENTS ARE COMING FROM
F. KEYS SO I CERTAINLY WISH YOU
I HOPE THIS IS ACCEPTABLE- AND I
WANTED TO BE SUCCESSFUL BUT THAT
I'M NOT GONNA TAKE IT FOR
GRANTED IT'S GOING. TO HAPPEN
WITHOUT A LOT OF EFFORT ON BOTH
SIDES SO I APPRECIATE THAT OKAY
THAT- AND IT'S THAT NOW- ACT
SENATOR IS HERE BEEN TO IN
ANOTHER COMMITTEE- HAS SOME
QUESTIONS IS THAT THE AND- AGAIN
- SANDRO WELCOME THANK YOU THANK
YOU MISTER CHAIR POLICY ARM IN A
FIVE. THIRTY BEEN ASKED WE FORGE
PLEASE THAT'S OUR BEEN ASK AND I
CAN STAFF WE WILL WHY THAT HE
AND GIVE ME THE RECEIPT. SO I DO
A HAVE BEEN BACK AND FORTH
BETWEEN TWO- AND THEN I HAVE
THIS ONE- SO I NEED SOMEBODY TO
ME UNDER WHY GOVERNOR'S OR THE
FOR THIS IT APPEARS TO ME THAT
COULD SIGNAL STE. PROVIDERS IN
OUR SAY NET- TO OPEN THIS AND
THEN ALL- I'D LIKE TO KNOW. AS
YOU KNOW WITH A TWO YEAR
PANDEMIC JUST THREE. BY US ARE
HEALTHCARE SYSTEM ARE ARE A STE-
EXTRA. DOES THIS HAVE TO BE
DONE. AND- WHAT ARE THE
REPERCUSSIONS IF THE LEGISLATURE
REJECTS THIS PROPOSAL. THAT
SOUNDS LIKE A DIRECTOR PROCESS
AND I THINK. I THANK YOU I'LL
I'LL TRY TO SUMMARIZE MANY OF
THESE POINTS HAVE BEEN COVERED
BUT REALLY FROM OUR PERSPECTIVE
THIS ADDS ADDITIONAL CAPACITY IN
THE MEDICAL PROGRAMS QUALITY
PROVIDERS FOR SHERRY STOKES I
THINK IT. CONFLICT WITH THE
SAFETY NET IT DOESN'T ON IT
MEDICARE BENEFICIARIES AND THE
REASON WE'RE PROPOSING THIS IS
THAT WE GO LIVE WITH OUR NEW
MEDICAID MANAGED CARE CONTRACTS
JANUARY ONE TWENTY TWENTY FOUR
AND SO WE THAT WE WANT TO ENTER
INTO AGREEMENTS AND UNDERSTAND
WHO ARE ARE PLANNED PARTNERS ARE
SO THAT WE CAN ENSURE READINESS
. THIRTEEN TWENTY FOUR NOT THAT
TO IN A MONTH PROCESS THAT WILL
BEGIN THIS SUMMER ONCE WE HAVE A
OUR PLAN IDENTIFY. M. THANK YOU
THANK YOU VERY MUCH FOR THAT. I
GUESS MY- IT SEEMS LIKE TO ME
THE WAY I UNDERSTAND THIS COULD
GO IS IT A KAISER COULD ACTUALLY
AND JUST REFER OUT ALL I MEAN
MEDICARE'S WHAT FIFTEEN CENTS ON
THE DOLLAR FOURTEEN CENTS ON THE
DOLLAR SOME UNGODLY
REIMBURSEMENT NUMBER- AND SO IF
THAT HAPPENS AND YOU JUST REFER
OUT THAT MEDICARE PATIENTS TO.
OUR SAFETY NET PROVIDERS WELL
THAT BECAUSE THEY'RE AND THEIR
ABILITY TO PROVIDE ACCESS TO
HEALTH CARE. AS WELL THAT YOU
KNOW WILL THAT IMPEDE THEM FROM
DOING THAT BECAUSE THE
AFFORDABILITY ISSUE FROM THE
HOSPITAL PERSPECTIVE. UNDER THIS
PROPOSAL ALL OF THE NEW CARS ARE
MEMBERS WOULD BE REQUIRED TO BE.
CARED FOR THE PRIMARY CARE
SERVICES WOULD BE REQUIRED TO BE
CARED FOR IN IN THE KAISER
FACILITIES SO THAT I REFERRAL
OUT TO. TO THE SAFETY NET IS NOT
IS NOT PART OF WHAT THIS THIS
PROPOSAL WOULD BE ABOUT. OKAY
AND THEN I GUESS MY LAST
QUESTION I THINK IT'S LIKE THE
SIXTY FOUR THOUSAND DOLLAR
QUESTION. WHAT HAPPENS IF THE
CONTRACT DOESN'T GET APPROVED- I
KIND OF WANTED A MORE DIRECT
ANSWER WILL KAISER PERMANENTE A
ACCENT THE MEDIC CAL AND-
MANAGED CARE SYSTEM. AGAIN I
THINK I WOULD PROBABLY REFER ARE
DEBT THAT'S A CRAZY QUESTION I
THINK IT'S A KAISER QUESTION I
GUESS IS THAT THE FEAR FROM THE
ADMINISTRATION IS A KAISER WOULD
EXIT THIS AND MEDIC CAL MANAGED
CARE SYSTEM WELL GRABBED HER
FROM OUR PERSPECTIVE JUST. THIS
IS ACTUALLY GETTING KAISER TO
PARTICIPATE MORE THAN THEY DO
TODAY SO EVEN IF WE WERE JUST TO
STIPULATE THAT WE SAY THE STATUS
QUO WITHOUT THIS WE ARE GETTING
MORE FROM KAISER WITH THIS
PROPOSAL THAN WE DO TODAY
IMPACTS THE VALUE ADD TO OUR
MEDICAL PROGRAM AND BENEFIT YOUR
REASON WHY WE'RE DOING THIS BUT
ALL THE ALCOHOL AT UNIT OVER TO
KAISER ON JAN THREE. THANK YOU
MA'AM. SURE YEAH I WOULD WOULD
THAT GO. DIRECTOR BY. MENTIONED
IS A THIS IS REALLY OPPORTUNE
FOR. TO TAKE THAT THE CALL- IT
HAS IN. IN THE MEDICARE PROGRAM
. I HAVE TWO MORE COUNTY THE
STATE ARE REALLY I THINK YOU
KNOW MY BACK TO THE AYE AYE AYE
ANDERSON. YOUR I'M YOU CAME IN-
A LITTLE THING THAT I'M IN
EARLIER IS THAT FOR KAISER I
RESPECT. THIS IS ABOUT. I'M
ADDING. FOR THE MEDIC PROGRAM
AND THEM TO COME. ARE I THAT IS
THE IS REALLY I THINK WHAT. WE
ARM OUR WAY WITH THE- ON TO MAKE
SURE THAT THAT- FOR OF OUR OUR
MEMBER AND ALSO FOR THE- THAT
WOULD. THAT WOULD. BE THE NEXT-
FIVE YEARS OF THE QUESTION
CONTRACT WITH THAT 20% GROWTH
THAT'S PART OF COMMITMENT I'M SO
I THINK THAT REALLY WOULD BE
THE- I GUESS THAT. YOU KNOW I
SEE THE DOWNSIDE RISK I THINK
YOU KNOW IN THE END AT THE END
OF THE DAY I THINK OUR
FACILITIES. ARE DOCTORS OR
PROVIDERS ARE GOING TO CARE FOR
OUR MEMBERS BUT I THINK IN TERMS
OF THE PROPOSAL- I THINK OUR
DEPOSIT BASS IT REALLY DOES
EXPAND. I'M ACCESS TO. PERMANENT
THESE QUALITY HEALTHCARE FOR OUR
INDIVIDUALS. ACROSS THE STATE.
RECEIVE THAT ELOQUENT RESPONSE.
THAT LINK CLEAREST. BUT I STILL
LIKE MY QUESTION A- IS K.
PERMAN. A HAVE ANY. M. DESIRE IN
CLEAN OR HAVE YOU TALKED ABOUT
EXITING THE MEDIC. SYSTEM
MANAGED CARE SYSTEM IF THIS.
PROPOSAL IS NOT- SECURED. AGAIN
WHAT I WHAT I MENTIONED EARLIER
AT ALL RESTATE THIS- STATES A
KAISER PERMANENTE'S INTEREST IN
THE MEDICARE PROGRAM IS PART OF
ITS CORE MISSION. I THINK WE
ARE. SHARED EARLIER THAT-
BECAUSE PERMANENT DATE- LOSES
ABOUT TWO BILLION DOLLARS A YEAR
I'M A MEDIC CAL THAT'S AND KERN
ST- AND DATA WITH THIS PROPOSAL
ACTUALLY GOING TO INCREASE- ARE
OUR MEDICARE FOR TRAINING YOU
NEED MORE COUNTIES ACROSS THE
STATE SO FOR KAISER I THINK. I'M
SERVING THE MEDICAID POPULATION
I'M SERVING THE MOST VULNERABLE
IN OUR COMMUNITIES THAT WE
SERVE- IS PART OF OUR MISSION
IT'S PART OF OUR DNA I'M SORRY I
CAN'T IMAGINE A SCENARIO WHICH
KILEY DOZENS. MEMBERS. PRECIADO
AN M. BUT I'M A BUSINESS OWNER
TO AND IF YOU'RE LOSING TO
DOLLARS A ON MEDICARE REMEMBER
THEN THERE'S A HE ISSUE THERE- I
DON'T THAT SHE THAT LOS- WITH
SAFETY NET PROVIDERS IN OTHER
AREAS- IS GOING TO SOLVE THE
PROBLEM AND- AGAIN I KNOW YOU
SAID YOUR MISSION IS TO TAKE
CARE OF MEDICARE PATIENTS BUT
YOU STILL HAVEN'T ANSWERED MY
QUESTION HAVE THERE BEEN
DISCUSSIONS ABOUT KAISER.
NOT
SERVING MEDIC CAL PUNCH.
OKAY SEEING NONE- LIKE CERTAINLY
CAN ASK MANY MORE QUESTIONS I
THINK- FAST BY MAINLAND SO I DO
WANT TO THANK OUR PRESENTERS WE
WILL NOW MOVE ON TO PUBLIC
COMMENT- ON THE ON. THE ISSUE SO
. WILL BEGIN HERE IN ROOM TWELVE
HUNDRED- SO WOULD ALLOW EACH
PERSON TO SPEAK FOR UP TO ONE
MINUTE- ON. ON THIS ISSUE AND
AGAIN IF YOU WISH TO GIVE MORE.
DETAILED COMMENTS OR REMARKS-
PLEASE FEEL FREE TO SUBMIT- YOUR
TESTIMONY IN WRITING TO THE- TO
THE SENATE COMMITTEE ON HEALTH
IN THE BUDGET SUBCOMMITTEE ON
HEALTH AND HUMAN SERVICES BUT
JUST AS A COMEDIAN FOR THREE-
BUT WITHOUT DID YOU HAVE ANY.
MOVED OUT TO THE PUBLIC COMMENT
OF SUCH SO- WILL NOW MOVE TO
PUBLIC COMMENTS SO BEGIN HERE
AND ROOM- TWELVE HUNDRED IS SET
AS OR ANY COMMENT FROM MEMBERS
OF THE PUBLIC HERE IN THIS ROOM.
OKAY SEEN ONE APPROACHING
MICROPHONE. MODERATOR PLEASE
OPEN THE LINES FOR- THE PUBLIC
WHO WISH TO TESTIFY ON IN
REGARDS TO- THIS. THE ISSUE OF-
THE- MEDICAL DIRECT CONTRACT
WITH THE KAISER PERMANENTE A
PROPOSAL- EACH UP PERSON AND I
CAN SPEAK FOR UP TO ONE MINUTE-
TO MAKE THEIR MAIN POINTS- SO-
IT PLEASE SAY YOUR NAME
INTRODUCED YOURSELF AND THE
ORGANIZATION WHICH REPRESENT IF
YOU REPRESENT AN ORGANIZATION.
AND THEN- YOU'RE YOUR YOUR
COMMENTS- IN REGARD TO THE TOPIC
OF THIS HEARING SO IF YOU COULD
PLEASE OPEN THE LINES AND- WILL
BE HAPPY TO TAKE YOUR PUBLIC
COMMENT. THANK YOU MISTER
CHAIRMAN IF YOU WOULD LIKE TO
PROVIDE PUBLIC COMMENT TODAY.
PLEASE PRESS ONE AND THEN ZERO.
THAT COMMAND AGAIN. ONE ZERO.
FIRST WE WILL HEAR FROM LINE
EIGHTY FOUR THANK. GOOD
AFTERNOON- I AM MICHAEL LOSE
AKKI KAISER PERMANENTE EMERGENCY
PHYSICIAN PRACTICE SACRAMENTO
AND ROSEVILLE MORE THAN ONE
THIRD OF THE PATIENTS THAT I SEE
IN OUR EMERGENCY DEPARTMENTS ARE
MEDICARE BENEFICIARIES. HOWEVER
THE MAJORITY OF THEM I'M NOT A
PAYMENT ACCOUNT MEMBERS A
SIGNIFICANT PROPORTION OF THESE
MEDICARE BENEFICIARIES THAT I
SEE IN THE EMERGENCY DEPARTMENT.
FIND OTHER PLANS AND THEY'RE NOT
COMING TO SEE ME IN THE
EMERGENCY DEPARTMENT NECESSARILY
BECAUSE OF AN EMERGENCY BUT
THEY'RE COMING TO SEE ME BECAUSE
THEY CAN'T ACCESS OR NOT
SATISFIED WITH THEIR PRIMARY
CARE SPECIALTY SERVICES THAT
THEY GET FROM THE PLAN THAT THEY
ARE ASSIGNED TO. IT SEEMS TO ME
THAT MEDICARE MANAGED CARE PLANS
AS CURRENTLY CONFIGURED ARE NOT
MEETING THE NEEDS OF THE- WHO
ARE I MET. AND WE'RE ON A
TRAJECTORY TOWARDS TIERS OF CARE
CAL. I SUPPORT DIRECT
CONTRACTING WITH THE STATE
BECAUSE I KNOW THAT KP MESCAL
MEMBERS HAVE THE SAME ACCESS
QUALITY AND SERVICE THAT I
RECEIVED AS A MEMBER OF OUR
PHYSICIAN GROUP THANK YOU ACT
CONTRACTING BREAK YOU THANK YOU
I APOLOGIZE YOU'RE OUT OF TIME I
THINK THANK YOU SO MUCH FOR YOUR
TESTIMONY AND AGAIN FEEL FREE TO
SUBMIT- MORE EXTENSIVE TESTIMONY
IN WRITING TO THE COMMITTEE.
WATER CAN WE MOVE ON TO THE
NEXT. SPEAKER ALLY EIGHTY. HELLO
HELLO YES PLEASE INTRODUCE
YOURSELF AND- YOU'RE TOTALLY.
THANK YOU I'M DOCTOR DEL I'M
KIND OF AN OLD DOCTOR SO I
WORKED IN THREE DIFFERENT
COUNTIES HERE IN SECOND AND THE
SECOND IN THE AREA. SACRAMENTO
COUNTY AND- AFTER COUNTY AND-
I'VE SEEN PATIENTS COMING OUT OF
EL DORADO COUNTY AND- I WOULD
SAY THAT I'VE NOTICED THAT OUR
CAL BENEFITS TO PATIENTS- CAN
HAVE TROUBLE ACCESSING
SPECIALIST- MAYBE SOME OF IT IS
YOU KNOW THE GEOGRAPHY BECAUSE-
THE ARIAN EL DORADO COUNTY CAN
BE A LITTLE REMOTE. BUT BUT I'VE
SEEN IT IN IN THE OTHER COUNTIES
AS WELL AND IT SEEMS LIKE
ANYTHING THAT WE DO TO IMPROVE
ACCESS. WOULD BE HELPFUL I MEAN
I THINK THAT THE- THE COUNTIES
WERE- WE'RE CLOSER IS
SUBCONTRACTED. IS EVIDENCE OF
THE PROBLEM OF HAVING INADEQUATE
ACCESS. THAT'S ALL I HAVE THANKS
VERY MUCH THANK YOU FOR
TESTIMONY. NEXT NEXT WITNESS.
SELENA NINETY ONE. CAN YOU HEAR
ME YES PLEASE INTRODUCE YOURSELF
THANK YOU- HELLO MY NAME IS CAN
NOW I'M AN INTERNAL MEDICINE
DOCTOR IN SAN JOAQUIN VALLEY I
WANT TO THANK THE ASSEMBLY MEN
FOR THIS BILL AND WISH TO SPEAK
IN SUPPORT OF THE CELL IS STILL
BE REALLY IMPORTANT FOR SOME
ROUTINE WHICH IS REALLY
MEDICALLY UNDERSERVED AND HAVE
SOLD FIFTY MOST VULNERABLE
POPULATION WILL MAKE IT EASIER
FOR MY LOW INCOME PATIENTS
ACTORS HIGH QUALITY CARE AT
KAISER. AND IN MY AREA KILEY OF
THE ONE OF THE BEST JOB YOU CAN
GET WHAT DO YOU I'M JUST A
RECEPTIONIST OR PHARMACY. COMING
COMMITTEE FOR MY PATIENTS AND
NEIGHBORS. I MENTION THIS
BECAUSE I HEARD SOME OPPONENTS
SAYING KAISER SOME THAT'S HOW IN
A WAY. BY OFFERING HIGHER
SALARIES I THINK THIS HAS BEEN A
- THING MY CAN. THE AYE JACKSON
. FOR WHAT INFO AND THEIR SHOULD
ASPIRE TO. HELP THE RETAIN. IN
SOUND LIKE VALLEY AND- A FAMILY
ENJOY DON'T TO MOVE AWAY FOR
GOOD JOB. THIRTY THREE. I IT'S
SUPPORT OF THE CELL. RIGHT YOU I
WOULD NOTE THE WITNESS WHO ARE-
THE IS AN FOR. HEARING THE BILL
THAT WAS REFERRED TO BY THE
PREVIOUS. WITNESS IS ACTUALLY
NOT BEFORE THIS THE SENATE YET.
ALTHOUGH IT IS ON THE SAME TOPIC
THAT'S WHY PERMITTED TO TEST ME
TO CONTINUE- BUT WE ARE NOT
ACTUALLY HEARING THE BILL BY.
SOME MEMBER ARAMBULA ON THIS
PARTICULAR TOPIC- SO WITH TO GET
JUST THE FOCUS THE REMARKS ON
THE TOPIC ITSELF OF THE- MEDICAL
DIRECT CONTRACT WITH KAISER
PERMANENTE A- THE PROPOSAL. BOTH
THE SO- MODERATE TO MOVE ON TO
THE NEXT WITNESS. LINE ONE
HUNDRED FIVE. WILK SAID DOUG
SAYING- I WORK WITH KAISER
PERMANENTE IN SAN DIEGO AND
PERMANENTLY MEDICAL GROUP NUMBER
YOU KNOW I FAVORED DIRECT
CONTRACTING WHAT HAPPENS IN SAN
DIEGO THAT WE DO HAVE A DIRECT
CONTRACTING AND WE KEEP WE DO
LOOK AT THE PATIENTS AND TAKE
CARE OF THE MOST VULNERABLE
POPULATION. YOU KNOW WE BELIEVE
THAT- YOU KNOW WHEN I SEE A
PATIENT I DON'T LOOK AT WHICH
CONTRACT YOU HAVE I JUST TAKE
CARE OF THEM AND BELIEVE THAT'S
THE REASON THAT WE DO HAVE SUCH
GOOD QUALITY AND OUTCOMES THE
DIRECT CONTRACTING ALLOW.
PACIENCIA WELL AND ALLOW THEM
ACCESS. TO THE SPACE THAT NEEDS
TO BE YOU KNOW AS A MEDICAL
GROUP WE REALLY BELIEVE IN
GIVING BACK TO THE COMMUNITY.
AND I CONTINUE TO DO THIS
WHETHER TO MEDIC CAL OTHERWISE
WHAT THE HOMELESS CLINIC THAT
THE- VOLUNTEER BUT THIS DIRECT
CONTRACTING WILL HELP. THE MOST
VULNERABLE GET THEM TO THE
QUALITY THAT THEY DESERVE- AND-
WE DO THIS BECAUSE OF YOU KNOW
WE'RE NOT. JUST TAKING CARE OF
PATIENTS WE ARE THE PATIENTS AND
WITH IN KIND OF PROMINENT TECH
THANK YOU THANK YOU QUALITY.
THANK THANK YOU SO MUCH FOR YOUR
TESTIMONY- MOVE ON TO THE NEXT
THE NEXT WITNESS PLEASE. WHITE
ONE HUNDRED. GOOD AFTERNOON WENT
AWAY WITH WESTERN CENTER ON LAW
AND POVERTY WERE NEUTRAL ON THE
DEPARTMENT'S PROPOSAL TO
DIRECTLY CONTRACT WITH KAISER WE
APPRECIATE THAT THIS PROPOSAL
WILL PROVIDE CONTINUITY OF CARE
AND HOLD KAISER TO THE SAME
STANDARDS THAT REQUIREMENT AND
OTHER MEDICARE PLANS WE ALSO
KNOW THAT THE MOST CLOSING THE
LEAD TO CURRENTLY RECEIVED CARE
FROM THERE UNDER THIS PROPOSAL
THE PATIENTS. WHO WOULDN'T BE
DIRECTLY THIRD BY HI THERE WILL
NOW HAVE ACCESS TO AN
INDEPENDENT MEDICAL REVIEW KILL
LIKE WHEN THE PLAN TONIGHT THE
SERVICE DONE BY IMPARTIAL
MEDICAL REVIEW. HOWEVER WE CAN
CATER TO. YEAH MORE. PLAYER AT
LEGAL AID. REPORT SAID THE MEDIC
CLAIM. TRYING TO GET INTO A CAR
COMMITTEE TO THE PROCUREMENT
PROCESS COULD TO HOLD THE BALL
PLAN INCLUDE KAISER COUNTY.
THANK YOU. THANKS VERY MUCH THE
NEXT WITNESS. WHITE ONE HUNDRED
. MY NAME IS MICHELLE ADVANCE
AND I PRACTICE CHILD ABUSE
PEDIATRICS ACROSS NORTHERN
CALIFORNIA WITH PERMANENT DAY IN
MY PRACTICE I FEEL THAT OF
PATIENT CARE EXPERIENCE WHO ARE
EXPERIENCING ABUSE AND ARE
PLACED INTO THE FOSTER CARE
SYSTEM THIS IS A COLOSSAL
DESTRUCTION IN THEIR LIFE AND
OFTEN THEIR AUTHOR REMOVED FROM
THEIR MEDICAL HOME WITH AS-
LITTLE DISRUPTION IN CONTINUITY
OF MEDICAL CARE CAN LEAD TO
DELAYS IN. RECEIVING WELL CARE
VACCINES AND TREATMENTS. FOR MET
CONDITIONS AND AT CHILDREN GOING
FOSTER ARE MORE LIKELY TO HAVE
AN HEALTHCARE NEEDS INCLUDING
MENTAL HEALTH NEEDS. I THINK
THIS. FINANCIAL GOING IN FOSTER
CAN REMAIN IN THEIR MEDICAL WITH
A OUR- SYSTEMIC. IT WOULD BE
ACCESS TO WELL BACK. AND OTHER
PRE. WELL AS AN ARRAY OF PDF
SPECIALISTS THANK YOU. THANK YOU
THAT'S WHAT. BLIGHTED SEVENTY
ONE. MISTER CHAIRMAN A MEMBER
POLICY- ON THE OF- MULTIPLE
COUNTIES IN CALIFORNIA SALAS
OBISPO MERCED HUMBOLDT SHASTA
SOLANO SONOMA AT A MINIMUM JUST
A COUPLE COMMENTS CENTER LIMÓN
HIT THE NAIL RIGHT ON THE HEAD
EARLIER WHEN SHE TALKED ABOUT
HOW IS THIS GOING TO AFFECT
HEALTH CARE COUNTY BY COUNTY.
BUT.
SERVICES EVERY DOCTOR THAT
CALLED IN SO FAR HAS BEEN A
PHYSICAL HEALTH DR SO BEHAVIORAL
HEALTH IS SOMETHING THAT THIS
COMMITTEE- THAT THE JOINT
COMMITTEES NEED TO TAKE A GOOD
HARD LOOK AT AND THEN LASTLY ON
THE WORK FORCE. IT IS REALLY.
EVERYTHING THE GOVERNOR SIGNED A
DEAL ON WORKFORCE RIGHT NOW IN
HE LEGISLATURE TRYING TO DO.
THAT THIS DOESN'T ACTUALLY
IMPAIR. Q. WHAT WILL WORK FOR
SINGLE LOOK LIKE A CALIFORNIA
THANK YOU THANK YOU VERY MUCH
NEXT WITNESS PLEASE. WHINE AT
NINETY THREE. THANK YOU MISTER
KAREN COMMITTEE MEMBERS MY NAME
IS DR DANISH EVEN I'M A KIND OF
PERMANENT ALCOHOL JUST THAT AND
I THIRD INNER SPECIALIST
PRACTICING IN L. A. COUNTY AND I
THINK IN SUPPORT AND THEY KEEP
YOU MEDICAL CONTRACT BECAUSE
I'VE BEEN PRACTICING IN L. A.
COUNTY FOR FOURTEEN YEARS
INCLUDES AN AREA THAT MONEY FOR
SIX YEARS AS- WE HAD VERY. NORTH
ANGELES. AREA THAT EVEN THAT
HIGH BY THE CALIFORNIA-
FOUNDATION IS NEARING. I HAD THE
PLEASURE OF RELIGIOUS SERVING
THE NEEDS OF THE COMMUNITY.
PERFORMING OFTEN LIFE CHANGING
EYE SURGERY AND I WOULD WELCOME
THE OPPORTUNITY TO SERVE MORE IN
THE COMMUNITY WHO NEED IT SO I
TRULY BELIEVE THIS CONTRACT WILL
OFFER MORE ACCESS. TO HIGH
QUALITY HEALTHCARE TO THOSE WHO
NEED IT THE MOST. THANK YOU.
THANK YOU NEXT WITNESS. LINE.
NINETY NINE. HI THIS IS JULIE
NIELSEN FOR THE NATIONAL UNION
OF HEALTHCARE WORKERS- WE ARE
VERY CONCERNED THAT WITHOUT
STRONG SAFEGUARDS EXPANDING
TIGERS MEDIC CALLIN ROMAN WOULD
PUT SOME OF THE STATE'S MOST
VULNERABLE RESIDENTS AT RISK DUE
TO PIETERS DEMONSTRATED FAILURES
TO PROVIDE TIME CORPORATE HELP.
FIFTY ITS CURRENT ENROLLEES. WE
CANNOT HOW COULD MEET THE NEEDS
OF AS MANY AS TWO HUNDRED
THOUSAND MORE MEDICARE
BENEFICIARIES WITHOUT
IMPLEMENTING MAJOR IMPROVEMENTS
TO ITS BEHAVIORAL HEALTH CARE
SYSTEM- SO WE OPPOSE THIS ITEM
UNLESS IT'S AMENDED TO REQUIRE
KAISER'S COMPLIANCE. WITH ALL
STANDARDS GOVERNING COVERAGE FOR
BEHAVIORAL HEALTH SERVICES OR AT
LEAST AGREEMENTS TO A PLAN OF
CORRECTION THAT WOULD ENSURE
COMPLIANCE WITH THE STANDARDS.
ALL RIGHT THANK YOU EXCELENTES.
BLIGHTED SEVENTY FIVE. DAVID
HURST- EMERGENCY POSITION FOR
KAISER PERMANENTE HEY SACRAMENTO
SPEAKING IN SUPPORT OF THIS
PROPOSAL I'M AT THE FRONT LINE
HEALTH CARE WORKERS THROUGHOUT
THE KOPET ANDEMIC AS FIRST HAND
HOW INTERRUPTIONS AND PATIENT
CONTINUITY OF CARE CAN HAVE
DISASTROUS IMPACTS ON THE HEALTH
AND WELLNESS OF THE COMMUNITIES
THAT WE SERVE AND I BELIEVE THAT
THIS PROPOSAL WILL SIMPLIFY
HEALTHCARE MANAGER ADEQUATELY
COACHES FOR BOTH STATIONS- AND-
QUALITY FR MEDICARE
BENEFICIARIES THANK YOU SO MUCH
FOR YOUR TIME. THANK YOU VERY
MUCH NEXT WITNESS. LINE NINETY
FIVE. PUT IN YOUR ME YES PLEASE
INTRODUCE YOURSELF. THANK YOU
THIS IS CAN'T INSTEAD N. ON THE
GENERAL PEDIATRICIAN ACROSS FROM
THAT TO A LOCAL HERE IN
ROSEVILLE AND SPEAKING TODAY ON
BEHALF OF KAISER IN SUPPORT OF
THIS CONTRACT I'M PROUD TO SERVE
AS THE CHAIR OF THE MEDIC CAL
CHILDREN PUBLIC PANEL HERE AT
THE CAPITOL AS WELL AS A MEMBER
OF THE CALTRAIN CHILDREN AND
YOUTH ABOUT YOUR GROUP'S
DEPARTMENT HEALTH CARE SERVICES.
AND WHAT TO THE PEDIATRICIANS
COMMUNITY FOR TWENTY YEARS BOTH
INSIDE OF KAISER AND ALSO IN
PRIVATE PRACTICE AND SELECT
CERTAINLY SEEN FIRSTHAND THE
NEED FOR IMPROVED ACCESS TO CARE
FOR MEDICARE BENEFICIARIES AND I
CERTAINLY BELIEVE DISCOUNT
REPRESENTS A VERY REASONABLE
APPROACH TO INCREASING MCALLEN
MOMENT WITHIN KAISER AND WHICH
MAY CREATE. YOUR APPROVAL THIS
CONTRACT THANK YOU. THANK YOU
NEXT WITH S. ONE ONE HUNDRED AND. IT'LL PROBABLY BE HERE WITH
YOU NOW- UNITED IN SUPPORTING
THE PROPOSAL WHICH ENABLE THE
INTEGRATIVE HEALTHCARE PROVIDERS
AB LARGER ROLE IN THE STATE'S
MEDICAL PROGRAMS INCLUDING
CAPABLE SO CHILDREN GO ELIGIBLE
AND OTHER LOW INCOME
CALIFORNIANS WHO RELY MEDICAL
PROGRAM TO GET THEIR COVERAGE
AND CARE I'M I'M A CONTRACTOR HE
HE WILL BE DIRECTLY ACCOUNTABLE
TO THE STATE DELIVERING QUALITY
SERVICE. AND A FULL PERSON TURN
ALL AREAS WHERE THEY CURRENTLY
EXIST THIS WILL BE ONE ASPECT
THE OVERALL EFFORT TO TRANSFORM
THE MEDICAL PROGRAM THAT WORKS
BETTER PATIENTS ACROSS THE.
CONTINUUM OF CARE. WELCOME WILL
REDUCE. FROM ON ON. COSTS ARE
NURSES AND HOW THE WORK. ASIAN
ADVOCATE THAT THE FEDERAL AND
BEYOND AND WE FORWARD SERVING
CURRENT FUTURE UP A OKAY. THANK
YOU YOUR KITCHEN. THANK YOU NEXT
WITNESS. LINE ONE HI ELEVEN.
GOOD AFTERNOON JOSH DUGGAR
BEHALF OF THE SANTA CRUZ AND
SANTA TO BOARD SUPER. BOTH THE
PO TO THIS PROPOSAL TE REASONS
MENTIONED BY MANY SPEAKERS TODAY
THANK YOU I THANK YOU NEXT
WITNESS. BETTER CARE THERE ARE
NO FURTHER COMMENT AT THIS TIME
ALL RIGHT THANK YOU VERY MUCH-
AGAIN REALLY APPRECIATE- THE-
PUBLIC TESTIMONY AND- ALSO WANT
TO THANK ALL OF THE PRESENTERS
HERE TODAY ONE THINK THE PARMA
HEALTHCARE SERVICES DIRECTOR
PASAR MEDICAID DIRECTOR. CASEY
COOPER DAISY COOPER- WHO ELSE
AND HAD TO TAKE ON MANY
QUESTIONS FROM US ALSO ALL OF
OUR STAKEHOLDERS AS WELL-
RESHAPED FROM KAISER PERMANENTE
A- GUIDANCE FROM LOCAL HEALTH
PLANS A CALIFORNIA WHO ALSO
FIELDED MANY QUESTIONS- ANDY.
ANDY MARTINEZ- PETERSON FOR THE
CALIFORNIA ASSOCIATION HAS A
TAURUS CONCEALERS FROM HEALTH
ACCESS CALIFORNIA I THANK ALL
THE MEMBERS OF THE COMMITTEE WHO
I KNOW HAVE MANY OTHER-
COMPETING- THINGS UNDER SCHEDULE
BUT- THE FACT THAT WE STATE
SOMEBODY. SEVERAL HOURS HERE TO
REALLY DIG INTO. THE I THINK
IT'S TELLING IN TERMS OF HELP
FOR THIS IS. SO LOOKING FOR TO
COULD THIS CONVERSATION BOTH IN
THE BUDGET DELIBERATIONS AND
ONCE- AB TWO TWENTY SEVEN TWENTY
FOUR BY SOME MEMBER RAMBLE IT
COMES TO THE SENATE- THIS- FIRST
OF ALL I WANNA SAY IS THAT-
THERE THERE'S A LOT OF WORK TO
IMPROVE. CAL GOING ON RIGHT NOW
SO WE'VE NOW. THERE'S THE CALLIN
PROGRAM. THE REPORT SHERMAN TO
THAT WE'RE DOING- AND- CERTAINLY
THIS- THIS PROPOSAL IS THE
QUESTIONS HOUSES PROPOSAL FIT
INTO THIS AND I THINK ULTIMATELY
WE WANT TO LOOK AT ANY SORT OF
PROPOSAL FROM THE FRAME OF
WHAT'S BEST FOR THE PATIENT ON
MEDICAL. THE CITY CALIFORNIA WE
HAVE RESPONSIBILITY THROUGH THE
MEDICARE PROGRAM TO ENSURE THAT
THEY HAVE HIGH QUALITY
HEALTHCARE- WE DON'T WANT TO
CREATE A TWO TIER SYSTEM WITH A
MEDIC CAL WE WANT TO BE SURE TO
EVERY HEALTH PLAN IS HELD
EQUALLY ACCOUNTABLE- FOR. THE
OUTCOMES THAT THE- BETTY
FISHERIES. IN MEDIC CALORIE-
AND- WE WANT TO BE SURE WE
PROVIDE- MANY MULTIPLE WAYS FOR
THEM TO BE SURE TO CAN GET THE
CARE THEY NEED- SO THAT- BECAUSE
WE OF THE- RUN MEDIC CAL- WELL
THERE'S CERTAIN. ARAMETERS IN
WHICH YOU GUYS PEOPLE THAT FIND
WHO IS ABLE TO ENROLL IN THE
MEDICARE PROGRAM WE KNOW WITHIN
THAT THERE'S MANY DIVERSE NEEDS
AS WELL. SO SO CERTAINLY WE WANT
TO LOOK AT- THIS PROPOSAL THE
CONTEXT OF IS. PATIENTS ON
MEDICARE IS IT PROVIDE GREATER
ACCESS HOW THE AFFECT- THE COR
NOT ONLY PATIENTS ARE ABLE TO
SIGN UP BUT THE PATIENTS WHO
AREN'T ABLE TO ARE MADE YOU KNOW
WHO MAY BE IN OTHER COUNTIES AND
SO FORTH SO WE FOR MANY OF THESE
ISSUES BROUGHT UP BY MEMBERS OF.
BOTH THE- BUDGET THAT BUT
SUBCOMMITTEE ON HEALTH HUMAN
SERVICES AS WELL AS THE SENATE
COMMITTEE ON HEALTH AND SO WILL
BE CONTINUED TO LOOK AT THESE
ISSUES I DO WANNA THANK AGAIN
ALL THE INDIVIDUALS WHO CALLED
IN AND- FOR PUBLIC TESTIMONY
TODAY AND ONE REMIND YOU THAT
YOU ARE NOT ABLE TO TESTIFY VIA
CONFERENCE SERVICE PLEASE SUBMIT
YOUR COMMENTS OR SUGGESTIONS IN
WRITING TO THE SENATE COMMITTEE
ON HEALTH OR VISIT OUR WEBSITE.
AND YOUR KIDS ARE FOUR PLUS ONE
OF THE TESTIMONY AND OFFICIAL
HEARING RECORD SO AGAIN WHAT
THANK YOU APPRECIATE YOUR
PARTICIPATION AND SO WITH THAT
AGAIN WANT TO THANK THE STAFF
THE SERGEANTS TECHNICAL STAFF TO
MEET THE SECURING A POSSIBLE AND
WE HAVE NOW- INCLUDED THE AGENDA
OF THIS HEARING OF THE SENATE
COMMITTEE ON HEALTH IN THE
SENATE BUDGET FISCAL REVIEW
SUBCOMMITTEE NUMBER THREE AT
THIS HEARING. IS NOW ADJOURNED
THANK YOU.