| Present: | Excused: | Unexcused: |
|
Ingrid Lamirault Jane Garcia (Vice-Chair) Ray Davis, Jr. MD Pamela Gumbs Marty Lynch John Norton Gail Steele Richard Thomason |
Michael Mahoney (Chair) Damita Davis-Howard Wright Lassiter Linda Price |
None |
| Agenda Item (& Supporting Documents) | Speaker | Discussion Highlights | Action | Follow-Up Required |
| Call to Order | R. Davis, MD | Meeting was called to order at 6:20 p.m. by Ray Davis. A quorum of the members was not yet present. | None | None |
| Approval of Agenda & Minutes
Two Attachments
Agenda July Meeting Minutes |
R. Davis, MD | Motion: Second: Vote: |
None | |
| Chair’s Report | R. Davis, MD | The Chair summarized the single action taken during the 7-26-07 Closed Session meeting:
The Board unanimously approved the PRCC’s recommendations for credentialing and recredentialing. Chair and Vice Chair Vote Delay - Nominating ad hoc committee will meet in October and vote will be on the agenda for the November Board Meeting. You will be receiving a phone call from Ingrid regarding your interest in the positions. |
None | None |
| CEO’s Report 3. CEO's Report 09.27.07 4. PROVIDER BULLETIN 08.01.07.pdf |
I. Lamirault | Follow up on Member Services Quality of Phone Service: During the July 2007 Board meeting, the CEO reported that the Member Advisory Committee, in response to their request, listened to two recorded Member Services calls to understand how members get responses to their inquiries/requests/complaints and to assist Alliance staff in the development of an evaluation tool. At the end of this report in July, Gail Steele requested that the agenda item be presented to the Board at the next meeting. Ingrid Lamirault asked Robin Mims, Alliance Director of Client Services, to make the presentation.
Robin Mims explained how the calls are randomly recorded to improve the service we provide our clients. The calls are randomly recorded and then rated internally, looking at factors such as accuracy of information provided, the professionalism, and courtesy level. A Member Satisfaction Tool was developed and they were asked for their feedback. Based on the calls they heard they thought the service was good and approved the Tool with one minor change. She passed out a copy of the Customer Service Survey. Call was played for the Board Members. Robin explained that the phone call met our requirements. An outside service will be used to rate our non-English calls. Dr. Norton requested changing the music. Twelve representatives are assigned to the telephones and their goal is to answer the calls within 30 seconds. Auto system answers the line and then a representative picks up. If a customer has a complaint, it is taken over the telephone The State has requirements for how complaints and grievances are handled. A member must receive a letter within five days and the issue must be resolved within 30 days. |
None | |
| Medi-Cal Rate Increase Still no definitive date when new rates will come out for the period of October 2007-September 2008. The State budget includes an average rate increase of 4%; some plans could get rate decreased. We would need 3% rate increase to break even next year without passing any rate increase along to providers. CEO reminded Board members that rate increase from QIF is reduced from 6% match to 5.5% match in January 2008. |
None | |||
| SCHIP Reauthorization On Tuesday September 25th, the House approved an expansion at a cost of $35 billion. Vote was 265-159 (more than 100 short of what’s needed to overcome a presidential veto). It would raise the money needed by raising the cigarette tax by 61cents. Could cover an additional 4 million children and limit federal match for income above 300% FPL (would grandfather those in now). In California, this would benefit 830,000 children in Healthy Families, 250,000 in Medi-Cal, and 8,000 pregnant women on AIM. California has enough funding to last until November (more than 10 states will run out of money this month). The Bush Administration is pushing to keep enrollment criteria at 250% FPL. This evening, by a vote of 67 to 29, the Senate passed an identical version of the SCHIP reauthorization bill that the House approved on Tuesday. This bill now is ready to be sent to the President. The margin of victory in the Senate today was large enough to override the expected presidential veto. However, the vote in the House earlier this week – 265 to 159 – fell about 25 votes short of the two-thirds majority that will be needed to override the veto. Meanwhile, Congress will be sending the President separate legislation, a “continuing resolution,” that includes language providing temporary federal funding for SCHIP until either November 16 or, if earlier, the date on which an SCHIP reauthorization bill is signed into law. This resolution was approved by the House on Tuesday and is expected to receive Senate approval later this evening, so the President can sign it into law before October 1. |
None | |||
| Medicare There was concern when Medicare Advantage rate reductions were tied to SCHIP Reauthorization. Managed care payment reductions are no longer in the House or Senate version of bill. Congress will have to create legislation next year because the MMA provisions sunset. There is no doubt that rate reductions will be part of the upcoming legislation. Now, on average MA plans receive 112% Medicare FFS. The federal government is convinced this is too high (significant number of plans getting into the business, highly positive earning reports for for-profit plans). Most in the industry believe that the legislation will probably not propose rates going below 100% Medicare because all believe that rural payments would be too low. Our actuaries advise us that if the Alliance manages well we could still have a positive margin if there is a reasonable reduction action taken by CMS. With the help of actuaries and other consultants, we have paid attention to how we structured the provider payments (either below 100% Medicare or tied to premiums). Congressional legislative staff would like to consider performance budgeting tied to Medicare payments. At a minimum, proposed legislation will include comparative effectiveness data requirements and payment strategies (comparisons made to FFS and from plan-to-plan). This will be accomplished by reviewing actual utilization and quality of care. There will be more focus on regulating marketing practices – seeking clear information between FFS and managed care (benefits, co-pays, and premiums). Congressional staff feel most abuse is coming from MA-private FFS plans. |
None | |||
| State Health Reform AB8/SB32 would establish a "pay or play" system and allowed employees of firms that “pay” to enroll and receive coverage. It would expand eligibility for public health insurance programs for children and parents, and improve access to coverage on the individual insurance market by standardizing medical underwriting, clarifying eligibility for the high-risk pool, and facilitating comparison shopping. AB 8 would be financed through employer and employee contributions (7.5% payroll) and new federal matching dollars associated with public program expansion. The Governor’s plan would require employers to offer coverage or contribute up to 4% of payroll toward the cost of employees' coverage through a purchasing pool. A purchasing pool would be established to administer premium subsidies and offer coverage. Financing for the proposal is subject to approval of a ballot initiatives, likely in November 2008. Key financing components include increased federal funding, employer contributions, a 4% fee on hospital revenue, county contributions, sliding scale individual/family contributions, and new revenue from leasing the state lottery. This proposal was not introduced as legislation during the regular 2007 legislative session to focus on health care. |
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| Healthy Kids Creation of state program largely dependent on SCHIP expansion – so not likely at all. Advocates are pushing for: pass strong policy bill during the special session that would mirror AB8/SB 32 and bridge funding for children with existing coverage. |
None | |||
| Strategic Planning Would like to get retreat scheduled for sometime in January 2008. CEO reminded the Board of the major topics that need to be discussed: Healthy Kids contingency planning, Medicare financial and other benchmarks, potential opportunities with health care reform, Medi-Cal rates, etc. Plan to invite Jim Gross (Alliance lobbyist in Sacramento). CEO will work with the Strategic Planning Committee members to draft an agenda for the all-day meeting. |
Patricia Protopappas will resend polling email to finalize retreat scheduling; Regular Strategic Planning meeting scheduled for October 25, 2007 | Staff will work with Board members’ calendars to schedule an all-day retreat. | ||
| Finance Committee Five attachments July Financial Report August Financial Report SAS 61 Letter Draft 09-24-07 AAH 2007 FS Draft - Issued 09-25-07 Board Presentation 2007 |
John Volkober | Moss Adams - Auditors Report was presented and questions taken. Jane - Moving forward will there be benchmarks comparing us to other organizations? Moss - Yes we can do that going forward Marty - Do you expect that other plans have experienced similar increase in inpatient costs in the last year and how does that fit with the industry. Moss - Yes some other plans are experiencing high dollar case claims coming in, more than they have in the prior years. John - In August, September, November & January we got hit with a significant number of high dollar cases. It was significantly greater than it was in prior years. Dr. Norton - Concerned about hospital in-patient services. Concerned about the doctors and why they went from 27% to 25%. John - That is a percent of total expense, not a year-to-year increase chart. Dr. Norton - Concerned that this could be a trend. Ingrid - We can look into that. It could be a membership decrease, etc. ................ J. Garcia asked for a motion to accept the auditor's report. |
Motion: John Norton Second: Marty Lynch Vote: Unanimous |
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| Financial report for month ended July 31, 2007. All expenses were up except inpatient and SNIPs. 2% increase in membership.
Some discussion…. J. Garcia asked for a motion accepting the July financial statements. |
Motion: M. Lynch Second: J. Norton Vote: Unanimous |
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| Financial report for month ended August 31, 2007. Looks significantly better. Significant discussion…. |
Motion: R. Davis Second: P. Gumbs Vote: Unanimous |
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| Chief Medical Officer’s Report Two attachments Resolution #07-06 Formulary Changes |
A. Chen, MD | Resolution #07-06 with one minor change.
J. Garcia asked for a motion to accept the Resolution. |
Motion: R. Davis Second: M. Lynch Vote: Unanimous |
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| Dr. Chen described changes to the formulary proposed or recommended by the Pharmacy and Therapeutics Committee.
The Chair asked for a vote on the proposed changes |
Motion: R. Davis Second: J. Norton Vote: Unanimous |
None | ||
| Other Business | J. Garcia | None | None | None |
| Public Comments | J. Garcia | Dr. Norton wanted to recognize J. Garcia for her accomplishment in receiving the award from the San Francisco foundation on Tuesday. She is to be commended.
J. Garcia congratulated Art Chen who was honored by Asian Health Services. |
None | None |