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BOARD OF GOVERNORS MEETINGNovember 3, 2016 2:00 PML.A. Care Health Plan1055 W. 7th Street, Los Angeles, CA 900171
About L.A. Care Health PlanMission StatementL.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-incomecommunities and residents and to support the safety net required to achieve that purpose.OverviewCommitted to the promotion of accessible, affordable and high quality health care, L.A. Care Health Plan (Local InitiativeHealth Authority of Los Angeles County) is an independent local public agency created by the State of California toprovide health coverage to low-income Los Angeles County residents. Serving nearly two million members in six productlines, 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 consumermembers, physicians, federally qualified health centers, children’s health care providers, local hospitals and the LosAngeles County Department of Health Services.L.A. Care advances individual and community health through a variety of targeted activities including a CommunityHealth Investment Fund that has awarded more than 132 million throughout the years to support the health care safetynet and expand health coverage. The patient-centered health plan has a robust system of consumer advisory groups,including 11 Regional Community Advisory Committees (governed by an Executive Community Advisory Committee),four Coordinated Care Initiative Consumer Councils, 35 health promoters and four Family Resource Centers that offerfree health education and exercise classes to the community, and has made significant investments in Health InformationTechnology for the benefit of the more than 10,000 doctors and other health care professionals who serve L.A. Caremembers.Programs Medi-Cal – In addition to offering a direct Medi-Cal line of business, L.A. Care works with three subcontractedhealth plans to provide coverage to Medi-Cal members. These partners are Anthem Blue Cross, Care 1st HealthPlan, and Kaiser Permanente. 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 allmembers of a family to receive health coverage under one health plan in the Covered California state exchange. L.A. Care Covered Direct – L.A. Care’s first private health plan for all members of a family. L.A. Care Cal MediConnect Plan– L.A. Care Cal MediConnect Plan provides coordinated care for Los AngelesCounty 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, Healthy Kids (0-5) provides comprehensive health carecoverage for children who do not qualify for Medi-Cal or Covered California. PASC-SEIU Homecare Workers Health Care Plan – L.A. Care provides health coverage to Los Angeles County’s InHome Supportive Services (IHSS) workers, who enable our most vulnerable community members to remainsafely in their homes by providing services such as meal preparation and personal care services.www.lacare.orgUpdated .-care-health-planTwitter: @lacarehealth2
AGENDABOARD OF GOVERNORS MEETINGThursday, November 3, 2016, 2:00 PML.A. Care Health Plan, 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017WelcomeMark Gamble, Chair1.Approve today’s AgendaChair2.Public CommentChair3.Approve September 1, 2016 meeting minutesp.6Chair4.Approve Consent Agenda Items Ratify CEO’s execution of Contract with Covered California, the California HealthBenefit Exchange (EXE 100A) p.44p.45 2017 Board & Committee Meeting Schedule (EXE 101) Third Quarter CY 2016 Investment Report (FIN 100) p.47p.63 Oracle Maintenance & Support Contract Amendment (FIN 101) Oracle Unlimited License Agreement Contract Amendment (FIN 102) p.64 SunGard Contract Amendment (FIN 103) p.65 PCM-G Contract Amendment (FIN 104) p.67 Authorization to Contract with Vendor still to be determined for Call CenterEnhancement (FIN 105) p.68 Policy AFS 008 (Annual Investment) (FIN 106) p.69 Policy AFS 004 (Travel and Other Expenses) and 027 (Non-Travel and OtherExpenses) (FIN 107) p.91 Policy AFS 025 (Tangible Net Equity & Board-Designated Reserves Funds) (FIN 108) p.118 RCAC Membership (ECA 100) p.123Chair5.Chairperson’s ReportChair6.Chief Executive Officer Report p.124 Strategic Vision Progress Report 4th Quarter FY 2015-167.Chief Medical Officer Reportp.148p.130John BaackesChief Executive OfficerGertrude S. Carter, MDChief Medical OfficerMotions for Consideration8. Contract with RR Donnelly (Moore Wallace) (BOG 100) p.156Contract with Michael S. Kenny & Co. to provide consulting services for the LosAngeles County Department of Health Services (BOG 101) p.1572016-17 Community Health Investment Fund (CHIF) priorities (BOG 102) p.158John BaackesAdvisory Committee Reports9.Executive Community Advisory CommitteeHilda Perez/Layla Gonzalez-DelgadoConsumer member and Advocate memberStanding Committee ReportsChairExecutive Committee10.Government Affairs Update10/31/2016 7:57 AMCherie CompartoreSenior Director, Government Affairs3
Board of Governors Meeting AgendaNovember 3, 2016Page 2 of 2Finance & Budget CommitteeMichael Rembis11.Financial UpdateMarie MontgomeryChief Financial Officer12.Monthly Investment Transactions Report13.Information Technology Motions Cognizant Infosys Staff Augmentation (FIN 109) New Encounter Systems Project (FIN 110) p.229Marie Montgomeryp.180p.228John BaackesTom SchwaningerADJOURN TO CLOSED SESSION (Estimated time: 40 minutes)14.CONTRACT RATESPursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Rates Provider Rates DHCS Rates15.REPORT INVOLVING TRADE SECRETPursuant to Welfare and Institutions Code Section 14087.38(n)Discussion Concerning New Product LinesEstimated date of public disclosure: November 201816.CONFERENCE WITH LEGAL COUNSEL—ANTICIPATED LITIGATIONSignificant exposure to litigation pursuant Section 54956.9(d)(2) of Ralph M. Brown Act: (3)17.CONFERENCE WITH LABOR NEGOTIATORPursuant to Section 54957 of the Ralph M. Brown ActAgency Negotiator: John BaackesUnrepresented Employees: L.A. Care EmployeesChairRECONVENE IN OPEN SESSIONChairAdjournmentThe next meeting will be on Thursday, December 1, 2016 at 2 pmAt L.A. Care Health Plan, 10th Floor, 1055 W. 7th Street, Los Angeles, CA 90017Please keep public comments to three minutes or less.The order of items appearing on the agenda may change during the meeting.If a teleconference location is listed at the top of this agenda, the public can participate in the meeting at that location.Teleconference arrangements listed at the top of this Agenda may change prior to the meeting. L.A. Care may make the teleconference number available to the public. If youwish to listen to the meeting by telephone, you can confirm details with L.A. Care Board Services staff prior to the meeting by calling (213) 694-1250, extension 4183 or 4184.THE PUBLIC MAY ADDRESS THE BOARD OF GOVERNORS ON ALL MATTERS LISTED ON THE AGENDA BY FILLING OUT A “REQUEST TO ADDRESS” FORM AND SUBMITTINGTHE FORM TO L.A. CARE STAFF PRESENT AT THE MEETING BEFORE THE AGENDA ITEM IS ANNOUNCED. YOUR NAME WILL BE CALLED WHEN THE ITEM YOU AREADDRESSING IS DISCUSSED. THE PUBLIC MAY ALSO ADDRESS THE BOARD ON L.A. CARE MATTERS DURING PUBLIC COMMENT. AN AUDIO RECORDING OF THEMEETING IS MADE TO ASSIST IN WRITING THE MINUTES AND IS RETAINED FOR 30 DAYS.NOTE: THE BOARD OF GOVERNORS CURRENTLY MEETS ON THE FIRST THURSDAY OF MOST MONTHS AT 2:00 P.M. POSTED AGENDA and PRINTED MEETING MATERIALSARE AVAILABLE FOR INSPECTION AT Board Services, 1055 W. 7th Street – 10th Floor, Los Angeles, California 90017.Any documents distributed to a majority of the Board Members regarding any agenda item for an open session after the agenda has been posted will be available for publicinspection 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 thismeeting and wish to request an alternative format for the agenda, meeting notice, and meeting packet may contact L.A. Care’s Board Services Department at (213) 694-1250. Notification at least one week before themeeting will enable us to make reasonable arrangements to ensure accessibility to the meetings and to the related materials.10/31/2016 7:57 AM4
New Board MembersAl BallesterosAl Ballesteros is the President & Chief Executive Officer of JWCH Institute, Inc. a Los Angelesbased non-profit, Federally Qualified Community Health Center. Al Ballesteros is also aCommissioner and past Co-Chair of the Los Angeles County Commission on HIV, appointed bythe LA County Board of Supervisors. Other current community work includes: Member of theBoard of Directors, International Gay and Lesbian Human Rights Commission; Member of theBoard of Directors, Community Clinic Association of Los Angeles County; Founder and Publisherof Adelante Magazine, a Latino Gay and Lesbian Monthly Publication produced and distributed inCalifornia.Layla DelgadoThe following statement was included in the member election materials in July:I have worked for the Personal Assistance Services Council (PASC) for 13 years helping seniors andpersons with a disability of low-income of varying degrees throughout the years. Currently, my mainfocus is to recruit more homecare providers so as to ensure the growth of the registry. I am also partof an Issue Solving Team that troubleshoots and submits claims to the In-Home SupportiveServices offices in order to assist both consumers and homecare workers with their payroll issues.Working at Personal Assistance Services Council (PASC), I have become familiar with L.A. Care, asit is the HMO for qualified homecare workers of the IHSS program. PASC, in conjunction withSEIU, worked diligently in establishing healthcare coverage with the important concept that ahealthy homecare provider is essential to the quality of care our IHSS recipients receive. Healthyhomecare workers happy consumers.Throughout the years, I have come to learn various aspects of the In-Home Supportive Servicesprogram and have become familiar with the creation and implementation of the Coordinated CareInitiative (CCI) that California has implemented. The CCI program is one of the many products thatL.A. Care provides. L.A. Care provides services to a growing and diverse population that includesome of Los Angeles' most vulnerable residents. Every human being should be able to have accessto quality health care regardless of their income level. L.A. Care is a big part of that picture. L.A.Care receives funding through the State of California and must comply with various regulations. Myhope is to be able to make sure that the healthcare needs of L.A. care members would not becompromised due to state limitations while still adhering to budget constraints.Stephanie Booth, MDDr. Stephanie Booth is an American Board of Pediatrics certified pediatrician who currently worksas a locum tenens physician, covering for other pediatricians when they are away from their offices.She is involved with professional organizations including the American Academy of Pediatrics andthe California Medical Association. She is a member of the Board of Directors of the Los AngelesCounty Medical Association (LACMA). She serves as the President of District #3; the Chair of theWomen Physicians’ Action Committee and participates as an active member of other LACMAcommittees.5
Board of GovernorsMeeting Minutes #257 – September 1, 2016The California Endowment, 1000 N. Alameda Street, Los Angeles, CA 90012MembersMark Gamble, ChairLouise McCarthy, Vice ChairMichael Rembis, TreasurerAlexander Li, MD, SecretaryHector De La TorreJann Hamilton LeeThomas Horowitz, DOOzzie Lopez, MPA*Hilda PerezG. Michael Roybal, MD, MPHHonorable Hilda Solis *Sheryl SpillerKimberly Uyeda, MD, MPHManagement/StaffJohn Baackes, Chief Executive OfficerPhinney Ahn, Chief of StaffHenry Charoen, Executive Director, Medi-Cal Plan PartnersMaribel Ferrer, Executive Director, Medicaid Coverage Expansion & TANFLinda Greenfeld, Executive Director for Commercial ProductsAugustavia Haydel, General CounselDino Kasdagly, Chief Operating OfficerMarie Montgomery, Chief Financial OfficerNoah Paley, Chief of Enterprise IntegrationBruce Pollack, Executive Director, Medi-Cal, SPD & CCIGarrison Rios, Executive Director. Cal MediConnect*Absent **Via teleconferenceAGENDAITEM/PRESENTERMOTIONS / MAJOR DISCUSSIONSWELCOMEMark Gamble, Chair, called the meeting to order at 8:55 a.m.Mark GambleHe welcomed attendees to the meeting. He announced that the public may address the Board onany matter at the Public Comment section of the meeting or on specific agenda items before orduring the Board’s discussion of those items. The public is welcome to sign the guest book at theentrance but should not feel compelled to do so. He welcomed members of the advisorycommittees and announced that members will be introduced later in the meeting.ACTION TAKENHe announced that the Board is glad to have people speak at the meeting. There are no Boardmembers calling in to the meeting so there is no teleconference. He announced that there is onePublic Comment section at the beginning of the meeting; there will not be one at the end of themeeting.APPROVAL OFMEETING AGENDAThe meeting agenda was approved as submitted.DRAFTApprovedunanimously. 8 AYES(De La Torre, Gamble,6
AGENDAITEM/PRESENTERMark GambleMOTIONS / MAJOR DISCUSSIONSPUBLIC COMMENTThere was no public comment at this section of the meeting, please see page 8.Framing the Issues andIntroduction of SpeakersJohn Baackes, Chief Executive Officer, informed Board members that two guest speakers willaddress the meeting, which will be followed by a roundtable discussion about the future ofhealth care, particularly in the aftermath of the implementation of the Affordable Care Act. Inthe afternoon, the Board will have a business meeting, followed by an update on the strategicvision announced at the retreat in 2015.John BaackesACTION TAKENHamilton Lee,Horowitz, Rembis,Roybal, Spiller, andUyeda).(Members Perez and McCarthy joined the meeting.)Mr. Baackes introduced Diana Dooley, the Secretary of California Health and Human Servicessince 2011. She has held other positions which demonstrate her commitment to the communityL.A. Care serves. Ms. Dooley attended an L.A. Care board meeting several years ago, andagreed to attend today following a meeting where Mr. Baackes discussed L.A. Care’s initiativesand the provider improvement project.Guest Speaker – WhereDo We Go From Here?Diana DooleyMs. Dooley noted that she receives many invitations and it is difficult for her to take time awayfrom her work. She came to this meeting to learn from Board members. She reviewed therecent significant changes in health care and her observations on opportunities. She asked theBoard to contribute thoughts on how to cement the progress that has been achieved and ideason further work to be done on health coverage in California.(Member Li joined the meeting.)The foundation for the Affordable Care Act (ACA) in California had been set when she tookoffice in 2011. Governor Schwarzenegger contributed to the initial steps taken to ensuresuccess during the initial work to implement the ACA. Unfortunately, the state budget deficitmeant that early planning was conditioned on the availability of funding to complete theimplementation. There was a diverse group of people committed to work together and to makehard decisions about how the health benefit exchange would operate in California. In someregions of the nation, the health benefit exchanges have seen an exodus of health plans, whichtakes away some of the choices for enrollees. California’s program, California Covered, has notseen that type of decline, because of robust competition among the health plans. Theestablishment of rate regions, requirements that plans meet qualifications to participate, andBoard of Governors MeetingSeptember 1, 2016, Page 2 of 27DRAFT7
AGENDAITEM/PRESENTERMOTIONS / MAJOR DISCUSSIONSrequired standard benefits that aligned with the private health insurance market, have ensured ahealthy competitive environment for health plans in Covered California and a good fit in theoverall health plan markets throughout the state. A commitment was made to invest heavily inmarketing to ensure a good mix of risk levels in the enrollment pool. California Covered has astructure that will survive. Open enrollment in 2016 will indicate the significance of consumerchoice. California’s program has seen an average 13% increase in premiums. Two health plansin Covered California were highest, with the other plans grouped much lower. Analysis hasshown that the market is working and adjustments are being made as consumers select a healthplan for 2017.ACTION TAKENThe quality of health care offered is important to Covered California. Increased transparency inthe market has exposed consumers to quality and cost aspects of health care, and consumers areselecting a plan that has a share of cost and benefit coverage that matches their need. Physicianshave informed her that they know very little about the cost of care. More transparency isneeded.California is looking at ways to change the financing incentives to create efficiencies and controlcost. She would like to use the power of government to set the policy framework and stay outof the way of the market. She mentioned that L.A. Care’s work with providers is an example oftransparency in quality. She noted that health plans and providers will be in conflict over costof care. She suggested that health plans will need to be an agent for the consumer for cost, andplans need to work with providers to gain the highest possible quality and best cost. She thinksthe structure of the ACA makes plans compete on quality and cost.There are dramatic changes in the market in Northern California, with mergers among hospitalsand medical groups. There are higher health care costs in Northern California because there arefewer providers.She offered that she would like to know what L.A. Care will need to continue the improvementin health coverage programs in Los Angeles County. She praised the work of L.A. County andL.A. Care in assuring that beneficiaries receive the care they need from providers in the publicsafety net. She hopes that Medi-Cal, Covered California and employer-sponsored insurance willone day be operating without barriers. She discussed the difficulties in getting to that idealbecause of the diverse pilot programs operating in California which dictate the structure ofpublic and private health coverage in individual counties. There are pilot programs that are veryirrational. She recommended that over the next 5-10 years California will look at transparent,rationalized and streamlined care models. She noted that public private partnerships areimportant; the public and private safety net providers work very well together. She hopes toBoard of Governors MeetingSeptember 1, 2016, Page 3 of 27DRAFT8
AGENDAITEM/PRESENTERMOTIONS / MAJOR DISCUSSIONSkeep progress going on health coverage in California. At one time California had 22%uninsured and now has only 9%.ACTION TAKENMr. Baackes thanked Secretary Dooley.Guest Speaker – Health3.0 and the CaliforniaSafety NetPeter Long, PhDMr. Baackes welcomed and introduced Peter Long, PhD, the Chief Executive Officer of BlueShield Foundation.Dr. Long will build on Ms. Dooley’s remarks and comment on the future. He presentedinformation about Blue Shi
I have worked for the Personal Assistance Services Council (PASC) for 13 years helping seniors and persons with a disability of low-income of varying degrees throughout the years. Currently, my main focus is to recruit more homecare providers so as to ensure th
