Board of Commissioners Meeting Agenda - …...An adjourned regular meeting of the Partnership HealthPlan of California will be called to order at A ndaz Hotel on February 26, 2020

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TimePage Item Description Presenter

Action/Discussion

11.1 8:00 AM Call to Order

An adjourned regular meeting of the Partnership HealthPlan of California will be called to order at Andaz Hotel on February 26, 2020 located at 1450 First Street, Napa, CA 94559.

1.2 Roll Call Board Clerk1.3 Agenda Approval or Modifications Randall Hempling, Chair Action1.4 4-5 Resolution to Approve the New Board Member

Appointment of Gary Pace, M.D., MPHAction

This resolution approves the new Lake County appointment of Dr. Gary Pace, Public Health Officer for County of Lake, Health Services. Dr. Pace replaces Robert Gardner, M.D. on the PHC Board.

1.5 6-7 Resolution to Approve the New Board Member Appointment of Melissa Marshall, M.D., MPH

Action

This resolution approves the new Yolo County appointment of Dr. Melissa Marshall, Chief Executive Officer for CommuniCare Health Centers. Dr. Marshall replaces Allan Yamashiro, M.D. on the PHC Board.

1.68-10

Resolution to Approve the New Board Chair / Vice Chair Appointments

This resolution approves the appointment of Nancy Starck as the new Board Chair for calendar year 2020 - 2022, and Alicia Hardy as the new Board Vice-Chair for calendar year 2020 - 2022.

1.7 11-23 Approval of Board Meeting Minutes

This action approves the Board meeting minutes for December 4, 2019

1.8 Commissioner Comments

At this time, Commissioners may provide comments and announcements.

1.9 Public Comments

At this time, members of the public may address the Board on any non-agenda item of interest to the public that is within the subject matter jurisdiction of the Board. Members of the public will have the opportunity to address the Board on a scheduled agenda item during the Board's consideration of that item. Speakers will be limited to three (3) minutes.

1.10 Correspondence Board Clerk Information

1.11 Recognition for Elba Gonzalez-Mares Board Clerk InformationMs. Gonzalez-Mares received an Honorable Mention from the Association for Community Affiliated Plans (ACAP) for the Leadership in Advocacy Award.

Liz Gibboney /Kevin Spencer

Information

Action

Liz Gibboney

Liz Gibboney Action

Information

Conflict of Interest Reminder - Commissioners should abstain from voting on any agenda item where they might have a conflict of interest.

PHC Mission Statement is "to help our members, and the communities we serve, be healthy"

Public and Guest Reminder - Public comment is welcome during designated "Public Comments" time frames.

Board of Commissioners Meeting AgendaAndaz Hotel Napa located at 1450 First Street, Napa CA

February 26, 2020 8:00 a.m. – 8:45 a.m.

No Video Conferencing Available (in-person meeting only)

Opening

Randall Hempling, Chair Action

InformationPublic

Commissioners

Randall Hempling, Chair

Liz Gibboney

PHC Board Meeting Packet for 02-26-20 | Page 1 of 95

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Action/Discussion

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8:10 AM 24-25 Resolution to Ratify Finance Committee's approval of a Special Decision for Mountain Valleys Health CenterThis resolution approves an early payout of PCP QIP dollars to Mountain Valleys Health Center.

Resolution to Ratify Finance Committee's approval of the Amendment to ADM-21

This resolution approves recommended changes to ADM-21 to add the Provider Grievance Review Committee. Resolution to Ratify Finance Committee's approval for a Finance Committee Membership Change

This resolution approves the resignation of Commissioner Letty Garza from the Finance Committee.Resolution to Ratify Finance Committee's approval to Fund PHC's Wellness & Recover Program Fiscal Model

This resolution approves the funding for PHC’s new Wellness & Recovery program.

3

Resolution to Accept All PHC Committee Minutes, Committee Packets, and Departmental Operating Reports. In addition, to Approve All PHC Policies and Program Descriptions Approved by the Physician Advisory Committee (PAC)

Liz Gibboney Action

This resolution provides commissioners with links to all PHC committee packets and departmental operating reports for their acceptance. It also provides them with all PHC policies and program descriptions previously approved by PAC in Janaury and February 2020 for their approval.340B Advisory Committee Update for December 2019

Consumer Advisory Committee (CAC) for December 2019 (North)Consumer Advisory Committee (CAC) for December 2019 (South)Finance Committee for Janaury 2020

Finance Committee for February 2020

Physician Advisory Committee for Janaury 2020- Quality and Utilization Advisory Committee (Q/UAC)- Internal Quality Improvement (IQI)- Provider Advisory Group- Credentialing CommitteePhysician Advisory Committee for February 2020- Quality and Utilization Advisory Committee (Q/UAC)- Internal Quality Improvement (IQI)- Provider Advisory Group- Credentialing CommitteeStrategic Planning Committee for January 2020

Resolution to Approve a Quality/Utilization Advisory Committee (Q/UAC) Membership ChangesThis resolution approves membership changes to the committee due to the resignation of Thomas Paukert, M.D., and the new appointment of Brandy Lane as a new member.

4

Resolution to Approve the Semi-Annual Board DashboardThis resolution approves PHC's dashboard that includes operational quality indicators.

Committee Meeting Minutes and Material is

available on the PHC Website

(Click on links)

Liz Gibboney

3.1 8:15 AM 37-38

Regular Agenda Items

Consent Calendar Actions (3.1 - 3.2)All matters listed on the Consent Calendar are to be approved with one motion unless a member of the Board removes an item for separate action. Any Consent Calendar item for which separate action is requested shall be heard as the next Agenda item.

Action

Sonja Bjork41-55 Action4.1 8:20 AM

2.4 34-36

2.1 Liz Gibboney / Patti McFarland

Action

26-31 Liz Gibboney Action

2.3 32-33 Liz Gibboney Action

2.2

Ratification of Finance Committee Actions (2.1 - 2.4)All matters listed will be approved with one motion unless a member of the Board removes an item for separate action. Any Consent Calendar item for which separate action is requested shall be heard as the next Agenda item.

3.2 39-40

Liz Gibboney Action


http://www.partnershiphp.org/About/Documents/340B/December%202018%20Update%20-%20340B%20Advisory%20Committee%20-%20FINAL.pdf

http://www.partnershiphp.org/Members/Medi-Cal/Documents/CAC/2019NRAgendaDec.pdf

http://www.partnershiphp.org/Members/Medi-Cal/Documents/CAC/SR_CAC-Dec2019-AgendaPacket.pdf

http://www.partnershiphp.org/About/Documents/FinanceCommittee/2020/Finance%20Committee_Packet_011520.pdf

http://www.partnershiphp.org/About/Documents/FinanceCommittee/2020/Finance%20Committee%20Packet%20_2.19.20.pdf

http://www.partnershiphp.org/Providers/HealthServices/Documents/Physicians%20Advisory%20Committee%20-%20PAC/2020/January%202020/PACPacket_01-08-2020.pdf

http://www.partnershiphp.org/Providers/HealthServices/Documents/Physicians%20Advisory%20Committee%20-%20PAC/2020/February%202020/PACPacket_02-12-2020r.pdf

http://www.partnershiphp.org/About/Documents/StrategicPlanning/SPC%20Agenda%201.8.20%20FINAL.pdf

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Action/Discussion

Resolution to Approve Commendations and Appreciation for Commissioner Randall Hempling's service to PHC as the Board Chair

This resolution recognizes and commends Commissioner Hempling for his outstanding service to PHC and the Board as the Board Chair from February 28, 2018 through February 26, 2020.Resolution to Approve Commendations and Appreciation for Commissioner Sarada Mylavarapu M.D.'s Service to PHC and the BoardThis resolution recognizes Commissioner Mylavarapu's service and contributions to the Board and to PHC since June 28, 2017.Resolution to Approve Commendations and Appreciation for Commissioner Letty Garza's Service to PHC and the BoardThis resolution recognizes Commissioner Garza's service and contributions to the Board and to PHC since June 22, 2016.Resolution to Approve Commendations and Appreciation for Commissioner Cheyenne Spetzler's Service to PHC and the BoardThis resolution recognizes Commissioner Spetzler's service and contributions to the Board and to PHC since June 27, 2018.

55.1 8:30 AM 64-80 Metrics and Financial Update for December 2019 Patti McFarland Information

5.2 81 PHC Committee Vacancies Liz Gibboney Information5.3 82 Quarterly Compliance Dashboard Amy Turnipseed Information5.4 83-87 COO Operations Update Written Report Only Information

5.5 88-92 Update on Local Innovations Grants on Housing Written Report Only Information

5.6 93-95 Press Releases Written Report Only Information

6 Member Story / Adjournment

6.1 8:40 AM Ribbon Cutting Celebrations in PHC's Southern and Northern Regions

Liz Gibboney Information

6.2 8:45 AM Meeting adjourned

7 Upcoming Board Meetings4/22/2020 - Main location is Santa Rosa6/24/2020 - Main location is Fairfield

10/23/2020 - Main location is Fairfield12/2/2020 - Main location is Santa Rosa

62-63

Liz Gibboney Action

Action

4.2 56-57

60-61

Liz Gibboney Action

4.3 58-59

Liz Gibboney

Government Code §54957.5 requires that public records related to items on the open session agenda for a regular commission meeting be made available for public inspection. Records distributed less than 72 hours prior to the meeting are available for public inspection at the same time they are distributed to all members, or a majority of the members of the Commission. The Commission has designated the Board Clerk as the contact for Partnership HealthPlan of California located at 4665 Business Center Drive, Fairfield, CA 94534, for the purpose of making those public records available for inspection. The Board Meeting Agenda and supporting documentation is available for review from 8:00 AM to 5:00 PM, Monday through Friday at all PHC regional offices (see locations above). It can also be found online at www.partnershiphp.org.

PHC meeting rooms are accessible to people with disabilities. Individuals who need special assistance or a disability-related modification or accommodation (including auxiliary aids or services) to participate in this meeting, or who have a disability and wish to request an alternative format for the agenda, meeting notice, agenda packet or other writings that may be distributed at the meeting, should contact the Board Clerk at least ten (10) days prior to the scheduled meeting at (707) 863-4241 or by email at [email protected]. Notification in advance of the meeting will enable the Board Clerk to make reasonable arrangements to ensure accessibility to this meeting and to materials related to it.

This agenda contains a brief description of each item to be considered. Except as provided by law, no action shall be taken on any item not appearing on the agenda.

8/26/2020 - Main location is Sheraton Hotel in Redding

Other Reports

Liz Gibboney Action

4.4

4.5


BOARD MEMBER APPOINTMENT AGENDA REQUEST for

PARTNERSHIP HEALTHPLAN OF CALIFORNIA

Board Meeting Date: Agenda Item Number: February 26, 2020 1.4

Resolution Sponsor: Liz Gibboney, CEO, Partnership HealthPlan of CA

Recommendation by: Lake County Board of Supervisors

Topic Description: On November 19, 2019, Gary Pace, M.D., MPH, the Public Health Officer for the County of Lake Health Services was appointed by the Lake County Board of Supervisors to the Partnership HealthPlan of California (PHC) Commission (known as the Board) to replace Robert Gardner, M.D.

Dr. Pace’s appointment commences on February 26, 2020, and concludes on December 31, 2024.

Reason for Resolution: To obtain Board approval to appoint Dr. Gary Pace to the PHC Board as the Lake County Representative.

Financial Impact: There is no financial impact to the HealthPlan.

Requested Action of the Board: Based on the recommendation of the Lake County Board of Supervisors, the Board is asked to approve the new appointment of Gary Pace, M.D., MPH, to the PHC Board.



PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board Meeting Date: Agenda Item Number: February 26, 2020 1.4

Resolution Number:

20- IN THE MATTER OF: APPROVING THE NEW LAKE COUNTY APPOINTMENT FOR GARY PACE, M.D., MPH, TO THE PHC BOARD

Recital: Whereas,

A. Certain agencies have responsibility for appointing Board members.

B. Lake County has a vacant seat.

C. The Board has authority to approve and appoint committee members.

Now, Therefore, It Is Hereby Resolved As Follows:

1. To approve the new Lake County appointment of Gary Pace, M.D., MPH, to the PHC Board for a four-year term of office.

PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 26th day of February 2020 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: Commissioners: ABSENT: Commissioners: EXCUSED: Commissioners:


Date ATTEST: BY:

Cynthia McCamey, Clerk






Recommendation by: Yolo County Board of Supervisors

Topic Description: On January 28, 2020, Melissa Marshall, M.D., the Chief Executive Officer of CommuniCare Health Centers was appointed by the Yolo County Board of Supervisors to the Partnership HealthPlan of California (PHC) Commission (known as the Board) to replace Allan Yamashiro, Pharm.D.

Dr. Marshall’s appointment commences on January 28, 2020, and concludes on January 28, 2024.

Reason for Resolution: To obtain Board approval to appoint Melissa Marshall, M.D., to the PHC Board as the Yolo County Community Health Center Representative.


Requested Action of the Board: Based on the recommendation of the Yolo County Board of Supervisors, the Board is asked to approve the new appointment of Melissa Marshall, M.D. to the PHC Board.




Resolution Number:

20- IN THE MATTER OF: APPROVING THE NEW YOLO COUNTY APPOINTMENT FOR MELISSA MARSHALL, M.D., TO THE PHC BOARD

Recital: Whereas,

A. Certain agencies have responsibility for appointing Board members.

B. Yolo County has a vacant seat.

C. The Board has authority to approve and appoint committee members.


1. To approve the new Yolo County appointment of Melissa Marshall, M.D. to the PHC Board for a four-year term of office.



Date ATTEST: BY:







Recommendation by: Southeast Region Nominating Committee

Topic Description: Based on the Partnership HealthPlan of California (PHC) bylaws (Article 3), the Commission (known as the Board) elects officers at the first February meeting every two years. PHC Board officers rotate by region (Southwest, Northeast, Northwest, and Southeast). A “nominating committee” made up of commissioners from each of those regions serve on a committee and they are responsible for selecting a vice-chair to represent their region. The full Board reviews and approves the “nominating committee’s” recommendation for the vice-chair position at the February Strategic Planning Retreat.

In October 2019, PHC’s Southeast region was responsible for selecting the next vice-chair, so the “nominating committee” made up of Commissioners Lewis Broschard, M.D., Alicia Hardy, Gerald Huber, Karen Larsen, Viola Lujan, Allan Yamashiro, Pharm.D., and Jennifer Yamashiro met by phone and selected Alicia Hardy.

Once approved by the full Board, Alicia Hardy will serve as the vice-chair for a two-year term of office when Nancy Starck rotates into the chair position. The term for both positions will begin on February 26, 2020 following the Strategic Planning Retreat and end on February 23, 2022.

Reason for Resolution: To obtain Board approval for Nancy Starck to rotate to the Board Chair position and Alicia Hardy to be appointed as the next Board Vice-Chair representing the Southeast region. As well as approving, the Southeast region “nominating committee” meeting minutes for October 23, 2019.


Requested Action of the Board: Based on the recommendation of PHC’s Southeast region Nominating Committee, the Board is asked to approve the appointment of Nancy Starck as the Board Chair and Alicia Hardy as the next Board Vice-Chair for a two-year term of office, as well as the Southeast region “nominating committee” meeting minutes for October 23, 2019.




Resolution Number: 20-

IN THE MATTER OF: APPROVING THE APPOINTMENT OF THE BOARD CHAIR AND VICE CHAIR AS WELL AS THE SOUTHEAST REGION NOMINATING COMMITTEE MEETING MINUTES Recital: Whereas,

A. According to PHC Bylaws, Board commissioners elects the officers of the Board.


1. To approve Nancy Starck as the next Board Chair for calendar year 2020 – 2022.

2. To approve Alicia Hardy as the next Board Vice-Chair for calendar year 2020 – 2022.

3. To approve the Southeast region “nominating committee” meeting minutes for October 23, 2019 (attached).



Date ATTEST: BY:



MINUTES OF THE MEETING OF PARTNERSHIP HEALTHPLAN OF CALIFORNIA (PHC)

Southeast Region Nominating Committee Meeting Meeting held at

PHC's Southwest Office located at 4665 Business Center Drive, Fairfield, CA

On October 23, 2019

Commissioners Present: Lewis Broschard, M.D., Alicia Hardy, Gerald Huber, Karen Larsen, Viola Lujan, Allan Yamashiro, Pharm.D., and Jennifer Yasumoto Staff Present Liz Gibboney, Sonja Bjork, Ashlyn Scott Liz Gibboney opened the meeting by informing the group that in February 2020, there will be a new rotation of Chair and Vice Chair for the Board of Commission. The current Vice Chair, Nancy Starck, will fill the Chair position and a Southeast Region Board Member will fill the upcoming two-year term for Vice Chair. The Southeast Region Nominating Committee is responsible for nominating the Vice Chair. Ms. Gibboney reminded the committee members that this is a four-year commitment, as the nominee will serve two years as the Board Chair following their Vice Chair term. Ms. Gibboney asked the members if there were any volunteers for the Vice Chair position. Karen Larsen, from Yolo County, and Alicia Hardy, from Napa County, both raised their hands to volunteer. Ms. Gibboney then announced that since we have two volunteers, we would take a vote to decide who will fill the Vice Chair position. All committee members present wrote down their vote and Ashlyn Scott, Assistant Board Clerk, collected and counted the votes. She then shared the results with Ms. Gibboney, who announced to the group that Alicia Hardy would be the next Vice Chair of the Board. Ms. Gibboney inquired whether anyone had questions. Hearing none, she asked for a motion to approve Alicia Hardy’s appointment to Vice Chair.

MOTION: Commissioner Broschard moved to approve Alicia Hardy’s appointment, seconded by Commissioner Huber.

The Assistant Clerk summarized the vote as follows:

BOARD ACTION SUMMARY: 6 yes, 0 no, 1 abstention (Alicia Hardy)


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MINUTES OF THE MEETING OF PARTNERSHIP HEALTHPLAN OF CALIFORNIA (PHC)

Meeting held at PHC's Southwest Office located at 495 Tesconi Circle, Santa Rosa, CA

Video Conference Locations: PHC's Southeast Office located at 4665 Business Center Drive, Fairfield, CA

PHC's Northeast Office located at 2525 Airpark Drive, Redding, CA PHC’s Northwest Office located at 1036 5th Street, Ste E, Eureka CA

On December 4, 2019

Commissioners Present: Jonathon Andrus, Aimee Brewer, Mary Kay Brooks, Lewis Broschard, M.D., Amby Burum, Tammy Moss Chandler, Paula Cohen, Donnell Ewert, Richard Fogg, Letty Garza, Dean Germano, Alicia Hardy, Randall Hempling, Gerald Huber, Lynn Hudgens, Dave Jones, Karen Larsen, Viola Lujan, Mitesh Popat, M.D., Kathryn Powell, William Remak, Heather Snow, Cheyenne Spetzler, Nancy Starck, Kimberly Tangermann, Matthew Willis, M.D., Allan Yamashiro, Pharm.D., and Jennifer Yasumoto

Commissioners Excused: Greta Elliott, Sarada Mylavarapu, M.D, John Reeves III, Barbie Robinson

Commissioners Absent:

Staff Present La Rae Banks, Kaylee Baquiax, Sonja Bjork, Mark Bontrager, Beth Caruso, Paula Frederickson, David Glossbrenner, M.D., Peggy Hoover, Jeff Ingram, Mary Kerlin, Margaret Kisliuk, Leslee Kitzman, Marshall Kubota, M.D., Stan Leung, Regina Littlefield, Dustin Lyda, Lisa Malvo, Cindy McCamey, Patti McFarland, Robert Moore, M.D., Tommee Naenphan, Jay Navarrete, Lisa O’Connell, Atim p’Oyat, Jose Puga, Erika Robinson, Michelle Rollins, Nikki Rotherham, Jing Sancho, Karl Santos, Chloe Schafer, Lynn Scuri, Tahereh Daliri Sherafat, Lyle Smith, Kevin Spencer, Chris Triolo, Amy Turnipseed, Colleen Valenti, Wendi West, James Wills, Elizabeth Gibboney, CEO, and Ashlyn Scott, Assistant Board Clerk

Guests Present T. Abrahams, Jessica Coyne-Lowe, Matt Gal, Heather Resseger


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AGENDA ITEM 1.0 OPENING AGENDA ITEM 1.1 CALL TO ORDER Commissioner Randall Hempling, Chair, called the bi-monthly meeting to order in PHC’s Southwest office located at 495 Tesconi Circle, Santa Rosa, CA, and welcomed everyone to the meeting. Board members were reminded to abstain from voting on any agenda item where they might have a conflict of interest, and to state their name before asking questions or making motions. As a reminder, Commissioner Hempling read the PHC Mission Statement that is, “to help our members, and the communities we serve, be healthy.” He also mentioned that guests would have an opportunity to speak at designated times throughout the agenda.

AGENDA ITEM 1.2 ROLL CALL Ashlyn Scott, Assistant Clerk of the Commission, called the roll and indicated there was a quorum. AGENDA ITEM 1.3 RESOLUTION TO APPROVE THE HOSPITAL QUALITY IMPROVEMENT PROGRAM WINNERS Dr. Robert Moore began by briefly outlining Partnership Healthplan’s Hospital Quality Improvement Program (QIP), in which twenty-five hospitals participated, and where we have seen improvements every year. Twenty-three of the twenty-five hospitals who participated scored above 70%. For the 2018-2019 Hospital Quality Improvement Program (HQIP), we had ten top performing hospitals that achieved high QIP scores: Adventist Health Howard Memorial (100%), Banner Lassen Hospital (90%), Mad River Community Hospital (100%), Mendocino Coast District Hospital (100%), Mercy Medical Center Mt. Shasta (95%), Mercy Medical Center Redding (90%), Northbay Hospital (90%), Petaluma Valley Hospital (90%), Trinity Hospital (100%), and Woodland Memorial Hospital (90%). The high performing hospitals were congratulated and honored with a plaque for their accomplishment. Commissioner Germano inquired about the standards for the Hospital QIP program. Dr. Moore replied that most of the measures align with national standards but there are some that are specific to PHC. Commissioner Hempling inquired whether anyone had questions, corrections, or comments regarding the Hospital QIP winners. Hearing no requests, he asked for a motion to approve.

MOTION: Commissioner Fogg moved to approve the Hospital QIP winners for 2018-2019 as presented, seconded by Commissioner Yamashiro.

Commissioner Hempling asked for commissioner or public comments. Hearing no requests, He called for a vote. The clerk summarized the vote as follows: BOARD ACTION SUMMARY: 28 yes, 0 no, 0 abstention. Motion carried with Commissioners Elliot, Mylavarapu, Robinson and Reeves excused. AGENDA ITEM 1.4 AGENDA APPROVAL OR MODIFICATION Commissioner Hempling asked if anyone had any changes for the agenda. Hearing no requests, he asked for a motion to approve the agenda.


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MOTION: Commissioner Cohen moved to approve the agenda as presented, seconded by Commissioner Hempling.

Commissioner Hempling asked for commissioner or public comments. Hearing none, he called for a vote. The Clerk summarized the vote as follows: BOARD ACTION SUMMARY: 28 yes, 0 no, 0 abstention. Motion carried with Commissioners Elliot, Mylavarapu, Robinson and Reeves excused. AGENDA ITEM 1.5 APPROVAL OF OCTOBER 23, 2019 MINUTES Commissioner Hempling inquired whether anyone had questions, corrections, or comments regarding the minutes. Hearing no requests, he asked for a motion to approve.

MOTION: Commissioner Cohen moved to approve the Board meeting minutes for October 23, 2019 as presented, seconded by Commissioner Hempling.

Commissioner Hempling asked for commissioner or public comments. Hearing no requests, He called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY: 28 yes, 0 no, 0 abstention. Motion carried with Commissioners Elliot, Mylavarapu, Robinson and Reeves excused. AGENDA ITEM 1.6 COMMISSIONER COMMENTS Commissioner Hempling asked if there were any commissioner comments or announcements. Commissioner Hempling apologized that PHC had to cancel the company’s Halloween festivities this year, due to the Kincade fire, as we know how important this event is to staff. Commissioner Spetzler stated that Open Door used their Partnership HealthPlan PCP QIP dollars to give staff holiday bonuses and it means so much to them. Hearing no more comments, Commissioner Hempling moved on to public comments. AGENDA ITEM 1.11 PUBLIC COMMENTS Commissioner Hempling asked if there were any public comments. Hearing no requests, he moved on to correspondence. AGENDA ITEM 1.12 CORRESPONDENCE Commissioner Hempling asked if there was any correspondence. Ashlyn Scott, Assistant Clerk of the Commission, replied no. AGENDA ITEM 1.13 CEO REPORT Ms. Gibboney briefly highlighted some of the topics included in her written report. Kincade Fire and PG&E Power Outages – We continue to feel the effects of the PG&E power shutoffs. In late October, due to the smoke impacts of the Kincade fire, our team faced both power outages and evacuations. Many providers were forced to close and in some cases evacuate. Our team did a great job at keeping operations running efficiently, while facing many challenging situations in their personal lives. DHCS Leadership – There continues to be changes at DHCS. Mari Cantwell, Chief Deputy Director for Health Care Programs and the State’s Medicaid Director, has submitted her


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resignation and will leave her post in January. Richard “Fig” Figueroa is still the interim DHCS Director. CalAIM (California Advancing and Innovating Medi-Cal) – Work continues on the CalAim waiver, which is DHCS’ next five-year waiver. There are five DHCS workgroups, four of which have PHC staff representation. We continue to track the new proposals and quickly give feedback to DHCS. There are twenty-two concepts in the waiver, one of which is the requirement for all Medi-Cal health plans to be NCQA accredited. The waiver proposal also calls for focus on population health management. There is a lot of work to be done before the new waiver rolls out in 2021. CalAIM will be a significant topic at our February Strategic Planning Retreat. Governor’s Executive Order (GEO) on Pharmacy – The State is moving forward in the process to carve-out Pharmacy from managed care plans to a fee-for-service system. Magellan Rx Management was awarded the pharmacy benefit management contract in October. They currently provide services to the Department of Corrections. Though the decision is under appeal, the contract is due to be executed this January. PHC is working to understand the division of financial responsibilities and determining the amount of staff required to oversee the benefit. Commissioner Germano commented that the pharmacy carve-out would result in $150 million of lost 340B funds. The Governor has indicated he will mitigate these funds but has provided no clear answer on how that might be done. These dollars help health centers a lot and it would be very difficult to lose those funds. Ms. Gibboney responded that DHCS has not explained how they will help mitigate 340B funds but the conversation around this will likely resume in January when the next budget is released. Commissioner Ewert asked Ms. Gibboney to comment on in-lieu of services on the CalAIM waiver proposal. Ms. Gibboney responded that health plans have been trying to get approval for in-lieu of services and the department has stated that housing, support services and alternatives to long-term care will all be included in the next waiver. Prop 56 Tobacco Tax – The department has been rapidly releasing Prop 56 funds. A number of health initiatives will be funded, including over $100 million for behavioral health integration grants. Health plans will be responsible for administering the grants on a local level. However, the state will set the deadlines and grant application requirements. PHC is encouraging providers to apply for funds and will present a webinar on December 13 that will include how to apply. Applications are due a few weeks after the webinar. PHC is happy to answer any questions regarding the behavioral health integration grants. Wellness and Recovery Program / Drug MediCal – DHCS has moved the start date for the Wellness and Recovery drug treatment benefit to March 1, 2020. The delay is due to CMS reviewing the fiscal model and application. Conversations continue between CMS and DHCS and PHC continues to prepare. Medicaid Fiscal Accountability Rule (“MFAR”) – CMS has released a draft proposed rule regarding fiscal accountability in Medicaid. The proposed rule would increase oversight, monitoring and reporting requirements on supplemental dollars to Medicaid. The draft will be in a comment period for 60 days. This change would affect $500 million in 1 year and $1B in 5 years. DHCS has yet to comment on the proposed rule.


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Board Meeting & Strategic Planning Retreat – Secretary Mark Ghaly, M.D. has accepted our invitation to speak at the February 2020 Board Meeting/Strategic Planning Retreat dinner on Tuesday, February 25. We are also working on a speaker for Wednesday, February 26. We will also hold a robust panel discussion regarding the CalAIM waiver. Commissioner Willis commented that DHCS puts a lot of responsibility on the health plans but it presents the opportunity and necessity to partner with departments of public health, as they already do a lot of work on the same initiatives. This could foster a collaborative relationship. Ms. Gibboney replied that we do not want to duplicate work that is already being done by the public health departments, so we would like to collaborate with all counties on the many upcoming changes. AGENDA ITEM 2.0 CONSENT CALENDAR – RATIFICATION OF FINANCE COMMITTEE ACTION Commissioner Hempling asked for a motion to approve the consent calendar items 2.1-2.2.

2.1 Ratify Finance Committee's approval of new benefit for PHC members- Bone Anchored Hearing Aids

2.2 Ratify Finance Committee’s approval of DHCS FY2017-2018 Rates Package 60 MOTION: Commissioner Lujan moved to approve resolutions 2.1-2.2 as presented, seconded by Commissioner Popat.

Commissioner Hempling asked for commissioner or public comments. Hearing no requests, he called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY ON ITEMS: 28 yes, 0 no, 0 abstention. Motion carried with Commissioners Elliot, Mylavarapu, Robinson and Reeves excused. . AGENDA ITEM 3.0 CONSENT CALENDAR Commissioner Hempling asked for a motion to approve the consent calendar items (3.1-3.8) Commissioner Hempling asked for a motion to approve resolutions 3.1-3.8.

3.1 Resolution to Approve Committee Minutes

3.2 Resolution to Approve Board Membership Reappointment of Karen Larsen

3.3 Resolution to Approve the Population Health Management Strategy, MCCD2027

3.4 Resolution to Approve the Utilization Management Program Description, MPUD3001

3.5 Resolution to Approve the Care Coordination Program Description, MPCD2013

3.6 Resolution to Approve the Brown Act Compliance Policy, CMP20

3.7 Resolution to Approve PAC Membership Changes

3.8 Resolution to Approve DHCS Contract Amendment due to Final Rule MOTION: Commissioner Powell moved to approve resolutions 3.1 through 3.8 as presented, seconded by Commissioner Remak.

Commissioner Hempling asked for commissioner or public comments. Hearing no requests, he called for a vote. The clerk summarized the vote as follows:


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BOARD ACTION SUMMARY ON ITEMS: 28 yes, 0 no, 0 abstention. Motion carried with Commissioners Elliot, Mylavarapu, Robinson and Reeves excused. AGENDA ITEM 4.0 REGULAR AGENDA ITEMS AGENDA ITEM 4.1 RESOLUTION TO ACCEPT THE 2020 COMPLIANCE PROGRAM PLAN, COMPLIANCE PROGRAM DASHBOARD AND AUDIT WORK PLAN Ms. Turnipseed began her presentation by reiterating the importance of the Board’s role in the Compliance Program. Ms. Turnipseed, as PHC’s Compliance Officer, reports to Ms. Gibboney, with a dotted line to the Board. Major compliance issues will be elevated to the Board. Ms. Turnipseed reminded the Board that they are required to fill out an FPPC form annually and there is a $100 fine for failing to do so. The purpose of this form is to ensure fair and ethical political business practices. PHC conducted our risk assessment differently this year. We wanted to better understand the priorities of our leadership team. Their top three priorities were the new claims system, Governor’s Executive Order on Pharmacy and Quality / HEDIS scores. Overall, the Board is key to a robust Compliance Program and we ask that you hold us accountable. Thank you for your engagement. Commissioner Yamashiro inquired whether there are external eyes on our Compliance Program. Ms. Turnipseed responded yes, DHCS regularly conducts audits, including ad-hoc audits. We are also regularly audited by DMHC. Additionally, the Department of Justice and CMS have the authority to audit us at any time. Commissioner Brooks commented that her FPPC form went into her spam folder and the reminder emails from PHC were helpful. Ms. Turnipseed replied that we would continue to remind the Board to look out for the FPPC form in their email. Ms. Turnipseed then began her overview of the Compliance Plan and Audit Calendar, as included in the Board packet. When developing the 2020 Compliance Plan, the Compliance Team strived to be collaborative with each department to identify and assist with their goals and objectives. The Compliance Committee charter was updated with new department leadership added to the committee. Also included in the Board packet is the external audit calendar. PHC is required to audit, so this gives our providers an idea of when we will conduct the audit. Commissioner Lujan stated there are a lot of reporting requirements for providers. Does PHC provide any communication on the specifics of reporting requirements? Do you train staff on how to coach providers through the reporting process? Ms. Turnipseed responded that we do communicate our process with our providers and provide training. In the event that there is a large breach, Ms. Turnipseed would communicate directly with the provider’s privacy officer. Ms. Turnipseed then highlighted the Compliance Dashboard, as included in the board packet. PHC earned an overall score of 95%. A few of our reports came back with follow-up questions


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from DHCS. We obtained information from our delegates to answer any questions and re-submitted the reports to DHCS. Ms. Turnipseed asked the Board if there were any questions regarding the 2020 Compliance Plan or the Q3 Compliance Dashboard. Hearing none, Commissioner Hempling asked for a motion to approve the 2020 Compliance Program Plan, Compliance Program Dashboard and Audit Work Plan.

MOTION: Commissioner Powell moved to approve resolution 4.1 as presented, seconded by Commissioner Remak.

Commissioner Hempling asked for commissioner or public comments. Hearing no requests, he called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY ON ITEMS: 28 yes, 0 no, 0 abstention. Motion carried with Commissioners Elliot, Mylavarapu, Robinson and Reeves excused. AGENDA ITEM 4.2 RESOLUTION TO APPROVE COMMENDARIONS AND APPRECIATION FOR ALLAN YAMASHIRO Ms. Gibboney stated that Commissioner Yamashiro is planning his retirement for January 2020. She thanked Commissioner Yamashiro for his fifteen year-tenure on the PHC Board and gave our appreciation for his consistent attendance and feedback. Commissioner Yamashiro thanked the Board for their support. Commissioner Hempling asked for a motion to approve commendations and appreciation for Allan Yamashiro.

MOTION: Commissioner Fogg moved to approve resolution 4.2 as presented, seconded by Commissioner Cohen.

Commissioner Hempling asked for commissioner or public comments. Hearing no requests, he called for a vote. The clerk summarized the vote as follows. BOARD ACTION SUMMARY ON ITEMS: 28 yes, 0 no, 0 abstention. Motion carried with Commissioners Elliot, Mylavarapu, Robinson and Reeves excused. AGENDA ITEM 5.0 OTHER REPORTS AGENDA ITEM 5.1 METRICS AND FINANCIAL UPDATE Ms. McFarland began her report by highlighting a $3.7 million takeback from DHCS for Hyde amendment rates spanning five years. DHCS split the family rate to a Child rate and an Adult but continued to pay the old rate to all health plans. PHC continues to experience positive financial experience from the Whole Child Model but costs are increasing. There is a positive budget variance on pharmacy costs. Overall, PHC is doing better than budget predictions and we will continue to be conservative in accruals. Commissioner Cohen asked if PHC knew the rate adjustment was coming. Ms. McFarland responded that we do our best to estimate what the rates will be, but there are always changes. As the state continues clean-up projects on the Medi-Cal membership counts, the rate adjustments continue.


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Commissioner Ewert asked if the Individual Mandate being reinstated in California would increase membership rates. Ms. McFarland responded that we are not sure how this will affect our membership count. Guest Matt Gal asked if the Medi-Cal clean-up projects are still presently happening. Ms. McFarland replied yes, they are and PHC tries to separately update our database if we know a member is deceased. Commissioner Popat inquired about the outlook of PHC’s reserves. Ms. McFarland replied that PHC has $70 million in excess reserves, which is a good position. We need these reserves for the Drug Medi-Cal program and potentially for the CalAIM infrastructure.

ACTION: No action required. Commissioner Hempling inquired whether anyone had questions for Ms. McFarland. Hearing no requests, he moved on to Ms. Bjork. AGENDA ITEM 5.2 COO OPERATIONS UPDATE Ms. Bjork began her report by stating that PHC now has FAQs and flyers on our website regarding two types of medical transportation, per Commissioner Germano’s suggestion for accessible member transportation materials. Ms. Bjork then thanked Commissioner Burum, for her great suggestions following the PG&E power outages. PHC now has an FAQ available for members covering what to do in the event of a power outage. Commissioner Burum also suggested PHC cover back-up batteries for electric medical devices. Ms. Bjork stated that back-up batteries are not a Medi-Cal benefit but our Benefits Review and Evaluation Workgroup (BREW) is now considering whether PHC can cover the batteries. Another path may be to ask the state to consider the batteries as an in-lieu of services benefit. Commissioner Burum commented that Ms. Bjork made her day. Ms. Bjork continued her report by reviewing PHC’s Delegation Oversight program, and reminding the Board that they may be audited and asked whether they have had compliance training. Delegation oversight is discussed frequently in our PHC Operations Committee, since it is a large responsibility that PHC handles. PHC contracts with providers, verifies provider credentials, ensures providers are in good standing and processes claims and TARS. In some cases, we delegate these functions to other entities, such as Kaiser, MTM, Beacon and hospitals. The state expects PHC to hold our delegates to our same standard. Our Provider Relations team is frequently auditing our delegates who also conduct their own credentialing. Our Member Services department also continually monitors the performance of our delegates. If a delegate is not operating at a satisfactory standard, PHC will issue a corrective action plan, fine or terminate our contract. Internally, our Delegation Oversite Review Subcommittee (DORS) produces a quarterly report and recommends whether we should continue to contract with each delegate. PHC does not have the bandwidth to handle all services in-house. For example, our transportation program produces thousands of calls per month. PHC’s delegation oversight has a good process for escalating issues if an entity is not performing. PHC audits are crucial and assists in catching issues to ensure delegates are meeting DHCS and PHC standards. We are currently preparing for the upcoming DHCS and NCQA audits.


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Commissioner Burum asked if a member has a poor experience with PHC delegate like MTM, who should they address the issue with. Ms. Bjork responded that the member should contact PHC’s Member Services team. This would be classified as a member grievance and would go through our normal grievance process. Commissioner Willis inquired whether PHC delegated entities are required to be NCQA accredited. Ms. Bjork replied that they are not required to be accredited by NCQA but we are very pleased when they are. Beacon is NCQA accredited and Kaiser is partially accredited. Commissioner Lujan asked Ms. Bjork to comment on the regional meeting for California Alliance for Prevention Funding. Ms. Bjork stated that Chloe Schafer, PHC’s Northwest Regional Manager attended on our behalf so she asked her to respond. Ms. Schafer said the meeting included many local community representatives and the proposal is to use tax dollars from products like sodas to fund public health initiatives. Commissioner Brooks asked if PHC currently has any current correction action plan issues with entities. Ms. Bjork responded that when an issue arises with one of our delegated entities, first PHC attempts to resolve with a call or letter. Sometimes a corrective action plan (CAP) is necessary. Many of our hospitals received CAPs for incorrect language in their TAR denial letters. Since NCQA audits our TARs it was necessary to place the hospitals on a corrective action plan. After the CAPs were sent, the hospitals quickly adopted the policies and letter templates.

ACTION: No action required.

Commissioner Hempling inquired whether anyone had questions for Ms. Bjork. Hearing no requests, he moved on to Dr. Moore. AGENDA ITEM 5.4 CMO REPORT ON QUALITY Dr. Moore began his report by overviewing the Primary Care Provider Quality Improvement Program. As quality measures increase, the ability for PCPs to earn more. The average points earned in CY 2018 was 48%. We saw a score increase above 70% in seven out of ten measures. The measures that have declining scores are asthma, well child visits and child immunizations. There will be several new measures added next year and the number of points obtainable for member experience will increase, which is a measure NCQA emphasizes. Commissioner Germano commented that he is happy there will be more dollars in this program, as it is discouraging when providers work so hard towards a goal and in return have the thresholds change. Dr. Moore continued that the patient experience measure would be calculated using a satisfaction survey, consisting of a combined communication score, based on how a member felt after speaking to the doctor, and a combined access score, based on phone wait times, wait times in waiting rooms, and how many providers there are. PHC plans to move the PCP QIP measures to align with NCQA standards.


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Commissioner Germano asked how patient survey data is collected. Dr. Moore responded that the patient survey would be conducted via the phone. Commissioner Germano replied that it is typical to only have a 15% response rate and it is concerning to put money into a survey system that is flawed. Dr. Moore replied that we are comparing results against different organizations to see what works best. Ms. Gibboney added that we will have additional information on this included in our Member Survey presentation at 1:00 pm.

ACTION: No action required. Commissioner Hempling inquired whether anyone had questions for Dr. Moore. Hearing no requests, he moved on to Ms. Kisliuk. AGENDA ITEM 5.5 LOCAL INNOVATIONS GRANTS ON HOUSING REPORT Ms. Kisliuk reviewed the Local Innovations Grants on Housing report that was included in the board packet. She highlighted that PHC helped fund the Ritter Center from unused Marin dollars. Commissioner Germano commented that the graph shows great disparity in the counties PHC operates. Commissioner Starck asked if PHC analyzes the ROI on the housing projects. Ms. Kisliuk responded that PHC uses a series of analytic tools and we are already measuring a difference in emergency room usage in areas which we have funded housing. Emergency room use drops about 25%. We will track this data much more specifically in the future.

ACTION: No action required. Commissioner Hempling inquired whether anyone had questions for Ms. Kisliuk. Hearing no requests, he moved on to Mr. Vemparala. AGENDA ITEM 7.0 FEATURED TOPIC AGENDA ITEM 7.1 HEALTHEGE CLAIMS SYSTEM Mr. Vemparala provided a presentation on PHC’s program to replace current claims processing system, Amisys. Amisys has been our claims processing system for twenty-five years. Unfortunately, there is no way to upgrade the Amisys system due to system limitations. In order to meet our current and future needs, we began looking for a new system. In total, twenty-five vendors were considered, and eventually we narrowed the vendors down and selected HealthEdge’s HealthRules Payor (HRP), since it meets all of PHC’s specific needs. PHOENIX is the name we gave to the system implementation program, which will take two years to complete. It is very important to ensure that there is no disruption to our providers during the implementation. After tests are completed and our new standard operating procedures are created, the Executive Team will give their final approval for the system to go-live, which is


Page | 11

expected to occur on January 17, 2022. Mr. Vemparala’s entire presentation is available upon request. Commissioner Yamashiro asked if providers would submit claims differently with the new system. Mr. Vemparala replied that the new system has the same file formats, so there will be no change in the submittal process. Commissioner Remak asked if the Health Edge would use the same data sets. Mr. Vemparala responded yes, the data sets would be the same. Commissioner Hempling asked if providers would see any positive changes after the implementation. Mr. Vemparala said that the data requests would be easier, more accurate and faster. Ms. Bjork added that we currently have serious limitations with our claim processing system. For example, providers are unable to submit attachments, which can be frustrating. Mr. Vemparala stated that the new system would interact better with other systems, which enables better sharing and assists in collecting better data. Commissioner Germano said the system should help calculate risk for cost savings and utilization costs. Mr. Vemparala agreed and stated that the system would provide better data, which we can then analyze and share. AGENDA ITEM 8.0 EDUCATION SESSION AGENDA ITEM 8.1 PROVIDER RELATIONS UPDATE, NORTHERN AND SOUTHERN REGIONS Ms. Kerlin and Ms. Sherafat began their presentation of the 2019 PCP and Specialist Satisfaction Survey by introducing PHC’s representative, Nydia Bieniewicz, from SPH Analytics, the third-party vendor who conducts the survey. Ms. Bieniewicz began by thanking PHC’s Provider Relations team for their help throughout the survey process. SPH Analytics has been conducting PHC’s annual PCP and Specialist Satisfactory Survey since 2013. SPH has over 300 health plan clients and are NCQA accredited. PHC’s 2019 survey was sent to providers via mail, then followed by a reminder call and a second survey sent three weeks later, if no response had been received. The Northern Region had a response rate of 43%, while the Southern Region had a response rate of 83%. Administrative staff or office managers submitted most of the responses. PHC has maintained high scores every year. In 2019, there was a notable increase in three areas: Utilization for pharmacy, treatment denial response method, and access to specialty care. Overall, the satisfaction scores remain near perfect. Utilization Management satisfaction is an area of strength, while Pharmacy department satisfaction is an area of potential improvement. Commissioner Spetzler asked if a health care system had multiple sites/locations, did each of their sites/locations receive a survey. Ms. Sherafat responded yes.


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Commissioner Germano inquired about the difference in response rates between northern and southern regions. Ms. Sherafat replied that PHC is more established in the Southern Region. The differences could be due to some providers throwing away the surveys and others may not like paper surveys. Commissioner Hempling inquired whether anyone had additional questions for Ms. Kerlin, Ms. Sherafat or Ms. Bieniewicz. Hearing no requests, he moved on to Mr. Spencer and Ms. Sherafat.

ACTION: No action required. AGENDA ITEM 8.2 MEMBER SERVICES UPDATE, NORTHERN AND SOUTHERN REGIONS Mr. Spencer and Ms. Sherafat presented the results of the 2019 Member Satisfaction Survey. They began by outlining some changes made to the survey, due to NCQA requirements. The survey now mirrors the State’s survey and PHC is no longer allowed to offer incentives for completion of the survey. The primary objective of the survey is to meet NCQA’s requirements. The survey response rate was 18% for adults and 17% for children. Next year, PHC will increase its sample size, track, and trend G&A 1st and 2nd quarter data. Mr. Spencer and Ms. Sherafat are confident in the development of intervention recommendations and the combined analysis of the 2019 CAHP survey and a full year of G&A data. The results of the survey are available upon request. Commissioner Yamashiro inquired whether there were any surprises with the data collected. Mr. Spencer replied no, the NCQA accreditation process has pushed PHC to continuously analyze the data surrounding member experience, so we expected the data collected from the survey. Commissioner Cohen asked if there was any correlation between the lack of providers and scores surrounding the ability for members to get care. Ms. Sherafat responded yes, the ability for our members to get care is one of our biggest challenges in rural areas. Commissioner Brooks asked if PHC offered courtesy cultural trainings. Mr. Spencer replied yes, we provide cultural trainings for our providers and delegates. Commissioner Germano commented that the survey results indicate the lack of provider capacity. PHC needs to get bolder in recruiting more providers.


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Commissioner Hempling inquired whether anyone had additional questions for Mr. Spencer or Ms. Sherafat. Hearing no requests, he moved on to Ms. Gibboney.

ACTION: No action required. AGENDA ITEM 9.0 2019 CCOMMUNITY REPORT & ADJOURNMENT AGENDA ITEM 9.1 COMMUNITY REPORT

Ms. Gibboney highlighted the 2019 Community Report, which was distributed to the group. The Community Report showcased PHC’s 25th anniversary, as well as PHC members, providers and employees. Commissioner Hempling inquired whether anyone had additional business, hearing no requests he adjourned the Board meeting at 1:50PM. AGENDA ITEM 10 CLOSED SESSION Pursuant to Government Code§ 549556.87, Contract Negotiations AGENDA ITEM 10.1 CONTRACT NEGOTIATIONS Commissioner Hempling opened the Closed Session of the meeting at 1:50 PM. Ashlyn Scott, Assistant Board Clerk, called the roll indicating there was a quorum. Commissioner Hempling adjourned the Closed Session portion of the meeting at 2:00 PM and reopened the Regular Session of the meeting at 2:01 PM. He reported that no action was taken in closed session.

ACTION: No action required. AGENDA ITEM 11.0 ADJOURNMENT Commissioner Hempling inquired whether anyone had additional business, hearing no requests he adjourned the Board meeting at 2:05 PM. Minutes respectfully submitted by: Ashlyn Scott, Assistant Clerk Board Approval Date: Signed:

Ashlyn Scott, Assistant Clerk Randall Hempling, Chair


AGENDA REQUEST FOR RATIFICATION for


Board / Finance Committee (when applicable) Agenda Item Number: Meeting Date: January 15, 2020 2.1 Board Meeting Date: February 26, 2020

Resolution Sponsor: Liz Gibboney, Partnership HealthPlan of CA

Approved by: Finance Committee

Topic Description: Mountain Valleys Health Center has asked PHC for a special decision to advance an early, partial PCP Quality Improvement Program (QIP) payout of $100,000. The funding is to assist with the transition and decreased provider productivity associated with needing to migrate to a new electronic health record.

Reason for Resolution: To gain approval for a special decision to advance Mountain Valleys Health Center QIP dollars.

Financial Impact: The immediate financial impact to the HealthPlan will be $100,000 that will be deducted from Mountain Valleys Health Center’s eventual QIP payment. There is no overall financial impact.

Requested Action of the Board: Based on recommendation of Finance Committee, the commission is asked to ratify a special decision for Mountain Valleys Health Center.



PARTNERSHIP HEALTHPLAN OF CALIFORNIA Board / Finance Committee (when applicable) Agenda Item Number: Meeting Date: January 15, 2020 2.1 Board Meeting Date: February 26, 2020


IN THE MATTER OF: RATIFYING THE FINANCE COMMITTEE’S APPROVAL OF A SPECIAL DECISION FOR MOUNTAIN VALLEYS HEALTH CENTER Recital: Whereas,

A. The commission is responsible for making decisions outside the chart of authority of the CEO/CFO.

B. Access to care is a major focus of the HealthPlan.


1. To ratify the Finance Committee’s approval of a special decision for Mountain Valleys Health Center.

PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 26 day of February 2020 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: Commissioners: ABSTAINED: Commissioners: ABSENT: Commissioners: EXCUSED: Commissioners:


Date ATTEST: BY:








Topic Description: PHC’s Stipends for Committee Members Serving on PHC’s CAC, FAC, PQC, and Q/UAC Committees policy, ADM-21 provides guidelines for PHC committee members to receive specified optional compensation and/or reimbursement for actual mileage for attending meetings at a PHC location.

The recommended changes to ADM-21 includes adding the new Provider Grievance Review Committee throughout the policy and to the title, adding the related Grievance Review Committee policy, MP PR GR 210, and updating the Physician Members on PHC’s PQC Committees Compensation Request Form ADM-21c to include committee members from the Grievance Review Committee to request compensation for attending meetings.

Reason for Resolution: To ensure Board members are aware of current compensation policies for other PHC committees.

Financial Impact: The financial impact to the HealthPlan is non-quantifiable.

Requested Action of the Board: Based on recommendation of Finance Committee, the commission is asked to ratify the amendment to the Stipends for Committee Members Serving on PHC’s CAC, FAC, PQC, and Q/UAC Committees policy, ADM-21.




Resolution Number:

20- IN THE MATTER OF: RATIFYING THE FINANCE COMMITTEE’S APPROVAL OF THE AMENDMENT TO THE STIPENDS FOR CONSUMER MEMBERS SERVING ON PHC’S CAC, FAC, PQC, PROVIDER GRIEVANCE REVIEW, AND Q/UAC COMMITTEES POLICY, ADM-21 Recital: Whereas, A. The Board has responsibility to review and approve the HealthPlan policies and benefits.

B. It is important to compensate appointed committee members who represent physician and consumers on eligible PHC committees and keep them updated.

Now, Therefore, It Is Hereby Resolved As Follows: 1. To ratify the Finance Committee’s approval of the amendment to the Stipends for

Committee Members Serving on PHC’s CAC, FAC, PQC, Provider Grievance Review, and Q/UAC Committees policy, ADM-21.

PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 26th day of February 2020 by motion of Commissioner, seconded by Commissioner, and by the following votes:

AYES: Commissioners: NOES: Commissioners: ABSTAINED: Commissioners: ABSENT: Commissioners: EXCUSED: Commissioners:


Date ATTEST: BY:




POLICY/ PROCEDURE

Page 1 of 3

Policy/Procedure Number: ADM21 Lead Department: Administration Policy/Procedure Title: Stipends for Committee Members Serving on PHC’s CAC, FAC, PQC, Provider Grievance Review, and Q/UAC Committees

☒External Policy ☒ Internal Policy

Original Date: 03/05/2010 Next Review Date: 12/04/2020 Last Review Date: 12/04/2019

Applies to: ☒ Medi-Cal ☐ Employees

Reviewing Entities:

☐ IQI ☒ FAC ☒ QUAC ☒ PQC

☐ OPERATIONS ☐ EXECUTIVE ☐ COMPLIANCE ☐ DEPARTMENT

Approving Entities:

☒ BOARD ☐ COMPLIANCE ☐ FINANCE ☒ CAC

☒ CEO ☐ COO ☐ CREDENTIALING ☐ DEPT. DIRECTOR/OFFICER

Approval Signature: Approval Date:

I. RELATED POLICIES:

A. MPQP1002 – Quality/Utilization Advisory Committee B. MCCP2025 –Pediatric Quality Committee C. MP PR GR 210 – Provider Grievance Review Committee

II. IMPACTED DEPTS:

A. Administration B. Member Services C. Quality Improvement D. Health Services

III. DEFINITIONS:

A. Consumer – is a PHC member or parent/guardian of a PHC member. B. Compensation – non-wages paid to committees members.

IV. ATTACHMENTS: A. Consumer members on PHC’s CAC and FAC Committees Compensation Request Form, ADM21a B. Physician / Consumer members on PHC’s Q/UAC Committee Compensation Request Form, ADM21b C. Physician members on PHC’s PQC and Provider Grievance Review Committee Compensation Request

Form, ADM21c

V. PURPOSE: A. This policy describes the guidelines for providing stipends to committee members serving on Partnership

HealthPlan of California (PHC) advisory committees. VI. POLICY / PROCEDURE:

A. Guidelines for PHC committee members to receive specified optional compensation and/or reimbursement for actual mileage for attending meetings at a PHC location are as follows: 1. A committee member who receives a stipend must submit a W9 form once at the beginning of each

calendar year. 2. Committee members must complete and sign a stipend form specific to their committee at each

meeting they attend as described below: a. Consumer members serving on the Consumer Advisory Committee (CAC) and the Family

Advisory Committee (FAC) must submit a Compensation Request Form, ADM21a after each meeting to the Administrative Assistant to receive compensation.

Deleted: Stipends for Committee Members Serving on PHC’s CAC, FAC, PQC, and Q/UAC Committees

Deleted: 02/27/2020

Deleted: 02/27/2019

Deleted: Elizabeth Gibboney

Deleted: 03/14/2019


Policy/Procedure Number: ADM21 Lead Department: Administration

Policy/Procedure Title: Stipends for Committee Members Serving on PHC’s CAC, FAC, PQC, Provider Grievance Review, and Q/UAC Committees

☒ External Policy ☒ Internal Policy



Page 2 of 3

b. Physician / Consumer members serving on the Quality/ Utilization Advisory Committee (Q/UAC) must submit a Compensation Request Form, ADM21b after each meeting to the Administrative Assistant to receive compensation.

c. Physician members serving on the Pediatric Quality Committee (PQC) and Provider Grievance Review Committee must submit a Compensation Request Form, ADM21c after each meeting to the Administrative Assistant to receive compensation.

3. Compensation rates for members of PHC advisory committees: a. The compensation rate for consumer members serving on the CAC or FAC is as follows:

1) $50.00 compensation for all CAC or FAC meetings attended for which a committee member must travel to a meeting at a PHC location.

2) CAC or FAC committee members may request the optional mileage reimbursement for actual mileage expenses incurred for attending meetings at the current IRS mileage reimbursement rate.

3) CAC or FAC committee members who use public or group transportation (e.g. taxi, paratransit, etc) to get to meetings, may request a transportation reimbursement in lieu of a mileage reimbursement.

b. The compensation rate for physician or consumer members of the Q/UAC who are not PHC staff (or otherwise compensated by PHC for management responsibilities) is as follows: 1) $50.00 compensation for all Q/UAC meetings attended for which a committee member

must travel to a meeting at a PHC location. 2) Q/UAC committee members may request the optional mileage reimbursement for actual

mileage expenses incurred for attending meetings at the current IRS mileage reimbursement rate.

3) Q/UAC committee members may request a “flat rate option” for compensation in lieu of a mileage reimbursement.

4) This stipend may be in addition to other compensation when a physician member serves as a clinical consultant/physician adviser.

c. The compensation rate for physician members of the PQC and Provider Grievance Review Committee who are not PHC staff (or otherwise compensated by their county CCS agency for attendance at PQC or by PHC for management responsibilities) is as follows:

1) $50.00 compensation for all PQC and Provider Grievance Review Committee meetings attended for which a physician member must travel to a meeting at a PHC location.

2) PQC and Provider Grievance Review Committee members may request the optional mileage reimbursement for actual mileage expenses incurred for attending meetings at the current IRS mileage reimbursement rate.

3) PQC and Provider Grievance Review Committee members may request a “flat rate option” for compensation in lieu of a mileage reimbursement.

4) This stipend may be in addition to other compensation when the physician member serves as a clinical consultant/physician adviser.

VII. REFERENCES: VIII. DISTRIBUTION:

A. SharePoint B. Provider Manual

IX. POSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE:


Policy/Procedure Number: ADM21 Lead Department: Administration

Policy/Procedure Title: Stipends for Committee Members Serving on PHC’s CAC, FAC, PQC, Provider Grievance Review, and Q/UAC Committees

☒ External Policy ☒ Internal Policy



Page 3 of 3

A. Board Clerk

X. REVISION DATES: A. Agenda Item 9.4 on 03/24/10 B. Agenda Item 9.7 on 12/14/11 C. Agenda Item 3.4 on 08/24/16 D. Agenda Item 3.5 on 02/27/19 E. Agenda Item 2.2 on 02/26/20 PREVIOUSLY APPLIED TO: ADM36 (Retired)


PHYSICIAN MEMBERS ON PHC’S

PQC AND PROVIDER GRIEVANCE REVIEW COMMITTEES COMPENSATION REQUEST FORM ADM21c

Meeting attended: Meeting Date PHC Office Location

Pediatric Quality Committee (PQC)

Provider Grievance Review Committee Attendance Stipend: (Physician members who are not PHC staff are eligible to receive a financial stipend for each meeting attended (unless otherwise compensated by their county CCS agency for attendance at PQC or by PHC for management responsibilities). This stipend may be in addition to other compensation when the member serves as a clinical consultant/physician adviser)

$50.00 compensation for all PQC and Provider Grievance Review Committee meetings attended in-person at one of PHC’s regional offices.

$100.00 “flat rate option” compensation for all PQC and Provider Grievance Review Committee meetings attended in-

person at one of PHC’s regional offices without a mileage reimbursement.

Total Stipend: $ Check Information for Attendance Stipend

Make Check Payable to:

Address City Zip Code Mileage Reimbursement Note: In lieu of a mileage reimbursement, a committee member can take the “flat rate option” for compensation.

Reimbursement for mileage related to round trip travel from home or place of business to the meeting. Round trip mileage was miles at the current IRS rate of 57.5 cents per mile = $

Total Compensation: $

Total Mileage Reimbursement: $

Check Information for Mileage Reimbursement

Physician Member Signature Make Check Payable to:

Printed Name Address City Zip Code Please send or give this form to: PHC Administrative Assistant

Partnership HealthPlan of California 4665 Business Center Drive Fairfield, CA 94534 (707) 863-4241 / FAX: (707) 420-7883

Date Received By

For PHC use only below this line.







Topic Description: Commissioner Letty Garza from Trinity County Health & Human Services has requested removal from the Finance Committee due to scheduling conflicts.

Reason for Resolution: To accept the resignation of Commissioner Garza from the Finance Committee.


Requested Action of the Board: Based on recommendation of Finance Committee, the commission is asked to accept the resignation of Commissioner Garza from the Finance Committee.





IN THE MATTER OF: RATIFYING THE FINANCE COMMITTEE’S APPROVAL OF THE RESIGNATION OF LETTY GARZA FROM THE FINANCE COMMITTEE Recital: Whereas, A. Commissioner Garza has requested removal from the Finance Committee due to scheduling

conflicts.

B. The commission has authority to approve committee members.


1. To ratify the Finance Committee’s approval of the resignation of Commissioner Garza from the Finance Committee.

PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 26th day of February 2020 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: Commissioners: ABSTAINED: Commissioners: ABSENT: Commissioners: EXCUSED: Commissioners:


Date ATTEST: BY:








Topic Description: PHC’s 14 counties have provided Substance Use Disorder (SUD) treatment services through the Drug Medi-Cal program. These services will be expanded in eight PHC counties through our new Wellness and Recovery Benefit, anticipated to “go live” in Humboldt, Lassen, Mendocino, Modoc, Shasta, Siskiyou, Solano, and Trinity counties no earlier than March 1, 2020.

The services include: Outpatient treatment (licensed professional or certified counselor)

Intensive outpatient treatment for individuals with greater treatment needs (licensedprofessional or certified counselor)

Detoxification services (withdrawal management)

Residential treatment (One ASAM level, DHCS licensed facility, certified staff)

Medically assisted treatment (methadone, buprenorphine, disulfiram, naloxone)

Case management

Recovery services (aftercare)

Physician Consultation

Reason for Resolution: To obtain approval for the program’s funding and to ensure that Board of Commissioners acknowledge the risk associated with the Wellness and Recovery Benefit, and the adaptations it requires for the various stakeholders involved in the benefit.

Financial Impact: The impact to the HealthPlan for three years is estimated to be no more than $35 million dollars; not to supplant any existing funding sources available for the program.

Requested Action of the Board: Based on recommendation of Finance Committee, the commission is asked to ratify funding for PHC’s Wellness & Recovery Program Fiscal Model.





IN THE MATTER OF: RATIFYING THE FINANCE COMMITTEE’S APPROVAL OF FUNDING FOR PHC’S WELLNESS & RECOVERY PROGRAM FISCAL MODEL Recital: Whereas, A. In 2015 the federal government approved California’s Organized Delivery System for Drug

Medi-Cal (DMC-ODS) services; and

B. The DMC-ODS model allows for the comprehensive provision of substance use services to Medi-Cal beneficiaries; and

C. The DMC-ODS model is only available to counties that “opted in” to administer the comprehensive benefit; and

D. On behalf of eight PHC Counties, PHC sought to administer the benefit on a regional basis, working to integrate substance use services and ensure that PHC members were able to receive substance use treatment; and

E. The development of the PHC regional DMC-ODS Model, called the Wellness and Recovery Benefit, requires changes to the county-specific financing process. Legacy funding structure presents a variety of challenges related to the development a fiscal structure that relies on County, State General Fund and Federal funding.; and

F. PHC and the participating counties have worked hard to develop such a model that relies heavily on a reconciliation process and a series of complex assumptions and assume the risk associated with this reliance; and

G. The Board has responsibility to review and approve the HealthPlan policies and benefits.


1. To ratify the Finance Committee’s approval of funding for PHC’s Wellnesses & Recovery Program Fiscal Model.


PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 26th day of February 2020 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: Commissioners: ABSTAINED: Commissioners: ABSENT: Commissioners: EXCUSED: Commissioners:


Date ATTEST: BY:



CONSENT AGENDA REQUEST for




Recommendation by: PHC Advisory Groups and Committees

Topic Description: Partnership HealthPlan of California (PHC) has a number of advisory groups & committees established by the Commission (known as the Board) with direct reporting responsibilities. These are the 340B, Compliance, Consumer Advisory, Finance, Personnel, Policies and Benefits, Physicians Advisory, Provider Advisory, Substance Use Services, Provider Advisory, and Strategic Planning.

The Physician’s Advisory Committee (PAC) has responsibility for oversight and monitoring for the quality and cost-effectiveness of medical care provided to PHC’s members. A number of other PHC advisory groups & committees have direct reporting responsibilities to PAC. These are the Credentialing, Cultural & Linguistics & Health Education, Internal Quality Improvement, Member Grievance Review, Over/Under Utilization Workgroup, Peer Review, Pharmacy & Therapeutics, Provider Grievance Review, Quality/Utilization Advisory, Substance Use Services Internal Quality Improvement, and Substance Use Services.

The Board is responsible for reviewing and accepting all minutes and packets approved by the various PHC advisory groups & committees, and approving the policies, program descriptions, and QIP policy changes that were approved by the PAC, from December 2019 through February 2020. In addition, the Board reviews and accepts PHC’s Claims, Health Services, Human Resources, Member Services, and Provider Relations department operating reports.

Reason for Resolution: To provide commissioners with all PHC committee minutes, committee packets, and departmental operational reports. In addition, to provide commissioners with all PHC policies and program descriptions approved by PAC and recommended for approval.

Financial Impact: Any financial impact to the HealthPlan is included in the budget assumptions.

Requested Action of the Board: Based on the recommendation of PHC’s advisory groups & committees, the Board is asked to accept receipt of all PHC committee minutes, committee packets, and the departmental operational reports. In addition, to approve all PHC policies and program descriptions approved by PAC linked to the packet.




Resolution Number:

20- IN THE MATTER OF: ACCEPTING ALL PARTNERSHIP HEALTHPLAN OF CALIFORNIA (PHC) COMMITTEE MINUTES, COMMITTEE PACKETS, AND DEPARTMENTAL OPERATING REPORTS. IN ADDITION, TO APPROVE ALL PHC POLICIES AND PROGRAM DESCRIPTIONS APPROVED BY THE PHYSICIANS ADVISORY COMMITTEE (PAC) Recital: Whereas,

A. The Board has fiduciary responsibility for the operation of the organization.

B. The Board has responsibility to review and accept all PHC committee minutes, packets, and departmental operational reports. In addition to review and approve all PHC policies and program descriptions approved by PAC.


1. To accept receipt of all PHC committee minutes, committee packets, and departmental operational reports.

2. To obtain approval for all PHC policies and program descriptions approved by PAC and recommended for Board approval.

PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 26th day of February 2020 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: Commissioners: ABSENT: Commissioner: EXCUSED: Commissioners:


Date ATTEST: BY:







Recommendation by: Quality/Utilization Advisory Committee and Physician Advisory Committee

Topic Description: Thomas Paukert, M.D., from Napa Valley Nephrology has resigned from the Quality/Utilization Advisory Committee (Q/UAC).

Brandy Lane is a PHC member who expressed interest in participating on Q/UAC. She is from Solano County and she has been appointed by Q/UAC to represent the Southeast Region.

Reason for Resolution: To obtain approval for membership changes to the Q/UAC due a resignation and a new appointment.


Requested Action of the Board: Based on the recommendation from the Quality/Utilization Advisory Committee and Physician Advisory Committee, the Board is asked to approve the membership changes to Q/UAC due to the resignation of Thomas Paukert, M.D., and the new appointment of Brandy Lane.




Resolution Number:

20- IN THE MATTER OF: APPROVING QUALITY/UTILIZATION ADVISORY COMMITTEE (Q/UAC) MEMBERSHIP CHANGES Recital: Whereas,

A. Thomas Paukert, M.D., has resigned from Q/UAC.

B. Brandy Lane has expressed interest in participating on the committee.

C. The Board has authority to appoint committee members.

Now, Therefore, It Is Hereby Resolved As Follows: 1. To obtain approval for the resignation of Thomas Paukert, M.D., and the new

appointment of Brandy Lane. PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 26th day of February 2020 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: Commissioners: ABSENT: Commissioners: EXCUSED: Commissioners:


Date ATTEST: BY:



REGULAR AGENDA REQUEST for




Recommendation by: PHC Staff

Topic Description: The Semi-Annual Board Dashboard is a tool developed by the PHC Management Team. The dashboard reflects the organization’s major focus areas and priorities; and allows PHC staff to track key metrics across the organization.

Reason for Resolution: To provide the attached Semi-Annual Board Dashboard for review and approval.

Financial Impact: There is no measurable financial impact to HealthPlan.

Requested Action of the Board: Based on the recommendation of PHC Staff, the Board is asked to approve the Semi-Annual Board Dashboard.





IN THE MATTER OF: APPROVING THE SEMI-ANNUAL BOARD DASHBOARD

Recital: Whereas,

A. The Board has ultimate responsibility for ensuing operational excellence.

B. Operational excellence is a major focus for the HealthPlan.


1. To approve the Semi-Annual Board Dashboard. PASSED, APPROVED, AND ADOPTED by the Partnership HealthPlan of California this 26th day of February 2020 by motion of Commissioner, seconded by Commissioner, and by the following votes: AYES: Commissioners: NOES: ABSTAINED: Commissioners: ABSENT: Commissioners: EXCUSED: Commissioners:


Date ATTEST: BY:



Q1 Q2 Q3 Q4

TARGET >> $122.96 $122.96 $122.96 $122.96

ACTUAL >> $143.92

TARGET >> $20.50 $20.50 $20.50 $20.50

ACTUAL >> $17.01

TARGET >> $29.45 $29.45 $29.45 $29.45

ACTUAL >> $26.62

TARGET >> $42.87 $42.87 $42.87 $42.87

ACTUAL >> $52.91

TARGET >> $135.59 $135.59 $135.59 $135.59

ACTUAL >> $158.74

TARGET >> $21.99 $21.99 $21.99 $21.99

ACTUAL >> $19.57

TARGET >> $33.83 $33.83 $33.83 $33.83

ACTUAL >> $33.18

TARGET >> $44.34 $44.34 $44.34 $44.34

ACTUAL >> $49.76>$53.65

Increased ICU, Post ICU Obs. & OB days. Total estimated incurred trend is conservaitive for the previous two quarters due to insufficient run‐out.

>$148.78

FINANCE: South

Primary Care Services Cost / PMPM

>$51.87

Specialty Care Cost / PMPM (excluding Kaiser)

RED THRESHOLD

Member Costs:

Inpatient Hospital Cost / PMPM (excluding Kaiser and Part A)

FINANCE: North

FISCAL YEAR 2019 / 2020 COUNTER MEASURE / COMMENTSKEY PERFORMANCE INDICATOR

Member Costs:

>$164.06

Primary Care Services Cost / PMPM >$29.03

>$40.60

>$35.34

Pharmacy Cost / PMPM (excluding Kaiser)

Increased ICU, Post ICU Obs. & OB days. Total estimated incurred trend is conservaitive for the previous two quarters due to insufficient run‐out.

MedImpact contract recently restructured as original signed in 3/2018 did not materialize. Membership decreases has a negative impact on PMPM trends. Drug prices continue to increase for both brand and generic.

Inpatient Hospital Cost / PMPM (excluding Kaiser and Part A)

Specialty Care Cost / PMPM (excluding Kaiser)

Pharmacy Cost / PMPM (excluding Kaiser)

>$27.06

MedImpact contract recently restructured as original signed in 3/2018 did not materialize. Membership decreases has a negative impact on PMPM trends. Drug prices continue to increase for both brand and generic.


TARGET >> 320 320 320 320

ACTUAL >> 312

TARGET >> 4.5 4.5 4.5 4.5

ACTUAL >> 4.7

TARGET >> 725 725 725 725

ACTUAL >> 597

TARGET >> 2.2 2.2 2.2 2.2

ACTUAL >> 2.3

TARGET >> 90.0% 90.0% 90.0% 90.0%

ACTUAL >> 98% 98.4%

TARGET >> 15.0% 15.0% 15.0% 15.0%

ACTUAL >> 8% 7.1%

TARGET >> 15.0%

ACTUAL >>

TARGET >> 0.32 0.32 0.32 0.32

ACTUAL >> 0.31

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 48.4%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 60.0%

TARGET >> 45 45 45 45

ACTUAL >> 37

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 25.6%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 24.9%

A Specialty Access Workgroup was organized and meets 4/year. Through recommendations made by the Specialty Access Workgroup, PHC has promoted the use of telehealth which resulted in an increase in specialty visit utilization.

Endocrinology

% of Specific Utilization Compared to a Well-Managed Benchmark:

>20%

Medi‐Cal Outpatient TAR Medical NecessityDenial Rate

Endocrine is area of focus by Specialty Access Team. Promoting the use of tele‐endocrine services are a major strategy for the Plan. Approximately 70% of visits now provided through telehealth in the northern region. Pleasd with upward trend in the third.

Allergist in short supply in the Region. The three‐year trend shows an increasing use rate. PCPs provide majority of allergy care.

Specialty gaps exist in several areas in the northern region. The Plan is actively promoting use of telehealth and eConsult services to improve access and reduce long drive time to urban centers.

<25%

<25%Allergy / Immunology

≥800

Average Length of Stay (ALOS)

PCP Visits / PMPY

Days Between RAFs and Claims

<80%

Specialty Access:

Specialty Visits / PMPY

>25%

Readmissions:

Medi‐Cal Percent Readmissions Within 30 Days (all causes)

Inpatient Day / 1000 / Yr.LOS greater >7 days reviewed in department rounds weekly. Meet with hospital case management/utilization management departs to discuss barriers to discharge weekly

% of Total Specialist Utilization Compared with a Well‐Managed Benchmark

* Medi‐Cal Outpatient TAR Timeliness

% of Specialties that Fall Below 50% of their Specific Well‐Managed Benchmark

ED Visits / 1000 / Yr.

HEALTH SERVICES UM: NorthSystems of Care

≥384

Utilization:

LOS greater >7 days reviewed in department rounds weekly. Meet with hospital case management/utilization management departs to discuss barriers to discharge weekly

<25%

<25%

≤1.8

≥5.0

<0.16

>60 days


TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 20.2%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 27.3%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 28.2%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 39.8%

Urologists in short supply in both the Northern and Southern Region. Piloting tele‐urology to manage non‐surgical cases.

Dermatology is an area of focus by the Specialty Access Team. The Team is developing tele‐dermatology strategy to help increase access.

Urology <25%

Dermatology

Otolaryngology

Rheumatology

Otolaryngologists are in short supply in both the Northern and Southern Region. The Plan continues to look for opportunities to expand the network.

<25%

Rheumatology is an area of focus by the Specialty Access Team. The Plan is actively promoting tele‐rheumatology and the use of referral guidelines. Both local rhenumatologists and telehealth providers are in short supply. Researching thrid quarter decline.

<25%

<25%


TARGET >> 275 275 275 275

ACTUAL >> 268

TARGET >> 4.8 4.8 4.8 4.8

ACTUAL >> 4.3

TARGET >> 625 625 625 625

ACTUAL >> 595

TARGET >> 2.2 2.2 2.2 2.2

ACTUAL >> 2.7

TARGET >> 90.0% 90.0% 90.0% 90.0%

ACTUAL >> 97.3% 98.4%

TARGET >> 15.0% 15.0% 15.0% 15.0%

ACTUAL >> 3.3% 3.4%

TARGET >> 15.0%

ACTUAL >>

TARGET >> 0.32 0.32 0.32 0.32

ACTUAL >> 0.38

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 60.0%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 38.0%

TARGET >> 45 45 45 45

ACTUAL >> 36

% of Specific Utilization Compared to a Well-Managed Benchmark:

% of Specialties that Fall Below 50% of their Specific Well‐Managed Benchmark

<25%

>60 days

The three‐year trend shows modest improvement. In 2016, seven specialties below the 50% benchmark, six in 2017 and 2018 respectively. The Plan promotes the use of imbedded specialty clinics in primary care sites, eConsult and telehealth services.

Significant increase in inpatient ICU days and slight increase in OB days in August 2018. Noted in FY2018‐19 inpatient days due to sepsis, unspecified organism (diagnosis with the highest number of days annually) are up 10% from last year. Finance has identified top providers with increased days due to sepsis in FY2018‐19 for outreach. Additional days due to cesarean deliveries are up 68%, days due to MRSA are up 16%, and hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease days increased 36%.

HEALTH SERVICES UM: SouthSystems of CareUtilization:

Inpatient Day / 1000 / Yr.

Average Length of Stay (ALOS)

Specialty Visits / PMPY

Specialty Access:

<0.16

≥330

Medi‐Cal Percent Readmissions Within 30 Days (all causes)

ED Visits / 1000 / Yr.

Noted increased ED visits for homeless and housed members with acute upper respiratory infection. PHC Housing initiative is working to provide housing for members experiencing homelessness. Will work with identified PCPs to increase use of primary care services for respiratory infections in winter months.

Medi‐Cal Outpatient TAR Medical NecessityDenial Rate

>20%

≥5.2

Readmissions:

≥700

PCP Visits / PMPY

>25%

≤1.8

* Medi‐Cal Outpatient TAR Timeliness <80%

% of Total Specialist Utilization Compared with a Well‐Managed Benchmark

Days Between RAFs and Claims

This annual measure will be reported at the August board meeting.

<25%


TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 33.9%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 41.8%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 39.6%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 35.5%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 45.5%

TARGET >> 50.0% 50.0% 50.0% 50.0%

ACTUAL >> 40.1%

Urology

Allergy / Immunology

Rheumatology

EndocrinologyEndocrine is area of focus by Specialty Access Team. The Plan is actively promoting tele‐endocrine services. Data shows a continued improvement in the use rate over time.

<25%

Otolaryngology

Dermatology is an area of focus by the Specialty Access Team. The Team is developing tele‐dermatology strategy to help increase access.

<25%

Dermatology

<25%Allergist in short supply in the Region. The three‐year trend shows an increasing use rate. PCPs provide majority of allergy care.

<25%

<25%

<25%

Otolaryngologists are in short supply in both the Northern and Southern Region. The Plan continues to look for opportunities to expand the network.

Urologists are in short supply, especially in the Northern region. The plan is continuing to look for opportunities to expand the network of providers.

Rheumatology is an area of focus by Specialty Access Team. The Plan is actively promoting tele‐rheumatology. Researching third quarter decline.


TARGET >> 80.0% 80.0%

ACTUAL >> 85.0% 86.0%

TARGET >> 95.0% 95.0%

ACTUAL >> 100.0% 100.0%

TARGET >> 6.9% 6.9%

ACTUAL >> 6.9% 7.1%

TARGET >> 1.0 1.0

ACTUAL >>

TARGET >> 80.0% 80.0% 80.0% 80.0%

ACTUAL >> 86.79% 88.36%

TARGET >> 0.35% 0.35% 0.35% 0.35%

ACTUAL >> 0.32% 0.25%

MTM Trips ‐ Taxi Transportation ACTUAL >> 72.56% 71.60%

MTM Trips ‐ Lyft Transports ACTUAL >> 4.34% 4.86%

MTM Trips ‐ Bus Transports ACTUAL >> 11.82% 11.41%

MTM Trips ‐ Gas Mileage Reimbursement ACTUAL >> 11.27% 12.12%

N/A

Mental Health Access ‐ Plan‐Wide Penetration Rate

Percent of Claims Paid within 45 Days

Behavioral Health (Combined Northern and Southern Regions)

Change of measure ‐ potential measure

MENTAL HEALTH ACCESS

Percent of Member Calls Answered within 30 Seconds (Beacon standards)

≤75%

TRANSPORTATION SERVICES (Combined Northern and Southern Regions)

MTM Call Performance ≤75%

<6

<6.3%

Mental Health Medication Access:Plan‐Wide Ratio of One FTE prescriber per 5,000 members

ACTUAL >> 83,603

MTM Trips that are Vendor No Shows

Vendor reports various reasons for no shows: call‐in sick, vehicle problems, staffing, and member not present. When MTM confirms driver fault, they track issues and take appropriate corrective actions such as counseling driver, moving lower on list, and even cancelling contracts. They cancelled four contracts last year for poor performance.

N/A

N/A

MTM Actual Total Trips 84,880

<98%

>0.47%

N/A

N/A


TARGET >> 95.0% 95.0% 95.0% 95.0%

ACTUAL >> 99.2% 98.6%

TARGET >> 27.0% 27.0% 27.0% 27.0%

ACTUAL >> 28.9% 27.4%

TARGET >> 5.0% 5.0% 5.0% 5.0%

ACTUAL >> 1.1% 0.7%

TARGET >> 95.0% 95.0% 95.0% 95.0%SR Pharmacy has made changes with staffing for P&T and improved workflow monitoring and processes. SR Pharmacy timeliness is now at goal (>95%)

ACTUAL >> 95.8% 95.1%

• Strategic shifting of pharmacist staff from formulary review tasks to TAR productionworkflow• Pharmacy department has requested temporary staffing to help provide assistance in theprocessing of TARs

TARGET >> 27.0% 27.0% 27.0% 27.0%

ACTUAL >> 24.1% 20.7%

TARGET >> 5.0% 5.0% 5.0% 5.0%

ACTUAL >> 1.4% 1.3%

48.00%ACTUAL >>

PHARMACY SERVICES: North

>9%

<89%

>34%

Pharmacy TAR Denials (%)

Percent Pharmacy TAR Appeals / Denials (Provider Appeals)

* Pharmacy TAR Timeliness

* Pharmacy TAR Timeliness

Pharmacy TAR Denials (%)

Percent Pharmacy TAR Appeals/Denials (Provider Appeals)

We had an increase in denials due to an internal process change in late February/early March. The TARs previously denied administratively are now captured under the standard denial status.

47.30% N/A

PHARMACY SERVICES: South

>9%

≥34%

<89%

Pharmacy Appeals Overturned


TARGET >> 80.0% 80.0% 80.0% 80.0%

ACTUAL >> 94.0% 91.0%

TARGET >> 30 30 30 30

ACTUAL >> 18 9

TARGET >> 10.0% 10.0% 10.0% 10.0%

ACTUAL >> 0.9% 1.4%

TARGET >> 80.0% 80.0% 80.0% 80.0%

ACTUAL >> 84.0% 88.0%

TARGET >> 30 30 30 30

ACTUAL >> 17 14

TARGET >> 10.0% 10.0% 10.0% 10.0%

ACTUAL >> 1.9% 0.8%

<80%

ACTUAL >> 545,338 538,854 N/A

18.7%

<80%

Total Percent of MS Calls Abandoned

Total Percent of MS Calls Abandoned

ACTUAL >>

>30

18.8% N/A

In Q1, we had low staffing due to staff leaving to other jobs (some within other PHC departments) as well as new staff who were still training. In Q2, we brought on new staff and focused on training.Department has focused on hiring bilingual staff, with a goal of 75% who speak English and Spanish. In the near future, Southern Region will take on all Spanish calls for the company.

Seniors and Members with Disabilities

>10.1%

MS Average Call Wait Time (30 Seconds)

GROWTH AND EXPANSIONMembership

Medi‐Cal

MEMBER SERVICES: South

* MS Calls Answered within 30 Seconds

MS Average Call Wait Time (30 Seconds)

* MS Calls Answered within 30 Seconds

MEMBER SERVICES: North

>30

>10.1%


TARGET >> 85.0%

ACTUAL >> 100.0%

TARGET >> 85.0%

ACTUAL >> 100.0%

TARGET >> 85.0%

ACTUAL >> 100.0%

TARGET >> 85.0%

ACTUAL >> 99.3%

TARGET >> 85.0%

ACTUAL >> 99.3%

TARGET >> 85.0%

ACTUAL >> 99.3%

TARGET >> 85.0% 85.0% 85.0% 85.0%

ACTUAL >> 97.7% 98.8%

TARGET >> 5% 5% 5% 5%

ACTUAL >> 0.0% 2.0%

PROVIDER RELATIONS: North

Specialty Providers (Satisfaction with Plan)

<84.90%

Primary Care Providers (Satisfaction with Plan)

Specialty Providers (Satisfaction with Plan)

<84.90%

<84.90%

>5.1%

<84.90%

PROVIDER RELATIONS: SouthProvider Satisfaction (Overall Satisfaction with Plan)

Provider Satisfaction (Overall Satisfaction with Plan)

<84.90%

<84.90%

<84.90%

Primary Care Providers (Satisfaction with Plan)

Provider Relations: ACD Calls Service Level

Provider Relations: ACD Call Abandonment


TARGET >> 97.0% 97.0% 97.0% 97.0%

ACTUAL >> 100.0% 100.0%

TARGET >> 97.0% 97.0% 97.0% 97.0%

ACTUAL >> 99.0% 97.0%

TARGET >> 97.0% 97.0% 97.0% 97.0%

ACTUAL >> 99.0% 99.4%

TARGET >> 90.0% 90.0% 90.0% 90.0%

ACTUAL >> 99.4% 99.5%

TARGET >> 55.0% 55.0% 55.0% 55.0%

ACTUAL >> 67.0% 55.7%

TARGET >> 95.0% 95.0% 95.0% 95.0%

ACTUAL >> 99.9% 99.9%

TARGET >> 97.0% 97.0% 97.0% 97.0%

ACTUAL >> 96.3%

TARGET >> 97.0% 97.0% 97.0% 97.0%

ACTUAL >> 96.2% 99.4%

TARGET >> 90.0% 90.0% 90.0% 90.0%

ACTUAL >> 95.0% 93.7%

TARGET >> 60.0% 60.0% 60.0% 60.0%

ACTUAL >> 84.0% 86.0%

Percentage of Medi‐Cal Claims Auto‐Adjudicated

<45%

≤90%

≤84%

CLAIMS: North & South - combined report

≤93%

Quality of Customer Service Calls

≤94%

Percentage of Medi‐Cal ClaimsSubmitted Electronically

Claims Customer Service Calls / Response

≤50%

ACTUAL >> $7,710

Accuracy of Claims Payment

Percent of Claims Paid / Denied Within 45 Days

$7,710

Data is reported one quarter behind. During Q1 the focus was new and cross‐training staff in the department. The numbers are reflected from not meeting quality in August and September because of the learning curve that comes along with new trainings. Staff who are recently trainined are on a concurrent status also so they can recieve additional audits weekly to provide additional feedback.

<96.9%Medi‐Cal Claims Accuracy

OPEX/PMO

Return on Investment (Type 1 or 2) N/A

CLAIMS: North

CLAIMS: South

<89.9%

Claims Customer Service Calls / Response

Quality of Customer Service Calls

<96.9%

<96.9%* Medi‐Cal Claims Paid / Denied


TARGET >> 10.0% 10.0% 10.0% 10.0%

ACTUAL >> 6.6% 6.6%

TARGET >> 10.0% 10.0% 10.0% 10.0%

ACTUAL >> 0.0% 0.0%

TARGET >> 1.60 1.60 1.60 1.60

ACTUAL >> 1.61 1.63

TARGET >> 10.0% 10.0% 10.0% 10.0%

ACTUAL >> 15.1% 12.7%

TARGET >> 10.0% 10.0% 10.0% 10.0%

ACTUAL >> 32.7% 37.8%

TARGET >> 3.0% 3.0% 3.0% 3.0%

ACTUAL >> 3.0% 2.4%

TARGET >> 3 3 3 3

ACTUAL >> 2 4

TARGET >> 0 0 0 0

ACTUAL >> 0 0

TARGET >> 0 0 0 0

ATTEMPTS >> 381 539

BREACHES >> 0 0

TARGET >> 0 0 0 0

ATTEMPTS >> 638 363

BREACHES >> 0 0

TARGET >> 0 0 0 0

ATTEMPTS >> 1.1M 847K

BREACHES >> 0 0

Email ‐ Security Breaches

Cisco Email Security Appliance ‐ provides the first layer of defense against cyber threats and protects sensitive outbound data. It guards against spam, fraudulent senders, and infected files – whenever they become malicious ‐ and blocks risky URLs to prevent attacks. It also prevents data loss and secures sensitive data in transit to ensure compliance.

<4%

HUMAN RESOURCES: NorthPercent Positions by Telework

Clinical RN (15 % or 8 total) and Medical Social Workers (8% or 4 total) are currently hard to fill positions due to the current competitive job market. As a countermeasure, we market surveyed these positions to compete with other organizations with salary. We are also exploring additional job posting sites to expand our candidate search. Recruiting an deploying out of state efforts to fill the positions mentioned. Currenlty Approved, Oregon, Nevada, Washington State, Arizona, Texas, and Colorado. Looking at compress schedule options as well as telework.

>20%

INFORMATION TECHNOLOGYInternet outages are those outages caused by a loss of our Internet Carrier (AT&T, Comcast, Spectrum, Telepacific, and/or Frontier) services resulting in a loss of Internet accessibility for our main Fairfield Datacenter. Internet outages shall typically hinder the ability for external entities (members, providers, public, vendors, etc.) interact with PHC.

≥2

>5%

Number of Worker's Comp. Claims FiledWe had an increase in claims filed. As a counter measure, we will be working more closely with our new workers compensation carrier to implement more tools and resources to further educate staff on preventative ways to mitigate injury.

>6

Employee Turnover Rate (All Cause)

≥2

Cylance ‐ antivirus and application control solution for fixed‐function devices that leverages artificial intelligence to detect and prevent malware from executing on endpoints in real time

Internet Outages

File Systems ‐ Security Breaches ≥2

Web ‐ Security Breaches

Percent Positions by Telework

Percentage of Positions Open after 90 days (Actively Recruiting)

HUMAN RESOURCES: SouthFTEs / 1000 Members

Collaborate with the executive team for review of the 2020‐2021 fiscal year budget for new FTE's. >1.86

A number of teleworkers have either come back to the office from telework, or left the company. As a countermeasure, we are assessing additional employees/positions that could successfully telework.

<4%

≥2

FirePower‐ high priority web application ‐ firewall appliance that delivers integrated threat defense across the entire attack continuum.

Percentage of Positions Open after 90 days (Actively Recruiting)

>20%


TARGET >> 50.0%

ACTUAL >> 26.4%

TARGET >> 50.0%

ACTUAL >> 11.3%

TARGET >> 75.0%

ACTUAL >> 73.2%

TARGET >> 75.0%

ACTUAL >> 78.4%

TARGET >> 0%

ACTUAL >> 23.5%

TARGET >> 0%

ACTUAL >> 41.2%

TARGET >> 0%

ACTUAL >> 9.5%

TARGET >> 0%

ACTUAL >> 0.0%

Northern Region

<25th percentileDHCS Quality Factor Score (QFS) Ranking ‐ Northwest

>0%

Southwest Region >0%

Southeast Region

Unchanged from prior update ‐ Annual measurement that will be revised per HEDIS 2020 ‐ There were 2 measures, CDC Nephropathy and Asthma Medication Ration (AMR) that were l<MPL (25th percentile). The CDC nephropathy measure had increasingly higher percentage thresholds for reaching the MPL year over year due to plans in the state continuting to meet or exceed the required targets. As a result, DHCS is not requiring plans to report the measure for MCAS 2020 reporting. As part of the HEDIS Tactical Plan which encompasses activities that are tied to the HEDIS 5 year Strategy, changes to the formulary and other initiatives to increase the use of controller vs rescue medications for treatment of asthma are being

DHCS Quality Factor Score (QFS) Ranking ‐ Northeast

No change from prior report ‐ Updates will occur post HEDIS 2020 <50th percentile

Northwest Region

>22%

DHCS Quality Factor Score (QFS) Ranking ‐ Southwest

No change from prior report ‐ Updates will occur post HEDIS 2020 ‐The Southwest Region showed a slight decline in the plan wide composite score over the prior year rate. Activities related to the HEDIS tactical plan including initiatives to engage members and providers through virtual and in person engagements as well as mailed and website based communication campaigns.

>22%

DHCS Quality Factor Score (QFS) Ranking ‐ Southeast

The Quality Factor Scores were shared during a presentation at the October 2019 PHC Board meeting. For the most recently reported HEDIS measurement year, across 53 Medicaid regions/health plans in California, our Northeast Region was ranked 39th and Northwest Region 47th on this Medicaid Dashboard. Our NE region saw notable improvement, from 49th to 39th position, rising above the 25th percentile reported compared to last year. Our NW region saw a decline from 45th to 47th position and is just above the 10th percentile. PHC is actively implementing its tactical and strategic HEDIS Score Improvement plans to drive both regional and plan‐wide performance improvement.

A HEDIS Score Improvement Tactical Plan is in place to address <MPL performance reporting and new DHCS quality directives. It is focused on population health management actions where PHC impacts members directly, incentivizes and supports our provider network in improving the health of our members, and improves data capture and validation within HEDIS measurement.

Northern RegionPercent of reportable HEDIS measures that are <25th percentile (MPL)

<25th percentile

Southern Region

<50th percentile

Northeast Region

Southern Region

QUALITY IMPROVEMENT (QI)


TARGET >> 1 1 1 1

ACTUAL >> 0 0

TARGET >> 0 0 0 0

ACTUAL >> 2 0

COMFORT ZONECAUTION ZONECRITICAL ZONE

Partnership HealthPlan ‐ Governing Board Quarterly Dashboard Key*Regulatory Target/Std. **Data inputs are delayed

2

Medi‐Cal Cases Closed outside of DHCS‐Mandated Timeframes

2

GRIEVANCES North & South*Medi‐Cal State Hearings overturned byDHCS

No cases closed outside of DHCS timeframes in FY 2Q19.

No State Hearings overturned by DHCS during FY 2Q19.







Topic Description: Commissioner Randall Hempling has made numerous outstanding contributions to Partnership HealthPlan of California (PHC). He served as the Board Chair since February 28, 2018, and provided excellent leadership and dedication to the HealthPlan and Board.

Reason for Resolution: To provide Commissioner Hempling with the highest level of commendation and appreciation for his outstanding service as the Board Chair for the past two years.


Requested Action of the Board: Based on the recommendation of PHC staff, the Board is asked to approve the commendations and appreciation for the support and dedication that Commissioner Hempling provided to PHC and to recognize all his efforts as the Board Chair from February 28, 2018 through February 26, 2020.




Resolution Number:

20- IN THE MATTER OF: APPROVING COMMENDATIONS AND APPRECIATION FOR RANDALL HEMPLING’S SERVICE Recital: Whereas,

A. Commissioner Hempling provided immeasurable volunteer services to the PHC and the Board.


1. To approve the highest level of commendations and appreciation for Commissioner Hempling’s outstanding service as the Board Chair for the past two years.



Date ATTEST: BY:








Topic Description: Commissioner Sarada Mylavarapu, M.D., Chief Medical Officer at Dignity Health Woodland Memorial Hospital has left the area and relocated to Southern California.

Commissioner Mylavarapu has made numerous outstanding contributions to Partnership HealthPlan of California (PHC) and the Commission (known as the Board) from June 28, 2017 to February 26, 2020. She has provided excellent leadership, been a dedicated volunteer, and her attendance has been exceptional. Her knowledge has been of great value to PHC, and she has kept the needs of our members, providers, and the community as a guiding principle.

Reason for Resolution: To provide Commissioner Sarada Mylavarapu, M.D., with the highest level of commendations and appreciation for her excellent service over the past two years and eight months.


Requested Action of the Board: Based on the recommendation of PHC staff, the Board is asked to approve the commendations and appreciation for the support Commissioner Sarada Mylavarapu, M.D., provided to PHC and the Board.





IN THE MATTER OF: COMMENDATIONS AND APPRECIATION FOR SARADA MYLAVARAPU, M.D.’S SERVICE TO PHC AND THE BOARD Recital: Whereas,

A. Dr. Sarada Mylavarapu provided valuable advice and support for PHC and the Board.

B. Dr. Sarada Mylavarapu was a faithful and active member of the Board.


1. To approve the highest level of commendations and appreciation for Commissioner Mylavarapu outstanding service to PHC and the Board.



Date ATTEST: BY:








Topic Description: Letty Garza is the Director of Trinity County Health & Human Services and she is retiring from the county on March 1, 2020.

Commissioner Garza has made numerous outstanding contributions to Partnership HealthPlan of California (PHC) and the Commission (known as the Board) from June 22, 2016 to February 26, 2020. She has provided excellent leadership, been a dedicated volunteer, and her attendance has been exceptional. Her knowledge has been of great value to PHC, and she has kept the needs of our members, providers, and the community as a guiding principle.

Reason for Resolution: To provide Commissioner Letty Garza with the highest level of commendations and appreciation for her excellent service over the past three years and eight months.


Requested Action of the Board: Based on the recommendation of PHC staff, the Board is asked to approve the commendations and appreciation for the support Commissioner Letty Garza provided to PHC and the Board.





IN THE MATTER OF: COMMENDATIONS AND APPRECIATION FOR LETTY GARZA’S SERVICE TO PHC AND THE BOARD Recital: Whereas,

A. Letty Garza provided valuable advice and support for PHC and the Board.

B. Letty Garza was a faithful and active member of the Board.


1. To approve the highest level of commendations and appreciation for Commissioner Garza’s outstanding service to PHC and the Board.



Date ATTEST: BY:








Topic Description: Cheyenne Spetzler has been functioning as both the Chief Executive Officer and Chief Operations Officer at Open Door Community Health Centers since March 2018. She is resigning from the Commission (known as the Board) and stepping down as the Chief Executive Officer. Ms. Spetzler will continue at Open Door Community Health Centers as the Chief Operations Officer.

Commissioner Spetzler has made numerous outstanding contributions to Partnership HealthPlan of California (PHC) and the Commission from June 27, 2018 to February 26, 2020. She has provided excellent leadership, been a dedicated volunteer, and her attendance has been exceptional. Her knowledge has been of great value to PHC, and she has kept the needs of our members, providers, and the community as a guiding principle.

Reason for Resolution: To provide Commissioner Cheyenne Spetzler with the highest level of commendations and appreciation for her excellent service over the past year and eight months.


Requested Action of the Board: Based on the recommendation of PHC staff, the Board is asked to approve the commendations and appreciation for the support Commissioner Cheyenne Spetzler provided to PHC and the Board.





IN THE MATTER OF: COMMENDATIONS AND APPRECIATION FOR CHEYENNE SPETZLER’S SERVICE TO PHC AND THE BOARD Recital: Whereas,

A. Cheyenne Spetzler provided valuable advice and support for PHC and the Board.

B. Cheyenne Spetzler was a faithful and active member of the Board.


1. To approve the highest level of commendations and appreciation for Commissioner Spetzler’s outstanding service to PHC and the Board.



Date ATTEST: BY:



FINANCIAL HIGHLIGHTS Of The Partnership HealthPlan Of CaliforniaFor the Period Ending December 31, 2019

Financial Analysis for the Current Period

Total (Deficit) Surplus For the month ending December 31, 2019, PHC reported a surplus of $996,989 bringing the year-to-date to a surplus of $334,954. Significant variances are explained below.

Revenue Total Revenue is under budget by $1.2 million for the month of December and is greater than budget by $11.9 million for the year-to-date. The year-to-date favorability is mainly driven by a slight underestimation of budgeted supplemental payments tied to Behavioral Health and American Indian Health Services, both of which have an offsetting healthcare cost component. Other revenue is lower than expected due to leasing vacancies.

Healthcare Costs Total Healthcare Costs are under budget by $2.1 million for the month of December and is greater than budget by $21.9 million for the year-to-date. Total Inpatient Hospital has an unfavorable year-to-date variance of roughly $24.5 million, or 5.8%. Incurred expenses are higher than anticipated partially due to high dollar whole child model (WCM) claims as well as timing of assumed impacts for hospital contract changes that took place in the prior year. PHC is closely monitoring the WCM inpatient claims on a weekly basis and analyzing the development against revenue and budget expectations. Long Term Care has an unfavorable year-to-date variance of $11.2 million mainly driven by an accrual for the annual long term care rate increases by DHCS effective August each year. Pharmacy expenses are favorable $16.4 million year-to-date primarily due to budget assumptions that were based on limited WCM information. Favorability of pharmacy may be reduced in future months as quarterly AWP increases are realized along with increased utilization of specialty drugs and new high cost treatments.

Administrative Costs Total administrative costs are under budget by $605,192 for the month bringing the positive variance to $5.7 million for the year-to-date. The positive variances continue to be in employee, computer and data costs. As open positions are filled and IT projects are completed during the year the positive variance should decrease.

Balance Sheet

Total Cash & Cash Equivalents decreased by $8.3 million for the month. $217.2 million in State Capitation Payments were received which were offset by $213.5 million in healthcare payments and $12.9 million in administrative and capital costs. The remaining difference can be attributed to interest, other revenues, and transfers.

Per Board approval, $35.0 million was moved from the Unrestricted Fund Balance into the Strategic Use of Reserve Fund for the upcoming Wellness & Recovery program.


FINANCIAL HIGHLIGHTS Of The Partnership HealthPlan Of CaliforniaFor the Period Ending December 31, 2019

General Statistics

Membership Membership had a net decrease of 4,607 members for the month. Medi-Cal Rate Regions 1 and 2 had net membership decreases of 1,920 and 2,687, respectively.

Utilization Metrics and High Dollar Case For the fiscal year 2019/20 through December 31, 2019, 102 members reached the $250,000 threshold with an average cost of $376,827. For fiscal year 2018/19, the number of members reached 429, and the average cost per case was $455,076. For fiscal year 2017/18, 460 members reached the $250,000 threshold with an average claims cost of $421,201.

Current Ratio/Required Reserves (Excluding Capital Assets)

Current Ratio Including Required Reserves 1.96Current Ratio Excluding Required Reserves: 1.26Required Reserves: $468,917,724Total Fund Balance: $604,680,402

Days of Cash on Hand Including Required Reserves: 91.89Excluding Required Reserves: 46.75


I:\HCCMTHND\MOR\Dashboard\FY 1819\Dashboard_201906

Partnership HealthPlan of CaliforniaExecutive Dashboard: Medi-Cal - Rate Region 1Key Measures of Financial Performance as of June 30, 2019

2018/19 2018/19 2017/18 2017/18LOB: Medi-Cal Budget Estimated FYTD Budget Actual

Average Enrollment 225,260 224,952 235,427 231,862Cost Per Member Per Month:

Global Subcapitation $45.01 $45.95 $44.89 $45.32Professional Cap $20.51 $21.72 $20.90 $21.43Medical Services (FFS &Prop 56) $91.40 $100.98 $79.82 $88.80IP Hospital - Cap $44.21 $47.96 $42.92 $45.88IP Hospital - FFS $65.05 $67.27 $60.25 $61.13Pharmacy $35.73 $38.90 $38.93 $37.27Long Term Care $52.11 $51.32 $47.23 $47.00Total $354.02 $374.10 $334.92 $346.83

Total Capitation Revenue PMPM $380.38 $402.36 $351.14 -$12.02

Annual Bed Days/1000 324 306 Annual Admissions/1000 66 64 Avg Length of Stay (ALOS) 4.88 4.75 Avg Cost Per Bed Day $4,244 $4,132ED Visits/1000 583 594 Physician Visits PMPY 2.75 3.14 Pharmacy Avg Cost Per Fill $78.06 $69.56Pharmacy Pct. Generic Fills 89% 89%Pharmacy Fills PMPY 7.71 8.16 FY 2017-2018 Utilization measures as of 6/30/18. FY 2018-2019 as of Q3.

Global Subcapitation

12%

Professional Cap6%

Medical Services27%

IP Hospital -Cap13%

IP Hospital - FFS18%

Pharmacy10%

Long Term Care14%

Medi-Cal Expenditures by Cost Category

FY 2018/2019

Global Subcapitation Professional CapMedical Services IP Hospital - CapIP Hospital - FFS PharmacyLong Term Care

Professional Cap7%

Medical Services31%

IP Hospital -Cap14% IP Hospital - FFS

20%

Pharmacy12%Long Term

Care16%

Medi-Cal Expenditures(excluding Kaiser)

by Cost CategoryFY 2018/2019

Professional Cap Medical ServicesIP Hospital - Cap IP Hospital - FFSPharmacy Long Term Care


Partnership HealthPlan of CaliforniaExecutive Dashboard: Medi-Cal - Rate Region 2Key Measures of Financial Performance as of June 30, 2019

2018/19 2018/19 2017/18 2017/18LOB: Medi-Cal Budget Estimated FYTD Budget Actual

Average Enrollment 324,740 329,271 337,993 333,914Cost Per Member Per Month:

Global Subcapitation $13.91 $13.16 $12.59 $14.36PCP & Spec/Ancillary Capitation $12.41 $12.00 $12.69 $13.11Medical Services (FFS, AB915 & Prop 56) $119.65 $126.53 $97.65 $112.35IP Hospital - Cap $18.22 $18.26 $17.76 $18.32IP Hospital - FFS $98.68 $104.82 $82.55 $91.67Pharmacy $41.06 $45.80 $45.49 $41.39Long Term Care $48.50 $48.61 $48.96 $47.65Total $352.45 $369.19 $317.70 $338.84

Total Capitation Revenue PMPM $375.85 $389.92 $343.33 $350.66

Annual Bed Days/1000 321 298 Annual Admissions/1000 66 63 Avg Length of Stay 4.84 4.72 Avg Cost Per Bed Day $4,340 $4,281ED Visits/1000 655 671 Physician Visits PMPY 2.61 3.10 Pharmacy Avg Cost Per Fill $71.75 $65.32Pharmacy Pct. Generic Fills 89% 90%Pharmacy Fills PMPY 7.88 8.20 FY 2017-2018 Utilization measures as of 6/30/18. FY 2018-2019 as of Q3.

Global Subcapitation

4%

Professional Cap3%

Medical Services34%

IP Hospital - Cap5%


Pharmacy13%

Long Term Care13%

Medi-Cal Expenditures by Cost Category

FY 2018/2019

Global Subcapitation Professional CapMedical Services IP Hospital - CapIP Hospital - FFS PharmacyLong Term Care

Professional Cap3%

Medical Services36%

IP Hospital - Cap5%


Pharmacy13%Long Term

Care14%

Medi-Cal Expenditures(excluding Kaiser)

by Cost CategoryFY 2018/2019

Professional Cap Medical Services

IP Hospital - Cap IP Hospital - FFS

Pharmacy Long Term Care


Member Months by County:

County Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19

Solano 107,608 107,460 107,350 107,493 107,333 107,442 106,084 106,461 106,294 106,010 105,954 104,966 104,320 Napa 27,349 27,457 27,444 27,410 27,460 27,750 27,597 27,681 27,663 27,592 27,694 27,775 27,717 Yolo 52,718 52,511 52,261 51,830 51,672 51,798 50,905 50,909 50,690 50,117 50,432 50,217 49,882 Sonoma 106,065 106,034 106,421 106,071 104,764 105,420 104,766 104,559 104,234 103,702 103,285 102,775 102,023 Marin 37,027 37,139 37,185 37,087 37,177 37,403 37,251 37,294 37,295 37,353 37,123 36,840 36,660 Mendocino 38,377 38,354 38,155 38,123 38,232 38,007 37,228 36,820 36,899 36,172 36,032 35,496 34,983 Lake 30,185 30,253 30,265 30,124 29,917 30,082 29,772 30,040 29,994 29,985 29,939 29,681 29,387 Del Norte 11,268 11,268 11,222 11,168 11,133 11,130 11,124 11,120 11,107 11,113 11,200 11,090 11,070 Humboldt 51,790 51,949 51,958 51,939 52,460 52,762 51,856 52,179 52,016 52,035 52,103 52,086 52,009 Lassen 7,174 7,151 6,955 6,973 6,989 7,095 7,011 7,062 7,097 7,051 7,147 7,101 7,127 Modoc 3,180 3,194 3,198 3,210 3,163 3,193 3,177 3,158 3,202 3,218 3,200 3,212 3,268 Shasta 59,774 59,449 59,097 59,177 59,075 59,057 58,622 58,572 58,629 58,710 58,867 58,575 58,353 Siskiyou 17,480 17,480 17,481 17,367 17,280 17,254 16,978 17,065 16,994 17,011 17,126 16,917 16,819 Trinity 4,258 4,285 4,285 4,275 4,218 4,200 4,234 4,128 4,104 4,139 4,127 4,134 4,157 All Counties Total 554,253 553,984 553,277 552,247 550,873 552,593 546,605 547,048 546,218 544,208 544,229 540,865 537,775

Medi-Cal Region 1: Solano, Napa, Yolo & Marin; Medi-Cal Region 2: Sonoma, Mendocino & Rural 8 Counties

551,073

548,691 546,328 543,984

541,661 539,357

537,071

549,804 549,079 548,358

547,639 546,924 546,211

554,253

553,984

553,277 552,247

550,873 552,593

546,605

547,048 546,218

544,208 544,229

540,865 537,775

530,000

535,000

540,000

545,000

550,000

555,000

560,000

565,000

570,000

575,000

580,000

D E C - 1 8 J A N - 1 9 F E B - 1 9 M A R - 1 9 A P R - 1 9 M A Y - 1 9 J U N - 1 9 J U L - 1 9 A U G - 1 9 S E P - 1 9 O C T - 1 9 N O V - 1 9 D E C - 1 9

PARTNERSHIP HEALTHPLAN OF CALIFORNIAACTUAL V. PROJECTED MEDI-CAL ENROLLMENT

DEC 2018 - DEC 2019

Projected (Budgeted) Actual


43,708 As of

FINANCIAL INDICATORS Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 YTD Dec-19

Total Enrollment 543,170 542,248 540,608 540,739 537,716 533,109 3,237,590 539,598

Total Revenue 232,220,019 233,979,321 225,758,449 230,938,231 229,446,952 224,684,937 1,377,027,908 229,504,651

Total Health Care Costs 221,560,592 223,257,443 217,724,528 221,071,036 220,349,586 213,467,350 1,317,430,532 219,571,755

Total Administrative Costs 9,697,468 9,586,960 10,254,919 10,262,335 9,240,143 10,220,598 59,262,422 9,877,071

Total Current Year Surplus (Deficit) 961,959 1,134,918 (2,220,998) (395,140) (142,777) 996,989 334,954 55,825

Total Claims Payable 309,950,812 333,658,113 318,826,076 337,397,003 359,352,408 356,763,714 356,763,714 335,991,354

Total Fund Balance 605,307,407 606,442,325 604,221,326 603,826,187 603,683,410 604,680,402 604,680,402 604,693,510

Reserve Fund - Required Reserves 364,887,643 362,362,468 361,460,827 362,216,840 361,706,326 360,992,575 360,992,575 362,271,113

Reserve Fund - Capital Assets 105,166,231 108,043,421 108,574,111 107,960,113 108,326,115 107,925,149 107,925,149 107,665,857

Reserve Fund - Strategic Use of Reserves 59,756,800 59,651,513 59,380,941 57,548,808 56,942,396 91,126,990 91,126,990 64,067,908

Unrestricted Fund Balance 75,496,733 76,384,923 74,805,447 76,100,426 76,708,573 44,635,688 44,635,688 70,688,632

Fund Balance as % of Reserved Funds 114.25% 114.41% 114.13% 114.42% 114.56% 107.97% 107.97% 113.24%

Current Ratio 1.29:1 1.28:1 1.23:1 1.27:1 1.25:1 1.26:1 1.26:1 1.26:1

Medical Loss Ratio 95.41% 95.42% 96.44% 95.73% 96.04% 95.01% 95.67% 95.67%

Admin Ratio 4.18% 4.10% 4.54% 4.44% 4.03% 4.55% 4.30% 4.30%

Profit Margin Ratio 0.41% 0.49% -0.98% -0.17% -0.06% 0.44% 0.02% 0.02%

Avg / Month

As of

FINANCIAL INDICATORS Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 YTD Jun-19

Total Enrollment 558,229 555,694 554,259 553,722 554,344 551,393 550,184 549,293 548,517 547,283 547,276 544,864 6,615,058 551,255

Total Revenue 223,622,396 224,627,038 223,011,248 221,839,053 238,320,688 225,145,110 229,293,826 234,635,800 237,354,464 240,583,405 248,302,311 235,490,761 2,782,226,099 231,852,175

Total Health Care Costs 215,098,111 213,849,684 210,084,055 209,799,985 223,764,851 211,650,497 216,013,007 226,612,352 225,474,410 219,531,756 218,022,242 205,309,098 2,595,210,049 216,267,504

Total Administrative Costs 7,937,564 8,576,255 7,892,305 8,992,573 8,487,438 9,080,268 9,079,667 8,720,456 9,568,053 8,989,395 10,037,320 9,906,862 107,268,157 8,939,013

Medi-Cal Hospital & Managed Care Taxes 11,196,958 11,196,958 11,196,958 11,196,958 11,196,958 11,196,958 11,196,958 11,196,958 11,196,958 11,196,958 11,196,958 11,196,958 134,363,496 11,196,958

Total Current Year Surplus (Deficit) (10,610,237) (8,995,859) (6,162,070) (8,150,463) (5,128,559) (6,782,613) (6,995,806) (11,893,966) (8,884,957) 865,296 9,045,791 9,077,843 (54,615,603) (4,551,300)

Total Claims Payable 238,728,946 242,503,297 266,069,388 251,011,405 298,803,635 294,871,571 309,072,419 331,116,229 334,992,569 318,215,062 330,437,589 342,352,414 342,352,414 296,514,544

Total Fund Balance 648,231,184 639,235,325 633,073,254 624,922,791 619,794,231 613,011,618 606,015,812 594,121,845 585,236,888 586,102,184 595,147,976 604,225,819 604,225,819 612,426,578

Reserve Fund - Required Reserves 468,852,166 470,106,280 470,618,797 375,187,068 374,339,552 371,639,122 373,138,099 376,969,141 381,309,416 383,837,629 376,627,068 376,097,730 376,097,730 399,893,506

Reserve Fund - Capital Assets 84,135,058 85,929,106 88,073,284 89,834,151 93,533,892 97,192,597 97,351,505 96,896,491 95,866,835 95,577,773 104,951,344 105,532,414 105,532,414 94,572,871

Reserve Fund - Strategic Use of Reserves 66,188,548 63,204,100 73,804,101 72,586,265 71,540,381 68,267,962 66,495,382 66,082,314 65,094,988 63,538,939 61,259,598 60,646,102 60,646,102 66,559,057

Unrestricted Fund Balance 29,055,412 19,995,839 577,072 87,315,307 80,380,406 75,911,937 69,030,826 54,173,899 42,965,649 43,147,843 52,309,966 61,949,573 61,949,573 51,401,144

Fund Balance as % of Reserved Funds 104.69% 103.23% 100.09% 116.24% 114.90% 114.13% 112.86% 110.03% 107.92% 107.95% 109.64% 111.42% 111.42% 109.16%

Current Ratio 1.13:1 1.11:1 1.09:1 1.38:1 1.31:1 1.30:1 1.29:1 1.24:1 1.13:1 1.12:1 1.23:1 1.24:1 1.24:1 1.19:1

Medical Loss Ratio w/o Tax 101.26% 100.20% 99.18% 99.60% 98.52% 98.93% 99.04% 101.42% 99.70% 95.70% 91.95% 91.54% 98.01% 98.01%

Admin Ratio w/o Tax 3.74% 4.02% 3.73% 4.27% 3.74% 4.24% 4.16% 3.90% 4.23% 3.92% 4.23% 4.42% 4.05% 4.05%

Profit Margin Ratio w/o Tax -4.99% -4.21% -2.91% -3.87% -2.26% -3.17% -3.21% -5.32% -3.93% 0.38% 3.82% 4.05% -2.06% -2.06%

Partnership HealthPlan of CaliforniaComparative Financial Indicators Monthly ReportFiscal Year 2019 - 2020 & Fiscal Year 2018 - 2019

Avg / Month


$97.4 $96.9 $95.9 $95.6 $105.0 $105.5 $105.2 $108.0 $108.6 $108.0 $108.3 $107.9

$373.1 $377.0 $381.3 $383.8 $376.6 $376.1 $364.9 $362.4 $361.5 $362.2 $361.7 $361.0

$66.5 $66.1 $65.1 $63.5 $61.3 $60.6 $59.8 $59.7 $59.4 $57.5 $56.9 $91.1

$69.0$54.2 $43.0 $43.1

$52.3$62.1 $75.5 $76.4 $74.8

$76.1 $76.7

$44.6

$0.0

$100.0

$200.0

$300.0

$400.0

$500.0

$600.0

$700.0

Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019 Jun 2019 Jul 2019 Aug 2019 Sep 2019 Oct 2019 Nov 2019 Dec 2019

Partnership HealthPlan of CaliforniaFund Balance Comparison

(in Millions of Dollars)

Reserves - Capital Assets Required Reserves Strategic Use of Reserves Unrestricted Funds

For the Past 12 Months Ending December 31, 2019


CURRENT MONTH

PRIORMONTH INC / DEC MEMBERSHIP SUMMARY

CURRENT YTD AVG

PRIOR YTD AVG VARIANCE

216,597 218,517 (1,920) Medi-Cal Region 1 219,172 225,165 (5,992) 316,512 319,199 (2,687) Medi-Cal Region 2 320,426 329,442 (9,016) 533,109 537,716 (4,607) TOTAL 539,598 554,607 (15,009)

ACTUALMONTH

BUDGETMONTH

$ VARIANCE MONTH FINANCIAL SUMMARY

ACTUAL YTD

BUDGET YTD

$ VARIANCE YTD

224,684,937 225,903,609 (1,218,672) Total Revenue 1,377,027,908 1,365,141,592 11,886,316 213,467,350 215,540,419 2,073,069 Total Healthcare Costs 1,317,430,532 1,295,562,688 (21,867,844)

10,220,598 10,825,789 605,191 Total Administrative Costs 59,262,422 64,954,806 5,692,384 996,989 (462,599) 1,459,588 Total Current Year Surplus (Deficit) 334,954 4,624,098 (4,289,144)

95.01% 95.41%Medical Loss Ratio (HC Costs as a % of

Rev) 95.67% 94.90%

4.55% 4.79%Admin Ratio (Admin Costs as a % of

Rev) 4.30% 4.76%

PARTNERSHIP HEALTHPLAN OF CALIFORNIAMembership and Financial Summary

For The Period Ending December 31, 2019

Page 1 of 5


December 2019 November 2019

A S S E T SCurrent Assets

Cash &Cash Equivalents 373,861,975 382,162,687

ReceivablesAccrued Interest 566,500 382,200State DHS - Cap Rec 265,482,370 258,530,300Funds Receivable - Prov Risk 4,531,891 4,531,891Miscellaneous Receivable 1,338,617 1,355,052

Total Receivables 271,919,378 264,799,443

Other Current AssetsPayroll Clearing (1,856) 3,722Prepaid Expenses 4,886,357 4,793,869

Total Other Current Assets 4,884,501 4,797,591

Total Current Assets 650,665,854 651,759,721

Non-Current AssetsFixed Assets

Motor Vehicles 140,518 140,518Furniture & Fixtures 7,518,859 7,518,859Computer Equipment - HP 541,886 541,886Computer Equipment 19,487,765 19,472,250Computer Software 18,483,265 18,483,265Leasehold Improvements 962,374 962,374Land 6,767,292 6,767,292Building 55,932,088 55,932,088Building Improvements 27,408,018 27,408,018Accum Depr - Motor Vehicles (108,179) (106,869)Accum Depr - Furniture (6,004,756) (5,959,884)Accum Depr - Comp Equip - HP (541,886) (541,886)Accum Depr - Comp Equipment (9,438,872) (9,040,813)Accum Depr - Computer Sftware (13,989,194) (13,780,930)Accum Depr - Lsehld Improve (941,884) (939,812)Accum Depr - Building (5,588,722) (5,469,209)Accum Depr - Bldg Improvements (4,729,636) (4,579,623)Construction Work-In-Progress 12,026,212 11,518,590

Total Fixed Assets 107,925,148 108,326,114

Other Non-Current AssetsDeposits 16,038 7,656Board-Designated Reserves 360,692,575 361,406,326Knox-Keene Reserves 300,000 300,000Net Pension Asset 1,350,224 1,350,224Deferred Outflows Of Resources 927,581 927,581

Total Other Non-Current Assets 363,286,418 363,991,787

Total Non-Current Assets 471,211,566 472,317,901

Total Assets 1,121,877,420 1,124,077,622

PARTNERSHIP HEALTHPLAN OF CALIFORNIABalance Sheet

As Of December 31, 2019

Page 2 of 5


December 2019 November 2019

PARTNERSHIP HEALTHPLAN OF CALIFORNIABalance Sheet

As Of December 31, 2019

L I A B I L I T I E S & F U N D B A L A N C E Liabilities

Current LiabilitiesAccounts Payable 77,726,619 83,891,965 Unearned Income 132,612 201,334 Suspense Account 1,198,681 704,012 Capitation Payable 7,660,642 8,854,734 State DHS - Cap Payable 6,562,106 6,562,106 Claims Payable 113,316,527 81,052,362 Incurred But Not Reported-IBNR 243,447,187 278,300,046 Quality Improvement Programs 66,630,775 60,305,784

Total Current Liabilities 516,675,149 519,872,343

Non-Current LiabilitiesDeferred Inflows Of Resources 521,869 521,869

Total Non-Current Liabilities 521,869 521,869

Total Liabilities 517,197,018 520,394,212

Fund BalanceUnrestricted Fund Balance 44,635,688 76,708,573

Reserved FundsReserve Fund-Board Designated 345,692,575 346,406,326 Reserve Fund-Board Designated-Infrastructure 15,000,000 15,000,000 Reserve Fund-Board Designated-Capital Assets 107,925,149 108,326,115 Reserve Fund-Strategic Use Of Reserve 91,126,990 56,942,396 Reserve For Restricted Fund-Knox-Keene 300,000 300,000

Total Reserved Funds 560,044,714 526,974,837

Total Fund Balance 604,680,402 603,683,410

Total Liabilites And Fund Balance 1,121,877,420 1,124,077,622

Page 3 of 5


Current Month Activity Year-To-Date Activity

CASH FLOWS FROM OPERATING ACTIVITIES:Cash Received From:Capitation from California Department of Health Care Service 217,150,122 1,442,860,962 Other Revenues 3,975 15,096Cash Payments to Providers for Medi-Cal Members

Capitation Payments (34,328,664) (208,892,509) Medical Claims Payments (179,181,003) (1,058,462,312)

Cash Payments to Vendors (4,565,479) (148,466,463) Cash Payments to Employees (7,975,575) (47,699,870) Net Cash (Used) Provided by Operating Activities (8,896,624) (20,645,096)

CASH FLOWS FROM CAPITAL FINANCING & RELATED ACTIVITIES:Purchases of Capital Assets (401,397) (7,967,003) Net Cash Used by Capital Financial & Related Activities (401,397) (7,967,003)

CASH FLOWS FROM INVESTING ACTIVITIES:Board-Designated Reserve Transfers 713,751 15,105,154Interest and Dividends on Investments 283,558 2,840,303Net Cash (Used) Provided by Investing Activities 997,309 17,945,457

NET (DECREASE) INCREASE IN CASH & CASH EQUIVALENTS (8,300,712) (10,666,642)

CASH & CASH EQUIVALENTS, BEGINNING 382,162,687 384,528,617

CASH & CASH EQUIVALENTS, ENDING 373,861,975 373,861,975

RECONCILIATION OF OPERATING (LOSS) INCOME TO NET CASH PROVIDED (USED) BY OPERATING ACTIVITIES:

TOTAL OPERATING (LOSS) INCOME 529,134 (2,608,952) DEPRECIATION 924,103 5,472,605CHANGES IN ASSETS AND LIABILITIES:Other Receivables 16,435 (1,084,140) California Department of Health Services Receivable (6,952,069) (27,483,681) Other Assets (217,031) 239,227Accounts Payable and Accrued Expenses (6,933,492) (21,388,315) Accrued Claims Payable (2,588,695) 14,411,300Quality Improvement Programs 6,324,991 11,796,860Net Cash Provided (Used) by Operating Activities (8,896,624) (20,645,096)

PARTNERSHIP HEALTHPLAN OF CALIFORNIAStatement of Cash Flow

For The Period Ending December 31, 2019

Page 4 of 5


-

ACTUALMONTH

BUDGETMONTH

$ VARIANCE MONTH

ACTUAL MONTH PMPM

BUDGET MONTH PMPM

ACTUAL YTD

BUDGET YTD

$ VARIANCE

YTD

ACTUAL YTD

PMPM

BUDGET YTD

PMPM

533,109 533,109 - TOTAL MEMBERSHIP 3,237,590 3,237,590 -

REVENUE224,102,191 225,205,919 (1,103,728) 420.37 422.44 State Capitation Revenue 1,373,399,045 1,360,955,452 12,443,593 424.20 420.36

467,858 513,350 (45,492) 0.88 0.96 Interest Income 2,943,905 3,080,100 (136,195) 0.91 0.95 114,888 184,340 (69,452) 0.22 0.35 Other Revenue 684,958 1,106,040 (421,082) 0.21 0.34

224,684,937 225,903,609 (1,218,672) 421.47 423.75 TOTAL REVENUE 1,377,027,908 1,365,141,592 11,886,316 425.32 421.65

HEALTHCARE COSTS14,522,437 14,637,886 115,449 27.24 27.46 Global Subcapitation 88,036,307 88,292,253 255,946 27.19 27.27

2,072,476 2,111,525 39,049 3.89 3.96 Capitated Medical Groups 12,482,839 12,730,564 247,725 3.86 3.93

Physician Services5,170,142 5,210,971 40,829 9.70 9.77 PCP Capitation 31,377,906 31,451,436 73,530 9.69 9.71

174,419 377,230 202,811 0.33 0.71 Specialty Capitation 2,065,402 2,274,968 209,566 0.64 0.70 27,065,922 27,277,078 211,156 50.77 51.17 Non-Capitated Physician Services 162,798,095 161,644,023 (1,154,072) 50.28 49.93

32,410,483 32,865,279 454,796 60.80 61.65 Total Physician Services 196,241,403 195,370,427 (870,976) 60.61 60.34

Inpatient Hospital15,742,742 16,006,505 263,763 29.53 30.02 Hospital Capitation 95,439,962 96,506,893 1,066,931 29.48 29.81 46,934,651 46,407,112 (527,539) 88.04 87.05 Inpatient Hospital - FFS 301,785,739 278,262,669 (23,523,070) 93.21 85.95 1,718,030 1,718,030 - 3.22 3.22 Hospital Stoploss 12,363,657 10,363,657 (2,000,000) 3.82 3.20

64,395,423 64,131,647 (263,776) 120.79 120.29 Total Inpatient Hospital 409,589,357 385,133,219 (24,456,138) 126.51 118.96

29,172,632 27,861,059 (1,311,573) 54.72 52.26 Long Term Care 179,595,344 168,362,749 (11,232,595) 55.47 52.00

21,944,022 26,197,564 4,253,542 41.16 49.14 Pharmacy 141,076,043 157,462,059 16,386,016 43.57 48.64

Ancillary Services941,129 965,547 24,418 1.77 1.81 Ancillary Services - Capitated 5,732,401 5,824,761 92,360 1.77 1.80

34,892,746 34,640,330 (252,416) 65.45 64.98 Ancillary Services - Non-Capitated 212,490,982 209,355,535 (3,135,447) 65.63 64.66 35,833,875 35,605,877 (227,998) 67.22 66.79 Total Ancillary Services 218,223,383 215,180,296 (3,043,087) 67.40 66.46

Other Medical1,871,688 2,193,321 321,633 3.51 4.11 Quality Assurance 11,732,720 13,159,994 1,427,274 3.62 4.06

809,657 459,870 (349,787) 1.52 0.86 Healthcare Investment Funds 4,557,534 2,759,220 (1,798,314) 1.41 0.85 - 96,350 96,350 - 0.18 Advice Nurse 385,264 578,100 192,836 0.12 0.18

8,646 18,170 9,524 0.02 0.03 HIPP Payments 41,278 109,020 67,742 0.01 0.03 4,101,020 3,036,882 (1,064,138) 7.69 5.70 Transportation 17,519,114 18,474,853 955,739 5.41 5.71 6,791,011 5,804,593 (986,418) 12.74 10.88 Total Other Medical 34,235,910 35,081,187 845,277 10.57 10.83

6,324,991 6,324,989 (2) 11.86 11.86 Quality Improvement Programs 37,949,946 37,949,934 (12) 11.72 11.72

213,467,350 215,540,419 2,073,069 400.42 404.29 TOTAL HEALTHCARE COSTS 1,317,430,532 1,295,562,688 (21,867,844) 406.90 400.15

ADMINISTRATIVE COSTS6,549,884 6,659,946 110,062 12.29 12.49 Employee 38,437,953 39,959,748 1,521,795 11.87 12.34

49,825 89,654 39,829 0.09 0.17 Travel And Meals 329,772 537,924 208,152 0.10 0.17 1,153,358 1,192,916 39,558 2.16 2.24 Occupancy 7,081,629 7,157,496 75,867 2.19 2.21

185,344 465,739 280,395 0.35 0.87 Operational 1,581,051 2,794,434 1,213,383 0.49 0.86 1,765,231 1,396,044 (369,187) 3.31 2.62 Professional Services 8,450,479 8,376,264 (74,215) 2.61 2.59

516,956 1,021,490 504,534 0.97 1.92 Computer And Data 3,381,538 6,128,940 2,747,402 1.04 1.89 10,220,598 10,825,789 605,191 19.17 20.31 TOTAL ADMINISTRATIVE COSTS 59,262,422 64,954,806 5,692,384 18.30 20.06

996,989 (462,599) 1,459,588 1.88 (0.85) TOTAL CURRENT YEAR SURPLUS

(DEFICIT) 334,954 4,624,098 (4,289,144) 0.12 1.44


For The Period Ending December 31, 2019Statement of Revenues and Expenses

**The Notes to the Financial Statement are an Integral Part of this Statement

Page 5 of 5


PARTNERSHIP HEALTHPLAN OF CALIFORNIA NOTES TO FINANCIAL STATEMENTS

December 31, 2019

Page 1 of 3

1. ORGANIZATION

The Partnership HealthPlan of California (PHC) was formed as a health insurance organization,and is legally a subdivision of the State of California, but is not part of any city, county or stategovernment system. PHC has quasi-independent political jurisdiction to contract with the Statefor managing Medi-Cal beneficiaries who reside in various Northern California Counties. PHC isa combined public and private effort engaged principally in providing a more cost-effectivemethod of health care. PHC began serving Medi-Cal eligible persons in Solano in May 1994. Thatwas followed by Napa in March of 1998, Yolo in March of 2001, Sonoma in October 2009, Marinand Mendocino in July 2011, and eight Northern Counties in September 2013. Beginning July2018 and in accordance with direction from the Department of Health Care Services (DHCS), PHChas consolidated its reporting from these fourteen counties into two regions; these are in alignmentwith the two DHCS rating regions.

As a public agency, the HealthPlan is exempt from state and federal income tax.

2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

ACCOUNTING POLICIES:The accounting and reporting policies of PHC conform to generally-accepted accountingprinciples and general practices within the healthcare industry.

PROPERTY AND EQUIPMENT:Effective July 2015, property and equipment totaling $10,000 or more are recorded at cost; thisincludes assets acquired through capital leases and improvements that significantly add to theproductive capacity or extend the useful life of the asset. Costs of maintenance and repairs areexpensed as incurred. Depreciation for financial reporting purposes is provided on a straight-linemethod over the estimated useful life of the asset. The costs of major remodeling andimprovements are capitalized as building or leasehold improvements. Leasehold improvementsare amortized using the straight-line method over the shorter of the remaining term of theapplicable lease or their estimated useful life. Building improvements are depreciated over theirestimated useful life. Buildings purchased are recorded at cost and are depreciated on the straight-line basis over their estimated useful lives.

INVESTMENTS:PHC investments can consist of U.S. Treasury Securities, Agency Notes, Repurchase Agreements,Shares of Beneficial Interest and Commercial Paper and are carried at fair value.



December 31, 2019

Page 2 of 3

BOARD-DESIGNATED & KNOX KEENE RESERVES: In April 2004, PHC’s Board established a policy to set aside in a reserve account a designated amount that represents the Knox-Keene Tangible Net Equity (TNE) requirement. This policy was subsequently revised in May 2012 and beginning July 2012, the new methodology has been reflected on the balance sheet. Based on this policy and as of As of December 2019, PHC has Board-Designated and Knox-Keene Reserves of $468.6 million and $0.3 million respectively. To account for the Board approved Strategic Use Of Reserves (SUR) initiatives, which includes funding for the Wellness & Recovery program, $91.1 million has been set aside as a “Reserve Fund-Strategic Use of Reserve.” The amount represents the net amount remaining of all of the SUR projects that have been approved to date; this balance is periodically adjusted as projects are completed.

3. STATE CAPITATION REVENUE Medi-Cal capitation revenue is based on the monthly capitation rates, as provided for in the State contract, and the actual number of Medi-Cal eligible members. Capitation revenues are paid by the State on a monthly basis in arrears based on estimated membership. Prior to January 2010, enrollment was subject to retrospective adjustments by the State upon completion of the 6th and 12th months following the month of service. Effective January 2010, the retrospective adjustments have been replaced with monthly reconciliations with the State. As such, capitation revenue includes an estimate for amounts receivable from or refundable to State for these retrospective adjustments. These estimates are continually monitored and adjusted, as necessary, as experience develops or new information becomes known.

4. HEALTH CARE COST

PHC continues to develop completion factors to calculate estimated liability for claims incurred but not reported. These factors are reviewed and adjusted as more historical data become available. Budgeted capitation revenues and health care costs are adjusted each month to reflect changes in enrollee counts.

5. QUALITY IMPROVEMENT PROGRAM

PHC maintains quality incentive contracts with acute care hospitals and primary care physicians. As of December 2019, PHC has accrued a Quality Incentive Program payout for of $66.6 million.



December 31, 2019

Page 3 of 3

6. ESTIMATES

Due to the nature of the operations of the Partnership HealthPlan, it is necessary to estimateamounts for financial statement presentation. Substantial overstatement or understatement of theseestimates would have a significant impact on the statements. The items estimated through variousmethodologies are:- Value of Claims Incurred But Not Received- Quality Incentive Payouts- Earned Capitation Revenues- Total Number of Members- Retro Capitation Expense for Certain Providers

7. COMMITMENTS AND CONTINGENCIES

In the ordinary course of business, the HealthPlan is party to claims and legal actions by enrollees,providers, and others. After consulting with legal counsel, HealthPlan management is of theopinion any liability that may ultimately be incurred as a result of claims or legal actions will nothave a material effect on the financial position or results of the operations of the HealthPlan.

8. UNUSUAL OR INFREQUENT ITEMS REPORTED IN CURRENT MONTH’SFINANCIAL STATEMENTS

Per Board approval, $35 million was moved from the Unrestricted Fund Balance into the StrategicUse of Reserve Fund for the upcoming Wellness & Recovery program.


Partnership HealthPlan of CaliforniaInvestment ScheduleDecember 31, 2019

Name of Investment Investment Type Yield to Maturity

Trade Date Maturity Date

Call Date Face Value Market Value Credit Rating Agency

Credit Rating

FUNDS HELD FOR INVESTMENT:

Highmark Money Market Cash & Cash Equiv NA Various NA NA NA 1,526,835$ NA NRCertificate of Deposit for Knox Keene Cash & Cash Equiv 0.00015 9/12/2015 12/30/2018 NA NA 300,000$ NA NR

FUNDS HELD FOR OPERATIONS:

Merrill Lynch Insitutional Cash for Operations NA NA NA NA NA 68,294,270$ Merrill Lynch MMA - Checking Cash for Operations NA NA NA NA NA 154,341$ UBOC - General/MMA and Checking Cash for Operations NA NA NA NA NA 553,429,398$ Government Investment Pools (LAIF) Cash for Operations NA NA NA NA NA 65,000,000$ Government Investment Pools (County) Cash for Operations NA NA NA NA NA 39,593,127$ West America Payroll Cash for Operations NA NA NA NA NA 6,553,280$ Petty Cash Cash for Operations NA NA NA NA NA 3,300$

GRAND TOTAL: 734,854,551$

Required Reserves (Liquid)Board Designated Assets 360,692,575$ Knox Keene Reserves 300,000$ Total Required Reserves (Liquid) 360,992,575$

Cash on Hand / Cash Days Available:Including Requried Reserves 734,854,551$ Excluding Required Reserves 373,861,975$

Cash Days Available incl. Required Reserves 91.89

Cash Days Available excl. Required Reserves 46.75


0.010%0.110%0.210%0.310%0.410%0.510%0.610%0.710%0.810%0.910%1.010%1.110%1.210%1.310%1.410%1.510%1.610%1.710%1.810%1.910%2.010%2.110%2.210%2.310%2.410%2.510%

JUL AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN

Per

cen

tage

Yie

ld

Periods

Partnership HealthPlan of California Investment Yield Trends

FISCAL YEAR 19/20

PMIA 19/20

FISCAL YEAR 18/19

PMIA 18/19


Commissioners on Other PHC CommitteesRevised: 01/13/20

*Committee membership that goes to the PHC Board for approval.

Date

Region County(Appointed by Board

or CEO)

*340B Advisory Committee Viola Lujan Southeast Solano 9/25/2013

*340B Advisory Committee - Chair Dean Germano Northeast Shasta 9/25/2013

*340B Advisory Committee Kathryn Powell Southwest Sonoma 9/25/2013

*340B Advisory Committee Northwest

CEO Evaluation Committee Lewis Broschard, M.D. Southeast Solano

CEO Evaluation Committee Kathryn Powell Southwest Sonoma 6/28/2017

CEO Evaluation Committee Dave Jones Northeast Shasta

CEO Evaluation Committee Randall Hempling Northeast Shasta

CEO Evaluation Committee Dick Fogg Southwest Sonoma

CEO Evaluation Committee Nancy Starck Northeast Humboldt 8/7/2018

Consumer Advisory Committee (CAC) William Remak Southwest Sonoma 8/28/2019

Consumer Advisory Committee (CAC) Amby Burum Northwest Eureka 8/28/2019

*Finance Committee Kathryn Powell Southwest Sonoma 2/15/2017

*Finance Committee Karen Larsen Southeast Yolo 9/19/2018

*Finance Committee Viola Lujan Southeast Solano 5/18/2016

*Finance Committee - Chair Dave Jones Northeast Shasta 10/23/2013

*Finance Committee Nancy Starck Northwest Humboldt 12/2/2015

*Finance Committee Randall Hempling Northeast Shasta 10/23/2013

*Finance Committee Dick Fogg Southwest Sonoma 4/25/2012

*Finance Committee Northeast

Governance Committee Lewis Broschard, M.D. Southeast Solano

Governance Committee Southeast

Governance Committee Donnell Ewert Northeast Shasta 7/1/2016

Governance Committee Dick Fogg Southwest Sonoma

Governance Committee Northwest

Personnel Committee Southeast

Personnel Committee Gerald Huber Southeast Solano

Personnel Committee Viola Lujan Southeast Solano 6/22/2011

Personnel Committee Randall Hempling Northeast Shasta

Personnel Committee Greta Elliott Northeast Modoc 5/18/2016

Personnel Committee Dick Fogg Southwest Sonoma

Personnel Committee Northwest

*Physician Advisory Committee (PAC) Mitesh Popat, M.D., MPH Southwest Marin 3/13/2013

*Physician Advisory Committee (PAC) North

*Strategic Planning Committee Alicia Hardy Southeast Napa 4/25/2018

*Strategic Planning Committee Lewis Broschard, M.D. Southeast Solano

*Strategic Planning Committee Dick Fogg Southwest Sonoma

*Strategic Planning Committee Kathryn Powell Southwest Sonoma 1/13/2016

*Strategic Planning Committee Paula Cohen Southwest Mendocino 4/17/2019

*Strategic Planning Committee Melissa Marshall Southeast Yolo 4/17/2019

*Strategic Planning Committee Jonathon Andrus Northeast Shasta 2/22/2017

*Strategic Planning Committee Dean Germano Northeast Redding

*Strategic Planning Committee Nancy Starck Northwest Humboldt

*Strategic Planning Committee Heather Snow Northwest Del Norte 2/27/2019

*Strategic Planning Committee Tim Rine Northwest Humboldt 2/27/2019

Quality/Utilization Advisory Commmittee (Q/UAC) South

Quality/Utilization Advisory Commmittee (Q/UAC) North

County Representing

Other PHC Committee's Commissioner's Name


Regulatory Affairs and Compliance Dashboard2019

Threshold percentages are as follows:

≥ 95% = GREEN 90 - 94.9% = YELLOW < 90% = RED

Category Description Q1 Q2 Q3 Q4 YTD CommentsDELEGATION OVERSIGHT Annual Delegate / Subcontractor Audits 2 / 2 7 / 7 5 / 5 3 / 3 17 / 17

Percentage of delegate/subcontractor audits conducted annually, either through direct facilitation or evidence collection from responsible department.

100% 100% 100% 100% 100%

Oversight of Reporting 162 / 162 181 / 182 211 / 211 196 / 196 750 / 751Percentage of timely submissions of items from delegate/subcontractor to PHC per regulatory requirements and contract.

100% 99.5% 100% 100% 99.9%

TRAINING Completed Compliance Primers 45 / 45 46 / 46 35 / 35 28 / 28 154 / 154Percentage of new hires that have completed their compliance primers as part of new hire LMS trainings within the quarter. 100% 100% 100% 100% 100%

Annual FWA Prevention Training 822 / 861 861 / 861 861 / 861Percentage of employees that have completed the annual FWA training. *Annual training released in Q3 2019*

n/a n/a 95% 100% 100%Note: Q4 2019 numbers are total completion for 2019

Annual HIPAA Training 820 / 861 861 / 861 861 / 861Annual HIPAA Training - percentage of employees that have completed the annual HIPAA training. *Annual training released in Q3 2019*

n/a n/a 95% 100% 100%Note: Q4 2019 numbers are total completion for 2019

Annual Code of Conduct 826 / 861 861 / 861 861 / 861Annual Code of Conduct - percentage of completed annual Code of Conduct employee attestations. *Annual renewal released in Q3 2019*

n/a n/a 96% 100% 100%

Note: Q4 2019 numbers are total completion for 2019

REGULATORY REPORTING DHCS Reports Submitted Timely 38 / 38 37 / 37 38 / 38 35 / 35 148 / 148Percentage of regulatory reports submitted timely by RAC to DHCS with no extension request or missed due date per RAC Master Tracker and Regulatory Reporting Calendar.

100% 100% 100% 100% 100%

Report Acceptance Rate 35 / 38 36 / 37 34 / 38 34 /35 139 / 148Percentage of standard regulatory reports submitted by RAC and not rejected by DHCS for being incomplete, on the wrong template, or for other findings.

92.1% 97.3% 89.5% 97.1% 93.9%

HIPAA REFERRALS Timely DHCS Privacy Notification Filings 99 / 107 109 / 114 101 / 104 80 / 81 388 / 406Appropriate safeguards, including administrative policies & procedures, to protect the confidentiality of PHI and ensure compliance with HIPAA regulatory requirements.

Percentage of reportable notifications that PHC filed timely within applicable DHCS required timeframe. *Initial notice within 24 hours, initial PIR within 72hours, and final PIR within 10 business days. If any deadline is missed, it will be counted as untimely.

92.5% 95.6% 97% 99% 95.8%

FWA REFERRALS Timely DHCS FWA Notifications 19 / 19 58 / 58 34 / 34 24 / 24 135 / 135Regulatory Affairs oversees the Fraud, Waste and Abuse Prevention program intended to prevent, detect, investigate, report and resolve suspected and/or actual FWA in the PHC daily operations and interactions, whether internal or external.

Percentage of reportable notifications that PHC filed timely with DHCS within 10 business of discovery per contractual obligations. 100% 100% 100% 100% 100%

Staff are informed of the PHC Code of Conduct, Compliance Plan, FWA Prevention Program, and HIPAA policies and procedures relevant to their job functions to ensure compliance with requirements.

The Delegation Oversight Review Sub-Committee ensures that delegated activities of subcontracted entities are in compliance with PHC policies and procedures, NCQA standards and any regulatory and contractual requirements.


Page 1 of 5

Operations Report

Sonja Bjork, Chief Operating Officer

February 2020

Provider Relations

Contracting

Provider Relations spent many hours collaborating with other PHC departments to finalize the Dignity Health contracts. This effort was led by Nancy McAdoo, Director of Provider Contracts and included multiple staff from many departments. We continue to work toward finalizing a new agreement with UCSF/BCHO and other providers of all types in order to ensure ongoing access for our members. This includes contracting with providers for the PHC Wellness and Recovery Program.

DHCS Audit

The on-site audit began on February 3, 2020. The PR Department participated in interviews related to credentialing and state mandated trainings for the providers in our network. We also submitted policies, procedures, reports and other documentation to demonstrate our compliance with member access and provider availability standards.

Network Certification

Provider Relations, with assistance from Finance Analytics and IT staff, is in the process of developing the annual Network certification reports for DHCS. These include mapping provider sites in relation to the location of our members’ residences. This very difficult and time-consuming process will be completed and submitted to DHCS for review in March 2020.

Credentialing

In order to prepare for our NCQA First Survey, the PR team is conducting mock audits of the entities to whom we delegate the credentialing of providers. We must ensure that they also meet the NCQA standards, particularly in light of new 2020 requirements that are pass/fail.

Surveys

Our team will soon conduct the annual “third next available appointment” (3NA) survey of all PCP sites and other high volume provider sites. In addition, we are preparing to


Page 2 of 5

launch the annual physician satisfaction survey. Timelines for these surveys had to be moved up in order to meet the NCQA audit look back period for the November 2020 audit.

Provider Representatives Meeting

The bi-annual PR Rep. meeting for all of our PHC provider representatives will be held in Redding on 2/24 and 2/25/2020. The focus this year will be on collaboration, identifying best practices, sharing ideas, improving consistency between the representatives throughout or service area, NCQA, and regulatory requirements.

Operational Excellence/Project Management Office

Telehealth

Econsult Update

Last quarter, there were an average of 90 consultations per month. Over 70% of patient needs were addressed via consult, without the need for a face to face specialty visit.

Video Update

There were an average of 300 visits per month last quarter across 32 health care sites. We continue to work on a contract and discuss logistics with UC Davis in order to add pediatrics to our telehealth program. In addition, we are working with our current telehealth vendor to develop a global calendaring solution to serve our network for telehealth video specialty care.

Enterprise Contract Management System

We have begun the implementation process for Contraxx, the software solution offered by our vendor, Ecteon. Next steps will include coordinating with all affected departments, finalizing the implementation timeline, establishing work flows, data fields, contract templates and reporting capabilities, security protocols and user acceptance testing plans.

Behavioral Health Integration Grants – Proposition 56 Funding

PHC received 69 project applications from providers across all fourteen PHC counties. Our Scoring/Review Committee, composed of 8 subject matter experts, reviewed the applications based on DHCS criteria. We submitted 56 applications to DHCS for a total of $58.33 million. DHCS will provide their decision on funding amounts to us by 3/18/20.

Wellness & Recovery Program

The fiscal plan and reconciliation process for this new benefit has been completed and reviewed by participating counties. We continue to await CMS review and approval of the plan. We will need to re-establish a “go-live" date as March 1, 2020 is no longer feasible. In the meantime, all state-required readiness deliverables have been submitted to DHCS and approved. We continue to work with the state on provider network certification. Our


Page 3 of 5

contracting team is in active discussions with 7 providers, and 15 contracts have already been signed. The PHC Credentialing Committee will review the first batch of contracted providers this month.

Member Services

Undocumented Young Adult Full Scope Medi-Cal Expansion

As of January 1, 2020, eligibility for full scope Medi-Cal was expanded to include undocumented young adults under the age of 26. For Partnership, this meant an addition of 1,902 members. The transition went smoothly with one exception: enrollment/eligibility was to commence on January 1, however the state’s updated Medi-Cal eligibility file provided a start date of February 1, 2020.

DHCS requested that all plans track calls from the identified members. Below is the outcome of that tracking:

DHCS YOUNG ADULT EXPANSION REPORT FROM: 2/3/2020 2/7/2020

SUMMARY REPORT

RMKTYPE Lake Sonoma Solano Yolo Total

Remarks PCP Change 2 6 6 14

General Request 2 2 Kaiser Request 2 2

General Question 3 3 Question about Rx 4 4

Total Remarks/Calls by County

2 9 12 2 25

Preventative Services Outreach Call Campaigns

Starting March 16th Member Services will initiate calls to families with members under age 21 who have not received a check-up or well check visit for preventative care services within the last 12 months. The calls are intended to remind families of the services that fall under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services that are available at no cost to the member.

Claims

January 31, 2020 (Reflects January month end)

All regions

99.6% of all claims were paid within 30 calendar days of receipt 99.9% of all claims were paid within 45 working days of receipt 99.9%% of all claims were paid within 90 calendar days of receipt


Page 4 of 5

Fairfield Region

99.5% of all southern region claims were paid within 30 calendar days of receipt 99.9% of all southern region claims were paid within 45 working days of receipt 99.9% of all southern region claims were paid within 90 calendar days of receipt

Standards

90% of clean claims paid or denied within 30 calendar days of receipt 95% of claims are paid or denied within 45 working days of receipt 99% of claims are paid or denied within 90 calendar days of receipt

Health Services

Care Coordination

To best meet the multitude of new and upcoming initiatives for both DHCS and NCQA, Health Services (HS) is undergoing a re-organization. In addition to Care Coordination and Utilization Management Teams, HS is expanding to add a third team for Population Health Management.

Rebecca Boyd Anderson, formerly the Director of Care Coordination, is transitioning into the role of Director of Population Health. Rebecca has done an excellent job in leading the Department’s efforts to create programs and policies to meet the obligations for Population Health Management. The Department is positioned well to lead the charge into the implementation phase. Rebecca will have the Health Education/Cultural and Linguistics Team, Education Specialists and Healthy Living Coaches joining her in the Population Unit of Health Services.

Katherine Barresi, RN, PHN has been promoted to the position of Director of Care Coordination (CC). Katherine has been with PHC for 5 years and most recently has served as the Associate Director of Care Coordination. She brings a wealth of knowledge and experience to her new role.

Each of these directors has had the opportunity to serve on the DHCS CalAIM workgroups for Population Health and Enhanced Care Management. This has allowed them to share their perspectives with others and gain additional insight into these new programs. The success of the Population Health Program will require active collaboration and participation from every Department within the organization as well as the support of our community partners. We look forward to working together to promote the health and well-being of our members.

Utilization Management

The UM team continues to focus on ensuring compliance with NCQA and DHCS requirements. A key part of this focus involves oversight of our UM Delegated hospitals and medical entities. In addition, the UM Team continues to meet regularly with many of our hospital partners to assist in placing members in alternative settings when available and appropriate.


Page 5 of 5

Santa Rosa Regional Office

Drs. Kubota and Townsend met with Touro University staff to discuss their Endocrine Fellowship Program for primary care providers as another strategy to increase resources for endocrine care. The fellowship is a yearlong intensive training in endocrine specialty care for primary care physicians.

Northern and southern PHC regional staff met to discuss expanding the “Birthday Club” program to encourage families with children ages 3-6 years old to see their primary care provider at least annually for well child check-ups. The program provides a gift card for those who complete timely wellness visits. It was successfully piloted in the northern region and we are now expanding the pilot to northern Mendocino County.

PHC staff attended the Sanctuary Villas Open House and Ribbon cutting. Sanctuary Villas provides supervised housing and support for foster youth ages 18-24. A PHC housing grant helped fund this important program.

Regional office staff participated in a Community Preparedness training with Sonoma County Department of Emergency Management. The main discussion covered how to prepare for upcoming planned power shutoffs. Our staff was advised to expect and prepare for 4-6 shutoffs per high fire season.

Configuration

Project Phoenix Update

Over the last couple of months, the Configuration team has shifted from a focus of learning toward the task of building configuration to prepare for the new system. In December we completed a training on the HealthRules configuration that provided us with an in-depth tour of the system’s ability to handle complex scenarios. Our next step was to build the framework for our benefit plans. These benefit plans will continue to evolve with Medi-Cal and PHC but the structure is in place.

We have now turned our focus to provider contracts. Our Provider Relations team was able to work with our implementation partner to automate the configuration of hundreds of contracts. The Configuration team is now working to complete the remaining contracts that could not be done through the automation tool due to their complexity. This will remain the configurations teams’ primary focus for the remainder of the first quarter of 2020.


LOCAL INNOVATIONS GRANTS ON HOUSING

CountyGrant Funds Allocated For This County

Unspent Grant Funds For This

ProjectGrantee Status and New Activity Update

Del Norte $493,118 $493,118Del Norte County

Department of Health & Human ServicesCounty plans to secure NPLH funding in the

next round of the State process.

Humboldt $1,125,000 Redwood Community Action Agency

1 of 2 Capital Projects complete: Onyx Family Housing opened September 16, 2019. Housing Project is fully leased (24 clients). The second site, the Blue Vic, is in the process of opening.

Humboldt $1,048,809Community Revitalization and Development

CorporationNew construction nearly complete;

groundbreaking scheduled!

Lake $1,330,904 $1,330,904 Adventist Health Clear Lake Planning process underway.

Lassen $323,225 $323,225 Lassen County Health & Social ServicesReviserd MOU signed; County developing

service guidelines for PHC review.

PSH and Transitional: Rehabilitation of existing structure in Clearlake, CA targeted to result in 26 new additional beds in supportive housing for adults

without children that are experiencing homelessness.

PSH: Scattered-site subsidized rental properties serving low-income households in Susanville, CA.

STATUS OVERVIEW: County Map of PHC Members Suspected to be Experiencing Homelessness

$2,316,486

PSH: Approximately 30 supportive housing units for homeless people with serious mental illness in Del Norte County; PHC grant will be used in combination

with funds from No Place Like Home and other state programs.

Project Description

PSH: Rehabilitation of existing housing sites and new construction in Eureka, CA to result in 40 new additional beds of for families with children and homeless

individuals with substance use disorders and/or mental health diagnosis.

PSH: New Construction of 25 supportive housing units for low-income families, chronically homeless individuals and homeless families in Rio Del; PHC grant will

be used in combination with California Low-Income Housing Tax Credit funds.





ProjectGrantee Status and New Activity UpdateProject Description

$150,000 Ritter CenterProject underway; intensive case management

services.

$1,567,065 Homeward Bound of MarinMajority of funds have been secured, including No Place Like Home funds; pre-development

work underway.

$618,404 Health and Human Services of Mendocino

County

Project Developer has acquired full funding commitment from all sources; tax credit application pending for February 2020.

$1,027,792 Redwood Community ServicesSite secured July 2019; pre-development

activities in progress; additional funding being sought.

Modoc $133,239 $33,239 T.E.A.C.H., Inc.Successfully housed PHC Members in

Permanent Supportive Housing.

Napa $310,000 Peter A. & Vernice H. Gasser Foundation

Fully approval secured; No Place Like Home funding awarded. Pre-development activities

advancing: Environmental Impact Reports/Entitlement process etc. Construction

anticipated to begin in 2021.

Napa $260,820 Abode Services18 PHC Member Households have been

successfully housed

Shasta $21,300Shasta Women's Refuge, Inc.

(One Safe Place)

Serving numerous PHC members. Reporting vocational successes as a result of housing

placement: recent graduates of Paralegal, LVN and CNA programs.

Shasta $0Hill Country Community Clinic

(The Center of Hope)

New Market Tax Credit reservation letters signed along with Non-Profit Finance Fund (NNF) totaling $22M. Additional financing committed from Dignity Health along w/site

donation from McConnell Foundation.

Shasta $80,922Hill Country Community Clinic

(Youth Without A Home)

Currently engaging homeless PHC members with local subsidies, resources and housing

opportunities.

Shasta $0 Northern Valley Catholic Social Service, Inc.Successfully Housed 11 project participants in

local community rentals.

Marin $1,717,065

Facilitation: Provide clinical and social case management for persons experiencing chronic homelessness; link them to housing through County Whole

Person Care project.

Facilitation: Flexible housing funds targeted to eliminate housing barriers for approximately 50 high-need homeless households in need of move-in assistance and other critical housing supports, that agree to participate in case management.

PSH: New construction of 53 supportive housing units for Napa residents experiencing homelessness, mental health disabilities and other barriers to

housing; PHC grant will be used in combination with funds from No Place Like Home and other state programs. Project implementation supported by Burbank

Housing, County of Napa HHSA and the City of Napa.

Facilitation: Flexible housing funds targeted to eliminate housing barriers for 18-24 vulnerable, high-need homeless households in need of move-in assistance and

other critical housing supports.

Transitional/facilitation: Transitional Housing with Case Management, Rapid Rehousing and Permanent Housing Serving an estimated 50-70 members that are victims of domestic violence; PHC grant is leveraged with a funding award from

the Federal Victims of Crime Act program.

PSH: New construction of a housing complex offering primary medical care, mental health treatment, substance abuse treatment, dental care and case

management for 16 transitional age homeless youth (ages 16-24) and 30 adults with complex housing needs; PHC grant will be used in combination with funds

from No Place Like Home and other state programs.

Case Management and housing support funds to house 15 Transitional Aged Youth (TAY) experiencing homelessness identified by local educational partners:

Shasta College and California Heritage YouthBuild Academy.

PSH: New Construction of 15 supportive housing units for chronically homeless adults prioritized by quantified vulnerability; PHC grant will be used in

combination with funds from No Place Like Home and other community programs.

PSH/Facilitation: 10 units of a larger project, Orr Creek Commons and associated facilitation services.

PSH: New construction of 10 single resident occupancy units for individuals experiencing chronic homelessness in the city of Ukiah; PHC grant will be used in

combination with Redwood Community Services' resources. Construction completion targeted for Winter 2020.

PSH: Purchase and rehabilitation of an 8 unit apartment complex to provide Permanent Supportive Sober Living for PHC members.

$2,627,376

$1,260,820

Mendocino $1,646,196






Shasta $425,000 Northern Valley Catholic Social Service, Inc.Utilized PHC funds to execute initial land

purchase.

PSH: New Construction of 15 supportive housing units for adults with severe mental illness in the town of Burney, CA; PHC grant will be used in combination

with state and federal housing funds.






Siskiyou $219,949Siskiyou County Health & Human Services

Agency - Social Services Division - Rapid Re-Housing Project

Services being provided.

Siskiyou $560,000 Siskiyou County Health & Human Services

Agency - Behavioral Health Services DivisionNPLH funding commitment secured; community

process underway with site selection ongoing

CAP Solano Joint Powers Authority Subcontract with Berkley Food and Housing

Contractor status under re-evaluation

CAP Solano Joint Powers Authority Subcontract with Caminar For Mental Health

Services provided; report in progress.

CAP Solano Joint Powers Authority Subcontract with Mid-Pen Housing

Pre development underway.

CAP Solano Joint Powers Authority Subcontract with Eden Housing

Pre development underway.

Sonoma $1,088,538Sonoma County

Community Development

Working with a robust volume of PHC members, successfully housed 4 project

participants.

$3,264,000Sonoma County

Community Development Commission NPLH applications awarded; projects working

on site control and pre development

Sonoma $195,390 Trinity County

Behavioral Health DepartmentNPLH funds secured; additional resources being

identified.

Trinity $195,390 $700,313 Davis Community Meals and Housing

Building leveraged funding from local stakeholders and community donations. Fundraising/Capital Campaign kick-off

accomplished.

Yolo $455,601 City of West SacramentoAcquisition complete and relocation planning

underway; tax credit application pending.

Facilitation: Subcontracts with Catholic Charities, Committee on the Shelterless, Drug Abuse Alternatives Center, Reach of Home and West County

Community Services; facilitation project for the placement of 140 PHC members into permanent housing and sober living environments while connecting them with

health and social services.

PSH: New construction of 20 units of permanent affordable housing for persons who are seriously mentally ill and homeless or at risk of homelessness. PHC grant will be used in combination with funds from No Place Like Home and other state

programs.

PSH and Transitional: Multi-functional housing service facility with 18 units of PSH, 10 transitional units, and 4 emergency shelter beds. PHC grant will be used

in combination with funds from Sutter's Getting to Zero Initiative and other fundraising efforts from Davis Community Meals and Housing.

PSH: new construction project for 75 Permanent Supportive Multi-Family Housing Units.

Facilitation: Rapid Re-Housing services for 36 individuals and families; PHC grant will be utilized with funding as an expansion to the existing Siskiyou County

CalWORKs Housing Support Program.

PSH: Project targeted for grantee to identify a Development Sponsor through an RFP process contingent upon a state-approved project plan for the use of No Place

Like Home funding.

PSH: 8 units in Vallejo and 8 in Vacaville as part of larger housing development projects.

Solano

$779,949

$4,917,538 PSH: Projects with the Committee on the Shelterless (11 beds Petaluma); Reach of Home (Cloverdale); West County Community Services (trailers and apartments in Sebastopol); Catholic Charities (30 NPLH beds in Santa Rosa); Danco Group (26 NPLH and others beds in Santa Rosa): Community Support Network (details

pending; Santa Rosa).

$4,913,964 $4,863,964

Facilitation: Expansion of established Rapid Re-Housing program: Funding to support 75 Solano County households with rental assistance and case management

in Permanent Supportive Housing

Facilitation: Supportive Housing Program providing rental assistance and supportive services to Solano County adults with serious mental illness. Funding

to support 38 individuals.

PSH: 10 supportive housing units as part of a larger project in Fairfield






Yolo $679,972 City of WoodlandObtained Exclusive Right to Negotiate

(ENA)/long-term lease with purchase option of City owned land.

Yolo

PSH: New construction of 60 permanent housing units.$2,344,729


Page 1 of 3

In the News …

PHC Issued Release

PHC committed to ensuring access to care as contract with Dignity Health ends on January

31, 2020

January 3, 2020 Statement from PHC CEO Elizabeth Gibboney - “At this time, approximately 23,000 Partnership

HealthPlan of California members receive care from Dignity Health providers in Shasta, Siskiyou, and Yolo counties.

PHC and Dignity Health reach agreement in Shasta, Siskiyou, and Yolo counties

January 29, 2020 Partnership HealthPlan of California (PHC) has reached an agreement with Dignity Health on a new three-year contract. The new agreement will allow PHC members to continue seeing Dignity primary care and specialty providers in Shasta, Siskiyou, and Yolo counties, as well as affiliated Dignity and Mercy hospitals.

Published (PHC Mentioned)

City, county agree to purchase H Street duplex

Davis Enterprise

December 22, 2019 Last week, both the city and county dedicated resources to a pilot project aimed at ensuring those living homeless in Davis have a place to go during the day to escape the elements, shower, do laundry and access services.

Thousands on Medi-Cal might be out-of-network at Mercy Medical Center starting next month

Record Searchlight

January 8, 2020 Getting non-emergency care in the Redding area could be a lot harder for people on Medi-Cal starting next month.

Mercy Medical Center in Redding and some of its sister hospitals might no longer accept Partnership HealthPlan, the main Medi-Cal administrator for the North State. Dignity Health, the hospital's parent company, confirmed the change will start Feb. 1 if it doesn't reach a contract agreement with Partnership.


http://www.partnershiphp.org/About/Documents/Press%20Release/Press%20Release_DignityContractStatement_Final.pdf#search=Dignity

http://www.partnershiphp.org/About/Documents/Press%20Release/Press%20Release_DignityContractStatement_Final.pdf#search=Dignity

http://www.partnershiphp.org/About/Documents/Press%20Release/PHCandDignityAgreement_Press%20Release_Final.pdf

https://www.davisenterprise.com/local-news/city-county-agree-to-purchase-h-street-duplex/

https://www.redding.com/story/news/local/2020/01/08/thousands-medi-cal-might-out-network-mercy-medical-center/2810287001/

Page 2 of 3

In the News …

People with Medi-Cal may no longer be covered for non-emergency services at several Dignity

Health centers.

Action News Now

January 8, 2020 REDDING, Calif.- People with Medi-Cal may no longer be covered for non-emergency services at several Dignity Health Centers. A spokesperson for Partnership HealthPlan of California says patients will continue to get care from any Dignity provider until January 31st.

Medi-Cal patients left high and dry by Dignity Health | Another View

Daily Democrat

January 22, 2020 Why were Dignity Health and Partnership HealthPlan of California (PHC) unable to agree on a contract for 2020?

Dignity Health, PHC say they’re working to reach agreement

Daily Democrat

January 25, 2020 With less than a week left before their contract expires, leaving 23,000 patients from Shasta, Siskiyou, and Yolo counties in limbo, Dignity Health and Partnership HealthPlan of California have yet to reach an agreement. Mercy Medical Center expected to keep taking Medi-Cal after agreement with Partnership

HealthPlan

Record Searchlight

January 29, 2020 Medi-Cal patients in the North State are expected to be able to continue getting care at Redding's Mercy Medical Center.

Clearlake City Council considers helping fund Hope Center

Lake County News

January 30, 2020 CLEARLAKE, Calif. – The Clearlake City Council has indicated it is open to considering a city contribution to the opening of a facility to help address the homeless problem in the county, but that it wants more financial information on the project.


https://www.actionnewsnow.com/content/news/Healthcare-Access-Cutback-566832031.html

https://www.actionnewsnow.com/content/news/Healthcare-Access-Cutback-566832031.html

https://www.dailydemocrat.com/2020/01/22/medi-cal-patients-left-high-and-dry-by-dignity-health-another-view/

https://www.dailydemocrat.com/2020/01/25/dignity-health-phc-say-theyre-working-to-reach-agreement/

https://www.redding.com/story/news/2020/01/29/mercy-medical-center-keep-taking-medi-cal-after-agreement-reached/4611692002/

https://www.redding.com/story/news/2020/01/29/mercy-medical-center-keep-taking-medi-cal-after-agreement-reached/4611692002/

https://www.lakeconews.com/index.php/news/64173-clearlake-city-council-considers-helping-fund-hope-center

Page 3 of 3

In the News …

New Contract Means No Interruption Of Medi-Cal Services At Redding's Mercy Medical Center

Jefferson Public Radio

January 31, 2020 Around 23,000 low-income Californians in Siskiyou, Shasta and Yolo Counties won’t experience an

interruption in their medical care. That’s thanks to a contract agreement that was finalized this week

between Dignity Health and Partnership HealthPlan of California. Latest ‘Point in Time Count’ finds growth in Lake County homeless residents

Lake County News

February 13, 2020 LAKE COUNTY, Calif. – The latest numbers from a countywide survey of people experiencing homelessness conducted last month shows an increase in the numbers.

Paul’s Place backers host open house

Davis Enterprise

February 13, 2020 Paul’s Place is a multi-functional facility designed to help more people experiencing extreme poverty and homelessness. Assemblyman Marc Levine calls for timely follow-up care for mental health patients

Press Democrat

February 18, 2020 A state lawmaker from Marin County has introduced a bill that would ensure timely follow-up appointments for patients needing urgent mental health care.


https://www.ijpr.org/post/new-contract-means-no-interruption-medi-cal-services-reddings-mercy-medical-center#stream/0

https://www.lakeconews.com/index.php/news/64339-latest-point-in-time-count-finds-growth-in-lake-county-homeless-residents

https://www.davisenterprise.com/community/briefly/pauls-place-backers-host-open-house/

https://www.pressdemocrat.com/news/10707710-181/assemblyman-marc-levine-calls-for