BOARD OF GOVERNORS MEETING #237 - Home | L.A. …lacovered.org/sites/default/files/071014 BoG Mtg...

BOARD OF GOVERNORS MEETING #237

July 10, 2014 ● 2:00 PM L.A. Care Health Plan 1055 W. 7th Street, Los Angeles, CA 90017

1

Mission, Vision & Values

Our Mission To provide access to quality health care for Los Angeles County’s vulnerable and low income communities and residents and to support the safety net required to achieve that purpose. Our Vision A healthy community in which all have access to the health care they need. Our Values We are committed to the promotion of accessible, high quality health care that:

* Is accountable and responsive to the communities we serve and focuses on making a difference;

* Fosters and honors strong relationships with our health care providers and the safety net;

* Is driven by continuous improvement and innovation and aims for excellence and integrity;

* Reflects a commitment to cultural diversity and the knowledge necessary to serve our members with respect and competence;

* Empowers our members, by providing health care choices and education and by encouraging their input as partners in improving their health;

* Demonstrates L.A. Care’s leadership by active engagement in community, statewide and national collaborations and initiatives aimed at improving the lives of vulnerable low income individuals and families; and

* Puts people first, recognizing the centrality of our members and the staff who serve them.

2

AGENDA BOARD OF GOVERNORS MEETING No. 237 Thursday, July 10, 2014, 2:00 P.M. L.A. Care Health Plan, 10th Floor, 1055 W. 7th Street, Los Angeles, CA 90017

I. Welcome

Thomas Horowitz, D.O.

Chair

II. Approve today’s meeting agenda Chair

III. Public Comment

Chair

IV. Approve June 5, 2014 meeting minutes

Chair

V. Approve Consent Agenda Items 1. TenTek Temporary Staffing (FIN 100) 2. DTL Temporary Staffing (FIN 101) 3. Cognizant Technology Solutions U.S. Corporation Contract Amendment (FIN 102) 4. RCAC Membership (ECA 100)

Chair

VI. ADJOURN TO CLOSED SESSION (Est. time: 75 mins.)

Chair A. CONTRACT RATES

Pursuant to Welfare and Institutions Code Section 14087.38(m) • Plan Partner Rates • Provider Rates • DHCS Rates

B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion concerning New Product Lines Estimated date of public disclosure: June 2016

C. CONFERENCE WITH LEGAL COUNSEL –EXISTING LITIGATION Pursuant to Section 54956.9 (d) (1) of Ralph M. Brown Act Name of case: Lancaster Hospital Corp (dba Palmdale Regional Medical Center; formerly known as Lancaster Community Hospital) v. Toby Douglas, Director of DHCS, L.A. Care Health Plan, Care 1st, L.A. County CHP et al., Case No.: MC024766

D. CONFERENCE WITH LEGAL COUNSEL – ANTICIPATED LITIGATION Pursuant to Section 54956.9 (b) of the Ralph M. Brown Act One (1) potential case

E. CONFERENCE WITH LABOR NEGOTIATOR Pursuant to Section 54957 of the Ralph M. Brown Act Agency Negotiator: Howard A. Kahn Unrepresented Employee: All L.A. Care Employees

F. PUBLIC EMPLOYMENT Pursuant to Section 54957 Ralph M. Brown Act Title: Chief Executive Officer

VII. RECONVENE IN OPEN SESSION

Chair

VIII. Chairperson’s Report

Chair

3

maloub

Text Box

p.5

maloub

Text Box

p.17

maloub

Text Box

p.18

maloub

Text Box

p.19

maloub

Text Box

p.20

IX. Chief Executive Officer Report • Recognition of Barbara Cook • L.A. Care/DHS Medi-Cal Operational Realignment

Howard A. Kahn Chief Executive Officer

X. Chief Medical Officer Report

Gertrude S. Carter, MD, MPH Chief Medical Officer

XI. Motions for Consideration 1. Craig Stephens/Beecher Carlson Holdings, Inc. Contract (BOG 100)

2. Healthy Kids 0-5 extension to 2015 (BOG 101)

3. Sierra Pacific Constructors contract extension (BOG 102) 4. Authorization for Restacking Project of HQ Building (BOG 103) 5. Authorization to open an account with Mutual of Omaha Bank (BOG 104)

6. Amendment Cognizant contract for CCA related services (BOG 105)

Chair

XII. Committee Reports

A. Executive Committee

Thomas Horowitz, D.O., Chair

1. Legislative Update

Cherie Fields Director, Government Affairs

2. Retirement Plan Motion (EXE 100) Jonathan Freedman Chief of Strategy, Regulatory & External Affairs

3. Robert E. Tranquada, M.D. Safety Net Infrastructure V HEDIS Initiative Awards (EXE 101)

Jonathan Freedman

B. Finance & Budget Committee

Michael Rembis, Chair

1. Financial Report

Tim Reilly Chief Financial Officer

2. 2014-2015 Budget Update

Tim Reilly

3. Cornerstone Contract Amendment (FIN 104)

John Wallace Chief Operating Officer

C. Governance Committee

Alexander K. Li, MD Chair

XIII. Advisory Committee Reports

A. Executive Community Advisory Committee

Hilda Perez/Ozzie Lopez Board Consumer member and Advocate member

XIV. Adjournment

Chair

The next meeting is scheduled for Thursday, September 4, 2014. The order of items appearing on the agenda may change during the meeting. Teleconference arrangements may change prior to the meeting. Those planning

to participate by telephone should confirm with L.A. Care Board Services prior to the meeting. Please keep your comments to three minutes or less.

THE PUBLIC MAY ADDRESS THE BOARD OF GOVERNORS ON ALL MATTERS LISTED ON THE AGENDA BY FILLING OUT A “REQUEST TO ADDRESS” FORM AND SUBMITTING THE FORM TO L.A. CARE STAFF PRESENT AT THE MEETING BEFORE THE AGENDA ITEM IS ANNOUNCED. YOUR NAME WILL BE CALLED WHEN THE ITEM YOU ARE ADDRESSING IS DISCUSSED. THE PUBLIC MAY ALSO ADDRESS THE BOARD ON L.A. CARE MATTERS DURING PUBLIC COMMENT. AN AUDIO RECORDING OF THE MEETING IS MADE TO

ASSIST IN WRITING THE MINUTES AND IS RETAINED ONLY FOR 30 DAYS.

NOTE: THE BOARD OF GOVERNORS CURRENTLY MEETS ON THE FIRST THURSDAY OF MOST MONTHS AT 2:00 P.M. POSTED AGENDA and PRINTED MEETING MATERIALS ARE AVAILABLE FOR INSPECTION AT Board Services, 1055 W. 7th Street – 10th Floor, Los Angeles, California 90017.

Any documents distributed to a majority of the Board Members regarding any agenda item for an open session after the agenda has been posted will be available for public inspection at Board Services, L.A. Care Health Plan, 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017, during regular business hours, 8:00 a.m. to 5:00 p.m., Monday – Friday.

Meetings are accessible to people with disabilities. Individuals who may require any accommodations (alternative formats – i.e., large print, audio, translation of meeting materials, interpretation, etc.) to participate in this meeting and wish to request an alternative format for the agenda, meeting notice, and meeting packet may contact L.A. Care’s Board Services Department at (213) 694-1250. Notification at least one week before the meeting will enable us to

make reasonable arrangements to ensure accessibility to the meetings and to the related materials.

4

maloub

Text Box

p.21

maloub

Text Box

p.25

maloub

Text Box

p.28

maloub

Text Box

p.32

maloub

Text Box

p.33

maloub

Text Box

p.34

maloub

Text Box

p.35

maloub

Text Box

p.36

maloub

Text Box

p.37

maloub

Text Box

p.38

maloub

Text Box

p.44

maloub

Text Box

p.64

DRAFT

Board of Governors Retreat/General Meeting # 236 Meeting Minutes – June 5, 2014 Japanese American Cultural & Community Center 244 S. San Pedro Street, Los Angeles, CA 90012

Members Management/Staff Thomas Horowitz, DO, Ozzie Lopez, MPA Howard A. Kahn, Chief Executive Officer Mark Gamble, Vice Chairperson Supervisor Gloria Molina* Trudi Carter, MD, Chief Medical Officer * Michael A. Rembis, FACHE, Treasurer Hilda Perez Jonathan Freedman, Chief of Strategy, Regulatory & External Affairs Louise McCarthy, Secretary G. Michael Roybal, MD, MPH Augustavia J. Haydel, Esq., General Counsel Jann Hamilton Lee Sheryl Spiller * Tim Reilly, Chief Financial Officer Thomas S. Klitzner, MD, PhD Walter A. Zelman, PhD Tom Schwaninger, Chief Information Officer Alexander K. Li, MD *absent John Wallace, Chief Operating Officer

AGENDA ITEM/PRESENTER

MOTIONS / MAJOR DISCUSSIONS

ACTION TAKEN

WELCOME AND INTRODUCTIONS

Thomas Horowitz, DO Howard A. Kahn

Thomas Horowitz, DO, Chairperson, called the retreat to order at 8:55 a.m.

Chair Horowitz announced that the public may address the Board on the matters listed on the agenda before or during the Board’s consideration of the item, and on any other matters at the public comment section.

APPROVAL OF TODAY’S AGENDA Thomas Horowitz, DO

The Agenda for today’s meeting was approved. Approved unanimously. 11 AYES (Gamble, Hamilton Lee, Horowitz, Klitzner, Li, Lopez, McCarthy, Perez, Rembis, Roybal and Zelman).

CHIEF EXECUTIVE OFFICER’S REPORT

Howard A. Kahn

Howard A. Kahn, Chief Executive Officer, welcomed everyone to the annual retreat, which is an opportunity for the Board to think about L.A. Care’s future and provide guidance to staff. During the Board meetings there is typically not much time for strategic discussion. The deliberations today will provide priorities and guidance for staff to develop operational plans for later consideration by the Board.

Mr. Kahn introduced John Connolly, Deputy Director of Insure the Uninsured Project, as the moderator for the Retreat discussion.

Mr. Connolly invited Board members to express their thoughts on the challenges facing L.A.

5

Board of Governors Retreat/Meeting June 5, 2014

DRAFT DRAFT



ACTION TAKEN

Care: · Simultaneously an unusually high number of new programs, transition of Medi-Cal members

which are to be implemented in a short time frame, and a large influx of new Medi-Cal members which all require focused, systematic approaches;

· Potentially severe long term financial risk of new programs and new categories of members; · Change in orientation of L.A. Care from family and child health programs to programs

serving adults, seniors and people with disabilities; · Increased workload for staff of health care related organizations in an atmosphere of

constant change, particularly the organizations which make up the fragile safety net; · Difficulty of balancing the best use of government programs and private organizations in

providing care, and how to coordinate private insurance organizations and public health systems in order to best serve the needs of the public;

· Determining the best method to serve the needs of the new members in the safety net system, and to focus on primary care to provide clear entry to care for enrollees.

· Board members now must consider not only the safety net organizations but must also oversee new Medicare and commercial lines of business in determining L.A. Care’s future needs.

Mr. Kahn reported that L.A. Care’s staff has performed very well in facing the new programs and transformation. He noted that turnover among members within the system also creates challenges within the health care system.

He indicated that goals of the retreat are: · To understand the changing health care environment and L.A. Care’s role; · To articulate the role and value of the local initiatives and the Two-Plan Model within that

landscape.

Discussion questions for the retreat are: 1. Given the major changes in the health care environment, how can L.A. Care adapt to better

serve its members and the community? How can L.A. Care most effectively support safety net providers?

2. Is the Two-Plan Model still necessary to L.A. Care’s success? What should L.A. Care do in terms of both operations and advocacy to address threats to the Two-Plan Model?

3. How can L.A. Care best demonstrate and communicate its value as the Local Initiative?

6


DRAFT DRAFT



ACTION TAKEN

Mr. Kahn referred Board members to the CEO Report included in the retreat. This past year significant events included: · An historic Medi-Cal expansion, transition of the Low-Income Health Program (Healthy

Way LA) members; · Implementation of L.A. Care Covered, Coordinated Care Initiative and Cal MediConnect.

L.A. Care entered these new markets to continue serving low income members. Some programs presented a great challenge and have been implemented rather well. On July 1 there will be another large influx of members. These conversions and start-ups are rarely smooth, but in the long term are the right thing to do and will serve members well.

Another big project this year has been the implementation of a new core data system at L.A. Care, which has gone largely on budget and on time. The larger lines of business will be loaded in the next few months.

Mr. Kahn noted that staff has performed very well amidst all these challenges. The low performing icon (LPI) issued by the Centers for Medicare and Medicaid Services (CMS) was due to a combination of too many projects going on at once, some naiveté with regard to changes in Medicare pharmacy requirements, serving an exclusively low income population, , and a retroactive change in federal policy.

Mr. Kahn initially supported Obamacare legislation because of the expansion toward universal coverage. The legislation is triggering additional profound changes in the health care environment beyond those originally envisioned. There are changes in relationships between health plans and providers as ownership and leadership changes; multiple provider organizations are applying for Knox- Keene licenses.

L.A. Care’s competition is increasing as organizations that in the past were not interested are now interested in Medi-Cal products. A large portion of apparent growth in the first year of the health benefit exchange in California is in enrollment of members who have transferred from the individual coverage market. Medi-Cal expansion enrollment on the other hand, represents the newly insured. Although L.A. Care’s rapid increase in enrollment maintains our solid market share in Medi-Cal, L.A. Care must continue to develop strategies to improve care for its 1.4 million members and promote its value to policy makers. L.A. Care must focus on operational issues, quality of care, and support for the safety net in Los Angeles County. Safety net providers will need to evolve to meet the needs of members. These are tremendous challenges for health plans, and can be particularly difficult for public health plans because of their

7


DRAFT DRAFT



ACTION TAKEN

structure and governance. It was noted that the stakeholder nature of L.A. Care’s Board makes it unlike boards of other health plans.

Tim Reilly, Chief Financial Officer, noted as L.A. Care enrollment grows, the complexity of the financial arrangements for its product lines makes meaningful tracking difficult. Staff is working to accomplish the L.A. Care mission in the changing financial environment and ensure sufficient funding streams for continued quality services for L.A. Care members.

Mr. Kahn stated that L.A. Care staff is working toward development of financially sustainable high-quality services and is not focused primarily on maximizing profit and growth. There are opportunities to build new models and new relationships to maximize L.A. Care’s value to policy makers and to strengthen safety net partners in the new environment. Safety net providers must attract new and retain current patients who now have the option to select providers.

Among potential threats is the shift of financial responsibility, risk and operational activities to health plans by government funders that are moving toward oversight functions.

Among current regulators there is some loss of the institutional understanding of the origins and rationale for the Two-Plan Model in California. This creates a strong need for Local Initiatives to help safety net organizations protect their place in the market.

Post ACA – Changing Health Care Environment Part 1

Burt Margolin, President, The Margolin Group, reviewed political developments affecting health care. On the federal level, it seems unlikely that the Affordable Care Act (ACA) will be significantly amended or repealed in the current environment. He noted that 8 million people have enrolled in exchanges, and opposition to Medicaid Expansion has become unpopular because of the potential for financial disadvantages to states not receiving federal Medicaid funding. Key leaders throughout the country are proposing alternative methods for drawing down those federal funds.

The federal budget impasse was resolved through 2014, so fundamental Medicaid restructuring is likely on hold until 2015. Leadership turnover is expected in 2015 as long term incumbent politicians retire. Most prominently, Henry Waxman has been an effective and powerful supporter of Medicaid. With his departure there may be a void which may be collectively filled by several people. There is a change in the leadership of Health and Human Services (HHS) agency. Sylvia Burwell, the new HHS Secretary, is the former director of the Office of Management and Budget. The federal Section 1115 Waiver will expire in 2015 and its successor waiver will be critically important.

8


DRAFT DRAFT



ACTION TAKEN

Improvements in the state economy have brought budget surpluses. California is the leader in ACA implementation and Medi-Cal expansion, which gives it national credibility. The Brown administration health agenda is to maximize federal funding of health programs and to avoid using state general funds.

Changes in legislative term limits will foster increased expertise, forming of constituencies and creating champions among state legislators who will now serve longer. New leadership in Sacramento means that education on the critical issues will be needed.

Dominant legislative developments include: · Lara bill addressing coverage for the residual uninsured (may be premature this year due to

lack of a funding source); · Health industry accord between hospital association and labor (CHA and SEIU); · Section 1115 waiver process launched.

Regarding federal legislative work on immigration reform and health coverage, Mr. Margolin noted that there is indication that Speaker Boehner is developing a specific strategy; details may come out in July. Mr. Margolin acknowledged the potential for a political vacuum in the center, although there are no incentives for politicians to remain in a centrist position, and the lame duck presidency may hamper innovation.

In response to Mr. Connolly’s question about funding for state health care programs, Mr. Margolin noted that health care programs are not a current priority for Governor Brown, although given the revenue surplus; the Governor may compromise with health program advocates.

Mr. Margolin opined that the agreement between labor and the state hospital association may have a positive effect on health program funding in California.

PUBLIC COMMENTS There were no public comments.

ADJOURN TO CLOSED SESSION Thomas Horowitz, DO

Augustavia Haydel, Esq., General Counsel, announced the following items to be discussed in closed session. The Board adjourned to a closed session at 10:30 a.m.

A. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion concerning New Product Lines

9


DRAFT DRAFT



ACTION TAKEN

Estimated date of public disclosure: May 2016

(Member Zelman left the meeting.)

RE-ADJOURN TO CLOSED SESSION Thomas Horowitz, DO

Augustavia Haydel, Esq., General Counsel, announced the following items to be discussed in closed session. The Board adjourned to a closed session at 1:59 p.m.

B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion concerning New Product Lines Estimated date of public disclosure: May 2016

(Member Zelman returned to the meeting.)

RECONVENE IN OPEN SESSION

The Board reconvened in open session at 2:50 p.m. Ms. Haydel announced there was no report on items considered during the closed session.

RETREAT CLOSING REMARKS

Thomas Horowitz, DO Howard A. Kahn

Chairperson Horowitz asked Board Members to provide additional comments to staff. Mr. Kahn thanked the Board for participating and the expert guests for their contributions. The Retreat offered Board Members an opportunity to discuss L.A. Care’s future. Board members thanked the staff for arranging the discussions and the presentations from Mr. Margolin and Ms. Ogle.

PUBLIC COMMENTS

There were no public comments.

ACCEPTANCE OF MINUTES OF May 1, 2014 MEETING

Thomas Horowitz, DO

The minutes of the May 1, 2014 meeting were approved as submitted. Approved unanimously. 11 AYES (Gamble, Hamilton-Lee, Horowitz, Klitzner, Li, Lopez, McCarthy, Perez, Roybal, Rembis, and Zelman.)

APPROVAL OF CONSENT AGENDA

Thomas Horowitz, DO

The Board considered the following 14 motions on a Consent Agenda: 1. Revisions to Legal Services Policy & Procedure LS-009 relating to Government Claims

Motion EXE 100.0614* To approve revisions to Legal Services Policy & Procedure No. LS-009 (Government Claims Presentation & Delegation of Authority to Approve, Deny and/or Settle Certain Government Claims), as attached and subject to review as to form only by

All 14 motions on the Consent Agenda were approved unanimously. 11 AYES

10


DRAFT DRAFT



ACTION TAKEN

L.A. Care’s Regulatory Affairs & Compliance Department.

2. Integrated Systems Inc./Presidio Inc. Contract Motion FIN 100.0614* To approve an amendment to an existing contract with Integrated Systems Inc. in the amount of $1,070,475.80, (total contract amount not to exceed $2,519,812.80) for telecommunications equipment additions and upgrades through December 31, 2014, and to authorize the purchase of Presidio's Inc. call recording solution for an amount not to exceed $720,036.50.

3. Infosys Contract Amendment Motion FIN 101.0614* To authorize staff to amend a contract with Infosys adding $1,037,870 (total contract not to exceed $5,000,000) for core system consulting through September 2014.

4. Appeals and Grievances System Project Motion FIN 102.0614* To authorize staff to amend a contract with Edmund Jung & Associates to provide software and consulting services for $800,000 (total contract amount not to exceed $1,395,000) through June 1, 2015 and to authorize $300,000 for an undetermined qualified vendor through June 1, 2015 for appeals and grievances assistance.

5. Equis Staffing Contract Amendment Motion FIN 103.0614* To amend a contract with Equis Staffing for $477,680 through December 31, 2014 (total contract not exceed $879,390) for temporary employee assistance in L.A. Care’s Information Technology and the Project Management Office.

6. McKesson Health Solutions LLC Contract Extension Motion FIN 104.0614* To extend nurse advice line (NAL) services with McKesson Health Solutions LLC, from July 1, 2014 to June 30, 2015, for an amount not to exceed $730,307 to allow time for completion of the request for proposal process.

7. Joseph Wanski, M.D, Contract Renewal Motion FIN 105.0614* To renew the consulting agreement with Joseph Wanski, MD from August 1, 2014 through July 31, 2015, for a total amount not to exceed $242,500.

11


DRAFT DRAFT



ACTION TAKEN

8. ICD-10 Project Vendors Motion FIN 106.0614* To amend a contract with HCL America, Inc. for the amount of $1,171,894 (total contract not to exceed $2,292,698) for ICD-10 remediation services through October 31, 2015, and amend a contract with Infosys Public Services for an amount of $382,564 (total contract not to exceed $5,382,517) for ICD-10 test environment setup and support services through the end of January 2015.

9. Contract for the development of the Participating Physicians Group Authorization Processing Application Motion FIN 107.0614* To authorize the Chief Executive Officer to sign a contract with a vendor that has not yet been selected in an amount not to exceed $300,000 through December 31, 2014, for the development of the participating physicians’ group authorization processing application.

10. Prequalified Vendors Motion FIN 108.0614* To approve the addition of two vendors to the prequalified staffing and consulting list and new contract funding for these vendors through FY 2013-14 not to exceed the amount indicated per vendor:

3Key Consulting $ 200,000 Milliman $ 200,000

11. Firstsource Contract Amendment for Medi-Cal Claims Processing Motion FIN 109.0614* To approve a contract amendment with Firstsource for an amount not to exceed $1,717,610 (total contract amount not to exceed $3,107,710) for Medi-Cal claims processing services through March 2015.

12. Firstsource Contract Amendment for Medicare Claims Processing Motion FIN 110.0614* To approve a contract amendment to Firstsource for an amount not to exceed $264,575 (total contract amount not to exceed $3,372,285) for Medicare claims processing services through March 2015.

13. CHCAC Member Approval (CHC 100)

12


DRAFT DRAFT



ACTION TAKEN

Motion CHC 100.0614* To approve the nomination of Melanie Hunter, M.D., MBA, as Member of the Children’s Health Consultant Advisory Committee, for the Medical Director for Quality Management of L.A. Care Health Plan seat; for the first 4-year term from June 2014 to June 2018.

14. RCAC Membership (ECA 100) Motion ECA 100.0614* To approve the following candidate(s) to the Regional Community Advisory Committees (RCAC) as reviewed by the Executive Community Advisory Committee (ECAC) during the May 14, 2014 ECAC meeting.

Name RCAC # Type of Member Melissa Bryant RCAC 1 Consumer, Medi-Cal Care 1st Alicia Flores RCAC 1 Consumer, Medicare Advantage SNP Diana Leff RCAC 2 Consumer, Medi-Cal MCLA Christine Provencio RCAC 2 Consumer, Medi-Cal MCLA Laura Rhone RCAC 2 Consumer, PASC-SEIU (IHSS) Olivia Bravo RCAC 3 Consumer, Medi-Cal MCLA Esmeralda Cerezo RCAC 3 Consumer, Medi-Cal Blue Cross Dolores Martinez RCAC 3 Consumer, Medi-Cal Blue Cross Marta Ramirez RCAC 3 Consumer, Medi-Cal Care 1st Mariana Santini RCAC 3 Consumer, Medi-Cal Blue Cross Marielena Solorio RCAC 3 Consumer, Medi-Cal Blue Cross Gizelle James RCAC 4 Consumer, Medi-Cal MCLA Irene Romero RCAC 6 Consumer, Medi-Cal Fresia Paz RCAC 10 Consumer, Medi-Cal SPD

RE-ADJOURN TO CLOSED SESSION Thomas Horowitz, DO

Augustavia Haydel, Esq., General Counsel, announced the following items to be discussed in closed session. The Board adjourned to a closed session at 2:40 p.m.

C. PUBLIC EMPLOYMENT Pursuant to Section 54957 Ralph M. Brown Act Title: Chief Executive Officer

D. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m)

13


DRAFT DRAFT



ACTION TAKEN

· Provider Rates The following two items were not discussed:

· Plan Partner Rates · DHCS Rates

E. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Including discussion concerning New Product Lines Estimated date of public disclosure: June 2016

F. CONFERENCE WITH LABOR NEGOTIATOR Pursuant to Section 54957 of the Ralph M. Brown Act Agency Negotiator: Howard A. Kahn Unrepresented Employee: All L.A. Care Employees


The Board reconvened in open session at 4:45 p.m. Ms. Haydel announced there was no report on items considered during the closed session.

(Member Rembis left the meeting.)

Public comment Mike Vick addressed the Board on behalf of independent pharmacists through managed pharmacy care. He noted that there are a lot of changes in the industry. Pharmacists have always been regarded as a primary care resource and the first person others go to with questions. He is very concerned with the policies in reimbursement, and work gets so intense that we lose our main goal, which is to take care of patients. For each care provider visit, people go to a pharmacy up to six times. He has worked in clinics for many years in several different counties. He is frustrated that much of his time is taken up in dealing with insurance plans and other third parties instead of helping the patient.

Chairperson Horowitz noted that a letter from the pharmacy association had been received by the Board on this topic, and he confirmed that John Wallace, Chief Operating Officer, is investigating the situation.

Chairperson Horowitz expressed the appreciation of the Board in having Mr. Vick attend the meeting. He noted that as a stakeholder board we all live with the same frustrations.

There was no other public comment.

14


DRAFT DRAFT



ACTION TAKEN

ITEMS FOR CONSIDERATION

Review of future costs of changes to retirement benefits Jonathan Freedman

Jonathan Freedman, Chief of Strategy, Regulatory and External Affairs, reviewed a proposal with a number of actions regarding the retirement plan. Amendments are required to comply with changes in California law. There will be Social Security as well as a 401(k) program. There will be options offered to staff under this approach to balance portability options for employees.

Karen M. Mack, of Altman & Cronin Benefit Consultants, LLC, stated that the cost of the new program will be the same as the old program (before PEPRA). For employees hired after January 2013 there is a cost increase of 1.5% of payroll cost for about 30% of the total payroll (representing employees hired after January 2013).

Mr. Freedman noted that there will be actions brought at a future meeting. Materials will be developed to help the employees understand the changes.

Legislative Matrix Cherie Fields

(A copy of the legislative matrix report included in the materials for this meeting can be obtained by contacting Board Services.)

Member Perez asked about the Emergency Room payment, and Ms. Fields indicated that the legislation will not go forward without federal approval, and she will update the Board at a future meeting.

California 2014 May Budget Revisions

Cherie Fields

(A copy of the Budget Revisions memorandum included in the materials for this meeting can be obtained by contacting Board Services.)

CHAIRPERSON’S REPORT

Thomas Horowitz, DO

There was no report from the Chairperson.

CHIEF EXECUTIVE OFFICER’S REPORT Howard A. Kahn

Mr. Kahn reported: · Dr. Carter was unable to attend today’s meeting as her child is getting married. · Barbara Cook is retiring later this year, and Bob Turner, L.A. Care’s new Chief of Human

Resources, will begin on June 9. Mr. Turner is the former Chief of Human Resources for Alta Med. Ms. Cook will remain on staff through August as Senior Advisor.

· Cal MediConnect is moving forward with significant membership expected in July.

15


DRAFT DRAFT



ACTION TAKEN

· Member services and other related departments have moved to the Garland Building. Mr. Kahn thanked Lance Maclean, Tom Schwaninger and Barbara Cook and their staffs for the smooth move of several hundred people over the past weekend.

· Elizabeth Darrow, the CEO of Santa Clara Health Plan will be retiring in March 2015 · It was announced today that the Kern County Board of Supervisors is seeking to combine

the public health center with the Kern health plan. This represents a significant change with implications that are not yet apparent.

Member Perez asked that Ms. Cook’s replacement be introduced to members of the Executive Community Advisory Committee, and Mr. Kahn indicated that oversight of the RCAC/ECAC activities will not be Mr. Turner’s responsibility. It has not yet been announced but those functions will be integrated under Member Services and will be reported at a future meeting.

Committee Updates

(A copy of the Committee Updates can be obtained by contacting Board Services.)

MOTION FOR CONSIDERATION

Financial Report

Tim Reilly

Tim Reilly, Chief Financial Officer, reported that L.A. Care has a surplus of $23 million through April, due in part to retroactive rate adjustments. The year to date surplus is $37 million, or 1.8% of revenue. The product lines are performing along historical patterns.

Motion FIN 111.0614 To accept the Financial Report for the seven months ended April 30, 2014, as submitted.

Approved Unanimously. 10 AYES (Gamble, Hamilton-Lee, Horowitz, Klitzner, Li, Lopez, McCarthy, Perez, Roybal, and Zelman)

ADJOURNMENT

Mr. Kahn thanked the members of the Board of Governors and the staff for a productive retreat. The meeting was adjourned at 5:02 p.m. 5

Respectfully submitted by: Linda Merkens, Manager APPROVED BY: ______________________________ Malou Balones, Committee Liaison Louise McCarthy, Secretary Hilda Stuart, Committee Liaison ` Date Signed ______________________________

16

Board of Governors MOTION SUMMARY

Date: July 10, 2014 Motion No: FIN 100.0714

Committee: Finance & Budget

Chairperson: Michael Rembis

Issue: Request to authorize staff to add funds to TenTek staffing firm for professional temporary labor services for the Information Technology (IT) department through 2014. Background: TenTek is a professional employment firm specializing in the placement of temporary technology labor support. L.A. Care has utilized TenTek since January 2014 to augment staff for IT projects. Staff requests an additional $538,560 for TenTek expeditures, for a total of $678,880 through December 31, 2014, for temporary labor services for the IT department. TenTek currently augments IT staff when the workload exceeds capacity. Additional staff is currently needed to manage maintenance and support for ICD-10 testing on QNXT and surrounding IT systems, as well as to build and maintain the testing framework. A request for quotes was conducted in 2014 which resulted in the selection of TenTek. L.A. Care’s experience with TenTek has yielded positive results and high quality work products in their assigned areas of responsibilities. TenTek rates are competitive and comparable to similar industry vendors. TenTek has been evaluated for preferred vendor status and may be chosen as a vendor for FY 2014-15. The requested funds will extend TenTek’s current temporary labor services through December 31, 2014 to help IT staff satisfy L.A. Care’s increasing need for IT support on core and surrounding systems. Permanent positions are being reviewed for the long term. Budget Impact: Of the amount requested, $446,080 is budgeted in IT department for FY 2013-14 and $232,800 will be included in the FY 2014-15 budget. Motion: To authorize expenditures with TenTek Staffing Firm for an additional

$538,560 (total expenditures not to exceed $678,880) for professional temporary labor services in L.A. Care’s Information Technology department through December 31, 2014

17


Date: July 10, 2014 Motion No. FIN 101.0714

Committee: Finance and Budget


Issue: Request to authorize staff to add funds to DLT Staffing employment agency authorized expenditures for professional temporary labor services to support the Claims Department. Background: DLT Staffing is an employment agency that specializes in the placement of provisional staff. L.A. Care has utilized DLT Staffing services over the past two years for Claims Department temporary staffing demands that support various projects. Staff requests authorization for an additional $170,000 to DLT Staffing employment services, for a total amount of $541,757. Staffing services are needed to support core and surround systems in the Claims department. Additional funds and services have increased due to QNXT implementation that has extended the use of MHC; redeployment of Claims’ staff to QNXT testing; and an increase of membership due to Medi-Cal expansion, Cal-Medi Connect and L.A. Care Covered The additional funds will extend the DLT Staffing contract for temporary employment services while permanent positions are being created for the long-term. Budget Impact: This additional $170,000 cost is covered by a favorable variance in the FY 2013-14 Operational division budget. Funds will be requested in the FY14-15 budget process for next year. Motion: To authorize staff to add $170,000 to approved expenditures with

DLT Staffing services for professional temporary labor in the Claims Department, for a total amount not to exceed $541,757.

18


Date: July 10, 2014 Motion No. FIN 102.0714

Committee: Finance and Budget


Issue: Request to authorize staff to amend a contract with Cognizant Technology Solutions U.S. Corporation (Cognizant) to provide Oracle performance testing services. Background: L.A. Care is requesting approval to amend a contract with Cognizant, through October 31, 2014, in the amount of $80,000, in order to support L.A. Care’s implementation of ICD-10. Cognizant will provide Oracle performance testing services in preparation for next fiscal year’s strategic project to migrate L.A. Care’s Oracle system from version 10g to 11g. Oracle is a database application system currently used by L.A. Care for its healthcare business processes outside of the QNXT core system. Cognizant is a leader in providing services to the healthcare and information technology industries, and is currently providing services for L.A. Care on ICD-10 and Care Advance implementation efforts. Prior to these services, Cognizant provided support for L.A. Care’s Health Exchange implementation and related products. Cognizant is headquartered in New Jersey and delivers services by way of onsite and offshore resources. Currently this contract’s total amount is $1,547,922 through the 2013-14 fiscal year. The requested amendment will bring the total to $1,627,922. The current 12 month expense history with Cognizant is $1,547,922. Budget Impact: Sufficient funds of $2.8 million are budgeted for the ICD-10 project in the FY 2013-14 IT budget. Staff will request sufficient funds to be included in the FY 2014-15 budget. Motion: To authorize staff to amend a contract with Cognizant to provide

Oracle performance testing services in preparation of the migration of L.A. Care’s Oracle system from version 10g to 11g, in the amount of $80,000, through October 31, 2014.

19


Date: July 10, 2014 Motion No. ECA 100.0714

Committee: Executive Community Advisory Committee

Chairperson: Aida Aguilar

Issue: Approval of organizational members to the Regional Community Advisory Committees (RCACs).

Background: L.A. Care is required by the enabling legislation to ensure consumer, advocate and provider involvement through Community Advisory Committees. The enabling legislation allows L.A. Care to determine the rules for participation in the Community Advisory Committees. It is difficult for community based organizations to ensure that the same staff person will attend each meeting, even when the organization has a strong desire to regularly participate in the RCAC activities. To enable participation of these groups, L.A. Care’s Executive Community Advisory Committee (ECAC) has proposed recognizing the organization for membership, rather than requiring individuals to be members. This is the first motion brought by the ECAC for organizations to have memberships in L.A. Care’s Regional Community Advisory Committees. The organization can then designate their representative to participate in the RCAC and ECAC meetings and activities.

Budget Impact: None.

Motion: To approve the following candidate(s) to the Regional Community Advisory Committees (RCAC) as reviewed by the Executive Community Advisory Committee (ECAC) during the June 11, 2014 ECAC meeting.

Name

RCAC # Type of Member

Antelope Valley Partners for Health RCAC 1 Advocate County of Los Angeles Department of Public Health Area Health Office SPA 1

RCAC 1 Advocate

County of Los Angeles Department of Public Health Area Health Office SPA 2

RCAC 2 Advocate

USC Hartford Center of Excellence RCAC 6 Advocate Parents with Exceptional Kids Inc. RCAC 7 Advocate Fiesta Educativa Inc. RCAC 10 Advocate

20

July 1, 2014 TO: Board of Governors FROM: Howard A. Kahn, Chief Executive Officer SUBJECT: CEO Report – July 2014 I would like to thank you again for participating in L.A. Care’s annual Board Retreat last month. I believe it was an insightful and productive day for Board members and L.A. Care staff. With half of 2014 behind us already, we will be holding our last Board meeting of the summer prior to the Board and Committees going “dark” in August. I hope you enjoy the brief respite and have the opportunity to spent time with family and friends. Please find below an update on organizational activities that occurred in June 2014. Additional updates will be made during my CEO report at the July 10, 2013 Board meeting. 1. Coordinated Care Initiative (CCI) and Cal MediConnect (CMC)

L.A. Care currently has over 200 active members in our CMC product that joined voluntarily in May and June. We anticipate approximately 7,000 additional members in July 2014, who represent the crosswalk population (members who are eligible for CMC and are enrolled with L.A. Care for their Medi-Cal benefit and and fee-for-service for Medicare). As of July 1, 2014, L.A. Care began to cover the Managed Long Term Supports and Services (MLTSS) benefit for L.A. Care Medi-Cal members. The Multipurpose Senior Services Program (MSSP) benefit will begin on October 1, 2014. L.A. Care continues to build and develop our internal LTSS department. L.A. Care continues our stakeholder engagement and education efforts. On June 20, 2014 we hosted a behavioral health stakeholder meeting, with over 40 meeting participants representing a variety of independent physician associations and provider groups. L.A. Care also hosted our first CCI Stakeholder Community Meeting and Consumer Community Meeting, in Palmdale. This is an opportunity to extend our current stakeholder meetings to various locations to reach additional members, advocates, and caretakers

2. L.A. Care Receives Blue Shield of California Foundation Grant L.A. Care received a grant from the Blue Shield Foundation for the Advancing Primary Care and Behavioral Health Integration through Community Collaboration program. This project aims to create Health Neighborhoods in Los Angeles County that will integrate safety net medical, mental health, and substance use disorder care within defined neighborhoods. The partnering agencies include the Los Angeles County Departments of Health Services, Mental Health, and Public

21

CEO Report – July 2014

Health, the Community Clinic Association of Los Angeles County, and L.A. Care serving as the lead applicant. The grant is for $175,000 for a one-year period and will be used largely for consultant services and community convening expenses.

3. Children’s Health Initiative (CHI) Coalition of Greater Los Angeles On June 11, 2014, L.A. Care hosted the final Children’s Health Initiative (CHI) Coalition of Greater Los Angeles meeting. The CHI Coalition was formed in May, 2003, with L.A. Care as a strong supporter and co-convener along with The California Endowment (TCE) and the L.A. County Department of Health Services. The CHI set a three-year goal to cover 150,000 children ages 0-18 by expanding Healthy Kids to children ages 6-18, increase enrollment of children eligible for Medi-Cal and Healthy Families, and pursue a long-term policy solution to sustain affordable health coverage for children. Within a year, $80 million was raised to launch the Healthy Kids expansion in June 2004 and, by 2006, enrolled more than 100,000 children in Medi-Cal and Healthy Families and 40,000 children in Healthy Kids. The Healthy Kids 6-18 program was slated to end in 2007; however, additional donor support maintained the program through March 2013. The CHI went above and beyond all set goals and expectations and was acknowledged by Dr. Robert Ross, President and CEO of TCE, as contributing to the local and statewide partnerships that helped to facilitate California’s statewide health reform effort and enabled California to lead the way in implementing federal health reform. The CHI was a milestone for L.A. Care. It was our first opportunity to become a leader in Los Angeles. A special thanks to Shawnalynn Smith, Senior Manager, Group Products, for their dedication and hard work to ensure the success of the CHI.

4. Los Angeles County Chief Executive Officer, William Fujioka Announces Retirement

On June 26, Los Angeles County CEO, William Fujioka, announced his retirement at the end of November 2014. Mr. Fujioka was appointed by the Board of Supervisors in 2007 and continued on past his original intent of five years to see Los Angeles County through challenging economic times. After November, the County will also have two new Supervisors, a new sheriff, assessor, legal counsel, and public health director.

5. California Association of Health Plans Announces Charles Bacchi as New President and CEO The California Association of Health Plans (CAHP) announced that Charles Bacchi will be the association’s next President and CEO when current CEO, Patrick Johnston, retires at the end of the year. Bacchi, who has been with CAHP for the past eight years, served first as Vice President of Government Relations and most recently as Executive Vice President. As a member of the CAHP Board, I participated in the CEO selection process and am very pleased with the selection.

6. Operations Report Please find attached to my report the quarterly update on health plan operations from John Wallace, Chief Operating Officer.

7. Meetings and Events of Interest I participated in the Association for Community Affiliated Plans (ACAP) Board meeting in Washington D.C. on June 23-26. During the ACAP meeting, I had the opportunity to moderate discussions on Medicaid expansion, the future of duals special needs plans (D-SNPs), and competition in the current health insurance environment.

22


L.A. Care provided downtown meeting space for community activities and training this past month:

· June 3, 2014 – L.A. Care hosted a Health Promoters training on the Coordinated Care Initiative and access to care issues.

· June 11, 2014 – L.A. Care hosted the last meeting of the Children’s Health Initiative. · June 20, 2014 – L.A. Care hosted a behavioral health stakeholder meeting.

Attachments:

· June 2014 sponsorship list · Operations report

23


June 2014 Participation and Sponsorship List

Event Date Organization Event Location 6/5/2014 California Association of

Physician Groups Annual Health Care Conference

Los Angeles

6/7/2014 Housing Works Annual Fundraising Dinner Los Angeles

6/17/2014 California Pan-Ethnic Health Network

Voices for Changes Los Angeles

6/17/2014 National Medical Fellowships Champions of Health Awards

Long Beach

6/19/2014 Los Angeles County Medical Association

Installation Dinner Pacific Palisades

24

L.A. Care / DHS Medi-Cal

Operational Realignment

Effective 7/1/2014

John Wallace

Chief Operating Officer

25

L.A. Care / DHS Operational Realignment

Changes Effective July 1, 2014

Background: • Upon DHS’ request, L.A. Care assumed financial and operational responsibility for

inpatient and emergency services provided to L.A. Care / DHS Medi-Cal members outside of the DHS delivery system.

Line of Business: Medi-Cal only. (No change for PASC-SIEU members.)

New L.A. Care Responsibilities:

• Utilization Management and Claims Processing for: • Non-DHS Hospital Inpatient Admissions • Non-DHS Emergency Room Visits • Emergency Transportation

Estimated Workload Volume:

• Non-DHS Inpatient Services: ~800 admits / month • Out-of-Network Inpatient and ER Claims: ~32,000 additional claims / month

26

L.A. Care Readiness Efforts

Key Accomplishments and Activities:

• Hired and trained additional staff to support L.A. Care UM & claims business units.

• Jointly developed care coordination interfaces and workflows with DHS. • Issued provider communications to impacted hospitals and H.A.S.C. (e.g.

letters, calls, remittance advice). • Re-configured L.A. Care claims information system to support new DOFR

and claims processing rules. • Convened regular project coordination meetings to ensure seamless

transition.

Next Steps:

• Contract amendment signed by 7/11/2014. • Ongoing monitoring to ensure successful implementation. • Evaluation and data analysis of out-of-network activity.

27

June 25, 2014 To: Board of Governors From: Trudi Carter, MD, Chief Medical Officer Subject: CMO Report for July 2014 L.A. Care Covered In May 2014, members from the State Covered California team and L.A. Care participated in an onsite visit to review our programs for L.A. Care Covered members. The meeting focused on quality, member outreach and engagement, and the provider network. The State team shared concerns, opportunities for improvement, and best practices. They commended L.A. Care on several of our practices and seemed pleased with our overall program. Between January and May 2014, we have received 739 adult health risk assessments (HRAs). We have given an incentive to each member who completed their HRA. We want to encourage more members to utilize the member portal and are exploring an increased incentive for online completion of the HRA. Below is a table of HRA return rates.

30 Day Rate

60 day Rate

90 day rate

120 day rate

HRAs Returned

January 2014 (n=3,321) 2.10% 8.60% 11.70% 13.20% 419 February 2014 (n=1,777) 2.60% 7.50% 9.70% 10.80% 189 March 2014 (n=1,339) 3.60% 6.90% 8.10% - 104 April 2014 (n=211) 1.90% 5.20% - - 11 May 2014 (n=393) 0.50% - - - 2

HRAs are risk stratified into high, moderate and low categories. Members with High HRA scores are referred to L.A. Care Case Management for care coordination. Members with moderate and low scores received care coordination by the participating provider group (PPG). The risk stratification levels for the HRAs received between January and May are as follows: These stratification results are consistent with the pattern that was expected for a commercial product without significant historical data. In order to supplement member identification, L.A. Care flags specific responses in the HRA as a trigger for Care Management (CM) or Behavioral Health (BH) review. The Care Management department reviewed 120 HRAs with CM triggers and 33 HRAs with BH triggers.

Risk Level Total High 4 Moderate 80 Low 655

28

July CMO Report June 25, 2014

Quality Improvement (QI) Update We have finalized our quality strategy for fiscal year 2014-2015. The strategy involves a provider and member outreach program that focuses on closing gaps in care and education. The first strategy involves a Plan Partner Collaboration to jointly have goals that make it easy for PPGs to engage with L.A. Care and the Plan Partners. The second strategy involves provider and member outreach programs that focus on closing gaps in care and education at the provider level. This dual strategy allows us to work at the individual provider level more effectively. In June 2014, we restructured the Healthcare Effectiveness Data and Information Set (HEDIS) quality improvement infrastructure by creating a HEDIS oversight team and five workgroups. The HEDIS oversight team provides oversight to all HEDIS activities. The five initiative-specific workgroups focus on designing interventions and implementation. Each workgroup consists of members from various L.A. Care departments. The five workgroups include behavioral health, pharmacy, women and child health, tests and screenings, and diabetes care. We have prioritized the measures based on performance and importance: auto-assignment, Medicare Star, Accreditation and the Department of Health Care Services (DHCS) required measures. With the July 2014 refresh of HEDIS administrative data, we will update our prioritization and identify measures that will require an end of year push starting in August 2014 to improve performance. National Committee for Quality Assurance (NCQA) As you know, NCQA accredited health plans face a rigorous review of more than 60 standards and must report on their performance in more than 40 areas around HEDIS and CAHPS to earn NCQA’s seal of approval. This review occurs every three years. The most recent NCQA onsite visit took place on June 16. Prior to the onsite, L.A. Care had electronically submitted policies and documentation and received 100% on this portion of the review. The onsite process was scheduled for two days but we did so well that it only took one day. We scored 100% on case management, utilization management, credentialing, and grievance and appeals during the visit. While the site outcomes are not final, due to the completeness and accuracies of the files, the reviewers were able to provide leadership with very positive feedback. The final outcomes will be made public approximately 34 calendar days from the completion of the audit. Medicare Star Rating A summary of the 2014-2015 Medicare Star Rating improvement strategy includes:

· Conduct comprehensive inventory of current interventions · Conduct root cause analysis to identify barriers towards achieving goals · Create interventions for each star measure · Implement interventions targeted at each stakeholder group involved in a measure · Prioritize measures at 1 and 2 Stars and measures with a 3-fold weighting · Organize interventions into a short-term (address critical gaps, high priority) and long-term

strategy (system changes)

Based on the analysis, the following areas were prioritized: · Part C: Breast cancer screening , Colorectal cancer screening, Plan All-Cause Readmissions · Part D: Call Center TTY/Foreign Language Line, Medication Adherence

Barrier analysis identified the following challenges for improvement: · Lack of member compliance with screening recommendations · Member fear about screening procedures

29


· Requirement for prior authorization resulting in delays in accessing screenings · Multi-factorial issues related to medication adherence · Lack of detailed data to identify root causes for some measures i.e. member disenrollment,

member satisfaction

The Centers for Medicare and Medicaid Services (CMS) has made changes to the Medicare Star Rating Program. Based on the final CMS call letter, we anticipate a change in the weighting for improvement measures, a new case management measure, and the retirement of the glaucoma screening measure. There are also measures subject to technical specification changes by NCQA or CMS. These changes will be finalized with the release of the 2015 Star technical specifications in the fall. Additionally, effective December 31, 2014, CMS has the authority to terminate plans below a 3-star for Part C or D in each of the 2013, 2014, or 2015 set of ratings. However, we are uncertain how this new termination policy will be implemented. Model of Care Training On June 11, 2014, L.A. Care hosted its 2nd Medicare PPG webinar training for all Medicare contracted PPGs. There were 154 individuals who attended the training session. The training was a part of the CMS Corrective Action Response (CAR) around the Model of Care (MOC) measures/deficiencies. The presentation covered Health Risk Assessments (HRA), Individualized Care Plans (ICP), and Interdisciplinary Care Teams (ICT). It also covered the responsibilities of L.A. Care, PPG staff and the primary care provider. The training reviewed how L.A. Care will monitor PPGs delegation responsibilities, including monitoring and auditing. A pre and post-test was conducted to gauge the effectiveness of the training. A comprehensive PPG toolkit of information related to the presentation was provided and will be posted on L.A. Care’s provider intranet site. Department of Health Services (DHS) Contract Medical Management staff is participating in internal workgroups focused on implementing activities to support the realignment of the DHS provider contract. These activities include developing an infrastructure to support the transition of the management of out-of-network hospitalizations, all transportation services, and coordinating letters of agreements to utilize non-DHS providers in the management of a small sub-set of members with service needs that cannot be met by a DHS provider. Safety Net Initiative and DHS staff is working closing with the team to provide available data to assist in developing staffing ratios and special programs to support this new contract. As this change directly impacts community hospitals, Safety Net Initiative staff has also solicited the support of the Hospital Association of Southern California in communicating the contract changes and educational information on how to work with L.A. Care for these admissions. Health Services staff have developed internal programs to support discharge planning, transition of care and post-discharge follow up to ensure members are re-connected to their medical home and mitigate the risk of re-admission. Managed Long Term Services and Support (MLTSS) L.A. Care’s MLTSS department oversees the delivery of MLTSS benefits to members. Gretchen Brickson became the MLTSS department Senior Director in late April 2014. Key 2014 milestones:

· Standardized the referral and authorization process with long term care facilities; in process of implementing 260 contracts to serve our members

· Established a Memoranda of Understanding (MOU) and conducted provider training for delivery of In-Home Supportive Services (IHSS)

· In process of negotiating contracts with the Multipurpose Senior Services Program (MSSP) in anticipation of transitioning the program to managed care on October 1.

30


Behavioral Health The L.A. Care Behavioral Health (BH) Department, in collaboration with Beacon and the Behavioral Health entities of the other four Cal MediConnect (CMC) plans have launched a series of trainings on CMC and care coordination for the BH provider network in L.A. County. One of the important messages is the requirement of care integration and coordination. The process of linking and transitioning members to different levels of care at the right place and the right time continues to be successful. There continues to be no cases needing dispute resolution between L.A. Care and the County Department of Mental Health and Department of Public Health. In an effort to continue our mission in providing holistic care, the BH department continues to engage and collaborate with community providers. Our monthly stakeholder meetings draw many providers across a wide variety of disciplines and sectors, from primary care settings to behavioral health, housing, social services, and advocates. The meetings provide a forum to foster care integration and the concept of patient-centered care. The last stakeholder meeting that occurred in June focused on housing; fifty individuals attended the meeting. The Corporation of Supportive Housing highlighted a homeless program serving high cost super utilizers. High cost super utilizers are individuals who have multiple ER visits and hospitalization. The presentation was well received and we intend to have a follow-up discussion soon. Substance Abuse Initiative L.A. Care participates in the Association of Community Affiliated Plans (ACAP) Substance Abuse Collaborative on opioid abuse. Given the rise in national opioid abuse and opioid related death, we proposed a Prevention and Early Intervention Initiative focusing on individuals being prescribed opiates as a part of pain management for non-cancer related conditions. Two outpatient clinic sites have been identified to participate in this pilot: Harbor/UCLA and Olive View. These two sites are associated with Family Practice and Internal Medicine Residency training programs. The eventual goal is to spread this program to all of our network providers. The program includes screening members with abuse potential prior to treatment initiation, screening members on long-term treatment to identify individuals misusing opioid, and delivering comprehensive pain management program that has a counseling component. Staffing Dr. Sarita A. Mohanty’s last day at L.A. Care was June 6, 2014. She accepted a position as the Executive Director of Community-Clinical Care Integration, Dual Eligible and Medi-Cal programs for Kaiser Foundation Health Plan, Northern California. Dr. Mohanty was the Senior Medical Management Medical Director and spent 3 years at L.A. Care. She provided leadership around the roll-out of L.A. Care’s new product lines, including Seniors and Persons with Disability, Covered CA, the CHP transition, and the Coordinated Care Initiative/Cal MediConnect. She was also instrumental in implementing many key process improvements and strategic programs within Medical Management. We wish her all the best in her new role. L.A. Care welcomed Dr. Derek Lanier, MD, MPH as the new Utilization Management Medical Director on June 2nd. Prior to joining L.A. Care, Dr. Lanier was the Medical Director at Meridian Health Plan in Chicago, Illinois. Dr. Lanier has extensive experience in the healthcare and some of his past roles include being the Chief Executive Officer at Oakland Primary Health Services, and the Medical Director and Operations Director at Blue Care Network. We are very excited to have him on board.

31


Date: July 10, 2014 Motion No. BOG 100.0714

Committee:

Chairperson: Thomas Horowitz, DO

Issue: Authorize a contract with Craig Stephens/Beecher Carlson Holdings, Inc., for pharmacy consulting services in support of L.A. Care’s transition of Pharmacy Benefit Manager (PBM) vendors.

Background: L.A. Care is requesting approval to execute a contract with Craig Stephens/Beecher Carlson Holdings, Inc., from July 1, 2014 through June 30, 2015, in the amount of $450,000. The vendor will provide L.A. Care with pharmacy management expertise and consulting services in support of L.A. Care’s transition of PBM vendors.

Mr. Stephens will provide services that include creating a PBM transition plan for all L.A. Care lines of business and managing communications with the new PBM. He will lead the development of the L.A. Care transition team and identify functional areas and key deliverables required for implementation. He will also hold business ownership of the contracting terms with the new PBM, and enforce the run out process with the incumbent PBM.

For the past five years as a consultant with EvergreenRx, Mr. Stephens has assisted in identifying and implementing strategies for performance improvements of L.A. Care’s PBM, MedImpact. He provided leadership and expertise during the request for proposals process to select a new PBM vendor for 2015, which included the evaluation of five PBM bidders, including MedImpact.

With his expertise and prior experience with L.A. Care, including his knowledge of our market, Plan Partner relationships and provider group arrangements, Mr. Stephens is uniquely qualified to provide these services to L.A. Care, so we are not conducting a request for proposals for this contract, and we propose that he be classified as a Sole Source Vendor.

Mr. Stephens will bill L.A. Care a fee of $225 per hour, for a total not to exceed $360,000 for 12 months.

Mr. Stephens is located in Minneapolis, Minnesota, and he will be traveling to Los Angeles on a weekly basis, where he will provide 30 hours of consulting services while at L.A. Care’s offices. L.A. Care will be compensating him for all related travel expenses, not to exceed $90,000.

Budget Impact: FY13-14 Budget did not include this contract; however savings within the Pharmacy Department are sufficient to cover this spending. Sufficient funds will be requested for FY14-15.

Motion: To authorize staff to execute a contract with Craig Stephens/Beecher Carlson Holdings, Inc. to provide pharmacy management expertise and consulting services, for a total amount not to exceed $450,000, from July 1, 2014 to June 30, 2015.

32



Committee:


Issue: Formalize L.A. Care Healthy Kids 0-5 contract with First 5 LA through June 30, 2015. Background: On January 12, 2012, the First 5 LA Commission approved a contract to continue the Healthy Kids 0-5 program through June 30, 2015. The Healthy Kids contract was placed on an automatic annual contract renewal at approximately $4 million per year. L.A. Care approved a contract for July 1, 2012 – June 30, 2013. In August 2012, First 5 LA amended the Healthy Kids contract to a multi-year agreement for July 1, 2012 through June 30, 2015. The L.A. Care Board was apprised of the multi-year contract by Howard Kahn at the November 2012 meeting. In December 2012, L.A. Care received an executed contract and the three-year $12.9 million grant. This motion will formalize approval of the multi-year contract. Budget Impact: Motion: To ratify execution of the Healthy Kids 0-5 multi-year contract

amendment effective July 1, 2012 through June 30, 2015.

33



Committee:


Issue: Authorize staff to improve 1,200 square feet of Suite 115 that L.A. Care currently subleases in the Garland building at 1200 W. 7th Street, Los Angeles. Background: On January 23, 2013, the Finance & Budget Committee approved (Motion No. FIN A.0113) for planning and construction improvements for a Member Services reception space on the first floor of the headquarters building at 1055 W. 7th Street, Los Angeles, in an amount not to exceed $275,200. The space was intended for member exchange enrollment, member advocacy and public reception for L.A. Care. Due to inability to negotiate adequate first floor space, a lease was never finalized at 1055 W. 7th St.. With L.A. Care’s recent tremendous growth, in June 2014 the Member Services Department staff was relocated to the third floor of the Garland building. The proposed reception area was included in that lease. From a customer service perspective it makes sense to locate the member reception space in the Garland building. This motion provides for appropriate leasehold improvements to that space. Budget Impact: $275,200 is included in FY13-14 Capital Budget for Leasehold Improvements. Sufficient funds will be requested in FY14-15. Motion: To authorize staff to use the funds approved in Motion FIN A.0133

to construct a member reception space in the Garland building (instead of the HQ building) subject to obtaining adequate building front signage to direct members appropriately, and to extend Sierra Pacific Constructors contract to June 30, 2015, in an amount not to exceed the budgeted $275,200.

34



Committee:

Chairperson: Thomas Horowitz, D.O.

Issue: To efficiently utilize the recently vacated HQ building work space, we will need to construct additional private offices, rebuild workstations, purchase additional furniture and perform needed repairs on floors 4, 5, 7, 8, 9.

Background: On June 6, 2014 the Member Services department relocated to the 3rd floor Garland building. This move has opened up workspace and presented the opportunity to restack the remaining departments in the HQ building. Based on Human Resources approved staffing levels and departmental organization charts a restack plan has been created. To meet the appropriate space needs it will be necessary to reconfigure workstations and to build additional private offices. The plan is to modify approximately (40) 6’ X 8’ workstations, create (20) manager 8’ X 12’workstations, build out 7 private offices and order additional furniture.

Company Purpose Estimate Westfall Commercial Furniture workstation reconfigurations, furniture 150,000 Sierra Pacific Constructors TI construction, repairs 90,000 HOK architectural Architectural plan, city permits, engineering 10,000 C3 Network cabling Network cabling offices and workstations 7,500 Bekins Relocation moving services 15,000

TOTAL 272,500

Budget Impact: $272,500, included in FY13-14 Capital Budget for Leasehold Improvements. Sufficient funds will be requested in FY14-15. Motion: 1) To delegate authority to the CEO to approve vendors for the HQ

building restack project construction, repair work and furniture purchase and reconfiguration; 2) To delegate to the CEO discretionary authority for a cumulative 10% expense contingency calculated on the not-to-exceed total of $272,500.

35



Committee:


Issue: Corporate Authorization Resolution for signing authority with Mutual of Omaha Bank.

Background: The Board previously approved delegated authority to contract with Benaissance to process premium payments for L. A. Care Covered members. Benaissance uses Mutual of Omaha Bank to process payments. The motion below designates signatory authority for the Chief Financial Officer, Senior Director Accounting & Financial Services and Controller for banking services with Mutual of Omaha Bank. Budget Impact: Motion: To designate Tim Reilly, Chief Financial Officer; Patricia Mowlavi,

Senior Director, Accounting & Financial Services; and Irene Chang (Lem), Controller with banking signatory authority applicable to premium processing.

36


Date: July 10, 2014

Motion No. BOG 105.0714

Committee: Chairperson: Thomas Horowitz, DO

Issue: Amend a contract with Cognizant for Trizetto Clinical CareAdvance® implementation project management and provider self-service portal development.

Background: Staff requests approval of a contract amendment of $212,168 with Cognizant for Trizetto Clinical CareAdvance® implementation project management, and Provider Self Service Portal development, through January 31, 2015. The vendor staff has specialized knowledge and experience necessary to complete this work. This motion is presented to the Board of Governors without prior review by the Finance & Budget Committee due to time constraints.

The amendment includes the following scope extensions through January 31, 2015. 1. Extension of the Cognizant project manager for the Trizetto Clinical CareAdvance®

implementation, for the amount of $168,168 (current contract amount of $206,976) 2. Development of a web based provider authorization portal that will enable providers to submit

and view authorization status and details online, for the amount of $44,000 (current contract amount of $129,800).

The total contract amount including the requested amendments is $1,840,090 Budget Impact: The contract amendment amount $212,168 is covered by the Information Technology staffing budget of FY13-14 and FY14-15.

Cognizant Current Approved Contract 1,547,922 FIN 102 (Oracle Testing) 80,000 BOG 105 (Clinical Care Advance) 212,168

Total 1,840,090

Motion: To authorize staff to amend a contract with Cognizant adding

$212,168 (total contract not to exceed $1,840,090) for Clinical Care Advance related implementation, support and development, through January 31, 2015.

37


Date: July 10, 2014 Motion No. EXE 100.0714

Committee: Executive Chairperson: Thomas Horowitz, D.O

Issue: Revisions to Retirement Plan – Implementation of Social Security.

Background: In response to the enactment of the California Public Employees' Pension Reform Act of 2013 ("PEPRA") in 2012, L.A. Care redesigned its retirement program. To comply with PEPRA, L.A. Care maintained the existing defined contribution structure for pre-2013 employees (known as the Legacy DC Plan), established a new PEPRA-compliant defined benefit plan for post-2012 employees (known as the PEPRA 2@62 DB Plan), and maintained the cash balance retirement plan for named executives. In October 2013, SB-13, a technical clean-up to PEPRA, was enacted. Among its provisions, SB-13 makes it possible to unwind the PEPRA 2@62 DB Plan by clarifying that a public agency may offer a defined contribution plan after 2012, even to post-2012 employees.

In light of this development, L.A. Care has explored approaches to best configure its retirement program. Upon review, it has been determined that the PEPRA 2@62 DB Plan does not meet the long-term goals of providing a clear and strong retirement program that balances cost, investment risk, longevity, and flexibility for L.A. Care and its employees.

In response, it is recommended that a hybrid Social Security/modified defined contribution design be developed. This approach will offer future new hires lifetime income replacement under Social Security, plus a defined contribution savings opportunity based on the Legacy DC Plan, modified to take into account employee and employer Social Security payroll taxes (Social Security + Modified DC Plan). Additionally, under this approach, the PEPRA 2@62 DB Plan will be frozen and terminated, and current employees will be able to choose either the Legacy DC Plan, or Social Security + Modified DC Plan.

As part of this redesign, certain leadership employees hired after 2012 will, beginning in 2015, be offered additional contributions to a new qualified defined contribution plan and a new nonqualified defined contribution plan to replace the pre-PEPRA cash balance plan.

Management recommends a two-step process to implement the proposed retirement program redesign. First, L.A. Care will freeze and terminate the PEPRA 2@62 DB Plan effective December 31, 2014, fully vesting the post-2012 employees in their benefits under that plan, and allowing them to receive and roll over distributions to, and become participants in, the Legacy DC Plan beginning in 2015. All new hires after 2014 will participate in the Legacy DC Plan. Second, L.A. Care will join Social Security, effective October 2015. To accomplish this second step, L.A. Care will conduct a "divided-vote" referendum in early 2015, whereby all current employees will be given the choice to participate in Social Security – those who choose Social Security will participate in the Social Security + Modified DC Plan; those who do not will participate in the Legacy DC Plan. All future hires after the referendum will automatically participate in Social Security + Modified DC Plan.

Budget Impact: The actuarial firm of Altman & Cronin has provided an analysis of the cost impact to the Board as follows:

38


Page 2 of 3

As compared to the retirement program that was in place in 2012 (Legacy DC Plan), the proposed program will have no cost impact upon L.A. Care. The two programs that will be offered to current employees (Legacy DC Plan and Social Security + Modified DC Plan) are exactly cost-neutral and equal to the 2012 program as a percent of payroll, and future employees will enter the Social Security + Modified DC Plan.

As compared to the current program cost (Legacy DC Plan and PEPRA 2@62 DB Plan), there will be a cost increase attributable to the current and future PEPRA 2@62 DB Plan employees (all employees hired after January 1, 2013 and through December 31, 2014), since those employees will receive a higher level of benefits under the Legal DC or the Social Security + Modified DC Plans. Compared with current total program costs, the proposed total program cost for L.A. Care will increase by approximately 1.5% of payroll in 2015.

In addition to the above costs, all current and future PEPRA2@62 DB Plan, employees will become immediately vested in the benefits under that plan when it is terminated on December 31, 2014. The estimated cost to L.A. Care to fund the vested amounts is roughly $300,000. There will be a cost to L.A. Care related to terminating the plan, which will involve offering the choice to participants of offering a lump sum rollover versus fulfillment of the original annuity promise which must be transferred to an insurance company at historically low interest rates. It is estimated that the cost of this transfer could be an additional $600,000, based on a reasonable assumptions regarding likely participant choice.

Motion:

To approve the following to implement the retirement program redesign:

1. Freeze and terminate the PEPRA 2@62 Defined Benefit Plan effective December 31, 2014, fully vesting all participants in their benefits under that plan.

2. Amend the existing qualified defined contribution "401(a)" Basic Plan to: a. Permit employees hired after 2012 to participate in that plan effective

January 1, 2015; b. Eliminate the election for employees hired before 2013 to participate in

the PEPRA 2@62 Defined Benefit Plan effective as of the amendment date; and

c. Effective October 1, 2015, provide for a new modified defined contribution benefit coordinated with Social Security for those current employees who elect to participate in that system and all new employees hired after the Social Security referendum.

3. Adopt the attached resolution (PERS-SOC-40D) to: a. Request authorization from CalPERS, the State's Social Security

administrator, to conduct a divided-vote referendum (Division) under section 218(d)(6) of the Social Security Act for the defined contribution retirement system;

b. Establish October 1, 2015 as the effective date of Social Security coverage;

c. State that no optional exclusions from Social Security are to be requested;

39


Page 3 of 3

d. Name Robert Turner, the Chief of Human Resources, as the Local Division Officer (representative designated by L.A. Care to conduct the referendum); and

e. Specify that the defined contribution retirement system will be modified to coordinate contributions under that retirement system with Social Security.

4. Establish a new qualified supplemental defined contribution plan, effective January 1, 2015, to provide additional contributions to certain leadership employees hired after 2012. The amount of L.A. Care contributions (if any) shall be determined by the Executive Committee on advice of the Chief Executive Officer and the presentation of cost and budget impacts on L.A. Care as appropriate.

5. Establish a new nonqualified supplemental defined contribution plan, effective January 1, 2015, to provide additional contributions to certain leadership employees hired after 2012. The amount of L.A. Care contributions (if any) shall be determined by the Executive Committee on advice of the Chief Executive Officer and the presentation of cost and budget impacts on L.A. Care as appropriate.

6. Delegate and instruct the Chief Executive Officer to take all necessary or appropriate actions to implement the above resolutions, including but not limited to filing of such forms with the Internal Revenue Service related to the above-mentioned actions as may be necessary or appropriate, and taking any and all actions necessary or appropriate to conduct the divided-vote Social Security referendum and implement Social Security coverage for affected employees.

40

PERS-SOC-40D (Rev. 10/94) DIVISION AUTHORIZATION RESOLUTION

6351425.3

Return to: California Public Employees’ Retirement System Affiliate Programs Services Division State Social Security Administrator Program P.O. Box 720720 Sacramento, CA 94229-0720

RESOLUTION

WHEREAS, Local Initiative Health Authority for Los Angeles County , (Official Name of Public Agency)

hereinafter designated as “Public Agency”, desires to establish a “deemed” retirement

system pursuant to Section 218(d)(6) of the Federal Social Security Act composed of

positions of members of the L.A. Care Health Plan Retirement Benefit Plan , (Retirement System)

hereinafter designated as “Present Retirement System”, desiring coverage, and to

include services performed by individuals employed by the Public Agency in positions

covered by said “deemed” retirement system, as members of a coverage group

established by Section 218(d)(4) of said Act, in the California State Social Security

Agreement of March 9, 1951, providing for the coverage of public employees under the

insurance system established by said Act as amended; and

WHEREAS, State and Federal law and regulations require, as a condition of

such coverage, that a division be authorized by the Board of Administration, Public

Employees’ Retirement System; and

WHEREAS, it is necessary that the “Public Agency” now designate any services

which it desires to exclude from coverage with respect to such coverage group under

said insurance system; and

WHEREAS, it is necessary for the Public Agency to set forth the modification, if

any, of the benefits and contributions under the Present Retirement System that may

result from coverage under the said insurance system with respect to such coverage

group;

41

PERS-SOC-40D (Rev. 10/94) 2 DIVISION AUTHORIZATION RESOLUTION

6351425.3

NOW, THEREFORE, BE IT RESOLVED, that the Board of Administration, Public

Employees’ Retirement System, be and hereby is requested to authorize the foregoing

division; and

BE IT FURTHER RESOLVED, that upon receipt of authorization from the Board of

Administration a division shall be conducted in accordance with the requirements of

Section 218(d) of the Social Security Act, and applicable State and Federal laws and

regulations; that each eligible member of the Present Retirement System at the time of

the division shall be furnished a form to permit the member to elect whether or not his

services should be excluded from or included under the said California State Social

Security Agreement as hereinbefore provided; with such coverage effective as to

services performed on and after October 1, 2015 ; and (Date)

BE IT FURTHER RESOLVED, that the following services with respect to said

coverage group of the Public Agency shall be excluded from coverage under said

agreement:

1. All services excluded from coverage under the agreement by Section 218

of the Social Security Act; and

2. Services excluded by option of the Public Agency (Check only one; fill in

part b. if checked):

X a. No optional exclusions desired.

b. Service performed:

42

PERS-SOC-40D (Rev. 10/94) 3 DIVISION AUTHORIZATION RESOLUTION

6351425.3

BE IT FURTHER RESOLVED, that with respect to the said coverage group the

benefits and contributions of the Present Retirement System shall be modified to be

coordinated with Social Security; and

BE IT FURTHER RESOLVED, that notice of the division shall be given to

members of the Present System not less than ninety days prior to the date of the

division; provided, however, that notice shall be given to employees becoming members

of the Present Retirement System after the date of such notice up to and including the

date of the division on the date on which they attain membership in the system; and that

Robert Turner, Chief of Human Resources (Name and Title of Local Official)

is hereby designated and appointed to conduct such division on behalf of the Public

Agency in accordance with law, regulations, and this resolution, including the fixing of

the date and the giving of proper notice thereof to members of the Present Retirement

System and to all such eligible employees; and

BE IT FURTHER RESOLVED, that the Public Agency will pay and reimburse the

State at such time and in such amounts as may be determined by the State the

approximate cost of any and all work and services relating to such division.

Presiding Officer

Local Initiative Health Authority for Los Angeles County Official Name of Public Agency

43


Date: July 10, 2014 Motion No. EXE 101.0714

Committee: Executive


Issue: To fund seven Robert E. Tranquada, M.D. Safety Net Infrastructure V – HEDIS Initiative Awards for $1,350,000.

Background: Staff recommends the approval of $1,350,000 for seven Robert E. Tranquada, M.D. Safety Net Infrastructure V (Tranquada V) awards and for technical assistance support. In March 2014, the Board of Governors approved $2 million for the implementation of the Tranquada V initiative to provide population health outcomes support to community-based and private providers in L.A. Care’s network.

Community Benefits staff released a request for proposal and invited over 50 L.A. Care network non-profit and private providers. Applicants submitted proposals to increase their performance on four targeted Healthcare Effectiveness Data and Information Set (HEDIS) measures. A Review Committee, composed of staff and community experts, convened in mid-April to assess the submitted proposals and to provide input and recommendations. All the recommended applicants are expected to improve their HEDIS scores by at least 4% over the 2013 baseline and directly impact over 10,500 members.

The requested funds will support project-related staff, registries software, and interfaces to help identify, collect, organize and report health data. Funds will also support interventions such as outreach campaigns, extending clinical hours to improve access, enhanced care coordination and case management. Approximately $300,000 will be used to provide initiative-wide support and hire either in-house or external experts to provide technical assistance and support in clinical quality improvement, information technology, data coding, and data flow tracking. Additionally, these funds will be used to hire an independent initiative evaluator.

Alignment with L.A. Care Goals: Tranquada V is consistent with L.A. Care’s organizational goals of strengthening the safety net, expanding access and improving the quality of health care services for Los Angeles County’s vulnerable and low-income communities. The initiative aligns with L.A. Care’s overall organizational goal of improving HEDIS performance scores and is consistent with the Triple Aim goals of improving patient experience of care, improving health outcomes and reducing the cost of healthcare delivery.

Budget Impact: The $5 million Community Health Investment Fund (CHIF) budget for fiscal year 2013-2014 includes a $2,000,000 allocation for the Tranquada V Initiative which covers this request. Motion: To approve seven Robert E. Tranquada, M.D. Safety Net

Infrastructure V – HEDIS Initiative Awards and consultant support not to exceed $1,350,000 as outlined in the enclosed memo and Attachment A.

44

Date: June 16, 2014 TO: Executive Committee FROM: Jonathan Freedman, Chief of Strategy, Regulatory and External Affairs Roland Palencia, Director, Community Benefit Program SUBJECT: Approval to fund seven Robert E. Tranquada, M.D. Safety Net Infrastructure V –

HEDIS Initiative Awards for $1,350,000. Introduction Staff is recommending approval to fund seven Robert E. Tranquada, M.D. Safety Net Infrastructure Initiative V (Tranquada V) awards totaling $1,350,000. The requested award also includes an allocation amount for expert in-house or outside consultants to provide quality improvement, health information, data management support and for a program evaluator. Please see “Attachment A” for more details on the specific applicant recommendations. In March 2014, the Board of Governors approved $2 million for the implementation of the Tranquada V initiative to support providers in L.A. Care Health Plan’s network to increase population health outcomes by demonstrating improvements in targeted Healthcare Effectiveness Data and Information Set (HEDIS) measures. Over 50 non-profit and for-profit private providers that met the minimum initiative criteria were invited to submit an application. Background In 2005, L.A. Care’s Board established the initiative to honor Dr. Robert E. Tranquada, a founding Board member and past Chairman. The Tranquada initiatives have totaled $7.7 million, encompassing 40 projects designed to deliver systemic changes. Tranquada V Initiative Priorities The objective of the Tranquada V Initiative is to help community-based safety net clinics and private providers to improve quality of care and population health outcomes by improving their performance on four selected HEDIS measures. Grantees will implement population disease management strategies to improve care among children, women and adult patients for the following HEDIS measures: · Child health: Well child visits and immunizations for children · Maternal health: Prenatal and post-partum visits · Women’s health: Breast and cervical cancer screening

45

June 16, 2014 Tranquada V Initiative Page 2 of 3

· Adults with chronic disease: Hemoglobin A1 C testing and low-density lipoprotein (LDL)

cholesterol control Although staff invited 25 private practice providers to apply, we only received one proposal from a private provider, which was not recommended for funding. Given this, staff is exploring the possibility of designing a similar population health outcomes initiative to address the specific HEDIS and population health management needs of private providers. All the proposed grantees meet the following initiative criteria: · Have a minimum of 4,000 L.A. Care members, · Achieve Meaningful Use Stage 1 for 90% of providers, · Have a 501(c)(3) non-profit status, and · Be a stand-alone clinic, and either a licensed free clinic, Federally Qualified Health Center or

FQHC Look-Alike that provides comprehensive primary care services. L.A. Care will allocate $1,050,000 to support seven grantees at a maximum of $150,000 each. These funds will pay for project-related staff, registries and configurations software, upgrades or interfaces to help identify, collect, organize and report health data. Other expenses to be covered include program interventions such as outreach campaigns to bring in patients in need of services, extending clinical hours to improve access, enhanced care coordination and case management. An additional allocation of $300,000 will be used to provide initiative-wide technical assistance support and hire consultants or in-house staff with expertise that includes clinical quality improvement, information technology, data coding, and data flow tracking to improve data accuracy and reporting among the clinic participants and L.A. Care. These funds will also be used to hire an independent initiative evaluator. Staff will first identify internal expertise and secondarily solicit external consultants if no in-house experts are available. L.A. Care’s Quality Improvement department will partner with Community Benefits in the hiring, coordinating and monitoring of these consultants or in-house expertise. To select outside consultants, staff will release a request for proposal, assemble a review committee composed of L.A. Care staff and community experts and perform all the necessary due diligence. Out of the $300,000 allocation, approximately $150,000 will be used for information technology and data management support; $100,000 for quality improvement and $50,000 for an independent evaluator. Application Process and Recommendations Safety net clinics and private providers that met the minimum initiative requirements received a request for proposal (RFP) application in March, 2014, and staff held informational calls a few days later to address applicant questions. We received nine applications that were evaluated by a Review Committee composed of community experts in the areas of population health management, information technology, and quality improvement in addition to selected L.A. Care staff. Please see “Attachment B” for the Review Committee Roster.

46

June 16, 2014 Tranquada V Initiative Page 3 of 3

The Review Committee convened in mid-April to assess the proposals and provide input and their recommendations. Criteria considered by the reviewers included past and current organizational and information technology capacity including software to identify and manage health populations. The Committee assessed the cost effectiveness of the request versus the number of L.A. Care members being impacted. Two of the nine proposals received were not recommended for funding due to poorly developed program narratives and work plans, lack of a solid intervention that could lead to increased HEDIS scores and insufficient organizational infrastructure to support the proposed project. All the recommended applicants received a site visit or had extensive due diligence phone calls. Initiative Evaluation The initiative will be evaluated by an independent evaluator based on outcomes that can be measured through changes in HEDIS scores, including strategies and interventions that led to desired outcomes as well as lessons learned. L.A. Care’s departments of Quality Improvement, Health Outcomes and Analysis and Health Information Technology will partner with Community Benefits to coordinate and implement this initiative as well as evaluate its progress and impact. By the end of the contract, all grantees are expected to improve their HEDIS scores by at least 4% over the 2013 baseline. Recognition L.A. Care will receive acknowledgement and recognition including, but are not limited to, joint press releases, L.A. Care logo on program related literature, website acknowledgment, organizational annual reports, events, and strategically located plaques in funded equipment. Timeline If the attached recommendations are approved at the July Board of Governors meeting, grant agreements will start no later than September 2014 for grant periods of up to 24 months. Consultants are expected to be hired within four months after the initiative starts.

47

Attachment ARobert E. Tranquada Safety Net V Recommendations - FY 2013-2014

June 16, 2014Name of

Organization HEDIS Target Populations

Program and Services to be Provided Recommended Amount

L.A. Care Health Plan

Network

Previous L.A. Care Awards

Regional Community

Advisory Committee

(RCAC)

1

Arroyo Vista Family Health Center

Child health and Adults with Chronic disease

To improve health outcomes by providing case management, health education and care coordination. Funds will be used to hire two RN case managers, and one non- RN case manager.

150,000$ Y 553,461$ 10 Los Angeles, Highland Park

2

Eisner Pediatric & Family Health

Center

Child health and Maternal health

To optimize health outcomes by enhancing communication with patients and improve access to care. Funds will be used for staff training, licenses, computers, mobile technology software and supplies.

150,000$ Y 629,800$

4 Downtown L.A./ Hollywood/ Wilshire/Central/Glendale

3

JWCH Institute, Inc.

Women's health care and Adults with Chronic Disease

To improve preventive care outcomes through enhanced utilization of health information technology, patient education and care coordination processes. Funds will be used to hire an IT/EHR specialist and LVN/compliance auditor.

150,000$ Y 837,476$ 10 Los Angeles, Highland Park

4

Northeast Valley Health Corporation

Child health and Women's health

To improve health outcome measures through implementation of interfaces between registries, development of a Automated Assigned Patient Outreach System to follow-up of IPA patient, and increased outreach through reminder letters, IVR calls and phone calls. Funds will be used to hire health education specialist and consultants for coding and IPA tracking, supplies, interfaces and registry licenses.

150,000$ Y 2,129,291$

2San Fernando Valley/Santa Clarita/West Valley

5

St. John's Well Child and Family Center


To build and implement a population health management program at its four largest sites to improve identification and scheduling of HEDIS impacted populations. Funds will be used for interface software system, licenses, mapping and services of information technology administrator.

150,000$ Y 852,250$ 6 South Los Angeles

6

Valley Community Clinic


To improve outcome measures through enhanced care coordination, added outreach to current patient populations, expanded hours, and up-to-date technology. Funds will be used for hiring care coordinator, auto calling system, licenses, maintenance fees and mailings.

150,000$ Y 911,080$

2San Fernando Valley/Santa Clarita/West Valley

148

Attachment ARobert E. Tranquada Safety Net V Recommendations - FY 2013-2014

June 16, 2014Name of

Organization HEDIS Target Populations

Program and Services to be Provided Recommended Amount

L.A. Care Health Plan

Network

Previous L.A. Care Awards

Regional Community

Advisory Committee

(RCAC)

7

Venice Family Clinic

Women's health care and Adults with Chronic Disease

To build a population health management system that will enable identification and scheduling of appointments for targeted populations to achieve better health outcomes. Funds will be used for hiring clinic coordinator project lead and purchase of population health management software system.

150,000$ Y 1,006,084$ 5 Venice, Culver City, Santa Monica

Total Recommended 1,050,000$ 6,919,443$

249

Name Organization Title

1 Jennifer Sayles, MDOlive View -UCLA Medical Center- Medical Administration Assistant Chief Medical Officer

2 Martha Tasinga, MD Inland Empire Health Plan Senior Medical Director

3 Bridget Cole Community Partners Senior Program Director

4 Keith A. Emmons, MD PacifiCare Health Systems, Inc.Marketing Medical Director-Southern California

5 Heather Readhead, MD, MPH

Division of Chronic Disease Los Angeles County Department of Public Health Chief, Clinical Preventive Services

7 Jonathan Freedman L.A. Care Health PlanChief of Strategy, Regulatory & External Affairs

8 Sarita Mohanty, MD L.A. Care Health PlanSenior Medical Director, Medical Management

9 Mary Franz L.A. Care Health PlanInformation Technology/HITEC-LA Executive Director

10 Wendy Schiffer L.A. Care Health Plan Strategic Planning Director

11 Ellen Turner L.A. Care Health Plan Provider Enhancement Project Manager

12 Roland Palencia L.A. Care Health Plan Director, Community Benefits

13 Nico Potterat L.A. Care Health Plan Incentives Manager

14 Rosa Castillo L.A. Care Health Plan Program Specialist, Community Benefits

Attachment B

Review Meeting on April 16, 2014

Robert E. Tranquada, M.D. Safety Net Award V - Review Committee Roster

Outside Expert Panelists

L.A. C

are Staff

50

Board of Governors

UMOTION SUMMARY UDateU: July 10, 2014 UMotion NoU. FIN 103.0714

UCommitteeU: Finance and Budget UChairpersonU: Michael Rembis

UIssueU: Amend a contract with Cornerstone Data Strategies, Inc., (Cornerstone) for the continued provision of core system consulting and staffing through January 31, 2015.

UBackgroundU: L.A. Care staff requests approval of a contract amendment with Cornerstone, for core system consulting and staffing past the current contract end date of September 30, 2014. Staff requests that the current contract be extended to January 31, 2015 for an additional amount of $2,800,000, for a total contract amount not to exceed $9,329,795 (includes the prior total requested of $6,529,795). The additional funds and the time extension are being requested due to the implementation of QNXT to additional lines of business that did not exist when the original core system transition began. Additionally, the implementation of L.A. Care Covered also resulted in the need for increased resources.

In April 2012, the Board approved a contract for $1,585,000 with Cornerstone, for core system consulting including TriZetto contract negotiations and supplemental technical program and project management. In December 2012, the Board approved an amendment for core system consulting, project management, and interim staffing services through September 30, 2013, at an additional cost up to $1,625,000.

In February 2013, Chief Information Officer responsibilities were added to the contract scope of work, and Tom Schwaninger, then the managing partner of Cornerstone, assumed that role and relinquished all responsibilities that could lead to any conflict of interest. Since then, to protect the integrity of the Cornerstone contract, the Chief Operating Officer oversees the Cornerstone contract and approves all expenditures and amendments to the scope of work.

In July 2013, the Board approved an amendment for core system consulting and interim staffing services through September 30, 2014 for an additional $3,269,795, increasing the total contract amount to $6,529,795.

Staff requests an extension of the Cornerstone contract from September 30, 2014 to January 31, 2015, for an additional $2,800,000 for a total contract amount not to exceed $9,329,795, for consulting and staffing services for the core system implementation. The request of additional funds and time extension are a result of work that still needs to be completed on the core system migration to TriZetto QNXT and Clinical Care Advance (CCA). The added funding will pay for the development of the remaining additional lines of business that did not exist when the original core system transition began and the addition of CCA to the scope of the project. Specifically, Cornerstone will be asked to complete the following:

· Support and analyze the system configuration execution of the interface testing for Cal-MediConnect (CMC), and Dual Eligible Special Needs Plan (D-SNP) lines of business;

· Develop and improve contingency plans for D-SNP system, as it requires further assessments due 64

to undefined changes by the State; · Track, report and analyze the claims forwarding interfaces to satisfy L.A. Care’s requirements; · Monitor and examine enrollment and billing processes of L.A. Care Covered on QNXT; · Manage the implementation of the Health Benefit Exchange (HBEX) · Integrate testing support for L.A. Care surround systems; · Administer system architecture and requirements for appropriate configuration; · Implement system data conversion, integration testing, user acceptance testing and training and; · Manage end-state and transitional issues as needed

Cornerstone has provided critical support to the core system project that has enabled internal staff to be fully dedicated to ongoing health plan operations and expansion. The amendment will support the critical and time sensitive multi-phased core system project, its continued enhancement and reporting analysis; and ensure that all system deliverables are satisfactorily completed and meet L.A. Care’s requirements. BBBudget Impact: There are sufficient funds in the Information Technology department budget through the end of FY2013-14 and funds will be allocated in the proposed budget for FY2014-15. UMotionU: To authorize staff to amend a contract with Cornerstone Data

Strategies, Inc., for an additional amount of $2,800,000 (total contract amount not to exceed $9,329,795) for consulting and staffing services through January 31, 2015.

65

APPROVED

BOARD OF GOVERNORS Finance & Budget Committee Meeting Minutes May 28, 2014 Conference Room 1019, 1055 W. 7th Street, Los Angeles, CA 90017

Members Management/Staff Guest/Public Michael Rembis, Chairperson Howard A. Kahn, Chief Executive Officer Alan Bloom, Care1st Jann Hamilton Lee Gertrude S. Carter, MD, Chief Medical Officer Laurie Garcia, Anthem Blue Cross Thomas Horowitz, DO Jonathan Freedman, Chief of Strategy, Regulatory & External Affairs Lemmon McMillan, MD, Hawthorne Clinic Ozzie Lopez* Augustavia Haydel, General Counsel Avanti Wadu, iHealth, Inc. Louise McCarthy, Secretary** Tim Reilly, Chief Financial Officer Tom Schwaninger, Chief Information Officer *Absent ** Via Teleconference John Wallace, Chief Operating Officer

AGENDA

ITEM/PRESENTER


ACTION TAKEN CALL TO ORDER

Michael Rembis

Michael Rembis, Chairperson, called the meeting to order at 1:05 p.m.

Chairperson Rembis announced that members of the public may address the Committee on each matter listed on the agenda before or during the Committee’s consideration of the item, or on any other topic at the Public Comment section.

APPROVE MEETING AGENDA

Michael Rembis

The Agenda for today’s meeting was approved as presented.

Approved unanimously by roll call. 4 AYES (Hamilton Lee, Horowitz, McCarthy, and Rembis)


APPROVE MEETING MINUTES

The minutes from April 23, 2014 were approved as presented. Approved unanimously by roll call. 4 AYES.

ADJOURN TO CLOSED SESSION

Augustavia J. Haydel, Esq., General Counsel, announced that the Committee will discuss the following items in closed session. There was no public comment, and the meeting adjourned to closed session at 1:07 p.m.

A. CONTRACT RATES Pursuant to Welfare and Institutions Code Sect. 14087.38 (m)

74

Finance and Budget Committee May 28, 2014

APPROVED



ACTION TAKEN · Plan Partner Medi-Cal Rates · Provider Rates · DHCS Medi-Cal Rates

B. REPORT INVOLVING TRADE SECRETS Pursuant to Welfare & Institutions Code 14087.38 (n) Including discussion concerning New Product Lines Estimated date of disclosure May 2016


Michael Rembis

The meeting reconvened in open session at 1:55 p.m. No reportable actions were taken during the closed session.

CHAIRPERSON’S REPORT

At the request of Chairperson Rembis, Member Hamilton Lee reported that the Audit Committee authorized staff to execute a contract with Deloitte & Touche for an independent audit of L.A. Care for Fiscal Years 2013-14 and 2014-15. Staff will conduct a vendor selection process for subsequent audits.

CHIEF EXECUTIVE OFFICER REPORT

Howard A. Kahn, Chief Executive Officer, reported:

Coordinated Care Initiative (CCI)/ Cal MediConnect (CMC) · Seventeen members voluntarily enrolled in L.A. Care’s CMC program as of May 1,

2014, and L.A. Care expects approximately 186 members to enroll for June 1, 2014. · L.A. Care is preparing a crosswalk enrollment of dual eligible members currently

enrolled in Medi-Cal on July 1, 2014. L.A. Care continues working with the California Department of Health Care Services (DHCS) to identify the members for this transition.

· DHCS mistakenly included share of cost (SOC) members in the May electronic eligibility file. DHCS staff acknowledged the error and is disenrolling members. John Wallace, Chief Operating Officer, noted that only members currently residing in nursing homes or participating in the Multipurpose Senior Service Program (MSSP), Long Term Care Services (LTCS), and In-Home Supportive Services (IHSS) will

75


APPROVED



ACTION TAKEN join a managed care Medi-Cal plan.

Covered California Site Visit · On May 14, 2014, Jeff Rideout, MD, Senior Medical Advisor, and several clinical,

quality, and network staff from Covered California participated in a site visit at L.A. Care.

· L.A. Care presented an overview of the L.A. Care Covered product, including the Quality Improvement program and provider network.

· More than 38,000 members are enrolled in L.A. Care Covered.

Mr. Kahn informed the Committee that a news article was released today regarding other major organizations in the health care exchange.

June Finance & Budget and Executive Meetings Mr. Kahn informed the Committee that he will not be attending the June Finance & Budget and Executive Committee meetings.

Recycling Computers to Community Based Organizations (CBOs) Tom Schwaninger, Chief Information Officer, reported: · L.A. Care staff researched a prior Committee request to donate old desktops and

laptops to non-profit organizations. · L.A. Care can wipe out all of the data from the machine’s hard drive, following legal

requirements and specifications from the Department of Defense, to ensure that all patient health information is protected; and reload the operating system to make the machine usable.

· L.A. Care will keep the monitors to be reused by L.A. Care staff. · The Committee previously suggested donating equipment to L.A. Shares, a non-

profit program that accepts tax-deductible donations of reusable goods and materials from the local business community and redistributes the items free of charge to non-profit organizations and schools throughout Los Angeles. Mr. Schwaninger asked Committee members to provide other recommendations for recipient organizations.

76


APPROVED



ACTION TAKEN · The equipment will be available by the end of June.

APPROVE COMMITTEE CONSENT AGENDA

Chairperson Rembis presented a Consent Agenda for Committee review and consideration:

1. Integrated Systems/Presidio Contract Motion FIN 100 To approve an amendment to an existing contract with Integrated Systems Inc. in the amount of $1,070,475.80, (total contract amount not to exceed $2,519,812.80) for telecommunications equipment additions and upgrades through December 31, 2014, and to authorize the purchase of Presidio’s Inc. call recording solution for an amount not to exceed $720,036.50.

2. Infosys Contract Amendment Motion FIN 101 To authorize staff to amend a contract with Infosys adding $1,037,870 (total contract not to exceed $ $5,000,000) for core system consulting through September 2014.

3. Equis Staffing Contract Amendment Motion FIN 102 To authorize staff to add $477,680 (total amount not exceed $879,390) to Equis Staffing Sevices for temporary employee assistance in L.A. Care’s Information Technology and the Project Management Office through December 31, 2014.

4. HealthAll Consulting LLC Contract Amendment Motion FIN-A To amend a contract with HealthAll Consulting, LLC in the amount of $85,000 (total amount not to exceed $491,990) through September 30, 2014 for assistance on the TriZetto Clinical Care Advance (CCA) system.

5. McKesson Health Solutions LLC Contract Extension Motion FIN 103

Motions FIN 100, 101, 102, 103, 104, -A and -B were approved unanimously by roll call. 4 AYES

77


APPROVED



ACTION TAKEN To extend nurse advice line (NAL) services with McKesson Health Solutions LLC from July 1, 2014 to June 30, 2015, for an amount not to exceed $730,307 to allow time for completion of the request for proposal process.

6. Joseph Wanski, M.D, Contract Renewal Motion FIN 104 To renew the consulting agreement with Joseph Wanski, M.D, from August 1, 2014 through July 31, 2015, for a total amount not to exceed $242,500.

7. 3Key Consulting, Inc. Contract Amendment Motion FIN-B To approve a contract amendment with 3Key Consulting for $246,000 with a total amended contract amount not to exceed $400,000 for additional temporary project management resources through June 30, 2015.

COMMITTEE ISSUES

APPROVE FINANCIAL STATEMENTS

Tim Reilly, Chief Financial Officer, reviewed highlights of the financial report for the period ended April 30, 2014: · Total enrollment for April is 1,407,511 members. · Fiscal year-to-date performance resulted in a surplus of $37.2 million or 1.8% on

revenue of $2.1 billion, and is favorable to plan. April results are a surplus of $23 million and include rate adjustments retroactive to October 2013.

· Administrative expense savings have added to the favorable variance to plan. · The new Medi-Cal Expansion enrollment appears to be a financially positive

population, though it is still a very new program. · Plan Partner fiscal year-to-date performance is a surplus of $ 44.3 million. · L.A. Care’s direct Medi-Cal line of business (MCLA) fiscal year-to-date

performance is a surplus of $419,000. · L.A. Care Covered fiscal year-to-date performance is a deficit of $2.4 million,

mainly driven by ramp-up administrative costs related to implementation of the program.

78


APPROVED



ACTION TAKEN · Medicare, PASC-SEIU and Healthy Kids product line performance resulted

respectively in a minor deficit, surplus and break even. · The total fund equity is $213 million. Reserves have recently increased; increased

revenue is necessary to maintain them. Chairperson Rembis and Member Hamilton Lee suggested developing goals for long term financial sustainability and projections on the timeframe required to achieve them. Mr. Reilly will follow up on these suggestions at a future meeting.

Motion FIN 105 To accept the Financial Report for the seven months ended April 30, 2014, as submitted.

Approved unanimously by roll call. 4 AYES.

INFORMATION TECHNOLOGY MOTIONS

Mr. Schwaninger presented the following motions for Committee’s consideration:

A motion to authorize staff to amend the existing contract for ICD-10 test environment setup and remediation services with HCL America, Inc. (HCL) and Infosys Public Services (Infosys). Staff may need to request additional funds in the future.

Motion FIN 106 To amend a contract with HCL America, Inc. for the amount of $1,171,894 (total contract not to exceed $2,292,698) for ICD-10 remediation services through October 31, 2015, and amend a contract with Infosys Public Services for an amount of $382,564 (total contract not to exceed $5,382,517) for ICD-10 test environment setup and support services through the end of January 2015.

A motion requesting delegated authority to contract with one of three potential vendors for the development of the participating physician group (PPG) authorization processing application. A new clinical system that will have the capability to handle all types of electronic transactions.

Motion FIN 107 To authorize the Chief Executive Officer to sign a contract with a vendor that has not yet been selected in an amount not to exceed $300,000 through December 31, 2014, for the development of the participating physicians’ group

Motions FIN 106, 107 and 108 were approved unanimously by roll call. 4 AYES

By consensus, the Committee recommended these motions be included in the Consent Agenda for the June 5, 2014 Board meeting.

79


APPROVED



ACTION TAKEN authorization processing application.

A request for a Medicare appeals and Grievances system and additional business analysis and reporting mechanisms to achieve a comprehensive foundational system for more integrated work across departments.

Motion FIN 108 To authorize staff to amend a contract with Edmund Jung & Associates to provide software and consulting services for $800,000 (total contract amount not to exceed $1,395,000) through June 1, 2015 and to authorize $300,000 for an undetermined qualified vendor through June 1, 2015 for appeals and grievances assistance.

PREQUALIFIED VENDORS

Jonathan Freedman, Chief of Strategy, Regulatory and External Affairs, reminded Committee members that in September 2013, the Board approved seven prequalified staffing and consulting vendors for services through fiscal year 2013-14 in the amount of $500,000 each. Approval included quarterly reports to this Committee on projects and spending per vendor, as well as updates on vendors that reach or exceed 50% of the total approved contract. L.A. Care recently conducted a request for Statement of Qualifications to add vendors to the prequalified vendor list, and five firms responded to the solicitation. L.A. Care recommends that two firms be added to the list of previously approved prequalified vendors. Mr. Freedman noted that the Committee is not approving contracts or scope of work, but rather for the vendors to be added to the roster with a prorated amount for this fiscal year.

Motion FIN 109 To approve the addition of two vendors to the prequalified vendor staffing and contracting list and new contract funding for these vendors through FY 2013-14 not to exceed the amount indicated per vendor: 3Key Consulting $200,000 Milliman $200,000

Motion FIN 109 was approved unanimously by roll call. 4 AYES By consensus, the Committee recommended this motion be included in the Consent Agenda for the June 5, 2014 Board meeting.

FIRSTSOURCE CONTRACT

John Wallace, Chief Operating Officer, presented the following motions for the consideration of the Committee:

80


APPROVED



ACTION TAKEN AMENDMENT FOR MEDI-CAL CLAIMS PROCESSING

To approve a contract amendment with the current claims outsourcing vendor. Firstsource is an “on shore” vendor currently processing between 25,000 and 30,000 Medi-Cal claims. Staff requests additional funds due to the increased membership and monthly volume of claims outsources for processing and adjudication. The requested funds are fully budgeted this fiscal year and will be budgeted in fiscal year 2014-15.

Motion FIN 110 To approve a contract amendment with Firstsource for an amount not to exceed $1,717,610 (total contract amount not to exceed $ 3,107,710) for Medi-Cal claims processing services through March 2015.

Motions FIN 110 and 111 were approved unanimously by roll call. 4 AYES By consensus, the Committee recommended these motions be included in the Consent Agenda for the June 5, 2014 Board meeting.

FIRSTSOURCE CONTRACT AMENDMENT FOR MEDICARE CLAIMS PROCESSING

To approve a contingency motion to include Medicare claims for processing and adjudication in QNXT in the event that L.A. Care needs to outsource Medicare claims.

Motion FIN 111 To approve a contract amendment to Firstsource for an amount not to exceed $264,575 (total contract amount not to exceed $3,372,285) for Medicare claims processing services through March 2015.

ADJOURNMENT The meeting adjourned at 2:25 p.m.

APPROVED BY: Respectfully submitted by: Hilda Stuart, Committee Liaison, Board Services __________________________________________ Linda Merkens, Manager, Board Services Michael Rembis, Chair Date Signed _____________________________________

81

Board of Governors Executive Community Advisory Committee Meeting Minutes – April 9, 2014 L.A. Care Health Plan, 1055 West 7th Street, Los Angeles, CA 90017

ECAC Members RCAC Members/Public L.A. Care Board of Governors/Staff Maria Adela Guadarrama, RCAC 1 Chair, Carlos Aguirre, RCAC 2 Chair Roberto Santos, RCAC 3 Vice Chair Hercilia Salvatierra, RCAC 4 Chair María Guadalupe Méndez, RCAC 5 Chair Mary Romero, RCAC 6 Chair Dalia Cadena, RCAC 7 Chair Ana Romo, RCAC 8 Chair Cristina Deh- Lee, RCAC 9 Chair Aida Aguilar, RCAC 10 Chair , ECAC Chair Elda Sevilla, RCAC 11 Chair Silvia Poz, At Large Member, ECAC Vice Chair Demetria Saffore, At Large Member * Excused Absent ** Absent *** Via teleconference

Maricruz Álvarez, RCAC 2 Lidia Parra, RCAC 3 María Casarrubias, RCAC 4 Alicia Henríquez, RCAC 5 Celia M. Hernández, RCAC 6 María Toscano, RCAC 7 Olga Puentes, RCAC 8 Arun Tes Yang, RCAC 9 Blanca Villagrán, RCAC 10 María Ángel Refugio, RCAC 11 Marika Pena, Public Tzeli Triantafillon, Public Eduardo Kogan, Spanish Interpreter

Hilda Pérez, Consumer Member, Board of Governors Ozzie López, Consumer Advocate, Board of Governors Gertrude S. Carter, Chief Medical Officer Barbara Cook, Chief of Human & Community Resources John Wallace, Chief Operating Officer Gerardo Alejandre, Lead Member Relations Navigator, Member Services Jim Banks, Senior Director, Quality Improvement Idalia Chitica, Community Outreach Lead Field Specialist CO&E Christina Delgado, Administrative Manager, Family Resource Centers Auleria Eakins, Community Outreach Manager CO&E Laura Garcia, Health Promoter Liaison CO&E Felicia Gray, Community Outreach Liaison CO&E Hilda Herrera, Community Outreach Liaison CO&E Devina Kuo, Health Promoter Program Manager CO&E Linda Merkens, Manager, Board Services Cheyenne Pierce, CCI Field Specialist Peter Prampetch, Community Outreach Analyst CO&E Cynthia Rios, Community Outreach Events Coordinator CO&E Jose Ricardo Rivas, Community Outreach Liaison CO&E Laura Rodriguez, CCI Liaison Hilda Stuart, Committee Liaison, Board Services Prity Thanki, Local Government Advisor, Government Affairs Martin Vicente, Community Outreach Field Specialist CO&E


MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN

CALL TO ORDER Aida Aguilar, ECAC Chair, called the meeting to order at 10:07 a.m.

APPROVAL OF MEETING AGENDA

Chairperson Aguilar announced that RCAC 4 Member Services Department under item IV of today’s Agenda will not be discussed. The Agenda was approved unanimously as amended.

Approved unanimously as amended. 13 AYES (Aguilar, Aguirre, Cadena, Deh-Lee, Guadarrama,

91

APPROVED



Méndez, Poz, Romero, Romo, Saffore, Santos, Salvatierra, and Sevilla.

APPROVAL OF MEETING MINUTES

The March 12, 2014 meeting minutes were approved as presented.

Hercilia Salvatierra, RCAC 4 Chair, and Mary Romero, RCAC 6 Chair, noted that the meeting materials were delivered too late to review prior to the meeting. Idalia Chitica, Lead Field Specialist, informed the Committee that there were delays in preparing the materials. Ozzie López, Board Member Advocate, noted that transmitting electronic meeting materials is more timely and efficient. Ms. Chitica responded that materials are sent by U.S Mail and can be transmitted by e-mail to ECAC members who have provided L.A. Care with an e-mail address. Board Member López asked if Committee members can be trained to use e-mail so they can receive electronic materials. Auleria Eakins, Manager, CO&E polled Committee members about their access to e-mail, and the majority answered positively. CO&E staff will send materials electronically to those who provide an email address.

Approved unanimously as presented. 13 AYES

STANDING ITEMS ECAC Chairperson Report

Aida Aguilar, Chair

Chairperson Aguilar presented the following motions:

Motion ECA 100.0514 To approve the following candidate(s) to the Regional Community Advisory Committees (RCAC) as reviewed by the Executive Community Advisory Committee (ECAC) during the April 9, 2014 ECAC meetings, as attached. • Anna Ochoa, RCAC 3, Advocate, Lake Avenue Community Foundation • Celestina Gomez, RCAC 5, Consumer, Medi-Cal L.A. Care, Care 1st • Sofia Sulca, RCAC 5, Consumer, Medi-Cal L.A. Care, Care 1st • Yolanda Rivera, RCAC 7, Consumer, SNP, L.A. Care • Viridiana Don Juan, RCAC 8, Consumer, Medi-Cal L.A. Care, Care 1st • Sandra Coatney, RCAC 9, Consumer, Medi-Cal L.A. Care, MCLA • Rosa Marquez, RCAC 10, Advocate, Garfield High School Parent Center • Ana Gonzalez, RCAC 11, Advocate, Sacred Heart Church • Gladys R. Alvarez, RCAC 11, Consumer, Medi-Cal L.A. Care, Blue Cross

Motion ECA-A.0414 To form an ad hoc Committee reporting to the Executive Community Advisory Committee

Motions ECA 100 and ECA-A were Approved unanimously. 13 AYES

92

APPROVED



to discuss the Coordinated Care Initiative (CCI) Councils and to approve amendments to the ECAC/RCAC Operating Guidelines to describe the role and responsibilities of the ECAC At-Large member in representing the four Councils.

Board Member Report

Hilda Pérez, Consumer Board member, reported that the Board of Governors met on April 3. • The Board approved motions (A list of the motions approved can be requested from the Board Services

Department). Board member Pérez encouraged Committee members to share this information with their RCACs.

• Maria Jaime was approved as a RCAC 5 Consumer member. • Gertrude S. Carter, MD, Chief Medical Officer, spoke about the incentive programs designed to

promote quality improvement for L.A. Care’s plan partners, participating provider groups (PPG), physicians, and members. Member incentive programs are planned to start this summer; more details will be available as the programs are developed.

• At its March meeting, the Governance Committee elected Alexander Li, MD, as the 2014 Chairperson. The Committee heard a report on the RCAC Ambassador program and development of Coordinated Care Initiative Councils for CCI beneficiaries.

• Howard A. Kahn, Chief Executive Officer, reported that L.A. Care is reviewing the purpose and goals of the Technical Advisory Committee (TAC). For the last few years TAC has focused primarily on health information technology. A proposal for updating TAC’s role will be presented to the Governance Committee this summer.

• The Children’s Health Advisory Committee (CHCAC) will be setting aside time at its regular bi-monthly meetings for focused discussion in three small groups. Areas for the subcommittee discussions are: HEDIS/Member Experience, Health Policy, and Care Delivery System/ Operations. CHCAC members approved adding a consumer member to the Committee. Details on the member appointment will be available soon.

Board Member López urged Committee members to share the list of motions approved by the Board of Governors with RCAC members and stressed the importance of the actions taken by the Board of Governors and how those actions impact L.A. Care members.

Board Member López reminded Committee members that he and Board Member Pérez want to help make sure that L.A. Care members have access to the highest quality care. He noted the importance of voicing member concerns so that he and Board member Pérez can look for opportunities to bring issues to the Board, particularly if there is anything that keeps members from connecting to needed care.

Last month CO&E Staff presented information about resolving member issues. That same information has been shared with members at the RCAC meetings. Board Member López reminded

93

APPROVED



Committee members of the importance of talking to L.A. Care members about issues such as getting appointments and referrals to specialists in a timely manner, pharmacy, interpretation services, urgent care, member services communications, and any other matter that he and Board Member Pérez can help with.

Board Member López asked ECAC to motivate members to bring issues, ask questions or share concerns using the member issue process. Board Member López asked Committee members to identify and communicate any barriers they encounter so that improvements can be made.

Chairperson Aguilar asked for clarification on recently approved Board Motions BOG 100 and FIN 104. Board member Pérez informed the Committee that Motion BOG 100 approved delegated authority to Board Chairperson Horowitz and Mr. Kahn to execute contracts related to the selection of a firm to recruit a Chief Executive Officer. In regard to motion FIN 104, Board member Pérez noted that L.A. Care staff requested additional funds to extend the lease of the Inglewood Family Resource Center (FRC) until 2019.

L.A. Care Senior Staff Report

John Wallace, Chief Operating Officer, reported:

Membership Enrollment increased by 6,144 members in Medi-Cal, for a total membership of 1,340,807. L.A. Care’s Medi-Cal direct line of business (MCLA)enrollment increased by 9,468. Mr. Wallace noted that the growth is mostly due to people choosing MCLA rather than Care 1st or Blue Cross. Enrollment in L.A. Care Covered is over 31,000 members, with 7,500 members in the Dual Eligible Special Needs Plan (D-SNP).

Cal MediConnect (CMC)/ Coordinated Care Initiative(CCI) The CMC program started on April 1. L.A. Care does not currently have any membership in this program, but three people voluntarily enrolled to become members as of May 1, 2014.

Centers for Medicare and Medicaid Services (CMS) Audit L.A. Care recently concluded an audit by CMS and is working on corrective action plans for problems identified by the auditors. Mr. Wallace noted that L.A. Care agreed with auditors on the deficiencies that were identified, and staff is making improvements.

L.A. Care Family Resource Centers (FRCs) Mr. Wallace noted that L.A. Care’s new FRC in The Wellness is on the ground floor of the old LAC+USC hospital and has a lot of shared space. Mr. Wallace suggested that RCAC meetings could be held at The Wellness Center.

Ana Romo, RCAC 8 Vice Chair, asked if the enrollment deadline for Covered California applies to those who did not start their application prior to March 31. Mr. Wallace noted that the extension is

94

APPROVED



for people who had already started the application process by March 31, and he encouraged enrollment by April 15.

Board Member Pérez asked Mr. Wallace to summarize Board motions FIN 100 Contract Amendment with Ansafone Communications, and FIN 101 for FlexTech. Mr. Wallace informed the Committee that Ansafone is L.A. Care’s after hour call center vendor. Calls received after 7:00 p.m. during the week and on weekends are routed to Ansafone. Ansafone staff has been trained and can verify members’ eligibility, doctor assignment information, and can ensure that a follow up call is made by an L.A. Care Member Services Representative on the next business day. Mr. Wallace indicated that the Flextech motion approves work for enhancements needed for the L.A. Care Information Technology (IT) infrastructure so that L.A. Care can pay provider claims more efficiently. Mr. Wallace noted that the Board also approved a motion for a contract with Zones, to purchase computers for the new staff. Board member Pérez asked about the old equipment, and noted that in the past, she asked whether CO&E staff could use laptops or IPADs to help them work in the field, and suggested donating old equipment to safety net clinics in need. Mr. Wallace responded that L.A. Care has a vendor that purchases the old equipment. He also told the Committee that L.A. Care is reviewing its practices in disposing of used equipment and staff will report to the Board on this issue.

Chairperson Aguilar asked if L. A Care would have to amend motions if the funds are not used by the date in the motion. Mr. Wallace noted that the amounts and dates on the motions are based on L.A. Care’s plans and projections, but if a change is needed to extend the timeframe or add funds to the contracts, the Board will consider those changes.

Health Services Report

Dr. Carter presented (a copy of the presentation can be requested through the CO&E Department):

CMS Audit Audit findings will help the organization improve and alerts L.A. Care staff on where it should focus resources. Dr. Carter commended the CMS auditors’ concern about members and the care they receive, as well as their efforts to find opportunities for L.A. Care to improve the systems that may have an impact on how members receive their care. Dr. Carter noted that auditors asked L.A. Care to do an impact analysis when an error or problem was found to determine the members affected.

Dr. Carter noted that auditors were particularly interested in learning if members encountered problems with prescription medication due to misspelled names and other small errors. Auditors advised L.A. Care to establish different ways to identify the member, so that the pharmacy could verify and dispense the medication as needed without delay. Auditors also stressed the importance of notifying members in their language when a prescription medication is not covered and the reason for the denial.

95

APPROVED



Dr. Carter informed the Committee that L.A. Care will continue to use the skills learned from the audit, and noted that staff is working closely with the Board of Governors and CMS to ensure that L.A. Care provides timely and quality care to its members.

eConsult Program and Blue Button Pilot • eConsult is a web based system which allows primary care providers (PCPs) to communicate

electronically with a specialist on behalf of members. • PCPs and specialists can communicate via e-mail, getting a response within 48 hours. By using

eConsult, specialists can provide recommendations and help the PCP decide if he can treat a patient or should submit an urgent referral to a specialist, according to the patient’s symptoms.

• eConsult was created to increase access to care and do all the necessary pre-tests prior to referring a member to a specialist, and to help the specialist quickly identify patients that really need specialty care and it helps members prepare for specialist appointments.

• There are about 2,000 PCPs and 195 clinics in L.A. County using eConsult, serving approximately 500,000 patients. Approximately 20 specialties participate in the system.

• eConsult continues to grow and L.A. Care has made a commitment to offer the e-Consult system to community physician offices and to community clinics.

Blue Button Pilot • It is a federal demonstration pilot, created initially for Medicare. • L.A. Care was offered the opportunity to be one of the first Medicaid plans in the country to

participate in the pilot through the University of California at Davis. • Blue Button is a computer-based application which provides member access to their personal 12-

month prescription history. When members register; they can review the list of medications they have been prescribed, a list of their doctors, and information about each medication. Members need to register personal information in order to access the list.

• Blue Button is a member-only service; providers and health plans do not have access to the information. The purpose of the Blue Button is to provide information to members and encourage active engagement in their health care.

• There is discussion about providing equipment in provider offices so that members who may not have access to a computer at home can access the information while waiting for an appointment.

• Blue Button adoption strategy criterion is to engage members who have multiple prescriptions written by multiple providers, high volume L.A. Care providers already on electronic health records (EHRs).

• Blue Button is on the L.A. Care website and even thought the program hasn’t started, more than 60 people have visited that page.

96

APPROVED



• Dr. Carter will bring more information about Blue Button to the next meeting.

Board member Pérez asked if Blue Button will be available on smart phones. Dr. Carter noted that a primary goal of the Blue Button pilot program is to find out if members will use it and will find value in it. A phone application may become available in the future.

Chairperson Aguilar asked if all L.A. Care members could access the Blue Button application regardless of the region where they reside, and why is it so difficult for some providers to authorize medication when a pharmacy calls to request it on behalf of a member. Dr. Carter responded affirmatively to the first question. She noted that providers sometimes cannot authorize medication when a patient does not have an established relationship with the provider or the pharmacy. She also noted there are rules for prescribing some medications, and a doctor must have supporting information when prescribing those medications. Staff is working on making pharmacy rules easier for members and providers.

Ms. Eakins asked if participation in eConsult is voluntary or mandatory for federally qualified health care centers (FQHCs) and Department of Health Services (DHS) providers. Dr. Carter responded that it is currently mandatory for FQHC and DHS primary care providers to participate in eConsult.

Ms. Romo asked if mental health services have increased recently due to families being separated by deportation and asked about ways in which L.A. Care is supporting the mental health needs of these families. Dr. Carter informed the Committee that L.A. Care does not have any information related to deportation. Behavioral health benefits are provided to L.A. Care members. Members can call L.A. Care’s toll free number and request an evaluation.

Cristina Deh-Lee, RCAC 9 Chair, asked if L.A. Care’ s nurse advise line has the capability to receive pictures by phone in order to help the patient with a medical condition and to asses if it there is a need for immediate care. Dr. Carter informed the Committee that L.A. Care’s after hour vendor does not currently have that capability. L.A. Care staff is planning to look for an after hour service vendor that has those capabilities in the future.

Demetria Saffore, At-Large Member, asked if L.A. Care is monitoring if the Seniors and People with Disabilities (SPD) members are getting the services they need and if L.A. Care is finding cost effective ways to deliver quality care to this population. Dr. Carter informed the Committee that L.A. Care is putting a lot of effort into care coordination for SPDs. Dr. Carter noted that L.A. Care continues to work on quality and access to services for all populations, and is also working to improve the specialized needs of SPDs.

Chairperson Aguilar requested a copy of the presentation. Dr. Carter will update the presentation and forward to CO&E staff for distribution.

97

APPROVED



Legislative Update

Prity Thanki, Local Government Advisor, reported (a copy of the report can be requested through CO&E): • Governor Brown recently signed a continuity of care bill (AB369) to protect people whose prior

individual health policies were cancelled between December 1, 2013 and March 31, 2014 to comply with the Affordable Care Act. The law requires health plans to allow patients with certain specific medical conditions such as pregnancy or a terminal illness to continue to see their existing doctor until their treatment is completed. The new law is effective on March 20, 2014.

• Open enrollment for people to buy health insurance from Covered California formally ended on March 31, 2014. According to Covered California representatives, over 32,000 individuals selected L.A. Care Covered. Last month, Covered California announced that people who started the enrollment application process by 11:59 p.m. on March 31 have until April 15 to complete the process and select a health insurance plan.

• People who missed the March 31 deadline for health coverage will pay a tax penalty of $95 or 1 percent of their annual income above the tax-filing threshold of $10,150, whichever is higher.

• The next enrollment period is November 15, 2014 for coverage starting in 2015. • Enrollment for Medi-Cal is open throughout the year. People who missed the deadline for

individual coverage can get insurance later in the year if they qualify for a “special enrollment period” due to a qualifying life event (marriage, moving, birth of a baby or adoption of a child, loss of their current coverage or a change in income that affects eligibility for financial assistance).

Ms. Eakins asked for the date and length of the next open enrollment period. Ms. Thanki responded that Covered California open enrollment is expected to begin on November 15, 2014 and the enrollment period is expected to last about two months.

Quality Improvement Department Update

Jim Banks, Senior Director, Quality Improvement, reported: • The QI department is reorganizing; and its emphasis continues to be on improving the overall

quality of care of the members. Mr. Banks noted that the QI department needs input from RCAC members on development of new incentives and programs that will impact L.A. Care members. Mr. Banks added that he would like to hear ideas on what this Committee thinks would work, and about the priorities in each RCAC.

• L.A. Care has new incentive programs directed to providers and members. The focus is to develop a work plan for 2014 based on areas for which L.A. Care feels an incentive would help the member get required care. According to HEDIS data from last year, L.A. Care identified the following areas of focus: Well child care (ages 3-6), childhood immunization, cervical cancer screening, diabetes care, prenatal and postpartum care.

• The QI department is currently developing incentive programs to address these areas, and Mr. Banks will bring the proposed incentives to this Committee to gather feedback.

98

APPROVED



Chairperson Aguilar asked if L.A. Care will get feedback from the clinics for development of the work plan. Mr. Banks indicated that L.A. Care would like input from ECAC, individual providers, provider groups, and plan partners. Mr. Banks further noted the importance of obtaining feedback from all stakeholders for the design and implementation of effective incentive programs. Chairperson Aguilar urged Committee members to bring their feedback at a future meeting.

Board member Pérez noted that the ratings for the focus areas have been historically low, and asked if there have been incentive programs addressing these areas. Mr. Banks informed the Committee that there have been incentive programs in some of those areas in the past. L. A. Care will apply lessons learned from past incentive programs.

Health Promoters/Promotora Update

Devina Kuo, Health Promoters Program Manager, reported: • Health Promoters (HPs) met on March 7, 2014 to receive CCI & Access to Health Care updates.

On March 28, 2014 they participated in one of three sessions about motivational interviewing. On April 4, 2014 they received training on Access to Health Care in preparation for presentations to the RCACs, and a review of A Network for a Healthy California’s “Rethink Your Drink, Be Sugar Savvy” curriculum for the Active Steps Program (ASP).

• HPs will meet again on April 11 and April 25 for the last two sessions of motivational interviews. • HPs completed presentations on health care fraud and abuse, which included a review of the

Everyone On-Board Campaign “Don’t Be A Victim of Fraud” brochure with RCAC members. Some HPs included a puppet show in the presentations.

• In April and May RCAC meetings, HPs will teach members about preventive, urgent, and emergency care. This topic was chosen based on RCAC member requests about the difference between the levels of care and when each should be used.

• HPs continue to help in the ASP with data collection, body measurements, surveys, one-on-one phone calls, and reporting. This year, HPs will be teaching three of the sixteen classes on 1) a personal goal setting to help participants make SMART (specific, measureable, attainable,

reachable, and time bound) goals, or have “ACTION STEPS” to reach their overall goal, 2) MyPlate Nutrition curriculum, to help participants eat balanced meals, and 3) ReThink Your Drink curriculum from A Network for a Healthy California to emphasize the

importance of healthy drinks and alternatives. • HPs continue weekly one-on-one sessions on the motivational interviewing technique to

motivate participants to take action steps toward reaching their goals. • HPs continue providing health topic presentations in the community. Recent events included

attending local church events and health fairs to conduct Covered California enrollment. • The application period for the 2014 HPP training group is closed. About 30 applications from

members of several RCACs were received. Applicants have a variety of ethnic backgrounds. The committee will review applications and schedule interviews later this month. The first

99

APPROVED



orientation meeting will be held on May 6.

At-Large Member Update (Member Recruitment/CCI)

Silvia Poz, and Demetira Saffore, At-Large Members, reported: • L.A. Care hired staff to coordinate CCI Councils. Staff is reviewing data on L.A. Care’s

membership. Additional updates on CCI Councils will be provided. • Ms. Poz reported that nine RCAC member candidates have been sent to ECAC this month for

approval in Motion ECA 100.

Ms. Eakins thanked the At-Large members for the report, and she introduced Laura Rodriguez, CCI Liaison, and Cheyenne Pierce, CCI Field Specialist. Ms. Eakins reported that additional staff will be hired in mid-April. Ms. Eakins asked Committee members to support these new staff members to help ensure a successful effort engaging SPDs in the L.A. Care stakeholder advisory process.

Member Issues Staff from the Member Services Department was available at the end of the meeting to assist with member issues.

Community Engagement

ECAC members

• Board member Pérez informed the Committee that a representative from Global Energy Services can provide presentations and useful tips on how to save money and energy. Board member Pérez encouraged other ECAC chairs to invite this organization to their RCACs. Elda Sevilla, RCAC 11 Chair, or Board member Pérez can provide contact information to those that are interested.

• Ms. Deh-Lee informed the Committee about recycle bank, a website that offers animated lessons on how to reduce trash. Recycle bank rewards users with points for watching the animated lessons. The points can be redeemed for magazine subscriptions and retail discounts.

• Ms. Sevilla informed the Committee about the 12th Annual Cesar Chavez Pilgrimage and Celebration in Pomona on April 12. Information was distributed to the Committee.

• Ms. Poz informed the Committee about the Los Angeles OIC Computer Training Center Program which offers low cost computers to low income families. Additional information was distributed to the Committee.

NEW BUSINESS Clarification of roles- Group activity

• Ms. Eakins introduced a group activity to gain a better understanding, strengthen and improve the member issue process. Small group discussions were held to identify the role of the RCAC, ECAC and BOG in addressing and helping to resolve member issues.

• Committee members and members of the public participated in the activity and shared the following feedback: o Role of the RCAC Talk among RCAC members to find relevant member issues- Get member feedback

100

APPROVED



Communicate issues to RCAC Chair and L.A. Care staff Forward issues to ECAC (through RCAC Chair or staff) if necessary Provide the toll free L.A. Care member services telephone number Focus on community issues

o Role of the ECAC Hold discussions to identify global issues that need to be forwarded to the Board of

Governors and forward identified issues to the Board File, support and forward motions to the Board of Governors Educate and inform the RCACs Forward RCAC issues to ECAC if not resolved at the RCAC level

o Board of Governors Advocate for members’ concerns and needs, to improve quality of health care services Listen to ECACs’ concerns, make recommendations, and report back to the Board of

Governors if necessary Provide regular updates concerning motions related to member issues as presented at

ECAC meetings Forward issues to ECAC to request feedback Visit the RCACs*

Ms. Eakins asked Committee members to discuss the purpose of Board members visiting RCAC meetings. Chairperson Aguilar noted that it is important for Board member representatives to hear the RCAC members’ discussion on issues within the community (for example: an overcrowded community clinic, where members have to wait long hours to be seen). Chairperson Aguilar noted that Board members can help L.A. Care determine resolutions. RCAC members must first reach consensus on the issue to be forwarded to ECAC or to the Board of Govenrors. Barbara Cook, Chief of Human & Community Resources, reminded the Committee that it is important for RCAC members to research an issue and recommend solutions. Ms. Cook invited Committee members to work closely with Board and RCAC members to attain greater achievements.

Board Member Pérez noted that she attends as many RCAC meetings as possible because it is important to be in contact with people and get direct input. Board member Pérez also noted the importance of helping members identify and deal with issues and submit their recommendations to the Board.

OLD BUSINESS

RCAC Member Recruitment

This Agenda item was not discussed.

101

APPROVED



Family Resource Center(FRC)- Pacoima

Ms. Delgado reported:

L.A. Care FRC/The Wellness Center • The grand opening of the L.A. Care Boyle Heights FRC in The Wellness Center at the historic

LAC+USC Medical Center took place on March 15. The Wellness Center is a collaborative effort among 16 organizations,

• The address is 1200 N. State Street, Los Angeles, CA 90033. The telephone number is 213-294-2833.

• There is free parking in lot 10, with a free shuttle to take visitors to the entrance of the center. • The FRC is open from 8:00 a.m. to 5:00 p.m. The Wellness Center is open from 8:00 a.m. to

9:00 p.m. • The FRC will offer classes on disease management, diabetes, asthma, obesity, nutrition, fitness

and body sculpturing, self-esteem, zumba for seniors and people with disabilities, health education, yoga, pilates, and has member services support for any inquiries that members may have. Domestic violence support groups will meet at the FRC.

• Jovita Murillo is the site Administrator and Irene Rivas is the Member Service representative. A community representative will be hired soon.

Board member Pérez asked if the FRC will offer physical activity classes for children. Ms. Delgado responded affirmatively, and noted that the FRC will be open for everyone in the community. Classes will be offered depending on need and in partnership with other organizations at The Wellness Center that provides services. Ms. Delgado noted that the organizations can’t compete for nor duplicate services. The center has a YMCA that provides childcare while parents attend classes.

Ms. Chitica asked if there is a calendar available for the FRC. Ms. Delgado responded affirmatively but noted that a calendar will available once it is approved by Supervisor Gloria Molina’s office, The Wellness Center staff, and LAC/USC hospital before it can be finalized and distributed to the community.

Board member Pérez noted the lack of community members present at the grand opening event, and expressed her concern and disappointment about the lack of advertisement. Board member Pérez asked about quality control measures for the classes taught at the FRC, and asked for clarification on the recently approved Board motion to extend the lease of the Inglewood FRC. Ms. Delgado acknowledged the lack of community members at the grand opening event. The goal was to have a soft grand opening and open the doors to the community. Ms. Delgado informed the Committee that sometimes the FRCs collaborate in community events and must allow the collaboration partner to lead the marketing efforts.

Chairperson Aguilar asked if staff keeps a log of participants visiting the FRC, and if L.A. Care has a

102

APPROVED



visible sign. Ms. Delgado noted that the FRC documents visitors and the Wellness Center registers all visitors and refers them to services provided by the tenants. She noted that there is a sign outside by the main entrance of The Wellness Center. The Wellness Center staff is requesting approval for more signage outside the building and in the parking lot to guide visitors to The Wellness Center. Ms. Delgado informed the Committee that the FRC is open to the community although some IT glitches have delayed full operation. L.A. Care IT staff is aware of the glitches and will fix them.

Pacoima FRC Dora Evans was introduced as the Site Administrator of the Pacoima FRC. Ms. Evans was hired prior to opening of the site so she can fully engage in the community, attend community meetings, foster collaboration and avoid preventable issues. The Pacoima FRC is expected to open by October 1, 2014 and will be located at 10807 San Fernando Road, Pacoima, CA 91331. A phone line will be available when construction is complete.

Ms. Delgado invited Committee members to call her or her staff if they have ideas, questions or concerns.

PUBLIC COMMENTS • Ms. Saffore informed the Committee that she has noticed that Interpreters do not show up to

member appointments when needed. Ms. Eakins will forward the concern to Member Services and Culture and Linguistics departments for follow up.

• Chairperson Aguilar asked Committee members to complete the meeting survey.

ADJOURNMENT Chairperson Aguilar adjourned the meeting at 1:05 p.m.

RESPECTFULLY SUBMITTED BY: APPROVED BY: Hilda Stuart, Committee Liaison, Board Services _________________________________________ Linda Merkens, Manager, Board Services Aida Aguilar, ECAC Chair

Date _____________________________

103

Board of Governors Executive Community Advisory Committee Meeting Minutes – May 14, 2014 L.A. Care Health Plan, 1055 West 7th Street, Los Angeles, CA 90017

ECAC Members RCAC Members/Public L.A. Care Board of Governors/Staff Maria Adela Guadarrama, RCAC 1 Chair, Carlos Aguirre, RCAC 2 Chair Cynthia Conteas-Wood, RCAC 3 Chair Hercilia Salvatierra, RCAC 4 Chair María Guadalupe Méndez, RCAC 5 Chair Mary Romero, RCAC 6 Chair Dalia Cadena, RCAC 7 Chair Ana Romo, RCAC 8 Chair Cristina Deh- Lee, RCAC 9 Chair Aida Aguilar, RCAC 10 Chair , ECAC Chair Elda Sevilla, RCAC 11 Chair Silvia Poz, At Large Member, ECAC Vice Chair Demetria Saffore, At Large Member * Excused Absent ** Absent *** Via teleconference

Bellen Telléz, RCAC 1 Rosa Ávalos, RCAC 2 María Ramirez, RCAC 3 Herceys Catalina Donis, RCAC 4 Romalda Meza, RCAC 5 Briggitte Green, RCAC 6 Rosario Moreno, RCAC 8 María Ceballos, RCAC 9 Engracia López, RCAC 10 Estela Vejar, RCAC 11 Interpreters: Eduardo Kogan Paula Alvira Paulina Laurent Sina New Visitors: Tyler Coby, Optimity Advisors

Hilda Pérez, Consumer Member, Board of Governors Barbara Cook, Chief of Human & Community Resources John Wallace, Chief Operating Officer Idalia Chitica, Community Outreach Lead Field Specialist CO&E Kristina Chung, Field Specialist, CO&E Auleria Eakins, Community Outreach Manager CO&E Laura Garcia, Health Promoter Liaison CO&E Felicia Gray, Community Outreach Liaison CO&E Hilda Herrera, Community Outreach Liaison CO&E Judy Hsieh Bigman, Resource Specialist, CO&E Devina Kuo, Health Promoter Program Manager CO&E Susan Ma, CCI Field Specialist, CO&E Linda Merkens, Manager, Board Services Frank Meza, Field Specialist, CO&E Roland Palencia, Director, Community Benefits Cheyenne Pierce, CCI Field Specialist, CO&E Peter Prampetch, Community Outreach & Engagement Analyst, CO&E Jose Ricardo Rivas, Community Outreach Liaison CO&E Laura Rodriguez, CCI Liaison, CO&E Hilda Stuart, Committee Liaison, Board Services Prity Thanki, Local Government Advisor, Government Affairs Paola Valdivia, Special Projects Manager Martin Vicente, Community Outreach Field Specialist CO&E



CALL TO ORDER Aida Aguilar, ECAC Chair, called the meeting to order at 10:09 a.m.

APPROVAL OF MEETING AGENDA

Chairperson Aguilar informed the Committee that Agenda items IV (D) Health Services report and VI (B) Blue Button presentation will not be provided. The Agenda was approved unanimously as amended.

Approved unanimously as amended. 11 AYES (Aguilar, Aguirre, Cadena, Deh-Lee, Guadarrama,

104

Méndez, Poz, ,Romo, Saffore, Salvatierra, and Sevilla.)

APPROVAL OF MEETING MINUTES

The April 9, 2014 meeting minutes were approved as presented.

Approved unanimously as presented. 11 AYES

STANDING ITEMS ECAC Chairperson Report

Aida Aguilar, Chair

(Member Conteas-Wood joined the meeting) Chairperson Aguilar presented the following motion: Motion ECA 100.0614: To approve the following candidate(s) to the Regional Community Advisory Committees (RCAC) as reviewed by the Executive Community Advisory Committee (ECAC) during the May 14, 2014 ECAC meeting.

Name RCAC # Type of Member

(Agency, if applicable) Melissa Bryant RCAC 1 Consumer, Medi-Cal Care 1st Alicia Flores RCAC 1 Consumer, Medicare Advantage SNP Diana Leff RCAC 2 Consumer, Medi-Cal MCLA Christine Provencio RCAC 2 Consumer, Medi-Cal MCLA Laura Rhone RCAC 2 Consumer, PASC-SEIU (IHSS) Olivia Bravo RCAC 3 Consumer, Medi-Cal MCLA Esmeralda Cerezo RCAC 3 Consumer, Medi-Cal Blue Cross Dolores Martinez RCAC 3 Consumer, Medi-Cal Blue Cross Marta Ramirez RCAC 3 Consumer, Medi-Cal Care 1st Mariana Santini RCAC 3 Consumer, Medi-Cal Blue Cross Marielena Solorio RCAC 3 Consumer, Medi-Cal Blue Cross Gizelle James RCAC 4 Consumer, Medi-Cal MCLA Irene Romero RCAC 6 Consumer, Medi-Cal Fresia Paz RCAC 10 Consumer, Medi-Cal SPD

Chairperson Aguilar read a letter from Elizabeth Cooper, RCAC 2 member to Board Chairperson Horowitz. In the letter, Ms. Cooper requests permission to participate as a non-voting public member in the selection, input, and interview process of the L.A. Care Chief Executive Officer (CEO) recruitment. Chairperson Aguilar also read a response letter from Board Chairperson Horowitz acknowledging Ms. Cooper’s request and valuable feedback, and informing her of the

Approved unanimously 12 AYES (Aguilar, Aguirre, Cadena, Conteas-Wood, Deh-Lee, Guadarrama, Méndez, Poz, , Romo, Saffore, Salvatierra, and Sevilla.)

105

following: o The Board of Governors authorized Chairperson Horowitz to appoint members of an ad-hoc

CEO search Committee. Board consumer member Hilda Pérez was appointed to the Committee.

o In order to facilitate the work of the ad-hoc Committee it is necessary to keep the number of members to an appropriate minimum.

o Comments and insight can continue to be provided to both of the elected RCAC Consumer and Advocate Representatives, Hilda Pérez and Ozzie López, so they can provide the information to the Board of Governors.

o An invitation to continue attending the Board of Governors meeting to share any concerns. Board member Pérez noted that her appointment to the ad-hoc CEO Search Committee offers her an opportunity to gather feedback from ECAC and RCAC members. She asked ECAC members to provide input. The feedback will be forwarded to the ad-hoc Committee and recruitment firm. Chairperson Aguilar asked if the ad-hoc CEO Search Committee meetings and CEO interview process are open to the public, and if Board member Pérez will have a vote on the hiring of a candidate. Barbara Cook, Chief of Human and Community Resources, responded negatively. Board member Pérez noted that Board members will vote on the selection of a new CEO. Cynthia Conteas-Wood, RCAC 3 Chair, suggested asking RCAC members to also provide input on the characteristics and qualifications they would like for the new CEO. Feedback can be submitted to Board member Pérez. Linda Merkens, Manager, Board Services, informed the Committee that candidates may request confidentiality in the interview and selection process. Members will have access to all public information and will receive updates as the process moves along. Ms. Merkens noted that the Board is proceeding thoughtfully in the process and has hired a professional recruitment firm to conduct the search. She emphasized that member input is important and there is time to provide input to the Board. Silvia Poz, At Large member, requested a sample format for the feedback and asked for clarification on how the information will be presented to Board member Pérez. Idalia Chitica, Lead Field Specialist, informed the Committee that CO&E and staff will work on a format and will put together some information to be presented to RCAC members requesting their feedback. Board member Pérez asked for a format with specific questions to help RCAC members provide their input. Auleria Eakins, Manager, CO&E noted that CO&E will work with Board Services to prepare the materials.

Board Member Report

(Member Romero joined the meeting) Hilda Pérez, Consumer Board Member, reported that the Board of Governors met on May 1.

106

• The Board approved several motions (A list of the motions approved can be requested from the Board Services Department). Board member Pérez encouraged Committee members to share the information with their RCAC members. Approved motions include ECA 100 RCAC Membership, 14 grants totaling $657,000 for the VI Oral Health Initiative (OHI) budget, and a $125,000 sponsorship for the 2014 CareHarbor LA Clinic.

• Donald Manelli, Founder of the CareHarbor LA Clinic, was at the Board meeting and reported that this years’ clinic will be on September 11 at the Los Angeles Sports Arena. There will be a volunteer training program and they are working hard to increase dental services at the event. The target is to serve 4,000 people.

• On April 27, 2014 Howard A. Kahn, Chief Executive Officer , received the first Safety Net Hero Award at St. John’s Well Child and Family Center’s Moveable Feast.

Member Conteas-Wood asked if September 11 is the start date of the CareHarbor clinic or the date for wristband distribution. Board member Pérez informed the Committee that the event will start on September 11 and the wristbands will be distributed three or four days prior. Christina Deh-Lee, RCAC 9 Chair, asked if there is a more organized way to distribute wristbands without asking people to line up at 6:00 a.m. and camp outside the event in order to get a wristband. Member Deh-Lee suggested that the event’s organizers screen people prior to the event to find out what services they need, and distribute wristbands accordingly. In response to question from Chairperson Aguilar, Roland Palencia, Director, Community Benefits, informed the Committee that $5 million were allocated to the Community Benefits budget to fund projects for this fiscal year. There are unspent funds from other programs, and some of these funds were reallocated to the OHI. Mr. Palencia noted that a total of 27 applications were received for the OHI grants, and the Review Committee recommended to fund 14 organizations, but were limited due to approved allocations of $500,000 which allowed L.A. Care to fund only 11. The approved increase to the allocation will allow L.A. Care to fund the 14 recommended organizations. Mr. Palencia noted that funds were granted for infrastructure projects, renovations to expand space, dental software, and additional staff rather than to provide direct dental services.

L.A. Care Senior Staff Report

John Wallace, Chief Operating Officer, reported:

Membership • L.A. Care’s Medi-Cal enrollment increased by 11,229 members; 8,652 of those enrolled in L.A.

Care’s direct Medi-Cal line of business (MCLA) and current total enrollment in MCLA is 573,606. • It is expected that Medi-Cal membership will increase in the future once the backlog in Medi-Cal

applications is relieved. Los Angeles County Department of Public and Social Services (DPSS) is working to verify and process those applications, and the California Department of Health Care

107

Services (DHCS) is considering delaying the redetermination process for existing members to expedite the processing of pending applications. Mr. Wallace noted that there is no action required from existing members, unless L.A. Care notifies them of required actions regarding their redetermination.

Cal MediConnect (CMC)/ Coordinated Care Initiative(CCI) • The CMC program is also known as the Duals pilot. • L.A. Care has 15 members enrolled in CMC to-date. • L.A. Care is expecting between 10,000 and 12,000 members to join CMC by July 2014.

L.A. Care Covered/Covered California • There are 41,000 members currently enrolled in L.A. Care Covered. All of these members

actively chose L.A. Care and approximately 85% of them are paying their premiums. • Covered California offers bronze, silver, gold and platinum metal tiers. All metal tiers cover the

same benefits and services, with different out-of- pocket co-payment, and premium costs. The bronze metal level offers a lower monthly premium with a higher co-payment. Younger and healthier people may choose bronze if they don’t anticipate multiple doctor visits or hospitalization.

• The silver medal tier offers subsidies from the federal government to those who qualify. Lessons have been learned this first year, and people will most likely choose the tier that fits their needs. L.A. Care will make efforts to educate the community about available subsidies for low income people that can be maximized when they choose the silver tier.

Member Conteas-Wood asked if Covered California will find funds for people who haven’t paid their premiums. Mr. Wallace informed the Committee that there is a standard 90-day grace period. The health plan will notify a member about the grace period and verify eligibility and ability to pay the premium. Between 85-90% of current members have paid the premium.

Centers For Medicare and Medicaid Services (CMS) Audit • Last month CMS conducted an onsite Audit at L.A. Care for its Dual Special Needs Plan (D-

SNP) Medicare program. • L.A. Care is doing follow up work, and corrective action plans (CAPs) have been submitted.

CMS has accepted all of L.A. Care’s CAPs. • There are 8,500 members currently enrolled in the L.A. Care Medicare program.

Upcoming Events • L.A. Care Sales and Marketing team has entered into a partnership with Chivas USA. L.A. Care

staff will be present at the Chivas USA games at the StubHub Center stadium and will have an opportunity to do free television work with the team.

• Howard A. Kahn, CEO, will deliver the commencement address at Western University School

108

of Optometry 2014 graduation on May 15, 2014. At this ceremony Mr. Kahn may receive an honorary Doctorate Degree (PhD).

Chairperson Aguilar asked if dentists know about the reinstatement of dental benefits in the Medi-Cal program. Mr. Wallace noted that not all dentists participate in Denti-Cal, and dental benefits are not administered by L.A. Care. Mr. Wallace will ask the Provider Relations Department staff to provide a list of Denti-Cal providers in L.A. County. Chairperson Aguilar also asked if funding the CareHarbor event would be a conflict for those enrolled in Medi-Cal and eligible to receive dental services through Denti-Cal. Mr. Wallace noted that people who receive services at CareHarbor are mostly uninsured, and don’t qualify for any other program, and CareHarbor does not screen people for program eligibility. Application assistors are available at Care Harbor for those who want to see if they are eligible for government sponsored health coverage and social service programs. CareHarbor provides volunteer services and does not bill for the services provided.

Ms. Poz informed the Committee that Western Dental accepts Denti-Cal but they tell patients that not all services are covered by Denti-Cal and covered services are low quality. According to Ms. Poz, Western Dental tells patients that it’s best to pay for dental services. Mr. Wallace informed the Committee that he will ask staff for a fact sheet on Denti-Cal covered benefits for adults to be distributed to all RCAC members.

Cristina Deh- Lee, RCAC 9 Chair, noted that she received information about Denti-Cal benefits but she doesn’t know where she can receive services.

Board member Pérez asked for information about how to file a complaint about Denti-Cal. Mr. Wallace noted that members can call the Department of Health Care Services or the Department of Managed Health Care, and the numbers will be added to the fact sheet.

Health Services Report

A Health Services report was not provided.

Legislative Update Prity Thanki, Local Government Advisor, reported (A copy of the report can be requested through CO&E): • In February, State Senator Ricardo Lara introduced “The Health for All Act” (SB1005). This bill

would ensure that all California residents have access to quality and affordable health care regardless of immigration status. Under this bill, immigrants would be able to purchase affordable health care coverage in a state-wide marketplace similar to Covered California and would be able to receive Medi-Cal, if eligible. The California Senate Health Committee approved the bill after hearing dozens of immigrants’ rights and healthcare groups’ concerns. Federal funding cannot be used for the undocumented so funding would have to come from sources such as state and private funds. A hearing is scheduled on May 19, and more information may be available at the next meeting. L.A. Care Government Affairs Department will continue to monitor and provide updates on legislation.

• California Governor Brown released his Budget Revise on May 13. The May Revise has many significant components, including repaying debt and funding the state pension program.

109

Following are components that may impact L.A. Care and its membership: Medi-Cal Expansion: Last year California adopted Medi-Cal expansion through the

Affordable Care Act (ACA). The May Budget Revise projects that more than one million people will enroll in health coverage through Covered California and Medi-Cal. Medi-Cal enrollment is expected to rise from 7.9 million to 11.5 million in 2014-2015. Medi-Cal will cover about 30% of California’s population. The May Revise projects that the Medi-Cal costs will increase by $2.4 billion.

Medi-Cal application backlog: There are about 900,000 Medi-Cal applications pending income and residency verification. To get rid of the backlog, the Department of Health Care Services will suspend recertification for existing Medi-Cal members until July 2014.

Pilot program to expand pediatric vision screenings: The May Revise includes $2 million for a pilot program to expand pediatric vision screenings using mobile vision service providers and contracting with school districts to provide vision exams and eyeglasses for children who are enrolled in Medi-Cal. The Department of Health Care Services has indicated that L.A. County will have the first pilot, but the start date has not been announced.

• The California Assembly and Senate will review the Governor’s May Revise and hold a series of hearings on the budget, and they may propose modifications. It is expected that a budget plan will be approved by both legislative bodies and sent to Governor Brown by the end of June.

• Since 2011, L.A. County has enrolled more than 300,000 people in the Healthy Way L.A. low income program. On January 1, 2014 Healthy Way L.A. members transitioned into Medi-Cal managed care programs. About 5,000 participants did not transition and lost coverage. In most cases it was because a last name or date of birth provided to the county did not match the records of Department of Health Care Services (DCHS). L.A. County Department of Health Services (DHS) and Department of Public Social Services (DPSS) officials reported that most of those who lost eligiblity have been reinstated, but it takes time to correct and cross-check information. About 200,000 new Medi-Cal applications were received through the Covered California website. DHS instructed providers to alert DHS about patients with urgent medical needs so they can be immediately enrolled in Medi-Cal. People can contact Healthy Way L.A. office at (877) 333-4952 for more information.

Board member Pérez asked for clarification on pediatric vision services. Ms. Thanki informed the Committee that the May Revise proposes a pilot program that will use mobile vision service providers for children currently enrolled in a Medi-Cal managed care plan. Board member Pérez also asked if DPSS will priority enrollment for people with chronic conditions that need prescription medications. Ms. Thanki advised ECAC to tell people to contact the Department of Managed Care, the Department of Health Services, the providers, and the Healthy Way L.A. program to report medical concerns and needs.

110

Ms. Poz asked for a copy of the May Revise. Ms. Thanki stated that she will provide an internet link to CO&E staff so they can distribute it to ECAC members. Ms. Thanki noted that the May Revise is also available on the Governors’ website.

Health Promoters/Promotora Update

Devina Kuo, Health Promoters Program Manager, reported: • Health Promoters (HPs) participated in motivational interviewing training sessions on April 11

and 25. • On May 22, the Health Education Department will train HPs on pre-diabetes programs. • HPs will attend April/May RCAC meetings to provide information on access to preventive,

urgent, and emergency medical care. HPs encourage members to use L.A. Care nurse advice line if they have questions about medical conditions and where to get care.

• This year HPs have increased participation in the Active Steps Program (ASP) by co-teaching classes on personal goal setting, my plate nutrition, and rethink your drink. HPs assist with data collection, body measurements, conducting surveys and follow up phone sessions, and reporting.

• HPs provide workshops in the community on various health topics and participate in health fairs and events. Last year HPs submitted a proposal to the Mini CABE conference in the Antelope Valley, and they invited the HPs to attend this year’s conference to provide an update on the ACA and present on access to care and nurse advice line.

• The HP 2012 graduates took two written exams and an oral exam to support the Train-the-Trainer model. HPs that pass all three exams will be able to assist staff by teaching one or two training sessions for the new group of HPs.

• The new group of HPs held their first meeting on May 6, 2014. They participated in two main activities, “my personal flag” to learn more about themselves and what they bring to the program, and the “marshmallow challenge” to encourage them to work as a team while building the tallest model using 20 spaghetti noodles, tape, strings and a marshmallow. At this meeting HPs also learned about the CO&E department, the RCACs, the importance of community involvement, the HP training, and post-graduation activities.

• HPs will meet again on May 21 and May 27 for training on access to care from the Member Services Department.

Ms. Conteas-Wood asked if the meetings on May 21 and 27 are for current or new HPs. Ms. Kuo noted that both meetings are for the new group of HPs, and the pre-diabetes training on May 22 is for the 2012 graduates.

Carlos Aguirre, RCAC 2 Chair, asked about the number of HPs currently participating in the program. Ms. Kuo noted that 24 applicants participated in the training on May 6.

At-Large Member Update (Member Recruitment/CCI)

Demetria Saffore, and Silvia Poz, At-Large Members, reported: • Susan Ma is a new Coordinated Care Initiative (CCI) Field Specialist. • There are 14 L.A. Care Health Plan members enrolled in CCI to date. L.A. Care will keep

111

members informed about the CCI and member enrollment status. • University of Southern California Advocates for African American Elders and the Center for

Healthcare rights will host a CCI information session on Saturday, May 17, 2014 at Graceful Senescence Center at 120 W. El Segundo Blvd. Everyone is encouraged to attend and call 213-740-1887 for additional information.

• Fourteen RCAC member candidates are proposed for approval in Motion ECA 100. • As of May, the CO&E department has received 25 interest cards from RCACs 1,2,4,6,7,8,9. A

total of 76 interest cards have been received. Not all of the interest cards are processed due to lack of eligibility. New recruitment efforts include targeting specific product lines to ensure representation from all L.A. Care’s product lines.

Ms. Conteas-Wood requested a copy of the At-Large member report to share with the RCAC members, and a copy of the report and the flyer announcing the CCI event will be provided as requested.

Board member Pérez asked if the CCI council meeting in Palmdale was, and if a CCI event will take place in the South L.A. area, which has a high number of CCI members. Ms. Cook indicated there will be no CCI council meeting in Palmdale. Ms. Eakins noted that staff is evaluating the best way to reach out to CCI members. The four geographic areas that were selected to have a CCI Council are the areas with the highest density of L.A. Care members who are seniors and people with disabilities. Board member Pérez asked for clarification on the CCI event scheduled on May 17. Ms. Eakins noted that this event is not hosted by L.A. Care. Staff will keep Committee members informed of CCI outreach efforts conducted by all community partners. Board member Pérez asked if the upcoming L.A. Care CCI Council meetings will be occur at the same time for the four areas, and recommended that South L.A. be given priority because of the large number of seniors and people with disabilities residing in the area. Ms. Eakins acknowledged her concern and informed the Committee that the CCI has a core team from different departments at L.A. Care. Ms. Eakins will forward the concern to the CCI core team to assess the best way to effectively roll out the CCI councils.

Chairperson Aguilar asked if the reason for not processing a RCAC application is due to ineligibility or not being enrolled in a specific product line, and also asked if the applications of those that are eligible but enrolled in a different line of business are put on a waiting list or discarded. Ms. Poz responded affirmatively to the first question. In response to the second question, Ms. Chitica informed the Committee that ineligible applications are discarded and those who are eligible but enrolled in other product lines are notified and placed on a waiting list.

Ms. Poz asked if staff sends a letter notifying applicants why their application cannot be processed. Ms. Chitica noted that staff will contact the applicants by phone, and clarified that the interest card is not a complete application. The form only asks for the candidates’ name and telephone number, but it doesn’t include personal member information. Staff determines eligibility during the phone call.

112

Board member Pérez asked if ECAC will get a copy of the At-Large member report. Ms. Chitica noted that a copy of the report will be available at future meetings.

Member Issues • Member Issue Flow Chart • RCAC 3-Cynthia Conteas-

Wood • RCAC 6-Mary Romero • RCAC 10-Aida Aguilar

Member Issue Flow Chart

Auleria Eakins, Manager, CO&E, reported (a copy of the RCAC Member Issue-Process Chart can be requested through the CO& Department):

• The CO&E department heard ECAC members’ concerns regarding the previously proposed RCAC member issue flow chart. The revised chart includes a simplified process that will make it easier for ECAC and RCACs to assist with the member issue campaign.

• Ms. Eakins explained each step and how individual and global member issues would be addressed, resolved and communicated to ECAC so that ECAC can inform the RCACs. Ms. Eakins noted that an Interdisciplinary Committee, composed of various departments at L.A. Care, will be working on all global issues submitted by RCACs and ECAC, and they will forward issues to the Governance Committee and Board of Governors, if needed.

Ms. Poz asked for an estimated timeframe for resolving member issues, and if examples can be provided to ECAC and RCAC members. Ms. Eakins noted that the time it takes for an issue to be resolved will depend on the particular issue and the number of departments that get involved. Ms. Eakins clarified that the Member Services Department will help resolve issues impacting access to care on an individual basis, and as quickly as possible. She noted that if the issue affects many members, it may require more to resolve. Ms. Eakins informed the Committee that some RCACs will present member issues later on today’s Agenda.

PUBLIC COMMENT: Brigitte Green, RCAC 6 member, addressed Committee members with a concern about the importance of an early cancer diagnosis. Ms. Green noted that her mother was never diagnosed with cancer and instead pain medication was prescribed and she was sent home. Ms. Green offered assistance in addressing this issue in the Community, to collaborate with ECAC and the Board of Governors, to address and resolve this issue. Ms. Green asked when the RCACs will address the issues and concerns that have been presented at their meetings. Ms. Eakins noted that she will work with the Field Specialists and Health Promoters to address health concerns throughout the year.

RCAC 3 Member Issue Ms. Conteas Wood informed the Committee that RCAC 3 has been discussing the importance of communication for approximately four months, and recommend the following: • Amend the RCAC Operating Guidelines to include language noting that actions that are relevant

to the entire Committee be voted upon at regular ECAC meetings not subcommittees or other educational events.

• Provide ECAC with brief and concise reports from ECAC subcommittees or other events to be

113

documented and relayed to the RCACs in writing.

Ms. Conteas-Wood asked for recommendations on how to present her proposals. Ms. Cook asked if there had been a situation where voting outside of an ECAC meeting has occurred in the past. Ms. Conteas-Wood responded negatively, but noted that clarification and revised policies and Operating Guidelines would avoid misunderstanding and provide clarity to members.

Ms. Poz asked Ms. Conteas-Wood if she would like to be informed by phone. Ms. Conteas-Wood clarified that she would like a report to be provided at the next ECAC meeting so that all Committee members can stay informed.

Ms. Deh-Lee asked Ms. Conteas-Wood if the RCAC 3 request relates to training materials. Ms. Conteas-Wood indicated that the recommendation is to receive information regarding the topic, discussion, and outcome of ECAC subcommittees and educational events. Ms. Cook informed the Committee that subcommittee reports and information about trainings and other educational events are currently provided at ECAC meetings. Ms. Cook asked for clarification and inquired if Committee members would like additional information provided to them. Ms. Conteas-Wood requested that ECAC have an Agenda item for educational events and subcommittee updates. Idalia Chitica, Lead Field Specialist noted that ECAC subcommittees do not vote on ECAC issues. The subcommittees or ad hoc committees develop recommendations which are presented to ECAC for review and approval. Ms. Chitica summarized the activities of the recent ad hoc Committee to discuss At-Large member roles and responsibilities, and the RCAC training ambassador program.

Ms. Conteas wood requested a vote by ECAC on her proposals. Linda Merkens, Manager, Board Services Department, informed the Committee that an item for action by ECAC must have been publicly posted on the Agenda prior to the meeting. Ms. Conteas-Wood noted that she brought up this topic at previous meeitngs, and asked for guidance on how to properly present the motion. Ms. Merkens informed the Committee that the Brown Act requires that the meeting Agenda have a description of an item on which the Committee will vote. Ms. Conteas-Wood asked for clarification on the process to get that description on the Agenda. Ms. Merkens suggested Ms. Conteas-Wood contact Ms. Chitica for additional information on the next ECAC Agenda.

RCAC 6 Member Issue Mary Romero, RCAC 6 Chair, described a member issue raised at the RCAC 6 meeting on April 17, 2014. RCAC 6 members reported that providers in the community are reluctant to conduct timely diagnosis for terminal illness, and instead resort to prescribing pain medication as a temporary solution. Ms. Romero noted that several RCAC 6 members noted having lost a family member, neighbor, or friend due to untimely diagnosis. Ms. Romero noted that RCAC 6 members are brainstorming about this issue. Ms. Cook informed the Committee that this topic will be forwarded to the Interdisciplinary Committee. Ms. Cook noted that RCAC 6 members may be contacted by a member of the Interdisciplinary Committee to get more information. An update will be provided to

114

ECAC at a future meeting. Ms. Cook noted that Gertrude S. Carter, MD, Chief Medical Officer, and the Quality Improvement Department are working on incentive programs for providers to encourage improved services for L.A. Care members.

Ms. Deh-Lee asked if hospitals and provider offices have protocols for cancer screening. Ms. Conteas-Wood informed the Committee that there are protocols and standards and treatment depends on the timing of the visit and the stage of the condition.

RCAC 10 Member Issue Chairperson Aguilar noted that at the February 20, 2014 meeting, RCAC 10 members reported that Altamed and other clinics in East Los Angeles are overcrowded, have long waiting periods for appointments, and over prescribe medication. Ms. Cook noted that this issue will be forwarded to the Interdisciplinary Committee for review.

Member Romero noted lack of accessible parking at community clinics, and further noted that this is an issue especially for ceniors and people with disabilities, who require handicapped parking.

Chairperson Aguilar informed the Committee that El Sereno Medical Clinic operates with just one physician assistant (PA) which sees 82 patients a day, and the appointment wait time can be up to nine hours. She noted that about half of the patients at this clinic are seniors. Ms. Cook acknowledged her concerns and the need for a better delivery of healthcare in the existing medical system. Ms. Cook noted that speaking out about concerns and providing feedback can help resolve issues.

Ms. Poz asked if L.A. Care can provide a questionnaire for the At-Large members to use at community clinics to gather feedback to help resolve the issues that have been presented. Ms. Cook noted Health Insurance Portability and Accountability Act (HIPA) regulations protect patients’ privacy, and cautioned Committee members that conducting surveys at doctor’s office may invade privacy. Ms. Cook informed ECAC members that there will be opportunities to provide information through partnerships with the Quality Improvement department and Interdisciplinary Committee.

Staff from the Member Services Department was available at the end of the meeting to assist with individual member issues.

Community Engagement

ECAC members

Elda Sevilla, RCAC 11 Chair, informed ECAC that RCAC 11 will host a “Get Fit Passport to Health” event on Tuesday, May 20, 2014, from 9:00 a.m. to 1:00 p.m. at Sacred Heart Church in Pomona, and she encouraged everyone to attend. Flyers in English and Spanish with additional information about the event were distributed to Committee members.

NEW BUSINESS Culture and Linguistics (C&L) Presentation

Trina Ruiz, Interpreting Services Specialist, reported: • L.A. Care’s Culture & Linguistics (C&L) Department offers interpreting services to its members.

115

• L.A. Care notifies members of these services through videos the annual member mailing. • L.A. Care informs providers of interpreting services provided by L.A. Care through the annual

provider audit, provider tool kits, provider manual and contracts. • L.A. Care offers face to face and telephonic interpreting. Face to face interpreting is often used

for clinic and Primary Care Physician (PCP) visits. Telephonic interpreting is mostly used in the Call Center/Member Services Department, but is also available for providers for last minute or walk in appointments.

• There are challenges in getting American Sign Language interpreters. C&L staff works with the member and the provider to get an interpreter for provider appointments.

• C&L sends satisfaction surveys to members who receive interpreting to get feedback about the session.

Chairperson Aguilar asked how members can get a DVD about LA Care enrollment. Ms. Ruiz indicated that that L.A. Care sends a DVD to members in their preferred language. She noted that a response card included in the packet also includes information for Spanish speaking members.

Board member Pérez inquired about the number of interpreters available per area and if L.A. Care has evaluated the need to contract with additional vendors to provide interpreting services. Ms. Ruiz noted that L.A. Care is challenged with accessing primarily American Sign Language interpreters. The vendor has about 80 interpreters available, and they also work in call centers, courts, and schools. L.A. Care has contracts with other vendors and can accommodate member requests.

Adela Guadarrama, RCAC 1 Chair, noted that a RCAC 1 member has reported issues accessing an interpreter for a doctor appointment. According to Ms. Guadarrama, call center representatives tell the member to request an interpreter within two weeks of an appointment, but the interpreter never shows up to the appointment. Ms. Ruiz noted that L.A. Care can receive interpreter services requests even one month prior to the appointment; L.A. Care confirms the appointment with the. Ms. Ruiz will follow up with training for call center and Member Services staff.

Ms. Poz asked if L.A. Care provides interpreting services for emergency medical care. Ms. Ruiz noted that hospitals provide this service in the emergency room.

Health Information Technology (HIT)- Blue Button Presentation

The presentation was not provided at this meeting.

RCAC Chair and Vice Chair Nominations/Elections

Idalia Chitica, Lead Field Specialist, CO&E, informed ECAC members that RCAC Chair and Vice Chair nominations will be open at the June and July RCAC meetings, and will close prior to the elections at the August and September RCAC meetings. Chairs that have served two (2- year) terms are not eligible for the Chair but may be eligible for the Vice Chair position. ECAC members are encouraged to talk to RCAC members about the Chair and Vice Chair positions and the associated responsibilities. RCAC members will receive by mail a list of eligible candidates and a summary of

116

the responsibilities for each position.

OLD BUSINESS

CO&E Staff Changes

Ms. Chitica summarized staff changes effective May 2014: • The Field Specialist for RCACs 1 and 2 will be Judy Hsieh Bigman. Hilda Herrera continues to

be the Liaison for these RCACs. • The Field Specialist for RCACs 3 and 4 will be Kristina Chung, and Ricardo Rivas will be the

Liaison. • The Field Specialist for RCAC 6 will be Frank Meza, and Laura Garcia will temporarily serve as

Liaison until Cynthia Rios returns. • The Field Specialist for RCAC 7 will be Frank Meza, and Ricardo Rivas will be the Liaison. • The Field Specialist for RCAC 8 will be Frank Meza beginning in June, and Laura Garcia will

continue to be the Liaison. • There are no staff changes in RCACs 5, 9, 10, and 11.

Ms. Chitica asked ECAC to support staff during the transition to ensure successful meetings.

Board member Pérez noted that Laura Garcia is the Liaison for the Health Promoter program, and that this program is growing along with the organization. She also noted that Cynthia Rios, Program Coordinator, will be acting Liaison at some RCACs. Board member Pérez is concerned that the Health Promoter’s program may be understaffed. Ms. Chitica acknowledged her concerns.

Community Health Improvement Project (CHIP)

Ms. Chitica reported: • A total of 8, 674 outreach encounters were received. • The RCACs with the most membership participation are RCAC 8, RCAC 7, and RCAC 11.

These RCACs will be recognized with a special breakfast or lunch at a RCAC meeting. • All RCAC members who participated in the CHIP outreach program will receive a certificate of

participation at the upcoming RCAC meetings, and those with highest number of encounters will receive special recognition.

Ana Romo, RCAC 8 Chair, asked if the recognition process could be modified to include those who did exemplary outreach on an individual basis. Ms. Chitica noted that members who turned in at least one outreach form will receive a certificate of recognition. In past years, members that went above and beyond were recognized at a ceremony but this year L.A. Care will consider recognizing them in the member newsletter and individual RCAC meetings. Ms. Cook shared her disappointment with the total outreach encounters compared to previous years, where 40,000 outreach encounters were reported. Ms. Cook noted that the changing healthcare environment was a great opportunity to reach out to people about the changes and resources available in the community.

117

Dalia Cadena, RCAC 7 Chair, asked ECAC members to encourage RCAC members to actively participate in all activities to further enhance the RCACs and L.A. Care’s programs.


ADJOURNMENT Chairperson Aguilar adjourned the meeting at 12:55 p.m.

RESPECTFULLY SUBMITTED BY: APPROVED BY: Hilda Stuart, Committee Liaison, Board Services _________________________________________ Linda Merkens, Manager, Board Services Aida Aguilar, ECAC Chair

Date _____________________________

118

Please take note that Board and its Committees traditionally go DARK in August. There will be no meetings in August. For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last

moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. Prepared by mhbalones/printed on 07/03/14

Monday Tuesday Wednesday Thursday Friday Saturday Sunday 1 2 3

4 5 6

7 8 9

ECAC 10 am

(for approximately 2 hours)

10 Board of Governors

Meeting 2 pm


11 12 13

14

15 CHCAC

8 am (for approximately 2 hours)

16 Finance & Budget

1 pm (approximately 1-1/2 hours)

Executive Committee 2:30 pm


17

18

19 20

21

22

23

24 TAC 9 am

(for approximately 2 hours) Compliance & Quality

1 pm (for approximately 2 hours)

Audit - 2:30 pm (for approximately 2 hours)

25 26 27

28 29 30

31

Schedule of Meetings July 2014

124

For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting,

please call (213) 694-1250 or send email to [email protected].

Compliance & Quality 1 pm


1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017 Tel. (213) 694-1250 / Fax (213) 438-5728

MEETING DAY, TIME, & LOCATION

MEETING DATES

MEMBERS

Board of Governors

General Meeting

1st Thursday 2:00 PM

(for approximately 3 hours) 1055 W. 7th Street,

10th Floor, Los Angeles, CA 90017

**moved due to July 4 holiday

July 10**

No meeting in August

September 4 October 2

November 6 December 4

Thomas Horowitz, DO, Chairperson Mark Gamble, Vice Chairperson Michael Rembis, FACHE, Treasurer Louise McCarthy, Secretary Jann Hamilton Lee Thomas S. Klitzner, MD, PhD, Alexander K. Li, MD Ozzie Lopez Honorable Gloria Molina Hilda Perez G. Michael Roybal, MD, MPH Sheryl Spiller Walter A. Zelman, PhD

Staff Contact: Howard A. Kahn, Chief Executive Officer, x4102 Linda Merkens, Manager, Board Services, x4050

Board of Governors & Public Advisory Committees 2014 Meeting Schedule / Member Listing

125

BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2014 MEETING SCHEDULE / MEMBER LISTING



Board of Governors - Standing Committees


MEETING DATES

2014 MEMBERS

Executive Committee 4th Wednesday of the month 2:30 PM

(for approximately 2 hours) 1055 W. 7th Street,


**moved due to summer /

holidays

July 16 ** No meeting in

August September 24 October 22

November 19* No meeting in

December

Thomas Horowitz, DO, Chairperson Mark Gamble Michael Rembis Louise McCarthy G. Michael Roybal, MD, MPH Alexander K. Li, MD

Staff Contact: Linda Merkens, Manager, Board Services, x4050

Compliance & Quality Committee

3rd Thursday every 2 months 2:30 PM


1055 W. 7th Street, 10th Floor, Los Angeles,

CA 90017

*Rescheduled meeting at 1 pm

July 24 * No meeting in

August September 18 November 20

No meeting in December

G. Michael Roybal, MD, MPH, Chairperson Jann Hamilton Lee Alexander Li, MD Honorable Gloria Molina Hilda Perez Staff Contact: Malou Balones Committee Liaison, Board Services, x 4183

Finance & Budget Committee

4th Wednesday of the month 1:00 PM



CA 90017

*moved due to summer / holidays

July 16 ** No meeting in

August September 24 October 22

November 19* No meeting in

December

Michael A. Rembis, FACHE, Chairperson Jann Hamilton Lee Thomas Horowitz, DO Ozzie Lopez Louise McCarthy

Staff Contact: Hilda Stuart Committee Liaison, Board Services, x 4184

Governance Committee

MEETS AS NEEDED 1055 W. 7th Street,


Alexander K. Li, MD, Chairperson Mark Gamble Ozzie Lopez Hilda Perez Sheryl Spiller Walter A. Zelman, PhD

Staff Contact: Malou Balones Committee Liaison, Board Services/x 4183

126





MEETING DATES

2014 MEMBERS

Service Agreement Committee

MEETS AS NEEDED 1055 W. 7th Street,


Chairperson to be elected Ozzie Lopez Louise McCarthy Honorable Gloria Molina Hilda Perez Sheryl Spiller

Staff Contact Malou Balones Committee Liaison, Board Services/x 4183

Audit Committee MEETS AS NEEDED 1055 W. 7th Street,


July 24 2:30 pm

G. Michael Roybal, MD, MPH, Chairperson Jann Hamilton Lee Alexander K. Li, MD Staff Contact Hilda Stuart Committee Liaison, Board Services, x 4184

127





MEETING DATES

MEMBERS

L.A. Care Community

Health

Meets Annually or as needed 1055 W. 7th Street,




L.A. Care Joint Powers Authority

Meets Quarterly or as needed


CA 90017



128




Public Advisory Committees MEETING DAY, TIME,

& LOCATION MEETING

DATES

STAFF CONTACT Children’s Health

Consultant Advisory Committee

General Meeting

3rd Tuesday of every other month

8:30 AM (for approximately 2 hours)

1055 W. 7th Street,


July 15 September 16 November 18

Lyndee Knox, PhD, Chairperson Staff Contact: Hilda Stuart Committee Liaison, Board Services, x 4184

Executive Community Advisory

Committee

2nd Wednesday of the month 10:00 AM



CA 90017

July 9 No meeting in August

September 10 October 8

November 12 December 10

Aida Aguilar, Chairperson Staff Contact: Idalia Chitica, Community Outreach & Education, Ext. 4420

Technical Advisory Committee

4th Thursdays every other month

9:00 AM (for approximately 2 hours)

1055 W. 7th Street,



Chairperson to be elected Staff Contact: Malou Balones Committee Liaison, Board Services/x 4183

129




REGIONAL COMMUNITY ADVISORY COMMITTEES

REGION


MEETING DATE

STAFF CONTACT

Region 1 Antelope Valley

3rd Friday of every other month

10:00 AM (for approximately 2-1/2 hours)

Chimbole Cultural Center 38350 N. Sierra Highway

Palmdale, CA 93550 Tel (661) 267-5656

August 15 October 17

December 19

Adela Guadarrama, Chairperson Staff Contact: Kristina Chung Community Outreach & Education, Ext. 5139

Region 2 San Fernando Valley

3rd Monday of every other month

10:00 AM (for approximately 2-1/2 hours) Francis Polytechnic Senior High

School 12431 Roscoe Blvd.

Sun Valley, CA 91352


December 15

Carlos Aguirre, Chairperson Staff Contact: Kristina Chung Community Outreach & Education, Ext. 5139

Region 3 Alhambra, Pasadena

and Foothill

3rd Tuesday of every other month 9:30 AM

(for approximately 2-1/2 hours) Jackie Robinson Community

Center 1020 N. Fair Oaks Blvd.

Pasadena, CA 91103 Tel (626) 744-7300


December 16

Cynthia Conteas-Wood, Chairperson Staff Contact: Liliana Arevalo Community Outreach & Education, Ext. 4586

Region 4 Hollywood-Wilshire, Central and Glendale

3rd Tuesday of every other month


St. Vincent Medical Center Mark Taper Building Board Rm

2200 W. Third St. Los Angeles, CA 90057

Tel. (213) 484-7766


Hercilia Salvatierra, Chairperson Staff Contact: Liliana Arevalo Community Outreach & Education, Ext. 4586

Region 5 West

3rd Monday of every other month 2:00 PM

(for approximately 2-1/2 hours) Mar Vista Housing Dev.

Multipurpose Room 4909 Marionwood Street Culver

City, CA 90230 Tel. (310) 915-9006


December 15

Maria Guadalupe Mendez, Chairperson Staff Contact: Martin Vicente Community Outreach & Education, x 4423

130




REGION


MEETING DATE

STAFF CONTACT

Region 6 South, Compton,

Inglewood

3rd Thursday of every other month 3:00 PM

(for approximately 2-1/2 hours) Saint John’s Well Child & Family Center

808 W. 58th Street Los Angeles, CA 90037

Tel. (323) 541-1600


December 18

Mary Romero, Chairperson Staff Contact: Auleria Eakins Community Outreach & Education, x 4280

Region 7 San Antonio and

Bellflower


(for approximately 2-1/2 hours) Old Timers Foundation Family

Center 3355 E. Gage Avenue

Huntington Park, CA 90255 Tel (323) 582-6090


Dalia Cadena, Chairperson Staff Contact: Liliana Arevalo Community Outreach & Education, Ext. 4586

Region 8 Torrance and Harbor

3rd Friday of every other month


John Mendez Community Center 707 W. C Street

Wilmington, CA 90748 Tel. (310) 549-0052


Ana Romo – Chairperson Staff Contact: Idalia Chitica Community Outreach & Education, x 4420

Region 9 Long Beach

3rd Monday of every other month

9:00 AM (for approximately 2-1/2 hours) Miller Family Health Education Center

3820 Cherry Avenue Long Beach, CA 90807

Tel. (562) 570-7987


Christina Deh-Lee, Chairperson Staff Contact: Kristina Chung Community Outreach & Education, Ext. 5139

Region 10 East Los Angeles,

Whittier and North-East


(for approximately 2-1/2 hours) Boyle Heights Technology Youth Center

1600 East 4th Street Los Angeles, CA 90033

Tel. (323) 526-0145


December 18

Aida Aguilar, Chairperson Staff Contact: Martin Vicente, Community Outreach & Education, Ext. 4423

Region 11 Pomona and El

Monte

3rd Wednesday of every other Month


First Christian Church 1751 North Park Avenue

Pomona, CA 91768 Tel. (909) 622-1144


Elda Sevilla, Chairperson Staff Contact: Martin Vicente, Community Outreach & Education, Ext. 4423

131

BOARD OF GOVERNORS MEETING #237 - Home | L.A. …lacovered.org/sites/default/files/071014 BoG Mtg...

Documents

Transcript of BOARD OF GOVERNORS MEETING #237 - Home | L.A. …lacovered.org/sites/default/files/071014 BoG Mtg...