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  • 2 016 ANNUAL REPORT

  • Lenda Townsend-Williams, MBA Chief Operating Officer

    Steve Yedlin, MD Chief Medical Officer

  • Shareholder’s Meeting April 25, 2017

    To Our Shareholders,

    As your Independent Practice Association (IPA), we are proud of the continued quality services provided to your members and your availability to accomodate their needs.

    We remain committed to supporting the future of independent physicians, who provide members with outstanding care. We are researching options to assist with sustaining your practice.

    In this report, you will read about some of the accomplishments made possible by outstanding employees of Children First Medical Group, Inc. We value our physician shareholders who continue to serve as a choice for pediatric well care and specialty care services in the local community, and surrounding counties and states.

    Thank you for all you do to contribute to the overall success of your IPA.

    Arnold Blustein, MD Board President

    2016 Annual Report

    Lenda Townsend-Williams, MBA Chief Operating Officer

    Steve Yedlin, MD Chief Medical Officer

    Table of Contents

    2016 Highlights..........................................1

    Financial Review.........................................2

    Independent Auditor’s Report...................3

    Administrative Services..............................5

    Medical Management................................9

    Board of Directors & Committees.............11

  • Children First Medical Group, Inc.

    2016 Highlights

    1

     Seventy-four (74) new physicians joined our network.

     Primary Care Physicians expressed high satisfaction with CFMG’s prior authorization process.

     Successfully met and exceeded financial solvency requirements for the Department of Managed Care.

     We received excellent results on the following audits:

    1) Claims

    2) Credentialing

    3) Utilization Management

     Excellent Member Satisfaction results with the primary care practices rating of 95%.

     Successfully met National Committee for Quality Assurance and Department of Health Care Services requirements for all delegated activities.

     The Provider Relations Department received 2,850 calls on the customer service line compared to 3,359 calls in 2015, a 15% decrease.

     The Medical Management Department processed 6,680 authorizations compared to 7,091 in 2015, a 6.1% decrease.

     We hosted three (3) Provider Education & Training Workshops.

     We maintained credentialing delegation authority with 19 payors.

     The Claims Department processed 204,544 paper and EDI claims.

     The Claims Error Ratio was

  • 2016 Annual Report to Shareholders

    In 2016, Children First Medical Group, Inc. continued its course of stable financial growth. Our total revenue increased 4.5%. Our operating expenses remain at approximately 12%, a ratio well within industry standard. Our physician membership increased by 74 physicians. We continue to add UCSF faculty who have partnered with our physicians to provide clinic and ED coverage at UCSF Benioff Children’s Hospital Oakland. As most know, we also have primary care and specialty physician members who are associated with Stanford Health Care and Lucile Packard Children’s Hospital Stanford. We continue to provide administrative support services to UCSF Benioff Children’s Physicians to which many of our physicians belong.

    For the calendar year 2016, our surplus was a new high of six million dollars. About $1.6 million was distributed in September. The remainder was distributed in March.

    The distribution was determined first by providing a participation bonus to both primary care physicians and specialists open to providing services to our Medi-Cal members. A member-month bonus was distributed to our PCPs. Most of the remaining funds were distributed based on services provided by all participating physicians.

    We again provided funding to the Children’s Specialty Care Coalition (CSCC), a statewide group of California Children Services (CCS) providers that works to ensure continued support for our most at risk patients. The State is moving toward a Whole Child Model. This will result in CCS being rolled into managed care, which hasn’t been clearly defined. The goal is to have the individual child’s care to be fully integrated into a single responsible entity to ensure appropriate care coordination. CSCC is providing insight to the state on the best options for care being provided at the specialty level to prevent disruptions and to ensure access.

    The healthcare industry continues to consolidate with further concentration of facilities and physicians into larger and larger networks. We have encouraged UCSF Benioff Children’s Hospital to reform the Physician Hospital Organization (PHO). This is the first step toward a Pediatric Medi-Cal Managed Care Accountable Care Organization. We were involved in a PHO from 1995 to 2007. A PHO would again allow us to do coordinated capitated contracting to benefit our medical group and the hospital. We could work with Canopy Health, the commercial ACO being developed by UCSF, to bring the power of data analytics to serve our members. It would also allow us to be the pediatric arm of a commercial ACO.

    We maintain strong relationships with our two Medi-Cal Managed Care plans, Anthem Blue Cross and Alameda Alliance for Health. We continue to successfully meet and exceed financial solvency requirements for the Department of Managed Health Care.

    Financial Review

    2

  • Independent Auditor’s Report

    Children First Medical Group, Inc.3

  • PPO Contracts

    We currently maintain Preferred Provider Organization (PPO) contracts with the following payors:

     Aetna  Benefit Risk Management  CIGNA Healthcare  Coventry First Health Care  Healthsmart (Interplan)  Hometown Health  Humana/ChoiceCare Network  MultiPlan

     Pacific Health Alliance  Pacific Foundation for Medical Care  Prime Health Services, Inc.  Provider Select  Sutter Redwoods Medical Foundation  Three Rivers Provider Network  USA Managed Care Organization

    Administrative Services

    Membership CFMG currently serves over 60,000 enrollees who are participants through Alameda Alliance for Health and Anthem Blue Cross.

    Provider Network Our provider network is comprised of 562 physicians, with 187 Primary Care Physicians (PCPs) and 376 Specialty Care Physicians (SCPs).

    Contract Management HMO Commercial Contracts

    We maintain contracts for Specialty services with the following payors:

    Medi-Cal Contracts

    We manage contracts with the following state-sponsored plans:

     Alameda Alliance for Health

     Anthem Blue Cross

    Medi-Cal HMO Specialist Contracts

    We manage contracts with the following state-sponsored plans:

     Contra Costa Health Plan

     Community Health Center Network

     Health Plan of San Joaquin

     Brown & Toland Medical Group  CIGNA Healthcare  Hill Physicians Medical Group  John Muir Physician Network

     Meritage Medical Network  Palo Alto Medical Foundation  Sutter Gould Medical Group  Sutter Medical Foundation

    5 Children First Medical Group, Inc.

    Michael McCarty Claims Manager

    Lenda Townsend-Williams, MBA Chief Operating Officer

  • Children First Medical Group, Inc. Contracts

    To view CFMG contracts, please access our website at www.childrenfirstmedicalgroup.com.

    Claims Management 2016 2015

    Processed Claims 204,544 209,001

    Errors Ratio

  • Credentialing The Credentialing Department received 100% on all health plan annual audits.

    Our provider network continues to steadily increase, with the addition of seventy-four (74) new physicians.

    We maintained delegation authority for credentialing with the following payors:

     Aetna  Alameda Alliance for Health  Anthem Blue Cross  Benefit Risk Management Service  Brown & Toland Medical Group  Humana ChoiceCare Network  CIGNA Healthcare  Contra Costa Health Plan  Coventry First Health Care  Health Plan of San Joaquin

     Healthsmart (Interplan)  Hill Physicians Medical Group  Meritage Medical Network  Multiplan/Private Health Care Systems  Pacific Foundation for Medical Care  Provider Select, Inc.  Prime Health Services, Inc.  Sutter Redwoods Medical Foundation  USA Managed Care Organization

    Children First Medical Group, Inc.7

    Provider Network Credentialing

    600

    500

    0

    100

    200

    300

    400

    Total CFMG Physicians

    New Recredentialed Terminated/ Retired

    # of PCPs

    # of Specialists

    # Total Physicians

    186

    18 44

    10

    376

    115

    56 43

    562

    74

    159

    53

  • 8

    Customer Service Calls

    Member Services We received 301 calls from Anthem Blue Cross and Alameda Alliance for Health Managed Medi-Cal enrollees.

    Provider Relations/Customer Services In 2016, we handled 2,850 customer service calls compared to 3,359 in 2015 and returned all calls within 24 hours. Utilization Management handled 1,842 calls from providers and and retur