BOARD OF GOVERNORS MEETING #248 - L.A. Care Health Plan · Chairperson Horowitz noted that the...

BOARD OF GOVERNORS MEETING #248

September 3, 2015 ● 8:30 AM

Center for Healthy CommunitiesConference Room Yosemite BThe California Endowment1000 N. Alameda Street, Los Angeles, CA 90012

1

www.lacare.org Facebook/lacarehealth LinkedIn/company/l.a.-care-health-plan Twitter: @lacarehealth

Mission Statement

L.A. Care’s mission is 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.

Overview

Committed to the promotion of accessible, affordable and high quality health care, L.A. Care Health Plan (Local Initiative Health Authority of Los Angeles County) is an independent local public agency created by the State of California to provide health coverage to low-income Los Angeles County residents. With more than 1.8 million members in five product lines, L.A. Care is the nation’s largest publicly operated health plan.

L.A. Care Health Plan is governed by 13 board members representing specific stakeholder groups, including consumer members, physicians, federally qualified health centers, children’s health care providers, local hospitals and the Los Angeles County Department of Health Services.

L.A. Care advances individual and community health through a variety of targeted activities including a Community Health Investment Fund that has awarded more than $132 million throughout the years to support the health care safety net and expand health coverage. The patient-centered health plan has a robust system of consumer advisory groups, including eleven Regional Community Advisory Committees (governed by an Executive Community Advisory Committee), health promoters, and three Family Resource Centers that offer free health education and exercise classes to the community, and has made significant investments in Health Information Technology for the benefit of the more than 10,000 doctors and other health care professionals who serve L.A. Care members.

Programs

Medi-Cal – In addition to offering a direct Medi-Cal line of business, L.A. Care works with three subcontracted health plans to provide coverage to Medi-Cal members. These partners are Anthem Blue Cross, Care 1st Health Plan, and Kaiser Permanente. Since 2012, L.A. Care has enrolled more than 170,000 Seniors and Persons with Disabilities as members, and as of January 1, an additional 164,000 Healthy Way LA members transitioned to L.A. Care’s Medi-Cal program. Medi-Cal beneficiaries represent a vast majority of L.A. Care members.

L.A. Care Covered™ – As a state selected Qualified Health Plan, L.A. Care provides the opportunity for all members of a family to receive health coverage under one heath plan in the Covered California state exchange.

L.A. Care Cal MediConnect Plan– L.A. Care Cal MediConnect Plan provides coordinated care for Los Angeles

County seniors and people with disabilities who are eligible for Medicare and Medi-Cal.

L.A. Care Healthy Kids (0-5) – Sponsored by First 5 LA and the Children’s Health Initiative of Greater Los Angeles, Healthy Kids (0-5) provides health coverage for children who do not qualify for Medi-Cal and Healthy Families.

PASC-SEIU Homecare Workers Health Care Plan – L.A. Care provides health coverage to Los Angeles County’s In-Home Supportive Services (IHSS) workers, who enable our most vulnerable community members to remain safely in their homes by providing services such as meal preparation and personal care services.

About L.A. Care Health Plan

Updated 7/8/2015

2

http://www.lacare.org/

http://on.fb.me/y4xmGQ

http://linkd.in/xc7g8r

8/28/2015 10:29 AM

AGENDABOARD OF GOVERNORS RETREAT-MEETING No. 248Thursday, September 3, 2015, 8:30 A.M.Center for Healthy Communities, Conference Room Yosemite BThe California Endowment, 1000 N. Alameda Street, Los Angeles, CA 90012

Welcome Mark Gamble, Chair

1. Approve today’s Agenda Chair

2. Public Comment Chair

3. Approve July 30, 2015 meeting minutes Chair

4. Approve Consent Agenda Items

Delphix Corporation (FIN 100)

Oracle (FIN 101)

Revisions to the Regional Community Advisory Committee/Executive CommunityAdvisory Committee Operating Rules and Guidelines (BOG 100)

Eplus (BOG 101)

Chair

ADJOURN TO CLOSED SESSION (Est. time: 45 mins.) Chair

5. CONTRACT RATESPursuant to Welfare and Institutions Code Section 14087.38(m)

Plan Partner Rates

Provider Rates

DHCS Rates

6. REPORT INVOLVING TRADE SECRETPursuant to Welfare and Institutions Code Section 14087.38(n)Discussion Concerning New Product LinesEstimated date of public disclosure: August 2017

7. CONFERENCE WITH REAL PROPERTY NEGOTIATORSSection 54956.8 of the Ralph M. Brown ActUnder negotiation: Price and Terms of PaymentAgency negotiator: John Baackes, CEO

Property: 3180 E. Imperial Highway, Lynwood, California 90262Negotiating parties: Plamex Investments, LLC

Property: 3111 W. Century Blvd., Inglewood, CA. 90305Negotiating parties: Khedr Family Trusts

Property: 3102 W. Century Blvd., Inglewood, CA 90305Negotiating parties: Centers Business Management

Property: 1834 - 1852 W. Imperial Highway, Inglewood, CA. 90305Negotiating parties: Binmore Trust

Property: 320 - 330 E. Manchester, Inglewood, CA. 90305Negotiating parties: 330 Manchester Management, LLC

RECONVENE IN OPEN SESSION Chair

3

maloub

Text Box

p.29

maloub

Text Box

p.30

maloub

Text Box

p.31

maloub

Text Box

p.49

maloub

Text Box

p.5

Board of Governors Retreat-Meeting AgendaSeptember 3, 2015, Page 2 of 2

8/28/2015 10:29 AM

8. Chairperson’s Report Chair

9. Chief Executive Officer Report

Overview of major initiatives, opportunities and challengesfor the organization

John BaackesChief Executive Officer

10. Finance & Budget Committee Report

Monthly Investment Report

2015-16 Fiscal Year Capital and Operating Budget (FIN 102)

Tim ReillyInterim Chief Financial Officer

11. Strategic Discussion: Healthcare Trends

ADJOURN TO CLOSED SESSION (Est. time: 3 hours)

12. REPORT INVOLVING TRADE SECRETPursuant to Welfare and Institutions Code Section 14087.38(n)Discussion Concerning New Product LinesEstimated date of public disclosure: August 2017

RECONVENE IN OPEN SESSION

13. Strategic Vision John Baackes

14. Closing Remarks John BaackesMark Gamble

Adjournment

The next meeting will be on Thursday, October 1, 2015at L.A. Care Health Plan, 1055 W. 7th Street, Los Angeles, CA 90017

The order of items appearing on the agenda may change during the meeting. Teleconference arrangements may change priorto 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 TOADDRESS” FORM AND SUBMITTING THE FORM TO L.A. CARE STAFF PRESENT AT THE MEETING BEFORE THE AGENDA ITEM ISANNOUNCED. 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 MADETO 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 AGENDAand 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 beenposted 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 ServicesDepartment 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.50

maloub

Text Box

Steven T. Valentine President, The Camden Group

maloub

Text Box

maloub

Text Box

p.57

maloub

Text Box

p.74

maloub

Text Box

p.120

of 24

DRAFT

Board of GovernorsGeneral Meeting # 247Meeting Minutes –July 30, 2015L.A. Care Health Plan Conference Room 1018-10191055 W. Seventh Street, Los Angeles, CA 90017

Members Management/StaffThomas Horowitz, DO, Chairperson Alexander K. Li, MD John Baackes, Chief Executive OfficerMark Gamble, Vice Chairperson Ozzie Lopez, MPA ** Gertrude S. Carter, Chief Medical OfficerMichael A. Rembis, FACHE, Treasurer Hilda Perez Jonathan Freedman, Interim Chief Operating Officer andLouise McCarthy, Secretary G. Michael Roybal, MD, MPH Chief of Strategy, Regulatory & External AffairsMichael D. Antonovich* Sheryl Spiller Ellin Davtyan, Associate CounselHector De La Torre* Kimberly Uyeda, MD, MPH* Tim Reilly, Chief Financial OfficerJann Hamilton Lee Tom Schwaninger, Chief Information Officer

*Absent ** Teleconference Robert Turner, Chief of Human Resources

AGENDAITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKENCALL TO ORDER

Thomas Horowitz, DO,

Thomas Horowitz, DO, Chairperson, called the meeting to order at 2:05 p.m.

Chair Horowitz announced that the Public may address the Board on any matter at the PublicComment section at the beginning of this meeting. Guests are welcome to introduce themselvesor can remain anonymous.

APPROVAL OFMEETING AGENDA

Thomas Horowitz, DO

Chairperson Horowitz suggested amending the Agenda to add ten items to the Consent Agenda.

The meeting agenda was approved as amended.

Approved unanimouslyby roll call. 10 AYES(Gamble, Hamilton Lee,Horowitz, Li, Lopez,McCarthy, Perez,Rembis, Roybal, andSpiller).

PUBLIC COMMENT Elizabeth Cooper indicated she would like to comment when the Board considers the ConsentAgenda.

RCAC 2PRESENTATION

Eveline Bravo Ayala, District Representative for Senator Robert M Hertzberg, and Jaqueline Serrano,Field Representative for Congressman Tony Cardenas, presented Judy Bigman and Hilda Herrera withcertificates recognizing their contributions to community advocacy and teaching advocacy skillsto community members.

5

Board of Governors MeetingJuly 30, 2015, Page 2 of 24 DRAFTDRAFT

AGENDAITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN

Hilda Perez, Consumer Board Representative, congratulated Ms. Bigman and Ms. Herrera, and sheintroduced Elizabeth Cooper and Ana de Jesus, members of RCAC 2. Ms. Cooper thanked allthe members of the Community Outreach and Engagement staff. Ms. Perez thanked Ms. Ayalaand Ms. Serrano for coming to the meeting.

Chairperson Horowitz noted that the presentation of certificates of appreciation attests to thehigh caliber of people who work at L.A. Care.

ACCEPTANCE OFMINUTES OFMEETING

Thomas Horowitz, DO

The minutes of the meeting on June 4, 2015 were approved as submitted. Approved unanimouslyby roll call. 10 AYES

APPROVAL OFCONSENT AGENDA

Thomas Horowitz, DO

John Baackes, Chief Executive Officer, commented that two of the motions are brought to theBoard to comply with the new policy for Board approval of expenditures for meals. Goingforward these items will be brought for Board approval in the fiscal year Operating Budget.Tim Reilly, Chief Financial Officer, added that those items will be explicitly indicated in the budget.Chair Horowitz noted that the Chair of Finance & Budget Committee will also continue toreview such expenditures for meals.

PUBLIC COMMENT: Elizabeth Cooper, member of RCAC 2, asked that Board membersconsider the budget for the RCACs, under management of Maribel Ferrer and Auleria Eakins,that it is sustained. She commented on item 3, that she is for anything to help the providers.She recommended that staff receive fresh fruit to keep them healthy and happy, and that theBoard should also consider making the RCAC members happy.

1. Ratify execution of Amendment No. 18 to Contract 04-36069 between the CaliforniaDepartment of Health Care Services and L.A. Care Health Plan, and to ratify any non-substantive changes (EXE 100)

2. Contract amendment with WeiserMazars for temporary consulting services to MedicalPayment Services and Health Services (FIN 100)

3. Execute contract with WeiserMazars, LLP to provide project management and oversight ofthe Health Management System (HMS) coordination of benefits project on behalf of L.A.Care (FIN 101)

4. Amend contract with WeiserMazars, LLP, to provide consulting and project managementservices to develop and test a replacement Provider Dispute Resolution (PDR) program

6



(FIN 102)5. Authorize staff to procure network and wireless equipment from FireOwls to support L.A.

Care’s floor expansions (FIN 103)6. Authorization for Fresh Fruit Friday to L.A. Care employees (FIN 104)7. Update Finance & Budget Committee Meeting Schedule (FIN 105)8. Quarterly Investment Report (FIN 106)

Member McCarthy may have financial interests for which she might have a potential conflict of interest, andas such she refrained from participating in the discussion and vote on Motion FIN 107.0715.

9. Department of Health Care Services for Medi-Cal electronic health record (EHR) incentiveprogram technical assistance (FIN 107)

10. Interpreting Services International contract (FIN 108)11. International Business Machines (IBM) contract (FIN 109)12. Approve RCAC Membership approved at June 10, 2015 ECAC Meeting (ECA 100)13. Approve RCAC Membership approved at July 8, 2015 ECAC Meeting (ECA 101)14. Ratify RCAC 10 Chair Election (ECA 102)

The following items were added during Approval of the Meeting Agenda, earlier in this meeting:1. Approve award Worker Education & Resource Center, Inc. (EXE 101)2. Approve Award for Los Angeles Network for Enhanced Services (LANES) (EXE 102)

Members Lopez and McCarthy may have financial interests for which they might have a potential conflict ofinterest, and as such they refrained from participating in the discussion and vote on Motion EXE103.0715.

3. Approve Specific Community Health Investment Fund (CHIF Allocation) (EXE 103)4. Approve Revisions to Policy AFS-006 (Authorization and Approval Limits (FIN 111)5. Approve Contract Amendment with Health Management System to provide Cal

MediConnect capitation recovery services and coordination of benefits services for L.A.Care lines of business (FIN 112)

6. FirstSource Contract Amendment for Medi-Cal Claims (FIN 113)7. Fall 2015 (Consumer) Education Conference and Executive Summit (FIN 114)8. Approval to execute various contracts for the Provider Continuing Education Program

(FIN 115)9. Approve Expense for New Staff Orientation (FIN 116)10. Salesforce and Cognizant Contract Amendment for customer relationship management

services (FIN 117)

The Consent Agenda with24 items was approvedunanimously by roll call.10 AYES (Gamble,Hamilton Lee, Horowitz,Li, Lopez, McCarthy,Perez, Rembis, Roybal,and Spiller).

Member McCarthyabstained on motion FIN107.0715.

Members Lopez andMcCarthy abstained onmotion EXE 103.0715.

7


AGENDAITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKENADJOURN TOCLOSED SESSION

Thomas Horowitz, DO

Ellin Davtyan, Associate Counsel, announced the following items to be discussed in closed session. The Board adjourned to aclosed session at 2:20 p.m.

A. CONTRACT RATESPursuant to Welfare and Institutions Code Section 14087.38(m)

Plan Partner Rates

Provider Rates

DHCS Rates

Medi-Cal Managed Care Supplemental Payment

B. REPORT INVOLVING TRADE SECRETPursuant to Welfare and Institutions Code Section 14087.38(n)Discussion Concerning New Product LinesEstimated date of public disclosure: July 2017

C. CONFERENCE WITH REAL PROPERTY NEGOTIATORSSection 54956.8 of the Ralph M. Brown ActProperty: 3180 E. Imperial Highway, Lynwood, California 90262Agency negotiator: John Baackes, CEONegotiating parties: Placo Investment, LLCUnder negotiation: Price and Terms of Payment

D. CONFERENCE WITH LEGAL COUNSEL –ANTICIPATED LITIGATIONPursuant to Section 54956.9 (d)(2) of the Ralph M. Brown ActOne potential case

E. CONFERENCE WITH LABOR NEGOTIATORPursuant to Section 54957 of the Ralph M. Brown ActAgency Negotiator: John Baackes, CEOUnrepresented Employee: All L.A. Care Employees

F. CONFERENCE WITH LABOR NEGOTIATORPursuant to Section 54957 of the Ralph M. Brown ActAgency Negotiator: Thomas Horowitz, DOUnrepresented Employee: John Baackes

8


AGENDAITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKENRECONVENE INOPEN SESSION

Thomas Horowitz, DO

The Board reconvened in open session at 2:50 p.m. There was no report of action taken duringthe Closed Session.

CHAIRPERSON’SREPORT

Thomas Horowitz, DO

Board Services will send information about the 2016 Board committee assignments. TheChairperson that is elected later in this meeting will announce committee assignments at theSeptember meeting.

Chair Horowitz encouraged Board members to attend the World Special Olympics.

CHIEF EXECUTIVEOFFICER REPORT

John Baackes

Mr. Baackes reported:

L.A. Care is being audited by the California Department of Health Care Services (DHCS)and the Department of Managed Health Care (DMHC). Staff expects intense scrutiny ofplan operations and that there will be findings which will require corrective action by L.A.Care. Mr. Baackes commended the work of staff in medical services and operations toprepare for the audits. L.A. Care has added many new members in new lines of business.He noted that the strategic vision segment that seeks to hold contracted entities responsiblefor their performance is clearly very important to L.A. Care’s overall performance. Reportson the audits are expected early next year.

Mr. Baackes noted that there have been recent media reports of merging health insurers andproviders, reportedly due to the effects of Affordable Care Act which compel insurers toconsolidate to preserve profitability. He indicated that L.A. Care is a local plan, and whileL.A. Care needs to remain competitive, he sees its local aspect as an advantage inmaintaining and supporting ties with members and stakeholders in the community.

Mr. Baackes has visited all the L.A. Care Family Resource Centers (FRC), and has been tothree meetings of Regional Community Advisory Committees and plans to visit others soon.He noted that RCAC members have asked about adding FRCs in their areas and he isincluding in the strategic vision an analysis of the FRCs to stay in contact and provide addedvalue to L.A. Care members.

He recently participated in a meeting of the California Association of Provider Groups,where he informed them that the elevated scrutiny of L.A. Care health plan operations isdriving a need for L.A. Care to more intensely evaluate the performance of its contractedproviders.

Mr. Baackes also recently traveled to Washington D.C., to attend the ACAP meeting and tomeet with members of the Los Angeles County Congressional delegation.

9



He noted that he sees an opportunity for L.A. Care to continue to improve its services andprovide more value for members and providers in L.A. County, and he thanked the Boardfor the opportunity.

Operations Report

Jonathan Freedman

Jonathan Freedman, Interim Chief Operating Officer and Chief of Strategy, Regulatory & External Affairs,referenced the report included in the materials for this meeting. (A copy of the report may berequested from Board Services.)

He noted the increase in membership (up to 1.787 million members), which is 17% of thepopulation of Los Angeles County.

He also noted the large claims inventory which is being aggressively addressed in a variety ofways and improvements are being made. Appropriate notifications have been made toDMHC and DHCS.

He invited Board members to review the report sections for the Cal Medi-Connect (CMC)program and the Star initiative related to CMC. He noted that L.A. Care’s providercontracts are being updated with a standardized division of financial responsibility (DOFR)which should help L.A. Care and its partners process claims more efficiently.

There has been a significant improvement in data completeness for the HealthcareEffectiveness Data and Information Set (HEDIS), through a collaborative initiative with theLos Angeles County Department of Health Services.

Core System Update

Tom Schwaninger

Mr. Baackes reported that there have been challenges in implementing L.A. Care’s conversion toQNXT. The project has been delayed and has been over budget as a result of complications insimultaneously adding multiple new product lines. The core system conversion is critical to L.A.Care’s operations, and staff has worked to develop a new plan to ensure the project’ssuccess. Bruce Pollack has taken on the role of Core System Czar, and is leading staff in acomplete examination of the project and recommendations for completion of the conversion.

Tom Schwaninger, Chief Information Officer, reported on the new approach to completing theQNXT conversion. The project is being repositioned to improve the quality of businessprocesses and data, while at the same time implementing the new system.

Bruce Pollack, Core System Czar, reported that the lines of business already installed on QNXTare being adjusted to benefit from the functionality provided in the new core system.Mr. Schwaninger added that core processes including authorizations, claims, and provider datawill be refined in the course of the project and the scope has been expanded to include newportals for both members and providers. The Enterprise Data Warehouse continues to be built

10



as a foundation for data across the enterprise as part of the project. Conversion of the Medi-Calline of business is now set for September, 2016.

Mr. Pollack indicated that intensive testing is underway in a separate environment to make surethe system functions properly before the member and provider information is moved to thenew system. System functions will be measured against performance benchmarks which arebeing established.

In response to a question regarding the timeline for addressing the backlog of claims, Mr.Freedman noted that 24,000 claims are in the QNXT system. L.A. Care’s Medi-Cal programhas not yet migrated to QNXT, so most of the claims backlog is in the MHC Legacysystem. Mr. Schwaninger indicated that in improving provider data quality for transfer toQNXT, the MHC Legacy system and the Medi-Cal claims backlog will also benefit.

Mr. Freedman reported that L.A. Care has informed DMHC that the claims backlog will bewithin acceptable parameters by September, 2015. Member Rembis, Treasurer, asked that staffprovide a report on accounts receivable to the Finance & Budget Committee.

Member Li asked that staff clarify the design and build for the Medi-Cal line of business. Mr.Schwaninger reported that in defining the system requirements, it was recognized that whilethere are some common core foundational requirements across the lines of business, staff wantsto be sure that the processes and systems are carefully designed to successfully transition theunique needs of each line of business which can vary significantly.

Mr. Schwaninger indicated that additional project costs are included in the budget for the nextfiscal year. Member Gamble requested that information to be included in 2016 budget showingthe total cost of the QNXT conversion.

Mr. Baackes noted that the delay in order to review the project has helped avoid potentiallyserious problems. Mr. Baackes informed the Board that the incentive program for the QNXTconversion will be adjusted for the new timeline. The Board requested a project status report tothe Board on a quarterly basis.

Third QuarterOrganizationalPerformance Report FY2014-1015

Mr. Freedman referred to the report included in the materials for this meeting. (A copy of thereport may be requested from Board Services.) He reported that L.A. Care has completed manyimportant tasks, including:

New member portal to meet new National Committee on Quality Assurance (NCQA)member services standards.

11


AGENDAITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKENJonathan Freedman Pilot project with vision to learn –outreach to school age population for eyeglasses,

reaching 1,800 children.

Member Lopez noted that Mr. Baackes earlier stated that L.A. Care will evaluate placingadditional FRCs in the community, and he asked if he would consider a mobile unit to respondto member requests for FRC services in their area, and Mr. Baackes thanked Mr. Lopez andindicated that his suggestion will be explored.

MOTIONS FORCONSIDERATIONContract with CommunityClinics Association of LosAngeles County(CCALAC), andsubcontracts with ObjectHealth and e2o Health

Member McCarthy and Hamilton Lee may have financial interests for which they might have a potential conflictof interest, and as such they refrained from participating in the discussion and vote on this motion.

Gertrude S. Carter, Chief Medical Officer, summarized a motion to continue the third year of workunder a grant that funds L.A. Care technical assistance through its vendors to community clinicsand practices that need help with health information technology.

Motion BOG 100.0715To authorize staff to execute a contract with Community Clinics Association of LosAngeles County (CCALAC) and subcontract with Object Health and e2o Health toprovide consulting services to CCALAC for the amount of $278,000 for the period ofDecember 1, 2015 to July 31, 2016.

Approved by roll call.8 AYES (Gamble,Horowitz, Li, Lopez,Perez, Rembis, Roybal,and Spiller)

2 ABSTENTIONS(Hamilton Lee,McCarthy).

Award to FederallyQualified Health Centers(FQHCs) and FQHC look-alikes to provide stipendsto participatingcommunity based clinics

Members Hamilton Lee and McCarthy may have financial interests for which they might have a potential conflictof interest, and as such they refrained from participating in the discussion and vote on this motion.

Mr. Freedman noted that this motion will authorize grant funding for a program to helpFQHCs to improve financial acumen of its staff.

Motion BOG 101.0715To approve an award of up to $300,000 to a future selected entity to provide financialtechnical assistance to Federally Qualified Health Centers (FQHCs) and FQHC look-alikes and to provide stipends to participating community-based clinics.

Approved by roll call.8 AYES (Gamble,Horowitz, Li, Lopez,Perez, Rembis, Roybal,and Spiller)

2 ABSTENTIONS(Hamilton Lee,McCarthy).

Care Harbor Sponsorship Mr. Freedman summarized a recommendation to allocate $120,000 to continue L.A. Care’ssponsorship of the 2016 Care Harbor LA clinic. The annual sponsorship promotes L.A. Care’sbranding awareness and the clinic occurs during enrollment activities for California Covered,which provides an opportunity for L.A. Care to assist clinic attendees to enroll in health care

12



programs.

PUBLIC COMMENT: Ms. Cooper asked if the clinic serves diverse populations.Chairperson Horowitz responded that the clinic does serve diverse populations and that is itsmain purpose.

Motion BOG 102.0715To approve a sponsorship of $120,000 and $13,000 for promotional items for the 2015“Care Harbor LA” Healthcare Clinic.

Approved unanimouslyby roll call. 10 AYES(Gamble, Hamilton Lee,Horowitz, Li, Lopez,McCarthy, Perez,Rembis, Roybal, andSpiller).

Pacific Health ConsultingGroup

Mr. Baackes reviewed the motion summary. The Board is asked to consider the request by TimReilly to return to his role as a consultant for L.A. Care. It is proposed to enter into aconsulting agreement at the same value as his salary as Chief Financial Officer. Mr. Reilly willcontinue in the CFO role until a replacement is hired, and he will be available for continuedadvice and assistance to L.A. Care.

Motion BOG 104.0715To authorize staff to execute a contract in the amount of $775,000 with PacificConsulting Group to provide consulting services for the period of August 1, 2015 to July31, 2016.

Approved unanimouslyby roll call. 10 AYES

Review of future costs ofchanges to retirementbenefits and considerationof amendment,termination or creation ofpension plans inconformance with theCalifornia PublicEmployees’ RetirementPension Reform Act of2013 and delegation ofauthority to the Finance &Budget to approveproposed changes.

Mr. Freedman reported that changes are recommended to L.A. Care’s employee retirementprogram.

As required by law, the following motion was considered with David V. Pappalardo, F.S.A., E.A., F.C.A.,M.A.A.A., Vice President & Consulting Actuary, Retirement Plan Strategies, Prudential Retirementparticipating in the meeting by telephone.

Staff proposes to provide a one-time contribution to L.A. Care’s Basic Defined Contribution401 (a) plan on behalf of L.A. Care employees that were previously members of its DefinedBenefit Plan (also known as the “2@62 plan”) prior to its termination and that are employedwith L.A. Care at the time the contribution will be made. Pursuant to Gov. Code Section 7507,the Board is advised that the anticipated future annual cost to bring L.A. Care’s contribution to7.5% of salary will be a non-recurring one-time payment of approximately $1,769,000. Thisnon-recurring payment will be funded from the excess employer contributions to the 2@62 plantrust of approximately $940,000 that will be returned to L.A. Care upon termination of theDefined Benefit Plan together with an additional contribution amount of approximately$829,717.

13



Motion BOG 103.0715To delegate authority to the Finance & Budget Committee to review and approve thefuture costs and authorize any necessary action, including but not limited toamendment of L.A. Care’s Basic Defined Contribution Plan to allow for a one-timecontribution to that Plan, or other payment options, as allowed under applicable law, toprovide a contribution of approximately $1,769,000 (funded from the excess employercontributions to the “2@62 plan” trust of approximately $940,000.00 that will bereturned to L.A. Care upon termination of the Defined Benefit Plan and additionalcontribution of approximately $829,717.00) for L.A Care employees that participated inthe Defined Benefit Plan and that are employed on the date of the distribution.


STANDING COMMITTEE REPORTS

EXECUTIVECOMMITTEE

Thomas Horowitz, DO

Chairperson Horowitz reported that the Committee met on June 24 and July 22 (minutes areavailable by contacting Board Services). Robert Turner, Chief of Human Resources, summarized a reporton the fees paid to brokers for various health and welfare benefits L.A. Care offers to itsemployees (report can be obtained by contacting Board Services.) In addition to one motion approvedearlier on the Consent Agenda, the Committee approved:

Human Resources new policy HR-125 (Sick Leave for Per Diem, Part-Time and Non-Regular Employees), to comply with new regulations (AB1522).

Amendment in the amount of $50,000 and a new contract in the amount of $75,000, with atotal not to exceed amount of $340,000 through December 31, 2015, with Pearl Meyer forconsulting work related to compensation, benefits, and job classifications.

Government AffairsUpdate

Jonathan Freedman

Mr. Freedman indicated that he is reporting in place of Cherie Fields, who is attending meetingson legislation co-sponsored by L.A. Care, the Community Clinics Association of Los AngelesCounty and the California Primary Care Association, regarding alternative paymentmethodology for federally qualified health centers.

He noted that the Legislature is in special session called by Governor Brown. At issue is thebillion dollar managed care organization (MCO) tax on Medi-Cal plans that does not complywith federal rules. The Governor proposed a model which places a replacement tax burden oncommercial health insurance and largely holds Medi-Cal plans harmless. The Governorproposes a tiered tax based on membership size, and a flat tax counter proposal favored bysome in the industry. The legislation may take months to resolve and is a dominant issue in the

14



health insurance industry. A failure to produce a tax could create a billion dollar funding crisis,despite the state’s improved economy. The tax must be passed by a 2/3rds vote. L.A. Care islargely neutral on the issue.

Senator Lara’s initiative will provide coverage for undocumented adults, and there will likely befurther legislative action on that.

Mr. Freedman noted that Mr. Baackes sent an email to staff reflecting on the 50th anniversary ofMedicare and Medicaid. There have been profound changes in access to care in the last 50years.

California Department ofHealth Care ServicesContract Amendment No.18

Motion EXE 100.0715*To ratify the Chief Executive Officer’s execution of Amendment No. 18 to Contract 04-36069 between the California Department of Health Care Services and L.A. Care HealthPlan, and to ratify any non-substantive changes to Amendment No. 18 which may bemade or negotiated by the Chief Executive Officer and/or his designees.

Approved on the ConsentAgenda.

Award Worker Education& Resource Center, Inc.

Motion EXE 101.0715*To approve an award of up to $500,000 to the Worker Education & Resource Center,Inc., a non-profit organization, to design and implement a community clinic-basedCommunity Health Worker Apprenticeship program to address the needs of high-costand medically complex patients.

Approved on the ConsentAgenda.

Award for Los AngelesNetwork for EnhancedServices (LANES)

Motion EXE 102.0715*To approve an award of up to $750,000 to Los Angeles Network for Enhanced Services,to support implementation of county-wide safety net health information exchangenetwork. The Public Health Foundation Enterprises (PHFE) may serve as a non-profitfiscal agent for this project.

Approved on the ConsentAgenda

Approve SpecificCommunity HealthInvestment Fund (CHIF)Allocation

Members Lopez and McCarthy may have financial interests for which they might have a potential conflict ofinterest, and as such they refrained from participating in the discussion and vote on this motion.

Motion EXE 103.0715*To approve two Community Health Investment Fund (CHIF) FY 2014-15 allocations ofup to $1,650,000 for Robert E. Tranquada, MD Safety Net VI Initiative-CareCoordination awards, up to $500,000 for Oral Health Initiative VII awards and up to$250,000 for one or more ad hoc projects that do not fit into any of the CHIF initiatives

Approved on the ConsentAgenda with 8 AYES(Gamble, Hamilton Lee,Horowitz, Li, Perez,Rembis, Roybal, Spiller)and 2 ABSTENTIONS(Lopez, McCarthy )

15



but meet general CHIF guidelines.Amendment to CEOEmployment Agreement

Chairperson Horowitz indicated that a motion to approve an amendment to Mr. Baackes’employment agreement was included in the materials for this meeting.

Motion EXE 104.0715To approve amendment of L.A. Care Chief Executive Officer John Baackes’employment agreement to adjust his annual compensation by Two Thousand, OneHundred and Sixty Six Dollars ($2,166), to provide health care benefits as required underhis employment agreement.


FINANCE & BUDGETCOMMITTEE

Michael Rembis, Chairperson, reported that the Committee met on June 24 and July 22, 2015.(Minutes of the meetings can be obtained by contacting Board Services.) In addition to the motionsapproved earlier on today’s consent agenda, the Committee approved the motions that do notrequire Board approval.

Motions approved onToday’s Consent Agenda

Motion FIN 100.0715*To authorize staff to amend a contract in the amount of $592,600 with WeiserMazarsLLP, to provide for temporary consulting services to the Medical Payment Systems andServices department and the Healthcare Analytics department for the period ofSeptember 1, 2015 to June 30, 2016.

Motion FIN 101.0715*To authorize staff to execute a contract in the amount of $89,500 (total contract amountnot to exceed $1,423,336, if accompanying motions are approved) with WeiserMazars,LLP to provide project management and oversight of the Health Management System(HMS) coordination of benefits project on behalf of L.A. Care.

Motion FIN 102.0715*To authorize staff to amend a contract in the amount of $67,500 (total contract amountnot to exceed $1,423,336, if accompanying motions are approved) with WeiserMazars,LLP, to provide consulting and project management services to develop and test areplacement Provider Dispute Resolution (PDR) program for the period of July 1, 2015to December 31, 2015.

Motion FIN 103.0715*To authorize staff to procure network and wireless equipment from FireOwls, for thepurpose of supporting L.A. Care’s floor expansions, in an amount not to exceed

16



$800,000.

Motion FIN 104.0715*Authorize $55,480 through September 31, 2016 for staff to continue offering Fresh FruitFriday.

Motion FIN 105.0715*To add the August 26, 2015 Finance & Budget Committee meeting and the meetinglocation for the September 3, 2015 Board of Governors Retreat, to the regular 2015meeting schedule for the Board of Governors.

Motion FIN 106.0715*To accept the Quarterly Investment Report for the quarter ended June 30, 2015, assubmitted.

Motion FIN 107.0715*To authorize staff to execute a contract for L.A. Care to receive funding in the amount of$10,825,000 for the approximate period of August 1, 2015 to July 31, 2018 from theCalifornia Department of Health Care Services. L.A. Care will use the funding toprovide electronic health record technical assistance services to L.A. County Medi-Calproviders and subcontractors up to $8,000,000 collectively with Community ClinicsAssociation of Los Angeles County, e2o Health, Object Health, Health ServicesAdvisory Group, and Medical Technology Solutions, to provide on-site technical,outreach and education support to L.A. Care.

Motion FIN 108.0715*To authorize L.A. Care staff to execute a multi-year contract with Interpreting ServicesInternational (ISI) for the provision of translation and face-to-face interpreting servicesin the amount of $2,670,000 from November 1, 2015 to October 31, 2018.

Motion FIN 109.0715*To authorize staff to execute a contract with International Business MachinesCorporation for software licenses, training, and technical support for electronic datainterchange translation, from August 1, 2015 through July 31, 2016, for an amount not toexceed $950,000.

Motion FIN 111.0715Approve the revisions of Authorizations and Approvals Policy (AFS-006), as attached,

Motions FIN 100 throughFIN 106, FIN 108,FIN 109, andFIN 111 throughFIN 117 were approvedunanimously by roll callon the Consent Agenda.10 AYES

FIN 107 was approvedunanimously by roll callon the Consent Agendawith 9 AYES (Gamble,Hamilton Lee, Horowitz,Li, Lopez, Perez, Rembis,Roybal, and Spiller) and1 ABSTENTION(McCarthy).

17



and to authorize staff to make non-significant changes.

Motion FIN 112.0715To authorize staff to amend an existing contract with Health Management Systems(HMS) in the amount of $4,000,000 (total contract not to exceed $4,095,000) to providecapitation recovery services for Cal MediConnect and coordination of benefits (COB)services for all L.A. Care’s lines of business from July 31, 2015 through June 30, 2017.

Motion FIN 113.0715To authorize staff to amend a contract with FirstSource in the amount of $3,459,886(total contract not to exceed $6,567,596), to provide processing services in the ManagedHealth Care (MHC) system for Medi-Cal claims for the period of June 1, 2015 throughDecember 31, 2015. This motion will replace FIN 104.0715 earlier approved by theFinance & Budget Committee on June 22, 2015.

Motion FIN 114.0715To approve the allocation of funds for L.A. Care’s Executive Community AdvisoryCommittee Fall 2015 Education Conference in the amount of $38,550 to cover expensesfrom July 1, 2015 to September 30, 2015. Additionally, approve funds for the ProviderLeadership Summit in August 2015 in the amount of $8,000.

Motion FIN 115.0715To authorize staff to execute various contracts for the Provider Continuing EducationProgram not to exceed the total amount of $350,000 for continuing medical educationtraining activities for the period of June 1, 2015 to September 30, 2016.

Motion FIN 116.0715Authorize a maximum of $24,840 in meal expenditure, and a maximum of $13,320 inoffice supplies, together totaling $38,160, for a new onboarding program for the 17month period beginning May 1, 2015 through September 30, 2016.

Motion FIN 117.0715To authorize staff to amend the existing contract with Salesforce adding $1,257,000(total contract not to exceed $2,842,781) to provide Service Cloud - Unlimited Editionlicenses and file storage for the period through September 30, 2017 and to execute anagreement with Cognizant for an additional $500,000 (total contract not to exceed$803,557) for continued assistance with Salesforce implementation activities through

18



September 30, 2016.

Financial Report Mr. Reilly reviewed highlights of the financial report for the period ended June 30, 2015 (a copy ofthe report can be obtained by contacting Board Services):

Revenue is $4.7 billion, slightly behind plan, primarily due to lower enrollment ofinstitutional and high cost members in the Coordinated Care Initiative (CCI) and CalMediConnect (CMC). Those members are enrolling in higher numbers.

Surplus is $145 million year to date, and $84 million favorable to budget, due to enrollmentof more adult Medi-Cal Expansion (MCE) members than planned.o MCLA shows a surplus due to MCE enrollment.o Both CMC and L.A. Care Covered show deficits for this period.

Medical Loss Ratio is 93.3%, slightly favorable to the budget of 94.7.

Administrative Costs are lower than planned.

Sufficient working cash and tangible net equity.

Cash to Claims ratio is slightly down from last month due to a lower cash balance driven byDMHC holding L.A. Care’s June payment until July. The state now plans to skip paymentto health plans every June.

In response to a question about the impact of paying the claims backlog Mr. Reilly noted thatthe amount of cash on hand would be affected, but more importantly, the lag in processingclaims obfuscates the level of the liability. To account for that, unpaid claims are included in theforecast.

Motion FIN 110.0715To accept the Financial Report for the six months ended June 30, 2015, as submitted.


Monthly InvestmentTransaction Report

Mr. Reilly referenced the Investment Transaction Report included in the meeting materials (acopy of the report can be obtained by contacting Board Services).

Fiscal Year 2015-2016Budget

Mr. Reilly, reviewed highlights of the 2015-16 Fiscal Year Budget:

Revenue is budgeted at $6.8 billion, an increase of 9.7% over the last fiscal year.

Surplus of almost $104 million. Staff is hoping to achieve a higher surplus.

Membership growth is estimated at 7%, the majority of growth will be in Medi-Cal.

Assuming the Medi-Cal rate will increase 2%, with the expansion adult rate reduced by 27%.

Health care costs are based on the current trends.

19



Breaking even on L.A. Care Covered is projected to occur in the coming year.

It will take longer for CMC to reach breakeven.

The Budget will be reviewed by the Finance & Budget Committee in August and by the Boardin September.

COMPLIANCE &QUALITYCOMMITTEE

G. Michael Roybal, MD, Chairperson, reported that the Compliance & Quality Committee met onJuly 16 (minutes are available by contacting Board Services).

Denise Corley, Compliance Officer, provided an update on various audits performed on L.A.Care and audits performed by L.A. Care on Plan Partners and provider groups.o A Coordinated Medical Audit has been taking place July 20-31, 2015 conducted jointly

by the Department of Managed Health Care (DMHC) and the Department of HealthCare Services (DHCS).

o DMHC will evaluate L.A. Care’s compliance with requirements under the federalSection 1115 Waiver for Seniors and Persons with Disabilities (SPDs), the Knox-Keenerequirements for Medi-Cal, Medicaid-based services for Cal MediConnect andrequirements for our non-Medi-Cal lines of business.

o DHCS will conduct a routine medical audit.o Centers for Medicare & Medicaid Services (CMS) informed L.A. Care it had passed a

monitoring review on Interpreter Availability and TTY Services.o L.A. Care scored 97.9%, on a 2014 Data Validation Audit (DVA) to ascertain the quality

and integrity of Medicare managed care data. The score is above the passing thresholdof 95% but L.A. Care expects a request for a corrective action plan relating toGrievances, which requires 100% compliance and L.A. Care scored 90.1% (Part C) and99.2% (Part D).

o Health Services Advisory Group informed L.A. Care that it passed the Quality WithholdMeasure Validation Audit, the primary purpose of which is to “validate self-reporteddata for the quality withhold performance measure” relating to Core 2.1, for memberswith a health assessment completed within 90 days of enrollment.

o CMS is monitoring L.A. Care to evaluate compliance in the content of denial noticessent to members.

o Ms. Corely’s full written report is available by contacting Board Services.

Dr. Carter and Mary Franz, Executive Director of HIT, announced that L.A. Care has beenselected to receive DHCS funding to support technical assistance for electronic healthrecord (EHR) implementation and meaningful use among Medi-Cal providers in L.A.

20



County, continuing the work of HITEC-LA. Up to 37 million dollars over three years toassist 7450 Medi-Cal providers has been awarded to four California organizations: L.A.Care, CalHIPSO, CalOptima and Object Health. L.A. Care is the exclusive awardee in L.A.County receiving up to 10.8 million dollars to assist 2165 Medi-Cal primary care, specialtyand large group providers. This funding will enable L.A. Care to continue to transform theL.A. County delivery network and help improve quality, patient engagement and costobjectives as set forth under triple aim.

Dr. Carter updated the Committee on the process of improving results following anassessment of provider access and availability. A full report will be presented at a futuremeeting.

Dr. Chau reported on integrating Behavioral Health assessments in the primary care setting.

AUDIT COMMITTEE G. Michael Roybal, MD, Chairperson, reported that the Audit Committee met on July 8 to discussthe work plan for the 2014-15 fiscal year audit. (Minutes can be obtained by contacting Board Services.)

The Board delegated authority to the Audit Committee for overseeing the work of ourexternal independent financial audit firm.

Last year a request for proposal (RFP) process was conducted which resulted in Deloitte &Touche being retained as L.A. Care’s independent auditors for fiscal years 2013-14 and2014-15.

Deloitte and Touche has changed the Senior Partner in charge of L.A. Care’s audit, which isa part of audit best practices.

The Committee discussed the scope of work with Deloitte and Touche representatives,asking detailed questions about areas of significant risk and issues in the larger market.Deloitte will bring in experts in some areas as appropriate during the audit.

The fees are consistent with prior years’ audits, and the audit report will be available inDecember or January 2016.

GOVERNANCECOMMITTEE

Alexander Li, MD, Chairperson, reported that the Governance Committee met on June 18. (Acopy of the minutes can be obtained by contacting Board Services.)

Timing of L.A. Care Board Officer Elections

Last fall, the Board revised timing of the 2015 election of officers for the Board because ofthe transitions in new leadership.

It is recommended that the delay in officer elections from November to May beimplemented again for 2016(so the next election will be in about a year from now).

21



If there is no objection the Governance Committee will move forward on that basis tomove the elections to mid-2016.

A permanent change in the timing of the officer elections would require a change to theL.A. Care Bylaws, and the Governance Committee will consider that change in the future.

2015 Officer Election

At the June Board meeting it was announced that nominations would be solicited for theBoard officer elections. Nine nominations had been received by the date of the GovernanceCommittee meeting.

The Governance Committee reviewed and discussed the nominations received and, basedon a consensus among the nominations, the Committee agreed to recommend for theBoard’s consideration the following slate of officers for 2015:

Chair: Mark GambleVice Chair: Louise McCarthyTreasurer: Michael RembisSecretary: Alex Li, MD

Chairperson Horowitz presided over the election of 2015 Officers. By consensus, the Boarddecided to vote on the slate of officers.

(Member Rembis left the meeting.)

Motion BOG 105.0715To elect the following Board Officers for 2016, effective September 1, 2015.

Chairperson Mark GambleVice Chairperson Louise McCarthyTreasurer Michael RembisSecretary Alexander K. Li, MD

On behalf of the Board, Member Gamble thanked Dr. Horowitz for his service during a verychallenging time for L.A. Care and the Board of Governors.

Approved unanimouslyby roll call. 9 AYES(Gamble, Hamilton Lee,Horowitz, Li, Lopez,McCarthy, Perez, Roybal,and Spiller).

SERVICESAGREEMENTCOMMITTEE

Louise McCarthy

On behalf of Hector De La Torre, Committee Chair, Member McCarthy reported that theCommittee met by teleconference on June 10 and July 27. (Minutes are available by contacting BoardServices.)

On June 10, the Committee approved a motion to execute a contract with Health Integratedfor utilization management administrative services to support Los Angeles County

22



Department of Health Services. Authority to approve the motion had been delegated by theBoard of Governors to SAC due to the number of potential conflicts of interest amongBoard members.

The Committee met by teleconference on July 27 for closed session discussions on ContractRates, and to hear comments from Plan Partners and members of the public.

There was no report from that closed session.

(Member Rembis rejoined the meeting.)

PUBLIC ADVISORY COMMITTEE REPORTS

EXECUTIVECOMMUNITYADVISORYCOMMITTEE (ECAC)

Hilda Perez, Consumer Representative, thanked the L.A. Care Staff for providing the Board meetingAgenda in Spanish and Khmer. ECAC met on June 10 and July 8, 2015.

Ms. Perez acknowledged RCAC and CCI members present

Pedro Martinez RCAC 1

Demetria Saffore, Russel CCI

Elizabeth Cooper ana jesus rodriguez RCAC 2

Wilma Ballew CCI

Shonovia Escoe RCAC 3

Michael R. Shelton RCAC 4

Silvia Poz

Martha Rodriguez

Alba Nohemi Pastor Perez RCAC 6

Irene Romero

Maria Guadalupe Sandoval RCAC 7

Rosario Moreno-Mother RCAC 8

Steven Sample CCI

Thoura Day RCAC 9

Ana Rubio RCAC 10

Hilda Sevilla RCAC 11

The Board approved the motions for RCAC and CCI Council membership and ratification

23



of elected RCAC 10 Chair on the consent agenda earlier in this meeting.

There are 34 consumer members in the four CCI Councils. Recruiting members for CCICouncils continues to be a challenge. Staff is discussing outreach and recruitment ideas andis working with other partners in each area to increase membership. Members of theRCACs are partnering with the staff.

L.A. Care’s Grievance and Appeals Department provided a presentation on the process ofthe grievance and appeals. Hopefully we will see a presentation on G&A processing at theconference in September.

ECAC received a report from the Interdisciplinary Team and the status of member issuessubmitted. Ms. Perez indicated that she thinks this is a very good idea because membersshould know how to submit a complaint. CCI council members need personalizedassistance in filling out forms.

UCLA Center for Behavioral Health Excellence representative talked to ECAC about thesignificance of racial, ethnic and socioeconomic disparities in mental health.

The next ECAC meeting will be on September 9, 2015.

Motion ECA 100.0715*To approve the following candidate(s) to the Regional Community AdvisoryCommittees (RCAC), and Coordinated Care Initiative Councils (CCI) as reviewed bythe Executive Community Advisory Committee (ECAC) during the June 10, 2015 ECACmeeting.

Name RCAC/CCI AreaCouncil #

Type of Member(Agency, if applicable)

Muriel Briggs CCI Area 1 ConsumerNicole Fitzgerald CCI Area 1 ConsumerMandie Henry CCI Area 1 ConsumerAbelardo Menor CCI Area 1 ConsumerJosefina Nagar CCI Area 1 ConsumerAuleria Pimentel CCI Area 1 ConsumerLafayette Powell CCI Area 1 ConsumerMarcia Ramos CCI Area 1 ConsumerErnesto Sarmeinto CCI Area 1 ConsumerRay Clarance CCI Area 3 Consumer

Motions ECA 100, 101 and102 were approved on theConsent Agenda.

24



Sharon Johnson CCI Area 3 ConsumerJudith Hackney CCI Area 4 ConsumerNesima Istrefi CCI Area 4 ConsumerCristobel Schwallie CCI Area 4 ConsumerPhally Srey RCAC 9 ConsumerJulie Alvarado RCAC 10 ConsumerMaria Ibarra RCAC 10 Consumer

Motion ECA 101.0715*To approve the following candidate(s) to the Regional Community AdvisoryCommittees (RCAC), and Coordinated Care Initiative Councils (CCI) as reviewed bythe Executive Community Advisory Committee (ECAC) during the July 8, 2015 ECACmeeting.

Name RCAC/CCI AreaCouncil #

Type of Member(Agency, if applicable)

Angela Molinar CCI Area 1 ConsumerMarilen A. Menor CCI Area 1 ConsumerTessie Pimentel CCI Area 1 ConsumerJulio Rodriguez CCI Area 2 ConsumerCharles Keedie CCI Area 3 ConsumerFeliciano Barranda CCI Area 4 ConsumerCarmencita B. Fernandez CCI Area 4 ConsumerBertha Poole CCI Area 4 ConsumerSteven Sample CCI Area 4 ConsumerPhalley Srey CCI Area 4 ConsumerEstela Lara RCAC 2 ConsumerMargaret Belton RCAC 3 Consumer

Motion ECA 102.0715*To approve the election of Elsa Gervacio as Chairperson of the Regional CommunityAdvisory Committee (RCAC) of region 10 to complete the remainder of the term untilSeptember 2016 as reviewed by the Executive Community Advisory Committee duringthe June 10, 2015 meeting.

Revisions to the Hilda Perez reported that at the December meeting, ECAC members approved changes to the

25


AGENDAITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKENECAC/RCAC OperatingRules

Operating Rules that will allow a member of the Coordinated Care Initiative (CCI) Councilrepresentation as an at large member of ECAC.

PUBLIC COMMENTElizabeth Cooper, RCAC 2 Member, commented that she is unclear about the at large member.She noted that L.A. Care has a CCI council and they have an election. She is a strongproponent of the CCI councils. She needs to look at more details. She asked if one memberwill represent all CCI members. She is also concerned that ECAC discusses recruitment and shewould like Board members and the chair to please take notice that she would like to be anambassador in perpetuity. She has reached out to the community and for diversity as avolunteer.

Demetria Saffore, RCAC 1 Member, asked if about progress to improve the provider situation inthe Antelope Valley. Mr. Baackes responded that a report will be made at the next meeting.

Motion ECA 103.0715To recommend revisions to the Executive Community Advisory Committee/RegionalCommunity Advisory Committee Operating Rules to include recommendations for theAt-Large positions as presented, and to create detailed guidelines, handbook andapplication.


STRATEGICDISCUSSION: VALUEPROPOSITION OF L.A.CARE

John Baackes

Mr. Baackes described the strategic vision process which was started to assess L.A. Care’s statusgiven the growth in membership and in the diversity and in the complexity of the populationsserved. There are issues that need to be addressed within the framework of the added valueL.A. Care can bring to its members and providers.

At the last meeting the Board discussed added value for the member. Board members wereasked for thoughts on what added value is brought or should be brought to providers.L.A. Care is in a unique situation as contracts are with physician groups, and it does not holdcontracts directly with providers except at a hospital level. When there is an issue with aprovider the group is contacted and the group deals directly with the provider.

Is the value L.A. Care adds limited to the groups, and how does L.A. Care build relationshipswith providers who serve its members?

At the upcoming Board Retreat a reorganization outline will be presented, and the strategicvision will be discussed along with tactics to achieve the attributes that were previouslydiscussed:

26



Clear lines of accountability that simplify processes and drive efficiency and excellence

A network that aligns reimbursement with member risk and provider performance

Tailored models of care for the specific needs of our member populations

Recognized leader in improving health outcomes for low income and vulnerable populations

L.A. Care’s partnership with providers represent unique added value in its legislative andregulatory work, HITECH LA, Community Health Investment Funding, and funding providerincentives. Other tasks that could increase the value added could be to evaluate provider groupsand find those groups that enhance L.A. Care’s services to the members and look foropportunities to reduce issues that prevent providers from delivering timely and full service carefor L.A. Care members. Innovative ideas for pilot programs are needed to facilitate providerties with specialty services for members, and for L.A. Care to develop closer relationships withproviders that directly serve the members. Simplification of administrative process will help allproviders.

It was suggested that L.A. Care look for ways to support providers and systems that may beoutside of the traditional safety net.

PUBLIC COMMENT: Dr. Lemon McMillan commented that the most important thing is tokeep unproductive issues away from the practitioner and let them do their job. Keep the solepractitioner in mind. Protect the doctor-patient relationship and keep it forefront.It was also suggested that L.A. Care help integrate social programs and services in health care,which will help the members served and will help the providers who serve those members tofocus on health care. Design a model for person-centered care for Medi-Cal to solve socialissues outside of chronic health conditions. Set up a model where providers and members willhave a single person serve as their contact to L.A. Care.

PUBLIC COMMENT Elizabeth Cooper, Member, RCAC 2, commented that the cultural has not been addressed. Shewould like to see Mr. Baackes give a plan on how to improve cultural diversity. She noted thatthe Board officer elections did not include a consumer representative in any of the offices. Sheasked for L.A. Care to provide information for consumers on how the water shortage couldaffect health.

Chairperson Horowitz responded that Dr. Chau is presenting cultural diversity education classesfor L.A. Care providers.

27


AGENDAITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKENADJOURNMENT The meeting was adjourned at 5:04 p.m.

The next meeting will be an all-day retreat on Thursday, September 3, 2015, at The CaliforniaEndowment Center for Healthy Communities, 1000 N. Alameda Street, Los Angeles.

Respectfully submitted by:APPROVED BY: ______________________________

Linda Merkens, Manager, Board Services Alexander Li, MD, SecretaryMalou Balones, Committee Liaison

Date Signed ______________________________

28

Board of Governors

MOTION SUMMARY

Date: September 3, 2015 Motion No. FIN 100.0915

Committee: Finance & Budget Chairperson: Michael Rembis

Issue: Procure a data masking solution from Delphix Corporation to safeguard L.A. Care’s

membership data and meet regulatory compliance requirements.

New Contract Amendment Sole Source

Preferred Vendor RFP/RFQ was conducted

Background: L.A. Care staff requests approval to procure a data masking solution from Delphix Corporation in the amount of $1,500,081 from October 1, 2015 through September 30, 2018, to assist in the protection of L.A. Care’s membership data and meet regulatory compliance requirements.

L.A. Care must take necessary measures to protect sensitive and proprietary information, and ensure that it meets the industry regulations for data protection. Data masking is a solution that replaces confidential data such as social security numbers, birthdates, and addresses with distorted data. This tool will enable the Information Technology staff to eliminate confidential and private information and therefore reduce the amount of data at risk. A request for quote (RFQ) was not conducted for this product. However, staff compared other vendors with similar products and deemed this vendor a sole source as it is the only vendor that holds a product with all the functionalities needed to carry out L.A. Care’s business requirements. Staff worked with the vendor to negotiate pricing, and a 37% discount was obtained by proposing to carry out with a three year agreement.

Proposed Payment Schedule

1st payment - September 2015 $500,027

2nd payment - August 2016 $500,027

3rd payment - August 2017 $500,027

3 year Total Price: $1,500,081

Budget Impact: Sufficient funds are budgeted in the Information Technology department for

FY 2014-15. Additional funds will be requested in the budget for FY 2015-16 and FY 2016-17.

Motion: To authorize staff to procure a data masking solution from Delphix Corporation in the amount of $1,500,081 from October 1, 2015 to September 30, 2018, to safeguard L.A. Care’s membership data, sensitive information, and meet regulatory requirements.

29

Board of Governors

MOTION SUMMARY



Issue: Amend the current Unlimited License Agreement (ULA) with Oracle to renew the existing annual ULA software support and maintenance services, and procure Oracle’s GoldenGate Data Integration software and maintenance services.



Background: L.A. Care staff requests approval to amend the Oracle Unlimited License Agreement to procure GoldenGate Data Integration software for $777,115, and renew the existing ULA software support maintenance agreement from November 12, 2015 through November 11, 2016 in the amount of $1,576,415, for a total requested amount of $2,353,530 (total contract not to exceed $9,749,034).

Oracle’s GoldenGate software is a real-time data integration solution that will help support L.A. Care’s Structured Query Language (SQL)/Oracle replication requirements. This purchase will enable integration and continuous data availability by capturing and delivering updates of critical information, and it will also provide continuous data synchronization across varied environments.

The renewal of the annual ULA software support and maintenance agreement is a critical component of our technical infrastructure and is necessary for continued operations on the existing platform. Oracle supports L.A. Care’s transactional system for member auto-assignment, encounter data processing and repository. It is the database for facility site review, and it performs numerous functions outside of the CORE QNXT System.

Description Amount

GoldenGate Data Integration Software, including licenses and maintenance fees $777,115

Renewal of ULA maintenance agreement $1,576,415

Total: $2,353,530

A request for quote (RFQ) was not conducted as it is a sole source product only available through Oracle. The vendor provided a discounted quote to purchase the GoldenGate product as part of the already existing ULA which amounted to a 54% cost savings from the original quote.

Budget Impact: Sufficient funds for the GoldenGate Data Integration software is budgeted in the Information Technology Department for FY 2014-15. Remaining funds for the annual renewal of the ULA support and maintenance has been budgeted in the FY 2015-16 Information Technology budget.

Motion: To amend L.A Care’s current Unlimited License Agreement (ULA) with Oracle in the amount of $777,115 for the purpose of procuring GoldenGate Data Integration software to support L.A. Care’s replication needs, and to renew the annual ULA Support and Maintenance agreement from November 12, 2015 through November 11, 2016 in the amount of $1,576,415, for a total requested amount $2,353,530 (total contract not to exceed $9,749,034).

30

Board of Governors

MOTION SUMMARY

Date: September 3, 2015 Motion No. BOG 100.0915

Committee:

Chairperson: Mark Gamble

Issue: Approval of revisions to the Regional Community Advisory Committee (RCAC) / Executive

Community Advisory Committee (ECAC) Operating Rules.

Background: In June, 2015, the Governance Committee reviewed and approved changes to the

operating rules proposed by the Executive Community Advisory Committee to allow for representation of CCI Consumer representatives on ECAC. The changes will allow L.A. Care Cal-MediConnect members the opportunity to improve managed care healthcare services by keeping L.A. Care Health Plan informed about better access to services for seniors and persons with disabilities as required by the State of California. One ECAC At-Large member will be represented by a CCI Consumer or community partner actively involved in the CCI. The changes to the Operating Rules have been publicly posted for 30 days as required in L.A. Care Bylaws Article XI, and no public comment was received. The Board is requested to approve the changes recommended by the Executive Community Advisory Committee and other documents as necessary.

Budget Impact: None

Motion: To approve the recommended revisions to the Regional Community

Advisory Committee (RCAC)/Executive Community Advisory Committee (ECAC) Operating Rules for the At-Large position as presented, and to direct that revisions be made to the RCAC/ECAC guidelines, handbook, application and other documents as appropriate to implement the revisions.

31

OPERATING RULES FOR THE REGIONAL COMMUNITY ADVISORY COMMITTEES

AND EXECUTIVE COMMUNITY ADVISORY COMMITTEE

OF L.A. CARE HEALTH PLAN (Revised on September 6, 2012 through Motion GOV 100.0912)

I. Authority and Purpose

The Regional Community Advisory Committees (RCACs) of L.A. Care Health Plan (L.A. Care) were

established to ensure community involvement in implementation of Medi-Cal managed care in Los

Angeles County, as mandated by California Welfare and Institutions Code §14087.966, and as clarified in

the Medi-Cal Managed Care Division Policy Letter 99-01 of April 2, 1999 from the California State

Department of Health Services, et seq. Rules for the RCACs are subject to the Bylaws of the Board of

Governors of L.A. Care.

The purposes of the Regional Community Advisory Committees are to:

1. Provide a vehicle for L.A. Care’s member population to be represented by product line in its actual

geographic, ethnic, linguistic and disability diversity, with a special focus on those who are

monolingual and/or disabled;

2. Provide advice and guidance to the Board of Governors and management regarding the direction,

approach and response of L.A. Care to regional and cultural issues that have implications on member

satisfaction, new product lines, health promotion and education efforts, marketing, and outreach;

3. Inform and empower L.A. Care members to become advocates for themselves and their communities

through leadership in responding to pertinent issues raised among members and in the community

by partnering with L.A. Care to implement RCAC-initiated projects, policy initiatives, programs

supporting L.A. Care strategic health initiatives and legislative campaigns;

4. Provide information on regional community health issues that impact large numbers of L.A. Care

members or the community at large to the Board of Governors through the Executive Community

Advisory Committee, (ECAC), where joint planning and development of policy recommendations

for the Board of Governors should occur, and

5. Create, promote and sustain positive and cooperative relationships among health plan members,

providers, and advocates who serve the L.A. Care population.

II. Function and Role

RCACs shall serve in an advisory capacity and may be given opportunities by the Board of Governors

and/or the management of L.A. Care to have input into and evaluate the operation of Medi-Cal managed

32

OPERATING RULES FOR THE REGIONAL COMMUNITY ADVISORY COMMITTEES AND EXECUTIVE COMMUNITY ADVISORY COMMITTEE OF L.A. CARE HEALTH PLAN (Revised on September 6, 2012 through Motion GOV 100.0912)

2

care in Los Angeles County. Areas where community and especially L.A. Care member input may be

requested include:

1. improving member satisfaction with L.A. Care’s provision of services;

2. improving access to care;

3. ensuring the provision of culturally and linguistically appropriate services and programs;

4. identifying emerging needs in the community and establish programmatic responses;

5. determining and prioritize health education and outreach programs: and

6. addressing community health concerns collaboratively.

To ensure community involvement, L.A. Care staff from various departments and functions will

periodically attend meetings of the RCACs to create a meaningful and productive dialogue with RCAC

members and provide educational information. Such dialogues will seek feedback and input from the

RCAC members as well as input from the public in each region through the public comment portions of

each RCAC meeting.

The RCACs also have a responsibility to support the gathering of information about issues and concerns

that are pertinent to the health and well-being of L.A. Care members in the region. This information will

be used by the RCACs, the ECAC, and L.A. Care staff to plan, implement, and evaluate activities to

address identified concerns.

Each RCAC brings together L.A. Care members, community-based member advocates and health care

providers from the regions that have been approved to serve on a RCAC by the Board of Governors.

The committee format should assure equal participation by all RCAC members as they discuss relevant

health, managed care and access to care issues. The Chairperson of each RCAC shall represent the region

on the ECAC and shall carry issues between the RCAC and ECAC.

When the ECAC reaches consensus on specific items appropriate for action by the Board of Governors,

it shall make recommendations to the Board in the form of motions. In addition, the L.A. Care members

of the RCACs are responsible for electing the Consumer Member and Member Advocate representatives

to the L.A. Care Board of Governors.

33


3

Within a standard meeting framework for all RCACs as described below, each RCAC shall establish its

meeting agenda. ECAC can place items on each RCAC’ agenda if the ECAC determines that the issue

needs to be addressed by all the RCACs.

RCAC activities are based on an annual work plan developed by the membership of each RCAC and

approved by L.A. Care management. The work plan identifies key projects, timelines, and evaluation

measures. At the beginning of each fiscal year, ECAC will establish a common theme for each RCACs’

work plans.

III. Membership

Composition of the RCAC and criteria for membership shall be approved by the Board of Governors of

L.A. Care, and shall be in accordance with applicable law, regulations, and L.A. Care Bylaws.

A. RCAC Membership Voluntary Status and Member Categories

All participants in the RCACs serve on a voluntary basis, regardless of category. RCAC membership

is not a form of employment with L.A. Care, nor is any permanent relationship or right to serve

implied or established by such membership.

1. Consumer Member

A “Member” as defined by these Rules is an L.A. Care member; or a parent, legal guardian or

conservator of a L.A. Care member. L.A. Care membership is determined by reviewing L.A.

Care’s member records. Proof of legal guardian or conservator status will be requested, when

applicable.

2. Provider

A “Provider” as defined by these Rules is a person or a representative of an entity contracted

with either L.A. Care or its plan partners to offer health care services to L.A. Care members. L.A.

Care’s Provider Network Operations Department may assist in confirming a provider applicant’s

contractual status. Providers contracted with both L.A. Care and Health Net are permitted to

serve as RCAC members in this category.

3. Member Advocate

A “Member Advocate” as defined by these Rules must comply with at least one of the following

criteria:

34


4

1. A person who, while employed by a community-based organization1, represents the interests

and brings forward the issues and concerns of the population served by L.A. Care; or

2. A volunteer of a community-based organization who is recommended by that organization as

its representative to L.A. Care’s RCACs.

B. Committee Composition

1. Each RCAC shall have at least eight and no more than 35 members with a target membership of

20, and at least one-third of who shall be Members, as defined above.

2. One-third of the membership of each RCAC shall consist of Consumer Members; however, a

RCAC may also include both Providers and Member Advocates in its membership. To maintain

the one-third Member composition, new Provider or Member Advocate applicants may be

placed on a waiting list and ranked according to the date their applications were verified. Waiting

list applicants shall be added to the RCAC membership according to their ranking as new

Provider or Members Advocates.

3. The membership of each RCAC may include up to one-third Provider members; however, a

RCAC need not have any Provider members.

4. If a RCAC falls below the minimum membership of eight persons, the RCAC must shift its

energies to recruitment to achieve the minimum number of members. The RCAC must refrain

from implementing any Work Plan activities until the minimum membership number is met.

5. The RCACs’ membership shall seek to be representative of ethnic, cultural, linguistic, age, sexual

orientation, disability and special medical needs of the Member population in the designated

region. Diversity is a desired goal for recruitment of Members to be approved by the Board of

Governors and shall not dictate any specific membership approval decision.

C. Application for RCAC Membership

1. Applications for RCAC membership are accepted by the Community Outreach and Education

(CO&E) Department at any time. A RCAC candidate’s application and category of eligibility

(Consumer Member, Provider or Member Advocate) shall be verified by L.A. Care staff. Once

the application has been verified by L.A. Care staff, a sub-committee will be established to review

the new RCAC member application. The sub-committee will consist of the Chair, Vice-Chair of

the RCAC for which member application is submitted and L.A. Care Staff. The sub-committee

1A “community-based organization” as defined by these Rules is a non-profit corporation, a public benefit agency or other public entity.

35


5

will schedule a meeting with the new applicant. If the new applicant does not show-up to the

scheduled meeting this will automatically forfeit the applicant’s application. Once the sub-

committee has met with the new applicant, their application will be submitted to ECAC for

review and consent to forward the applicants name to the Board of Governors for their approval.

The new RCAC member will enter the RCACs as a “Provisional Member” for a period of one

year, with all the rights of a non-provisional member, which includes being allowed to vote,

receive a RCAC stipend and eligibility to receive reimbursements, so long as other provisions of

the Rules with respect to stipend and reimbursement are complied with. “Provisional Members”

will be assessed based on attendance and participation at RCAC meetings, Work Plan events,

Community Health Improvement Project (CHIP) outreach efforts, and following L.A. Care’s

Code of Conduct and the RCAC Standards of Behavior. After successful completion of one

year, the “Provisional Member” will automatically become an “Active Member”. There is an

expectation that the “Active Member” is expected to and must comply with the Rules, Standards

of Behavior, abide by L.A. Care’s Code of Conduct, participate in and attend meetings. If a

member does not meet these expectations, this will constitute the right of ECAC to review

membership in compliance with RCAC and ECAC Operating Rules.

2. Any applicant who disagrees with a decision concerning their application may appeal to CO&E

management, if the applicant disagrees with CO&E’s decision the applicant may then appeal to

the Governance Committee if applicant disagrees with the Governance Committee they may

appeal within 60 calendar days to the Executive Committee of the Board of Governors. The

decision of the Executive Committee is final in all cases.

D. Re-certification

RCAC member recertification by L.A. Care staff shall occur annually, typically in the month of

September and always prior to the election of the RCAC Chairpersons and Vice Chairpersons. The

purpose of recertification shall be to confirm that RCAC members remain eligible to continue

participating in the RCAC.

E. RCAC Member Term

Since RCAC member applications are received on an on-going basis, a RCAC member’s term of

eligible service extends between the dates of his or her application until the next recertification

period. A RCAC member whose term has been less than six months will not have to complete the

recertification process until the following year’s recertification period.

36


6

1. A Consumer Member’s membership on a RCAC will end if she/he loses eligibility for L.A. Care’s

benefits program. The Consumer Member may be removed within two months of the date of

loss of eligibility unless L.A. Care membership eligibility has been re-established.

2. No more than two persons age 18 or older from the same immediate family may serve on a

RCAC at the same time in the same region.

3. Only one Provider or Member Advocate member employed by or volunteering with a particular

community based organization (CBO) or provider agency may serve on a given RCAC. In cases

where the CBO or provider agency is supporting multiple programs or projects in a specific

RCAC or in multiple RCACs, an exception may be made to allow for more than one CBO or

provider agency representative to participate in the RCAC(s).

4. Providers or Member Advocates must retain their respective eligibility status during their term on

the RCAC. If the Provider or Member Advocate member is no longer associated with an L.A.

Care provider or community based organization, a new representative must be assigned by the

respective entity.

5. If a RCAC Consumer Member moves to another region, he or she can become a member of the

RCAC of their new residence. The Consumer Member shall either be added to the new RCAC’s

roster, or be placed on the waiting list if the new RCAC’s membership is at the maximum of 35.

6. A Consumer Members membership in a RCAC, or any of the privileges associated with

membership, is non-transferable. Each Member of the RCAC is chosen, in part, for his or her

unique ability to bring valuable input to the group’s discussions, deliberations and decisions.

Therefore, substitute representatives may not vote and may not participate in discussion, except

as a member of the public.

7. New RCAC members must complete a formal new member orientation as provided by L.A. Care

staff within 90 days of being approved as a RCAC member by the Board of Governors. Such

orientations may occur during regularly scheduled RCAC meetings, or at other designated times

and locations.

F. Resignation and Removal

1. Resignation: A member may resign from the RCAC upon giving written notice to the RCAC

Chairperson and/or the assigned CO&E staff person. A resignation is effective immediately,

unless stated otherwise in the letter of resignation.

2. Removal:

a. Absences

37


7

1) Consistent with the Public Advisory Committee Operating Rules, an absence is excused

when a member notifies the RCAC Chairperson or assigned CO&E staff person of his or

her impending absence prior to the meeting or event. Notice must be in the form of a

written, verbal, telephonic or electronic communication and received within two business

days prior to the scheduled meeting.

2) RCAC members who have two absences (excused or unexcused) and one medically

excused absence (with doctor’s note) from RCAC meetings, RCAC work plan events, or

other L.A. Care sponsored events in a fiscal year, will be considered having voluntarily

resigned from the RCAC, effective the date of the last meeting or event missed.

3) If a RCAC member is deemed to have voluntarily resigned due to absences as described

above, he or she will be ineligible to re-apply to the RCAC for a period of one calendar

year from the loss of RCAC member eligibility. Members who leave the RCAC because

of personal reasons are excluded from the one calendar year ineligibility period. These

members will be allowed to reapply and will follow the new member application process.

b. Non-Compliance with the Code of Conduct or RCAC Member Standards of Behavior

1) A RCAC member shall be removed from the RCAC if the member substantially violates

L.A. Care’s Code of Conduct or the RCAC Member Standards of Behavior. RCAC

members shall receive annual training on the Code of Conduct and Standards of Behavior

and are required to sign an acknowledgement stating that the member has read and

understood both the Code of Conduct and the RCAC Member Standards of Behavior.

2) The removal process shall consist of a petition from L.A. Care staff or a motion

recommending removal “for cause” by a majority of RCAC members, which will be

reviewed by the Legal Services Department and forwarded to the Governance Committee

of the Board of Governors for a disposition.

3) A member removed as a result of an action by the Governance Committee may appeal to

the Executive Committee2 of the Board of Governors, within 60 calendar days of the

Governance Committee action, whose decision shall be final in all cases.

4) Any RCAC member removed for substantial violation of the Code of Conduct or RCAC

Member Standards of Behavior shall be ineligible to reapply for RCAC membership. The

following, while not intended to be an exhaustive list are examples of the kind of conduct

2 Members serving jointly on the Executive and Governance Committee and who participated in the initial proceedings shall

recuse themselves from consideration of a subsequent removal appeal.

38


8

which are not permitted and which will subject any RCAC member to termination from

Regional Community Advisory Committee membership:

Unlawful sexual harassment or other unlawful harassment, whether verbal, physical or

visual.

Actual or threatened violence.

Falsifying or making material omission on RCAC applications, request for stipend

and reimbursement forms.

Misusing, destroying or damaging property belonging to L.A. Care, a L.A. Care

employee, a member or visitor.

Fighting on L.A. Care property or at L.A. Care sponsored events.

Gross misconduct (stealing, conflict of interest and other forms of misrepresentation)

No disciplinary or retaliatory actions will be taken against anyone who reports potential fraud or abuse in

good faith.

IV. Role and Term of RCAC Chairperson and Vice-Chairperson

A. RCAC Leadership

The elected leadership of each RCAC shall be a Chairperson and a Vice-Chairperson. At any time,

the RCAC Chairperson and Vice-Chairperson may not be related by blood, marriage or belong to the

same “household” as defined in the RCAC Member Handbook and Guidelines and Procedures.

B. Duties of RCAC Chairpersons

1. The Chairperson shall preside at all meetings of his or her RCAC. In the absence of the

Chairperson, the Vice-Chairperson shall preside.

2. In partnership with the assigned CO&E staff person, the Chairperson shall develop RCAC

meeting agendas, moderate business meetings and other discussions, provide guidance and

oversight for RCAC work plan projects, maintain a respectful and productive environment

during meetings for discussion, and ensure inclusion of all RCAC members in RCAC events and

activities.

3. The Chairperson of each RCAC shall be the official representative of that RCAC to the ECAC.

In the absence of the Chairperson, the RCAC’s Vice-Chairperson will represent the RCAC at

ECAC.

39


9

4. The RCAC Chairperson is responsible for reporting to ECAC the issues presented by his or her

RCAC and to share information gathered at ECAC with his or her RCAC members.

C. RCAC Chairperson Term and Election

1. The RCAC Chairperson’s and Vice-Chairperson’s term shall be two years. The Chairperson or

Vice-Chairperson may be re-elected for one additional two year term for a maximum of four

consecutive years.

2. RCAC Chairperson and Vice-Chairperson regular elections shall be held in September. Only

Consumer Members and Member Advocates are eligible to be Chairpersons or Vice-

Chairpersons.

3. If a RCAC is unable to elect a Chairperson and/or a Vice-Chairperson in September, the current

Chairperson and/or Vice-Chairperson in good standing may retain their position beyond the

conclusion of their current term for a maximum of three additional months or until a

Chairperson and/or a Vice-Chairperson is elected, whichever is shorter. After three months, the

Chairperson and/or the Vice-Chairperson positions will automatically become vacant and remain

so until a new Chairperson and/or Vice-Chairperson is elected.

4. The outgoing Chairperson will be encouraged to mentor the incoming Chairperson for two

months following the Chairperson election.

5. The Vice-Chairperson replacing a RCAC Chairperson who was removed or resigned prior to end

of their elected term, will complete the remaining term of the departing Chairperson with all the

rights and privileges of the Chairperson as described in the L.A. Care Bylaws, PAC Operating

Rules and these RCAC Operating Rules. The RCAC shall have the ability to have a Vice-

Chairperson election to fill the vacancy left by former Vice-Chairperson.

6. RCAC Chairpersons or Vice-Chairpersons may resign by giving written notice to the assigned

CO&E staff person responsible for that region.

7. A RCAC Chairperson or Vice-Chairperson can be removed for any one of the following reasons:

a) he or she no longer resides or is employed in the geographic area;

b) he or she has been convicted of a crime involving corruption, fraud or any felony;

c) he or she fails to follow L.A. Care’s Code of Conduct or RCAC Member Standards of

Behaviors;

d) he or she has two absences (excused or unexcused) and one medically excused absence (with

doctor’s note) from RCAC or ECAC meetings, RCAC Work Plan events, ECAC Leadership

Trainings or other L.A. Care-sponsored events; or has failed to attend a majority of RCAC or

40


10

ECAC meetings, RCAC Work Plan events, ECAC Leadership Trainings or other L.A. Care-

sponsored events in a fiscal year, will be considered having voluntarily resigned from the

RCAC, effective the date of the last meeting, training or event missed.

e) a request for removal has been voted on by RCAC members at a scheduled meeting and

submitted by the RCAC to L.A. Care for disposition.

f) a request for removal has been voted by the ECAC members at a scheduled meeting and

submitted by the ECAC for L.A. Care disposition.

g) a request for removal has been submitted by L.A. Care staff to the L.A. Care Board of

Governors, and it is approved by the Governance Committee where a quorum is present.

8. The RCACs shall have the ability to have a RCAC Chairperson and/or Vice-Chairperson election

at least once every two years, or as needed when:

a) A Chairperson or Vice-Chairperson resigns;

b) The RCAC calls for the removal of a Chairperson or a Vice-Chairperson;

c) Other circumstances considered appropriate by the ECAC.

V. Role and Term of ECAC Leadership

The elected leadership of ECAC shall be a Chairperson and a Vice-Chairperson. At any time, the ECAC

Chairperson and Vice-Chairperson may not be related by blood, marriage or belong to the same

“household” as define in the RCAC Member Handbook and Guidelines and Procedures.

A. ECAC Chairperson and Vice Chairperson Terms

1. The Chairperson and Vice Chairperson for ECAC will be elected by the members of ECAC, in

November of each year, to complete a one year term with the possibility of re-election for a

second one year term.

2. In order to be eligible for election to Chairperson or Vice Chairperson of ECAC, the individual

must have served on the ECAC for at least one year and have actively participated in leadership

development training during their tenure on the ECAC.

3. ECAC Chairpersons or Vice-Chairpersons may resign by giving written notice to the assigned

CO&E staff person responsible for that region.

4. A Chairperson or Vice-Chairperson can be removed for any one of the following reasons:


b) he or she has been convicted of a crime involving corruption, fraud or any felony;

41


11


Behaviors;


doctor’s note) unexcused absences or three consecutive absences from RCAC, Coordinated

Care Initiative (CCI) or ECAC meetings, RCAC/CCI Work Plan events, ECAC Leadership

Trainings or other L.A. Care-sponsored events; or has failed to attend a majority of RCAC or

ECAC meetings, RCAC Work Plan events, ECAC Leadership Trainings or other L.A. Care-

sponsored events in a fiscal year, will be considered having voluntarily resigned from the

ECAC, effective the date of the last meeting, training or event missed.

e) a request for removal has been voted on by RCAC/CCI members at a scheduled meeting and

submitted by the RCAC/CCI to L.A. Care for disposition.

f) a request for removal has been voted by the ECAC members at a scheduled meeting and




B. ECAC At-Large Member Terms

1. The two ECAC At-Large Members, one At large member will represent the RCACs and the

other At-Large Member will represent the CCI Councils, will be selected by the members of

ECAC, in November of each year, to complete a two year term with the possibility of re-

selection to a second two year term.

2. Only RCAC/CCI Consumer Members or Member Advocates in good standings are eligible for

selection for the two At-Large Members to the ECAC.

3. In addition to the RCAC Chairpersons, the two At-Large Members shall comprise the ECAC.

4. At-Large Members may resign by giving written notice to the assigned CO&E staff person

responsible.

5. At-Large Members can be removed for any one of the following reasons:


b) he or she has been convicted of a crime involving corruption, or any felony;


Behaviors;


doctor’s note) unexcused absences or three consecutive absences from RCAC, CCI or ECAC

42


12

meetings, RCAC/CCI Work Plan events, ECAC Leadership Trainings or other L.A. Care-

sponsored events, or has failed to attend a majority of RCAC or ECAC meetings, RCAC

Work Plan events, ECAC Leadership Trainings or other L.A. Care-sponsored events in a

fiscal year, will be considered having voluntarily resigned from the ECAC, effective the date

of the last meeting, training or event missed.

e) a request for removal has been voted on by RCAC/CCI members at a scheduled meeting and

submitted by the RCAC/CCI to ECAC for disposition.

f) a request for removal has been voted on by the ECAC members at a scheduled meeting and




6. Guidelines and procedures for role and responsibility for the ECAC and At-Large Members can

be found in the RCAC Member Handbook and Guidelines and Procedures.

VI. Code of Conduct

L.A. Care’s Code of Conduct and the RCAC Member Standards of Behavior shall govern the behavior of

RCAC members when they are acting on behalf of L.A. Care. As part of L.A. Care’s Public Advisory

Committee structure, each RCAC member shall receive; review and acknowledge receipt of copy of the

Code of Conduct and RCAC Member Standards of Behavior annually.

VII. RCAC Meetings

A. Public Meeting

Notice of RCAC meetings is posted 72 hours in advance of the meeting or in accordance with the

“Ralph M. Brown Act.” All RCAC meetings are open to the public.

B. Meeting Schedule and Location

RCACs will meet every other month on a schedule and location to be determined jointly by L.A. Care

staff and the RCAC members. With guidance from the assigned CO&E staff person, RCAC members

shall set the date and time of each meeting. RCACs shall meet at a convenient location within its regional

boundaries with appropriate meeting facilities and access to public transportation and/or parking.

43


13

C. Quorum and Voting

A majority of that month’s official RCAC membership must be present in person to have an official

RCAC meeting. All official acts of the RCAC require a majority vote of the members present. No vote or

election shall be by secret ballot.

D. Additional Meeting Guidelines

1. RCAC meetings will be conducted as informal discussion forums, in such a way that all members

have input and the opportunity to reach consensus on issues. Use of formal communications

systems such as parliamentary procedures based on the most recent edition of “Robert’s Rules of

Order Newly Revised” may be used to supplement the informal conversation and provide

structure, especially to the disposition of motions from the members.

2. All official RCAC business (i.e., votes, consensus items, election of Chairperson and Vice-

Chairperson, recommendations to the ECAC, RCAC Work Plan project, etc.) shall occur at a

designated time and location every other month and entered into the public record through the

meeting summary written by the assigned CO&E staff person and then reviewed and approved at

a subsequent RCAC meeting.

3. Decisions concerning work plans, events and other issues will be made by the RCAC as a whole.

Reports from the work groups shall be a regular part of the RCAC meeting structure and shall

include recommendations for consideration by the RCAC as a whole.

4. The RCAC meeting will be conducted in accordance with the official meeting agenda. RCAC

members will be mailed the agenda by L.A. Care at least seven days prior to the meeting or as

soon as practical thereafter. The Chairperson of the RCAC with the assistance of the assigned

CO&E staff person will prepare the agenda for each general meeting based on the input of the

RCAC as a whole. Agendas will be reviewed and approved by the RCAC members at the

beginning of every meeting.

5. Only RCAC members may participate in votes on an issue and the election of a Chairperson and

Vice-Chairperson. L.A. Care staff and the public may participate in discussion when recognized

by the RCAC Chairperson. The public shall be encouraged to share its comments during the

public comment portions of the meeting.

6. RCAC requests for information and materials should be made through the RCAC Chairperson to

the assigned CO&E staff person, who will forward the request(s) to any appropriate departments.

L.A. Care staff will make every effort to respond to these requests in a timely manner. Copies of

44


14

L.A. Care’s public documents are available to individuals by request through L.A. Care’s Board

Services or Legal Departments.

7. Any written communication(s) the RCAC decides to send or distribute outside of L.A. Care must

first be reviewed and approved by the Director of the Community Outreach and Education (or

his or her designate) and when appropriate, management in the Marketing Department. Certain

outreach materials intended for wide distribution (brochures, posters, etc.) may also require

approval from the California Department of Health Services.

8. Funding for support of the RCACs and ECAC is determined by the Board of Governors each

year in the annual L.A. Care budget. Completed project plan and budget request forms shall be

submitted and reviewed by the Community Outreach and Education staff prior to expenditure of

funds. Unspent RCAC Work Plan funds cannot be donated or carried over into the next fiscal

year. Unused Work Plan funds will be returned to L.A. Care’s general fund.

9. RCAC approved recommendations may be forwarded to the ECAC by the RCAC Chairperson.

In addition, the ECAC may request the RCACs to review and comment on issues ECAC

identifies.

10. The RCAC Chairperson is responsible for ensuring that all issues or concerns carried to the

ECAC for discussion and consideration reflect a true RCAC consensus and diversity of opinion.

VIII. Regional Boundaries

1. RCACs shall be established within each of the regional areas as defined by L.A. Care’s Board of

Governors.

2. RCAC members are assigned to a specific RCAC based on their zip code of residence (Consumer

Members), area of community service (Member Advocates), or place of work (Providers).

Regional boundaries are for RCAC purposes only and do not affect a L.A. Care member’s ability

to access care in different regions.

IX. RCAC and ECAC Member Stipends and Reimbursement

1. RCAC members serve as volunteers and shall not be compensated for their services or

reimbursed for their out-of-pocket expenses except as provided by L.A. Care’s Policy AFS-004

(Expense Reimbursement) or as indicated below, subject to approval by L.A. Care’s Board of

Governors.

2. Eligible RCAC Consumer Members who attend at least 80% of their scheduled RCAC meetings

or CO&E staff approved L.A. Care, ECAC or RCAC special meetings or events may receive a

45


15

cash stipend or grocery gift card for participating in the meeting. The stipend amount is

determined by the Governance Committee of the Board of Governors.

3. Eligible RCAC and ECAC members may receive a cash stipend or grocery gift card for

participating in CO&E staff approved L.A. Care, ECAC or RCAC special meetings or events.

4. ECAC Chairpersons or Vice Chairpersons assuming the leadership role at the ECAC monthly

meeting may be eligible to receive a cash stipend or grocery gift card for leading the ECAC

meeting.

5. RCAC Chairpersons or Vice-Chairpersons assuming the leadership role at their RCAC Meeting

may be eligible to receive a cash stipend or grocery gift card, for leading their RCAC meeting.

6. At-Large Members assuming the work of the ECAC may be eligible to receive a cash stipend or

grocery gift card.

7. Details specific to RCAC and ECAC member eligibility and for determining which meetings,

events or special functions are eligible for possible receipt of a cash stipend or grocery gift card

and amount of the stipend can be found in the RCAC Member Handbook and Guidelines and

Procedures.

8. Only Consumer Members are eligible to receive a cash stipend (or grocery gift card) with the

exception of ECAC members.

9. In all cases, stipends paid shall be deemed taxable income and reported to the relevant tax

authorities in accordance with applicable law and regulations.

10. RCAC Consumer and Advocate members may be eligible for certain reimbursements to attend

other approved L.A. Care, ECAC or RCAC special meetings or events.

11. In addition, in order to be eligible to receive a stipend and/or reimbursement, each RCAC

member or ECAC member must complete RCAC Member Orientation and AB 1234 training

provided by L.A. Care once every two years.

X. Election of Member and Member Advocate to the Board of Governors

The Board approved Members in each RCAC shall vote for one Member and one Member Advocate to

represent the interest of Members on the Board of Governors. The two representatives’ names shall be

forwarded to the Los Angeles County Board of Supervisors, the official appointing body for the Board

of Governors of L.A. Care.

46


16

XI. Amendments to the RCAC and ECAC Operating Rules

These RCAC and ECAC Operating Rules are duly adopted by L A. Care’s Board of Governors and may

be amended by the Board of Governors according to L.A. Care Bylaws Article XI. The RCAC and

ECAC Operating Rules were revised on September 6, 2012 through Motion GOV 100.0912.

ATTESTED BY:

Secretary, Board of Governors

Date Signed: _______________________________

47

Recommended Revisions for At-large Member Roles and Responsibilities

The following are responsibilities that were discussed by ECAC members Dalia Cadena, Demetria Saffore and Ana Romo and our Consumer Board Representative, Hilda Perez in the fall of 2014. The proposed roles and responsibilities are described below for the review and final approval of the Governance Committee. One At-Large Seat will stay as is and represent all lines of business except CalMedi-Connect

Should be a consumer member or a Community Partner (advocate) that will represent all L.A. Care product lines except Cal MediConnect (Coordinated Care Initiative Councils).

Work with the RCAC Chairs to bring forward health related issues addressed during the RCAC/ECAC meeting.

To provide support for member issues or concerns brought by the RCAC members to the Interdisciplinary Committee for review and resolution.

Be available to clarify and provide information to ECAC and RCACs.

Attend ECAC meetings, RCAC meetings, L.A. Care Board of Governors (BOG) and Committee meetings to support the work of ECAC.

Visit communities based organizations (CBO), with approval of CO&E staff, to network and learn about the services they provide to the community and L.A. Care membership and bring input to the ECAC meetings.

Provide monthly reports during ECAC meetings and attend RCAC, Board and Committee meetings, and visit CBOs.

Serve on and lead ECAC ad-hoc committees or other meetings as requested.

Participate as needed to support legislative office visits and advocacy efforts for L.A. Care members.

Work on special projects as needed.

One At-Large Member will represent Cal MediConnect Product Line and will focus efforts on seniors and people with disabilities and the Coordinated Care Initiative Councils

Should be a consumer member or a Community Partner that represents the Cal MediConnect population.

Work with Coordinated Care Initiative Council (CCI) Meeting Chairs to bring forward health related issues affecting seniors and persons with disabilities addressed during the Council Meeting/ECAC.

To provide support for member issues brought forward by the council meetings to the Interdisciplinary Committee for review and resolution focused on seniors and people with disabilities.

Be available to clarify and provide information to ECAC and the CCI Meetings.

Attend ECAC meetings, CCI meetings, L.A. Care Health Plan Board of Governors meetings and Committee meetings to support ECAC, particularly for CCI related issues.

Visit community based organizations (CBO) that work closely with seniors and people with disabilities, with approval of CO&E staff, to network and learn about the services they provide to the community and L.A. Care membership, and bring their input to the ECAC meetings.

Provide monthly reports during ECAC meetings that will include attendance at CCI meetings, Board and Committee meetings, and at meetings of the CBOs.

Serve on and lead ECAC ad-hoc committees or other meetings as requested.

Participate as needed to support legislative office visits and advocacy efforts for L.A. Care members, particularly those that support seniors and people with disabilities.

Work on special projects as needed.

48

Board of Governors

MOTION SUMMARY

Date: September 3, 2014 Motion No. BOG 101.0915

Committee: Chairperson: Mark Gamble

Issue: Request approval to procure disk storage space equipment and installation services from

Eplus to accommodate vital systems and growing data storage needs.



Background: L.A. Care staff requests approval to procure disk storage space equipment and

installation services from Eplus in the amount of $627,483. The Information Technology (IT) Department must add data storage capacity to effectively support the organization’s increasing data storage requirements. A key component of L.A. Care’s network infrastructure consists of the hardware and software that stores the organization’s critical and ever-expanding data. Due to the ongoing QNXT upgrade, exchange upgrade project, increased call recording in member services, and in preparation for future data growth, it is necessary to increase storage adequately to support current and upcoming needs. L.A. Care conducted an RFQ from Eplus, Academy Partners, and Zones in July/August 2015. Eplus was the vendor chosen as they provided the lowest price for the same products and services.

Budget Impact: Total cost for this purchase is $627,483 and is budgeted under the

Enterprise Data Warehouse Strategic Project for FY 2014-15.

Motion: To authorize staff to procure disk storage space equipment and installation services from Eplus in the amount of $627,483, to effectively support L.A. Care’s increasing data storage needs.

49

CHIEF EXECUTIVE OFFICER REPORT

OVERVIEW OF MAJOR INITIATIVES

L.A. Care has experienced substantial growth over the last two years driven largely by the Affordable

Care Act and California’s implementation of the Medi-Cal expansion. L.A. Care has gained new

membership, and developed new lines of business such as Cal MediConnect and L.A. Care Covered.

Last year, L.A. Care focused on implementing these mandated programs, each with distinct

populations and different payment systems, growing from an organization that largely oversaw Plan

Partners and a direct product line with mostly mothers and children, to a health plan with a more

varied and complex membership and multiple product lines. Along with this growth, there is new

leadership at L.A. Care that aims to position the health plan to further succeed in providing access to

high quality health care and improve performance for members, providers, and the community. To

move in this direction, the dominant demand this coming year is for L.A. Care to hone and improve

our products, make adjustments to our care and contracting models to best meet the needs of our

members and providers, and to roll out a strategic vision that defines where we want to be as a plan

in light of our mission and business needs within the context of changes to the health care

landscape. Throughout this process, L.A. Care maintains the organization’s commitment to the

community, including health care safety net.

Medi-Cal

The Affordable Care Act has raised the prominence of Medi-Cal and has brought about increased

interest in Medi-Cal among entities in the larger health care sector. One result has been has been

several proposed health insurance mergers. Centene has announced that it plans to acquire Health

Net, Aetna and Humana plan a merger, and Anthem and Cigna announced a merger. The mergers

may result in greater purchasing power of the newly merged, large insurers, providing the ability to

attract a wide range of providers at low rates. On the other hand, the process of merging large

organizations with different systems, work processes, and corporate cultures may result in some

disorder in the health care market during the transition. Although L.A. Care has experienced a rapid

increase in enrollment and maintain a solid market share in Medi-Cal, L.A. Care must continue to

develop strategies to improve care for its members and promote value to policy makers. L.A. care’s

long-term strategy should focus on the changing environment, strategic partnerships and potential

competitors. Achieving operational excellence is crucial in this competitive environment.

Although the big increase in Medi-Cal membership came in January 2014 with the transition of the

Low Income Health Plan population into Medi-Cal Expansion, Medi-Cal membership has

continued to increase. Medi-Cal membership, including Plan Partners, for the month of August was

1.7 million members. Unlike Covered California plans, there is no open enrollment period for Medi-

Cal so enrollment occurs all year round. The growth of Medi-Cal membership is expected to taper

with modest increases in the next year. There is still a population that is eligible for Medi-Cal but

not enrolled, who may enroll as health coverage increasingly becomes the norm. The enrollment

push during Covered California open enrollment always results in Medi-Cal enrollments in addition

50

to L.A. Care Covered. Finally, new populations such as undocumented children may become Medi-

Cal eligible.

California’s “Bridge to Reform” waiver will expire at the end of October 2015. California is

developing a new larger waiver package which represents $17 billion over 5 years. The Waiver asks

the federal government for permission to start new programs that will change payments and health

care delivery system for the Medi-Cal program. CMS is currently reviewing the application and state

expects the new Waiver will be in place by Nov. 1, 2015.

L.A. Care Covered

L.A. Care Covered remained relatively stable over the past year, with 16,000 members currently

enrolled. As the Statewide default renewal option was to remain with the same Covered California

health plan, L.A. Care Covered retained much of its membership. Because L.A. Care Covered

membership was heavily in the Bronze category, the product was adversely affected by risk

adjustment in which L.A. Care had to return funding because of its healthy member profile. In

addition, the Covered California participation fee was financially difficult since it is a flat fee that was

more difficult to absorb within a low Bronze premium than would have been within a higher Silver

premium. The MCO tax also affected the financial stability of L.A. Care Covered. For 2016, L.A.

Covered is priced similarly relative to other plans in Bronze and Silver, meaning that L.A. Care is not

the least expensive but is one of the lower priced plans in both metal tiers. This pricing strategy is

designed to attract more Silver members, which provides more value to members because of cost

sharing subsidies and which helps L.A. Care with risk adjustment and the participation fee.

L.A. Care is focusing on continued enhancements to customer service, provider network and brand

differentiation. This year, L.A. Care Covered successfully launched L.A. Care Covered Direct. Plans

in the Exchange are required to offer a product outside of the Exchange that “mirrors” LA Care

Covered, and people who cannot provide proper documentation for LA Care Covered can enroll in

that mirror product without federal premium subsidy. Additionally, LACC deployed cash premium

payment option for members called “Pay near ME” making LACC the first qualified health plan in

the CA health benefits exchange to accept direct cash payments from its members. This is a free

service will make it easier for members who do not have traditional bank accounts to pay their

premiums. This program allows LACC members to make cash payments at convenient stores

throughout the County. Although most of LAC’s LACC membership has subsidized premiums, a

small percentage of members may need to pay a portion of the monthly premiums.

Cal MediConnect

L.A. Care terminated the D-SNP product to enable the organization to fully focus all efforts on the

duals demonstration. The program terminated on December 31, 2014 and CMC-eligible members

were transitioned into the demonstration on January 1, 2015. The D-SNP Medicare Star work plan

has been reframed to focus on CMC interventions and measures. The Medicare Star work plan was

reprioritized to focus on CMC interventions and measures that have decreased by 1 to 2 stars. L.A.

Care also cured its Low Performing Icon (LPI) which qualified the plan to receive Cal MediConnect

51

passive enrollment effective January 1, 2015 through June 2015. Effective July 1, 2015, enrollment

into CMC is now a voluntary basis only. As of August 2015, membership is at 15,000 members.

Cal MediConnect has benefitted from passive enrollment and has a solid base membership.

However, the opt-out rate for all plans in Cal MediConnect has been high, partially driven by

providers encouraging their patients to opt out. L.A. Care has been working with other plans to

assess reasons for the high opt-out rate and to design strategies to attract and retain members. In

addition, there will no longer be passive enrollment so all new enrollment will result from marketing

efforts and inreach. LAC has a number of strategies to help minimize confusion and to encourage

people to participate in the program.

PASC-SEIU and Healthy Kids

L.A. Care continues to operate its PASC-SEIU product for IHSS workers as well as Healthy Kids.

As of August 2015, PASC-SEIU has a total membership of 46,000 members and Healthy Kids 400

members enrolled. Healthy Kids membership is very low as most children are eligible for Medi-Cal

or Covered California and other children have aged out of Healthy Kids. Healthy Kids will remain

operational until September 30, 2016, when these children will become Medi-Cal eligible.

Core System Plus

The Core System Modernization Project, now known as Core System Plus, is one of L.A. Care’s

most important initiatives to support efficient business practices. The goal of the L.A. Care Core

System Modernization Project is to replace and augment the functionality of the previous MHC core

system with a robust, user-friendly, and reliable system that can be readily integrated with provider

systems and more effectively administer our programs and improve service to our providers and

members. QNXT replaces inflexible, outdated technology and achieves cost efficiencies, increased

auto-adjudication rates, while meeting operational and compliance requirements.

Due to challenges experienced with complex system configurations and given the critical nature of a

successful implementation, a “Czar” was appointed for QNXT Core system conversion. The

timeline for full implementation is projected for September 2016.

Workforce Growth

Along with growth in membership and product lines, L.A. Care has grown as an organization. L.A.

Care’s forecasted full time equivalent (FTE) staffing is 1,675 positions at the end of fiscal year 2015.

During fiscal year 2016, the budget provides for up to 115 additional FTEs, raising the total FTE

count to 1,790 by the end of fiscal year 2016. The additional FTEs are to support membership

growth and the management of our complex populations.

L.A. Care raised the organization’s minimum wage to $15/hour in May. In addition, L.A. Care made

benefits, including health insurance, available to some new hires sooner.

52

Operational Budget

L.A. Care’s Board of Governors adopted a budget with a $66.0 million surplus for fiscal year 2014-

2015. Fiscal year-to-date performance for the first nine months ending in June 2015 has resulted in

a surplus of $84.1 million. Administrative savings contribute to the favorable variance by $15.1

million and lower-than-expected healthcare expenses make up the difference. The preliminary

forecast suggests that the favorable position will continue into the FY15-16 year with further

administrative savings as the membership is expected to reach a modest level of growth. Additional

savings will be explored in healthcare costs during this projected period of stabilization.

Quality Improvement

NCQA

L.A. Care successfully maintained the National Committee for Quality Assurance Accreditation. The

next review is in 2017.

NCQA Multicultural Health Care Distinction

L.A. Care was awarded the National Center for Quality Assurance (NCQA) Multicultural Health

Care (MHC) Distinction for its Medi-Cal and L.A Care Covered product lines. This is the second

time L.A. Care was awarded for the Medi-Cal product line and the first time for L.A. Care Covered.

L.A. Care is one of seven health plans nationwide to be awarded the MHC Distinction for Medi-Cal,

and one of five health plans for California Covered.

Implementation of MEM Standards

The National Commission on Quality Assurance (NCQA) requirements change the way health plans

communicate to its members. NCQA’s Standards for Member Connection (MEM) standards

became effective on July 1, 2015 for L.A. Care’s MediCal, Cal MediConnect, and L.A. Care Covered

lines of business. The standards focus on improving member access to healthcare information,

promotes members ability to manage their own care and make informed, ACA calls for increased

member participation and engagement in delivery of care, ongoing advances and access to

technology. L.A. Care successfully implemented new MEM standards on June 24, 2015, prior to the

effective date of July 1, 2015.

In response, L.A. Care launched a new member portal that meets both National Committee for

Quality Assurance (NCQA) Member Connection Standards and Health Insurance Portability and

Accountability (HIPAA) requirements. The portal is available for Cal MediConnect, Medi-Cal and

L.A. Care Covered members who register for online access. Features include personalized resources

to help these members be more involved with their own health and care. Members can view and

print their ID card, request a change of PCP, view and print a list of prescriptions, participate in

wellness programs, chat live online with a nurse, and view claims. Portal access for PASC-SEIU

members will go live in the fall.

53

HEDIS Improvement Efforts

At the end of the 2014 HEDIS measurement year, L.A. Care developed several initiatives aimed at

improving measures in areas that had low performance in the past. A major effort was made to

ensure robust data collection and clean-up. Efforts included working with participating provider

groups (PPGs) so they appropriately utilize the L.A. Care provider opportunity reports. We are also

engaging primary care physicians (PCPs) and conducting member outreach to ensure that members

are getting appropriate tests and screenings. We have implemented prenatal and postpartum

outreach strategies. These include programs that identify women in their third trimester, educating

them on the importance of prenatal and postpartum care, and providing a member incentive to

encourage women to attend a postpartum visit with their provider.

The existing Medicare Star workplan was reprioritized to focus on comprehensive interventions that

support member engagement, provider support, and documentation/reporting. Additionally, the QI

team is working with our Plan Partners on a strategy to improve L.A. Care’s overall HEDIS

performance. The goal is to develop a combined strategy to improve performance. The QI work

team will also work with Los Angeles County Department of Healthcare Services (DHS) to focus on

HEDIS improvement. We continue collaborative efforts with DHS to put effective interventions in

place and ensure accurate data is captured.

Health Information Technology (HIT)

HITEC-LA

HITEC-LA was awarded a second no-cost extension from the Office of the National Coordinator

of Health IT to continue until June 2016. The additional time will allow 200-400 HITEC-LA

members to reach meaningful use of electronic health records. As of May 2015, HITEC-LA passed

95 percent of its goal of helping 3,000 primary care providers reach meaningful use. The program’s

commitment to delivering high quality service has resulted in a high level of satisfaction among the

solo providers, small practices and clinics it works with.

Blue Button

Blue Button is a pilot project that enables L.A. Care members to download their prescription history

to engage in collaborative care with their provider. The Blue Button pilot is in process with

computer kiosks to be implemented at five practices small practices allowing patients to access their

prescription history on computer kiosks in the practice waiting rooms. This allows members to print

medication histories onsite for their physicians. An implementation strategy is being developed for

expansion to all L.A. Care members.

eConsult

L.A. Care’s eConsult program was developed to improve the access to quality specialty care for Los

Angeles County residents focusing on low-income and vulnerable populations by allowing HIPAA

secure conversations between primary care providers and specialists using a HIT software platform.

54

In 2011, it was expanded to the L.A. County Department of Health Services (LAC DHS) and

Healthcare (HCLA) IPA clinic sites making this program the largest rollout of its type in the United

States. As of December 2014, the program served over 30 specialties, 195 clinic sites, 2,500

providers and a base of up to 500,000 patients.

The second phase of the program consists of program expansion called eManagement to improve

care delivery by enhancing collaboration between primary care providers and mental health

specialists, improving co-management of complicated patients, reducing unnecessary office visits,

improving medication management and optimizing the specialist visits. Work continues on the

eConsult behavioral health pilot to support L.A. Care members, which is being designed with the

Behavioral Health department and the participation of DMH and DPH.

Continuing Medical Education (CME) Training Program

L.A. Care is an accredited continuing education provider by Institute for Medical Quality, a

subsidiary of the California Medical Association and also accredited by Board of Registered Nursing

and Board of Behavioral Sciences for CME activities and events provided by the Provider

Continuing Education Program. The CME activities and events specifically target the low

performing primary care physicians related to their HEDIS scores and Star Performance to improve

quality of patient care and physician-patient relationships. The CME program holds activities

throughout the year, with emphasize the identified needs of providers through conducted surveys

and ongoing feedback. The program topics include but are not limited to childhood and adult

chronic diseases, cultural awareness and competency, behavioral health, eHealth and preventive

healthcare.

Special Initiatives

Health Neighborhoods

L.A. Care entered into a partnership with the L.A. County Departments of Health Services, Mental

Health, and Public Health, and the Community Clinic Association of Los Angeles County for a year-

long collaborative planning process to create “Health Neighborhoods” to improve health outcomes

for homeless individuals with co-occurring mental health and substance use disorders. L.A. Care

received a grant from Blue Shield of CA Foundation Grant for Advancing Primary Care and

Behavioral Health Integration through Community Collaboration program in the amount of

$175,000 for a one-year period. This project aims to create Health Neighborhoods in L.A. County

that will integrate safety net medical, mental health, and substance use disorder care within defined

neighborhoods. As of June 2015, five neighborhoods across Los Angeles have signed MOUs to

improve care coordination among local physical health, mental health, and substance use disorder

providers. The pilot locations are Lancaster, Pacoima, Boyle Heights, Central Long Beach, and

Watts/Willowbrook. L.A. Care and its partners have applied for a second year of funding from the

Blue Shield Foundation, in order to conduct operational planning and implement in the selected

areas.

55

Mobile Vision Services

In June 2014, Governor Brown signed into law SB 870 establishing $6 million dollars over a 3-year

pilot in Los Angeles County to provide children, who are enrolled in Medi-Cal, vision care services

at school sites delivered by mobile vision clinics. The pilot launched on January 1, 2015 and is

intended to evaluate whether the provision of vision services through mobile vision clinics can

improve vision care utilization among children enrolled in Medi-Cal. L.A. Care has contracted with

Vision to Learn to serve as a provider. Vision to Learn has served approximately 3,600 total children

between January 1, 2015 and May 1, 2015. Of the 3,600, 1,800 children are estimated to be L.A. Care

members.

L.A. Care Strategic Vision

Now that L.A. Care has more experience with its new products and with its new Medi-Cal

population, we have the opportunity to refine our approach so that our products best meet our

members’ needs. L.A. Care experienced a leadership change in 2015, which also provides a new

perspective on business operations and approach to product lines. The major priority areas include

promoting clear lines of accountability to drive efficiency and excellence, aligning reimbursement to

member risk and provider performance, tailoring models of care to the specific needs of our

member populations, and maintaining leadership in improving health outcomes for low income and

vulnerable populations. L.A. Care wants to ensure that our members receive excellent care, that

their care is managed in a manner that promotes good health outcomes, and that care is accessible to

all members.

56

August 10, 2015

TO: Finance & Budget Committee

FROM: Timothy Reilly, Chief Financial Officer

SUBJECT: Monthly Investment Transaction Report –July 2015

In order to keep the Committee apprised of L.A. Care’s investment portfolios and to comply withCalifornia government code section 53607, presented herein are the investment transaction detailsfrom July 1, 2015, to July 31, 2015.

As of July 31, 2015, L.A. Care's total investment market value was $1.9 billion. This includesapproximately $50 million invested with the Los Angeles County Pooled Investment Fund(LACPIF) overseen by the County Treasurer and $10 million invested with the Local AgencyInvestment Fund (LAIF) overseen by the State Treasurer’s Office. The remainder, $1.8 billion, ismanaged by Payden & Rygel, an external professional asset management firm, and is divided to twoseparate portfolios based on investment style:

1. Short-term Portfolio and2. Extended Portfolio

57

TRANSACTIONS BY TYPE

Account Name: L.A. CARE HEALTH PLAN 07/01/2015Account Number: through 07/31/2015

Trade Settlement Transaction Maturity Coupon Accrued Interest TotalDate Date Type Units Description Date Rate CUSIP Proceeds / (Cost) (Purch) or Sold Amount

07/07/15 07/10/15 Buy 3,000,000.000 CHASE 2014-A1 A1 CDT 01/15/19 1.15 161571GJ7 (3,010,898.44) (2,395.83) (3,013,294.27)

07/07/15 07/10/15 Buy 1,640,000.000 GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.59 36159LCF1 (1,639,359.38) (481.14) (1,639,840.52)

07/09/15 07/14/15 Buy 200,000.000 GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.59 36159LCF1 (199,875.00) (71.71) (199,946.71)

07/09/15 07/14/15 Buy 850,000.000 JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 (850,531.25) (595.71) (851,126.96)

07/23/15 07/24/15 Buy 7,500,000.000 FHLB 08/28/17 0.75 3130A62S5 (7,483,200.00) (7,483,200.00)

07/24/15 07/24/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 10/09/15 313384MT3 (49,990,695.83) (49,990,695.83)

07/24/15 07/24/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 10/09/15 313384MT3 (49,990,909.72) (49,990,909.72)

07/24/15 07/24/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 10/23/15 313384NH8 (49,987,487.50) (49,987,487.50)


07/24/15 07/24/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 10/26/15 313384NL9 (49,987,727.78) (49,987,727.78)

07/24/15 07/24/15 Buy 43,000,000.000 FHLMC DISCOUNT NOTE 01/21/16 313396SB0 (42,963,246.94) (42,963,246.94)

07/28/15 07/28/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 01/15/16 313384RV3 (49,957,250.00) (49,957,250.00)

07/28/15 07/28/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 01/15/16 313384RV3 (49,957,250.00) (49,957,250.00)




07/28/15 07/28/15 Buy 50,000,000.000 FHLMC DISCOUNT NOTE 01/22/16 313396SC8 (49,956,736.11) (49,956,736.11)

07/28/15 07/28/15 Buy 50,000,000.000 U.S. TREASURY NOTE 03/31/16 0.38 912828C40 (50,056,640.63) (60,963.11) (50,117,603.74)

07/28/15 07/28/15 Buy 50,000,000.000 U.S. TREASURY BILL 08/20/15 912796ET2 (49,998,818.06) (49,998,818.06)

07/28/15 07/28/15 Buy 30,000,000.000 U.S. TREASURY BILL 08/20/15 912796ET2 (29,999,310.00) (29,999,310.00)

Payden & Rygel Page 158




07/27/15 07/30/15 Buy 1,382,797.560 NGN 2011-R2 1A 1MOFRN NCUA 02/06/20 0.59 62889CAA7 (1,387,118.81) (495.62) (1,387,614.43)

07/27/15 07/30/15 Buy 797,216.120 NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.59 62889EAA3 (799,956.55) (220.87) (800,177.42) 738,370,013.680 (738,106,374.51) (65,223.99) (738,171,598.50)

07/01/15 07/01/15 Coupon CA GOLDEN EMPIRE SCH FRN 05/01/16 0.22 381008AS0 2,036.71 2,036.71

07/02/15 07/02/15 Coupon FFCB 1ML FRN 01/02/18 0.23 3133EEWS 2,034.67 2,034.67

07/02/15 07/02/15 Coupon GE CAPITAL CORP FRN 04/02/18 0.99 36962G6X7 9,172.74 9,172.74

07/03/15 07/03/15 Coupon FFCB 1ML FRN 10/03/16 0.21 3133ED3B6 845.83 845.83

07/04/15 07/04/15 Coupon FFCB 1ML FRN 08/04/17 0.23 3133EDUD 1,873.33 1,873.33

07/07/15 07/07/15 Coupon ORACLE FRN 07/07/17 0.48 68389XAT2 951.96 951.96


07/07/15 07/07/15 Coupon ORACLE FRN 07/07/17 0.48 68389XAT2 1,308.95 1,308.95



07/08/15 07/08/15 Coupon GE CAPITAL CORP 01/08/16 1.00 36962G6R0 4,650.00 4,650.00

07/08/15 07/08/15 Coupon GE CAPITAL CORP 01/08/16 1.00 36962G6R0 10,000.00 10,000.00

07/08/15 07/08/15 Coupon NGN 2010-R2 1A 1MOFRN NCUA 11/06/17 0.56 62888UAA8 1,287.04 1,287.04

07/08/15 07/08/15 Coupon NGN 2011-R1 1A 1MOFRN NCUA 01/08/20 0.64 62888YAA0 6,550.57 6,550.57

07/08/15 07/08/15 Coupon NGN 2011-R1 1A 1MOFRN NCUA 01/08/20 0.64 62888YAA0 1,116.43 1,116.43

07/08/15 07/08/15 Coupon NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.57 62889FAA0 5,578.48 5,578.48

07/08/15 07/08/15 Coupon NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.57 62889FAA0 665.69 665.69





07/10/15 07/10/15 Coupon METLIFE GLOBAL FRN 144A 04/10/17 0.66 59217GBE8 2,469.13 2,469.13

07/11/15 07/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.64 263901AE0 490.46 490.46


07/11/15 07/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.64 263901AE0 5,018.54 5,018.54



07/11/15 07/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.64 263901AE0 2,096.33 2,096.33


07/13/15 07/13/15 Coupon BERKSHIRE HATHAWAY FRN 01/12/18 0.59 084664CD1 10,918.10 10,918.10

07/13/15 07/13/15 Coupon BERKSHIRE HATHAWAY FRN 01/12/18 0.59 084664CD1 837.05 837.05

07/13/15 07/13/15 Coupon JOHN DEERE CAPITAL FRN 10/11/16 0.58 24422ESE0 314.70 314.70

07/13/15 07/13/15 Coupon FFCB 1ML FRN 02/13/17 0.23 3133EDFB3 939.58 939.58

07/13/15 07/13/15 Coupon NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.59 62889EAA3 3,347.96 3,347.96

07/13/15 07/13/15 Coupon NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.59 62889EAA3 379.44 379.44

07/15/15 07/15/15 Coupon CHASE 2014-A1 A1 CDT 01/15/19 1.15 161571GJ7 3,354.17 3,354.17



07/15/15 07/15/15 Coupon CHASE 2015-A3 A CDT 1MOFRN 04/15/19 0.44 161571GW 2,613.00 2,613.00

07/15/15 07/15/15 Coupon DRYROCK 2014-2 A 1MOFRN CD 03/16/20 0.53 06742LAC7 4,379.17 4,379.17

07/15/15 07/15/15 Coupon DRYROCK 2014-2 A 1MOFRN CD 03/16/20 0.53 06742LAC7 2,189.58 2,189.58





07/15/15 07/15/15 Coupon EBAY 07/15/15 0.70 278642AD5 350.00 350.00

07/15/15 07/15/15 Coupon EBAY 07/15/15 0.70 278642AD5 420.00 420.00

07/15/15 07/15/15 Coupon HONDA 2014-4 A2 CAR 01/17/17 0.58 43814JAB0 596.92 596.92

07/15/15 07/15/15 Coupon HONDA 2015-1 A2 CAR 06/15/17 0.70 43814KAB7 991.67 991.67

07/15/15 07/15/15 Coupon HONDA 2015-1 A2 CAR 06/15/17 0.70 43814KAB7 1,633.33 1,633.33

07/15/15 07/15/15 Coupon JOHN DEERE 2013-B A3 EQP 08/15/17 0.87 477879AC4 1,733.50 1,733.50

07/15/15 07/15/15 Coupon JOHN DEERE 2014-A A3 EQP 04/16/18 0.92 47787VAC5 2,319.17 2,319.17

07/15/15 07/15/15 Coupon JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 3,559.75 3,559.75

07/15/15 07/15/15 Coupon JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 94.25 94.25


07/15/15 07/15/15 Coupon ORACLE FRN 01/15/19 0.87 68389XAR6 2,540.36 2,540.36

07/15/15 07/15/15 Coupon ORACLE FRN 01/15/19 0.87 68389XAR6 1,113.43 1,113.43

07/15/15 07/15/15 Coupon PFIZER 01/15/17 0.90 717081DD2 12,352.50 12,352.50

07/15/15 07/15/15 Coupon PFIZER 01/15/17 0.90 717081DD2 5,625.00 5,625.00

07/15/15 07/15/15 Coupon TOYOTA 2014-B A3 CAR 03/15/18 0.76 89231RAC8 2,546.00 2,546.00

07/15/15 07/15/15 Coupon TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 1,704.00 1,704.00

07/15/15 07/15/15 Coupon TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 769.17 769.17

07/15/15 07/15/15 Coupon TOYOTA 2015-B A2A GREEN CA 11/15/17 0.77 89237CAB7 3,365.76 3,365.76

07/15/15 07/15/15 Coupon USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 21.26 21.26






07/15/15 07/15/15 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 512.33 512.33

07/15/15 07/15/15 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 1,846.33 1,846.33

07/15/15 07/15/15 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 2,339.33 2,339.33

07/16/15 07/16/15 Coupon JOHN DEERE CAPITAL CORP FR 01/16/18 0.58 24422ESU4 10,721.89 10,721.89

07/16/15 07/16/15 Coupon JOHN DEERE CAPITAL CORP 01/16/18 1.35 24422EST7 13,500.00 13,500.00

07/16/15 07/16/15 Coupon FFCB 1ML FRN 04/16/18 0.24 3133EEZC7 1,354.70 1,354.70

07/17/15 07/17/15 Coupon FFCB 1ML FRN 01/17/18 0.22 3133EEZM5 1,793.75 1,793.75

07/17/15 07/17/15 Coupon FFCB 1ML FRN 04/17/17 0.24 3133EDJX1 588.13 588.13

06/25/15 07/19/15 Coupon FNA 2013-M7 ASQ2 CMBS 03/26/18 1.23 3136AEGM 2,085.70 2,085.70

07/20/15 07/20/15 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.59 36159LCF1 444.95 444.95



07/20/15 07/20/15 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.59 36159LCF1 1,704.51 1,704.51




07/20/15 07/20/15 Coupon GEDFT 2014-2 A 1MOFRN FLOO 10/20/19 0.64 36159LCN4 1,881.95 1,881.95

07/20/15 07/20/15 Coupon VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 7,000.00 7,000.00

07/20/15 07/20/15 Coupon VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 1,166.67 1,166.67

07/20/15 07/20/15 Coupon WELLS FARGO FRN 07/20/16 0.82 94974BFM7 610.53 610.53





07/20/15 07/20/15 Coupon WELLS FARGO FRN 07/20/16 0.82 94974BFM7 2,442.14 2,442.14

07/20/15 07/21/15 Coupon HONDA 2015-2 A3 CAR 02/21/19 1.04 43813NAC0 4,285.67 4,285.67

07/22/15 07/22/15 Coupon JOHN DEERE CAPITAL 01/22/16 0.75 24422ERZ4 1,612.50 1,612.50


07/22/15 07/22/15 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 434.29 434.29

07/22/15 07/22/15 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 1,302.86 1,302.86

07/23/15 07/23/15 Coupon BNY MELLON FRN 10/23/15 0.52 06406HCF4 1,282.22 1,282.22

07/23/15 07/23/15 Coupon GEET 2015-1 A2 EQP 11/24/17 0.89 36164EAB1 967.88 967.88

07/23/15 07/23/15 Coupon NEW YORK LIFE GLOBAL FRN 14 05/23/16 0.64 64952WBP 792.77 792.77

07/23/15 07/23/15 Coupon WELLS FARGO FRN 04/23/18 0.92 94974BFK1 2,293.33 2,293.33

07/23/15 07/23/15 Coupon WELLS FARGO FRN 04/23/18 0.92 94974BFK1 6,879.98 6,879.98

07/24/15 07/24/15 Coupon GEET 2013-2 A2 EQP 06/24/16 0.61 36163GAB7 81.18 81.18

07/25/15 07/25/15 Coupon BMW 2014-A A3 CAR 11/26/18 0.97 09658UAC3 1,705.58 1,705.58

07/01/15 07/25/15 Coupon FHMS K708 A2 CMBS 01/25/19 2.13 3137AQT24 2,378.50 2,378.50

07/01/15 07/25/15 Coupon FHMS K708 A2 CMBS 01/25/19 2.13 3137AQT24 1,775.00 1,775.00

07/01/15 07/25/15 Coupon FHMS K710 A2 CMBS 05/25/19 1.88 3137ARPY6 2,997.11 2,997.11

07/25/15 07/25/15 Coupon FHMS KF01 A 1MOFRN CMBS 04/25/19 0.53 3137AUP52 182.91 182.91

07/01/15 07/25/15 Coupon FNA 2012-M9 ASQ2 CMBS 12/25/17 1.51 3136A7L26 2,688.04 2,688.04

07/01/15 07/25/15 Coupon FNA 2013-M1 ASQ2 CMBS 11/25/16 1.07 3136ABPT4 1,242.28 1,242.28

07/01/15 07/25/15 Coupon FNA 14-M1 ASQ2 CMBS 11/25/18 2.32 3136AHUV 3,871.67 3,871.67





07/01/15 07/25/15 Coupon FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 75.08 75.08


07/01/15 07/25/15 Coupon FNA 2014-M3 ASQ2 CMBS 03/25/16 0.56 3136AJKZ8 2,730.64 2,730.64

07/01/15 07/25/15 Coupon FNA 2014-M3 ASQ2 CMBS 03/25/16 0.56 3136AJKZ8 2,654.97 2,654.97

07/01/15 07/25/15 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.54 3136AJ2A3 203.44 203.44

07/01/15 07/25/15 Coupon FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.44 3136AKQJ5 560.39 560.39

07/01/15 07/25/15 Coupon FNA 2015-M3 FA 1MOFRN CMBS 06/25/18 0.41 3136AMMC 480.54 480.54

07/01/15 07/25/15 Coupon FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.40 3136AMTM 4,413.27 4,413.27

07/01/15 07/25/15 Coupon FNA 2015-M7 ASQ2 CMBS 04/25/18 1.55 3136ANJY4 4,843.75 4,843.75

07/01/15 07/25/15 Coupon FNA 2015-M8 FA CMBS 11/25/18 0.36 3136ANMF 3,959.47 3,959.47

07/26/15 07/26/15 Coupon US BANK 01/26/18 1.35 90331HMQ 3,356.25 3,356.25

07/27/15 07/27/15 Coupon JPMORGAN CHASE FRN 01/25/18 1.20 46625HJF8 3,957.01 3,957.01



07/27/15 07/27/15 Coupon NATL RURAL UTILITIES 01/27/17 1.10 637432MW 2,750.00 2,750.00

07/28/15 07/28/15 Coupon PNC BANK 01/28/16 0.80 69349LAH1 1,680.00 1,680.00




07/29/15 07/29/15 Coupon AMERICAN EXPRESS FRN 07/29/16 0.80 0258M0DH 1,096.93 1,096.93







07/30/15 07/30/15 Coupon MANUFACTURERS & TRADERS T 01/30/17 0.67 55279HAC4 825.51 825.51



07/30/15 07/30/15 Coupon MANUFACTURERS & TRADERS T 01/30/17 0.67 55279HAC4 1,073.16 1,073.16

07/30/15 07/30/15 Coupon U.S. TREASURY FRN 01/31/17 0.13 912828H60 12,700.05 12,700.05

07/30/15 07/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.53 90331HMD 642.25 642.25

07/30/15 07/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.53 90331HMD 2,568.98 2,568.98

07/30/15 07/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.53 90331HMD 1,605.61 1,605.61

07/30/15 07/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.53 90331HMD 642.25 642.25

07/30/15 07/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.53 90331HMD 4,174.59 4,174.59 327,345.01 327,345.01

07/01/15 07/01/15 Income 26.130 STIF INT USD 26.13 26.13

07/01/15 07/01/15 Income 2,454.200 ADJ NET P&I USD 2,454.20 2,454.20 2,480.330 2,480.33 2,480.33

07/24/15 07/24/15 Contributn 300,000,000.000 NM USD 300,000,000.00 300,000,000.00

07/28/15 07/28/15 Contributn 435,000,000.000 NM USD 435,000,000.00 435,000,000.00 735,000,000.000 735,000,000.00 735,000,000.00





07/07/15 07/08/15 Sell Long 19,000,000.000 FHLB DISCOUNT NOTE 07/10/15 313384HY8 18,999,292.79 696.66 18,999,989.45

07/07/15 07/08/15 Sell Long 25,000,000.000 FHLB DISCOUNT NOTE 07/10/15 313384HY8 24,999,069.45 916.66 24,999,986.11

07/07/15 07/08/15 Sell Long 25,000,000.000 FHLB DISCOUNT NOTE 08/10/15 313384KF5 24,992,345.84 6,531.25 24,998,877.09


07/13/15 07/14/15 Sell Long 7,500,000.000 PRIVATE EXPORT FUNDING CP 01/05/16 7426M2A5 7,478,781.25 6,635.42 7,485,416.67


07/14/15 07/15/15 Sell Long 50,000,000.000 FHLMC DISCOUNT NOTE 08/07/15 313396KC6 49,984,000.00 14,722.22 49,998,722.22

07/22/15 07/24/15 Sell Long 1,930,000.000 FHLB 09/28/16 0.50 3130A2T97 1,930,225.02 3,109.44 1,933,334.46 158,430,000.000 158,374,451.56 40,818.60 158,415,270.16

07/08/15 07/08/15 Pay Princpl 53,146.255 NGN 2010-R2 1A 1MOFRN NCUA 11/06/17 0.56 62888UAA8 53,146.25 53,146.25

07/08/15 07/08/15 Pay Princpl 180,117.785 NGN 2011-R1 1A 1MOFRN NCUA 01/08/20 0.64 62888YAA0 180,117.79 180,117.79

07/08/15 07/08/15 Pay Princpl 30,697.959 NGN 2011-R1 1A 1MOFRN NCUA 01/08/20 0.64 62888YAA0 30,697.96 30,697.96

07/08/15 07/08/15 Pay Princpl 375,577.140 NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.57 62889FAA0 375,577.14 375,577.14

07/08/15 07/08/15 Pay Princpl 44,818.275 NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.57 62889FAA0 44,818.27 44,818.27

07/13/15 07/13/15 Pay Princpl 93,334.622 NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.59 62889EAA3 93,334.62 93,334.62

07/13/15 07/13/15 Pay Princpl 10,577.924 NGN 2011-R3 1A 1MO FRN NCU 03/11/20 0.59 62889EAA3 10,577.92 10,577.92

07/15/15 07/15/15 Pay Princpl 145,206.557 JOHN DEERE 2013-B A3 EQP 08/15/17 0.87 477879AC4 145,206.56 145,206.56

07/15/15 07/15/15 Pay Princpl 41,739.941 USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 41,739.94 41,739.94


07/20/15 07/20/15 Pay Princpl 132,043.124 VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 132,043.12 132,043.12



Account Name: L.A. CARE HEALTH PLAN 07/01/2015Account Number: 2365 through 07/31/2015



07/22/15 07/22/15 Pay Princpl 84,795.753 GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 84,795.75 84,795.75


07/24/15 07/24/15 Pay Princpl 147,887.635 GEET 2013-2 A2 EQP 06/24/16 0.61 36163GAB7 147,887.64 147,887.64

07/25/15 07/25/15 Pay Princpl 173,184.885 FHMS KF01 A 1MOFRN CMBS 04/25/19 0.53 3137AUP52 173,184.89 173,184.89

07/01/15 07/25/15 Pay Princpl 2,508.286 FNA 2012-M9 ASQ2 CMBS 12/25/17 1.51 3136A7L26 2,508.29 2,508.29

07/01/15 07/25/15 Pay Princpl 170,734.760 FNA 2013-M1 ASQ2 CMBS 11/25/16 1.07 3136ABPT4 170,734.76 170,734.76

07/01/15 07/25/15 Pay Princpl 174,801.374 FNA 2013-M7 ASQ2 CMBS 03/26/18 1.23 3136AEGM 174,801.37 174,801.37

07/01/15 07/25/15 Pay Princpl 11,990.590 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 11,990.59 11,990.59


07/01/15 07/25/15 Pay Princpl 1,743,556.190 FNA 2014-M3 ASQ2 CMBS 03/25/16 0.56 3136AJKZ8 1,743,556.19 1,743,556.19

07/01/15 07/25/15 Pay Princpl 1,695,241.800 FNA 2014-M3 ASQ2 CMBS 03/25/16 0.56 3136AJKZ8 1,695,241.80 1,695,241.80

07/01/15 07/25/15 Pay Princpl 38,862.232 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.54 3136AJ2A3 38,862.23 38,862.23

07/01/15 07/25/15 Pay Princpl 17,472.380 FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.44 3136AKQJ5 17,472.38 17,472.38

07/01/15 07/25/15 Pay Princpl 1,716.568 FNA 2015-M3 FA 1MOFRN CMBS 06/25/18 0.41 3136AMMC 1,716.57 1,716.57

07/01/15 07/25/15 Pay Princpl 13,080.760 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.40 3136AMTM 13,080.76 13,080.76

07/01/15 07/25/15 Pay Princpl 110,206.830 FNA 2015-M8 FA CMBS 11/25/18 0.36 3136ANMF 110,206.83 110,206.83 5,802,949.362 5,802,949.36 5,802,949.36



Account Name: L.A. CARE HEALTH PLAN 07/01/2015Account Number: 2365 through 07/31/2015


07/15/15 07/15/15 Mature Long 100,000.000 EBAY 07/15/15 0.70 278642AD5 100,000.00 100,000.00

07/15/15 07/15/15 Mature Long 120,000.000 EBAY 07/15/15 0.70 278642AD5 120,000.00 120,000.00 220,000.000 220,000.00 220,000.00

07/08/15 07/08/15 Withdrawal (75,000,000.000) WD USD (75,000,000.00) (75,000,000.00)

07/15/15 07/15/15 Withdrawal (75,000,000.000) WD USD (75,000,000.00) (75,000,000.00) 150,000,000.000) (150,000,000.00) (150,000,000.00)



Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 07/01/2015Account Number: through 07/31/2015


07/23/15 07/24/15 Buy 840,000.000 FHLB 08/28/17 0.75 3130A62S5 (838,118.40) (838,118.40)

07/23/15 07/24/15 Buy 2,000,000.000 U.S. TREASURY BILL 07/21/16 912796GW (1,993,445.83) (1,993,445.83) 2,840,000.000 (2,831,564.23) (2,831,564.23)


07/08/15 07/08/15 Coupon GE CAPITAL CORP 01/08/16 1.00 36962G6R0 750.00 750.00

07/10/15 07/10/15 Coupon METLIFE GLOBAL FRN 144A 04/10/17 0.66 59217GBE8 1,037.04 1,037.04


07/13/15 07/13/15 Coupon FFCB 1ML FRN 02/13/17 0.23 3133EDFB3 751.67 751.67

07/13/15 07/13/15 Coupon GE CAPITAL CORP FRN 07/12/16 0.94 36962G7A6 1,100.02 1,100.02

07/15/15 07/15/15 Coupon CHASE 2014-A1 A1 CDT 01/15/19 1.15 161571GJ7 479.17 479.17

07/15/15 07/15/15 Coupon CHASE 2015-A3 A CDT 1MOFRN 04/15/19 0.44 161571GW 290.33 290.33

07/15/15 07/15/15 Coupon DRYROCK 2014-2 A 1MOFRN CD 03/16/20 0.53 06742LAC7 437.92 437.92

07/15/15 07/15/15 Coupon DRYROCK 2014-2 A 1MOFRN CD 03/16/20 0.53 06742LAC7 437.92 437.92

07/15/15 07/15/15 Coupon EBAY 07/15/15 0.70 278642AD5 280.00 280.00

07/15/15 07/15/15 Coupon EBAY 07/15/15 0.70 278642AD5 175.00 175.00

07/15/15 07/15/15 Coupon EBAY 07/15/15 0.70 278642AD5 175.00 175.00

07/15/15 07/15/15 Coupon HONDA 2014-4 A2 CAR 01/17/17 0.58 43814JAB0 316.58 316.58

07/15/15 07/15/15 Coupon JOHN DEERE 2014-A A3 EQP 04/16/18 0.92 47787VAC5 1,150.00 1,150.00


07/15/15 07/15/15 Coupon PFIZER 01/15/17 0.90 717081DD2 4,833.00 4,833.00





07/15/15 07/15/15 Coupon TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 595.40 595.40

07/15/15 07/15/15 Coupon TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 125.03 125.03

07/15/15 07/15/15 Coupon TOYOTA 2015-A A2 CAR 07/17/17 0.71 89236WAB 272.17 272.17

07/15/15 07/15/15 Coupon TOYOTA 2015-B A2A GREEN CA 11/15/17 0.77 89237CAB7 359.33 359.33


07/15/15 07/15/15 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 273.08 273.08

07/17/15 07/17/15 Coupon FFCB 1ML FRN 04/17/17 0.24 3133EDJX1 294.06 294.06

07/18/15 07/18/15 Coupon HONDA 2013-4 A3 CAR 09/18/17 0.69 43814FAC6 570.13 570.13

07/20/15 07/20/15 Coupon GEDFT 2014-2 A 1MOFRN FLOO 10/20/19 0.64 36159LCN4 495.25 495.25

07/20/15 07/20/15 Coupon VOLKSWAGEN 2013-2 A3 CAR 04/20/18 0.70 92867PAC7 466.67 466.67

07/20/15 07/20/15 Coupon WELLS FARGO FRN 07/20/15 94985H5G5 1,122.54 1,122.54

07/20/15 07/21/15 Coupon HONDA 2015-2 A3 CAR 02/21/19 1.04 43813NAC0 216.67 216.67


07/22/15 07/22/15 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 241.27 241.27

07/23/15 07/23/15 Coupon GEET 2015-1 A2 EQP 11/24/17 0.89 36164EAB1 155.75 155.75

07/23/15 07/23/15 Coupon NEW YORK LIFE GLOBAL FRN 14 05/23/16 0.64 64952WBP 634.22 634.22

07/25/15 07/25/15 Coupon BMW 2013-A A3 CAR 11/27/17 0.67 05578XAC2 380.60 380.60

07/01/15 07/25/15 Coupon FHMS K501 A1 CMBS 06/25/16 1.34 3137ANLN3 2.76 2.76

07/01/15 07/25/15 Coupon FHMS K502 A1 CMBS 12/25/16 0.73 3137B03V4 207.60 207.60

07/25/15 07/25/15 Coupon FHMS KF01 A 1MOFRN CMBS 04/25/19 0.53 3137AUP52 40.65 40.65







07/01/15 07/25/15 Coupon FNA 2014-M4 ASQ2 CMBS 01/25/17 1.27 3136AJB21 660.40 660.40



07/01/15 07/25/15 Coupon FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.44 3136AKQJ5 311.33 311.33

07/01/15 07/25/15 Coupon FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.40 3136AMTM 371.98 371.98

07/01/15 07/25/15 Coupon FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.40 3136AMTM 129.25 129.25

07/27/15 07/27/15 Coupon JPMORGAN CHASE FRN 01/25/18 1.20 46625HJF8 624.79 624.79



07/27/15 07/27/15 Coupon PNC BANK 01/27/17 1.13 69353RCG1 2,250.00 2,250.00


07/29/15 07/29/15 Coupon FFCB 1ML FRN 08/29/17 0.23 3133EDTT9 301.33 301.33

07/30/15 07/30/15 Coupon MANUFACTURERS & TRADERS T 01/30/17 1.25 55279HAD 1,562.50 1,562.50

07/30/15 07/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.53 90331HMD 513.80 513.80 37,723.63 37,723.63

07/01/15 07/01/15 Income 4.180 STIF INT USD 4.18 4.18





07/13/15 07/14/15 Sell Long 835,000.000 PRIVATE EXPORT FUNDING CP 01/05/16 7426M2A5 832,637.65 738.74 833,376.39

07/22/15 07/24/15 Sell Long 830,000.000 FHLB 09/28/16 0.50 3130A2T97 830,096.77 1,337.22 831,433.99 1,665,000.000 1,662,734.42 2,075.96 1,664,810.38

07/15/15 07/15/15 Pay Princpl 72,637.890 TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 72,637.89 72,637.89

07/15/15 07/15/15 Pay Princpl 15,253.957 TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 15,253.96 15,253.96


07/18/15 07/18/15 Pay Princpl 77,848.094 HONDA 2013-4 A3 CAR 09/18/17 0.69 43814FAC6 77,848.09 77,848.09



07/25/15 07/25/15 Pay Princpl 58,139.814 BMW 2013-A A3 CAR 11/27/17 0.67 05578XAC2 58,139.81 58,139.81

07/01/15 07/25/15 Pay Princpl 1,931.220 FHMS K501 A1 CMBS 06/25/16 1.34 3137ANLN3 1,931.22 1,931.22

07/01/15 07/25/15 Pay Princpl 6,160.420 FHMS K502 A1 CMBS 12/25/16 0.73 3137B03V4 6,160.42 6,160.42

07/25/15 07/25/15 Pay Princpl 38,485.530 FHMS KF01 A 1MOFRN CMBS 04/25/19 0.53 3137AUP52 38,485.53 38,485.53



07/01/15 07/25/15 Pay Princpl 16,723.190 FNA 2014-M4 ASQ2 CMBS 01/25/17 1.27 3136AJB21 16,723.19 16,723.19



07/01/15 07/25/15 Pay Princpl 9,706.878 FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.44 3136AKQJ5 9,706.88 9,706.88

07/01/15 07/25/15 Pay Princpl 1,102.520 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.40 3136AMTM 1,102.52 1,102.52





07/01/15 07/25/15 Pay Princpl 383.080 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.40 3136AMTM 383.08 383.08 433,724.138 433,724.15 433,724.15




07/20/15 07/20/15 Mature Long 800,000.000 WELLS FARGO FRN 07/20/15 94985H5G5 800,000.00 800,000.00 980,000.000 980,000.00 980,000.00


Board of Governors

MOTION SUMMARY



Issue: 1. Approve the FY 2015-16 Capital and Operating Budget; 2. Authorize and approve expenditures related to programs, grants, sponsorships, provider incentives,

staffing and other administrative initiatives highlighted in the 2015-16 Budget

Background: L.A. Care has experienced rapid growth and change over the past two years. Since

September 2013, membership has grown by over 50 percent, driven by the launch of new products and benefits including Medi-Cal Expansion, Coordinated Care Initiative (CCI), Cal MediConnect (CMC) and L.A. Care Covered (LACC). It is expected that L.A. Care will have a steadier growth trajectory in 2015-16, which is reflected in the proposed fiscal year 2015-16 Capital and Operating Budget. Revenue is projected at $6.86 billion for 2015-16; a 10.5 percent increase over 2014-15 revenue. The proposed budget also yields a surplus of $100.9 million or 1.5 percent of revenue. The enclosed 2015-2016 Budget explicitly lists a number of items to be authorized and approved concurrently with the overall FY 2015-2016 Capital and Operating Budget. These items include, but are not limited to: provider incentives, staffing projections, community programs, grants, sponsorships and project requests. Staff is submitting the complete budget for all lines of business for approval with assumptions based on information available to date. L.A. Care’s strategic vision plan will continue to evolve, which may drive shifts in organizational budget needs. There is a high probability that staff will bring a revised capital and operating budget to the Finance & Budget Committee for consideration in January or February 2016.

Budget Impact: The proposed budget reflects a surplus of $100.9 million or 1.5 percent margin on

$6.86 billion in revenue.

Motion: To authorize and approve the proposed Capital and Operating Budget for FY 2015-16, as submitted.

74

.

DATE: September 3, 2015

TO: Board of Governors

FROM: Timothy Reilly, Chief Financial Officer

SUBJECT: Fiscal Year 2015-2016 Operating Budget

The enclosed package contains a draft of the fiscal year 2015-2016 Operating and Capital Budget foryour review and consideration. The proposed fiscal year 2015-2016 Operating Budget, withrevenues of $6.86 billion, represents a 10.5 percent increase over fiscal year 2014-2015 forecastedrevenue of $6.21 billion. The proposed budget surplus is $100.9 million or 1.5 percent of revenue.

L.A. Care experienced rapid growth and change over the past two years. Since September 2013,membership grew by over 50 percent, driven by the launch of new products and benefits including:Medi-Cal Expansion, the Coordinated Care Initiative (CCI), Cal MediConnect (CMC) and L.A. CareCovered. Over the upcoming fiscal year, L.A. Care will transition to a steadier trajectory; withprojected membership growth of 7.3 percent, to reach 1,988,000 members by September 2016.

L.A. Care’s strategic vision will continue to evolve which may drive a shift in organizational budgetneeds. There is a high probability staff may bring a revised capital and operating budget to thecommittee for consideration in January or February 2016.

Key fiscal year 2015-2016 budget assumptions include:

• Membership growth of 7.3 percent to reach 1,988,000 members by September 2016 from1,853,000 forecasted at the close of the 2014-2015 fiscal year.

• Community Programs are budgeted at $11.3 million.

• Medi-Cal (Non Expansion & Non Duals) revenue assumes a 2.4 percent DHCS rate increasein July 2015 and a 3 percent DHCS rate increase in July 2016.

• Medi-Cal Expansion rate reduction of 26.8 percent is anticipated in July 2015 and anotherrate reduction of 10 percent in July 2016.

• Health care costs are based on current trends or actuarial estimates.

• Provider incentives are based on a flat per member per month (pmpm) and budgeted tofollow current trends.

• Healthy Kids (0-5) program assumed to end September 30, 2016.

75

L.A. Care membership continues to grow and is projected to reach 1,988,000 by September 2016.This represents an increase of 7.3 percent or 135,000 members over the fiscal year. The direct linesof business have steadily grown and will approach 53 percent of total membership in FY 2015-2016.

The trajectory of revenue growth is more dramatic than membership growth and reflects the shift inmembership mix from predominantly mothers and children under the Temporary Assistance forNeedy Families (TANF) program to the more complex seniors and people with disabilities and dualeligible populations. Revenue also reflects the additional CCI benefits for long term care, IHSS (In-Home Supportive Services) and HCBS (Home and Community Based Services) that were added in2014.

76

Administrative expenses, still considered low by industry standards, are budgeted to be 4.5 percentof revenue. If we segregate these benefits and focus only on the direct lines of business, thebudgeted administrative ratio is 5.6 percent of revenue. A comparison of cost ratios for selectedHealth Plans and L.A. Care, based on 2014 DMHC annual filing information, is shown below:

L.A. Care continues to improve the fund equity position which helps to ensure the financial stabilityof the organization. The proposed budget surplus brings the end-of-year fund balance to $513.0million. Included in fund balance is the state’s required reserve known as tangible net equity (TNE).L.A. Care records TNE at 130 percent of the state’s required level. For fiscal year 2015-2016, TNEis projected to be $155.3 million. Health plans with reserves that are within 130 percent of thestate’s TNE requirement may be subject to a financial review by the state. L.A. Care’s projectedfund balance includes TNE at 330 percent which is well above the state requirement.

Health Plan GroupsAdministrative

Cost Ratio

County Organized Health Systems 5.1%

Local Initiatives without L.A. Care 5.8%

Selected Commercial without Kaiser: (ABC, HN, Molina, Care1st) 11.8%

Statewide without Kaiser 10.1%

Local Initiative Health Authority for L.A. County 4.1%

Source: DMHC 2014 Annual Filing

Administrative Cost Ratio

L.A. Care versus Selected Health Plan Groups

Note: This chart reflects TNE at 130% of the state’s minimum required level.

77

OPERATING AND CAPITAL BUDGETFISCAL YEAR 2015-2016

DRAFTAs of August 28, 2015

Board of GovernorsSeptember 3, 2015

78

2

Table of Contents

I. EXECUTIVE SUMMARY........................................................................................................................................... 3

- Environmental Overview........................................................................................................................................ 3

- Strategic Vision......................................................................................................................................................... 5

- Operating Assumptions .......................................................................................................................................... 6

- Combined Operations & Financials...................................................................................................................... 8

- Membership .............................................................................................................................................................. 9

- Revenue ................................................................................................................................................................... 10

- Cost of Health Care ............................................................................................................................................... 11

- Provider Incentives ................................................................................................................................................ 12

- Administrative Expenses ...................................................................................................................................... 13

- Staffing and Total Cost of Labor......................................................................................................................... 17

- Sales, Marketing and Advertising Strategy.......................................................................................................... 18

- Community Health Improvement Programs..................................................................................................... 21

- Capital Expenditures and Other Projects........................................................................................................... 25

II. FINANCIAL STATEMENTS................................................................................................................................... 31

79

3

EXECUTIVE SUMMARY

Environmental Overview

L.A. Care has experienced substantial growth over the last two years driven largely by the Affordable Care Act(ACA) and California’s implementation of Medi-Cal expansion. L.A. Care has gained new membership anddeveloped new lines of business such as Cal MediConnect (CMC) and L.A. Care Covered (LACC). Along with thisgrowth, there is new leadership at L.A. Care that aims to position the health plan to further succeed in providingaccess to high quality health care and improve performance for members, providers and the community. To movein this direction, the dominant demand this coming fiscal year is for L.A. Care to hone and improve our products,make adjustments to our care and contracting models to best meet the needs of our members and providers, and toroll out a strategic vision that defines where we want to be as a plan in light of our mission and business needs andwithin the context of changes to the health care landscape.

L.A. Care Product LinesAlthough the large increase in Medi-Cal membership came in January 2014 with the transition of the Low IncomeHealth Plan population into Medi-Cal Expansion, Medi-Cal membership has continued to increase. UnlikeCovered California plans, there is no open enrollment period for Medi-Cal so enrollment occurs all year round. Thegrowth of Medi-Cal membership is expected to taper with modest increases in the next year. There is still apopulation that is eligible for Medi-Cal but not enrolled, who may enroll as health coverage increasingly becomesthe norm. The enrollment push during Covered California open enrollment always results in Medi-Cal enrollmentsin addition to L.A. Care Covered. Finally, new populations such as undocumented children may become Medi-Caleligible.

L.A. Care Covered remained relatively stable over the past year. As the Statewide default renewal option was toremain with the same Covered California health plan, L.A. Care Covered retained much of its membership.Because L.A. Care Covered membership was heavily in the Bronze category, the product was adversely affected byrisk adjustments in which L.A. Care had to return funding because of its healthy member profile. In addition, theCovered California participation fee is a flat fee that was more difficult to absorb within a low Bronze premiumthan would have been within a higher Silver premium. The Managed Care Organization (MCO) tax also affectedthe financial stability of L.A. Care Covered. For 2016, L.A. Covered is priced similarly relative to other plans inBronze and Silver, meaning that L.A. Care is not the least expensive but is one of the lower priced plans in bothmetal tiers. This pricing strategy is designed to attract more Silver members providing more value because of costsharing subsidies. This strategy will improve L.A. Care’s position related to risk adjustments and the participationfee.

Cal MediConnect has benefited from passive enrollment and has a solid base membership. However, the opt-outrate for all plans in Cal MediConnect has been high, partially driven by providers encouraging their patients to opt-out. L.A. Care has been working with other plans to assess reasons for the high opt-out rate and to designstrategies to attract and retain members. In addition, since the passive enrollment period ended, all new enrollmentwill result from marketing and provider outreach.

L.A. Care continues to operate its PASC-SEIU product for in-home supportive services (IHSS) workers as well asHealthy Kids. Healthy Kids membership is very low as most children are eligible for Medi-Cal or CoveredCalifornia and other children have aged out of Healthy Kids. Healthy Kids will remain operational until September30, 2016, when these children will become Medi-Cal eligible.

80

4

Changes to the Health Care EnvironmentThe Affordable Care Act has raised the prominence of Medi-Cal and has brought about increased interest in Medi-Cal among entities in the larger health care sector. One result has been several proposed health insurance mergers.Centene has announced that it plans to acquire Health Net, Aetna and Humana plan a merger and Anthem andCigna announced a merger. If these all go through, the number of large health insurers will be reduced to three.The mergers may result in greater purchasing power of the newly merged, large insurers, providing the ability toattract a wide range of providers at low rates. On the other hand, the process of merging large organizations withdifferent systems, work processes and corporate cultures may result in some disorder in the health care marketduring the transition.

L.A. Care Strategic VisionNow that L.A. Care has more experience with its new products and with its new Medi-Cal population, we have theopportunity to refine our approach so that our products best meet our members’ needs. L.A. Care experienced aleadership change in 2015, which also provides a new perspective on business operations and approach to productlines. The Strategic Vision is outlined in this budget document. The major areas of priority include promoting clearlines of accountability to drive efficiency and excellence, aligning reimbursement to member risk and providerperformance, tailoring models of care to the specific needs of our member populations and maintaining leadershipin improving health outcomes for low income and vulnerable populations. L.A. Care wants to ensure that ourmembers receive excellent care that is managed in a manner that promotes good health outcomes and that the careis accessible to all members.

81

5

Strategic Vision

L.A. Care Strategic Vision (2015–2018)

Strategic Priority Tactics

Goal 1: Clear lines ofaccountability that simplifyprocesses and drive efficiencyand excellence

1.1 Ensure timely success of the core system conversion, to support L.A. Care’shigh-touch approach to serving members and providers.

1.2 Identify and select competencies needed for the functions performed at L.A.Care.

1.3 Conduct a talent assessment to match employees’ skill sets with thecompetencies needed for the functions we perform and bridge the gapsthrough learning and development strategies.

1.4 Establish accountability for product line performance, including financialsustainability.

1.5 Improve our access to data by centralizing data management and deployingthe Enterprise Data Warehouse.

1.6 Use data to drive decision-making across product lines and functional areasby centralizing enterprise data analytics and operationalizing data governance.

Goal 2: A network that alignsreimbursement with memberrisk and provider performance

2.1 Ensure an equitable distribution of risk among MCLA and Plan Partners.

2.2 Align high-risk members with providers most capable of serving their needs.

2.3 Increase dual risk contracting arrangements for direct lines of business.

2.4 Reassess and enforce performance standards for providers in our networks.

Goal 3: Tailored models ofcare for the specific needs ofour member populations

3.1 Improve our capability to develop and support direct networks forsubpopulations within our membership.

3.2 Develop tailored population health management programs for the uniqueneeds of our vulnerable, high-risk and other subpopulations.

3.3 Pilot direct networks for certain member subpopulations.

Goal 4: Recognized leader inimproving health outcomesfor low income and vulnerablepopulations

4.1 Develop an L.A. Care brand that articulates our value proposition.

4.2 Actively support safety net providers’ ability to perform their delegatedfunctions and succeed in a managed care environment.

4.3 Capitalize on our community resources such as our public advisorycommittees to ensure that we are a responsive, accountable and responsiblepartner in support of the L.A. Care brand.

4.4 Optimize the financially responsible growth potential of Cal MediConnectand L.A. Care Covered.

4.5 Foster innovative approaches to improving health status of our members andthe quality of care provided by the safety net.

82

6

Operating Assumptions

The proposed Operating Budget for Fiscal Year 2015-2016 outlines the financial resources and personnel needed tomeet L.A. Care’s significant growth and strategic objectives for the coming year. The primary focus of the budgetwill be to sustain the continuity of existing business while incorporating anticipated growth, building infrastructure,launching new products and successfully navigating the complexities of the Coordinated Care Initiative.

A summary of proposed objectives and operating assumptions are as follows:

• Membership growth of 7.3 percent to reach 1,988,000 members by September 2016 from 1,853,000forecasted at the close of the 2014-2015 fiscal year.

• Community Health Improvement Programs are budgeted at $11.3 million.

• Medi-Cal (Non Expansion & Non Duals) revenue assumes a 2.4 percent DHCS rate increase in July 2015and a 3 percent DHCS rate increase in July 2016.

• Medi-Cal Expansion rate reduction of 26.8 percent is anticipated in July 2015 and another rate reduction of10 percent in July 2016.

• Health care costs are based on current trends or actuarial estimates.

• Provider incentives are based on a flat per member per month (pmpm) and budgeted to follow currenttrends.

• Healthy Kids (0-5) funding assumed to end September 30, 2016.

Budget Presentation

The proposed operating budget combines L.A. Care’s on-going baseline operating costs with new programs andproducts, ramping infrastructure expenses to support regulatory compliance and membership growth as well asincremental costs associated with strategic projects. For presentation purposes, the proposed budget has beensegmented into the following categories: Plan Partners, Direct Services, Cal MediConnect, PASC-SEIU, L.A. CareCovered (Health Benefits Exchange) and L.A. Care Covered Direct, Community Programs and Other.

Plan Partners budget consists of all of the operating costs required to support the Medi-Cal line of businessdelivered through the contracted Plan Partner health care networks.

Direct Services encompasses all of the operating costs associated with L.A. Care’s directly contracted carenetworks that support L.A. Care’s Direct Medi-Cal product (MCLA) and Healthy Kids.

Cal MediConnect is the CCI pilot program developed in conjunction with California’s Department of Health CareServices to integrate medical care, long-term care, behavioral health care and social services for people eligible forboth Medicare and Medi-Cal. L.A. County is one of the selected counties for the pilot. L.A. Care received initialmembership in May 2014.

PASC-SEIU program provides administrative services for the health care of in-home supportive services (IHSS)workers in Los Angeles County. Among the administrative services provided are: claims processing, memberservices and information technology services.

83

7

Healthy Kids program provides access to low-or no-cost health insurance for children ages 0-5 in Los AngelesCounty who are not eligible for Medi-Cal and who live at or below 400 percent of federal poverty level. First 5 LAfunds L.A. Care Health Plan to administer Healthy Kids insurance, a comprehensive benefit package that includesmedical, mental health, dental and vision care. Funding for this program is assumed to end September 30, 2016.

L.A. Care Covered represents L.A. Care members that join the Health Benefit Exchange Qualified Health Plan(QHP) which offers all metal coverage levels (Platinum, Gold, Silver and Bronze) and a Catastrophic Plan. L.A.Care Covered started in January 2014.

New! L.A. Care Covered Direct was launched in February 2015. This product is available to consumers whowould like to purchase insurance privately ‘Off-the-Exchange’. The plan mirrors L.A. Care Covered with two maindifferences: premium assistance is not available for ‘Off Exchange’ plans and members must apply for coveragedirectly to L.A. Care. L.A. Care received initial membership in March 2015.

Community Programs include all direct funding and L.A. Care administrative costs required to fulfill the Board ofGovernors’ approved initiatives and community support. Funding for the Community Programs will be drawnfrom L.A. Care’s existing financial reserves. This element of the annual operating budget earmarks the funding levelof L.A. Care’s financial reserves, which are anticipated to be disbursed in this fiscal year. HITEC-LA is included inCommunity Programs and the project is expected to phase-out by June 2016.

Other includes depreciation, non-operating income and expenses which encompass gross premium taxes andinvestments.

84

8

Combined Operations & Financials

Combined operations are budgeted to produce a net operating surplus of $100.9 million which includes $11.3million in support of community programs.

Core Operations

Plan

Partners

Direct

Services*

Cal

MediConnect

(CMC) PASC-SEIU

L.A. Care Covered

& L.A. Care

Covered Direct

Community

Programs** Other*** Total

Revenue $2,572.5 $3,799.1 $277.4 $179.2 $36.0 $0.2 $6,864.4

Cost of Health Care 2,433.0 3,547.5 263.4 176.3 27.7 - 6,447.9MCR 94.6% 93.4% 95.0% 98.4% 76.9% n/a 93.9%

Operating Margin 139.5 251.6 14.0 2.9 8.3 0.2 - 416.5

Administrative Expense 54.9 203.3 28.3 2.4 6.8 6.5 7.0 309.2

Administrative Ratio 2.1% 5.4% 10.2% 1.3% 18.9% n/a 4.5%

Gain / (Loss) from Operations 84.6 48.3 (14.3) 0.5 1.5 (6.3) (7.0) 107.3

Community Investments (5.0) (5.0)

Gross Premium Tax, net (1.4) (1.4)

Investments Income, net - -Revenue over (under) Expenses $84.6 $48.3 ($14.3) $0.5 $0.1 ($11.3) ($7.0) $100.9

Margin 3.3% 1.3% -5.2% 0.3% 0.3% n/a 1.5%

* Includes MCLA and Healthy Kids (0-5)

** Includes Community Programs and HITEC-LA

*** Includes Depreciation Expenese and Non Operating Income and Expenses

Consolidated Statement of Operations

Fiscal Year 2015-2016

(dollars in millions)

Direct Lines

Plan

Partners MCLA

Healthy Kids

(0-5)

Cal

MediConnect

(CMC) PASC-SEIU

L.A. Care

Covered

L.A. Care

Covered

Direct Total

Revenue $2,572.5 $3,798.6 $0.5 $277.4 $179.2 $35.9 $0.1 $6,864.2

Cost of Health Care 2,433.0 3,547.2 0.3 263.4 176.3 27.7 0.0 6,447.9

Operating Margin 139.5 251.4 0.2 14.0 2.9 8.2 0.1 416.3

Administrative Expense 54.9 203.3 - 28.3 2.4 6.8 - 295.7

Gain / (Loss) from Operations $84.6 $48.1 $0.2 ($14.3) $0.5 $1.4 $0.1 $120.6


Statement of Core Operations


85

9

Membership

Overall, the projected membership growth between fiscal year 2015 and fiscal year 2016 is expected to be 135,000members or 7.3 percent with member months growing by 2,145,000 or 10.2 percent. Combined line of businessmembership is projected to be 1,988,000 at September 30, 2016. Direct lines of business represented approximately20 percent of total membership in fiscal year 2011 and have steadily grown to reach 53 percent of total membershipin fiscal year 2016.

2015 2016 Members Percent 2015 2016 Members Percent

Medi-Cal

Plan Partners 896 931 35 3.9% 10,348 10,976 628 6.1%

L.A. Care 879 972 93 10.6% 9,665 11,152 1,487 15.4%

Total Medi-Cal 1,775 1,903 128 7.2% 20,013 22,128 2,115 10.6%

Cal MediConnect 15 18 3 20.0% 153 200 47 30.4%

Medicare SNP - - - 0.0% 27 - (27) -100.0%

Healthy Kids 0-5 - - - 0.0% 4 4 - 0.0%

PASC-SEIU 46 46 - 0.0% 559 554 (5) -0.8%

L.A. Care Covered (Exchange) 17 21 4 26.6% 215 230 15 6.8%

L.A. Care Covered Direct - - - 0.0% - - - 0.0%

Total 1,853 1,988 135 7.3% 20,971 23,116 2,145 10.2%

Membership by Fiscal Year

(in thousands)

Membership Change Member Months Change

MEMBERSHIP BY LINE OF BUSINESS


MonthCal

MediConnect

Plan

Partner MCLA HK (0 - 5)

PASC-SEIU

Workers

LA Care

Covered

LA Care

Covered Direct Total

Oct-15 15,250 898,963 886,273 384 46,175 16,590 19 1,863,654

Nov-15 15,500 901,823 894,097 375 46,175 16,665 23 1,874,658

Dec-15 15,750 904,683 901,921 366 46,175 17,248 27 1,886,170

Jan-16 16,000 907,543 909,745 357 46,175 17,829 30 1,897,679

Feb-16 16,250 910,403 917,569 348 46,175 18,652 33 1,909,430

Mar-16 16,500 913,263 925,393 339 46,175 19,341 36 1,921,047

Apr-16 16,750 916,123 933,217 330 46,175 19,916 39 1,932,550

May-16 17,000 918,983 941,041 321 46,175 20,365 42 1,943,927

Jun-16 17,250 921,843 948,865 312 46,175 20,530 45 1,955,020

Jul-16 17,500 924,703 956,688 303 46,175 20,675 48 1,966,092

Aug-16 17,750 927,563 964,511 294 46,175 20,803 51 1,977,147

Sep-16 18,000 930,423 972,334 285 46,175 20,915 54 1,988,186

Member Months 199,500 10,976,316 11,151,654 4,014 554,100 229,529 447 23,115,560

86

10

Revenue

Medi-Cal (Non Expansion & Non Duals) Capitation RatesThe assumed revenue for FY 2015-2016 is based on rates provided by the California Department of Health CareServices (DHCS). The rates represent a 2.4 percent increase from the prior year. These rates include MCO taxes,SB 335 and SB 208. The rates are only for the first nine months (Oct-June) of the fiscal year. The budget assumesthat the rates for the last three months of our fiscal year will be 3 percent higher than the first nine months.

Cal MediConnectThe revenue for this pilot program is based on rates received from DHCS and the Centers for Medicare andMedicaid Services (CMS).

Healthy Kids (ages 0-5)The Healthy Kids Program is funded by First 5 LA. The Healthy Kids funding is assumed to end September 30,2016.

PASC-SEIUPASC-SEIU revenue rate assumes a 5 percent increase from the previous fiscal year.

L.A. Care CoveredL.A. Care Covered rates are based on the Covered California approved rates.

87

11

Cost of Health Care

Medi-Cal Plan PartnersThe delegated contract with the three Plan Partners (Anthem, Care 1st and Kaiser) have been negotiated in 2015and they reflect both a capitation rate for the Medi-Cal benefit and an incentive program. Kaiser rates reflect amaximum of 2 percent being withheld from the net DHCS rate paid to L.A. Care, based on the “three-wayagreement” negotiated between L.A. Care, Kaiser and DHCS. The agreements with all three Plan Partners will berenegotiated in 2016.

L.A. Care will continue monitoring the planned acquisition of Care 1st Health Plan by Blue Shield of California, anonprofit health plan with significant experience in California. The deal is expected to close in 2015.

Plan Partners (with the exception of Kaiser) will be eligible for an incentive program based on measurement year2015 (payable in 2016). The incentive is designed to align quality goals among L.A. Care and its subcontractedhealth plans and target specific performance measures that impact member auto assignment, health outcomes andpatient satisfaction. Plan Partners are eligible for an annual per member per month financial incentive for meetingeligibility and performance criteria.

Direct Lines of BusinessL.A. Care’s direct lines of business consist of Medi-Cal (MCLA), CMC, Healthy Kids, PASC-SEIU, L.A. CareCovered and L.A. Care Covered Direct. The health care budget for these lines of business is based on currentexperience and actuarial estimates.

Consistent with a maturing health care delivery network, the utilization growth and the consumption of health careservices has become more complex. L.A. Care’s management team remains focused on utilization managementprocesses, provider contracting and claims payment management. The fundamental goal is to assure that L.A.Care’s members have access to an appropriate health care provider at the most cost effective venue.

88

12

Provider Incentives

L.A. Care Quality Score Investments (Provider Incentive Programs)L.A. Care’s provider incentives are an essential part of L.A. Care’s interventions to maximize clinical quality andmember satisfaction. In addition to rewarding performance and improvement on clinical and utilization measures,these programs provide a business case for provider investment in quality improvement, and use industry standardmetrics, such as HEDIS (Healthcare Effectiveness Data and Information Set) clinical measures to promoteaccountability for quality. L.A. Care’s provider-level incentives are designed to advance L.A. Care’s collaborationwith key business partners, and to align the quality and improvement goals of Plan Partners, PPGs and physicians.

Note 1. Excludes Kaiser2. Other category includes Healthy Kids and PASC-SEIU Product Lines

Plan Partner Quality Score Investments (Incentives)In 2014 the Plan Partner Incentive Program was re-designed to combine two previous plan-level incentives intoone. The revised incentive program continues in 2015. In the streamlined program’s clinical quality domain,eligible plans are rewarded for defined improvement in core HEDIS auto-assignment measures. Plans areadditionally rewarded for the encounter data submission performance of their largest PPGs.

PPG Quality Score Investments (Incentives)LA P4P (Pay-for-Performance for PPGs) measures, reports and rewards PPG performance in multiple domainsthat affect quality of care, including HEDIS clinical quality, utilization and member satisfaction. In addition torewarding performance and driving quality improvement, LA P4P reports and promotes meaningful improvementin encounter data submission. Performance-based incentive payments in LA P4P are now adjusted based on aprovider group’s encounter data submission rate.

Physician Quality Score Investments (Incentives)The Physician Pay-for-Performance (P4P) Program provides financial rewards to physicians and community clinicsfor outstanding performance and year-over-year improvement on multiple HEDIS measures. The program isclosely aligned with incentives available to PPGs.

L.A. Care also operates a provider incentive in support of completing Medicare Annual Wellness Exams, with thegoal of maximizing Hierarchical Condition Category (HCC) coding and HEDIS/STAR attainment. Additionally,L.A. Care’s member incentives advance L.A. Care’s priorities related to member experience, health education andreceipt of important medical services

Incentive Level

Programs

Plan

Partners (1) MCLA CMC LACC

Community

Benefit Other (2) Total

Plan Partners $10,824 $10,824

PPG 9,020 12,114 299 344 1 21,778

Physician 9,020 8,516 3,700 230 21,466

Member 1,341 48 200 65 1 1,655

Total $28,864 $21,971 $4,047 $774 $65 $2 $55,723

Provider Incentive Budget

FY 2015-2016(dollars in thousands)

Product Lines

89

13

Administrative Expenses

(A) (B) (C=A+B)

FYE 9/2015 FYE 9/2016

dollars in thousands Projected Additions/ Pending

Expense Programs Budget

Net Increase in Base Line Operations $290,062 $15,106 $305,168

New Programs/ Additions to Forecast

General Growth in Salaries (1,675 FTEs vs. 1,790) 11,500

FTE Equalization Project - Projected for FY15-16 10,650

Annual Merit Increase on FTEs at 1,675 6,640

Benefit Load - adjusted in FY15-16 Budget 5,759

Incremental Staffing support for QNXT and Claims 14,780

1115 Waiver - Medi-Cal 2020 500

Batch Job Monitoring 700

Behavioral Health eManagementLA Program 1,000

Compliance & Regulatory 1,000

Configuration Management Database (CMDB) 1,500

Data Center Equipment Expansion & Upgrades 75

Data Governance (DG) 600

Data Masking and Data at rest Encryption 350

Direct Network for Members 1,500

Electronic Data Interface (EDI) Uplift Phase II 500

Encounters Uplift Phase II 1,100

Exchange 2016 2,500

Finance System Upgrade Phase I (eProcurement) 1,000

Fraud, Waste and Abuse Project 750

Human Resource Information System (HRIS) Implementation 1,000

ICD-10 Phase III 500

IT Development & Change Management Controls 698

Medical Management Initiatives 2016 (ELDA) 1,500

Member Portal Phase II 500

NCQA/HEDIS process 2016 300

Oracle Legacy Transitions to 11G and 12C 1,000

Provider Portal Redesign 1,000

QNXT Enhancements 2016 1,500

Total New Administrative Costs $290,062 $85,508 $375,570

excludes depreciation

FY 2015-2016 General Administrative Budget Cross-Walk

L.A. Care Health Plan

90

14

Comparative Administrative Cost –Fiscal Year 2015 vs. Fiscal Year 2016

L.A. Care has undergone significant growth and change over the past two fiscal years. Membership increased by 50percent since September 2013 and direct lines of business now represent 53 percent of membership. Thecomplexity of products and benefits has also dramatically increased with the shift in membership mix frompredominantly mothers and children under TANF to the more complex seniors and people with disabilities anddual eligible populations. L.A. Care is developing the infrastructure required to efficiently manage these productsand populations while remaining regulatory compliant, serving the needs of the members and adding value to thecommunity.

The following is a summary of the forecast and budget between the fiscal years.

FY 2014-2015 FY 2015-2016

Forecast Budget

(dollars in thousands) $ PMPM $ PMPM

FTE's (at year end) 1,675 1,790

Salaries & Benefits $136,902 $6.53 $178,422 $7.72

Temporary Labor 19,486 0.93 8,695 0.38

Professional Fees 22,891 1.09 44,915 1.94

Purchased Services 47,567 2.27 66,912 2.89

Advertising & Promotions 6,929 0.33 8,398 0.36

Business Fees & Insurance 22,180 1.06 25,806 1.12

Occupancy & Leases 13,629 0.65 16,447 0.71

Supplies & Other 20,478 0.98 25,975 1.12

Total Administrative Expenses $290,062 $13.83 $375,570 $16.25

Administrative Ratio 4.4% 5.5%

Administrative Expenses including Medical Administrationexcludes depreciation

91

15

New Programs:

Continuing Medical Education (CME) Training ProgramL.A. Care is an accredited continuing education provider by the Institute for Medical Quality, a subsidiary of theCalifornia Medical Association and also accredited by the Board of Registered Nursing and the Board of BehavioralSciences for CME activities and events provided by the Provider Continuing Education Program. The CMEactivities and events specifically target the low performing primary care physicians related to their HEDIS scoresand Star Performance to improve quality of patient care and physician-patient relationships.

Catering

Programs Expense Other Total

Proposed Programs

Advocacy Day $17,000 $17,000

Board of Governors and Committee Meetings Refreshments 7,005 7,005

Board of Governors Retreat 4,500 2,000 6,500

Business Development, Education, Training with Providers 27,000 27,000

Community Events at FRCs 26,400 100,000 126,400

Coordinated Care Initiatives 167,400 167,400

Continuing Medical Education (CME) Training Program 275,000 275,000

Fresh Fruit Fridays and Flu Vaccinations 40,000 13,000 53,000

FRC's rewards for Education 50,000 50,000

Legislative Briefing 900 900

Meetings with I.T. Mgmt. from Sister Health Plans 875 875

National Committee for Quality Assurance Mock Audit 1,200 1,200

New Employee Orientation 12,480 20,800 33,280

On-site Hiring events 3,600 3,600

Pharmacy Quality and Oversight Committee 2,200 2,200

QNXT User Group Meetings 525 525

Quarterly Joint PICC/PQC 1,400 1,400

RCAC & ECAC Meetings and RCAC Conferences 19,000 16,000 35,000

Recognizing Excellence Awards Program 30,000 12,000 42,000

Spring Elections 24,000 25,000 49,000

Toastmasters 4,900 4,900

$385,485 $518,700 $904,185

Note: Other may contain such expenses as they relate to the event including Facilities Rentals, Logistics and Promotional Items.


Meeting, Catering and Other Expensefor Fiscal Year 2015-2016

92

16

The CME program will hold activities throughout the year, with emphasis on the identified needs of the providersthrough conducted surveys and ongoing feedback. The program topics include but are not limited to childhoodand adult chronic diseases, cultural awareness and competency, behavioral health, eHealth and preventive healthcare. The success of the program will depend on providing activities on content areas that are important forimproving providers’ competency, performance and patient outcomes.

New Employee OrientationInitial phase of the Employee Orientation Program will be a robust on-boarding program designed to promoteemployee engagement and retention. All new hires will receive a standard curriculum to review L.A. Care’s businesslines, performance expectations, compliance training requirement and employee support services. Participants willcomplete a post-orientation test to demonstrate what they have learned.

Spring ElectionsIn 2016, L.A. Care’s Regional Community Advisory Committee (RCAC) and Coordinated Care Initiative Council(CCIC) members will elect two representatives to the L.A. Care Board of Governors. One must be a consumerenrolled in L.A. Care and the other must be an advocate representing consumers enrolled in L.A. Care. Theelection process includes pre-election informational meetings for RCAC and CCIC members culminating in anElection Day event that includes the L.A. Care members that are eligible to vote.

Ongoing Programs:

Advocacy Strategy EventsIn order to develop a more proactive and comprehensive advocacy strategy, several events are planned to preserveand promote the value of the Two-Plan Model by providing education to internal and external stakeholders and theLocal Initiative in meeting local community and safety-net needs. One of these events is Advocacy Day held inSacramento to ensure access to care for low income and vulnerable populations. Another event is the LegislativeBriefing meetings which will be held to provide updates to legislative staff.

Meetings with Providers and Other External StakeholdersVarious mandatory, regulatory and advisory meetings are held at L.A. Care’s facilities in order to provide committeemeetings, trainings, educational conferences and community events, the goal of which is to support and strengthenthe relationship between L.A. Care and the communities in which we serve. Such events include Board ofGovernors meetings, Health Promotors meetings, Executive Community Advisory Committee (ECAC) andRegional Community Advisory Committee (RCAC) meetings, Coordinated Care Initiative Council (CCIC) meetings,Community Events at the Family Resource Centers (FRCs) and a variety of advisory and user group meetings.

Business DevelopmentL.A. Care representatives are engaged in business development activities related to the sales and promotion of thevarious products offered. Continuation of these development activities are an integral part of the messaging andbranding strategy in relationship building with Providers and other external stakeholders.

Staff Recognition and RetentionPrograms have been designed to recognize and reward the staff at L.A. Care for going above and beyond theirnormal job duties or to further the L.A. Care mission. Additional programs, such as Toastmasters, are beingoffered to further training or career development. Fresh Fruit Fridays and flu vaccinations serves to bolsteremployee health and connection with L.A. Care through minimal expenditure.

93

17

Staffing and Total Cost of Labor

L.A. Care’s forecasted full time equivalent (FTE) staffing is 1,675 positions at the end of fiscal year 2015. Duringfiscal year 2016, the budget provides for up to 115 additional FTEs, raising the total FTE count to 1,790 by the endof fiscal year 2016. The additional FTEs are in support of growth and the demands required to serve the complexpopulations including the Coordinated Care Initiative, Cal MediConnect Pilot, Medi-Cal Expansion and L.A. CareCovered. These new positions will be added throughout the year as membership thresholds are attained or as newsystems become operational. Salaries and Benefits, budgeted at $178.4 million for fiscal year 2016, includes meritincreases budgeted at 3.25 percent.

In an effort to focus employees on organizational goals and objectives, L.A. Care will reward some employees up to5 percent of Salaries and Benefits in incentives based on criteria established in its Organizational Incentive Program.The incentive program is not a guaranteed bonus for employees, but rather a reward for excellent performance,either at the organizational or individual level. Incentive compensation earned by an employee is paid as a lump sumand does not become a part of the employee’s base pay rate.

Chart below depicting existing staff, currently recruiting and 2015-2016 positions requested:

Forecast FY

2014-2015

Budget FY

2015-2016

Beginning of the Year 1,294 1,675

2015 - 2016 New Positions

Membership Growth 175 62

Infrastructure support (QNXT) 75 20

Infrastructure support (Other) 131 33

Total Additions 2015 - 2016 381 115

End of the Year 1,675 1,790

FTEs FTEs per Ramp Up(at year end) 000 Members Factor

FY 2011 (Actual) 539 0.57 9%FY 2012 (Actual) 693 0.65 8%FY 2013 (Actual) 888 0.73 24%FY 2014 (Actual) 1,284 0.81 27%FY 2015 (Forecast) 1,675 0.90 15%FY 2016 (Budget) 1,790 0.90 7%

FTE History

excluding HITEC-LA staff

Ramp up Factor = Position remains open until it is filled, for example,

25% is about 3 months.

94

18

Sales, Marketing and Advertising Strategy

Overview

The 2015 fiscal year reflected the continued growth of L.A. Care’s direct lines of business. Medi-Cal expansioncontinued to benefit from the increased access and ease of obtaining enrollment support through the CoveredCalifornia enrollment entities, counselors, health plan representatives and agents. The Affordable Care Actexpanded Medi-Cal eligibility for adults resulting in a significant shift in member demographics for our Medi-Caldirect line of business. Historically, 70 percent of our membership included women and children under the age oftwenty (20) years old; current demographics reflect a 27 percent reduction or 43 percent of MCLA membership.Adults within the age of 21-64, now represent approximately 57 percent of MCLA membership. The expansion ofour adult population may generate enrollment support for Cal MediConnect (CMC) and the Coordinated CareInitiative (CCI) as these adult members age-in or become eligible for Medicare through disability.

Covered California conducted their annual open enrollment period a short seven months after the launch of theexchange. L.A. Care Covered maintained approximately 84 percent of members through the first renewalenrollment cycle. In addition to the renewing enrollments, a significant number of members became eligible forMedi-Cal and were transitioned from the Covered California product to L.A. Care’s Medi-Cal direct line ofbusiness.

L.A. Care is completing our first Cal MediConnect passive enrollment cycle. Beginning July 2015, growth isforecasted to be generated from newly eligible beneficiaries that age-in or become Medicare eligible throughdisability. MCLA currently has approximately 8,800 members aged 64+ that may age-in to Medicare over the nexttwelve months. Member education and enrollment support programs are planned for implementation in 2015 andwill continue through 2016. To continue to educate our MCLA members that are already dual eligibles who areenrolled with L.A. Care for Medi-Cal only, we plan to include them in the educational and enrollment supportmailing program.

L.A. Care Health Plan has transitioned from our start as an administrator for Medi-Cal into a robust organizationwith multiple product lines to address the diverse health needs of Los Angeles County residents. We are highlyrecognized for our Medi-Cal product but do not have the same level of awareness for our new products: CoveredCalifornia and Cal MediConnect. Current members and newly eligible consumers may overlook L.A. Care as aviable option when selecting or renewing their health plan of choice as a result of the limited number of productsthat have historically been available. It is very timely for the organization to consider the re-visioning of L.A. Care’sbrand messaging and associated media campaign to more fully reflect our current product offerings and servicesthat are now available.

To fully benefit from our investment in consumer facing advertising, we are recommending refreshing the L.A.Care Health Plan parent brand for consumer market testing to support member, beneficiary and consumerengagement and future growth. L.A. Care will be positioned as the parent brand and our product lines will reflectthe unique products and value added services we offer through Medi-Cal L.A. (MCLA), L.A. Care Covered, L.A.Care Covered Direct, Cal MediConnect, Healthy Kids and our Family Resource Centers.

Rationale: Refresh the L.A. Care Health Plan Parent, Products and Service BrandsEngage our current Advertising and Marketing agency, Maricich Healthcare Communications to review L.A. Caremarket and member research, and develop a brand strategy and recommendations for refreshing the current L.A.Care parent brand. Services will also include the development of messaging and advertising strategy for our directlines of business. The scope of work will be designed to address recommendations for a tactical plan that will utilizethe new messaging with creative concepts to communicate the L.A. Care brand messaging to the Los Angeles marketyear round and not only during open enrollment for commercial or Medicare products.

95

19

Goal 1: Drive broad awareness of L.A. Care and its lines of business in Los Angeles County

Goal 2: Impact the choice of prospective members for L.A. Care’s direct lines of business

Goal 3: Engage prospective members at a local level, building consumer confidence in theL.A. Care parent brand and all lines of business

Rationale: Media Awareness CampaignThe brand refresh will be supported by a multi-channel media strategy to support beneficiary and consumerengagement and future growth. A comprehensive media campaign will be geared towards positioning theparent brand and L.A. Care direct lines of business to demonstrate the unique products and value addedservices L.A. Care offers through Medi-Cal (MCLA), L.A. Care Covered, Cal MediConnect and the FamilyResource Centers. The media campaign will work to build broad scale awareness in L.A. County year roundand engage prospective members with the express goal of building consumer confidence and impacting choicefor L.A. Care’s direct lines of business.

Goal 1: Increase product brand recognition

Goal 2: Impact choice and increase the number of conversions to membership

Goal 3: Increase retention and engagement tools and activities to support target membership goals

Rationale: Commercial Lines of Business (L.A. Care Covered and L.A. Care Covered Direct)The L.A. Care Covered product line will continue to renew current members and enroll new consumers duringOpen Enrollment and special enrollment periods. The driving goal remains to increase enrollment to 50,000members. However, member retention and engagement are also key priorities as the product continues tomature. In this enrollment cycle, L.A. Care has the opportunity to leverage both traditional advertising anddigital marketing into conversion tools that firmly establishes L.A. Care Covered as the health plan for all ofL.A. There are still about one million uninsured residents in L.A. County who will be facing steeper taxpenalties with each year that passes and who, for reasons to be identified, have not yet enrolled in a health plan.This is an opportunity for L.A. Care to develop targeted campaigns based on research that will personalize theconsumer interaction with the health plan. Finally, this year’s campaign will also bring more attention to all ofL.A. Care’s product offerings especially Medi-Cal and further contribute to achieving membership goals.

Goal 1: Increase consumer education related to better understanding of insurance and benefits vs. premiums

Goal 2: Influence choice through L.A. Care’s value added services and provider network

Goal 3: Increase retention and engagement tools and activities to support target membership goals

Rationale: Develop and Implement Tactical Marketing Services InternallyTo leverage the training and experience that the Sales and Marketing Department has gained through theexpansion of our direct lines of business, we are recommending that the tactical elements of our sales andmarketing outreach programs be developed and managed by our talented department employees. Vendors willbe selectively utilized to support our strategies, identified opportunities and effective use of full-time internaland external team members. Programs to be supported include:

Publicity and Support for Large Community Enrollment EventsAs the trusted source for health plan information and services in Los Angeles County, this tacticcreates the opportunity to provide valuable information to targeted demographic audiences

96

20

including the Hispanic, African American and Asian consumer segments. Credible media, print,radio and online channels will be researched and incorporated into the plan. Direct to home printfor increasing traffic to events will also continue to be utilized and refined.

Leverage Provider Relationships and Presence in Community ClinicsThe current tactical billboard hand sanitizer unit campaign is recommended for continuation with safety netclinics and contracted providers to build consumer awareness and provider relationships. Clinic front officestaffs are typically among the first contacts that the uninsured have when they are seeking medical attentionand help with insurance. The goal of this tactic is two-fold; 1) provide an effective resource to help providerstaff explain the programs available to them and, 2) visually highlight and differentiate L.A. Care fromcompetitor plans.

97

21

Community Health Improvement Programs

The proposed Community Health Improvement Program budget for fiscal year 2015-2016 allocates $11.3 million ofL.A. Care’s financial reserves for selected projects to be funded throughout the fiscal year. Community HealthImprovement Programs include the Community Health Investment Fund (CHIF), HITEC-LA and CommunityPrograms (which includes the eManagement, Family Resource Centers (FRCs), Community Clinic Program,Community Benefits Program, Community Outreach Program, Promotoras and Sponsorships).

Community Health Investment Fund (CHIF) $5 MillionCHIF was established to improve access and quality of care by filling gaps and supporting infrastructure to benefitthe underserved and the safety net that serves them. CHIF is managed by the Community Benefits Program and thefour overarching goals of this program include:

CHIF HITEC-LA Community Total

Programs *

Grant -$ 0.2$ -$ 0.2$

Cost of Health Care - - - -

Operating Margin - 0.2 - 0.2

Administrative Expense - 0.2 6.3 6.5

Gain/(Loss) from Operations - (0.0) (6.3) (6.3)

Community Investments (5.0) (5.0)

Revenue over (under) Expenses (5.0)$ (0.0)$ (6.3)$ (11.3)$

Statement of Community Health Improvement Programs



* Community Programs include eManagement, FRCs, Community Clinic Program, Community Benefits Program, Community Outreach Programs,

Promotoras and Sponsorships

FY 2015-2016 Community Health Improvement ProgramsFunding

(dollars in thousands)

Community Health Investment Fund (CHIF) $5,000

HITEC-LA 22

eManagement & Health Center Controlled Network (HCCN) Grant 396

Family Resource Centers (FRCs) 3,211

Community Clinic Program 500

Community Benefits Program 580

Community Outreach Program 540

Promotoras/Health Promoter Program 261

Sponsorships 750

Total $11,260

98

22

Improve community and public health for the underservedExpand health insurance coverageStrengthen the public and private safety netEnable L.A. Care and the community to jointly address community-wide health issues

Each year, the CHIF grant-making budget is divided between funds for predetermined initiatives and for those inresponse to external requests. The grant budget for fiscal year 2014-2015 was $5 million and the same amount isbeing proposed for fiscal year 2015-2016.

HITEC-LA $22,000HITEC-LA is the exclusive Health Information Technology Regional Extension Center for L.A. County, formed tohelp 3,000 of the county’s priority primary care providers (PPCPs) reach meaningful use on certified electronichealth records (EHRs) by April 2014. The program started in 2010 when L.A. Care was awarded a $15.6 millionfederal grant from the U.S. Department of Health and Human Services through the Health InformationTechnology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery andReinvestment Act of 2009. L.A. Care supplied a 10 percent match to the federal grant. Due to positiveprogrammatic results achieved by HITEC-LA in the first two years, the federal grant was increased to $16.9 millionin 2012 with a corresponding match by L.A. Care. HITEC-LA continues to accomplish its program objectives. Asof May 2015, HITEC-LA passed 95 percent of its goal of helping 3,000 primary care providers reach meaningfuluse. As a result of its strong performance, HITEC-LA was awarded a second no-cost extension from the Office ofthe National Coordinator of Health IT to continue until June 2016. The program’s commitment to delivering highquality service has resulted in a high level of satisfaction among the solo providers, small practices and clinics itworks with.

Community Programs

eManagement (formerly eConsult) $396,000L.A. Care’s eConsult program was developed to improve the access to quality specialty care for Los Angeles countyresidents focusing on low-income and vulnerable populations by allowing HIPAA secure conversations betweenprimary care providers and specialists using a HIT software platform. In 2011, it was expanded to the L.A. CountyDepartment of Health Services (LAC DHS) and Healthcare LA (HCLA) IPA clinic sites making this program thelargest rollout of its type in the United States. As of December 2014, the program served over 30 specialties, 195clinic sites, 2,500 providers and a base of up to 500,000 patients. Because of the success of the program, in 2014,LAC DHS invested over $7 million of its own funds over four years and added an additional 200 clinics and healthcenters to the program.

The second phase of the program consists of program expansion called eManagement to improve care delivery byenhancing collaboration between primary care providers and mental health specialists, improve co-management ofcomplicated patients, reduce unnecessary office visits, improve medication management and optimize the specialistvisits. L.A. Care will conduct an evaluation to measure up to eight key triple aim areas that demonstrate quality ofcare, cost and patient engagement. If this phase proves successful, it could be expanded in future years.

Health Center Controlled Network (HCCN) GrantIn December 2012, the Health Resources and Services Administration awarded Community Clinic Association ofLos Angeles (CCALAC) the L.A. Regional Health Center Controlled Network (HCCN) grant for $1.8 million overthree years to support adoption and meaningful use Stage 2 of certified electronic health record (EHR) technologyand technology-enabled quality improvement initiatives in health centers. HITEC-LA was selected as a ServicePartner for CCALAC to provide L.A. County Federally Qualified Health Centers (FQHCs) with education and on-

99

23

site technical assistance to implement certified EHRs. The L.A. Regional HCCN supports 27 collaborating healthcenters and serves almost 700,000 patients each year. It is expected that CCALAC & L.A. Care will be receiving anextension with additional funding through June 2016.

Family Resource Centers (FRCs) $3.2 MillionThe Family Resource Centers are aimed at addressing health disparities by creating a single point of service wherethe community can turn to for help with health education and assistance with navigating the health care deliverysystem and available programs. Dedicated L.A. Care staff and contracted health education vendors provide anumber of activities for community residents including health education, disease prevention, promotion of self-management tools and education on establishing or maintaining health coverage. Four Family Resource Centers(FRCs) have successfully been launched in Lynwood, Inglewood, Boyle Heights and Pacoima. Since the opening ofthe first Center in November 2007, the project has been successful in delivering well-integrated health educationresources and services that address important health topics such as asthma, diabetes and obesity. The fifth andsixth Family Resource Centers are expected to open in fiscal year 2016-2017. The budget in FY15-16 is aplaceholder with the Capital Leasehold improvements to start in fiscal year 2015-2016.

Community Clinic Program $500,000A new Community Clinic Program Plan was approved in January 2015 which replaces the previous Star Partnerclinic incentive program. The new program provides additional support in the form of programs and initiatives forFederally Qualified Health Centers (FQHCs) and Community Clinics to:

Achieve recognition amongst community clinics as their preferred health plan partnerStrengthen clinic managed care infrastructure and secure their position as a strong provider in the communityImprove clinic performance in the areas of patient experience of care, health outcomes and cost reduction

The strategic focus of the plan includes member experience of care, growth & retention, business operationalimprovements, managed care technical assistance, workforce recruitment & retention and clinic staff training anddevelopment.

Community Benefits Program Administration $580,000The Community Benefit Program's department staff is responsible for managing all aspects of L.A. Care’s CHIFgrant making activities. Every year L.A. Care commits a portion of its revenues to community benefit activities.Staff researches gaps in healthcare, especially for vulnerable, uninsured individuals. Program initiatives aredeveloped and announced to the community. Proposals are reviewed by staff and external experts. Granteemanagement includes review and support of grantee programs to assure that all funds are appropriately used. Inaddition to L.A. Care-developed initiatives, staff reviews proposals which are submitted for targeted needs. Ad-hocproposals that meet our mission and the themes developed for funding in the Board-approved CommunityInvestment Strategy are presented to Leadership, Executive Committee and finally the Board of Governors forfunding approval.

Community Outreach Program $540,000The Executive Community Advisory Committee (ECAC) and Regional Community Advisory Committee (RCAC)have been put in place in order to improve the delivery and quality of care for L.A. Care’s consumer members. TheECAC/RCACs have been implemented to ensure that L.A. Care has consistent feedback on its services toconsumer members by identifying strengths, weaknesses and opportunities to improve the quality of care and themember experience. The Community Outreach Program provides the ECAC/RCACs an opportunity torecommend and develop programs specific to their region using established criteria. Such programmatic costscould include training, stipends for meeting attendance, conferences, programming such as the Active Stepsprogram, Get Fit Health events, sponsorships and other community events. The Community Outreach and

100

24

Education staff will work with the committee members to develop programs within an annual budget while bestmeeting the needs of the members the committees serve.

Health Promoters/Promotoras Program $260,700A multicultural Health Promoters Program was created to empower community members to identify health issuesand find solutions to their community needs by empowering community members to promote healthy lifestyles andbuild healthy families for a stronger community. The Health Promoters groups will consist of 35 current L.A. Careconsumer members. Health Promoters lead peer-to-peer community outreach and engagement throughworkshops, health fairs and educational theater. Topics include access to health care, health care reform, nutritionand health promotion. They assist with data collection for the Active Steps Program through written reports,weekly one-on-one reviews, motivational phone session interviews and focus groups.

Sponsorships $750,000The community sponsorship program supports strategically selected events in target communities across LosAngeles County. Funds are used to support activities organized by health care, education and advocacy focusedcommunity based organizations, community clinics, health care providers and industry organizations. Allinvestments are considered in the context of how they support L.A. Care’s organizational goals and raise awarenessabout L.A. Care with key stakeholders. In FY 2015-2016, staff will be implementing a more proactive and strategicapproach to community sponsorship investments. This will include identifying new opportunities to partner withorganizations representing specific populations in the county as well as those that can help support L.A. Careinitiatives led by other parts of the organization. Staff will also be considering participation in larger communityevents targeting certain segments of the county’s diverse population in order to introduce event attendees to L.A.Care.

101

25

Capital Expenditures and Other Projects

The list reflects projects proposed and may include amount to be spent over multiple fiscal years. Projects primarilysupport infrastructure and systems improvements while allowing L.A. Care the flexibility to achieve Strategic Goals.

Capital Professional

Programs Expense Fees Other Total

Proposed Programs

Family Resource Center #5 Antelope Valley $900,000 $900,000

Family Resource Center #6 San Gabriel Valley 900,000 900,000

1115 Waiver - Medi-Cal 2020 500,000 500,000

Grievance & Appeals Phase II and III (PCT) 1,000,000 1,000,000

Batch Job Monitoring 700,000 700,000

Behavioral Health eManagementLA Program 1,000,000 1,000,000

Clinical Care Advance (CCA) Disease Management 900,000 900,000

Clinical Care Advance (CCA) LOB Conversion/roll out 1,800,000 1,800,000

Compliance and Regulatory 1,000,000 1,000,000

Configuration Management Database (CMDB) 1,500,000 1,500,000

Data Center Equipment Expansion & Upgrades 2,250,000 75,000 2,325,000

Data Governance 600,000 600,000

Data Masking and Data at rest Encryption 700,000 350,000 1,050,000

Direct Network for Members 1,500,000 1,500,000

Electronic Data Interface (EDI) Uplift Phase II 500,000 500,000

Encounters Uplift Phase II 1,100,000 1,100,000

Enterprise Data Warehouse 4,150,000 4,150,000

Enterprise Document Management/Imaging/Claims OCR 3,280,000 3,280,000

Enterprise Workflow System 2,000,000 2,000,000

Exchange 2016 2,500,000 2,500,000

Finance System Upgrade Phase I (eProcurement) 1,000,000 1,000,000

Fraud, Waste and Abuse Project 750,000 750,000

Human Resource Information System (HRIS) Implementation 2,500,000 1,000,000 3,500,000

ICD-10 Phase III 500,000 500,000

IT Development & Change Management Controls 698,000 698,000

Interactive Voice Response System (IVR) Modernization 800,000 800,000

Medi-Cal Conversion to QNXT 7,020,000 7,020,000

Medical Management Initiatives 2016 (ELDA) 1,500,000 1,500,000

Member Portal Phase II 500,000 500,000

NCQA/HEDIS process 2016 300,000 300,000

Oracle Legacy Transitions to 11G and 12C 1,000,000 1,000,000

Provider Portal Redesign 1,000,000 1,000,000

Provider Data Management Source of Record 1,100,000 1,100,000

QNXT Enhancements 2016 1,500,000 1,500,000

Sales Force Dot Com (SFDC) Expansion 2,500,000 2,500,000

Leasehold Improvements 15,000,000 15,000,000

$46,800,000 $19,573,000 $1,500,000 $67,873,000


Proposed Projectsfor Fiscal Year 2015-2016

102

26

Project Requests

Family Resource Center #5 - Antelope Valley: $900,000The Family Resource Centers (FRC) project is focused on addressing health disparities by creating resourcecenters to which the community can turn for help with health education, navigating the health care deliverysystem and learning more about available programs. The FRC will offer a number of activities including healtheducation, disease prevention and promotion, self-management tools and education on establishing andmaintaining health coverage. The FRC will be a resource for residents and providers, where significant healthdisparities exist, and will seek to augment the services of traditional Medi-Cal providers who may not have suchresources available.

Family Resource Center #6 - San Gabriel Valley: $900,000Please see FRC Project description above.

1115 Waiver – Medi-Cal 2020: $500,000The Medi-Cal 2020 waiver is necessary for building on the successes of the current waiver and enhancing theMedi-Cal program, thus meeting the goals of the State for 2020. This project will improve health outcomes andreduce disparities while continuing to reduce costs, thus aligning with the goals of CMS and serving as a goodplatform for testing new approaches as the county's largest Medicaid program. L. A. Care will commit tospecific metrics at the statewide, regional, plan and provider levels.

Grievance & Appeals Phase II and III (PCT): $1,000,000Grievance & Appeals (G&A) daily processing and reporting are critical components of L.A. Care’s viability.PCT (Process Tracking Tool) software was purchased in order to merge and absorb the current G&A systems.The PCT system will support the G&A data collection, G&A query generation, G&A reporting and lettergeneration and provide consistent G&A tracking for all of L.A. Care’s lines of business. The plan is to have anintegrated approach with the Member Eligibility Information System on QNXT (QMEIS), Plan Partner Portaland various other enhancements such as the repository of the Claims Optical Character Recognition (OCR) andProvider Dispute Resolution (PDR). The major deliverables of the G&A Phase II & III will be writtentechnical design recommendations, development and management of the PCT processing system.

Batch Job Monitoring: $700,000LACC (Exchange) and CMC (CCI Pilot) were new lines of businesses added to QNXT in the previous fiscalyear. L.A. Care employees have little to no access to the system and logs so there is limited ability to understandwhen incoming and outgoing files are only partially processed or not processed at all. The purpose of thisproject will be to implement a tool across all touch points for file processing to provide a dashboard andmethod for end-to-end reconciliation.

Behavioral Health eManagementLA Program: $1,000,000This program, underpinned by the eConsult software platform, has been developed by L.A. Care incollaboration with the Los Angeles County Department of Mental Health (LAC DMH) to enhancecommunication between Primary Care Providers (PCP) in the L.A. Care network and the DMH psychiatricspecialists. The goal is to improve care delivery by enhancing collaboration between the PCP’s and mentalhealth specialists, improve co-management of complicated patients, reduce unnecessary office visits, optimizethe specialist visit when needed and decrease no-show or cancellation appointments.

Clinical Care Advance (CCA) - Disease Management: $900,000This project will roll out all remaining lines of business away from the Asthma Disease Management andDiabetes Disease Management to the new CCA Platform. Additional disease management programs are inscope. This will facilitate continuous business process improvement and greater workflow efficiency.

103

27

Clinical Care Advance (CCA) - LOB Conversion/Roll Out: $1,800,000This project will roll out all remaining lines of business away from the Essette application to the CCA Platform,facilitating continuous business process improvement and greater workflow efficiency.

Compliance and Regulatory: $1,000,000This is the annual support for regulatory items from CMS, DHCS and DMHC. These items includerequirements outlined in the Health Plan Management System memos for CMC, All Plan Letters, Dual PlanLetters and Policy Letters for Medi-Cal. This project will begin in October 2015.

Configuration Management Database (CMDB): $1,500,000A CMDB will provide the foundation for all service support and delivery processes. The system will provide anaccurate and comprehensive database of software, infrastructure and documentation. A CMDB will supportincident and problem resolution of IT services. It will also serve as the source for the IT Service portfolio,which encompasses both customer delivered solutions and those which are under development. This will inturn shorten the system design planning lifecycle and aid Business Relationship Managers with businessdevelopment planning.

Data Center Equipment Expansion & Upgrades: $2,325,000As new lines of business are deployed, Data Center resources need to expand to accommodate the growth ofL.A. Care’s staffing and membership. This project will include storage expansion and host server installation todirectly support this increased demand. The improvements will increase the efficiency and performance of thedata systems.

Data Governance: $600,000The objective of this project is to develop and implement definition, policies and ongoing procedures for data,its source, ownership and quality across all L.A. Care systems, as well as to resolve data discrepancies. This willresult in improved data quality and consistency in L.A. Care’s operational systems. This project will require 3consultants for 12 months each.

Data Masking and Data at Rest Encryption: $1,050,000This project will mask PHI (protected health information) in lower environments and encrypt data at rest in allproduction systems in order to comply with all HIPAA (health insurance portability and accountability act) dataprotection requirements. This will reduce the risk of non-compliance and provide accuracy for the applicationtesting process. This project will benefit L.A. Care by allowing compliance with the HIPAA rules andregulations.

Direct Network for Members: $1,500,000The purpose of this project is to provide access to care in targeted areas, primarily for special needs members, aspart of a direct network with care managed directly by L.A. Care. With this network, there would be nodelegation or fee for service providers.

Electronic Data Interface (EDI) Uplift Phase II: $500,000The demand for EDI resources continues to increase as our portfolio of services diversifies, as business areasbring on new vendors with data exchange requirements and as our membership expands. A tracking and alertsystem will be implemented to monitor expected and actual data exchange activities. This system will enableproactive versus reactive responses to incidents when we know about them before our customers do. It willalso help pinpoint problems and resolve them more quickly. Current Sybase mapping tools, which are nolonger being updated, will be replaced with enhanced tools to be continuously maintained and improved by thevendor.

104

28

Encounters Uplift Phase II: $1,100,000This project will be a process improvement for the Encounter system, an application that loads and processesall encounters for L.A. Care lines of business. The affected business functions include revenue determination,quality of care measurement and the ability to understand cost of care trends. The project will include analyzingthe proposed improvements, archiving the database, upgrading the Oracle Database, creating User Interfaces,creating an error processing system, creating a communication protocol and creating a separate Encounterreporting database. This process improvement will contribute to a robust Encounter system and speed up theprocessing time when working with Plan Partners, CMS and DHCS.

Enterprise Data Warehouse (EDW): $4,150,000The objective of this project is to design, build and deploy an enterprise wide data warehousing solution that isrobust and adaptable to address both current and future L.A. Care business information needs, as well as toimprove access to data. The project will encompass the development of a strategy and roadmap, EDWarchitecture and data models, business use cases, EDW infrastructure and tools, data governance integration,training and a performance scorecard. The result will be greater data availability, accessibility and quality.

Enterprise Document Management/Imaging/Claims OCR: $3,280,000The new Enterprise platform will support document scanning, management, OCR requirements and makecontent more accessible throughout L.A. Care without compromising security. High speed scanning andsharing of documents across many divisions of L.A. Care is a growing requirement and strategic direction forthe company. This project will reduce the claims processing times in order to meet the compliancerequirements, but will need to be integrated into the total solution to add functionality. Other divisions such aslegal and Provide Network Operations also require this system’s capabilities to automate processes, reduceprinting costs and lower overall company operational expenses.

Enterprise Workflow System: $2,000,000The goal of this project is to purchase a business process management and enterprise content managementsolution. This workflow solution, combined with healthcare consulting services, will help L.A. Care to evaluateits enterprise operations processes. With this, L.A. Care can identify opportunities to integrate, streamline andtransform our enterprise into a more cohesive architecture.

Exchange 2016: $2,500,000The goal of this project is to identify and implement process improvements pertaining to the enrollment andmaintenance of the member data in QNXT (New Core System) that comes from the Inbound 834 CaliforniaHealthcare Eligibility Enrollment and Retention System (CalHEERS) file. Currently there are numerous dataissues within QNXT as a result of allowing incorrect data in from CalHEERS. This project will involve UserInterfaces for managing 834 errors, as well as CalHEERS to QNXT reconciliation exceptions. Applyingbusiness rule logic based on member enrollment/maintenance scenarios and rejecting incorrect transactionsback to CalHEERS will improve the data quality within QNXT and downstream interfaces.

Finance System Upgrade Phase I (eProcurement): $1,000,000The goal of this project is to integrate the procurement and contracting systems to increase L.A. Care’seffectiveness in automated approvals, purchase requisitions and contracts. Contract management andcompliance to L.A. Care’s policies will improve as well as automate the procurement-to-payment (P2P) process.

Fraud, Waste and Abuse Project: $750,000L.A. Care’s fraud, waste and abuse program for provider claims is currently limited and is largely dependentupon staff observations for identifying potential fraud, waste and abuse issues. This project will create a newdata mart to monitor and report on fraud, waste and abuse. Phase II of this project will incorporate QNXT

105

29

claims data and encounter data from external partners. This Claims Analysis tool will identify inaccurateprovider bills and help to decrease unnecessary healthcare expenditures.

Human Resource Information System (HRIS) Implementation: $3,500,000This project will be to implement a new SAP system. HRIS, the new system, will replace a number of internalsystems such as Epicor and HR Docs. Integration with other internal systems will be a vital component of thisimplementation project.

ICD-10 Phase III: $500,000Phase III of the ICD-10 (International Classification of Diseases, 10th Revision) Project is to provide post-implementation as well as post-compliance neutrality testing. L.A. Care plans to use professional services toaudit and perform claim adjudication neutrality testing for both QNXT and MHC. The project will compareICD-9 QNXT system pricing to ICD-10 QNXT system pricing to identify variances. When identified, analysiswill be conducted to determine which processing step(s) cause the variances. Fixes will be made whennecessary.

IT Development & Change Management Controls: $698,000This project is to achieve overall improvement in Information Technology internal processes. It will identify,select and implement project intake processes; project management, change and release management workflowprocesses; and controls that align with industry best practices for managing projects. This process improvementwill allow for work product delivery that meets the organizational and business needs. The project will alsoensure consistency in auditable project documentation, status and traceability.

Interactive Voice Response System (IVR) Modernization: $800,000This project involves the modernization of the Interactive Voice Response application to improve navigationand usability in direct support of the call center, and to provide a positive experience for our member base.This will include an infrastructure technology upgrade, a complete application upgrade and added functionalityto meet our increased demand for services.

Medi-Cal Conversion to QNXT: $7,020,000This project is a continuation of the Core System Project, which will focus on converting the Medi-Cal line ofbusiness from the old platform, MHC, to the new QNXT platform.

Medical Management Initiatives 2016 (ELDA): $1,500,000The Medical Management Department is planning to undertake advancements including additional diseasemanagement programs, automation of hospital admissions cases, advanced member stratification andenhancements to authorization/delegated authorization processes.

Member Portal Phase II: $500,000This project is to extend additional functionality to the Member Portal and Mobile Application. Phase II will beto implement the necessary functions identified in Phase I for the upgrade of the Member Portal to the HealthX portal.

NCQA/HEDIS Process 2016: $300,000The HEDIS Operations and Health Outcome & Analysis teams have transitioned to in-house reporting forHEDIS measures. In addition, the HEDIS Operations team has engaged a new vendor, Inovalon, the primaryHEDIS vendor, and will be phasing out Verisk (last year’s HEDIS vendor). Currently L.A. Care relies on bothvendors and requires IT support to ensure continued HEDIS operations from both an infrastructure and a dataexchange perspective. The success of this project is significant because HEDIS scores translate directly intoboth the quality scores with NCQA (National Committee for Quality Assurance) and L.A. Care’s proportionalassignment of Medi-Cal members from the State.

106

30

Oracle Legacy Transitions to 11G and 12C: $1,000,000This project is to move all databases from the unsupported Oracle 10G environments to the 11G and 12Cenvironments. This will require development work, upgraded infrastructure, added features and new hardwareto support database processes effectively. The project will provide added functionality to meet our increaseddemand for services and ensure compliance with software licensing agreements.

Provider Portal Redesign: $1,000,000The objective of this project is to re-platform from the existing Provider Portal to the Health X Portal. HealthX will deliver consistent branding, reduce the registration process, increase the self-services, increase WebAnalytics and reporting capabilities, implement security practices, reduce Provider support call volume andimplement a tracking mechanism on Provider Relations communication.

Provider Data Management Source of Record: $1,100,000The main objective of this project is to close the many gaps in our current provider database and create a uniquedownstream system of records for providers, optimally supporting all current and future system applications.The result will be an enhanced provider application and database system(s) that will eliminate the errors causedby the lack of synchronicity (gaps), such as the current dual entry of providers. Benefits will include fewergrievances, expedited claims processing, fewer errors, higher staff productivity and greater success in membertransfers to other PCPs.

QNXT Enhancements 2016: $1,500,000This project involves meeting the demands of service requests through the custom development of QNXTfunctionality outside the scope of the Core Systems Project (CSP). These efforts relate predominantly tobusiness process improvements, workflow and efficiencies. All budgeted costs are related to consulting fees.

Sales Force Dot Com (SFDC) Expansion: $2,500,000Currently SFDC is only available to the Member Outreach department. Expanding SFDC to allow its data to beshared with other systems would make its member information data gathering, robo-calling and call scriptingcapabilities available enterprise wide. The enhanced SFDC system could replace the current Family ResourceCenter application and link to MEIS (the original Member Eligibility Information System) and QMEIS(Member Eligibility Information System on QNXT). The system would allow for more efficient and successfuloutbound call campaigns, as well as more timely and effective follow-ups with disenrolled members. Analysis ofthese follow-ups will offer insight into how we may further improve our member services.

Leasehold Improvements and On-going Computer upgrades: $15,000,000The Leasehold Improvements budget includes carry-over amounts for on-going projects. Phase I will becompleted in September 2015 which will include floors 1, 2, 3 and 15 in headquarters. Phase II will becompleted in November 2015 for floors 6, 19 and 20. The rest of the budget is reserved for on-going upgrades,renovations, maintenance of existing space while allowing Leadership the flexibility to achieve strategic goalsand growth.

107

31

FINANCIAL STATEMENTS

Projected as of Budget as of

September 30, 2015 September 30, 2016

Combined Balance Sheet

Current Assets

Cash & cash equivalents $653,167 $718,593

Investments, at fair value 1,293,000 1,366,200

Other current assets 440,133 475,000

Total current assets 2,386,300 2,559,793

Capital Assets, net 42,000 45,000

Non-current assets 10,250 11,000

Total Assets $2,438,550 $2,615,793

Current Liabilities

A/P and accrued liabilities $60,000 $79,800

Subcapitation payable 1,214,103 1,269,600

Provider incentives 52,000 50,000

Other accrued medical expenses 695,000 700,000

Grants payable 1,580 2,000

Total current liabilities 2,022,683 2,101,400

Non-Current Liabilities 3,800 1,400

Total Liabilities 2,026,483 2,102,800

Fund Equity

Invested in Capital Assets 42,000 45,000

Restricted 300 300

Board Designated Funds 236,767 312,395

TNE (130% of Required) 133,000 155,298

Total Fund Equity 412,067 512,993

Total Liabilities and Fund Equity $2,438,550 $2,615,793


Balance Sheet


dollars in thousands

108

32

FY 2014-2015 FY 2015-2016

Forecast Budget

Membership 1,852,650 1,988,186

Member Months 20,971,255 23,115,560

Revenue

Capitation $6,085,227 $6,695,445

Maternity Kick 124,705 168,851

Other 1,969 198

Total Revenue 6,211,901 6,864,494

Cost of Health Care

Capitation 3,465,401 3,619,367

Provider Incentives & Shared Risk 155,414 62,573

Inpatient 695,992 777,707

Outpatient 775,645 1,178,972

Pharmacy 422,852 417,738

Long Term Care 180,476 291,047

Medical Administrative Expenses 83,921 100,484

Total Cost of Health Care 5,779,701 6,447,888

MCR 93.0% 93.9%

Operating Margin 432,200 416,606752

Total operating expense 237,806 309,261

Administrative Ratio 3.8% 4.5%

Net Income (Loss) from Operations 194,394 107,345

Non-Operating Income (Expense)

(Provision) for Community Investments (2,647) (5,000)

Gross Premium Tax, net (1,103) (1,419)

Investment Income (Expense), net 1,348 0

Revenues over (under) Expenses $191,992 $100,926

Margin 3.1% 1.5%

Note: The forecast is based on actual f inancials as of FYTD June 30, 2015.



Comparative Statement of Operations

Fiscal Year 2014-2015 vs. Fiscal Year 2015-2016

109

33

Projected for the FYE Budget for the FYE

September 30, 2015 September 30, 2016

Combined Statement of Cash Flow

Operating activities

Excess operating revenues expenses $191,992 $100,926

Add: Depreciation/Amortization 6,449 7,000

(Increase) in:

Other current assets (19,749) (34,867)

Non-current assets (99) (750)

Increase (Decrease) in:

Accounts payable 18,491 19,800

Subcapitation payable 593,407 55,497

Provider incentives 1,742 (2,000)

Other accrued medical expenses 276,889 5,000

Grants payable 753 420

Non-current liabilities 527 (2,400)

Cash provided by operating activities 1,070,402 148,626

Investing activities

(Purchase) of investments, net (992,791) (73,200)

Capital assets (investment) (19,795) (10,000)

Cash (used) by investing activities (1,012,586) (83,200)

Net increase in unrestricted cash & equivalents 57,816 65,426

Unrestricted cash & equivalents - beginning of period 595,351 653,167

Unrestricted cash & equivalents - end of period $653,167 $718,593


Statement of Cash Flows



110

34

Budget as of

September 30, 2016

Tangible Net Equity (TNE) Calculation

Healthcare expenses:

1. 8% of first 150 million of $12,000

annualized health care expenses,

except those paid on a capitated

or managed hospital basis

2. 4 % of the annualized health 64,710

care expenses, except those paid

on a capitated or managed hospital basis

3. 4 % of the annualized hospital 42,750

expenditures paid on a

managed hospital basis

TNE based on healthcare expenses 119,460

TNE (at 130% of State Required Level) 155,298

Fund equity 512,993

Excess equity over TNE @ 130% 357,695


Tangible Net Equity Calculation



111

STEVEN T. VALENTINE, MPAPRESIDENT, THE CAMDEN GROUP

Mr. Valentine is president of The Camden Group, one of the nation’s largest healthcare

management consulting companies with offices in California, Illinois, New York, Massachusetts, and

Texas. With more than 35 years of healthcare consulting experience, he has considerable expertise in

the areas of strategic planning, business transactions, mergers, hospital-physician relationships, and

financial analysis. Mr. Valentine authors the annual “Top 10 Trends in Healthcare” for Trustee. He is

a nationally recognized author and speaker on healthcare issues. Mr. Valentine is often quoted in

Payers and Providers, Modern Healthcare, Los Angeles Times, and HealthLeaders, as well as other

publications. Mr. Valentine is frequently invited to present his assessment of the industry trends and

its future outlook throughout the U.S. and NPR.

Mr. Valentine has directed numerous strategic planning and merger engagements for a wide variety

of healthcare organizations. He is a recognized facilitator of hospital board, medical staff, and

management retreats. He is the chair of both the Orthopaedic Institute for Children Board and

Strategy and Finance Committee. Mr. Valentine serves on the Program Advisory Board at the USC

School of Policy, Planning and Development. He was on the Board and Finance Committee (1996

to 2012) and chaied the Audit Committee of HealthCare Partners, Ltd., an MSO with approximately

$2.2 billion in revenue, Board member of Northridge Hospital Medical Center and also served on

the Executive Committee and chaired the Finance Committee of Partners in Care foundation.

Prior to joining The Camden Group, Mr. Valentine was an engagement executive in Ernst &

Young’s Health Care Business Advisory Group. His previous experience included senior positions at

Amherst Associates, Pacific Health Resources, National Medical Enterprises, and the health Systems

Agency of San Diego and Imperial counties. He was selected by California Medicine as one of

California’s top 100 most influential people in the healthcare field, and he also received a similar

honor for Los Angeles County from the Los Angeles Business Journal. He was honored with the USC

Health Services Administration Alumni Association Distinguished Graduate Award.

Mr. Valentine earned his bachelor’s degree from San Diego State University and his master’s degree

in public administration and certified health services administration from the University of Southern

California. He also completed the Ernst & young Management program with the Kellogg School at

Northwestern University.

120

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] by mhbalones/printed on 08/28/15

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

1 2 3Board of Governors

Retreat-Meeting8:30 – 4 pm

CR Yosemite BCenter for Healthy

CommunitiesThe California Endowment

1000 N. AlamedaLos Angeles, CA 90012

4 5 6

7 8 9ECAC10 am

(for approximately 2 hours)

10 11 12 13

14 15CHCAC8:30 am

(for approximately 1-1/2hours)

16 17Compliance & Quality

2:30 pm(for approximately 2 hours)

18 19 20

21 22 23Finance & Budget

1:00 pm(for approximately 1-1/2hours)

Executive2:30 pm


24 25 26 27

28 29 30

Schedule of Meetings

September 2015

121

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].

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

MEETING DAY, TIME,

& LOCATION

MEETING DATES

MEMBERS

Board ofGovernors

General Meeting

1st Thursday2:00 PM

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

10th Floor,Los Angeles, CA 90017

* All Day BoardRetreat at The Center

for HealthyCommunities Yosemite

B Conference Room,The CaliforniaEndowment

1000 N. Alameda, LosAngeles, CA 90012

September 3*October 1

November 5December 3**

**Strategic Focusfrom 12:00-2:00 p.m. in

addition to regularBoard meeting from

2:00-5:00 p.m.

Mark Gamble, ChairpersonLouise McCarthy, Vice ChairpersonMichael Rembis, FACHE, TreasurerAlexander K. Li, MD, SecretaryHonorable Michael D. AntonovichHector De La TorreJann Hamilton LeeThomas Horowitz, DOOzzie LopezHilda PerezG. Michael Roybal, MD, MPHSheryl SpillerKimberly Uyeda, MD, MPH

Staff Contact:John Baackes, Chief Executive Officerx4102Linda Merkens, Manager, Board Services,x4050

Board of Governors & Public Advisory Committees

2015 Meeting Schedule / Member Listing

122

BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES

2015 MEETING SCHEDULE / MEMBER LISTING




Board of Governors - Standing Committees

MEETING DAY,

TIME,

& LOCATION

2015

MEETING

DATES

MEMBERS

ExecutiveCommittee

4th Wednesday of themonth2:30 PM


10th Floor, Los Angeles,CA 90017

** moved due toThanksgiving holiday

September 23October 28

November 18**No meeting in

December

Mark Gamble, ChairpersonLouise McCarthyMichael Rembis, FACHEAlexander K. Li, MDThomas Horowitz, DOG. Michael Roybal, MD, MPH

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

Compliance &Quality

Committee

3rd Thursday every 2months2:30 PM


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

CA 90017

September 17November 19

No meeting inDecember

G. Michael Roybal, MD, MPH,ChairpersonJann Hamilton LeeAlexander Li, MDHilda Perez

Staff Contact:Malou BalonesCommittee Liaison, Board Services, x 4183

Finance &Budget

Committee

4th Wednesday of themonth1:00 PM


10th Floor, Los Angeles,CA 90017

** moved due toThanksgiving holiday


November 18**No meeting in

December

Michael A. Rembis, FACHE, ChairpersonJann Hamilton LeeThomas Horowitz, DOOzzie LopezLouise McCarthy

Staff Contact:Malou BalonesCommittee Liaison, Board Services/x 4183

GovernanceCommittee

1055 W. 7th Street,10th Floor

Los Angeles, CA 90017

MEETS AS NEEDED

Alexander K Li, MD, ChairpersonHector De La TorreMark GambleOzzie LopezHilda PerezSheryl Spiller


123






MEETING DAY,

TIME,

& LOCATION

2015

MEETING

DATES

MEMBERS

ServiceAgreementCommittee

1055 W. 7th Street,10th Floor


MEETS AS NEEDED

Hector De La Torre, ChairpersonLouise McCarthyHilda PerezSheryl Spiller

Staff ContactMalou BalonesCommittee Liaison, Board Services/x 4183

Audit Committee 1055 W. 7th Street,10th Floor


MEETS AS NEEDED

G. Michael Roybal, MD, MPH,ChairpersonJann Hamilton LeeAlexander K. Li, MD

Staff ContactMalou BalonesCommittee Liaison, Board Services, x 4183

124






MEETING DAY,

TIME,

& LOCATION

MEETING

DATES MEMBERS

L.A. CareCommunity

Health

Meets Annually or asneeded


CA 90017



L.A. Care JointPowers Authority

Meets Quarterly or asneeded


CA 90017



125






Public Advisory Committees

MEETING DAY,

TIME,

& LOCATION

MEETING

DATES STAFF CONTACT

Children’s HealthConsultant Advisory

CommitteeGeneral Meeting

3rd Tuesday of every othermonth

8:30 AM(for approximately 2 hours)


CA 90017


Lyndee Knox, PhD, Chairperson


ExecutiveCommunity

Advisory Committee

2nd Wednesday of themonth



CA 90017


November 11December 9

Elda Sevilla, Chairperson

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

Technical AdvisoryCommittee

4th Thursdays every othermonth



CA 90017

The Committee isbeing restructured

Chairperson to be elected


126






REGIONAL COMMUNITY ADVISORY COMMITTEES

REGION

MEETING DAY,

TIME,

& LOCATION

MEETING

DATE

STAFF CONTACT

Region 1Antelope Valley

3rd Friday of every othermonth

10:00 AM(for approximately 2-1/2 hours)Chimbole Cultural Center38350 N. Sierra Highway

Palmdale, CA 93550(661) 267-5656

October 16December 18

Adela Guadarrama, Chairperson

Staff Contact:Judy Hsieh BigmanCommunity Outreach & Education, Ext.4199

Region 2San Fernando

Valley

3rd Monday of every othermonth

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

Family Resource Center-Pacoima

10807 San Fernando RoadPacoima, CA 91331

(844) 858-9942


Carlos Aguirre, Chairperson

Staff Contact:Judy Hsieh BigmanCommunity Outreach & Education, Ext.4199

Region 3Alhambra,

Pasadena andFoothill



Rosemead Center3936 N. Muscatel Avenue,

Room 3Rosemead, CA 91770

(626) 569-2160


Lidia Parra, Chairperson

Staff Contact:Kristina ChungCommunity Outreach & Education, Ext.5139

Region 4Hollywood-

Wilshire, Centraland Glendale


9:00 AM(for approximately 2-1/2 hours)Hope Street Family Center1600 Hope Street, Rm 305

Los Angeles, CA 90015(213) 742-6385


Hercilia Salvatierra, Chairperson


127






REGION

MEETING DAY,

TIME,

& LOCATION

MEETING

DATE

STAFF CONTACT

Region 5West

3rd Monday of every othermonth2:00 PM

(for approximately 2-1/2 hours)Veterans Memorial Building

Garden Room4117 Overland AvenueCulver City, CA 90230

(310) 253-6625


Romalda Meza, Chairperson

Staff Contact:Martin VicenteCommunity Outreach & Education, x 4423

Region 6South, Compton,

Inglewood

3rd Thursday of everyother month

3:00 PM(for approximately 2-1/2 hours)Saint John’s Well Child &

Family Center808 W. 58th Street

Los Angeles, CA 90037(323) 541-1600


Dove Savage Pickney, Chairperson

Staff Contact:Frank MezaCommunity Outreach & Education, x 4239

Region 7San Antonio and

Bellflower


4:30 PM(for approximately 2-1/2 hours)

Old Timers FoundationFamily Center

3355 E. Gage AvenueHuntington Park, CA 90255

(323) 582-6090


Dalia Cadena, Chairperson


Region 8Torrance and

Harbor

3rd Friday of every othermonth


Harbor Vista HousingCommunity Area

430 N. Wilmington Blvd.Wilmington, CA 90744

(310) 835-7660


Ana Romo –Chairperson


128






REGION

MEETING DAY,

TIME,

& LOCATION

MEETING

DATE

STAFF CONTACT

Region 9Long Beach

3rd Monday of every othermonth


Miller Family HealthEducation Center

3820 Cherry AvenueLong Beach, CA 90807

(562) 570-7987


Christina Deh-Lee, Chairperson


Region 10East Los Angeles,

Whittier and North-East


4:00 PM(for approximately 2-1/2 hours)Boyle Heights Technology

Youth Center1600 East 4th Street

Los Angeles, CA 90033(323) 526-0145


Elsa Gervacio, Chairperson

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

Region 11Pomona and El

Monte

3rd Thursday of everyother Month


dA Center for the Arts252 D South Main Street

Pomona, CA 91766(909) 397-9716


Elda Sevilla, Chairperson

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

129






COORDINATED CARE INITIATIVE (CCI) CONSUMER COUNCIL

REGION

MEETING DAY,

TIME,

& LOCATION

MEETING

DATE

STAFF CONTACT

Area 1Antelope Valley


10:00 AM(for approximately 2-1/2 hours)Chimbole Cultural Center38350 N. Sierra Highway

Palmdale, CA 93550(661) 267-5656


Staff Contact:Jerry EdmondCommunity Outreach & Education, Ext.5254

Area 2San Fernando

Valley

4th Wednesday of everyother month


Family Resource Center-Pacoima

10807 San Fernando RoadPacoima, CA 91331

(877) 287-6290

September 23November 18 *

*will meet the 3rd

WednesdayStaff Contact:Susan MaCommunity Outreach & Education, Ext.4586

Area 3South Los Angeles

4th Wednesday of everyother month


Rogers Park CommunityCenter

400 W. Beach AvenueInglewood, CA 90302

(310) 412-5504

August 26October 28

December 16*

*Will meet the 3rd

Wednesday Staff Contact:Jerry EdmondCommunity Outreach & Education, Ext.5254

Area 4Long Beach

4th Tuesday of every othermonth1:00 PM

(for approximately 2-1/2 hours)Mark Twain Branch Library

1325 E. Anaheim StreetLong Beach, CA 90813

(562) 570-1046

August 18 *October 20 *December 22

*Will meet the 3rd

TuesdayStaff Contact:Susan MaCommunity Outreach & Education, Ext.4586

130

BOARD OF GOVERNORS MEETING #248 - L.A. Care Health Plan · Chairperson Horowitz noted that the...

Documents

Transcript of BOARD OF GOVERNORS MEETING #248 - L.A. Care Health Plan · Chairperson Horowitz noted that the...