March 18, 2016 Meeting Agenda

1. Standing Agenda Items 1.1. Welcome and Introductions – Chairperson Bill Byrnes, Clinic Manager, Community Medical Centers 1.2. Approval of Minutes 1.3. Review of Agenda

2. Presentation

2.1. It's Allergy Season – Presentation by Seturam Pandurangi, M.D. How to properly diagnose allergies What to treat in the Primary Care setting When and how to refer to a Specialist

3. Old Business

3.1 None

4. New Business 4.1.1. PHC Update & Report from Physician's Advisory Committee – Sonja Bjork, COO 4.2. Report from the Claims Department – Staff 4.3. Report from the Consumer Advisory Committee – Staff 4.4. Report from Provider Relations – Staff 4.5. Community Events, Health Fairs and Trainings: All Attendees

Meeting Adjourned

Partnership HealthPlan of California

Provider Advisory Group

Lunch: 12:00 Meeting 12:30

Mission Statement: The Provider Advisory Group of the Partnership HealthPlan of California will act as a liaison between the Health Care Services providers and the HealthPlan. The Group will make recommendations and provide a

forum for providers to have ongoing input into the activities of the HealthPlan.

PARTNERSHIP HEALTHPLAN OF CALIFORNIA

MEETING MINUTES

Committee: Provider Advisory Group (PAG)

Date/Time: January 22, 2016 12:30 p.m. – 1:30p.m.

Members Present: Santa Rosa: Bob G. Field, MD, Jacqueline Wood, Kim Loyd, Cheryl Coulter, Matt Forman, Theresa Revei, Teri Ortiz, Rosie Ramos, Heidi Hawkins, Karla Sancato, Zuo-Fen Hauf, MD, Maureen Foley, Louveta Jones, Sophea Ayala, Gregory Sachu, Mark Netherda, MD, Claudia Nola, Linda Camili, Ruben Noles, Gina Holben, Linda Alonso, Paula

Fairfield: Katie Ash, Maggie Galacia-Mendoza, Elizabeth Diaz, Pam Sakamoto, Bridget Oduni

Redding: Stephanie Austin, Susie Foster, Alicia Pizano, Shawna Silveira

Eureka: Michael Fratkin, Karen Severn, Velina Godoy, Terri Polizzi, Barbara Gier, Amy Bruce

PHC Staff Present: Santa Rosa: Lynne Scuri, Mark Netherda, MD, Stephanie Phipps, Judy Paul, Melissa Perez, Gloria Turner

Fairfield: Robert Moore, MD, Mary Kerlin, Jean Levato, Lynne DiModica, Tondenisha Coleman, Ledra Guillory, Gwen Basset, Maria Cabrera, Dianna Rodekohr, Takishka Wright, Rebecca Mannella, Carol Parker

Redding: Kelley Sewell, Sharon McFarlin, Tara Fogliasso, Kim Bergeron, Nai Chadderdon, Megan Shelton, Andrew Sager

Eureka: Jennifer Chancellor, Michelle Swift AGENDA ITEM

DISCUSSION/CONCLUSIONS RECOMMENDATIONS /

ACTION DATE RESOLVED

1. Standing Agenda Items

1.1. Welcome and Introductions

1.2. Approval of Minutes

1.3. Review of Agenda

1. None.

1.1. Meeting called to order by Chairperson Jacqueline Wood. Jacqueline welcomed participants from Fairfield, Redding, and Eureka via video conference.

1.2. Minutes from 11/20/2015 reviewed and approved.

1.3. Agenda was reviewed and approved.

1.

1.1

1.2. Approved.

1.3. Approved.

1/22/2016

2. Presentations

2. Bob G. Field, MD, gave a presentation to the group on the latest updates to Cervical Cancer screening.

Screening practices have reduced cervical cancer by over 70% since widespread use of Pap smear testing began in the 1950s.

New screening guidelines aim to prevent the anxiety and other treatment-related complications of overzealous management of lesions that mostly will regress.

Human papillomavirus (HPV) infections can lead to invasive cancer; early detection of HPV and treatment of more aggressive lesions is critical.

2. Presented as information only

1/22/2016

3. Old Business 3.1. None. 3. Presented as information

only. 1/22/2016

4. New Business

4.1. PHC Updates and Report from Physicians Advisory Committee

4.2. News from Claims

4.3. Report from Member Services

4.1. Robert Moore, MD, MPH, Chief Medical Director at Partnership HealthPlan of California presented updates on recent activities at PHC.

There may be cuts to Medi-Cal in the proposed State budget because Managed Care Organization Tax issues have not been resolved.

PHC had not participated in the Coordinated Care Initiative (the "duals" project); the project is not doing well and may be shut down.

Among the future developments that PHC is looking at: Healthcare System Reform, redesign of the Children's Care Services (CCS) model, implementation of the pilot Palliative Care Program, the Health Homes for patients with special needs project, and the transition of the ACA Substance Abuse benefit from State to county management.

PHC is currently working towards becoming and NCQA Accredited organization with a target date of 2020.

The California Department of Public Health (CDPH) named PHC one of the finalists in their "Innovation Challenge" program aimed at improving community health and promoting health equity.

The Social Determinants of Health Program at PHC works with key partners in the community to improve social determinants of health.

4.2. Rebecca Mannella, Claims Resolution Manager, presented information on billing in ICD-10.

Frequently asked questions include whether PHC will train providers on the use of the ICD-10 Diagnosis Codes implemented October 1, 2015, (the answer is no; this was mandated and administered by the federal government), and how to bill dates of service prior to the implementation date.

4.3. Maria Cabrera, Member Services Supervisor, updated the group on the activities of the latest Consumer Advisory Committee meeting.

The CAC shared member feedback for the Member Newsletter. Members would like to see more healthy recipes and recipes for diabetics, and have copies made available in a larger font size for visually impaired members.

4. Presented as information only.

1/22/2016

4.4. Report from Provider Relations

4.4. Joan Russell, Manager of Provider Education presented information on the Behavioral Health Treatment benefit for children with autism spectrum disorder and the new eCHDP online platform.

Effective February 1, 2016, PHC assumed responsibility for BHT services in children ages 3-21 diagnosed with Autism Spectrum Disorder. We estimate more than 600 children will transfer from regional centers to PHC.

An eRAF is not required for BHT Services. Contact the PHC Care Coordination Department if your patient receives treatment for BHT: our phone number is (800) 809-1350.

Reference Policy MPUP3126 in the PHC Provider Manual for more information.

The eCHDP online platform is in final testing and is expected to roll out in the next few weeks. Training will begin soon.

5. Provider Questions, Topics of Interest, Announcements, and Upcoming Events

5. None 5. Presented as information only.

1/22/2016

Meeting Adjourned Next Scheduled meeting: March 18, 2016 in Solano County. 3/18/2016

PHC – Provider Advisory Group – January 22, 2016 in Sonoma County Minutes prepared and submitted by: Carol Parker Jacqueline Wood 1/25/2016

Chairperson Jacqueline Wood Date

Allergy

Allergies are among the most common chronic conditions worldwide. 

Allergy symptoms range from making you miserable to putting you at risk for life‐threatening reactions

Allergy

What is allergy ?

Our immune system protects us from invading organisms that can cause illness. 

If you have an allergy, your immune system mistakes an otherwise harmless substance as an invader. This substance is called an allergen. 

The immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction

Allergy Symptoms

An allergic reaction typically triggers symptoms in the 

Upper airway: Hay fever sx – eyes, nose,   throat, sinuses, ears, 

Lower airway: Lungs, asthma GI Tract : lining of the stomach  Skin: rash, hives In the most serious cases, a life‐threatening reaction called anaphylaxis

Common Allergens

The most common include:• Pollen• Dust• Food• Insect stings• Animal dander• Mold• Medications• Latex

ROLE OF ALLERGIST

Role of the Allergist / ImmunologistAn allergist / immunologist is a physician certified in either internal medicine or pediatrics, who has completed an additional two years of training in allergy and immunology at an accredited training program and passed the examination given by the American Board of Allergy and Immunology (ABAI).

The allergist / immunologist is uniquely trained in:• Allergy testing (skin, in‐vitro)• History‐allergy test correlation• Bronchoprovocation testing (e.g. exercise, methacholine)• Environmental control instructions

Role of Allergist/Immunologist

• Immunotherapy (Allergy Inj.)‐inhalants• Immunomodulator therapy 

(e.g. anti‐IgE (Xolair), IVIG)•Venom immunotherapy• Food and drug challenges• Drug desensitization eg: ASA, PCN• Evaluation of immune competence

Role of Allergist

• Education (disease, medications, monitoring)

• Management of chronic or recurrent conditions where allergy is not always identified: rhinosinusitis, conjunctivitis, asthma, cough, urticaria/angioedema, eczema, anaphylaxis

PRIMARY CARE SUMMARY

How the Allergist / Immunologist Can Help:Consultation and Referral Guidelines Citing the Evidence

An allergist / immunologist can provide expert consultation for a number of diseases and conditions. These can be divided into two broad categories: 

1) chronic diseases frequently followed by primary care physicians or another specialist/sub‐specialist, and 

2) conditions in which allergist/ immunologist consultation is usually necessary for definitive diagnosis and treatment.

Allergist Referral Guidelines Chronic diseases frequently followed by primary 

care physicians or another specialist/sub‐specialistThese conditions include asthma, conjunctivitis, cough, dermatitis, rhinitis and sinusitis. 

In general, the following referral considerations apply to these conditions: 

Single consultation may be useful for confirmation of diagnosis, identification of allergic triggers, provision of avoidance advice, and other recommendations for therapy. 

Allergist Referral Guidelines Co‐management or specialty follow‐up: 

1) Referring physician or patient desires additional expertise, 

2) Patients with more severe or difficult to control disease manifestations, 

3) Outcomes of care have not met patient or physician expectations, 

Allergist Referral Guidelines Co‐management or specialty follow‐up: 

4) Patients with co‐morbid conditions such as rhinitis or sinusitis, or 

5) Patients interested in inhalant immunotherapy (asthma, conjunctivitis, rhinitis).

Allergist Referral Guidelines

Diagnosis: Challenge testing (e.g. methacholine, exercise) for confirmation of airway reactivity, role of allergy (correlation of specific IgE with history), role of occupational exposure

Improved outcomes in the following categories: Patients with asthma ER visits or hospitalizations Patients with potentially fatal asthma (prior 

severe life‐threatening episodes)

Allergist Referral Guidelines

Patients with moderate‐severe persistent asthma

Patients with uncontrolled asthma in spite of therapy

Patients who use excessive amounts of reliever medications (1 canister per month or more)

Patients in whom adherence or self‐management appears to be sub‐optimal

Patients with associated rhinitis or sinusitis

Allergist Referral Guidelines Dermatitis To confirm the diagnosis of atopic or contact 

dermatitis To identify the etiology of contact dermatitis 

(patch testing) To identify the role of environmental allergy (e.g. 

dust mite) in patients with atopic dermatitis To identify the role of food allergy in patients with 

atopic dermatitis Management of patients who are poorly 

responsive to treatment

Allergist Referral Guidelines Rhinitis or Conjunctivitis Diagnosis: Allergy testing and correlation of specific IgE with history

Management: Improved outcomes due to: Environmental management Optimal pharmacotherapy Immunotherapy (in properly selected patients)

Allergist Referral Guidelines Sinusitis Diagnosis: Associated allergic rhinitis Associated immunodeficiency Allergic fungal sinusitis Management: Improved outcomes due to: Treatment of associated allergic rhinitis 

(avoidance, pharmacotherapy, immunotherapy) Treatment of associated immunodeficiency

Allergist Referral Guidelines Conditions in which allergist/immunologist 

consultation is usually necessary for definitive diagnosis and treatment

These conditions include:

allergic bronchopulmonary aspergillosis,  anaphylaxis,  aspirin exacerbated respiratory disease,  drug allergy,  food allergy,  hypersensitivity pneumonitis, 

Allergist Referral Guidelines Conditions in which allergist/immunologist 

consultation is usually necessary for definitive diagnosis and treatment

Insect hypersensitivity,  latex allergy, occupational allergic diseases,  primary immune deficiency, and  urticaria/angioedema.  For these conditions, the allergist / immunologist 

often provides unique diagnostic information (skin testing, in vitro testing, provocative challenges) or therapeutic interventions (avoidance, drug desensitization, other immunologic therapy).

Updates: eCHDPProvider Advisory Group (PAG)

March 18, 2016

Eureka | Fairfield | Redding | Santa Rosa

Background:CHDP and the PM-160 Form

What is the Child Health and Disability Prevention Program ?

The Child Health and Disability Prevention (CHDP) program provides complete health assessments for the early detection and prevention of disease and disabilities for low-income children and youth.

The PM-160 form is used to submit CHDP data to Partnership HealthPlan of California (PHC) for payment and to DHCS for statistical reporting.

County CHDP offices can answer questions regarding CHDP services and provider enrollment.

Eureka | Fairfield | Redding | Santa Rosa

PM-160 Form

How many PM 160 forms are returned for missing/invalid data?200 - 400 a day. Our record high was 900 in one day.

How much time does your office spend to re-work those forms?

Eureka | Fairfield | Redding | Santa Rosa

eCHDP

PHC partnered with eCHDP to provide a faster and easier way to submit PM-160 information.

Training is provided by eCHDP.

What is New and Why use this Service?

The eCHDP program has edits to ensure accurate data entry

Patient demographics are stored for future visits and auto populate when needed.

Forms can be saved and “parked” for completion at a later date.

Forms can be printed to place in the medical chart, and/or share with the family.

Eureka | Fairfield | Redding | Santa Rosa

How to Register

o Register your free account with eCHDP: https://signup.pm160form.com

o Click “Free, Get Started Here!” and follow the on-screen instructions.

o Download the “837 Claims Enrollment & Payer Agreement” from the PHC website:

http://www.partnershiphp.org/Providers/Medi-Cal/Pages/HIPAAEDI-Publications.aspx

o eMail or mail the completed 837 agreement to:

Support@eCHDP.com

MedAid Consulting LLC P.O

Box 51572 Irvine, CA 92619

o An eCHDP trainer will contact you for training and the next steps.

Eureka | Fairfield | Redding | Santa Rosa

How to Register

o The process may take 1-2 weeks from the date of sign-up with eCHDP.

o If you have questions about eCHDP, have trouble signing up, or have any other concerns, contact us:

MedAid Consulting LLC:

Support@eCHDP.com or www.echdp.com

Partnership HealthPlan:

Southern County PCPs Gwen Bassett gbassett@partnershiphp.org

Northern County PCPs Lynne DiModica ldimodica@partnershiphp.org

SAVE THE DATES

2016 PARTNERSHIP HEALTHPLAN OF CALIFORNIA

PROVIDER ADVISORY GROUP (PAG) MEETING SCHEDULE

The 2016 Provider Advisory Group Meetings will be held as follows: Friday, March 18 in Solano County - video conferencing available from all PHC Regional locations Friday, May 20 in Napa County – video conferencing NOT AVAILABLE Friday, July 15 in Solano County - video conferencing available from all PHC Regional locations Friday, September 16 in Yolo County – video conferencing NOT AVAILABLE Friday, November 18 in Solano County - video conferencing available from all PHC Regional locations

Agenda items and guest speakers will be sent closer to the meeting dates

Lunch will be served at 12:00 p.m. at all locations. The meeting will begin promptly at 12:30 p.m.

PAG Mission Statement:

The Provider Advisory Group of the Partnership HealthPlan of California will act as a liaison between the Health Care Services providers and the HealthPlan. The Group will make recommendations and provide a forum for providers to have ongoing input into the activities of the HealthPlan. We welcome and encourage your active participation. To reserve your seating and lunch, please RSVP at least 2 days prior to the meeting.

Sheila Hakel (Santa Rosa office) via phone at (707) 863-4555 or via fax at (707) 545-2313

Carol Parker (Fairfield office) via phone at (707) 863-4242 or via fax at (707) 863-4356

Kerry LaRocca (Redding office) via phone at (530) 999-6815 or via fax at (530) 223-2508

Shelby Franklin (Eureka office) via phone at (707) 420-7529 or via fax at (707) 441-4989