GONNA GO AHEAD AND GET STARTED --
WE'RE A CALL TO ORDER THE JOINT
OVERSIGHT HEARING OF THE
LEGISLATIVE AUDIT COMMITTEE THE
ASSEMBLY HEALTH COMMITTEE.
THIS AFTERNOON WE WILL DISCUSS
THE FINDINGS AND RECOMMENDATIONS
IDENTIFIED BY THE STATE AUDITOR
AND THE ON REPORT RELEASED IN
MARCH OF THIS YEAR TITLE
DEPARTMENT.
OF HEALTH CARE SERVICES MILLIONS
OF CHILDREN AND MEDICAL CARE
MEDI CAL.
ARE NOT RECEIVING PREVENTATIVE
HEALTH SERVICES WE WILL ALSO
DISCUSS THE DEPARTMENT OF HEALTH
CARE SERVICES PLANS. TO
ACTIONS THAT WOULD.
HELP CALIFORNIA'S CHILDREN
RECEIVE PREVENTATIVE HEALTH
SERVICES.
NEARLY HALF OF CALIFORNIA'S
CHILDREN ABOUT FIVE POINT FIVE
MILLION RECEIVE MEDICARE --
MEDIC MEDICAL CARE THROUGH
BETTER CAL UNFORTUNATELY I FOUND
THAT MILLIONS OF CHILDREN ROLLED
AND MEDICARE I'VE NOT RECEIVED
ALL REQUIRED PREVENTIVE HEALTH
SERVICES.
IN FACT CALIFORNIA RANKS
FORTIETH FOR ALL STATES A
PROVIDING PREVENTATIVE HEALTH
SERVICES TO CHILDREN COVERED BY
MEDICARE.
THESE PREVENTIVE HEALTH SERVICES
INCLUDING DEVELOPMENTAL HEALTH
SCREENINGS IMMUNIZATIONS.
AND LEAD RISK ASSESSMENT ARE
DESIGNED TO ENSURE THAT CHILDREN
RECEIVE EARLY DETECTION AND CARE
SO THAT HEALTH.
PROBLEMS ARE VERDADE OR
DIAGNOSED AND TREATED AS EARLY
AS POSSIBLE. ONE KEY REASON THAT
CHILDREN DO NOT RECEIVE
PREVENTIVE SERVICES IS THAT IN
MANY PARTS OF THE STATE.
ACCESS TO PROVIDERS WHO TREAT
CHILDREN IN MEDI CAL IS LIMITED.
ANOTHER BARRIER TO CHILDREN
RECEIVING PREVENTED OF HEALTH
CARE SERVICES AND HEALTH CARE
SERVICES.
AND ADEQUATE OVERSIGHT OF THE
MANAGED CARE PLANS THROUGH WHICH
90% OF THE CHILDREN AND MEDICARE
OUR WORLD.
CALIFORNIA'S HEALTH SYSTEM IS
FACING A CRISIS WITH MILLIONS OF
CALIFORNIA'S LARGEST THOSE.
WITH MEDI CAL STRUGGLING TO
ACCESS CARE THAT THEY NEED.
A RECENT REPORT BY THE
CALIFORNIA FUTURE HEALTH
WORKFORCE COMMISSION HIGHLIGHTED
A KEY PROBLEM.
WORKFORCE SHORTAGES CALIFORNIANS
I HAVE ENOUGH OF THE RIGHT TYPES
OF HEALTH WORKERS IN THE RIGHT
PLACES TO MEET THE NEEDS OF THE
GROWING AGING.
AND INCREASINGLY DIVERSE
POPULATION.
MANY COUNTIES PARTICULARLY THOSE
IN THE RURAL PARTS OF THE STATE.
INCLUDING THE SAN JOAQUIN VALLEY
ARE EXPERIENCING SHORTFALLS OF
PRIMARY CARE.
DENTAL CARE AND MENTAL HEALTH
CARE PROVIDERS. FOR EXAMPLE THE
COUNCIL ON GRADUATE MEDICAL
EDUCATION RECOMMEND SIXTY TO
EIGHTY PRIMARY CARE PHYSICIANS
PER.
ONE HUNDRED THOUSAND POPULATION
BUT THE STATEWIDE AVERAGES ONLY.
FIFTY THE AVERAGE NUMBER OF
PRIMARY CARE PHYSICIANS IS
SIGNIFICANTLY LOWER.
AND UNDERSERVED REGIONS LIKE THE
SAN JOAQUIN VALLEY AND THE
INLAND EMPIRE WE'RE THEIR ONLY
THIRTY NINE AND THIRTY FIVE
PRIMARY CARE PHYSICIANS PER ONE
HUNDRED THOUSAND POPULATION.
THE CALIFORNIA FUTURE HEALTH
WORKFORCE COMMISSION CONCLUDED
THAT SEVERAL KEY VALUES LONG
STANDING HEALTH CARE
PROFESSIONAL SHORTAGES.
HAVE CONTRIBUTED SUBSTANTIALLY
TO ITS POOR HEALTH CARE.
IN FACT ACCORDING TO A TWENTY
FOURTEEN TWENTY FOURTEEN STUDY
RANKING HEALTH OUTCOMES IN
CALIFORNIA ALL SIX SAN JOAQUIN
VALLEY COUNTIES.
RANKED IN THE BOTTOM THIRD OF
THE STATE.
WE KNOW THAT THESE NUMBERS ARE
EXACERBATED DEPENDING ON THE
STUDY THAT YOU LOOK AT I BELIEVE
YOU CASF HAS A STUDY OUT THERE.
WERE THESE NUMBERS EVEN SHOW
GREATER DISPARITIES.
AS WE KNOW THIS IS NOT A PROBLEM
THAT ONLY AFFECTS RULE AREAS IN
THE SAN JOAQUIN VALLEY BUT THIS
IS A STATE WIDE PROBLEM.
I KNOW ONE OF THE GOVERNOR'S
FOLKS IS ENSURING THAT ALL
CHILDREN HAVE AFFORDABLE ACCESS
TO QUALITY HEALTHCARE.
PARTICULARLY THOSE THAT ARE
ENROLLED IN MEDICARE.
THE LEGISLATURE ALSO ALSO SHARES
THE GOVERNOR'S NAME. FOR TODAY I
LOOK FORWARD TO A PRODUCTIVE AND
ROBUST DISCUSSION REGARDING THE
AUTO REPORT AND WHAT THE
DEPARTMENT IS DOING TO IMPROVE
ACCESS TO CARE.
AND MOUNT ALSO INTERESTED TO
HEAR FROM THE STAKEHOLDERS ON
THE REACTION TO THE AUDIT AND
ANY PROPOSALS THEY MAY HAVE. TO
ADDRESS THE ISSUES RAISED I AM
PLEASED -- TO MAKE NOTE THAT THE
GOVERNOR'S.
INITIAL BUDGET.
DID SHOW THAT PROPOSITION SIXTY
FIVE DOLLARS WILL BE -- MOVE
TOWARDS A SANTA NINE OO MEMBERS
OF THE LEGISLATURE AS WE BEGIN
THAT BUDGET DELIBERATIONS. FOR
LOOKING AT SAYING HOW WE CAN
IMPROVE THESE ACCESS OUTCOMES
WITH THAT -- I'LL TURN THIS OVER.
TO THE CHAIR OF THE HEALTH
COMMITTEE.
ASSEMBLYMEMBER WHAT.
GREAT WELL THANK YOU VERY MUCH
ASSEMBLY MEMBER SALAS -- I WILL
REPEAT A LOT OF WHAT HE SAID --
BUT I WHAT I DO WANT TO SAY THIS
WHEN I REQUESTED THE THIS AUDIT
LAST YEAR ONE UNDERSTAND HOW
WELL.
THE PROGRAM IS FULFILLING ITS
MANDATE TO ENSURE THAT CHILDREN
AND ROLLED MEDI CAL RECEIVE
TIMELY ACCESS TO CARE AND
PREVENTIVE CARE SERVICES FOR
WHICH THERE ELIGIBLE UNDER THE
EARLY AND PERIODIC SCREENING
DIAGNOSIS AND TREATMENT PROGRAM --
WE WILL HEAR TODAY THE FINDINGS
AND RECOMMENDATIONS OF THAT
AUDITHAVE A FULL AGENDA WE'VE
GOT MUCH TO HEAR AND I LOOK
FORWARD TO THE TESTIMONY.
THAT I THINK WILL BRING UP OUR
FIRST PANEL YES.
SO THANK YOU LOOKS GOOD AND
BEGIN WITH THE AGENDA ITEM
NUMBER TWO OVERVIEW OF FINDINGS
AND RECOMMENDATIONS OF THE
CALIFORNIA STATE AUDITOR WITH US --
WE HAVE OUR STATE AUDITOR ELAINE
HOW.
AND I BELIEVE SHE IS COMPANY BY
MR JOSH -- HOOPER I DON'T
SUPERVISOR WITH CALIFORNIA SEA
OTTER.
SO PLEASE BEGIN WHEN YOU'RE
READY THANK YOU.
THANK YOU MISTER CAIR --
CHAIRMAN WOULD CHAIRMAN SALAS
FOR THE RECORD MY NAME TO LINE
HOW ON THE CALIFORNIA STATE
AUDITOR THE SERGEANTS HANDING
OUT.
A DOCUMENT THAT'LL BE REFERRING
TO WHEN I GO THROUGH MY COMMENTS
MISTER HOOPER WILL BE -- GOING
OVER THE LEGISLATIVE AND RECORD
THE RECOMMENDATIONS WE MADE TO
THE DEPARTMENT OF HEALTH CARE
SERVICES I'LL GO THROUGH THE KEY
ISSUES -- AT A FAIRLY HIGH LEVEL
OF OF THE VARIETY OF CONCERNS WE
IDENTIFIED IN THE REPORT AND
THEN WILL STEP THROUGH THE
SPECIFIC RECOMMENDATIONS SO.
AS YOU MENTIONED MISTER CHAIRMAN
NEARLY HALF OF CALIFORNIA'S
CHILDREN.
RECEIVE MEDICAL SERVICES THROUGH
MEDI CAL -- IN 90% OF THOSE
CHILDREN RECEIVE IT THROUGH
MANAGED CARE PLANS AND THAT WAS%
REALLY THE FOCUS OF THIS
PARTICULAR AUDIT REPORT AND
REQUEST BY BY MISTER WOOD.
AS YOU ALSO MENTIONED IN YOUR
COMMENT UTILIZATION RATES IN
CALIFORNIA RANKING RELATIVELY
LOW ACROSS THE COUNTRY WHERE WE
RANK FORTY S. ACCORDING TO A
STUDY THAT WAS DONE BACK IN.
TWO THOUSAND SEVENTEEN
UTILIZATION RATES OVER THE FIVE
YEAR WINDOW THAT WE LOOKED AT
WAS WHICH WAS FISCAL YEAR.
TWELVE THIRTEEN THROUGH
SEVENTEEN EIGHTEEN IT RANGED
BETWEEN FORTY EIGHT AND 50% SO
STILL A LOW PERCENTAGE --
UTILIZATION RATE FOR CALIFORNIA
CHILDREN -- WHAT THAT EQUATES TO
FOR CHILDREN WHO ARE IN MEDI CAL
IS ON AVERAGE THERE ARE TWO
POINT FOUR MILLION CHILDREN AT
ANY PARTICULAR YEAR LOSS FIVE
YEARS THAT WE LOOKED AT?
COR NOT RECEIVING ALL PREVENTIVE
SERVICES SOME OF THOSE CHILDREN
MAY NOT BE RECEIVING ANY
SERVICES SOME OF THOSE CHILDREN
MAY READ BE RECEIVING SOME
SERVICES BUT CERTAINLY NOT THE
FULL BREADTH.
OF SERVICES ARE PREVENTIVE
SERVICES THAT ARE BENEFICIAL TO
CHILDREN -- AS YOU.
IF YOU COULD TURN TO PAGE TWO ON
THE HAND OUT WE HAVE A MAP THAT
IS SHOWN IN THE AUDIT REPORT WE
WE HAVE JUST A FEW GRAPHICS THAT
ARE EXCERPTS FROM THE PORCH WHAT
THIS GRAPH SHOWS YOUR THIS
PICTURE OF THE STATE OF
CALIFORNIA.
IS THE UTILIZATION RATES BY
COUNTY AND AS YOU CAN SEE.
EASTERN A CALIFORNIA RURAL
COUNTIES REALLY HAVE A MUCH
LOWER UTILIZATION RATE -- THEN
COUNTIES AND MORE URBAN AREAS
COASTAL AREAS IT'S CENTER BUT
STILL THERE ARE SIGNIFICANT --
ISSUES WITH RESPECT UTILIZATION
THROUGHOUT THE STATE OF
CALIFORNIA.
SO WHY IS THAT WE WERE LOOKING
TO DETERMINE ACCESS TO CARE SO A
COUPLE OF THINGS THAT WE LOOKED
AT WITH RESPECT -- TO
ACCESSIBILITY AND TWENTY
EIGHTEEN THE STATE OF CALIFORNIA
AFTER GUIDANCE CAME OUT FROM THE
FEDERAL GOVERNMENT ESTABLISHED
TIME AND DISTANCE STANDARDS
SPECIFIC STANDARDS THAT A
MANAGED CARE PLANS ARE NETWORKS
ARE SUPPOSED.
TO MEET THAT ARE SHOWN ON PAGE
THREE OF YOUR HAND OUT IT'S A
TABLE THAT THAT BASICALLY LAYS
OUT FOR PRIMARY CARE IT USUALLY
WITHIN TEN MILES OR THIRTY
MINUTES. FOR A A BENEFICIARY
HAVE TO TRAVEL TO GET CARE.
THROUGH MANTA THROUGH A MANAGED
CARE PLAN OR A NETWORK -- WHAT
WE FOUND IS THAT CERTAINLY
DEPARTMENT HEALTH CARE SERVICES
PUT THAT THE THE THOSE --
STANDARDS OUT THERE FOR
PROVIDERS TO TO TRY TO MEET --
BUT THERE WAS ALSO STATE LAW
THAT ALLOWED PROVIDERS MANAGED
CARE PLANS EXCUSE ME TO SEEK
EXCEPTIONS TO THAT PARTICULAR
STANDARD.
ARMS AND AND WHAT WE SAW AND I
THINK HEALTH CARE SERVICES WOULD
WOULD.
TESTIFY TO THEY WERE QUITE
SURPRISED BECAUSE THEY GOT A
SIGNIFICANT NUMBER OF REQUEST
FOR EXCEPTIONS IT WAS UPWARDS OF
EIGHTY THOUSAND MANY OF THOSE
WERE IN COMPLETE SO THEY THEY
WEREN'T REALLY EVEN CONSIDERED.
BUT DEPARTMENT OF CARE SERVICES
APPROVED NEARLY TEN THOUSAND OF
THESE EXCEPTIONS THAT PLANS
ASKED.
FOR AS FAR AS WE CAN'T MEET THAT
PARTICULAR STANDARD WE HAVE AN
ALTERNATIVE ACCESS STANDARD THAT
WE WOULD LIKE THE DEPARTMENT TO
APPROVE -- AND OF THOSE TEN
THOUSAND THE DEPARTMENT APPROVED
ABOUT.
SIXTY EIGHT HUNDRED WITH RESPECT
TO PROVIDERS WHO ARE PROVIDING
SERVICES FOR CHILDREN SO YOU'RE
YOU'RE LOOKING AT ALTERNATIVE
ACCESS STANDARDS THAT DON'T
NECESSARILY MEET.
THE ONES THAT WERE ESTABLISHED
IN TWENTY EIGHTEEN CERTAINLY A
PROCESS THAT THAT WAS YOU KNOW
AUTHORIZED IN LAW BUT THERE WAS
A SIGNIFICANT NUMBER OF THOSE
ACCESS STANDARDS THAT. FOR WHICH
THERE ARE EXCEPTIONS NOW THE
CONCERN WE IDENTIFIED IN THE
REPORT -- IS THAT SOME OF THESE.
ALTERNATIVE STANDARDS WERE VERY
EXTREME AN EXCESSIVE OFF FOR
PARTICULAR TYPES OF SPECIALTIES
OR EVEN FOR PRIMARY CARE WHERE
BENEFICIARIES WOULD BE EXPECTED
TO TRAVEL HUNDREDS OF MILES --
POTENTIALLY HOURS JUST TO GET TO
A PARTICULAR -- PROVIDER TO GET
CARE FOR THEIR CHILDREN AND SO
DEPARTMENT OF HEALTH CARE
SERVICES WAS REALLY FOCUSING ON
DID THE PLAN.
DO ITS DUE DILIGENCE IN TRYING
TO FIND PROVIDERS THAT COULD --
PROVIDE SERVICES TO THESE
CHILDREN WITHIN THE EGG THE THE
TYPICAL STANDARDS THAT THAT --
THIRTY MINUTES TEN MILES IF THEY
COULDN'T DO THAT THEN DID THEY
PUT TOGETHER -- A PROPOSAL THAT
SEEMED REASONABLE -- THAT MET
THE REQUIREMENTS BUT AND I
CORRECT MYSELF THE
REASONABLENESS SO THEY WEREN'T
REALLY LOOKING TO SEE OKAY THEY
PROPOSED AN ALTERNATIVE STANDARD
THAT.
WE HAVE TO DRIVE THREE HUNDRED
FIFTY MILES TO TAKE MY CHILD TO
A PARTICULAR SPECIALIST IS THAT
REASONABLE THAT THAT WASN'T
REALLY THE FOCUS OF THE
DEPARTMENT HEALTH CARE SERVICES.
DECISION MAKING WHEN APPROVING
SOME OF THESE ALTERNATIVE
STANDARDS SO EVEN THOUGH THEY
WERE PROVED AGAIN AND AND
BENEFICIARY WHO'S IN MEDI CAL.
GETTING SERVICES FROM PROVIDERS
ARE TYPICALLY LOW INCOME
FAMILIES THEY DON'T HAVE THE
ABILITY TO DRIVE THREE HUNDRED
MILES OR THEY MAY HAVE MAY NOT
HAVE THE CAPABILITY TO DO THAT.
SO UNFORTUNATELY MANY OF THOSE
CHILDREN ARE NOT GETTING ACCESS
TO PREVENTIVE SERVICES THAT THEY
NEED -- THE OTHER THE OTHER
ISSUE WE HAD WITH RESPECT TO
THIS IS THERE ARE CERTAIN
CIRCUMSTANCES WHERE.
A PLAN WOULD BE REQUIRED TO
ALLOW THAT BEEN IF YOU SHARE IN
THAT CHILD TO SEEK.
CARE FROM A PROVIDER WHO'S OUT
OF PLAN SO MAY NOT BE IN THE
NETWORK BUT MAYBE MUCH CLOSER
THAN WHAT THAT ALTERNATIVE
STANDARD IS SUGGESTING MUCH
CLOSER THAN THE THREE HUNDRED
MILES.
THERE ARE CIRCUMSTANCES WHERE --
THE PLAN SHOULD BE ABLE TO AND
SHOULD.
NOTIFY THOSE BENEFICIARIES WE
DON'T HAVE A PROVIDER IN OUR
NETWORK BUT WE HAVE ONE CLOSE BY
WHERE YOU CAN TAKE YOUR CHILD.
AND AND DEPARTMENT HEALTH CARE
SERVICES WAS NOT ENSURING THAT
THE PLANS WERE NOTIFYING AND
LETTING THOSE BENEFICIARIES KNOW
THAT YOU DO HAVE OPTIONS.
RATHER THAN DRIVING THREADED
MILES YOU CAN GET CARE -- CLOSER
BY.
NOW SOME OF THE OTHER ISSUES
THAT WE LOOKED AT WITH RESPECT
TO ACCESS TO CARE AND AND MISTER
SALAS TALKED ABOUT IT A LITTLE
BIT IN HIS OPENING COMMENTS IS
THE SUPPLIER PROVIDERS.
WHY DON'T WE HAVE AS A STATE OF
CALIFORNIA HAVE MORE PROVIDERS --
WILLING TO PARTICIPATE IN MEDI
CAL -- IN PART OF THE CONCERN NO
SURPRISE TO MEMBERS A
LEGISLATURE THE REIMBURSEMENT
RATES IN CALIFORNIA ARE QUITE
LOW SOME OF THE LOWEST IN THE
COUNTRY -- THERE ARE ONLY
ACCORDING TO A STUDY DONE BY
KAISER BACK IN TWENTY SEVENTEEN
THERE WERE ONLY TWO OTHER STATES
THAT HAVE LOWER REIMBURSEMENT
RATES.
THAN THE STATE OF CALIFORNIA.
NOW WE HAVE TO SAY THE
DEPARTMENT HEALTH CARE SERVICES
IS TRYING -- TO HAS DEVELOPED
THE RECRUITING PROGRAM AN
INCENTIVE PROGRAM TO TRY TO GET
PHYSICIANS.
AND PROVIDERS IN CALIFORNIA TO
PARTICIPATE IN -- THE MEDI CAL
SYSTEM BY PROVIDING SOME TUITION
RELIEF -- AND SO THAT'S A GOOD
THAT'S A GOOD STEP FORWARD THEY
ALSO BE AN AND TWENTY EIGHTEEN
USING PROP FIFTY SIX MONEY TO
BACK OF TAX MONEY. TO ALSO
PROVIDE ADDITIONAL FUNDING FOR
PROVIDERS THE CONCERN WE HAVE
WITH THE PROP FIFTY SIX IT'S A
GREAT STEP IT'S A GREAT OPTION.
BUT THAT FUNDING STREAM IS NOT
NECESSARILY A STABLE CONSISTENT
RELIABLE FUNDING STREAM SO SOME
PROVIDERS MAY BE RELUCTANT. TO
PUT AGAIN PARTICIPATE IN MEDI
CAL BECAUSE THEY DON'T VIEW THAT
AS A A RELIABLE.
SOURCE OF FUNDING.
I'M ONE OF THE OTHER ISSUES THAT
WE WE DISCUSSED IN THE REPORT
SOME OTHER STATES USE PAY FOR
PERFORMANCE -- TO INCENTIVIZE
PROVIDERS -- TO PRO PROVIDE
ADDITIONAL SERVICES TO CHILDREN --
AND TO MEDI CAL BENEFICIARIES
THEY AREN'T NECESSARILY HOLDING
PLANS ACCOUNTABLE THIS IS THE
DEPARTMENT HEALTHCARE SERVICES
AGAIN.
WE HAVE TO PAY FOR PERFORMANCE
AND THE PLANS ARE UNDER
PERFORMING THEN WE'VE GOT TO
HOLD THEM ACCOUNTABLE TO THOSE
PARTICULAR EXPECTATIONS.
SO THAT FIRST SECTION OF THE
REPORT WE TALK ABOUT ACCESS TO
CARE UTILIZATION RATES -- THAT
THE NEXT STEP THAT WE LOOKED AT
IS OKAY WHAT KIND OF GUIDANCE
DOES DEPARTMENT HEALTH CARE
SERVICES PROVIDE WHAT TYPES OF
OVERSIGHT.
ACTIVITIES ARE THEY PERFORMING
TO MAKE SURE THAT MANAGED CARE
PLANS AND PROVIDERS ARE ACTUALLY
PROVIDING SERVICES TO CHILDREN
IN CALIFORNIA.
AND WHAT WE FOUND IS.
AND WE THANK THE DEPARTMENT
HEALTH CARE SERVICES COULD DO A
BETTER JOB OF MAKING CLEAR THE
EXPECTATIONS OF THE STATE OF
CALIFORNIA WITH RESPECT.
TO THE TYPES OF PREVENTIVE
SERVICES THAT CHILDREN SHOULD BE
RECEIVING THAT IT'S IT'S A
SCHEDULE CALL BRIGHT FUTURE
SCHEDULE WHICH LAYS OUT
IMMUNIZATION SCREENINGS OTHER
TYPES OF SERVICES PREVENTIVE
SERVICES THAT CHILDREN SHOULD BE
RECEIVING THAT PROVIDER SHOULD
BE.
OFFERING TO BENEFICIARIES -- AND
WHAT WE SAW AS A DEPARTMENT
HEALTH CARE SERVICES MAY HAVE
LAID OUT THOSE EXPECTATIONS BUT
THEY WEREN'T CLEAR.
NOT ONLY TO THEIR PLANS BUT ARE
NOT CLEAR TO THE PROVIDERS SO
THERE NEEDS TO BE A BETTER JOB
OF INFORMING BOTH PLANS AND
PROVIDERS AND WHAT IS EXPECTED --
WITH RESPECT TO SERVICES FOR
CHILDREN THROUGH THIS BRIGHT
FUTURES -- SCHEDULE.
IN ADDITION THERE IS A REPAIR
THE FEDERAL REQUIREMENT THAT THE
STATE HAS TO ANNUALLY AND FORM
FAMILIES OF CHILDREN WHO HAVEN'T
USED.
EARLY PERIODIC SCREENING -- E.
P. S. T. D. T. R. SCREENING
DIAGNOSTIC AND TREATMENT IF IF
THERE ARE BENEFICIARIES IN THE
MEDICAL SYSTEM THAT ARE NOT
AVAILING THEMSELVES OF THOSE
TYPES OF SERVICES THERE'S A
RESPONSIBILITY ON THE STATE. TO
INFORM FAMILIES THAT THESE
SERVICES ARE AVAILABLE TO YOU
AND THAT YOUR CHILDREN SHOULD BE
ABLE TO TO GAIN ACCESS TO THOSE
PARTICULAR SERVICES SO THE STATE
IS NOT DOING A GOOD JOB.
OF MAKING SURE THAT THAT IS
BEING COMMUNICATED TO
BENEFICIARIES WHEN WE TALK TO
THE DEPARTMENT THEY SAID WELL
WE'RE DEFERRING TO THE PLANS TO
INFORM THE BENEFICIARIES WELL WE
TALKED TO SOME OF THE PLANS
DURING THE COURSE OF THE AUDIT.
AND NONE OF THE PLANS THAT WE
SPOKE WITH ACTUALLY ARE DOING
THAT MAY CAN SURE THAT
BENEFICIARIES ARE AWARE.
OF THE SERVICES THAT ARE
AVAILABLE TO THEM.
NOW ONE THING WE DID FIND THAT
WE THINK IS -- INDICATIVE OF
AWAY THAT THE STATE OF
CALIFORNIA -- DEPARTMENT HEALTH
CARE SERVICES ARE THE STATE CAN
ACTUALLY INCREASE UTILIZATION
RATES ON PAGE FOUR OF THE HAND
OUT THERE IS A GRAPHIC THAT WE
HAD IN THE AUDIT REPORT.
THAT REALLY DEMONSTRATES AS YOU
CAN SEE AGES THREE THROUGH SIX
WHERE WE PUT A BOX AROUND THOSE
AGES.
THOSE ARE SPECIFIC AGE GROUPS
WHERE THE DEPARTMENT HEALTH CARE
SERVICES.
REALLY EXPECTS AND THEY HAVE
DEVELOPED PERFORMANCE METRICS
FOR MANAGED CARE PLANS TO MEET
AND TO REPORT ON SO WHEN THINGS
ARE BEING MEASURED ACTIVITY IS
IS HAPPENING.
SO YOU CAN SEE THE UTILIZATION
RATES FOR CHILDREN IN THOSE AGE
GROUPS ARE SIGNIFICANTLY HIGHER
THAN MOST OF THE OTHER AGE
GROUPS ACROSS THAT SCALE --
CERTAINLY THERE ARE SOME THERE
PARTICULARLY LOW AGE -- TO VERY
VERY LOW BUT BUT THE METRICS AND
IF YOU LOOK ON PAGE FIVE THIS IS
A TABLE THAT SHOWS.
THE VARIOUS TYPES OF SERVICES
THROUGH BRIGHT FUTURES I WAS
REFERRING TO AND YOU CAN SEE THE
COLUMN THAT HAS THREE TO SIX
YEARS.
THEY ARE CHECKING THEY HAVE
ESTABLISHED PERFORMANCE MEASURES
FOR THAT AGE GROUP FOR ALL OF
THESE DIFFERENT TYPES OF
SERVICES AND IN AND LOOKING BACK
ON THE ON THE GRAPH THE PRIOR
PAGE YOU CAN SEE THE UTILIZATION
RATES. FOR THOSE PARTICULAR
CHILDREN ARE MUCH MUCH HIGHER --
THAN ANY OF THE OTHER AGES --
ZERO THROUGH THROUGH.
TWENTY SO WHAT THAT DEMONSTRATES
IS IF YOU ESTABLISH THE METRICS
AND YOU HOLD PLANS ACCOUNTABLE
THEY AND PROVIDERS WILL PROVIDE
THOSE SERVICES FOR CHILDREN IN
CALIFORNIA.
WE ALSO LOOKED AT ANNUAL AUDITS
THAT THE DEPARTMENT HEALTH CARE
SERVICES CONDUCTS TO DETERMINE
WHETHER OR NOT PLANS ACTUALLY
HAVE THE UTILIZATION MANAGEMENT
PROGRAM -- MANY OF THE PLANS DO
BUT WHAT HEALTH CARE SERVICES IS
NOT INSURING.
IS THAT WHETHER OR NOT THESE
PLANS ARE TAKING THE ACTIONS
THAT HAVE BEEN IDENTIFIED SO
THEY HAVE A UTILIZATION
MANAGEMENT PLAN THEY WANT TO
INCREASE.
ACCESS TO CARE THEY WANT TO
INCREASE UTILIZATION HEALTH CARE
SERVICES IS NOT HOLDING THOSE
PLANS ACCOUNTABLE TO WHAT
SPECIFICALLY ARE YOU GOING TO DO
TO ADDRESS THE LOW UTILIZATION
RATES THAT YOU'RE PROVIDERS.
ARE YOUR DATA DEMONSTRATES.
IN ADDITION RELATED TO EARLY
PERIODIC SCREENING -- SERVICES
FOR CHILDREN D. D. H. U. S.
HEALTHCARE SERVICES JUST BEGAN
AUDITING AND LOOKING AT THOSE
TYPES OF SERVICES JUST LAST FALL
FALL OF TWENTY EIGHTEEN BUT
AGAIN WE LOOKED AT SOME OF THE
PROCEDURES THEY'RE REVIEWING A
VERY SMALL NUMBER OF THE SERVICE
IS NOT NECESSARILY LOOKING AT
ALL.
OF THEM AND LOOKING AT A VERY
SMALL NUMBER OF CHILDREN SO WE
THINK THEY NEED TO DO A BETTER
JOB -- IN CONDUCTING THAT WORK
AS WELL SO REALLY TRYING TO HOLD
PLANS ACCOUNTABLE TO TRY TO GET
THEM.
TO INCREASE PROVIDE SERVICES AN
INCREASE UTILIZATION RATES FOR
CHILDREN IN CALIFORNIA.
A COUPLE OF OTHER ISSUES RELATED
TO ACCESS AND PROVISION OF
SERVICES -- ANOTHER QUESTION
THAT MR WOOD HAD WAS RELATED TO
CULTURAL AND LINGUISTIC NEEDS SO
WHAT ARE THE PLANS DOING TO MAKE
SURE THAT BENEFICIARIES WHO
SPEAK A DIFFERENT LANGUAGE --
ARE FROM A DIFFERENT CULTURE
REALLY UNDERSTAND THE NATURE OF
BRIGHT FUTURES THE AVAILABILITY
OF SERVICES THE AND THE THE
ELIGIBILITY THAT THEIR CHILDREN
HAVE TO PROVIDE THESE TO RECEIVE
EXCUSE ME THESE VARIOUS TYPES OF
SCREENINGS IMMUNIZATIONS AT
CETERA.
AND EVEN THOUGH THE PLANS ARE
REQUIRED TO DEVELOP REPORT EVERY
FIVE YEARS AND LOOKING AT YOU
KNOW CULTURAL -- ISSUES AND
LANGUAGE ISSUES THEY ARE AGAIN
NOT ENSURING THAT THE PLANS ARE
TAKING ACT.
ACTION TO ADDRESS ANY OF THE
ISSUES THAT HAVE BEEN IDENTIFIED
AND WE HAVE SOME GRAPHICS IN THE
REPORT TO SHOW OF UP A DISTINCT
DIFFERENCE BETWEEN.
YOU KNOW CANTONESE SPEAKING
INDIVIDUALS AND RUSSIAN SPEAKERS
OR OR SO HISPANIC -- INDIVIDUAL
SPEAKING SPANISH IN CALIFORNIA
SO THEY HAVE THE DATA BUT THE
PLANS ARE REALLY NOT FOLLOWING
UP TO MAKE SURE THAT THEY'RE
DOING ANYTHING ABOUT.
THOSE PARTICULAR.
BENEFICIARIES WHO MAY HAVE A
LANGUAGE BARRIER AGAIN THEY'RE
RELYING ON THE PROVIDER -- TO
EITHER PROVIDE LANGUAGE SERVICES
OR THEY'RE EXPECTING THE
BENEFICIARIES TO ASK FOR A
TRANSLATION -- TRANSLATOR
SOMEONE TO ASSIST SO THERE AND
WHAT THE STATE IS NOT REALLY
BEING PROACTIVE IN MAKING SURE
THAT PLAN AND AND PROVIDERS ARE
ARE ADDRESSING THOSE THOSE
CULTURAL AND LINGUISTIC NEEDS.
THE LAST SECTION OF THE REPORT
TALKS ABOUT SOME INCENTIVES --
WE LOOKED AT SOME OTHER STATES
THAT ACTUALLY HAVE SOME
INCENTIVE PROGRAMS THAT WE
THOUGHT MIGHT BE BENEFICIAL TO
THE STATE OF CALIFORNIA WE THINK
THAT DEPARTMENT HEALTHCARE
SERVICES.
SHOULD LOOK AT SOME OF THOSE ONE
OF THOSE IS IS A STATE THAT
INCLUDES -- THE BRIGHT FUTURE
SCHEDULE AND SOME OF THE
PAMPHLETS OR THE INFORMATION
THAT'S PROVIDED TO BENEFICIARIES
SO THERE'S A VARIETY OF
DIFFERENT INCENTIVES THAT WE
THINK THE STATE OF CALIFORNIA
SHOULD LOOK AT I'M IN ADDITION
TO THAT THERE'S A REVIEWS THAT
ARE DONE BY AN EXTERNAL QUALITY
REVIEW.
TEAM IT'S A REQUIREMENT AND THEY
THEY LOOK AT ACCESS TO CARE THEY
LOOK AT QUALITY OF CARE WHAT WE
FOUND IS THOSE REVIEWS ARE BEING
DONE BUT AGAIN THE FOLLOW UP
ISN'T HAPPENING TO MAKE SURE
THAT.
ANY ISSUES THAT HAVE BEEN
IDENTIFIED IN THOSE REVIEWS ARE
BEING ADDRESSED AND HOPEFULLY
RESOLVED SO WE CAN GET THE
UTILIZATION RATES UP -- AND HAVE
CHILDREN GET ACCESS TO
PREVENTIVE CARE THAT THEY NEED.
SO THAT IS A KIND OF AA QUICK
OVERVIEW OF OF THE ISSUES THAT
WE IDENTIFIED IN THERE AND THE
AUDIT REPORT WHAT MISTER HOOPER
IS GOING TO DO IS THE FIRST PAGE
OF THE HANDOUT HE'S GONNA STEP
YOU THROUGH WE HAD SOME SPECIFIC
RECOMMENDATIONS THAT WE MADE TO
THE LEGISLATURE.
AND THEN SOMEBODY ADDITIONAL
RECOMMENDATIONS THAT WE MADE TO
THE DEPARTMENT HEALTHCARE
SERVICES.
THANK YOU MISS OUT [inaudible]
OKAY -- AS THE STATE AUDITOR
SAID WE IDENTIFIED SEVERAL
ISSUES IN THE REPORT -- AND WE
MADE RECOMMENDATIONS TO ADDRESS
THOSE ISSUES -- WE HAVE A
SUMMARY OF THOSE RECOMMENDATIONS
ON PAGE ONE OF THE HAND OUT.
WE MADE RECOMMENDATIONS TO BOTH
OF THE LEGISLATURE AND TO DH CS.
WE MADE TWO RECOMMENDATIONS TO
THE LEGISLATURE.
THE FIRST ADDRESSES THE ACCESS
ISSUE.
BY REQUIRING DH CS TO MODIFY THE
CRITERIA THAT IT USES FOR
APPROVING ITS ALTERNATIVE ACCESS
STANDARDS. TO CONSIDER THE
REASON ABILITY OF THOSE -- OF
THOSE ALTERNATIVE ACCESS
STANDARDS.
THEN IF A PLAN IS UNABLE TO MEET --
REASONABLE ACCESS STANDARDS. TO
REQUIRE THOSE PLANS TO ALLOW OUT
OF NETWORK ACCESS.
NOT ONLY THAT BUT THE A DH CS
SHOULD REQUIRE THOSE PLANS TO
INFORM THE MEMBERS THAT ARE
AFFECTED THAT THEY CAN ACCESS
THESE OUT OF NETWORK PROVIDERS.
AND IT SHOULD REQUIRE THE
PROVIDER OR THE PLANTS
THEMSELVES TO ASSIST MEMBER OUR
MEMBERS IN.
IN FINDING THOSE PROVIDERS.
OUR SECOND LEGISLATIVE
RECOMMENDATION ADDRESSES THE
REIMBURSEMENT RATES ISSUE.
BY HAVING BY DIRECTING DH CS
IMPLEMENT A PAY FOR PERFORMANCE
PROGRAM THAT SPECIFICALLY
TARGETS THE UTILIZATION
CHILDREN'S PREVENTIVE SERVICES.
TO THE EXTENT THAT.
DHS CAN DEMONSTRATE THAT THAT'S
GOING TO REQUIRE ADDITIONAL
FUNDING.
IT SHOULD I'D ASK THE
LEGISLATURE TO INCREASE FUNDING
SPECIFICALLY FOR THAT PURPOSE.
WE ALSO HAD RECOMMENDATIONS TO
THE DEPARTMENT OF HEALTH CARE
SERVICES.
OUR FIRST RECOMMENDATION IN THE
SUMMARIES -- TO I'D USE THE
TOOLS THAT DH CS ALREADY HAS
THIS WITH THE BY THE TIME WE
ACCESS STUDY.
AND THE THE DATA THAT IS
COLLECTED FROM THOSE ALTERNATIVE
ACCESS STANDARDS REQUESTS TO
IDENTIFY AREAS IN THE STATE.
WHERE IT SHOULD TARGET ITS
RECRUITING EFFORTS AND AS THE
STATE AUDITOR SAID?
DTS IS ALREADY WORKING USING
PROPS FIFTY SIX FUNDING OF FOR
SOME RECRUITMENT EFFORTS.
BUT THOSE RECRUITMENT EFFORTS
ARE.
NOT TARGETED TO CHILDREN'S
PREVENTIVE SERVICES -- AND THEY
AREN'T UTILIZING -- CONSISTENT
LONG TERM FUNDING SOURCE.
THE SECOND RECOMMENDATION TO
TAKE PART IN OF HEALTH CARE
SERVICES -- IS THAT IT SHOULD
UTILIZED -- PERFORMANCE MEASURES
FOR ALL AGE GROUPS AND NOT JUST
THOSE SPECIFIC AGE GROUPS THAT
WE SAW -- ON PAGE FOUR OF THE
HAND OUT THERE.
WE'VE SEEN THAT THE I
PERFORMANCE MEASURES WHAT YOU
MEASURE IS WHAT GETS IMPROVED
AND SO SINCE THERE IS A
SIGNIFICANT CORRELATION BETWEEN
INCREASED UTILIZATION AND THOSE
PERFORMANCE MEASURES WE
RECOMMENDED THAT DH CS IMPLEMENT
THOSE PERFORMANCE MEASURES. FOR
CHILDREN OF ALL AGES.
WE'VE ALSO RECOMMENDED THAT DH
CS SHOULD EXPANDED IT'S AUDIT
PROCEDURES IN ITS ANNUAL MEDICAL
AUDITS TO SPECIFICALLY TARGET
CHILDREN'S PREVENTIVE SERVICES
CONSISTENTLY AND FOR ALL
CHILDREN.
WE RECOMMENDED THAT THE
DEPARTMENT OF HEALTH CARE
SERVICES.
SHOULD UTILIZE THE PROVIDER
DIRECTORY SYSTEM.
WHICH CURRENTLY IT IT --
CURRENTLY IT'S VALIDATION
PROCESS FOR THOSE PROVIDER
DIRECTORIES IS LACKING.
DH CS WILL -- WILL APPROVE A AND
PLANTS PROVIDER DIRECTORY
[inaudible]
WITH -- A HIGH PERCENTAGE OF
ERRORS IN IT AND UTILIZING A LOW
CONFIDENCE RATE.
WE RECOMMENDED THAT IT INCREASE
THE CONFIDENCE INTERVAL.
MAINTAIN ITS -- MARGIN OF ERROR
AND INCREASE THE ACCURACY -- SO
THAT DH CS CAN.
ADDRESS ACCESS FOR THESE
FAMILIES.
IN A METHOD THAT DOESN'T REQUIRE
THE ADDITION OF A SINGLE NEW
PROVIDER.
WE'VE ALSO RECOMMENDED THE DH CS
WOULD REQUIRE PLANS TO TAKE
ACTION TO ADDRESS THE FINDINGS
IN ITS GROUP NEEDS ASSESSMENTS
THESE ARE THE THE END OF THE A
PERIODIC -- ASSESSMENTS THAT
PLANS TO TO ADDRESS CULTURAL AND
LINGUISTIC NEEDS -- WE KNOW THAT
THESE THESE REPORTS ARE BEING
CONDUCTED THE STUDIES ARE BEING
CONDUCTED BUT THE OUR
RECOMMENDATION IS FOR DHS TO
HOLD THE PLANS ACCOUNTABLE TO
ADDRESS WHAT IT'S FINDING IN
THOSE.
ASSESSMENTS.
THAT OUR LAST RECOMMENDATION ON
THE SUMMARIES FOR DH CS. TO
MONITOR AND IDENTIFY THE
INCENTIVE PROGRAMS THAT PLANTS
ARE DOING AT THE PLAN LEVEL. TO
IDENTIFY THOSE THAT ARE MOST
SUCCESSFUL AND THEN TO SHARE THE
RESULTS OF THOSE -- OF THOSE
PROGRAMS WITH ALL THE PLANTS.
SO THAT CONCLUDES MY TEST ON
WE'RE OPEN TO QUESTIONS AT THIS
TIME.
THANK YOU THANK YOU VERY MUCH I
APPRECIATE THE APPRECIATE THE
PRESENTATION AND APPRECIATE THE
WORK ON THE AUDIT -- SO I I DO
HAVE SOME SOME KIND OF BASIC
QUESTIONS SO -- BIGGEST IN YOUR
OPINION WAS YOU FEEL LIKE THE
ACS IS YOU KNOW.
LIVING UP TO THE STAND IT LIVING
UP TO THE ALTER OF ACCESS
STANDARDS AS THEY ARE OTHERS AS
THEIR PRESCRIBED.
WELL I I WITH RESPECT TO THE
ALTERNATE ACCESS STANDARDS THE
CONCERN THAT WE HAD IN THAT WE
RAISED IN THE REPORT IS.
THERE THEIR FOCUS WAS PRIMARILY
ON WHETHER OR NOT A PARTICULAR
PLAN DEMONSTRATED THAT THEY MADE
EFFORTS TO FIND PROVIDERS.
BUT THEN WHEN THEY APPROVE THE
ALTERNATIVE ACCESS STANDARD AS
WE SHOW IN THE REPORT SOME OF
THOSE ALTERNATIVE ACCESS
STANDARDS ARE REQUIRING
BENEFICIARIES AS I SAID TO
TRAVEL HUNDREDS OF MILES SO.
THERE NEEDS TO BE -- A DIFFERENT
FOCUS SO MAKE SURE THAT THE PLAN.
CONDUCTED EFFORTS ARE DID IS DUE
DILIGENCE IN TRYING TO IDENTIFY
A PROVIDER WITHIN ITS OWN
NETWORK.
BUT THEN REALLY LOOK AT THE
REASONABLENESS OF THE
ALTERNATIVE THAT THAT PARTICULAR
PLAN IS SUGGESTING.
KEEPING IN MIND WHO THEIR THEY
BENEFICIARIES ARE AND THEN MAKE
A DETERMINATION NO THAT'S NOT
THAT'S NOT A REASONABLE STANDARD
AS AN ALTERNATIVE WE WE YOU KNOW
WE KNOW YOU DID YOU DUE
DILIGENCE.
BUT YOU'VE COME UP WITH AN
ALTERNATIVE THAT STILL IS NOT
REASONABLE FOR BENEFICIARIES IN
CALIFORNIA THEREFORE -- PART OF
IT IS OUR RECOMMENDATION TO
ALLOW OUT OF PLAN BUT ALSO WE
DIDN'T REALLY SEE PLANS.
INFORMING BENEFICIARIES THAT YOU
KNOW IF THIS IS JUST TOO ARDUOUS
TO TAKE YOUR CHILD THREE HUNDRED
MILES FOR SERVICE THEN WE'RE
GOING TO ALLOW YOU TO GO TO WIN.
AN OUT OF PLAN PROVIDER SO -- IN
A NUT SHELL ANSWER YOUR QUESTION
IS I THINK DEPARTMENT HEALTH
CARE SERVICES NEEDS TO DO MORE
WITH RESPECT TO ALTERNATE ACCESS
STANDARDS AND NEEDS TO BE HAVE.
A MORE STRINGENT ANALYSIS OF
THOSE ALTERNATIVES THAT PLANS
ARE SUGGESTING.
SO YOU MENTIONED THAT THERE ARE
LIKE I BELIEVE SIXTY EIGHT
HUNDRED THAT WERE APPROVED.
HOW MANY OF THOSE WERE FOR
PRIMARY CARE?
TEAMS OF THE HEAD.
I DON'T HAVE I DON'T HAVE THE
NUMBER OF PRIMARY CARE BUT I
KNOW THAT THE 70% OF THE TEN
THOUSAND THAT WERE APPROVED FOR
SPECIFIC -- TO PROVIDERS FOR
CHILDREN -- SO SOME OF THOSE
WERE PRIMARY CARE AND SOME OF
THOSE WERE SPECIALISTS I CAN GET
YOU THOSE EXACT NUMBERS I GUESS
WHAT I'M I GUESS WHAT I'M
CONCERNED ABOUT IS THAT YOU KNOW
I I I KNOW THAT THERE ARE
PRIMARY CARE COMMUNITY.
PROVIDERS IN PRETTY MUCH EVERY
COMMUNITY OUT THERE.
SO IF IF THERE'S REQUEST FOR
PRIMARY CARE PROVIDERS FOR
PEOPLE HAVE TO GO LONG DISTANCES.
I KIND OF WANT TO KNOW HOW MUCH
OF THAT'S HAPPENING BECAUSE THAT
THAT ISN'T THAT IS AN
UNACCEPTABLE BURDEN I BELIEVE.
AND SO YOU KNOW IN THE IN THE
CASES YOU KNOW.
THE STATE YOU KNOW IF STATE LAW
PREVENT PER PERMITS
BENEFICIARIES TO GO OUT OF
NETWORK YOU KNOW.
COULD SHOULD THAT BE HAPPENING
SO THAT SOMEONE DOESN'T HAVE TO
TRUCK TRAVEL IN IN SOME CASES
MAYBE IS ONLY A HUNDRED FIFTY
MILES BUT UNDER FIFTY MILES IN
MY DISTRICT.
AS AN ADVENTURE RIGHT -- AND AND
THAT'S AND I THINK THAT'S ENOUGH
I THINK THAT'S AN ONEROUS BURDEN
ON ON PEOPLE.
ESPECIALLY PEOPLE WHO ARE --FOR
A QUALIFIED FOR THE SERVICES --
SO -- THERE SEEM TO BE -- QUITE
VARIATION IN THE NUMBER OF
ALTERNATIVE ACCESS STANDARDS BY
PLAN -- IT DO YOU HAVE ANY
THOUGHTS ON ON THAT YEAH WE
FOUND THAT THAT WHEN YOU TOOK
THE TOTAL POPULATION OF PRIMARY
CARE PHYSICIANS IN THE STATE.
AND AND YOU DIDN'T ISOLATE
DIDN'T HOLD PEOPLE SPECIFIC TO
ONE PLAN THAT THERE IS A GREATLY
INCREASED ACCESS SO ALLOWING
THIS OUT OF NETWORK ACCESS.
REALLY WILL MAKE A BIG
DIFFERENCE -- TO TO MEMBERS ALL
ACROSS THE STATE.
BUT IT'S NOT.
BEING REALLY UTILIZED.
THAT'S CORRECT THAT'S ONE OF THE
CONCERNS WE HAD IN THE REPORT
THAT THERE THAT IS AN OPTION BUT
IT'S NOT BEING SHARED WITH THE
BENEFICIARIES THEY AREN'T BEING
INFORMED OF ALL OF THEIR OPTIONS
WITH RESPECT.
TO GETTING ACCESS TO CARE FOR
THEIR CHILDREN AND THEN ALSO
DOCTOR WOULD WE WE HAD AS YOU
KNOW WHAT TABLE IN THE REPORT
WHERE WE WERE LOOKING AT
UTILIZATION RATES AND SO THOSE
PARTICULAR PLANS THAT HAD VERY
LOW UTILIZATION RATES FOR
CHILDREN.
GETTING PREVENTIVE CARE ARE THE
ONES WHO ARE GETTING THE HIGH
NUMBER OF ALTERNATIVE ACCESS
STANDARDS APPROVED SO THEIR
UTILIZATION RATES ARE ALREADY
LOW AND NOW YOU'RE EXPECTING A
BENEFICIARY. TO TRAVEL YOU KNOW
POTENTIALLY HUNDREDSOF MILES TO
GET ACCESS TO THAT CARE WHEN.
THEY'RE THERE MAY VERY WELL BE A
PROVIDER WHO'S OUT OF NETWORK
RELATIVELY CLOSE FOR THAT
BENEFICIARY.
WAS THERE ANY COMMON TO COULD
YOU DETECTIVES ARE A COMMON
DENOMINATOR IN THOSE REALLY LOW
PERFORMING [inaudible]
IN THE YEAH I'M SORRY IN THE LOW
PERFORMING PLANTS YEAH EXACTLY
IS THERE A COMMON DENOMINATOR
THERE.
WE DID SEE THAT IT WAS MORE
COMMON -- IN THE EASTERN PARTS
OF THE STATE AND IN RURAL PARTS
OF THE STATE -- EVERY EVERY PLAN
IN EVERY GEOGRAPHY ESPECIALLY
CALIFORNIA'S DIFFERENT -- BUT WE
DID SEE SOME COMMONALITIES IS
ESPECIALLY THAT HAD TO DO WITH
THEM.
URBAN VERSUS RURAL AND YOU KNOW
WESTERN VERSUS EASTERN.
AND THE NORTHERN.
A PART OF THE STATE ALSO SHOWED
SOME -- SOME STRUGGLING TO MEET
THE ACCESS STANDARDS
[inaudible]
SO -- AS YOU STARTED DOING YOUR
AUDIT DID DID DCS SEEM A
SURPRISED BY YOUR WEB BY WHAT
YOUR QUESTION IN OF YOUR
FINDINGS OR WAS IT WAS.
NOT AT ALL I THINK DHS IS VERY
AWARE -- BUT THE MAGNITUDE OF
THE ACCESS ISSUE IN THE STATE --
DATE BUT AS THE STATE AUDITOR
SAID THERE IS A LOT MORE THAT
THEY COULD BE DOING.
SO THEY'RE AWARE OF IT BUT THERE
WASN'T THEY'RE NOT REALLY
PUSHING THE PLANS ARE NOT
PUSHING FOR AND ANYTHING TO
HAPPEN IT'S BUT THAT'S THEIR
AWARE OF IT AND THERE'S THERE'S
MORE THAT THEY COULD DO.
THAT'S CORRECT YEAH.
RIGHT AND AND MISTER WHAT I
THINK WHAT WE WITH THE SCENE IN
THE REPORT IS THE DEPARTMENT OF
HEALTH CARE SERVICES HAVE REALLY
DELEGATED A LOT OF THEIR
RESPONSIBILITY. TO THE PLANTS TO
MAKE SURE THE PROVIDERS AND THE
BENEFICIARIES ARE INFORMED OF
EXPECTATIONS.
AND ANTI NOT HAPPEN TITLE MAN
BUT WHAT BENEFICIARIES WOULD BE
ELIGIBLE TO RECEIVE AND WHAT OUR
CONCLUSION IS IS THAT BERMAN
HEALTH CARE SERVICES NEEDS TO
STEP UP NOT ONLY GUIDANCE.
BUT OVERSIGHT THEY HAVE DEFERRED
AND DELEGATED TO MUCH TO THE
PLANS AND PROVIDERS THEMSELVES.
SO THAT THEY DEFERRED AND
DELEGATED SO IS THERE SO THERE
REALLY ISN'T ONE SET DELEGATION
AND REFERRALS HAPPEN THERE IS IT
ISN'T.
ISN'T THE OVERSIGHT THAT.
THEY'RE NOT FOLLOWING UP TO MAKE
SURE THAT THOSE THINGS THAT THE
ALLIGATOR ARE HAPPENING.
SO ACT LIKE SO CONSEQUENTLY
BASED ON THE FINDINGS THEY'RE
NOT HAPPENING.
THAT'S CORRECT THAT'S WHAT WE
FOUND SO -- SO RIGHT BEFORE THE
AUDIT WAS RELEASED -- DESIST DAC
ESTA NELSON NUMBER OF CHANGES
RELATING TO PLAN AND PERFORM A
PLANNED PERFORMANCE MEASUREMENT --
AND MANDATORY FINDS -- DO YOU
HAVE THOUGHTS ON THOSE CHANGES
AND AND WHERE YOUR SIXTY DAY
FOLLOW UP.
COMMENT ON THESE CHANGES WE ARE
THE SIXTY DAY RESPONSES TO YOU --
I BELIEVE IN A WEEK OKAY OR TWO
PRETTY SOON YEAH SO IT AT THAT
POINT WE'LL HAVE MORE TO SAY ON
THAT.
OKAY.
GREAT THANK YOU.
THANK YOU I HAVE A COUPLE
QUESTIONS AS WELL MAYBE I'LL
JUST FOLLOW UP ON WHAT -- DOCTOR
WOULD WAS TALKING ABOUT IN TERMS
OF THE AMOUNT OF MILES THAT.
FAMILIES HAVE TO TRAVEL RIGHT
AND YOU SAID IN SOME CASES OVER
A HUNDRED MILES.
YOU KNOW THAT SEEMS -- PRETTY
EGREGIOUS SO WAS IT IN YOUR
FINDINGS WAS A LACK OF
INFORMATION TO THE FAMILIES
LETTING THEM KNOW THAT THEY CAN
ACTUALLY GO TO OUT OF NETWORK
PROVIDERS.
SO THAT THEY WOULDN'T HAVE TO BE
TRAVELING THIS GREAT DISTANCES.
BUT IN IN SOM CASES IT'S NOT
INFORMING OF FOLKS THAT THEY
HAVE ACCESS TO OUT OF NETWORK
PROVIDERS -- UP MORE OFTEN --
IT'S NOT INFORMING FAMILIES THAT
THEY ACTUALLY.
CAN GET HELP GETTING TO THOSE
LONG DISTANCES -- BUT IT'S IT'S
MORE THAN JUST THE DISTANCE IN
THE TRAVEL TIME IT'S IT'S THE
TIME OFF WORK AND IT'S THE NO
IT'S GETTING THESE FAMILIES. TO
TO HAVE A LITTLE.
FAITH IN THE SYSTEM -- THAT THAT
THIS THAT.
ACCESS IS A REAL THING FOR THEM.
HI SO IT HAS TO DO WITH
INFORMING BUT IT ALSO HAS TO DO
WITH.
IMPROVING THAT CONDITION THAT
HAS LED TO THESE ON REASONABLE
STANDARDS.
SO WE SAY ACCESS TO HELP WITH
THE HELP SUCH AS ONE THERE'S
TRANSPORTATION HELP THE DH YESES
REQUIRED TO PROVIDE.
MR SALAS SIMILAR TO THE THE
DISCUSSION WE HAD EARLIER AGAIN
THIS IS A SITUATION WHERE THE
DEPARTMENT HEALTH CARE SERVICES
IS REALLY.
DELEGATING OR OR YOU KNOW
EXPECTING THE PLANS TO INFORM
PROVIDERS TO MAKE SURE PROVIDERS
ARE INFORMING BENEFICIARIES.
AND DEPARTMENT HEALTH CARE
SERVICES IS NOT MAKING SURE THAT
PLANS ARE DOING THAT SO THAT.
BENEFICIARIES ARE EVEN AWARE
THAT THEY CAN POTENTIALLY TAKE
THEIR CHILD TO AN OUT OF NETWORK
PROVIDER TO GET THOSE SERVICES
RATHER THAN TRYING TO EITHER
ARRANGE FOR TRANSPORTATION TO
TAKE THEIR CHILD HUNDRED FIFTY
TWO HUNDRED MILES.
SO AGAIN IT'S IT'S THE
DEPARTMENT HEALTH CARE SERVICES
NEEDS TO HOLD PLANS ACCOUNTABLE
TO MAKE SURE THAT THEY ARE FULLY
INFORMING BENEFICIARIES OF THEIR
RIGHTS IN THE ELIGIBILITY FOR
DIFFERENT TYPES OF SERVICES AND
WHO CAN OR SHOULD BE PROVIDING
THOSE SERVICES.
GOT IT.
NO I UNDERSTAND THAT I THINK
THAT LEADS TO MY NEXT QUESTION
WHICH YOU KNOW IN YOUR HANDOUTS
PAGE -- FOR AND THEN THE ON IT
FIGURE TWO ON PAGE.
FIFTEEN THE SAME BECAUSE THE CHS
HAS PERFORMANCE STANDARDS THE
BOXES YOU VIOLATED IS A JUST
THREE TO SIX BUT IT'S REALLY
HIGH.
BUT I LOOK AT YOU KNOW FROM ZERO
TO ONE TO TWO YOU DROP.
YOU KNOW FROM 70%. 2402% THE
FIRST YEAR AND ROUGHLY 25% FOR
TWO YEAR OLDS.
DID YOU FIND A REASON WHY THE
HUGE DROP OFF IS IT BECAUSE OF
THE LACK OF PERFORMANCE
STANDARDS.
IT IT'S PARTLY DUE TO THE LACK
OF PERFORMANCE STANDARDS IN THAT
SOMETHING THAT DH CS CAN DO
SOMETHING ABOUT -- IF.
WHEN YOU TALK WHEN YOU LOOK AT
THE DROP OFF FROM AGE -- ZERO
TWO ONE TWO TWO THE THERE ARE
REASONS FOR THAT THAT MAY BE.
BEYOND DHS CSS CONTROL -- SUCH
AS THE NEWBORNS CAN GO TO THE
DOCTOR A LOT MORE OFTEN THAN TWO
YEAR OLDS -- AND YET TWO YEAR
OLDS ARE STILL REQUIRED TO
RECEIVE -- OF MORE THAN ONE WELL
CHILD CHECK UP.
PRESS WATCHED.
LEX PANEL THAT QUESTION.
YES -- THANK YOU LET ME ASK IF
THERE'S ADDITIONAL MEMBERS THAT
HAVE ANY ADDITIONAL QUESTIONS.
ALL RIGHT TO HARIAN SAYING DONE
THANK YOU GUYS FOR LAYING THE
GROUNDWORK.
AND WE'LL GO TO CALL UP THE NEXT
PANEL.
GEN ITEM NUMBER.
THREE THE DEPARTMENT OF HEALTH
CARE SERVICES RESPONSE TO
FINDINGS RECOMMENDATIONS OF
CALIFORNIA STATE AUDITOR'S.
JENNIFER CAN'T.
WHO IS THE DIRECTOR OF THE
DEPARTMENT OF HEALTH CARE
SERVICES
?
PLEASE I BELIEVE YOU HAVE
PRESENTATION OR YOU ARE JUST.
I WAS JUST GONNA SPEAK BOTH TO
THE REPORT AS WELL AS HAPPY
ANSWERED WHEN YOU'RE READY
FINISH SURE THANK YOU.
SO JENNIFER CAN -- DIRECTOR FOR
THE DEPARTMENT OF HEALTH CARE
SERVICES -- I WANTED -- TO
PROVIDE JUST A LITTLE BIT OF
CONTEXT I'M FOR THOSE OF YOU
THAT MAY OR MAY NOT BE FAMILIAR
WITH THE DEPARTMENT AND THE MEDI
CAL PROGRAM -- MORE BROADLY
BEFORE WE TALK ABOUT THE AUDIT
SPECIFICALLY -- WE OVERSEE SIX
LARGE DELIVERY SYSTEMS AND THE
STATE OF CALIFORNIA -- THAT
COLLECTIVELY PROVIDE CARE TO
MEDI CAL RECIPIENTS AND SO THE
SIX SYSTEMS -- CONSIST OF THE
MANAGED CARE SYSTEM WHICH WILL
SPEND OBVIOUSLY THE MOST
SIGNIFICANT AMOUNT OF TIME
TALKING ABOUT TODAY -- THERE'S
THE FEE FOR SERVICE DELIVERY
SYSTEM THERE IS THE COUNTY
MENTAL HEALTH PROGRAM THAT
PROVIDES SPECIAL TO MENTAL
HEALTH SERVICES.
THERE'S THE SUBSTANCE USE
DISORDER SYSTEM THAT THE MIX OF
BOTH STATE PLAN SERVICES AND WE
WERE SERVICES WHICH I CAN TALK
ABOUT -- THERE'S THE DENTAL --
SYSTEM BOTH FEE FOR SERVICE AND
DENTAL MANAGE CARE AS WELL AS
CALIFORNIA CHILDREN SYSTEM --
CALIFORNIA -- CHILDREN SERVICES
SYSTEM IT IS THE OLDEST PROGRAM
IN OUR DEPARTMENT IT WAS STARTED
IN -- NINETEEN TWENTY SEVEN AND
IS REALLY KIND OF A NATIONAL
MODEL FOR AND SPECIALTY CARE FOR
CHILDREN WITH VERY SPECIFIC
MEDICAL CONDITIONS OF SERVICE
ABOUT TWO HUNDRED THOUSAND
CHILDREN.
A YEAR -- WE ARE THE SECOND
LARGEST PUBLIC HEALTH CARE
SYSTEM IN THE COUNTRY BEHIND
MEDICARE -- BOTH IN TERMS OF
SIZE OF POPULATION AS WELL AS IN
BUDGET -- THE NEXT LARGEST
MEDICAID PROGRAM IN THE NATION
IS NEW YORK AND WEIRD MORE THAN
TWICE AS BIG AS NEW YORK SO JUST
FOR PURPOSES OF COMPARISON.
WE AS THE AUDITOR NOTED HAVE
ABOUT FIVE AND A HALF MILLION
CHILDREN IN THE PROGRAM TODAY --
OUR CASELOAD CURRENTLY STANDS AT
ABOUT THIRTEEN MILLION --
INDIVIDUALS ALL TOLD WE COVER
HALF THE BIRTH IN THE STATE OF
CALIFORNIA WE COVER TWO THIRDS
OF THE NURSING HOME STAYS -- AND
SO WHEN YOU TALK ABOUT THE
SIGNIFICANT COMPLEXITY OF WHAT
WE DO AND HOW INDIVIDUALS GET
SERVICES WE ARE -- COMMITTED TO
OBVIOUSLY CONTINUE TO DELIVER
WHAT IS AN ENTITLED SERVICE TO
ENTITLED BENEFICIARIES -- WE WE
HAVE A SIGNIFICANT NUMBER OF
INDIVIDUALS THAT ARE SENIORS AND
PERSONS WITH DISABILITIES AS
WELL AS I NOTED WITH CALIFORNIA
CHILDREN'S SERVICES.
WE HAVE CHILDREN THAT HAVE
BECOME -- CCS ELIGIBLE UPON
THEIR BIRTH AND WILL REMAIN WITH
US FOR THE REMAINDER OF THEIR
LIVES AND WE REMAIN COMMITTED TO
CONTINUING TO IMPROVE AND ALWAYS
STRIVE TO DO BETTER WHEN WE
DELIVER CARE TO OUR VULNERABLE
POPULATIONS -- SOME OF THE
THINGS I THINK THAT WE ARE --
BOTH PROUD OF THAT CONTINUE TO
PROVIDE SERVICES TO KIDS TODAY --
INCLUDE AND IMPROVE DENTAL
PROGRAM I KNOW THAT I STOOD
BEFORE DOCTOR WOULD AND OTHERS I
WHEN I FIRST STARTED AT THE
DEPARTMENT BACK IN.
TWENTY FIFTEEN WE HAVE HAD AN
AUDIT DONE BY THE STATE AUDITOR
AROUND THE UTILIZATION OF
SERVICES BY CHILDREN AND OUR
DENTAL PROGRAM.
AND WE SAID WE WILL DO BETTER
AND WE'RE COMMITTED TO IMPROVING
THAT AND I THINK THAT FOUR YEARS
LATER -- WE CAN SAY THAT WE HAVE
MADE PROGRESS I WOULD SAY THAT
WE'RE NOT DONE BUT CERTAINLY WE
HAVE INCREASED OUR UTILIZATION
AND THAT HAS BEEN AS A RESULT OF
THE PARTNERSHIP THAT WE HAVE HAD
WITH BOTH THE FEDERAL GOVERNMENT --
THE LEGISLATURE AT THE
STAKEHOLDERS IN THE PROVIDERS --
SO THAT IS SOMETHING I THINK
THAT IS CONTINUING TO BOTH OF
ALL OF AND IMPROVE BUT CERTAINLY
SOMETHING THAT -- WE HAVE SEEN
SIGNIFICANT PROGRESS BEING MADE
IN TERMS OF DELIVERY OF SERVICES
TO CHILDREN -- A LITTLE KNOWN --
PROGRAM THAT WE STARTED A COUPLE
OF YEARS AGO IS KNOWN AS WHOLE
CHILD MODEL -- THESE ARE
CHILDREN THAT -- RESIDE IN
COUNTY ORGANIZED HEALTH SYSTEM
COUNTY SERVICE AREAS -- THEY ARE
CHILDREN THAT STRADDLE THE CCS
PROGRAM AS WELL AS THE MEDICAL
PROGRAM AND THEY WERE HAVING
THEIR SERVICES -- DISJOINTED
BETWEEN TWO DIFFERENT DELIVERY
SYSTEMS AND SO WE HAVE AN ROLE
THESE CHILDREN IN VERY SPECIFIC
COUNTIES -- INTO WHAT IS KNOWN
AS THE WHOLE CHILD MODEL SUCH
THAT ALL OF THEIR SERVICES ARE
BEING DELIVERED BY THE FACT
COUNTY ORGANIZED HEALTH SYSTEM.
AND CAL OPTIMA THE ORANGE COUNTY
MODEL WILL BE THE LAST COUNTY --
THAT WE BRING LIVE STARTING ON
JULY -- ONE SOME OF THE ITEMS --
WE'RE STATE THAT OPERATES LARGE
MEDICAID WAIVERS WITH THE
FEDERAL GOVERNMENT AND SO WHEN I
TALK ABOUT PARTNERSHIP WITH THE
FEDERAL GOVERNMENT -- THEY
CONSTITUTE ABOUT SIXTY BILLION
DOLLARS OF OUR HUNDRED BILLION
DOLLAR ANNUAL BUDGET -- WE HAVE
A SIGNIFICANT WAIVERS WITH THE
FEDERAL GOVERNMENT TO
DEMONSTRATE CERTAIN THINGS IN
THE STATE AND ONE OF THOSE IS --
WHOLE PERSON CARE WHICH I HINK
NOT NECESSARILY FOCUS ON
CHILDREN BUT CERTAINLY SOME OF
THE INNOVATIVE.
TYPES OF DELIVERY CHANGES THAT
WE AS A STATE HAVE BEEN WORKING
COLLECTIVELY WITH PROVIDERS AND
COUNTIES AND ADVOCACY GROUPS TO
TRY AND BRING ABOUT SIGNIFICANT
LIFE ALTERING.
OUTCOMES FOR INDIVIDUALS THAT
ARE STRUGGLING WITH EITHER
MENTAL ILLNESS OR HOMELESSNESS
OR CHRONIC DISEASE -- THE DENTAL
TRANSFORMATION INITIATIVE -- IS
ALSO A SIGNIFICANT -- INVESTMENT
THAT THE FEDERAL GOVERNMENT HAS
HELPED US MAKE AND IN TERMS OF
PROVIDING DENTAL CARE TO
CHILDREN.
DTI IS FOCUSED EXCLUSIVELY ON
CHILDREN AND MEDICAL CHILDREN IN
THE DENTAL PROGRAM -- WE HAVE
WORKED CLOSELY WITH THE DENTAL
ASSOCIATION AS WELL AS PROVIDERS
SCHOOLS MOBILE CLINICS TO
INCREASE AND ENHANCE THE
SERVICES THAT ARE BEING PROVIDED
TO CHILDREN IN TERMS OF
PREVENTIVE CARE I THINK WE HAVE --
HEARD QUITE WELL FRIEND THE
STATE ORAL HEALTH DIRECTOR
DOCTOR KUMAR THAT IF YOU DO NOT --
PROVIDE THE PREVENTIVE SERVICES
TO THE CHILDREN AT THE BEGINNING --
THEIR ADULT DENTAL DISEASE -- IS
IS M OR DRIVE DRAMATIC AND
MORE COSTLY AND SO WE HAVE
CERTAINLY -- BEEN EXCITED TO
EMBRACE AND SEE THE RESULTS OF
THAT DENTAL TRANSFORMATION
INITIATIVE THROUGH OUR FEDERAL
WAIVER -- LASTLY I KNOW THAT THE
AUDITOR SPENT A LITTLE BIT OF
TIME TOUCHING ON THE PROPOSITION
FIFTY SIX FUNDS -- I WILL
CERTAINLY PUT A PLUG IN TO SAY --
THOSE FUNDS HAVE BEEN -- BOTH
INCREASINGLY HELPFUL AND
REMARKABLY SUCCESSFUL I BELIEVE
IN THE THREE YEARS THAT WE HAVE
BEEN I USING THEM -- OBVIOUSLY
IN COOPERATION WITH THE
LEGISLATURE THROUGH THE ANNUAL
BUDGET PROCESS LAST YEAR WE
ADDED THE PREVENTIVE -- SERVICE
CODES FOR BOTH CHILDREN AND
ADULTS SO PHYSICIANS WHEN THEY
PROVIDE A PREVENTIVE SERVICE TO
A CHILD THEY RECEIVE A
SUPPLEMENTAL PAYMENT FOR THAT --
SERVICE WHETHER THEY'RE IN FEE
FOR SERVICE OR IN MANAGED CARE
AND I THINK THAT THOSE FUNDS
HAVE CERTAINLY AND WHAT WE HOPE
WILL HOPE WILL CONTINUE TO SHOW.
IS -- INCREASED -- BOTH
UTILIZATION AND ACCESS TO
PREVENTIVE SERVICES WHICH IS THE
OBVIOUSLY THE TOPIC OF TODAY'S
HEARING -- THE LOAN REPAYMENT
PROGRAM -- AGAIN CONSISTENT WITH
WHAT THE AUDIT CALLED OUT -- THE
APPLICATION PERIOD WAS SUPPOSED
TO CLOSE ON FRIDAY -- WE OPENED
APPLICATIONS FOR PHYSICIAN AND
DENTAL LOAN REPAYMENT ON ON
APRIL FIRST -- THE SYSTEM
APPARENTLY -- COULD NOT HANDLE
THE APPLICATIONS ON FRIDAY SO
THERE WAS A BUNCH OF OF HUMAN
NATURE -- AT ITS BEST IN TERMS
OF PROCRASTINATION FOR TRYING TO
GET THEIR APPLICATIONS AND AND
SO WE HAD TO EXTEND THE DATE FOR
APPLICATION THROUGH THIS WEEK --
AT LAST REPORT FOR ME -- THAT I
WAS GIVEN WE HAD OVER FOURTEEN
HUNDRED APPLICATIONS FROM BOTH
PHYSICIANS AND DENTISTS MOSTLY
ON THE PHYSICIAN SIDE -- WE ARE
OFFERING UP TO THREE HUNDRED
THOUSAND DOLLARS IN LOAN
REPAYMENT FOR PHYSICIANS AND
DENTISTS THAT PROVIDE US A FIVE
YEAR COMMITMENT. TO SERVING IN
THE MEDICAL PROGRAM -- TO HAVING
A THIRD OF THEIR PATIENT BASE BE
MEDIC HAL -- AND WE'RE ADDING
ADDITIONAL -- CONSIDERATION FOR
DOCTORS THAT SERVE EVEN MORE
THAN A THIRD OF THEIR PATIENT
BASE OR IF THEY ARE PRACTICING A
CERTAIN SPECIALTY AREA -- FOR
WHICH WE ARE -- IMMINENTLY
INTERESTED IN HELPING TO SUPPORT --
A INCREASE ACCESS IN THE STATE
OF CALIFORNIA SUCH AS AROUND
CHILD PSYCHIATRY -- SO WE ARE
REALLY EXCITED TO SEE HOW THESE --
LOAN REPAYMENT FUNDS WILL BE
USED OVER THE COURSE OF THAT
TIME IN WHICH THE LEGISLATURE
HAS APPROPRIATED THE FUNDING --
AND THEN LASTLY -- THE GOVERNOR
PROPOSED IN JANUARY -- VALUE
BASED PURCHASING OF A PAYMENTS
TO PROVIDERS THAT DEMONSTRATE --
BASELINE IMPROVEMENT IN CERTAIN
SPECIFIC AREAS THERE'S FOUR
AREAS OF IMPROVEMENT THAT WE
HAVE IDENTIFIED AND SPECIFICALLY
AROUND ON CHILDREN IT'S AROUND
OF BLOOD LED SCREEN.
VACCINATIONS WELL CHILD VISITS
AND DENTAL VARNISH AS APPLIED IN
A PRIMARY CARE PHYSICIAN'S
OFFICE -- SOME OF THE CHALLENGES
THAT WE AS A DEPARTMENT FACE AN
AS WE FACE IS A PROGRAM -- WE
ARE CONTINUING -- TO STRUGGLE TO
INTEGRATE OUR BEHAVIORAL HEALTH
AND OUR PHYSICAL HEALTH --
PROGRAM SUCH THAT WE RECOGNIZE
INDIVIDUALS IN OUR PROGRAM THEY
COULD BE PARENTS THEY CAN BE
CHILDREN THEY CAN BE SINGLE
CHILDLESS ADULTS -- A LOT OF
THEM HAVE MENTAL HEALTH
CONDITIONS EITHER SERIOUS OR
MILD TO MODERATE AND THE IMPACT
OF THAT DISEASE ON THEIR OVERALL
HEALTH AS WELL AS ON THEIR
FAMILY'S HEALTH AND SOCIETY'S
OVERALL -- IMPACT HUSBAND DEEPLY
FELT AND SO I THINK THAT THAT IS
SOMETHING THAT WE'RE CONTINUING
TO THINK THROUGH.
ESPECIALLY IS OUR FEDERAL
WAIVERS -- COME DUE IN TWENTY
TWENTY AND AND BOTH OUR
SPECIALTY MENTAL HEALTH SERVICES
WAIVER AS WELL AS OUR LARGE
ELEVEN FIFTEEN WAIVER ARE --
EXPIRING WITHIN SIX MONTHS OF
EACH OTHER AND I THINK YOU'LL
HEAR US TALK -- PUBLICLY BOTH
WITH THE LEGISLATURE AS WELL AS
WITH STAKEHOLDERS ABOUT OUR
INTEREST IN CONTINUING TO EVOLVE --
AND COORDINATE SERVICES BETWEEN
THESE TWO DELIVERY SYSTEM SUCH
THAT WE IMPROVE THE LIVES OF
INDIVIDUALS WITH MENTAL ILLNESS --
DATA AND TRANSPARENCY -- WE
CONTINUE.
TO LOOK FOR WAYS IN WHICH WE USE
THAT DATA TO DRIVE BETTER
DECISIONS AT THE DEPARTMENT AS
WELL AS TO DRIVE IMPROVEMENTS IN
THE PROGRAM.
THE DATA THAT WE HAVE WE ARE
ALWAYS AND EVERY TO MAKE
AVAILABLE IN A MORE TRANSPARENT
WAY SUCH THAT YOU WERE SEEN.
THE REPORTS AND THE DATA AND THE
OUTCOMES AND THE CHALLENGES THAT
WE HAVE IS A PROGRAM SO I THINK
THIS AUDIT CERTAINLY HIGHLIGHTS --
AN AREA IN WHICH DATA HAS SHOWN
US THAT THERE IS A LOT OF ROOM
FOR IMPROVEMENT AND THE FACT
THAT THE DATA SYSTEMS.
IN AND OF THEMSELVES PROBABLY
DIDN'T EXIST FIVE TO SIX YEARS
AGO IS REALLY KIND OF A
STATEMENT AND THE KIND OF
EVOLUTION THAT WE HAVE MADE AS A
DEPARTMENT IN TERMS OF
CONTINUING TO TRY TO IMPROVE
THAT AREA -- WE ARE SOMETIMES --
SLOW TO EITHER ADOPT OR ADAPT --
TECHNOLOGY -- WHEN IT COMES TO
OUR PROGRAM I THINK THAT THERE'S
A LOT OF REASONS FOR THIS BUT WE
ARE CERTAINLY -- LOOKING FORWARD --
TO SEEING HOW TECHNOLOGY CAN
CONTINUE TO MAKE A DIFFERENCE IN
THE LIVES OF OUR BENEFICIARIES
WE RECENTLY RELEASED.
GUIDANCE TO PROVIDERS ACROSS ALL
OF OUR DELIVERY SYSTEMS AROUND
TELEMEDICINE AND WHAT CAN WE DO
TO HELP EASE -- ACCESS IN
CERTAIN AREAS WHERE PROVIDERS
MAY OR MAY NOT BE READILY
ACCESSIBLE BUT CAN BE AVAILABLE
THROUGH A TELEMEDICINE TYPE OF
CONSULTATION.
AND THEN LASTLY -- I WOULD BE
REMISS TO SAY THAT -- SOME OF
THE CHALLENGES THAT WE HAVE
FACED HAVE BEEN INCREASING --
CHANGES AT THE FEDERAL LEVEL IN
TERMS OF THE OVERSIGHT -- AND
REQUIREMENTS THAT WE AS A STATE
MEDICAID PROGRAM HAVE -- BEEN --
SUBJECT TO AS A AS A RESULT OF
CHANGES AT THE FEDERAL LEVEL THE
FEDERAL MANAGE CARE RULE THAT
WAS IMPLEMENTED IN TWENTY
SIXTEEN WAS ONE OF THE MOST
SIGNIFICANT CHANGES TO THE
MANAGED CARE PROGRAM -- IN
TWENTY YEARS AND SO THAT -- VERY
VERY SIGNIFICANT REGULATION HAD
IMPLICATIONS ACROSS A
SIGNIFICANT SWATH OF OUR PROGRAM
AND THOSE ARE STILL CHANGES THAT
WE ARE -- IMPLEMENTING TODAY AND
OBVIOUSLY THE NETWORK STANDARDS
IN THE NETWORK ADEQUACY
DISCUSSION THAT WAS PART OF THIS
AUDIT WAS A RESULT OF THAT AND
FEDERAL MANAGED CARE RULE -- AS
IT PERTAINS TO THE AUDIT ITSELF --
AS YOU SEE IN OUR RESPONSES TO
THE AUDITOR'S OUR
RECOMMENDATIONS IS THAT WE BY
AND LARGE -- BOTH EXCEPT -- AND
AGREE WITH THEIR OF THE FINDINGS --
WE CAN AND ARE COMMITTED TO
DOING BETTER -- BY ALL OF OUR
POPULATION IN THE PROGRAM AND IN
THIS PARTICULAR CASE WE ARE
COMMITTED TO IMPROVING -- THE
UTILIZATION OF PREVENTIVE
SCREENINGS FOR CHILDREN -- THE
GOVERNOR OBVIOUSLY COMING INTO
OFFICE -- THIS YEAR HAD A VERY
CLEAR AND CONSISTENT MESSAGE
ABOUT HIS INTEREST IN EARLY
CHILDHOOD DEVELOPMENT AND WHAT
HE COULD DO TO INCREASE AND
IMPROVE ACCESS FOR CHILDREN AT
THE EARLIEST LEVELS AND SO.
THERE WERE -- COMMUNICATIONS
MADE TO THE PLANS -- WHEN HE
FIRST CAME INTO OFFICE AROUND
WANTING TO UNDERSTAND YOU KNOW
WE HAVE TEN AND A HALF MILLION
INDIVIDUALS AND OUR PROGRAM THAT
ARE IN MANAGED CARE TODAY HE
ASKED THE PLANS?
TO ODD.
LET HIM KNOW IN TERMS OF HOW ARE
THEY DOING IN TERMS OF THE
PROVISION OF SCREENINGS AND
SERVICES TO CHILDREN NOT ONLY
MEDI CAL BUT MORE BROADLY.
I'M OBVIOUSLY LOW INCOME
POPULATIONS HAVE A SPECIAL --
IMPACT IN OUR PARTICULAR
DEPARTMENT BUT CERTAINLY
CHILDREN IN ANY PART OF THE
STATE ON HE WAS INTERESTED IN
HEARING FROM THE PLANS AROUND
HOW WERE THEY DELIVERY SERVICES
AND WHAT COULD BE DONE TO
IMPROVE THAT -- CONSISTENT WITH
THE AUDIT AND THE GOVERNOR'S
INTEREST IN STRENGTHENING THE
ACCESS TO PREVENTIVE SCREENINGS
WE HAVE -- SOME RESOURCE REQUEST
THAT WE HAVE PENDING WITH THE
LEGISLATURE RIGHT NOW THROUGH
THE BUDGET PROCESS.
IN WHICH WE ARE PROPOSING TO DO
TARGETED OUTREACH TO FAMILIES SO
YOU CONSISTENT WITH THE
QUESTIONS THAT YOU'VE ALREADY
ANSWERED -- ASKED AROUND YOU TO
PARENTS EVEN KNOW THAT THE
SCREENS -- EXIST HOW DO THEY GET
THESE SERVICES -- CAN WE HAD
DONE -- TARGETED OUTREACH TO
FAMILIES AROUND THE DENTAL
SERVICES -- WHERE WE REACHED OUT
TO FAMILIES WITH CHILDREN ZERO
TO THREE AND SAID DO YOU KNOW
THAT YOU CAN TAKE YOUR CHILD TO
A DENTIST NOW AND HAVE THAT
COVERED AND?
THAT ACTUALLY INCREASED -- A
PRETTY SIGNIFICANT NUMBER OF
INDIVIDUALS SEEKING A DENTAL
VISIT FOR THEIR CHILDREN FOR THE
FIRST TIME WE'RE PROPOSING TO DO
THAT AGAIN -- USING THE BRIGHT
FUTURES -- SCHEDULE TO ADVISE
PARENTS THAT YOUR CHILDREN HAVE
ACCESS TO A VARIETY OF
PREVENTIVE SCREENINGS AND SO
LOOKING FOR RESOURCES IN THIS
YEAR'S BUDGET TO COME DO THAT IN
A TARGETED WAY -- WE WILL BE
REQUIRED IN OUR PLANS TO DO
FOLLOW UP ON THAT TARGETED
OUTREACH SO TO THE EXTENT THAT
THE STATE IS -- REACHING OUT TO
FAMILIES AND SAYING YOU HAVE
SERVICES AVAILABLE YOU SHOULD
MAKE SURE THAT YOUR CHILD IS
GETTING EACH OF THESE THINGS
ACCORDING TO THEIR AGE AND
ACCORDING TO THE TIME IN WHICH
THE SCREENING SHOULD BE DONE --
THE PLANTS WILL BE REQUIRED TO
BE FOLLOWING UP WITH THOSE
FAMILIES TO MAKE SURE THAT WE
ARE CONSISTENTLY TRYING -- TO
LET PARENTS KNOW THAT THEY CAN
MAKE THOSE APPOINTMENTS AND THAT
THERE'S TRANSPORTATION AVAILABLE
IN THOSE CASES IF THEY DON'T
HAVE -- APPROPRIATE
TRANSPORTATION I'VE SPOKEN ABOUT
THE ADDITIONAL MONEY -- FOR
SERVICES ESPECIALLY AROUND
DEVELOPMENTAL SCREENS -- WHICH
IS IN THE GOVERNOR'S BUDGET THIS
YEAR TO ADD A SUPPLEMENTAL
PAYMENT -- FOR PROVIDERS DOING
THAT AS WELL AS IN THE
PREVENTIVE SERVICES -- AND THEN
VALUE BASED PURCHASING -- I WILL
SPEAK BRIEFLY -- TO THE
ALTERNATIVE ACCESS REQUESTS --
WE AND THE AUDITOR'S CERTAINLY
STATED THIS OP CORRECTLY WE WERE
SURPRISED BY THE NUMBER OF
ALTERNATIVE ACCESS REQUESTS THAT
WERE MADE BY THE PLANS WHEN WE
INITIATED THAT PROCESS LAST YEAR.
I THINK WE WERE SURPRISED -- IN
PARTICULAR -- THAT THERE WAS A
REALLY HIGH NUMBER COMING FROM
UP ONE SINGLE COUNTY -- THAT HAS
BOTH A VERY VERY DENSE URBAN
AREA AS WELL AS A LOT OF
SIGNIFICANT RURAL AREAS WITHIN
THAT COUNTY -- AND SO IT WAS
ALSO ONE OF OUR LEARNING
EXPERIENCES TO KIND OF
UNDERSTAND WHAT WAS DRIVING THE
NATURE OF THOSE ALTERNATIVE
ACCESS REQUEST -- THEY ARE BY
ZIP CODE SO IF YOU ARE IN A
RURAL COUNTY WITH ZIP CODES IN
WHICH THERE ARE NO PEOPLE BUT
YOU STILL HAVE THE ZIP CODE.
EACH PLAN HAD TO FILE AN
ALTERNATIVE ACCESS FOR EACH TYPE
OF PROVIDER FOR WHICH THEY WERE
SUPPOSED TO BE SEEKING.
A STANDARD AND THEN THAT IS HOW
IN SOME CASES THE NUMBERS GOT SO
HIGH SO FAST SO -- IN INYO
COUNTY IF YOU'RE LOOKING -- TO
HAVE A PROVIDER STANDARD FOR YOU
KNOW PRIMARY CARE HOSPITALS OBG
WHY AND THE PEDIATRIC SPECIALTY
THE PHARMACY ALL OF THE
DIFFERENT CATEGORIES BY WHICH
THE PLANS HAD TO SUBMIT NETWORKS.
IF THERE IS NOTHING IN THAT ZIP
CODE MEANING THERE ARE NO PEOPLE
AND THERE ARE NO SERVICES THEY
HAVE TO FILE AN ALTERNATIVE
ACCESS STANDARD FOR EACH
PROVIDER TYPE IN EACH ZIP CODE
AND IF THERE'S A SIGNIFICANT
NUMBER OF ZIP CODES.
YOU CAN JUST SEE HOW THAT KIND
OF HOW THAT PLAYED OUT -- AROUND --
RATES I THINK THAT THIS IS
SOMETHING THAT -- ARE --
HEALTHCARE FINANCE SCENE --
DIVISION HAS WORKED CLOSELY WITH
THE PLANS ON WE HAVE AN OUTSIDE
ACTUARIAL FIRM.
THAT CONSISTENTLY -- WORKS WITH
BOTH OUR DEPARTMENT AS WELL AS A
A RATE WORK GROUP CONSISTING OF
A PLANNED CFO'S AND C. E. O.'S
WE SET SIXTEEN HUNDRED RATE
CELLS A YEAR -- AND THOSE ARE
ALL PUT TO THE FEDERAL
GOVERNMENT THROUGH THIS FEDERAL
ACTED AND SO WHEN YOU TALK ABOUT --
CHANGING OR ADDING OR INCREASING
RATES ARE DOING SUPPLEMENTAL
PAYMENTS ALL OF THAT WORK COMES --
INITIATED THROUGH OUR FINANCING
DIVISION -- WE IN GENERAL WORK
WITH THE PLANS -- IN TERMS OF
LIKE POLICY ISSUES MAKING SURE
THAT THE ACTUARIES FLOW THE
DRAFT RATES BACK TO THE PLANS.
THE PLANS CAN CERTAINLY -- LOOK
AT TRENDS AND TRY TO UNDERSTAND
THE UNDERLYING DATA BECAUSE WE
USE THE PLAN STATED TO HELP SET
THE RATES BUT AT THE END OF THE
DAY -- WE'RE USING THE PLANS
ENCOUNTERS THEIR OWN DATA
SUBMISSIONS AND THEN THE
ACTUARIES ARE TRENDING IT
FORWARD -- AND THOSE ARE THE
RATES THAT WE SUBMIT TO THE
FEDERAL GOVERNMENT FOR APPROVAL
AND THEN OBVIOUSLY FOR FOR
PAYOUT BUT SIXTEEN HUNDRED RATE
CELLS ACROSS THE STATE.
ACROSS THE PLAN TYPES ACROSS
ELIGIBILITY CATEGORIES -- AROUND
EPS TT SO THIS IS AN ENTITLED
BENEFIT FOR ANY CHILD IN
MEDICAID UNDER THE AGE OF TWENTY
ONE IT IS A VERY VERY BROAD.
BENEFIT AND IT ESSENTIALLY SAYS --
FOR CHILD THAT ALL OF THE
SCREENS THAT THEY NEED AS WELL
AS ANY OF THE DIAGNOSTIC --
SERVICES AS WELL AS ANY
TREATMENT OR ANYTHING THAT NEEDS
TO BE DONE TO AMELIORATETHE
CONDITION OF THE CHILD HAS HAS
TO BE PROVIDED IT IS IT IS BOTH
SIGNIFICANT.
AND COMPLETELY APPROPRIATE IT
APPLIES TO SUBSTANCE USE
DISORDER IT APPLIES TO MENTAL%
HEALTH IT APPLIES TO
DEVELOPMENTAL DISABILITIES IT
APPLIES TO PHYSICAL HEALTH
CONDITIONS AND SO -- WE HAVE
BEEN WORKING WITH ADVOCATES
THERE WAS A BILL THAT WAS SIGNED
BY -- THE GOVERNOR LAST YEAR SB
TWELVE EIGHTY SEVEN AROUND --
CONSISTENT YOU PST T. BOTH
LANGUAGE AND TREATMENT ACROSS
ALL THE DIFFERENT AREAS AND OF
OUR DEPARTMENT THAT HANDLE YOU
PST T. BENEFITS -- WE HAVE
CHANGED OUR EVIDENCE OF COVERAGE
THE THESE ARE THE DOCUMENTS THAT
FAMILIES GET FROM THE PLAN
SAYING THIS IS WHAT YOU ARE
ENTITLED TO AND SO WE HAVE.
BOTH -- CLARIFIED AND EXTENDED
THE AMOUNT OF DETAIL IN THE
EVIDENCE OF COVERAGE DOCUMENT
SURROUND THAT EPS TT BENEFIT --
WE HAVE AND I HAVE A COUPLE OF
COPIES OF PEOPLE WOULD LIKE WE
HAVE CHANGED WHAT USED TO BE
KNOWN AS THE IT WAS REALLY GOOD
PUB -- SIXTY EIGHT A REALLY GOOD
GOVERNMENT NAME TO ON MY MEDI
CAL WE HAVE MADE IT A MORE
FRIENDLY BROCHURE WE HAVE USED A
LOT MORE GRAPHICS WE HAVE TRIED --
TO HIGHLIGHT CERTAIN SERVICES
BUT IT IS AN ENCAPSULATION FOR
ALL BENEFICIARIES THAT THEY GET
ON AN ANNUAL BASIS TO SAY THIS
IS WHAT MEDI CAL IS FOR YOU THIS
IS WHAT MEDICAL IS FOR YOUR
CHILDREN.
THIS IS WHAT'S AVAILABLE IT
TALKS ABOUT DENTAL IT TALKS
ABOUT YOU PST T. -- IT IS --
TRANSLATED INTO ALL OF THE
DIFFERENT THRESHOLD LANGUAGES --
WE'RE REALLY PROUD OF THE FACT
THAT -- WE HAVE PUT IN A MUCH
MORE FRIENDLY AND ACCESSIBLE --
DOCUMENT AND CERTAINLY THAT IS
ONE OF THE WAYS IN WHICH WE'RE
TRYING TO HIGHLIGHT -- THE
AVAILABILITY OF EPS D. T. FOR
FAMILIES AND CHILDREN.
AND THEN LASTLY OUTWHAT THE
AUDITOR I HAD MENTIONED IS
SOMETHING THAT WE ARE WORKING --
WITH OUR PLANS ON IN TERMS OF
FURTHER CLARIFICATION AND
GUIDANCE AROUND ALL PLAN LETTERS
AS TO WHAT PLANS SHOULD BE
PROVIDING AND THE FREQUENCY OF
WHICH THOSE SERVICES -- NEED TO
BE MADE AVAILABLE.
AND THEN -- I THINK THOUGH THE
LAST THING I WILL -- SPEAK.
TO IS ON PROVIDER AVAILABILITY
SO ON THE AUDIT NOTED THAT OUR
ANNUAL ON IT SO WE SEND OUT OUR
AUDIT TEAM EVERY YEAR -- TO
AUDIT ARE MEDI CAL MANAGED CARE
PLANS THERE'S TWENTY FOUR PLANS --
THEY WERE ESSENTIALLY TESTING A
VERY SMALL SAMPLE SIZE OF
PROVIDERS BY CALLING AND SAYING
YOU KNOW I NEED AN A AN
APPOINTMENT YOU KNOW WHEN IS THE
NEXT ONE AVAILABLE -- IN THE
AUDIT HAD NOTED THAT THAT WAS A
PRETTY SMALL SAMPLE SIZE
STARTING LAST JANUARY SO JANUARY
OF TWENTY EIGHTEEN WE ASK OUR
EXTERNAL QUALITY REVIEW
ORGANIZATION TO DO A MUCH
BROADER SAMPLING OF PROVIDER
AVAILABILITY.
SO WE'RE SAMPLING -- UPWARDS OF
TWENTY EIGHT THOUSAND PROVIDERS --
THROUGH THIS EACH YEAR --
CONTRACT IN WHICH WE ARE CALLING
TO SAY YOU KNOW WHEN IS THE NEXT
AVAILABLE APPOINTMENT ARE YOU
ACCEPTING NEW PATIENTS AND
REALLY TRYING TO GET AN
UNDERSTANDING OF WHEN THOSE
NETWORKS ARE FILED WITH US -- WE
HAVE AN INDEPENDENT VALIDATION
BY AN INDEPENDENT ENTITY THAT IS
OUT THERE TESTING THAT TO MAKE
SURE AND THEN WE ARE GETTING
THOSE -- WE'RE GETTING THAT
FEEDBACK ON A QUARTERLY BASIS
AND I THINK THAT IS CERTAINLY
SOMETHING THAT WE'RE CONTINUING
TO BOTH REFINED AND HELP US
UNDERSTAND WHAT IS HAPPENING OUT
IN THE VARIOUS PARTS OF THE
STATE THAT MAY HAVE --
CHALLENGES WITH ACCESS.
SO -- WITH THAT I'M HAPPY TO AND
STOP IN IN ANSWER QUESTIONS.
THANK YOU FOR THAT TESTIMONY AND
I KNOW THAT.
THERE'S A COUPLE OF QUESTIONS I
APPRECIATE YOUR JUST WHEN YOU
TOUCHED UPON -- SOME OF SOME OF
THE THINGS I WAS WONDERING ABOUT
TELEMEDICINE AS WELL AS MAYBE AN
ALTERNATIVE ACCESS POINT -- BUT
YOU ALSO TALKED ABOUT THE BREAK
FUTURE SCHEDULE AND WHAT THAT
ACTUALLY MEANS AND USING THAT
ACTUALLY INFORMED -- FAMILIES OF
SOME OF THE SERVICES AND SO I
WAS WONDERING ARE THERE
ADDITIONAL WAYS TO TO PROVIDE
THAT INFORMATION TO FAMILIES
BECAUSE YOU KNOW WHEN YOU LOOK
AT THE RATES AND WHAT THE HONOR
TO POINT IT OUT.
YOU KNOW YOU SEE THIS THIS LACK
OF UTILIZATION AND I'M JUST
TRYING TO FIGURE OUT.
YEAH THAT'S GREAT YEAH THE
BROCHURE THE PUB.
SIXTY FIVE AND THAT BUT HOW ARE
WE ARE REMOVING PASSED.
YOU KNOW THESE ARE THINGS WE'RE
DOING BUT HOW ARE WE SHOWING THE
RESULTS KIND OF MOVING FORWARD
RIGHT.
THAT'S A GREAT QUESTION I THINK
THAT -- WHAT WE HAVE FOUND -- AT
LEAST CERTAINLY SPEAKING FOR
MYSELF PERSONALLY WITH MY
HISTORY WITH THE DEPARTMENT IS
YOU CANNOT RELY ON A SINGLE --
INTERVENTION TO AFFECT A CHANGE
IN OUR PROGRAM IT IS SIMPLY --
TOO BIG -- THERE ARE TOO MANY
DIFFERENT -- PLACES IN WHICH
POPULATIONS ARE DIFFERENT AND
NEEDED TARGETED INTERVENTION I
THINK THAT WE HAVE A S. A SERIES
OF CONVERSATIONS THAT WE WOULD
LIKE TO HAVE WITH OUR
STAKEHOLDERS -- THROUGH AND WE
HAVE A MANAGED CARE ADVISORY
GROUP AS WELL AS A BROADER
STAKEHOLDER ADVISORY COMMITTEE
ON AS WELL AS OBVIOUSLY THE
LEGISLATURE IN THE CONVERSATIONS
THAT WE HAVE -- IN A POLICY
BASIS.
WE LIKE TO GO AND SAY WE'RE
STRUGGLING -- WHAT'S HEALTH
DISPARITIES FOR EXAMPLE YOU KNOW
WE'RE LOOKING AT THE DATA AND
WHILE I'M HISPANIC CHILDREN --
HAVE A HIGHER VACCINATION RATE
WE'D REALLY LIKE TO UNDERSTAND
WHY ANOTHER ON POPULATION IS NOT
SEEN THAT SAME KIND OF
ACCEPTANCE AND ADOPTION OF THE
VACCINE.
AND SO -- SOME OF THE WORK
AROUNDS -- TARGETING
INTERVENTIONS REALLY COMES FROM
FEEDBACK FROM PEOPLE THAT ARE
CLOSER TO THE GROUND IF YOU WILL
IN TERMS OF PROVIDERS COMMUNITY
BASED ORGANIZATIONS LEGAL
ADVOCATES -- TRADE ASSOCIATIONS
AND CERTAINLY THE HEALTH PLANS
BECAUSE THEY ARE DELIVERY
SERVICES IN THAT REGIONAL AREA
AND SO -- SOME OF THE WORK
AROUNDS INCREASING UTILIZATION
WILL COME AS A RESULT OF YOU
KNOW DOING THE TARGETED OUT
REACH.
MAKING THE PLANS -- MORE
ACCOUNTABLE FOR THE FOLLOW UP
AND FEEDBACK ON TO THERE MEMBERS
TO MAKE SURE THAT THEIR MEMBERS
ARE ACCESSING SERVICES THERE'S
CERTAINLY A CONVERSATION AND AND
LEARNING COLLABORATIVE'S THAT
NEED TO TAKE PLACE WITH THE
PROVIDERS THEMSELVES.
I THINK THAT -- YOU KNOW THE
DOCTOR WOULD.
BE IN A PROVIDER CAN CERTAINLY --
APPRECIATE AS WELL AS FROM WHAT
WE HEAR ANECDOTALLY IS WHEN YOU
HAVE.
A FULL PRACTICE -- AND YOU HAVE
A VERY LIMITED AMOUNT OF TIME
WITH A PATIENT YOU MAY JUST BE
TREATING THE PATIENT FOR WHAT
THAT COMPLAIN AS TODAY AND YOU
MAY NOT BE ABLE TO HAVE THE TIME.
TO KIND OF LOOK AT THE FULL --
ARRAY OF SERVICES THAT THEY
SHOULD BE GETTING BUT THEY MAY
NOT BE -- USING AND SO I THINK
SOME OF THE VALUE BASED
PURCHASED SCENE -- INITIATIVES
THAT WERE WORKING ON RIGHT NOW
IS REALLY GETTING AT THE
PROVIDER LEVEL IN THE PROVIDER'S
OFFICE TO INCENTIVIZE THEM TO
LOOK AT THAT -- CHILD IN A MORE
COMPREHENSIVE WAY TO SAY YOU
MIGHT BE HERE FOR AN EAR
INFECTION -- BECAUSE THAT YOUR
CHIEF COMPLAINT TODAY BUT I'M
ALSO NOTICING THAT YOU'RE ABOUT
READY TO START SCHOOL -- HAVE
YOU RECEIVED YOUR VACCINES OR
YOU KNOW HAVE YOU EVER YOU KNOW
RECEIVED A BEHAVIORAL HEALTH
SCREEN OR YOU KNOW LET'S TALK
ABOUT YOUR DENTAL YOUR LASTED TO
LOOK SAM AND SO.
THERE'S A BUNCH OF DIFFERENT
INTERVENTIONS THAT WE HAVE
COMMITTED TO TO INCREASE
UTILIZATION BUT I DON'T BELIEVE
THAT THERE'S ONE THING THAT WILL
BE THE SILVER BULLET TO HELP. TO
HELP DRIVE THOSE UTILIZATION
RATES IT'S GOING TO REQUIRE A
BROAD SPECTRUM OF THINGS.
AND IN ADDITION YOU KNOW I THINK
THAT'S A REALLY GOOD IDEA TO
HAVE PRIMARY FOR THE OR THE
PHYSICIAN OR WHOEVER THEY'RE
GOING TO GO SEE.
YOU KNOW ASK FOR THOSE
ADDITIONAL SERVICES I THINK
THAT'S A GREAT WAY TO DO IT --
POLITICOS POINTED OUT AND
THOUGHT IT ALSO WAS A THE
PERFORMANCE METRICS.
RIGHT WHEN I THINK THAT WAS.
SO THE THINGS THAT WE MEASURE --
ARE ARE OKAY AND THE THINGS THAT
WE ARE NOT MEASURE EIGHTEEN ARE
NOT SO GREAT AND SO I THINK THAT
THAT -- WAS SOMETHING THAT WE
ANNOUNCED THAT WE WERE GOING TO
BE ADDING ALL OF THE CHILD AND
ADULT COURSE THAT MEASURES --
THAT IS AN ACCELERATION OF WHAT
A FEDERAL REQUIREMENT IS AND SO
TO THE EXTENT THAT WE WILL HAVE
THOSE AND WE WILL BE MEASURING
FOR ALL OF THOSE MEASURES.
YOU WILL CERTAINLY -- AND THIS
IS OUR HOPE -- YOU WILL SEE THAT
UTILIZATION INCREASE A BECAUSE
WE'RE GOING TO BE HOLDING THE
PLANS ACCOUNTABLE AND MEASURING
IT.
BUT IT ALSO -- COULD BE AND I
KNOW THAT -- YOU WOULD ASK THIS
OF THE PREVIOUS PANEL IT MAY
ALSO BE A DATA CHALLENGE AND
THAT IF YOU HAVE A ONE YEAR OLD
AND THEY'RE IN THE DOCTOR MORE
OFTEN.
IT IT COULD ALSO BE A DATA ISSUE
FROM THE STANDPOINT THAT THE
PHYSICIAN IS JUST BUILDING A
EXAM CODE.
AND NOT A WELL CHILD CODE AND SO
I THINK THAT IS ALSO SOME OF THE
WORK THAT WE HAVE BEEN DOING AS
A DEPARTMENT WHICH IS HOW DO WE
IMPROVE.
ENCOUNTER DATA SO ENCOUNTER DATA
FLOWS FROM THE PHYSICIAN TO THE
PLAN TO THE STATE AND SO THAT IS
CERTAINLY SOMETHING THAT WE HAVE
BEEN DASH FOURTEEN AND PLAN TO
MAKE AVAILABLE -- PUBLICLY IS
THE ENCOUNTER DATA THAT THE
PLANTS GET FROM THE PROVIDERS
AND I THINK THAT WILL ALSO HAVE.
SOME IMPACT NOT A SIGNIFICANT
BUT A BOWL HAVE SOME
DIFFERENTIAL IMPACT ACTUALLY
CHANGE SOME OF THE DATA IN THOSE
AREAS THAT WERE NOT CURRENTLY
HOLDING THE PLANTS ACCOUNTABLE
FOR YEAH I'D BE INTERESTED IN
SEEING WHAT THAT DATE IS I KNOW
YOU HEARD ME REFERENCE --
PREVIOUS PANEL THAT I THINK IT
WAS -- FIGURE TO PAGE FIFTEEN OF
THE IDEA TO WRITE.
WE SEE THE BIG DROP OFF BETWEEN
ONE AND TWO YEAR OLD YES AND SO
GET UPS THAT WOULD REFORM THAT
WOULD BE.
MY ASSUMPTION YEAH AND I THINK
WE'RE COMMITTED -- TO SHARING
THAT DATA THAT WE HAVE TOLD THE
PLANS THAT -- ALL OF THOSE --
MEASUREMENTS ARE BEING ADDED IN
THIS CURRENT YEAR SO IN THIS
CURRENT MEASUREMENT YEAR AND
THEY'LL BE HELD ACCOUNTABLE FOR
THAT AND SO IT WILL BE A
COMBINATION OF BOTH BETTER DATA
SUBMISSIONS FROM THE PROVIDERS
TO THE PLANS.
BUT ALSO FOR THE PLANS TO BE
WORKING WITH THEIR PROVIDERS TO
MAKE SURE THAT THEY KNOW THAT
THEY'RE GONNA BE HELD
ACCOUNTABLE FOR THOSE. FOR THOSE
MEASURES AND SO WE'RE HAPPY TO
KIND OF PROVIDE -- CONSISTED
FEEDBACK WITH WHAT WERE SEEN IN
TERMS OF THE DATA.
I APPRECIATE YOU -- MAKING
COMMENTS ABOUT HOLDING THE PLANS
A LITTLE MORE ACCOUNTABLE FOR
THIS PERFORMANCE METRICS.
COULD ONLY LOOK AT JUST.
THEY HANDED OUT AND YOU SEE ALL
THESE AXES. FOR FOR MEASUREMENTS
THAT ARE BEING MET FOR ALL THESE
AGE GROUPS.
YOU KNOW IT'S A LITTLE
CONCERNING I THINK FOR THE
LEGISLATURE.
IN OBVIOUSLY THREE TO SIX YEAR
OLDS SEEM LIKE THINGS ARE GREAT
BECAUSE THERE'S A PART FOR THE
PERFORMANCE METRICS ARE THERE.
BUT WE DON'T SEE THEM IN THE
OTHER AGE GROUPS AND YOU SEE THE
LACK OF PREVENTIVE SERVICES
BEING PROVIDED THERE.
YOU KNOW WE'D LIKE TO SEE THAT
AND HOPEFULLY THE SIXTY DAY SIX
MONTH AND CANNOT FOLLOW UPS AS
WELL SO I KNOW WILL BE LOOKING.
FOR FOR TO THAT ALSO -- ONE OF
THE ITS EXIT MENTIONED
ESPECIALLY FOR RURAL AREAS TO
REPRESENT SOME RURAL AREAS AS
WELL.
IS A ACCESS TO TO CARE.
AND THAT THE TRANSPORTATION.
AND SO YOU KNOW IN A FORGET
WHICH HEALTH PROFESSIONALS YOU
OUTLINED WHERE THEY MIGHT NOT BE
ACCESSIBLE THERE BUT ARE WE
LOOKING AT DOING THINGS LIKE
TELEMEDICINE.
TO PROVIDE THOSE ARE MAYBE SOME
OUT OF NETWORK PROVIDERS THAT
MIGHT BE A LOT CLOSER SURE SO --
A COUPLE THINGS SO TELEMEDICINE --
BUT WE THINK IT'S CERTAINLY.
BOTH HELPFUL AND AND A RURAL AND
IN AN URBAN AREA -- ESPECIALLY
AS IT PERTAINS TO SPECIALTY CARE
IT HAS -- BEEN EXTENSIVELY USED --
WITH OUR FQHCS APPAN THE HI
NORTHERN AREAS I KNOW THAT --
SHASTA HAS A VERY SUCCESSFUL
TELEMEDICINE -- PROGRAM THAT
THEY USE WITH UC DAVIS IN TERMS
TO TELL US LIKE HIGH ENTRY SO
PLANS ARE ABLE TO USE
TELEMEDICINE AND TELE CONSULS --
IN SOME CASES TO HELP MEET SOME
OF THEIR NETWORK REQUIREMENTS --
I THINK THAT.
THE LOAN REPAYMENT OF A
APPLICATIONS THE PHYSICIANS FOR
A HEALTHY CALIFORNIA IS DOING%
THE INITIAL KIND OF REVIEW OF
THE APPLICANTS TO MAKE SURE THAT
THEY'RE ELIGIBLE RIGHT THEY HAVE
TO BE WITHIN FIVE YEARS OF
RESIDENCY -- OR HAVE JUST
GRADUATED FROM TO AMEND MEDICAL
OR DENTAL SCHOOL WITHIN THE LAST
FIVE YEARS THEY'RE DOING THAT
KIND OF INITIAL CUT AND THEN WE
DOWN.
AND SAY YOU KNOW WHO ARE THESE
DOCTORS -- WHERE DO THEY
PRACTICE -- LET'S TRY TO BALANCE --
CENTRAL VALLEY NEEDS WITH HI
NORTHERN AREA WITH SPECIALTY
TYPE I MEAN IT'S A REALLY
EXCITING PROCESS FOR US I THINK
WE ARE.
REALLY -- CONVINCED THAT BY
TAKING THE DEBT -- CALCULATION
OUT OF A PROVIDERS -- MIND WHEN
THEY GRADUATE THAT THEY DON'T IF
THEY DON'T HAVE TO THINK ABOUT
HOW MUCH DEBT THEY HAVE TO
REPAIR THEM CHANGE THE NATURE OF
THE PROFESSIONAL.
PLACE IN WHICH THEY PRACTICE AND
WE'RE REALLY -- COMMITTED TO
HELPING THEM WANT TO STAY IN THE
MEDICAL PROGRAM LONGER THAN FIVE
YEARS -- SO I THINK THERE'S A
LOT TO BE SAID FOR THE NORTHERN
AREA AS WELL CENTRAL VALLEY
WHICH WE HAVE HEARD CONSISTENTLY
STRUGGLE -- I COME FROM I GREW
UP AND WENT TO HIGH SCHOOL EL
PATEL CALIFORNIA POPULATION.
SIX HUNDRED THIRTY NINE THE
ELEVATION IS HIGHER THAN THE
POPULATION -- THERE ARE PLACES
IN OUR STATE AND I KNOW THAT --
THE AUDITOR CERTAINLY USED --
THIS IS AN EXAMPLE IN WHICH
CERTAIN SPECIALTY -- TYPES
ESPECIALLY PEDIATRIC SPECIALTY
TYPES ARE THREE FOUR HUNDRED
MILES AWAY -- THERE ARE ONLY
PROBABLY A HANDFUL OF PEDIATRIC
NEURO OPHTHALMOLOGIST IN THE
ENTIRE STATE.
AND IF YOU LIVE IN INYO OR
MONNOW OR YOU KNOW I'LL PURTELL
CALIFORNIA -- YOU WILL HAVE TO
GO TO UC SAN FRANCISCO TO HAVE
ACCESS TO A PEDIATRIC NEURO
OPHTHALMOLOGIST THAT'S JUST KIND
OF THE WAY IT IS I THINK THAT --
TO THE EXTENT THAT THERE ARE
PROVIDERS CLOSER BY THAT CAN
SUCCESSFULLY ADDRESS THE CHILD'S
NEEDS AND I WOULD SAY --
CHILDREN AND I AM REMINDED OF
THIS BY THE CHILDREN'S SPECIALTY
CARE COALITION ALL THE TIME IS
PEDIATRIC -- SPECIALISTS ARE
VERY DIFFERENT THAN ADULT
SPECIALTY SO A ADULT
CARDIOLOGISTS DOES NOT A
PEDIATRIC CARDIOLOGIST AND SO.
ON WE ARE TRYING REALLY HARD TO
MAKE SURE THAT THE PLANS NO THEY
HAVE TO CONTRACT WITH PEDIATRIC
SPECIALISTS I THINK WE HAVE SEEN
EVEN IN THE INITIAL DATA THAT
THE PLANS HAVE BEEN DOING THAT
AND SO WE EXPECT THOSE
ALTERNATIVE ACCESS REQUEST TO BE
COMING DOWN PRETTY SIGNIFICANTLY.
AND THE NEXT REPORTING YEAR JUST
BASED ON THAT -- EXPECTATION SO
I THINK YOU WILL SEE REFINEMENT --
AS WE CONTINUE TO ROLL THIS
PROCESS OUT.
J. TELEVISION THOSE COMMENTS AND
SPECIALLY -- WOULD YOU KNOW.
HOW MORE QUALIFIED PHYSICIANS IN
THOSE AREAS AS WELL ON YOUR PUSH
FOR DOING THAT -- IS APPRECIATED
I KNOW THERE'S A LOT OF FOLKS
HERE -- ONE OF THE PER HOPE LOAN
REPAYMENT PROGRAMS TIME WAS A
STEPHEN THOMPSON LOAN PAYMENT
PROGRAM FOR INSTANCE.
AND YOU KNOW I HAVE LEGISLATION.
A NUMBER OF US OF SPORTS OF
THOSE MEASURES INCREASING HEALTH
CARE PROFESSIONALS ACROSS THE
SPECTRUM YEAH -- YOU KNOW IN ALL
PARTS OF THE STATE SO -- I
APPRECIATE THAT AND LET ME.
KNOW -- DOCTOR WHAT'S GOT A
COUPLE QUESTIONS OR MAYBE I'LL
JUST COME BACK -- WE'LL GO BACK
TO JUST FOR A SECOND -- BUT THE
TELEMEDICINE PART OF THIS
BECAUSE WE WE HEAR WE HEAR FROM
PLANS THAT.
THAT.
THAT -- TELEMEDICINE STILL
LACKING AND YOU YOU MENTIONED
THAT.
YOU SEE A VALUE THAT SAID THAT
CASEY'S BUT I HERE ON THE OTHER
END THAT PLANS ARE SAYING THAT.
IT'S STILL IT'S STILL NOT
WORKING AND AND PART OF IT IS.
THEY'RE TALKING ABOUT YOU KNOW
THE ABILITY ACCESS OUTSIDE THE
FOUR WALLS AND SO -- CAN YOU
HELP ME UNDERSTAND WHERE.
I WAS HE GOTTO WE GOT
DISCONNECTS HERE SO -- AND I
WOULD BE I'M I'M HAPPY TO
PROVIDE THE COMMITTEE -- WITH
THE TELEMEDICINE POLICY THAT WE
RELEASED IN THE FALL IT WAS
ACROSS MANAGE CARE FEE FOR
SERVICE -- OUR MENTAL HEALTH --
DELIVERY SYSTEM AS WELL AS ON
FAMILY PLANNING AND ANY PLACE IN
WHICH WE HAVE PROVIDERS THAT ARE
BILLING SERVICES ACROSS THE
DIFFERENT DELIVERY SYSTEMS -- WE
WERE TRYING TO MAKE IT VERY
CLEAR THAT A CONSULTATION THAT
WOULD TAKE PLACE -- IN A
PROVIDER'S OFFICE THAT COULD BE
DONE VIA TELEMEDICINE THERE'S
SOMETHING THERE SOME SERVICES
THAT ARE NOT APPROPRIATE BE TELL
US AND OBVIOUSLY BUT TO THE
EXTENT THAT IT COULD BE DONE.
THAT THEY COULD BILL FOR IT AND
HOW TO DO THAT AND SO WE
PROVIDED PRETTY EXPLICIT --
INSTRUCTIONS THROUGH ALL OF THE
DIFFERENT ON THE PROVIDER MANUAL --
OUR PROVIDER BULLETINS -- AND
THINGS LIKE THAT SO I'M HAPPY TO
PROVIDE THAT BECAUSE IT'S PRETTY
TECHNICAL AS TO SEE HOW WE SAID
IT COULD BE DONE BUT IT WAS OUR
INTENTION TO MAKE SURE.
THAT IF IT'S APPROPRIATE -- THEN
THE CONSULTATION SHOULD TAKE
PLACE VIA TELEMEDICINE AND YOU
WOULD BILL IT AS YOU NORMALLY
WOULD.
WELL I WOULD JUST SAY I GUESS IT
THAT'S DOESN'T APPEAR.
FROM THE PLANE'S PERSPECTIVE
THAT IS WORKING THAT WELL -- AND
THE COULD WE IN OTHER WORDS YOU
COULD BE DOING MORE WITH THAT I
THINK THAT'S THE IMPLICATION
THAT'S GREAT FEEDBACK -- SO.
BEEN LISTENING TO THE OUTSIDE OF
THE AUDITOR THEY SAID THAT.
THE DA SAYS WASN'T PARTICULARLY
SURPRISED BY.
SOME OF THE THINGS THAT THEY
WERE POINTING OUT ARE ASKING --
I GUESS IT WOULD HAVE AND A HALF
MILLION PEOPLE IN MANAGED CARE
AND YOU KNOW TWO AND A HALF
MILLION KIDS THAT ARE NOT
GETTING CARE ON A REGULAR BASIS.
HOW LONG THE JUNO?
UP ABOUT THIS.
AND AND WHAT IT WHAT IT WHAT'S
BEEN GOING ON IN THE BACKGROUND
I KNOW YOU KNOW THERE'S A NEW
DASHBOARD THIS BEEN GOING ON BUT
THIS IS THIS ISN'T SOMETHING
THAT JUST APPEARED OVERNIGHT.
HOW LONG DID YOU KNOW OR OR MAKE
ME THAT'S NOT A FAIR QUESTION
HAVE YOU BEEN ACTIVELY WORK HAS
THE DEPARTMENT ACTUALLY BEEN
REALLY WORKING ON THIS?
BECAUSE I WILL SAY THAT FROM MY
PERSPECTIVE WHEN I SAW THE AUDIT
I WAS PRETTY SHOCKED -- IT'S
PRETTY HARD TO MISS PLACE TWO
AND A HALF MILLION KIDS.
SURE I THINK -- A COUPLE THINGS.
THE ADDITION OF THE PREVENTIVE
SERVICE CODES -- IN LAST YEAR'S
BUDGET WHEN WE ADDED THOSE TO
THE PROP.
FIFTY SIX CERTAINLY REFLECTED --
BOTH OUR INTEREST IN
UNDERSTANDING THAT -- PROVIDERS
IF INCENTIVIZE TO BILL.
AN EXAM CODE A STANDARD EXAM
CODE WOULD BY PASS THE
APPROPRIATE CODE THAT THEY
PROBABLY SHOULD BE -- BILLING I
THINK WHAT WE HAVE BEEN DOING
OVER THE LAST COUPLE OF YEARS
HAS BEEN -- NOT NECESSARILY
IGNORING CHILDREN BUT WE HAVE
BEEN BUILDING THE BASE
INFRASTRUCTURE -- TO EVEN HAVE
THE DATA TO UNDERSTAND WHAT'S
HAPPENING AT A MORE AND MORE
GRANULAR LEVEL -- OUR PLANS HAVE --
MEDICAL GROUPS THAT OBVIOUSLY
YOU KNOW A PLAN WILL CONTRACT
WITH.
A CERTAIN IPA OR CERTAIN MEDICAL
GROUP AND SO THE DATA QUALITY
THE MORE THAT IT GETS DELEGATED --
THE HARDER IT IS FOR THAT DAY TO
COME BACK IN A BETTER WAY AND SO
WE HAVE BEEN WORKING WITH THE
PLANTS AROUND THE PROVIDER FILES
THAT WE GET.
AROUND THE ENCOUNTER DATA
SUBMISSIONS -- SOME OF THOSE
THINGS -- HAVE TAKEN AND A WHILE
TO BOTH -- IMPLEMENT AND THEN
ONCE YOU HAVE THE DATA COMING IN
YOU'RE LOOKING AT IT SAYING
ALRIGHT WHAT A MY SCENE HERE IN
TERMS OF THE MANAGEMENT SUMMARY.
I THINK THAT -- IT WAS CERTAINLY
NOT OUR INTENTION TO TAKE OUR
EYE OFF THIS PARTICULAR AREA OF
THE PROGRAM BUT I THINK THAT --
AS I SAID THERE HAVE BEEN --
SIGNIFICANT OTHER INITIATIVES
UNDER WAY IN OUR DEPARTMENT --
THE SAME PEOPLE THAT WORK MANAGE
CARE ALSO ARE WORKING ON
ACCORDING TO CARE INITIATIVE
WHICH IS OUR DUAL -- INITIATIVE
TO BLEND CARE BETWEEN MEDICARE
AND MEDICAID SERVICES FOR
INDIVIDUALS THAT SIT IN BOTH
PROGRAMS HE WAS JUST HAD A LOT
OF DIFFERENT COMPETING DEMANDS
AND SO I THINK THIS AUDIT WAS A
REALLY GOOD -- REMINDER FOR US
TO REFOCUS -- ON SOME OF THE
BASIC -- UNDERPINNINGS OF WHAT
THE PROGRAM IS SUPPOSED TO BE
DOING IN TERMS OF PREVENTIVE
SCREENINGS AND THAT'S NOT JUST
CHILDREN RIGHT -- WE'RE ADDING
NOT ONLY THE CHILD METRICS BUT
ALSO THE ADULT MEASURES AS WELL
TO THE EXTERNAL KIND ABILITY SET --
WE'RE RECOGNIZING THAT WE SERVE
A LOT OF VULNERABLE POPULATIONS
NOT JUST CHILDREN THIS AUDIT
CERTAINLY PUT A VERY STRONG
EMPHASIS AND HIGHLIGHT ON
CHILDREN IT IS CONSISTENT WITH
THE GOVERNOR'S -- INTEREST IN
DOING ON A LOT OF WORK TO
IMPROVE SERVICES IN THIS AREA
BUT WE ARE ALSO A PROGRAM THAT
SERVES.
SENIORS AND PERSONS WITH
DISABILITY AND SINGLE CHILDLESS
ADULTS AND SO -- A LOT OF THE
AUDIT IS GOING TO HAVE
RAMIFICATIONS FOR US MORE
BROADLY IN TERMS OF HOW WE HOLD
THE PLANTS ACCOUNTABLE FOR A
VARIETY OF PREVENTIVE SERVICES
NOT JUST RELATING TO KIDS -- I
KNOW THAT -- CORRECT I GO TO A
VARIETY OF THINGS HERE BUT I WE
ALSO ALSO HAVE ANOTHER PANEL.
TO OTHER STATES SEEM TO BE DOING.
THEY HAVE INCENTIVES SAY THAT
BUT YOU KNOW STATES LIKE IOWA --
HAWAII LOUISIANA.
ARE WE GOING TO IMPLEMENT SOME
SORT OF INCENTIVES OR ARE WE
GONNA DO SOMETHING PROACTIVE. TO
GET OR OR OR IS THIS GOING TO
CONTINUE TO DELEGATE TO THE
PLANS TO DO THAT TO ME.
I THINK WE HEARD FROM THE
AUDITOR WAS THAT THE PLANS.
DID WHAT THEY WERE BEING.
YOU KNOW CHECKING ON THERE BUT
THAT WAS AND THAT WASN'T THE
FULL PICTURE SO WE'RE GONNA
CHECK ON MORE THINGS THAT'S
GREAT BUT BUT IS THERE ANY AYE
IN ANY AND LOOK AT IT OTHER WAYS
TO BE.
MORE CREATIVE AND I JUST.
YES SIR SORT OF A SORT OF A LACK
FOR FOR UNDERSTAND WHY WE WERE
SO FAR BEHIND THESE OTHER STATES%
SO I THINK SOME OF THE INCENTIVE --
AND INNOVATION IS COMING THROUGH --
VALUE BASED PURCHASING -- WE
HAVE NEVER DONE THAT BEFORE AND
SO ON YOU KNOW AS THE GOVERNOR'S
PROPOSED IN THE LEGISLATRE
STILL NEEDS TO AGREE WITH HIS
PROPOSAL -- AROUND THAT
INITIATIVE -- THAT IS IN SOME
CASES OUR INTEREST IN
INCENTIVIZING CHANGES AT THE
LEVEL IN WHICH THE PATIENT CARE
IS DELIVERED -- WE HAVE BEEN.
IN CONVERSATIONS WITH THE PLANS
AROUND DIFFERENT WAYS TO CHANGE
THE RATES IN TERMS OF SURE SAY
BEANS OR ALLOWING THEM TO KEEP A
PORTION.
QUALITY OVER A CERTAIN AMOUNT I
THINK SOME OF THE CHANGES THAT
WE ARE SEEKING TO MAKE IN THE
PROGRAM CONSISTENT WITH THE
RENEWAL OF OUR WAIVER -- OUR
ENTIRE MANAGED CARE PROGRAM IS
IN THE ELEVEN FIFTEEN WAIVER
THERE IS AN OPPORTUNITY THAT WE
BELIEVE -- THAT WILL COME AS A
PART OF THAT DISCUSSION WE'RE
CHANGING THE RATE YEAR WE'RE
DOING A LOT OF DIFFERENT THINGS
TO STANDARDIZE THE BENEFIT
ACROSS THE DIFFERENT.
MEDICAL MANAGE CARE MODELS -- WE
HAVE A PLAN PROCUREMENT THAT'S
COMING UP STARTING NEXT YEAR
THERE'S A LOT OF PLACES IN WHICH
WE ARE.
KIND OF MARCELINE -- AN
OPPORTUNITY TO HAVE A
CONVERSATION WITH THE PLANS
ABOUT PLAN INCENTIVES VERSUS
PROVIDERS CENTERS AND THOSE ARE
VERY DIFFERENT AND FOR NOW WE'VE
CHOSEN TO FOCUS ON THE PROVIDER
INCENTIVES -- AND THE PLAN
INCENTIVES ARE A CONVERSATION
THAT WILL PROBABLY HAPPEN AS A
RESULT OF THE WAIVER RENEWAL AND
THE CHANGES THAT WERE MAKING IN
MANAGED CARE MORE BROADLY.
SO WHAT WHAT WHAT'S REASONABLE
FOR US TO EXPECT IN THE NEXT
YEAR. TWO YEARS.
I MEAN WHAT WE GONNA SEE.
WHAT METRICS ARE YOU GONNA PUT
IN PLACE SO WE CAN MONITOR HOW
WELL YOUR YOU GUYS ARE DOING AS
A DEPARTMENT -- I WOULD HAVE TO
TELL YOU AFTER THIS WHEN I GO
BACK AND CHECK WITH THE TEAM IN
TERMS OF HOW QUICKLY WE WOULD BE
ABLE TO PROVIDE -- DATA AND
INITIAL FEEDBACK ON WHAT THIS
MEASUREMENT YEARS GOING TO LOOK
LIKE.
RIGHT SO THE CHANGES THAT WE ARE
MAKING TO THE PLAN
ACCOUNTABILITY AND ALL OF THE
ADDITION OF THE CHILD AND ADULT
COURSE THAT MEASURES.
ON IS IN THIS CURRENT MEASURE
YEAR I'M NOT SURE ONCE THAT DATA
IS SUBMITTED TO US HOW LONG IT
TAKES FOR US TO KIND OF
AGGREGATED IN A RAW FASHION TO
KIND OF UNDERSTAND WHETHER OR
NOT THERE WERE SIGNIFICANT
CHANGES OR NOT.
I THINK I'M WEIRD LIKE I SAID
I'M AND WE'RE HAPPY TO HAVE A
EVOLVING AND CONTINUING REGULAR
CONVERSATION WITH YOU AROUND
WHAT WERE SEEN AROUND
ALTERNATIVE ACCESS STANDARD
REQUEST WE THINK THAT THAT'S
GOING TO CHANGE.
IN A PRETTY SIGNIFICANT MANNER
THIS YEAR EVEN FROM LAST YEAR --
SO I THINK WHAT YOU WILL HEAR
FROM US IS AN OPENNESS AND
WILLINGNESS TO HAVE AN ONGOING
DIALOGUE IN TERMS OF THIS IS THE
DATA THAT WE SEE -- THESE ARE
THE MEASURES THAT WERE --
STRUGGLING WITH IN TERMS OF WHAT
THE PLANS ARE STRUGGLING WITH --
SUMMER BETTER THAN OTHERS RIGHT
WE HAVE A DASHBOARD OUR PLANS
FOR SEVERAL YEARS NOW -- WE
CHOOSE DIFFERENT QUALITY
MEASURES EVERY QUARTER AND THOSE
DASHBOARDS REFLECT PLANS -- AND
IN EACH AREA AND SO YOU CAN SEE
THE PLANS THAT ARE CONSISTENTLY
RANKED AT THE TOP YOU CAN SEE
PLANS THAT ARE CONSISTENTLY NOT
AT THE TOP -- AND I THINK THAT
IS SOMETHING THAT WE WOULD --
BOTH WELCOME A DIALOGUE WITH AS
WELL AS WE'RE HAPPY TO PROVIDE
THE DATA TO YOU IN TERMS OF WHAT
WE'RE SEEN AND WHAT.
THE PLAN PERFORMANCES AND THEN --
LIKE I SAID THERE'S A LOT OF
INTERVENTIONS THAT WE HAVE KIND
OF UNDER WAY TO KIND OF IT.
CHANGE SOME OF THOSE OUTCOMES.
BUT CERTAINLY IN AND
UNDERSTANDING AND OPENNESS TO
HAVE AND CONTINUE DATA WITH --
DATA SHARING WITH YOU.
WHEN I LOOK AND I LOOK FOR TO
THAT ACTUALLY FOR TWO MORE
DISCUSSIONS AROUND THE
TELEMEDICINE PART OF THIS I
THINK ESPECIALLY IN?
REMOTE RURAL AREAS I THINK
THAT'S A REALLY VALUABLE TOOL
BUT MY IMPRESSION FROM THE PLANS
IS THAT.
THAT THAT THERE IS A DISCONNECT
THE TERROR THAT THAT.
THE DEPARTMENT IS SLOW AND
MOVING ON ON ON IMPLEMENTATION --
THAT'S MAYBE I'M PARAPHRASING SO
THAT BUT IT DOESN'T FEEL LIKE
IT'S IF THIS IS NOT A WELL OILED
MACHINE HERE ON THAT PART NOT
EVEN CLOSE.
IT APPEARS I WILL I HAVE I HAVE
NOTED THAT IT WILL GO BACK.
AND AND WE'RE CERTAINLY HAPPY TO
TALK -- BECAUSE WE CAN PULL.
DATA FROM OUR DATA WAREHOUSE NOW
AND TELL YOU HOW MANY ENCOUNTERS
HAVE BEEN BUILDING A
TELEMEDICINE -- BUT SAM MODIFIER
SO WE'RE HAPPY TO EVEN JUST TELL
YOU WHAT WE HAVE NOW AND TELL
YOU WHAT WE HAD LAST YEAR AND
SEE WHETHER THAT HAS CHANGED
INCREASED REMAINED FLAT.
AND THEN OBVIOUSLY IF WE NEED TO
RE ITERATE THAT CHANGE IN POLICY
WITH THE PLANS -- AND SEE IF
THAT CHANGES THE LEVEL OF BOTH
ACCEPTANCE ADOPTION AN
INTERVENTION -- THAT SOMETHING
THAT WERE WHAT CAN YOU DO
BECAUSE WE THINK IT MAKES --
SINCE BILLS FOR THE PROVIDER AS
WELL AS FOR THE BENEFICIARY IN
WHICH CASES.
OFTENTIMES IT'S MOST BENEFICIAL
FOR THE BENEFICIARY.
DOES THE DEPARTMENT EVER MEANS
ARE EVER IS YOU HAVE GUIDELINES
AND AND THINGS THAT YOU FOLLOW
IS THERE EVER FLEXIBILITY TO
REFLECT.
THE THE UNUSUAL OR OR
CHALLENGING NATURE OF CERTAIN
GEOGRAPHICAL AREAS OR THESE ARE
THE GUIDELINES THIS IS WHAT WE
HAVE TO LIVE WITHIN.
BUT WAIT A SECOND.
I'M IN SISKIYOU COUNTY AND YOU
KNOW.
IT'S ACCESSING CARE IS REALLY
REALLY DIFFICULT.
ARE WE ARE WE BOUND BY THIS IS
THIS IS THIS IS THE GUIDELINE
AND THERE IS NO FLEXIBILITY
THERE IS NO ABILITY -- TO LOOK
AT AN ALTERNATIVE HERE WITH
RESPECT THE FACT THAT.
WE DON'T HAVE SOME ALTERNATIVE
THIS PERSON'S GONNA HAVE TO
TRAVEL FIVE OR SIX HOURS AND WE
MAY BE ABLE TO DO THIS WITH
TELEPHONE TELEMEDICINE OR ARE WE
KIND OF BOUND BY THESE
GUIDELINES I THINK YOU KNOW
OBVIOUSLY AS A DEPARTMENT -- WE
WERE WE TRY REALLY HARD TO BOTH --
WE TRY TO BALANCE FLEXIBILITY
WITH -- RESPONSIVENESS AND
ACCOUNTABILITY -- AND SO AND I
KNOW THAT THE AUDITOR SAID THIS
IN HER PREVIOUS COMMENTS AND
THAT -- SHE FELT THAT WE
DELEGATED TO MUCH TO THE PLANS --
IN SOME CASES WHEN WE DELEGATE
TO THE PLANS WE ARE OFTEN SAYING
WE IN SACRAMENTO DON'T KNOW WHAT
IS HAPPENING AND SISKIYOU COUNTY
AND SO IF THE PLAN IS SAYING.
HEY I'VE GOT BENEFICIARIES THAT
IT'S CHEAPER EASIER AND FASTER
FOR ME TO HAVE THEM GO TO NEVADA --
AND I'D LIKE TO BE ABLE TO SEND
THEM TO NEVADA INSTEAD OF TO
SOMEWHERE IN CALIFORNIA WE DO
DEFERRED OF THE PLANS BECAUSE
THEY ARE ON THE GROUND AND
UNDERSTANDS TRAVEL PATTERNS AND
PROVIDER ARRANGEMENTS IN
CONTRACTING -- THAT BEING SAID
SO WE WE VALUE FLEXIBILITY WHEN
WE CAN PROVIDE IT WHEN IT IS
BENEFICIAL TO THE BENEFICIARY
AND WHEN IT IS APPROPRIATE.
IF THE FLEXIBILITY MEANS THAT IT
IS NOT ACCRUING TO THE
BENEFICIARIES.
BENEFIT THEN NOW -- YOU KNOW WE
DON'T WANT TO BE FLEXIBLE IN
THAT AREA AND SO FOR
TELEMEDICINE PURPOSES -- WE LOOK
MAKE THINGS MORE ACCESSIBLE TO
THEM AND TO THE EXTENT THAT IT
HELPS THE PLAN ALSO MADE ITS
NETWORK -- STANDARDS THAT AS A
AS ADDITIONAL BENEFIT BUT THAT'S
NOT THE REASON THAT WE'RE DOING
IT WE'RE DOING IT BECAUSE WE
WANT THE BENEFICIARY TO BE ABLE.
TO RECEIVE IT IN THE MOST
CONVENIENT WAY POSSIBLE -- IF
TELEMEDICINE'S THE CASE GREAT IF
IT'S NOT THEN IT'S SOMETHING
ELSE -- THE CHANGE IN THE
TRANSPORTATION BENEFIT A COUPLE
OF YEARS AGO WAS DONE FOR A
REASON -- THE PLANS NOW HAVE
RESPONSIBILITY TO PROVIDE
TRANSPORTATION BOTH MEDICAL.
NON EMERGENCY MEDICAL
TRANSPORTATION AS WELL AS NON
MEDICAL TRANSPORTATION THE TWO
WERE DIFFERENT -- FOR ALL OF
THEIR MEMBERSREGARDLESS OF THE
SERVICE THAT THEY'RE GETTING
WHETHER OR NOT THAT SERVICES THE
PLANT'S RESPONSIBILITY OR NOT.
OUR MANAGED CARE PLANS HAVE
RESPONSIBILITY TO PROVIDE
TRANSPORTATION TO DENTAL
SERVICES FOR EXAMPLE OR TO
SPECIAL TO MENTAL HEALTH
SERVICES.
AND SO THAT WAS REALLY OUR
EFFORT AN INTENTION TO MAKE IT
EASIER FOR THE BENEFICIARY TO
GET TO THE SERVICES THAT THEY
NEED AND IF TRANSPORTATION WAS
THE PROBLEM THAT WE WERE PUTTING
THE PLANS FULLY IN CHARGE OF
PAYING FOR THAT TRANSPORTATION
AND THAT HAS CERTAINLY BEEN A
BENEFIT.
THAT WE HAVE HEARD -- AND WE
WILL SEE CERTAINLY IN OUR RATE --
TEMPLATE THAT THAT HAS BEEN USED
IN A PRETTY SIGNIFICANT WAY AND
THAT WAS THE INTENTION IS WE
WANT TRANSPORTATION USED IF IT
IF THAT'S THE CHANGE THAT NEEDS
TO HAPPEN.
SO I THINK -- THERE'S A LIKE I
SAID EACH.
EACH -- CHALLENGE AN OPPORTUNITY
IN OUR PROGRAM REQUIRES
INTERVENTIONS AT DIFFERENT
LEVELS AT DIFFERENT TIMES FROM
DIFFERENT ENTITIES IN DIFFERENT
PLACES BUT WE TRY REALLY HARD TO
BE REASONABLE AND A PLANE COMES
WORKING FOR ME.
AND I NEED YOU TO MAKE THIS
MODIFICATION.
TO THE CONTRACTOR THE BENEFIT --
WE TRY REALLY HARD TO DO THAT IF
IT MAKES SENSE -- WE HAVE PLANS
THAT HAVE.
UNIQUE FEATURES -- YOU KNOW I
LIKE TO USE -- HEALTH PLAN OF
SAN MATTEO WHICH IS A GREAT PLAN --
THEY PAY FOR ANTI PSYCHOTICS
EVEN THOUGH NO OTHER PLAN IN THE
STATE IS RESPONSIBLE FOR THE
PROVISION OF ANTI PSYCHOTICS
IT'S A CARVED OUT BENEFIT TO FEE
FOR SERVICE.
DON'T ASK ME WHY HEALTH PLAN SO
MATTEO PAYS FOR ANTI PSYCHOTICS
AND DON'T ASK ME WHY WE AGREED
TO ALLOW THEM TO PAY FOR ANTI
PSYCHOTICS BUT THEY DO.
AND THERE'S PROBABLY SOME
HISTORY AS TO WHY THAT OCCURRED --
SO WE DO THERE'S TONS OF THOSE
LITTLE EXAMPLES BURIED IN OUR
PROGRAM WHERE WE HAVE MADE
ALLOWANCES AND CHANGES AND
FLEXIBILITY -- SOME OF THAT MAY
NEED TO CHANGE JUST GIVEN THE
BROADER GOALS THAT WE HAVE BUT
WE DO LIKE TO THINK OF OURSELVES
AS TRYING TO DO RIGHT BY THE
BENEFICIARY WHEN SOMEONE COMES
AND ASKS FOR US TO DO THAT.
AND FINALLY I APOLOGIZE I KNOW A
LOT OF QUESTIONS BUT THAT'S JUST
MY NATURE -- ARE THERE TIMES I
MEAN YOU YOU SAID I WAS THE
PLANS HAVE THE RESPONSIBILITY TO
PAY FOR TRANSPORTATION -- TO
CERTAIN KINDS OF APPOINTMENTS --
AT THE BELIEVE I'VE HEARD ENOUGH
I'M AND I'M NOT I DON'T BELIEVE
IN MAKING THIS UP BUT THERE ARE
TIMES WHEN THE PLAN PAYS MORE IN
TRANSPORTATION.
IN THE CONSULTATION WOULD HAVE
COSTED -- AND SO.
HOW OFTEN DOES THE PLAN HAVE THE
ABILITY TO THEN -- CONTRACT WITH
SOMEONE LOCAL SO THAT THAT THAT
IF ISSUE DOESN'T HAVE TO DO THAT.
AND WOULD NOT NECESSARILY BE A
MORE COST EFFECTIVE WAY OF DOING
THINGS SOMETIMES -- SO DID IT
DEPENDS RIGHT SO IT DEPENDS ON
THE CONSULTATION -- IF A
BENEFICIARY NEEDS TO BE SEEN BY
A CERTAIN SPECIALTY PROVIDER AND
THAT SPECIALTY PROVIDER IS.
A HUNDRED MILES AWAY THEN THE
PLAN HAS TO PAY FOR THAT BENEFIT
SURE TO GET THERE IF THEY
OTHERWISE DON'T HAVE.
TRANSPORTATION TO DO THAT EVEN
IF IT COSTS MORE TRANSPORTATION
BECAUSE THE PLAN IS RESPONSIBLE
TO MAKE SURE.
THAT THE MEDICALLY NECESSARY
SERVICE -- IS DONE BY THE
APPROPRIATE PROVIDER IF SOMEONE
NEEDS TO SEE A CARDIOLOGISTS.
THEN THE PLAN HAS TO PAY TO GET
THEM TO SEE THAT CARDIOLOGISTS --
IT DOESN'T MAKE SENSE FOR THEM
TO SEE A G. P. -- WHEN A
CARDIOLOGISTS IS THE INDIVIDUAL
THAT NEEDS TO BE SEEN THAT
PATIENT AND SO IT REALLY KIND OF
DEPENDS ON A PATIENT BY PATIENT
BASIS BUT -- THE PLAN IS
RESPONSIBLE FOR TRANSPORTATION --
BUT THAT'S WHY WE HAVE A RATE
PROCESS AND WHICH PLANS ACCOUNT
FOR THE COSTS.
AND THE AND PROVIDING THOSE
VARIOUS SERVICES AND THEN OUR
ACTUARIES INCORPORATE THAT INTO
THE RATE GOING FORWARD.
SO THERE'S A THERE'S AN
ACCOUNTING FOR THAT COST -- IN
THEIR RATE TEMPLATES.
SO THEY'RE NOT ALWAYS REQUIRED
TO EAT THE LOS THAT'S CORRECT.
OKAY WE'VE HEARD FROM A LOT OF
YOUR AS WELL AND I APOLOGIZE I
THOUGHT THAT WAS -- THAT THAT
THERE ARE TIMES WHEN WHEN THE
BENEFICIARY IS TRAVELING TO A
PRIMARY CARE PROVIDER AND
THEY'RE HAVING TO DO THAT.
THEY HAVE A HARD TIME BELIEVING
THAT THERE ARE PRIMARY CARE
PROVIDERS ALONG THE WAY -- BUT
THAT DOESN'T FEEL VERY HELPFUL
TO THE BENEFICIARY -- SO WAS THE
PLAN THAT JUST READ THE IS IS IT
UP TO THEM TO SAY WE'RE JUST
GONNA TRY TO WE WERE NOT GOING
TO CONTRACT WE'RE GOING TO WE'RE
GOING TO SEND THAT PERSON WITH A
CONTRACT -- WE WE CAN'T CONTRACT
BECAUSE WE CAN'T GET THE RATES
THAT WILL BRING THAT PROVIDER ON
YEAH AND AGAIN IT GOES BACK TO
THE SPECIFICS OF THE GEOGRAPHY --
YOU KNOW.
WERE ALWAYS CLEAR TO SAY --
PLANTS HAVE TO PROVIDE ACCESS TO
ALL MEDICALLY NECESSARY SERVICES
I DO THE APPROPRIATE PROVIDER --
AND THAT'S BOTH PRIMARY AND
SPECIALTY CARE -- THEY DON'T
HAVE TO GUARANTEE ACCESS TO A
PARTICULAR PROVIDER SO IF A
BENEFICIARY SAID I REALLY LIKE --
DOCTOR BOB HE'S FANTASTIC AND I
WANT TO SEE DOCTOR BOB AND IF
THE PLAN DOESN'T HAVE A CONTRACT
WITH DOCTOR BOB.
THE PLAN HAS TO MAKE SURE THAT
THE BENEFITS SURE HAS ACCESS TO
A PROVIDER OF EQUAL -- SPECIALTY
EXPERTISE BE IT.
YOU KNOW WHATEVER DOCTOR BOB IS
BUT IF TALK ABOUT REFUSES TO
CONTRACT -- THAN THE PLAN
DOESN'T HAVE TO SEND THE
BENEFICIARY THERE UNLESS.
IF DOCTOR BOB IS THE ONLY
PROVIDER OF THAT SPECIALTY TYPE
IN WHICH THE PATIENT HAS TO BE
SEEN BY HIM BECAUSE THERE IS NO
ONE ELSE THAT IS EQUIVALENT TO
THAT.
THEN THE PLAN HAS TO SEND THE
BENEFITS YOU THERE AND PAY OUT
OF NETWORK GREAT.
THAT'S THE WAY THE CONTRACT
WORKS AND THAT'S THE WAY THE
ACCESS WORKS.
SO THE PLAN HAS TO MAKE SURE
THAT ALL THE SERVICES ARE
AVAILABLE -- THEY TRY VERY HARD
OBVIOUSLY TO MAKE THEM AVAILABLE
IN NETWORK BUT FOR INSTANCES IN
WHICH PROVIDERS REFUSED TO
CONTRACT -- THEN THEY HAVE TO
SEND THE BENEFICIARY REGARDLESS
FOR PRIMARY CARE -- I WOULD SAY
I THINK THAT'S A LITTLE BIT LESS
OF AN ISSUE JUST BECAUSE THE
BACKBONE OF OUR PRIMARY CASH
CARE SYSTEM IS THROUGH FQHCS AND
RURAL HEALTH CLINICS AND SO.
EVEN IN AREAS -- SUCH AS YOURS
THAT THEY THERE SO THEY STILL
MAY NEED TO TRAVEL BUT THE
LIKELIHOOD OF AN FQHC BOTH
CONTRACTING AND TAKING THOSE
PATIENTS IS IS PROBABLY NOT AS
MUCH OF AN ISSUE AS IT WOULD BE
LIKE A SPECIALTY PROVIDER THAT
JUST SIMPLY DOESN'T EXIST OUT
THERE [inaudible]
THANK YOU.
RIGHT THANK YOU I ORDERED A MOVE
TO CENTER MORE LACK OF BOOKS
THAT ARE MORE LIKE HAS CLOSED.
THANK YOU MISTER.
JUST THAT THAT YOU MAY ALREADY
COVERED THIS I APOLOGIZE FOR
COMMINGLED.
WITH WITH A WONDERFUL AFTERNOON
CALENDAR HELLO BUT HEAVY HELLO
MISS CAN'T HOW ARE YOU GOOD HOW
ARE YOU I'M PLUGGING ALONG -- I
I CERTAINLY CAL OPTIMA BOARD AN
ORANGE COUNTY FOR FOUR YEARS AS
WELL BACK IN THE OLD DAYS WHEN
WE HAD TO WAIT FOR THE BUDGET.
TO BE APPROVED LIKE IN AUGUST
SEPTEMBER SOMETIMES OCTOBER.
BUT A ONE OF THE KEY FINDINGS IS
THAT -- MANY FAMILIES DO NOT
HAVE ADEQUATE ACCESS TO HEALTH
CARE PROVIDERS DUE IN PART TO
LOW MEDI CAL REIMBURSEMENT RATES.
SOME OF THE LOWEST IN THE NATION
AND SO WE EXPERIENCE THAT WHEN
THERE WAS A BUDGET CRISIS SERVE
RECESSION.
THE THE THE THE DOCTORS WOULD
GET A 10% CUT IN JUST SEEM LIKE
THAT HAPPENED A COUPLE TIMES I'M
JUST WONDERING SINCE THE
RECESSION HAVE.
THOSE CUTS BEEN RESTORED AND AND
AND HAVE WE GOTTEN BACK UP.
TO STATE. TWO THOUSAND FIVE
LEVELS AND WHAT ARE THE BUDGET.
PROPOSALS THAT YOU'LL BE MAKING
TO MAYBE RAISE THE RATES SO WE
CAN.
COMPENSATE OUR MEDICAL
PROFESSIONALS A LITTLE BETTER
SURE THAT'S A IT IS A MULTI --
STAGE QUESTIONS SO I WILL I WILL
TRY AND ADDRESS AT ALL -- SO THE
AB NINETY SEVEN CUT THE 10% --
PHYSICIAN CUT HAS NOT BEEN
RESTORED -- SO THAT IS STILL --
IN A FAX -- IN FEE FOR SERVICE
AS WELL AS THERE'S A WE CARRY
THAT THAT -- REDUCTION IN THE
MANAGED CARE RATES BUT IT'S IT'S
TREATED A LITTLE BIT DIFFERENTLY
SO LET ME ADDRESS THAT
SEPARATELY -- THE AB NINETY
SEVEN CUTS HAVE BEEN RESTORED IN
CERTAIN AREAS -- THE LEGISLATURE
MOST NOTABLY RESTORED THE DENTAL
CUT.
IN -- TWENTY FIFTEEN TWENTY
SIXTEEN SO THAT WAS RESTORED BUT
IN THE PHYSICIAN SIDE THAT HAS
NOT YET BEEN RESTORED -- WHEN
PEOPLE TALK ABOUT MEDICARE RATES
BEING SOME OF THE LOWEST IN THE
COUNTRY THEY'RE USUALLY
REFERRING TO THE FEE FOR SERVICE
SCHEDULE -- SO IN FEE FOR
SERVICE WE HAVE RATES ESTABLISH
FOR CERTAIN CODES AND THEY LOOK
AT THOSE CODES AND THEY SAY IT'S
YOU KNOW STANDARD EXAM CODE IS.
FIFTY DOLLARS AND SO THEREFORE
THAT SLOWER THAN ANY OTHER STATE --
IN MANAGED CARE THE MANAGED CARE
PLANS AND THE ACTUARIAL RATES
THAT WE SET ARE NOT TETHERED OR
TIED IN ANY WAY TO THE FEE FOR
SERVICE RATE SCHEDULE.
SO PLANS HAVE -- RATES THAT ARE
BUILT ON THEIR ENCOUNTERS THEIR
COSTS THEIR UTILIZATION OF
SERVICES -- AND THOSE DO NOT
REFLECT NECESSARILY WHAT THE FEE
FOR SERVICE RATES ARE SO PLANS
AND I HAVE BEEN IN THIS --
COMMITTEE ROOM ONE PLANS OF
TESTIFIED THAT THEY PAY A 100%
OF MEDICARE OR THEY PAY ABOVE
MEDICARE RATES FOR CERTAIN
SERVICES WITH CERTAIN PROVIDERS.
AND THAT IS FINE -- WE ALLOW IT --
WE ACCOUNT FOR IT WHEN THEY TURN
IN THEIR RATE -- DATA TO US AS
WE BUILD THEIR RATES ONGOING WE
OBVIOUSLY HAVE MITIGATION
STRATEGIES AND PLACE SUCH THAT.
A PLANE COULDN'T JUST SAY I'M
GOING TO BE.
REALLY GENEROUS AND GIVE.
YOU KNOW 4100% OF MEDICARE TO
EVERYONE BECAUSE WE DO SOME
COUNTY ADJUSTMENTS AND WE HAVE
SOME OTHER THINGS -- IN PLACE
BUT PLANS HAVE TO MAINTAIN AN
ADEQUATE NETWORK AND IN ORDER
FOR THEM TO MAINTAIN AN ADEQUATE
NETWORK THEY HAVE TO PAY RATES
AND WHICH PROVIDERS ARE WILLING
TO CONTRACT WITH THEM.
THAT IS IN NO WAY -- BEING
IMPACTED BY THE FEE FOR SERVICE
RATE SCHEDULE AND SO THOSE TWO
ARE HANDLED VERY DIFFERENTLY AS
AS WE SAT RATES AND SO.
I'M HOPING THAT THAT ADDRESSES
YOUR QUESTION IN SOME PART JUST
BECAUSE IF YOU ARE A PLAN AND
YOU ARE CONTRACTING WITH
PROVIDERS.
THE NEGOTIATION AND THE
CONTRACTS AND THE FINANCING THAT
FLOWS IS IS VERY DIFFERENT THAN --
OTHER PARTS OF THE OF THE
PROGRAM.
SO WE'RE AT ENJOYING MAYBE A
BUDGET SURPLUS AND SO OUR NEW
GOVERNOR IS.
FOUND A LOT OF PLACES TO PUT
TWENTY ONE AND A HALF BILLION
DOLLARS I'M JUST WONDERING DID
YOU WORK WITH THE DEPARTMENT OF
FINANCE IS A EIGHT WE'VE GOT TO
START [inaudible]
HELPING.
OUR SERVICE PROVIDERS SO THAT WE
CAN MEET.
NO GROUP OF PEOPLE IN THE STATE
ONE IN FIVE THEIR EVERY LEVEL.
THIS IS THIS WOULD BE A GOOD
PRIORITY WAS WILL WAS THAT DONE
YEAH SO THERE'S SEVERAL PLACES --
THAT WE HAVE BEEN WORKING WITH --
DEPARTMENT OF FINANCE AND THE
ADMINISTRATION MORE BROADLY
AROUND THE APPLICATION OF THE
PROPOSITION FIFTY SIX FUNDS --
SO -- THE IMPORTANCE OF THOSE
FUNDS AS AN ADDITIVE AND A
SUPPLEMENTAL AMOUNT COMPARED TO
THE BASE FUNDING THAT THE
GENERAL FUND PAYS -- FOR CANNOT
BE UNDERSTATED RIGHT THEY HAVE
BEEN TARGETED THEY HAVE BEEN --
AIMED AT PLACES IN THE PROGRAM
THAT WE FELT NEEDED THE MOST --
HELP SO NOT ONLY FOR PHYSICIANS
AND DENTISTS BUT PROPOSITION
FIFTY SIX FUNDS HAVE BEEN USED
FOR HIV AIDS WAIVER AGENCIES FOR
INTERMEDIATE CARE FACILITIES FOR
THE DEVELOPMENTALLY DISABLED.
FOR WOMEN'S HEALTH SERVICES FOR
PEDIATRIC SUB ACUTE -- THERE
WERE SOME TARGETED FUNDS LAST
YEAR PROVIDED FOR SEA BASS
DISABILITIES AND OTHERS AND SO --
WE HAVE A BIG PROGRAM AND WE
LARGELY LOOK AT AREAS IN WHICH
WE FEEL -- ACCESSES --
PROBLEMATIC LAST YEAR THERE WAS
A HOME HEALTH -- RATE INCREASE
FOR HOME HEALTH AGENCIES A 50%
RATE INCREASE THAT WAS -- BOTH
PROPOSED AND APPROVED BY THE
LEGISLATURE.
SO I WOULD SAY THAT THOSE ARE --
THE DEPARTMENTS -- AREAS IN
WHICH WE HAVE BOTH SIDES AND HAD
AGREEMENT THAT RATE
AUGMENTATIONS AND INCREASES WERE
APPROPRIATE AND SO THAT IS ALL
ACCORDING TO THE BENEFIT OF THE
BENEFICIARY ULTIMATELY.
GREETING JUST A COUPLE QUICK
QUESTIONS -- YOU HAVE SOFTWARE
TO MONITOR ALL OF I WILL LIKE TO
SOFTWARE.
I SO WE HAVE LOTS OF SOFTWARE WE
HAVE IS. TO TO HANDLE THE JOB
BECAUSE WE GET SO MANY.
SAD STORIES ABOUT SOFTWARE SO
I'M JUST WONDERING IF YOUR IDEAS
YES.
YES MY CHALLENGES -- IT
KNOWLEDGE MEANT -- EARLIER -- WE
HAVE CHALLENGES AND THE
INFORMATION TECHNOLOGY AREA --
WITHIN OUR ENTERPRISE AT THE
DEPARTMENT WE HAVE OVER A
HUNDRED DISTINCT IT SYSTEMS --
AND SO THE CONTINUED EVOLUTION
OF THOSE SYSTEMS -- AND THE
PROCESS BY WHICH THAT GETS DONE
IS CHALLENGING -- IT IS LONG --
SOMETIMES IT HAS OVERSIGHT BY
BOTH THE DEPARTMENT TECHNOLOGY
THE DEPARTMENT OF FINANCE -- AND
THEN WE BECAUSE WE'RE MEDICAID
AGENCY WE HAVE TWO AND WE'RE
USING FEDERAL FUNDS WE HAVE
OVERSIGHT PROVIDED BY THE
FEDERAL GOVERNMENT FOR I. T.
PROJECTS.
SO I KNOW THAT -- WE HAVE A LOT
OF SIGNIFICANT INFRASTRUCTURE
NEEDS THAT -- NEED TO BE UPDATED
SOME OF THOSE ARE IN PROCESS SO
MEDS IS OUR DATABASE OF RECORD
IT'S OVER FORTY YEARS OLD IT'S A
COBALT DATABASE.
AND IT IS THE BACKBONE OF OUR
ENTIRE PROGRAM -- AND SO.
IF YOU'RE WILLING TO INDULGE A
JOKE ON MEDS I LIKE TO SAY THAT
IT IS -- EXTRAORDINARILY SAFE
BECAUSE NO ONE HAS FIGURED OUT
HOW TO HACK A COUPLE -- AND THAT
WHEN WE NEED PROGRAMMERS WE
RECRUIT RECRUIT FROM SKILLED
NURSING FACILITIES SO THERE'S MY
MEDS DATABASE JOKE BUT I. T. IS
A CHALLENGE FOR US AND THAT IS
SOMETHING THAT WE STRUGGLE WITH
AND WE WISH WE WERE FASTER.
AT BEING ABLE TO MODIFIER
SYSTEMS -- SOME OF THAT IS JUST
THE NATURE OF STATE LARGE STATE
I. T. PROJECTS -- THAT YOU KNOW
ARE SIGNIFICANT IN NATURE AND SO --
THE PROGRAMMING AROUND RATE
INCREASES HAS CERTAINLY BEEN
SLOW -- BECAUSE WE HAVE A AGAIN
A SYSTEM THAT DOES OUR CLAIMS
FOR FEE FOR SERVICE AND
PROGRAMMING THAT SOME TAKE
SOMETIMES TAKES UP TO A YEAR.
IN ORDER THE MONEY'S GOOD IT
FLOWS BACK TO THE DATE THAT THE
RATE INCREASE WAS PROVIDED BUT
IN SOME CASES THAT LACK HAS BEEN.
YOU KNOW SIX NINE TEN MONTHS AND
SO WE ACKNOWLEDGE THAT AND WEIRD.
WE HAVE THAT ON ON THE SCHEDULE
TO IMPROVE AND AND MODERNIZE
THAT SYSTEM.
SO LAST QUESTION AND MAYBE FIFTY
WORDS OR LESS.
WHAT WAS YOUR REACTION OR OF OF
THE AUDIT -- YOU KNOW I DON'T
LIKE GETTING OUT IT'S LIKE THIS --
I LIKE TO THINK THAT OUR PROGRAM
IS CONSTANTLY IMPROVING -- THIS
WAS CERTAINLY -- AUDIT IN WHICH
WE ACKNOWLEDGE AND NEED TO DO
BETTER -- AND SO WE'RE COMMITTED
TO DOING THAT -- IN SOME CASES I
THINK THAT -- IT WAS A FAIR --
ASSESSMENT OF THE DATA AND SO
YOU CAN'T.
YOU CAN'T FAULT THE DATA AND SO
WE ARE LOOKING AHEAD AS TO HOW
WE IMPROVE HOW WE HOLD OUR PLANS
ACCOUNTABLE HOW DO WE MAKE SURE
THAT SERVICES ARE ARE BEING
DELIVERED TO THE FAMILIES AND
THE CHILDREN THAT WE SERVE AND
WE'RE COMMITTED TO DOING BETTER.
THANK YOU MS THANK YOU MISTER
CHAIR.
THANK YOU AND TERM OR LACKEY ONE
OF THE THINGS IN THE US ABOUT
THE BUDGET EARLIER. ONE OF THE
THINGS I FOUND FASCINATING AND
THIS YEAR'S BUDGET COMPARED TO A
PREVIOUS YEARS BUDGETS AS ALL
THE PROPOSITION FIFTY SIX MONEY
RIGHT NOW IS ALLOCATED ACTUALLY
TO HELP TOWARDS -- MEDICARE
REIMBURSEMENT RATES WERE BEFORE
IT WAS DIVVIED UP.
SO TO YOUR PREVIOUS QUESTION
WHAT THAT WILL MOVE TO ASSEMBLY
WOMAN WATER.
THANK YOU I'M JUST REALLY
BRIEFLY ONE OF THE THINGS THAT
HAS ALWAYS BEEN A PRIORITY OF
MINE IS TO MAKE SURE THAT --
CHILDREN ESPECIALLY IN WITH
VARYING ETHNIC BACKGROUNDS --
THAT THEIR PARENTS ARE ABLE TO
ACCESS CARE.
IN NAVIGATE A VERY COMPLEX
SYSTEM THAT EVEN FOR US WITH
INSURANCES HARD TO NAVIGATE --
AND TALK ABOUT THE HEALTH
DISPARITIES YOU KNOW BETWEEN
ETHNIC BACKGROUNDS AND ACCESSING --
HOW YOU KNOW BEYOND MAILINGS TO
THEM AND IN DIFFERENT LANGUAGES
BECAUSE SOMETIMES IT'S HARD TO
EVEN GET THAT INTO THE HANDS OF
THE ACTUAL CARE GIVER -- WHAT WE
IS COULD THAT BE IMPROVED AS FAR
AS BEING ABLE TO TARGET?
YOU KNOW -- COMMUNITIES OR
PEOPLE WHO NEED TO ACCESS CARE
WE'RE LOOKING AT THAT CRAP
EARLIER THE DROP OFF IN A YEAR
ONE AND YEAR TWO WE WERE SAYING
WELL OBVIOUSLY THAT'S THOSE
YEARS IN BETWEEN BEFORE THEY
START PRESCHOOL.
YOU KNOW WHEN IT'S KINDA KICKS
BACK UP WAS WHAT WE'RE LOOKING
AT YEAH I REMEMBER WHEN MY SON
WAS BORN WE GOT A LOT OF STUFF.
IN THE MAIL FROM YOU KNOW EVEN
YOU KNOW PAMPERS OR JANE JAY OR
WHATEVER WOULD SEND US WITH
SAMPLES AND THEY ALWAYS INCLUDE
THE VACCINE SCHEDULE OR MAKE
SURE YOU HAVE YOUR WELL BABY.
BUT THEN AFTER THAT IT KIND OF
DROPPED OFF.
UNTIL WE START SCHOOL IN IN THIS
MORE OF A SOCIAL NETWORK YOU'RE
EVEN TO THE THE SCHOOL SYSTEM OR
DAY CARE OR WHATEVER.
HOW WHAT WAYS CAN THAT IMPROVE
THAT YOU KNOW IF THEY'RE NOT
ACTUALLY SEEING THE PRIMARY CARE
OR A PEDIATRICIAN?
THAT.
THERE'S A WAY TO COMMUNICATE IN
THE LANGUAGE THAT THEY KNOW SO
THAT THEY CAN ACTUALLY.
NAVIGATION AND YEAH SO I THINK
THAT'S A GREAT QUESTION I THINK
THAT -- YOU KNOW WE'VE BEEN
WORKING WITH OUR OTHER SISTER
DEPARTMENTS -- YOU KNOW
DEPARTMENT OF PUBLIC HEALTH AS
IT PERTAINS TO THE BLACK INFANT
HEALTH PROGRAM.
DEPARTMENT OF SOCIAL SERVICES
WHICH SERVES A LOT OF CAO WORKS
FAMILIES AND HOME VISITING -- I
THINK THAT -- DEPENDING ON THE
DISPARITY THAT YOU'RE TRYING TO
ADDRESS -- THERE ARE SOMETIMES --
APPROPRIATE AND IS CRITICAL --
INTERVENTIONS THAT CAN BE
PROVIDED THROUGH LIKE -- THERE
WE'VE BEEN TALKING ABOUT DOULAS --
TO HELP IMPROVE -- BIRTH RATES
IN THE AFRICAN AMERICAN
COMMUNITY FROM A TODAS -- IN THE
LATINO COMMUNITY -- CERTAINLY
AROUND -- ASTHMA DIABETES
SOMETIMES THE CULTURAL -- DIVIDE
BETWEEN A A BENEFICIARY AND THE
PHYSICIANS OFFICE IS JUST TOO
SIGNIFICANT AND THEY'RE NOT
COMFORTABLE TALKING TO THEIR
PROVIDER AT OR AND WE'VE REALLY
BEEN STRUGGLING IN THE MENTAL
HEALTH AREA RIGHT THERE ARE
CERTAIN.
COMMUNITIES THAT ARE JUST NOT
COMFORTABLE ACKNOWLEDGING OR
SEEKING MEDICAL OUR MISSILE
HEALTH CARE AND SO I THINK --
OUR INTEREST AS A PROGRAM IS
LOOKING AT BOTH TRADITIONAL
PROVIDERS THAT SERVE THAT
COMMUNITY -- AS WELL AS
ALTERNATIVE PROVIDERS THAT CAN
HELP ASSIST IN TERMS OF MAKING
BENEFICIARIES FEEL COMFORTABLE
ARE HELPING DO.
PATIENT AT EDUCATION NAVIGATION
SUPPORT AND SO DEPENDING ON THE
DISPARITY THAT YOU'RE TRYING --
TO ADDRESS THERE'S DIFFERENT
WAYS IN WHICH WE WOULD DO IT BUT
I WOULD CERTAINLY SAY IT'S A
IT'S A MUCH MORE LOCAL COMMUNITY
BASED ORGANIZATION APPROACH AND
IN MY MIND I DON'T THINK IT'S A
STATE -- BASED WAY IN THE END
UNLESS WE'RE JUST PAIN TO HELP
SUPPORT THAT EFFORT AT A LOCAL
LEVEL.
THANK YOU.
AND IF I COULD JUST FOLLOW UP ON
THAT QUESTION SO WOULD DCH US
THEN BE REQUIRING THE PLANS TO
COME UP WITH.
A WAY TO GET AT THESE CULTURAL
DISPARITIES THAT WERE OUTLINED
IN THE AUDIT YOU KNOW I KNOW
BACK HOME YOU MENTIONED IT TO
YOU -- THE FROM WITHOUT US RIGHT
THAT'S A GOOD PROGRAM THAT I SEE
THAT GETS OUT THERE TO TRY TO
GET SOME OF THIS INFORMATION --
BUT IS THIS SOMETHING IN THE
FUTURE S. IS NOW MOVING TOWARDS
MORE TALKING ABOUT --
PERFORMANCE STANDARDS OR MAYBE
REQUIRING -- THE THE PLANTS TO
DO THIS YES SO I THINK PART OF
THE MULTITUDE OF THINGS THAT
WE'RE WORKING WITH THE PLANS ON
TO HELP ADDRESS THESE -- AREAS
AROUND THE AUDIT WAS THE THERE'S
A HEALTH DISPARITIES REPORT AND
PLANS ARE REQUIRED TO DO GROUP
NEEDS ASSESSMENT AND THEY
DEVELOP THEIR OWN SPECIFIC
EVALUATION REPORT I THINK THAT.
EACH PLAYER AS A PART OF THEIR
CONTRACT WITH US ARE REQUIRED TO
DO QUALITY IMPROVEMENT PRO --
PROJECTS AND SO SOME OF THE
THINGS THAT -- WE'RE TALKING
ABOUT HAVE BEEN IDENTIFIED BY
PLANS IN THE PAST AND I THINK WE
WOULD CERTAINLY SUPPORT
ENCOURAGE -- AND HOLD THEM
ACCOUNTABLE TO DO MORE OF THAT
IN TERMS OF HOW DO YOU ADDRESS
DISPARITIES WITHIN YOUR OWN PLAN
SO WE'RE REQUIRING THE PLANS TO
LOOK AT THEIR MEMBERSHIP AND SAY
WE SEE DISPARITIES IN --
MEDICATION MANAGEMENT FOR
HYPERTENSION AND BECAUSE WE SEE
THAT -- THAT YOU KNOW -- Là
MAKING THIS UP -- YOU KNOW OUR
POPULATION WITHIN THIS PLAN THE
AFRICAN AMERICAN POPULATION IS
NOT CONSISTENTLY -- KEEPING UP
WITH ITS MEDICATION MANAGEMENT
THE SAME WAY THAT OTHER
POPULATIONS ARE WE WOULD BE
LOOKING TO THE PLAN TO BOTH
IDENTIFY THAT AS A NEED AND THEN
TO COME TO US WITH A VERY
SPECIFIC WAY AND HOW THEY WANT
TO ADDRESS THAT.
IS SO THOSE ARE SOME OF THE KIND
OF QUALITY -- BOTH OUTCOMES AND
FOLLOW UP THAT WE'RE LOOKING TO
WE'VE DONE IT BEFORE BUT WE'RE
LOOKING TO BE BOTH MORE
CONSISTENT AND MORE INTENTIONAL
AND HOW WE FOLLOW THE PLANS AS
THEY DO THOSE ACTIVITIES ON
THEIR OWN.
YEAH AND I APPRECIATE THAT
BECAUSE I REMEMBER A LOT OF
REPORTED EVEN TALK ABOUT AFRICAN
AMERICANS ONLY BEING AT 40%
UTILIZATION. FOR FOR SOME THINGS
ARE REFERENCING RIGHT WHAT THAT
WAS COULD WE'VE TO ASSEMBLY
WOMAN ACT.
I THANK YOU THANK YOU VERY MUCH
FOR EVERYONE FOR THE
PARTICIPATION TODAY.
YOU JUST MAY JUST SOMEONE JUST
KIND OF PUT A RED FLAG UP ON ME
IN THAT WAS THAT -- YOU HAVE
NUMEROUS SOFTWARE SYSTEMS THAT
YOU ARE WORKING WITH.
AND I'M CONCERNED ABOUT THE
INTEGRATION OF ALL THOSE.
IT MIGHT BE WORKING FOR YOU
TODAY.
I'M MORE CONCERNED ABOUT WHAT'S
GONNA LOOK LIKE IN FIVE YEARS.
AND PARTICULARLY WHEN WE LOOK AT
SOFTWARE -- AND UPGRADES AND
CHANGES IS A SUMMER
INSTITUTIONAL KNOWLEDGE PEOPLE
WILL BE LIVING.
RETIRING.
AND I ALWAYS AND FEARFUL WHEN I
HEAR THAT SOMEONE IS GOING TO
WAIT AND THAT'S NOT.
A TOP PRIORITY RIGHT AWAY A
MAYBE IT IS BUT I'M CONCERNED
THAT THE LONGER WE WAIT THE
INSTITUTIONAL KNOWLEDGE IS GONE.
TO ACTUALLY HELPED IMPLEMENT A
GOOD SOFTWARE SYSTEM IT'S GOING
TO BE RUN AND RUNNING AND ROBUST.
FOR THE DEPARTMENT SO -- DO YOU
HAVE ANY THOUGHTS ON THAT OR
THANK YOU -- AND AND MY CHAU
SEARS ARE PROBABLY BURNING AS I
INVOKE HIS NAME -- SO THERE IS --
A POLICY THAT THE FEDERAL
GOVERNMENT HAS PUT FORWARD TO
MEDICAID AGENCIES IN PARTICULAR
AROUND -- ENTERPRISE MANAGEMENT
SO -- MY TO IS THE MEDICAID
INFRASTRUCTURE AND TECHNICAL
ARCHITECTURE -- AND WE ASA
STATE WHEN WE ARE CLAIMING
ENHANCE FEDERAL FUNDS TO DO
INFORMATION TECHNOLOGY PROJECTS.
IN THE PROCESS OF SEEKING THOSE
ENHANCED FUNDS -- WE HAVE TO
BASICALLY DEMONSTRATE THE
BROADER APPLICABILITY TO LARGER.
AND LARGER PORTIONS OF OUR
ENTERPRISE MEANING THEY DON'T
WANT US TO COME AND JUST SAY I'M
LOOKING.
TO DO ONE SYSTEM FOR THIS ONE
THING THEY WANT TO SEE A A
BROADER -- PROPOSAL THAT
INCORPORATES -- LARGER PARTS OF
THE PROGRAM AND MAKE SURE THAT
WE'RE NOT JUST -- SILO IN ALL OF
THE DIFFERENT TECHNOLOGY.
AND SO -- THOSE FOR FUNDS ARE
SUCH THAT IT IS -- HARD FOR
STATES TO NOT DO THAT IT'S A
NINETY TEN MATCH SO -- WE HAVE --
A SERIES OF CONSISTENT --
IMPROVEMENT PROJECTS THAT WE'RE
DOING -- TO LOOK MORE BROADLY I
WOULD -- NOTE THAT THE COUNTIES
HAVE THREE CURRENT --
ELIGIBILITY SYSTEMS THE
CONSORTIUM AND THE FEDERAL
GOVERNMENT HAS SAID -- AND THEY
ARE ON TRACK TO DO THIS BY
TWENTY TWENTY THREE IS TO
CONSOLIDATE THOSE INTO A SINGLE
SYSTEM FOR THE STATE SO THERE
WILL BE A SINGLE STATEWIDE
COUNTY CONSORTIUM SYSTEM --
WHICH IS A LOT OF WORK -- IT'S
GOING TO REQUIRE A LOT OF CHANGE
THEY HAVE REALLY -- EMBRACED IT
AND WE ARE KIND OF MOVING
THROUGH THAT PROCESS OF HOW DO
YOU TURN THOSE SYSTEMS INTO A
SINGLE SYSTEM BUT YOUR POINT IS
ABSOLUTELY WELL TAKEN AND I
THINK IT'S ONE OF THE THINGS
THAT I REALLY EMBRACE WHEN I WAS
THE DIRECTOR -- WHEN I FIRST
STARTED TWENTY FIFTEEN IS?
THERE'S ADMINISTRATIVE AND
OPERATIONAL INFRASTRUCTURE THAT
HAS TO BE BUILT IF THE PROGRAM
ITSELF IS GOING TO BE STABLE.
TEN TWENTY THIRTY YEARS FROM NOW
AND SO -- IT'S NOT PARTICULARLY
EXCITING FOR A LOT OF PEOPLE BUT
I ACTUALLY HAVE SPENT A FAIR
AMOUNT OF TIME -- ON I. T. JUST
BECAUSE I RECOGNIZE THAT IT
EXISTS LONG AFTER ANY OF US ARE
IN THESE POSITIONS BUT RISK AND
SO I THINK A LOT OF US -- SPEND
A LOT OF TIME WORKING IN THAT
PARTICULAR AREA.
WELL AS WE KNOW WE'VE HAD
PROJECTS WITHIN THE STATE THAT
HAVE NOT BEEN SUCCESSFUL OF HIM.
UPGRADES AND CHANGES THE
SOFTWARE I I DON'T WANT TO BE
ONE OF THOSE DEPARTMENTS YEAH.
I DON'T EITHER BUT I JUST THINK
WE NEED TO BE REALLY VISIONARY
AND TO FACE THE FACT THAT THESE
THINGS TAKE SOME TIME.
ON THE SHOULDN'T TAKE THAT MUCH
TIME BUT YOU KNOW INSTITUTIONAL
KNOWLEDGE DOESN'T ALWAYS WANT TO
GIVE OUT THEIR KNOWLEDGE.
AND IT SLOWS DOWN A PROJECT AND
I'VE BEEN -- INVOLVE SOME OF
THOSE PROJECTS IN THE PAST AND
IT WAS VERY FRUSTRATING SO --
THE SOONER WE GET THOSE PEOPLE
THAT THINK TO GET ON BOARD TO
HELP BEFORE THE GUN -- RETIRE
WHATEVER THAT WOULD BE VERY
HELPFUL BUT I HAVE TO ONE WOMAN
IN MY I. T. SHOP WHO HAS BEEN
WITH US SINCE.
NINETEEN SIXTY NINE AND WE HAVE
HER ON VIDEO SHE HAS TOLD US.
EVERYTHING THERE IS TO KNOW --
SHE IS LOVELY AND SHE'S A
RETIRED SHE CAME BACK AS A
RETIRED ANNUITANT BUT SHE IS
ACTUALLY HELPING LEAD.
A LOT OF THE WORK AROUND HOW DO
YOU EVOLUTION EYES AND MODERNIZE
THE SYSTEM THAT SHE HERSELF
CREATED BACK IN THE EIGHTIES --
AND IT IS.
IT IS REMARKABLE AND SHE'S SHE'S
REMARKABLE BUT I I HEAR YOU
BECAUSE I HAVE THAT EMPLOYEE IN
MY DEPARTMENT [inaudible]
THANK YOU.
RIGHT WITH THAT.
I BELIEVE MISTER WHAT HAS THE
FINAL THE FINAL QUESTION SORRY
IF I COULD JUST.
MAKE ONE REMARK JUST YOU KNOW.
H. TESTIMONY HERE FOR THE
INCREASED -- ACCOUNTABILITY AND
PERFORMANCE METRICS I KNOW -- ME
DOCTOR WOULD HAVE TALKED ABOUT
THIS SEEING THE SIXTY DAY AND
AND THE THE PROGRESS REPORTS AS
A START COMING OUT BUT YOU KNOW
THE I THINK I HEARD FROM YOU
MAKING LANS A LITTLE MORE
ACCOUNTABLE.
INCREASING THAT ACCOUNTABILITY
AND THERE WAS NOTHING THAT YOU
DISAGREED WITH THAT WAS IN THE
AUDIT REPORT -- DO YOU THINK YOU
SAID IT WAS FAIR.
BALANCED AND SO LOOK FOR THAT
MISTER WHAT HAS THE COUPLE
QUESTIONS YEAH -- CLOSE PANEL
THAT YEAH AS AS TALK AS
QUESTIONS GET ANSWERED IT IT'S
THAT SPURS OTHER THOUGHTS AND
AND OTHER QUESTIONS AND ONE WAS
YOU YOU MENTIONED THAT THAT
OBVIOUSLY PLANS HAVE THE ABILITY
TO NEGOTIATE WITH SOME OTHER
PROVIDERS FOR FOR SOME THESE
CONTRACTS.
AND THEN YOU SAID YOU THAT COMS
BACK AS PART OF A REVIEW.
OF LATER ON SO.
DOES THE DEPARTMENT SAY WELL YOU
GUYS BEEN PAYING TOO MUCH AND
JUST TO PUT THE THUMB ON THE
SCALES THERE -- OR HOW DOES HOW
DOES THAT WORK -- IN IN THAT
ENVIRONMENT BECAUSE THOSE ARE
RATES THAT ARE OBVIOUSLY HIGHER.
THAN THAN WHAT THE TYPICAL
ALLOWANCE WOULD BE SO.
I'M GONNA GET MYSELF INTO
TROUBLE -- AND MY RATES PEOPLE
WILL PROBABLY.
TAKE UMBRAGE AT THIS.
SO THERE'S EXTRAORDINARY AMOUNTS
OF DATA THAT COME TO US -- AND
THE RATE DEVELOPMENT PROCESS
FROM THE PLANS -- ACROSS A
VARIETY OF AREAS HOSPITAL
OUTPATIENT PHARMACY.
DURABLE MEDICAL EQUIPMENT ALL
THE DIFFERENT RATE AREAS -- AND
SO TO THE EXTENT THAT PLANS ARE
SEEN INCREASED UTILIZATION OR
INCREASE COSTS.
THAT IS ACCOUNTED FOR IN THE
RATE DEVELOPMENT PROCESS IT
DOESN'T MEAN THAT WE ACCEPT IT --
AT FACE VALUE AND JUST SAY --
YOU KNOW YOU PAID YOU DECIDED TO
PAY A PROVIDER US I MAKING THIS
UP A THOUSAND DOLLARS A
CONSULTATION -- AND SO WE'RE
JUST GOING TO BUILD THAT INTO
YOUR RATES AND THAT'S GOOD WHAT
WE DO IS E HAVE A WAY IN WHICH
WE LOOK AT THAT AND SAY.
YOU KNOW FOR SIMILARLY SITUATED
RATES AND OTHER AREAS ARE YOU
PAYING YOUR PROVIDERS A THOUSAND
DOLLARS A CONSULTATION ARE YOU
PAYING THE FIVE HUNDRED YOU KNOW
AND THEN WE LOOK AT THE OTHER
PLAN IN WHICH YOU KNOW MOST OF
OUR PLANS HAVE OTHER PLANS IN
THE SAME SERVICE AREA.
YOU'RE LOOKING AT WHAT THEIR
COSTS ARE AND IF THERE COSTS ARE
SIMILARLY SITUATED YOU'RE SAYING
WELL THAT'S JUST WHAT THE MARKET.
IS IF YOU ARE AN OUT LIAR AND
YOU'RE PAYING A THOUSAND DOLLARS
FOR A CONSULTATION AND THE OTHER
PLANS ARE PAYING TWO HUNDRED
REPUBLICAN AND NUDGE THAT DOWN.
BECAUSE YOU'RE CLEARLY DOING
SOMETHING THAT IS NOT IN KEEPING
WITH THAT.
SO WE DO AVERAGING WITHIN THE
PLAN AND WE DO AVERAGING FOR
PLANS AGAINST EACH OTHER AND
THEN WE HAVE OTHER TYPES AS LIKE
IN IN PHARMACY WE HAVE --
PHARMACY EQUIVALENCY -- I'M NOT
USING THE WORDS CORRECTLY BUT WE
HAVE WAYS IN WHICH WE SAY IT
LOOKS LIKE YOU SHOULD BE USING
MORE GENERICS AND YOU'VE BEEN
USING HIGHER BRANDS YOUR
PHARMACY COSTS ARE NOT IN
KEEPING WITH WHAT WE WOULD
EXPECT THEM TO BE AND SO WE'RE
GOING TO ADD.
A FACTOR TO THAT TO KIND OF
DRIVE IT DOWN INTO FORCE THE
PLAN. TO TO MODIFY THAT SO THE
RATE PROCESSES.
FAR MORE COMPLICATED THAN THAT
MAKE IT SOUND BUT IT IT DOESN'T
JUST SAY THAT WE TAKE THEIR
COSTS AND THEN WE JUST BUILD
INTO THE RATE THERE ARE WAYS IN
WHICH WE EITHER SMOOTHS THE DATA.
TREND IT OR WE LOOK AT IT IN
COMPARISON TO OTHER DATA THAT WE
HAVE TO SEE IF IT'S APPROPRIATE.
SO I GUESS THAT WITH THAT WITH
THAT STARTED ME THINKING ABOUT
IS THAT -- OBVIOUSLY THE FEE FOR
SERVICE PORTION OF THE
HEALTHCARE DELIVERY AROUND.
MEDI CAL IS SOMETHING THAT IS
THAT IS SMALLER NOW THAN IT WAS
IN AND GETTING SMALLER GETTING
SMALLER SO KNOWING THAT WE NEED
MORE PROVIDERS OUT THERE AND
THERE MIGHT BE PEOPLE AND THAT
FEE FOR SERVICE ENVIRONMENT THAT
WOULD BE WILLING TO DO IT.
BUT WE HAVEN'T RESTORED EVEN THE
10% CUTS.
AND AND IN YET THAT THERE ARE
PROVIDERS WITH THE MESSAGE THE
MANAGED CARE SYSTEMS THAT ARE
GETTING MORE MONEY IF I'M A FEE
FOR SERVICE PROVIDER OUT THERE.
AND I'M LIVING UNDER THE 10%
CUTS THAT HAPPENED AND WE'RE IN
A ROBUST ENVIRONMENT WHERE WE'VE
GOT RESERVES.
AND OTHER PROVIDERS ARE GETTING
MORE AND AYE I WANT TO BE ABLE
TO PROVIDE THE SERVICE BUT I'M
pERA.
FEES WHY ARE WE NOT USING
RESOURCE SOME OF THOSE RESOURCES.
OR ARE WE RELY SOLELY ON PROPS
FIFTY SIX TO HELP WITH THE
PROVIDER INCREASES WHY.
WOULD THOSE SHOULD BE
ENHANCEMENTS ON TOP IN MY
OPINION ENHANCEMENTS ON TOP OF
THE RESTORATION OF THE RATES
THAT WERE CUT.
SO.
WHEN WE LOOK AT SOME OF THE BIG
TICKET ITEMS THAT WERE WE'RE
LOOKING AT IN OUR BUDGET GOING
FORWARD THIS IS NOT PARTICULARLY
HUGE AND SOME OF THE BIG ONES?
SO IS THE DEPARTMENT.
OPEN TO THAT OR IS THIS IS THIS.
OR FOR IS THAT FEE FOR SERVICE
MODEL THAT'S THAT'S GRADUALLY
DWINDLING.
DESTINED TO NOT BE SUPPORTED AND
AND GO AWAY ALL TOGETHER YEAH --
SO COUPLE THINGS -- SO WE WILL
ALWAYS HAVE TO MAINTAIN A FEE
FOR SERVICE SYSTEM IN THE STATE --
DUAL ELIGIBLES -- IT USE IT TO
THE EXTENT THAT THEY'RE NOT
ENROLLED IN MANAGED CARE --
UNDOCUMENTED INDIVIDUALS FOR
LIMITED SCOPE SERVICES I'M WE
HAVE CERTAIN POPULATIONS THAT
ARE EXEMPT FROM MANAGED CARE
FOSTER KIDS FOR EXAMPLE -- AND
THEN INDIVIDUALS THAT HAVE BEEN
FOUND ELIGIBLE FOR MEDICAID BUT
ARE IN THE CHOICE PERIOD FOR
MANAGED CARE'S PLAN SELECTION
THERE IN ROLLED IN FEE FOR
SERVICE WILL THEY MAKE THEIR
PLAN CHOICE SO.
WE WILL NEVER GET RID OF FEE FOR
SERVICE IT WILL ALWAYS CONTINUE
TO EXIST -- TO THE EXTENT THAT --
SO THAT THE ADMINISTRATION HAS
NOT PROPOSED -- AB NINETY SEVEN
RESTORATION THE PHYSICIAN SIDE I
THINK TO THE EXTENT THAT THE
LEGISLATURE AND THE
ADMINISTRATION THROUGH BUDGET
NEGOTIATIONS WHICH OBVIOUSLY
WILL PROBABLY.
COMMENCE MORE -- AFTER THE MAY
REVISION -- THAT WOULD BE A
CHOICE BETWEEN THE THE
ADMINISTRATION AND THE
LEGISLATURE AS TO WHETHER THAT
WAS A PRIORITY.
RESTORATION THAT THEY WANTED TO
MAKE IN LIGHT OF OTHER YOU KNOW
SIGNIFICANT.
FISCAL CHOICES THAT THEY WOULD
OTHERWISE WANT TO SPEAK TO HAVE
THAT MANY USE.
FOR I GUESS I JUST WONDER FOR
GOING BACK TO YOU EXPAND
COVERAGE FOR PEOPLE YES EXPECT
THE FEE FOR SERVICE MODEL TO
HAVE THE SAME RATES.
I'M NOT SURE HOW WE'RE GOOD EVER
GOING TO HAVE THE PROVIDERS TO
BE ABLE TO PROVIDE WHAT WE NEED
IF WE CAN'T ADEQUATELY
REIMBURSED PEOPLE YES THAT'S
THAT'S REALLY THE AND I THINK A
LOT OF THE FEE FOR SERVICE
PROVIDERS TO BE HONEST.
SERVE BOTH WORLDS THEY'RE
SERVING FEE FOR SERVICE AND
THEY'RE ALSO CONTRACTED WITH
WITH MANAGED CARE SO THEY'VE GOT
THEY'VE GOT AREAS IN WHICH THERE
STRADDLING BOTH DELIVERY SYSTEMS
A LOT BUT NOT ALL.
THAT'S TRUE.
OKAY THANK YOU THANK YOU VERY
MUCH NOTHING HERE AFTER.
A TIME -- LIKE TO WELCOME OUR
NEXT PANEL -- OUR NEXT PANEL
INCLUDES -- MICHAEL DAY THE
DIRECTOR OF HEALTH POLICY FOR
CHILDREN NOW AND ACTUALLY I WANT
TO GIVE CREDIT TO CHILDREN NOW
THEY WERE THE INSPIRATION FOR
THIS AUDIT AND I THINK THEM
THANK THEM FOR THAT -- DIMITRI
MALLOY A IS A PLAN -- PROVIDER
PERFORMANCE MEDICAL DIRECTOR FOR
ANTHEM CALIFORNIA MAP I MEDICAID.
BOB FREEMAN THE CHIEF EXECUTIVE
OFFICER PERCENT CAL HEALTH.
A LINDA WAY -- POLICY ADVOCATE
FOR WESTERN CENTER -- ONLINE
PARTY AND CASEY NAY GOAL DOCTOR
CASING NICKEL POLICY AND
ADVOCACY ADVISER FOR THE
AMERICAN ACADEMY OF PEDIATRICS
IN CALIFORNIA SO -- IN THAT
ORDER I GUESS MR DAY -- CAN HEAR
ME.
GOOD AFTERNOON MY NAME IS
MICHAEL DAY DIRECTOR OF HEALTH
POLICY CHILDREN NOW WHERE A
STATEWIDE CHILDREN'S POLICY
RESEARCH AND ADVOCACY
ORGANIZATION FIRST THANKS TO THE
CHAIRS MEMBERS AND STAFF OF THE
COMMITTEES FOR HOLDING THIS
IMPORTANT HEARING.
WERE SPECIALLY GRATEFUL TO DR
WHAT FOR HIS LEADERSHIP IN
PURSUING ON IT LAST YEAR.
I'D ALSO LIKE TO ACKNOWLEDGE THE
DILIGENT WORK OF THE AUDITOR AND
HER STAFF AS WELL AS THE DCS
AFTER THEIR CONTRIBUTIONS TO THE
REPORT.
UNFORTUNATELY WE'RE HERE TODAY
BECAUSE THE STATE HAS FAILED TO
PROVIDE WHAT KIDS NEED.
AS AUDITOR'S PRESENTATION SHOWED
MILLIONS OF CHILDREN OF MEDI CAL
MISS OUT ON IMPORTANT PREVENTIVE
SERVICES EACH YEAR.
WE'RE TALKING ABOUT HIS MISSING
OUT OF PREVENTIVE SERVICES THAT
INCLUDE.
BASIC AGE APPROPRIATE WELL CHILD
VISITS AND CHECKUPS AS WELL
SPECIFIC SERVICES LIKE
IMMUNIZATIONS THAT KEEP KIDS
SAFE FROM COMMUNICABLE DISEASES.
AND SCREENING SECOND HELP
CATCHING ADDRESS CHILDREN'S
DEVELOPMENTAL DELAYS EARLY ON
PREVENTIVE CARE FOR KIDS IS A
FOUNDATIONAL PART OF THE FEDERAL
MEDICAID BENEFIT PACKAGE THAT
KIDS ARE ENTITLED TO UNDER.
FEDERAL LAW IT'S CALLED THE
EARLY AND PERIODIC SCREENING
DIAGNOSTIC AND TREATMENT BENEFIT.
THE EPS ET BENEFIT IS -- IS AN
ABSOLUTELY CRITICAL PART OF THE
SERVICES THAT MANAGED CARE PLANS
AGREED TO DELIVER WHEN THEY
SIGNED CONTRACTS WITH DH CS AND
ACCEPTED ACTUAR THE SOUND
PAYMENT RATES.
BUT MOST IMPORTANTLY PREVENTIVE
CARE FOR KIDS IS A KEY PART OF
WHAT KIDS NEED TO THRIVE
THROUGHOUT CHILDHOOD AND GROW UP
TO BE HEALTHY ADULTS.
I'M HEALTHY ADULTS ARE NOT A
SURPRISE WE CREATE THEM EVERY
DAY WHEN WE FAIL TO DELIVER
PREVENTIVE CARE FOR KIDS.
IT'S UNCONSCIONABLE TO LET
CHILDREN CONTINUE TO BEAR THE
COST.
OF THE SYSTEMIC FAILURES OF THE
MEDICAL PROGRAM THEY'RE
HAPPENING AT EVERY LEVEL.
KIDS MUST BE MADE A PRIORITY
MEDI CAL BECAUSE PREVENTIVE CARE
SO IMPORTANT AND HAS LASTING
IMPACTS INTO THEIR ADULTHOOD.
BACK IN TWENTY THIRTEEN CHILDREN
NOW IN OUR PARTNERS AT THE FIRST
FIVE ASSOCIATION FIRST START
ENQUIRING ABOUT MEDI CAL
DEVELOPMENTAL SCREENING RATES IN
EARNEST WE DIDN'T THINK BACK
THEN THAT IT WOULD BE SUCH A
LONG AND TROUBLING WROTE.
IN TWENTY FIFTEEN THIS
LEGISLATURE UNANIMOUSLY ADOPTED
A RESOLUTION BY ASSEMBLY MEMBER
STONE.
THAT'S A CLEAR CHILDREN'S
DEVELOPMENTAL SCREENINGS
REFERRAL AND EARLY INTERVENTION
AS A PRIORITY FOR THE STATE.
AND YET AS A PROGRAM MEDICAL WAS
NOT RESPONSIVE AND WAS IN FACT
UNDER DELIVERING ON THE SCREEN
EVEN THOUGH POLICY DICTATED THAT
SCREENING SHOULD BE HAPPENING.
IN TWENTY SEVENTEEN THE EXTERNAL
QUALITY REVIEW ORGANIZATION EACH
EURO RECOMMENDED DEVELOPMENTAL
SCREENS BE ADDED AS A MEDICAL
QUALITY MEASURE BUT THE STATE
AGAIN DID NOT TAKE ACTION.
THE STATE HAS A DUTY TO ENSURE
THAT CHILDREN RECEIVE THE
PREVENTIVE CARE THAT THEY'RE
ENTITLED TO THE EPS THE TEAM
TITLE IS MORE THAN A REQUIREMENT
TO COVER AND PAY FOR SERVICES.
BUT RATHER AN AFFIRMATIVE
RESPONSIBILITY TO PROMOTE
EDUCATE AND SURE CHILDREN ARE
RECEIVING THOSE SERVICES.
SO FIRST MEASUREMENT IT'S
COMMONLY UNDERSTOOD THAT WHAT
GETS MEASURED MATTERS AND IN
FACT AUDITOR'S INVESTIGATION
SHOWS THAT UTILIZATION RATES
WERE HIGHER FOR SERVICES WERE
THERE.
WHERE WHERE THERE WERE
PERFORMANCE MEASURES -- RATHER
THAN FOR SERVICES THAT THEY WERE
NOT.
SO THE STATE MUST SEND A SIGNAL
ABOUT THE IMPORTANCE OF YOU PST
PREVENTIVE SERVICES FOR KIDS BY
ROUTINELY AND ROBUSTLY TRACKING
IT ALONG THE WAY.
DATE ON PREVENTIVE CARE FOR KIDS
IS CRITICAL TO UNDERSTANDING IN
ADDRESSING HEALTH DISPARITIES
THAT WE KNOW EXISTING SERVICE
DELIVERY AND THAT COULD BE
EXACERBATED WITHOUT.
CONCERTED INTENTIONAL EFFORTS TO
ADDRESS THEM.
RELATED TO MEASUREMENT IS
ACCOUNTABILITY.
THE STEPS TO TEACH YES HAS
RECENTLY ANNOUNCED AROUND THE
QUALITY MEASURES AND
ACCOUNTABILITY PROCESS ARE AN
EXCELLENT FIRST STEP TO
AMELIORATE SOME OF THE
LONGSTANDING DEFICIENCIES AND
DATA AND OVERSIGHT.
THE STEPS ARE CLEARLY A PART OF
GOVERNOR NUISANCE PARTY FOCUS ON
EARLY CHILDHOOD AND ARE
SUPPORTED BY THE PROPOSED BUDGET
INVESTMENT IN MEDICAL PROVIDER
RATES.
HOWEVER THESE EFFORTS WELL
SIGNIFICANT ARE NOT SUFFICIENT
TO INCREASE CHILDREN'S RECEIPT
OF PREVENTIVE SERVICES.
AS NOTED IN READING YESTERDAY BY
THE CALIFORNIA HEALTHCARE
FOUNDATION.
MEDICAL MANAGED CARE OVERSIGHT
SHOULD MOVE BEYOND COMPLIANCE
INTO EXCELLENCE AROUND
CONTINUOUS QUALITY IMPROVEMENT
CARE.
IN ADDITION TO ESTABLISHING A
QUALITY STRATEGY OR GENDER FOR
KIDS.
THE STATE COULD BETTER
CLARIFYING GUIDANCE IN CONTRACT
THE SPECIFIC EPS D. T.
REQUIREMENTS THAT HEALTH PLANS
ARE DELEGATED TO PROVIDE.
AND TIE THEM TO SPECIFIC QUALITY
IMPROVEMENT PROJECTS.
NOTABLY THE STATE HAS AN
UPCOMING OPPORTUNITY TO MORE
STRONGLY OUTLINED THE EPS D. T. --
ENTIRELY SPECIFICATIONS IN
CONTRACTS AS MEDICAL IS
INITIATING THE RIVER FROM A
PROCESS TO TAKE PLACE NEXT YEAR.
AND FINALLY I WANT TO TALK ABOUT
OUR REGION EDUCATION.
SO AS WAS DISCUSSED EARLIER MORE
NEEDS TO BE DONE TO CLEARLY
COMMUNICATE TO FAMILIES AND
PROVIDERS ABOUT THE IMPORTANCE
OF AND RULES AROUND PREVENTIVE
CARE AND IT NEEDS TO BE DONE BY
BOTH THE DEPARTMENT HEALTH CARE
SERICES AND BY HEALTH PLANS.
SO ASSUMING THAT PROVIDER
NETWORKS ARE ADEQUATE AND
THEY'RE NOT UNREASONABLE TRAVEL
TIMES ARE DISTANCES.
AND IF PROVIDER DIRECTORIES ARE
UPDATED ENOUGH WHERE A PARENT
CAN EASILY IDENTIFY NEARBY
PROVIDER THAT WILL MEET THEIR
CHILD'S NEEDS.
AND IF THAT PARENT AND THEN
SECURE AN APPOINTMENT AN
INTERPRETER THING NEED IT WITHIN
THE REQUIRED TIMELY ACCESS
STANDARDS.
AND THEN WHEN THAT PARENT USES
THEIR RESOURCES OF TIME IN
TRANSPORTATION TO SHOW UP AT THE
DOCTOR'S OFFICE WITH THEIR CHILD
WHAT HAPPENS.
THIS IS WHERE THE STATE MUST
PROVIDE A VERY CLEAR
UNDERSTANDING OF THE
EXPECTATIONS AND
RESPONSIBILITIES AROUND
PREVENTIVE CARE FOR KIDS.
MORE MUST BE DONE TO COMMUNICATE
PROACTIVELY CLEARLY AND
CONSISTENTLY WITH FAMILIES
ESPECIALLY FOR CHILDREN WHO ARE
KNOWN BY THEIR PLANS BY THEIR
DOCTORS BY THE DEPARTMENT. TO
HAVE MISSED OUT ON PREVENTIVE
SERVICES IN THE PAST.
AGAIN THIS HAS TO BE A FOUGHT
FOR IN PROACTIVE EFFORT NOT AN
AFTERTHOUGHT TO CHECK BOX.
SO MORE THAN JUST LEARNING FROM
THE EXPERIENCE INTENT TO CAL WE
FULLY EXPECT T. H. U. S. T.
ENGAGE STAKEHOLDERS AND EXPERTS
EARLY AND OFTEN TO MAKE A
BENEFICIARY OUTREACH CAMPAIGN
FOCUSED ON IMPROVING PREVENTIVE
CARE FOR KIDS.
AS SUCCESSFUL AS POSSIBLE.
MILLIONS OF CHILDREN IN
CALIFORNIA ARE RELYING ON
MEDICAL AND WE MUST GET THIS
RIGHT.
THE AUDITOR'S REPORT OFFERS
VALUABLE BLUEPRINT TO ADDRESS
THE FUNDAMENTAL STRUCTURAL
PROBLEMS WITH THAT BECAUSE
DELIVERY OF PREVENTIVE CARE FOR
CHILDREN.
AND WE BELIEVE THE AUDIT
FINDINGS WEREN'T ONGOING
ATTENTION AND FOLLOW UP AND AS
SUCH RESPECTFULLY ASK THAT THESE
COMMITTEES -- WORK WITH THE
DEPARTMENT WE APPRECIATE THE
DIRECTORS WILLINGNESS TO DO SO.
AND MONITOR IMPLEMENTATION OF
THE AUDITOR'S RECOMMENDATIONS
AND SO JUST -- SUGGESTION IT
WOULD BE MAYBE A HEARING FROM
NOW TO KIND OF SEE WHERE WE ARE
I HEAR YOU'RE FROM NOW TO SEE
WHERE WE ARE -- SO WITH THAT
SAID -- CHILDREN NOW IS LOOKING
FOR TO WORKING WITH THE
DEPARTMENT WITH THE LEGISLATURE
HEALTH PLANS AND PEDIATRICIANS
MEMBERS OF THE MEDICAL
CHILDREN'S HEALTH ADVISORY PANEL
AND OTHER STAKEHOLDERS. TO MAKE
CHILDREN A PRIORITY IN MEDI CAL
AND TO IMPROVE HEALTH OUTCOMES
FOR KIDS THANK YOU.
p[inaudible]
DR.
AT THANK LEASE THANK YOU.
THANKS TO THE COMMITTEE.
FOR HAVING THIS HEARING AND
HEARING US OUT -- I I THINK MY
AREA THAT I WANTED TO SPEAK
ABOUT A LITTLE BIT MORE
SPECIFICALLY WAS -- A BIT ON THE
RECOMMENDATIONS THAT FOLLOWED
WITH ADDING THE METRICS AND TO
THE TIMELINE EVEN SOME OF THE
THINGS THAT MAYBE DOCTOR CAN
TOUCHED ON A BIT ON ADDINGTO
HAVING THE HEALTH PLANS.
I'M BE RESPONSIBLE SORRY LET ME
BACK UP AND INTRODUCED MYSELF
FOR SECOND.
I'M DR TO MEET YOUR MALLOY --
I'M UP PROVIDER -- PLAN
ACCOUNTABILITY MEDICAL DIRECTOR --
FOR ANTHEM BLUE CROSS AND BEEN
WITH ANTHEM SAID ABOUT TWENTY
FIFTEEN AND ALSO WORK WITH
MANAGED CARE ORGANIZATIONS.
PRIOR TO THAT I AM AN INTERNAL
MEDICINE DOCTOR.
I'M RAISING CALIFORNIA'S A VERY
TIED TO THE SYSTEM AND HAVE BEEN
WORKING WITH A LITTLE POPULATION
SINCE IT'S ALL OF MY CLINICAL
TRAINING -- I THINK YOU KNOW I
WANT TO STATE START BY SAYING
THAT ANTHEM BLUE CROSS IS NOT
TAKING THE STANCE AT ALL OF AT
HAVING ANY SORT OF PUSH BACK ON
THE ADDITIONAL METRICS THAT WERE
RECOMMENDED.
THE THINGS THAT SHOULD THAT WERE
STATED THAT SHOULD BE MEASURED
WE ALSO WE AGREE THAT WHEN IT'S
MEASURED.
IS WHEN PEOPLE TO PAY MORE
ATTENTION TO IT AND MATTER IS IT
DOESN'T DIRECTLY AFFECT YOU IS
ATION OF SERVICES -- TO THAT END
I THINK YOU KNOW WE'RE ACTUALLY
IN A UNIQUE POSITION BECAUSE WE
HAD BEEN ON A CORRECTIVE ACTION
PLAN WITH THE STATE MORE
RECENTLY AROUND QUALITY AND
ACTUALLY GREATLY INCREASED OUR
QUALITY PERFORMANCE OVER THE
LAST FEW YEARS -- FROM ONE LEVEL
TO A COMPLETELY DIFFERENT LEVEL
AND SO SORT OF YOU ARE UNIQUELY
ABLE TO SPEAK TO WHAT IT MIGHT
TAKE IN ORDER TO GET.
TO THOSE NEW LEVELS ADDING NEW
METRICS ADDING SCOPE.
I'M WITH THOSE MEASUREMENTS --
AND FOR US I THINK THAT WHAT I'D
LIKE TO SPEAK TO A BIT IS NOT
ANY ANY CHALLENGE AT ALL ON THE
METRICS THAT WOULD NEED TO BE
ADDED I THINK.
YOU KNOW BALANCING OUT AND THE
CARE FOR CHILDREN IN AND ADDING
IT TO THE THE CARE THE METRIC
THAT WE'VE WE'VE PUT IN FOR THE
COMPLEX ADULT.
POPULATIONS THAT HAVE BEEN
INCORPORATED INTO MANAGED CARE
IS A COMPLETELY FAIR AND
APPROPRIATE THING TO DO THE
ISSUE IS REALLY SOMEWHAT ON THE
TIME LINE OF EXECUTION TO ENSURE
THE SUCCESS -- AS A WORKING WITH
THE STATE IN THE STATE IS
WORKING WITH THE HEALTH PLANS IN
ORDER TO AT TO EXECUTE ON THAT --
THE THINGS THAT WE HAVE ARE SOME
LESSONS LEARNED FROM OUR ACTUAL --
RECENTS -- WORK WITH OUR
CORRECTIVE ACTION PLAN TO THE TO
RAISE OUR QUALITY TO A NEW LEVEL
WITH OUR HEALTH PLAN SOME OF THE
KEY THINGS I THINK THAT WE FOUND
WERE.
THAT -- THERE'S AN
INFRASTRUCTURE BILL THAT'S
NEEDED WHEN YOU HAVEN'T BEEN
MEASURING SOMETHING YOU NEED TO
APPROPRIATELY MEASURE IT.
NEED TO EDUCATE YOU TO MAKE SURE
THAT YOU'RE PULLING PULLING THAT
DATE OUT OF MEDICAL CHART
REPORTING IT APPROPRIATELY TO
THE STATE SO IT'S ACTUALLY BEING
CAPTURED BEING MEASURED SO THAT
THE GAPS ARE ACTUALLY IDENTIFIED
APPROPRIATELY -- AS WELL AND
THAT THIS SOME OF THESE THINGS
REQUIRE PERTAIN TO THE PROVIDER
BEHAVIOR CHANGES IN IN IN
TECHNICAL SPECS -- OUR ANALYSTS
SEEM TO TALK ABOUT WHAT YOU CAN
PULL FOR MYANMAR'S ELECTRONIC
MEDICAL RECORDS WHAT YOU'VE PUT
TEMPLE FOR MEDICAL CHART AND
JUST SIMPLY BUILDING THAT
INFRASTRUCTURE IN.
WE'VE DONE IT ON THE TECHNICAL
SIDE TO MAKE SURE THAT THOSE
THAT THAT DATA GETS REPORTED IN
FOR THE EXISTING METRICS AND
WHAT OF OBVIOUSLY DO IT FOR THE
NEW METRICS.
WE'VE ALSO DONE IT ON THE THE
PERSON SIDE SO WE'VE BUILT IN
THINGS LIKE PRACTICE PRACTICE
CONSULTANTS. TO ACTUALLY GO INTO
THE OFFICES LET POSITIONS NO AND
THEIR OFFICE STAFF KNOW HOW IT
IS TO TO CODE SOMETHING TO COUNT
SOMETHING TO MAKE SURE.
THAT THE CARE THAT THEY'RE
GIVING IS ACTUALLY BEING
CAPTURED AND REPORTED
APPROPRIATELY THOSE THINGS JUST
TAKE A BIT OF TIME THEY TAKE
RELATIONSHIP BUILDING THEY TAKE
EDUCATION THE TICKET OPTIONS IN
PROVIDER BEHAVIOR -- THE OTHER
THING IS THAT WE'VE ALSO USE
INCENTIVES AND SO YOU KNOW JUST
SPEAKING TO THE FACT OF HOW THE
STATE IS LOOKING AT USING PAY
FOR PERFORMANCE -- IS WHY WE
CARRY VERSUS SANCTIONS AND THE
STEAK AND HOW FAST THEY'RE
ACTUALLY GOING TO ENACT THOSE
AND AND AND TO HAVE A PROPER
BALANCE SO THAT THERE'S SOME.
EFFECTIVENESS WITH ACTUALLY
BUILDING IN PROGRAMMING -- AND
NOT DISINCENTIVE ISING HERE THAT
THAT YOU THAT YOU WANT SO WE
HAVE.
RECENT -- EXPERIENCE WITH THAT --
AND IN ADDITION I THINK THE LAST
THING IS JUST MAKING SURE THAT
THERE ARE SOME BUILDING IN OF
SOME PROGRESS AND INTERIM
PROCESS POINTS RIGHT SO THERE'S
AN OVERALL OUTCOME OF COURSE
THAT YOU WANT.
OF A QUALITY LEVEL OF THAT
YOU'RE REACHED ACROSS THE STATE
FOR ALL FOR ALL CHILDREN
BENEFICIARIES BUT OF COURSE
THERE ARE.
THERE ARE POINTS IN BETWEEN THAT
YOU THAT YOU CAN ACTUALLY HIT AS
WELL TO SHOW THAT YOU'RE MAKING
SOME PROGRESS TO WEAR THAT
OVERALL OUTCOME.
AND US HAVING ACTUALLY DONE THAT
AND IN IN OUR INTERACTION WITH
THE CORRECTIVE ACTION PLAN WE WE
TOOK.
OUR QUALITY LEVEL FROM THE YOU
KNOW HITTING A 54% LEVEL TO A
94% LEVEL FOR MINIMUM
PERFORMANCE LEVEL WITHIN A FEW
YEARS BUT INCREMENTALLY YOU
COULD SEE OVER EACH YEAR WE
REPORTED IN HOW THE IMPROVED
OVER TIME -- AND HOW THAT
REFLECTED THEN THE
INFRASTRUCTURE BILL THAT I WAS
TO DISCUSS.
SO I THINK THAT OF BUILDING IN
SOME OF THOSE THINGS WOULD ALSO
LEAD TO A REALLY HELPFUL
RELATIONSHIP WITH THE PLAN
ACTUALLY EXECUTING WHAT IS THE
STATE IS IS PUTTING IN -- AT
THIS POINT -- I DO HAVE A FEW
EXAMPLES OF SORT OF OTHER THINGS
THAT WE LEARNED -- TO WHILE WE
WERE DOING THAT INFRASTRUCTURE
BUILT -- THAT ARE MORE CONCRETE
EXAMPLES SUCH AS CLINIC DAYS
THOSE THOSE -- ENTITLED SOME
PARTNERSHIPS WITH OUR BETTER
QUALIFIED HEALTH CENTERS -- AND
WE WENT FROM HAVING YOU KNOW A
FEW A YEAR AND THAT VERY FIRST
YEAR -- THAT WE WERE
IMPLEMENTING INTO LAST YEAR
HAVING YOU KNOW OVER FIFTY AND A
LOT OF DIFFERENT PARTNERSHIPS
WITH A LOT OF FQHCS IN ORDER TO
AGAINST -- INCREASE THE SCARE
AND AND THE SCOPE AS WELL AND
AGAIN THOSE ARE JUST THINGS THAT
DEVELOP OVER TIME BUT ONCE YOU
STARTED AND YOU GET A GOOD
TEMPLATE YOU CAN ACTUALLY SCALE
IT AND ACTUALLY HAVE MUCH MORE
IMPACT.
IN ADDITION I TALKED ABOUT OUR
PRACTICE CONSULTANTS WE STARTED
OUT WITH A FEW WE HAVE MANY MORE
OVER THE STATE AS WELL THAT ARE
WALKING PRACTICES THROUGH
EXACTLY HOW TO REACH THESE
METRICS HAD ACCOUNT FOR THEM AND
HOW TO DELIVER THAT HERE.
ON ALL KINDS OF EDUCATION POINTS
AND THEN ACTUALLY BECAUSE WE GOT
TO PUT THOSE TOGETHER OVER TIME
WE SAW A SYNERGISTIC EFFECT.
BECAUSE WE BUILD THOSE
RELATIONSHIPS AND ACTUALLY
ENACTED EFFECTIVE PROGRAMMING IN
THOSE AREAS -- WE SAW PEOPLE
ASKING US TO THEN PARTNER ASKING
US TO DO IN A INNOVATIVE PROGRAM
THAT ALSO THEN -- GAVE A BOOST
TO THE OVERALL QUALITY
PERFORMANCE THAT WE HAD --
ACROSS THE WHOLE NETWORK AND SO
IT JUST THINK -- HAVING AN IN AN
INTIMATE UNDERSTANDING OF THOSE
NEEDS AND HAVING ACTED THEM JUST
RECENTLY -- AND SHOWN REALLY
GREAT OUTCOMES JUST USING SOME
OF THOSE LESSONS LEARNED TO SAY
HOW WE WOULD ACTUALLY ALSO APPLY
THOSE TO THE NEW METRICS THAT
ARE FAIRLY COMING IN -- AND
BEING INTRODUCED -- TO BALANCE
OUT AS WELL -- WHAT WE'RE
MEASURING FOR CHILDREN ACROSS
THE NETWORK?
RIGHT THANK YOU.
GOOD.
AFTERNOON I'M MY NAME'S BOB
FREEMAN I AM CEO OF SAN CAL
HEALTH WE ARE THE COUNTY
ORGANIZE HEALTH SYSTEM.
THAT SERVES SANTA BARBARA AND
SAN LUIS OBISPO COUNTIES AND WE
HAVE APPROXIMATELY A HUNDRED AND
SEVENTY FIVE THOUSAND MEDI CAL
RECIPIENTS.
SO I'M HERE TODAY NOT ONLY ON
BEHALF OF SOME CALVET ALSO THE
LOCAL HEALTH PLANS A CALIFORNIA
WHICH IS THE ASSOCIATION OF THE
SIXTEEN PUBLICLY SPONSORED
HEALTH PLANS.
THAT -- CIRCA MEDI CAL
POPULATION.
AND WHEN THIS REPORT CAME OUT I
THINK I SPEAK SPEAK FOR THE OUR
ENTIRE ASSOCIATION WITH SO WE
ALL.
A REDDIT CLOSELY AND TOOK THE
CONCLUSIONS SERIOUSLY.
OBVIOUSLY -- SOME AREAS -- WE
DID FAIRLY WELL SOME AREAS WE
DIDN'T AND AND THIS IS A GOOD
SNAPSHOT FOR US -- TO TO SEE
EXACTLY WHERE WE ARE AT THIS
PARTICULAR POINT TIME.
AND I THINK.
ALL THE PLANS OF A LOCAL PLANTS
HAVE ALL ACTION ACTUALLY
UNDERTAKEN REVIEW OF OKAY WHAT
ARE WE DOING WELL WHAT ARE WE
DOING NOT WHAT. TO START MY SO
WHAT CAN WE DO TO START
IMPROVING ON AND SOME OF THE
AREAS WHERE WE DIDN'T WE DIDN'T
SCORE SO WELL.
AND I THINK WERE -- VERY --
WILLING AND ANXIOUS TO WORK WITH --
DEPARTMENT HEALTHCARE SERVICES
LEGISLATURE OF PEOPLE THIS PANEL --
TO WORK TOGETHER TO FIGURE OUT
WHAT EXACTLY ONE ACCOMPLISH AND
HOW BEST TO ACCOMPLISH IT
[inaudible]
AND WHILE A DOCTOR WHILE I WAS
TALKING ABOUT KIND OF THE
PERFORMANCE MEASURES AND I
ALWAYS HAS BEEN TOUCHED UPON BUT
I A LOT OF DISCUSSION TODAY'S
ALSO BEEN ON THE ACCESS TO
PROVIDERS IN DIFFERENT AREAS.
AND I THINK IN OUR SIXTEEN
HEALTH PLANS THERE IS A VAST
DIFFERENCE IN THE CHALLENGES WE
MAY FACE ABOUT BUILDING AND
MAINTAINING PROVIDER NETWORKS --
THE CHALLENGES THAT.
WE MAY HAVE IN SANTA BARBARA SAN
LUIS OBISPO ARE NOT THE SAME
THAT WOULD BE -- IN MOST URBAN
AREAS.
AND I THINK THIS IS BEN -- ALSO
TOUCHED UPON.
FIRST FOR OUR EXAMPLE OUR
SERVICE AREA WE HAVE A HANDFUL
OF SMALL CITIES AND GREAT
DISTANCES BETWEEN THEM.
AND WE HAVE A LOT OF OUR RURAL
AREAS SO ARE CHALLENGES WITH THE
PROVIDER NETWORK REALLY REVOLVE
AROUND THE LACK OF PROVIDERS NOT
WHETHER THEIR CONTRACTOR NOT WE
ACTUALLY CONTRACT WITH THE VAST
MAJORITY OF ALL LICENSED
PHYSICIANS IN OUR SERVICE AREA.
BUT EVEN GIVEN THAT WE STILL
HAVE TO SUBMIT SIXTY SEVEN OF
THE ALTERNATE ACCESS --
STANDARDS.
AND THEY WERE ALL DUE TO EITHER
A SIMPLE LACK OF PROVIDERS HAVE
A COUPLE EXAMPLES -- PEDIATRIC
ENDOCRINOLOGY PEDIATRIC
CARDIOLOGY THERE AREN'T ANY OF
THOSE AND SO MOST BASEBALL
COUNTY SO THEY WOULD HAVE TO GO
TO SANTA BARBARA COUNTY.
OR PERHAPS MEMBERS THAT LIVE IN
REMOTE AREAS OR NO THERE ARE NO
POSITIONS OR FACILITIES
HOSPITALS NEARBY.
WHEN WE DO RUN INTO?
ISSUES WITH PROVIDERS --
ESPECIALLY -- THAT.
THEIR SKILLS ARE IN HIGH DEMAND
WE HAVE NEGOTIATED HIGHER RATES --
AS NEEDED -- TO YOU KNOW
RESPONSE TO THE MARKET AND WE'VE
BEEN OTHERWISE IT'S CREATIVE AND
FLEXIBLE AS WE CAN TO MAKE SURE
THAT.
WE HAVE IS FOR COMPREHENSIVE A
PROVIDER NETWORK IS LOCALLY AS
POSSIBLE -- AGAIN IN.
IN OUR SIXTY SEVEN CASES --
THERE WAS JUST THERE IS JUST NO
NONE OF THESE PROVIDERS IN THE
AREA.
AND MY EXPECTATION IS WE'VE
TALKED ABOUT TO CENTER VALLEY
TALK ABOUT NORTH OF SACRAMENTO
THOSE ARE THE AREAS -- AND SO I
THINK IF WE'RE LOOKING FOR
SOLUTIONS. TO THAT WE HAVE TO
REALIZE THAT IF YOU -- TO
TIGHTEN IT -- OF THE ACCESS
STANDARDS THAT MAY NOT HAVE AN
IMPACT ON AREAS WHERE IT'S NOT A
IT'S NOT A MATTER OF REFUSAL --
INABILITY TO CONTRACT IT'S THE
ISSUES THERE'S NO ONE TO
CONTRACT WITH.
AND I IT WE ALSO UNDERSTAND
OTHER AREAS HAVE THE MORE
DENSITY OF PROVIDERS -- BUT MAY
PERHAPS A LACK OF PROVIDERS
WILLING ACCEPT MEDICARE
REIMBURSEMENT.
COMPETITIONS BY OTHER PLANS FOR
THEIR SERVICES AND POSITIONS
VERY HELPFUL PRACTICES SO.
I THINK MOBILE OUR POINT ON THIS
IS THERE I DON'T THINK THEY'LL
BE ONE EASY OR SIMPLE.
OR SINGLE SOLUTION TO THIS I
THINK IT'S GOING TO BE A
COMBINATION OF HOW DIFFERENT
AREAS OF THE STATE -- NEED TO BE
ADDRESSED TO HELP BRING THESE --
DOUBLES UP SO WITH THAT I THANK
YOU.
THANK YOU PLEASE PROCEED.
GOOD AFTERNOON CHAIRS LINDA WAY
WITH WESTERN CENTER ON LAW AND
POVERTY FIRSTLY WOULD LIKE TO
THINK THE CO CHAIRS. FOR HAVING
THIS HEARING AS WELL AS THE
INVITATION TO SPEAK.
THE FEDERAL GOVERNMENT
RECOGNIZES THAT CHILDREN AND
ADOLESCENTS ARE NOT LITTLE
ADULTS AND THUS THE EARLY AND
PERIODIC SCREENING DIAGNOSIS AND
TREATMENT EPS TT BENEFIT. FOR
MEDI CAL ENROLLEES UNDER AGE
TWENTY ONE IS MORE ROBUST THAN
ADULTS.
THE PST T. IS DESIGNED TO ENSURE
CHILDREN GET THE HEALTHCARE THEY
NEED WHEN THEY NEED IT SOTHAT
HEALTH PROBLEMS OUR VERDICT OR
DIAGNOSED AND TREATED AS EARLY
AS POSSIBLE.
PREVENTING AND TREATING
POTENTIAL ILLNESSES AND
CONDITIONS EARLY CAN HELP
CHILDREN GROW INTO HEALTHY
ADULTS WHO NEED FEWER MEDICAL
SERVICES LATER IN THEIR LIVES.
ACCESS ISSUES TO PREVENTIVE
SERVICES HAS BEEN A LONG
STANDING ISSUE PARTICULARLY FOR
DENTAL PREVENTIVE SERVICES AS
SEEN BY UTILIZATION DATA BEING
LESS THAN 50% FOR MEDI CAL
CHILDREN IN NOVEMBER. TO TWENTY
EIGHTEEN TWENTY FOURTEEN AUDIT
FOUND SIMILAR DENTAL UTILIZATION
WHICH RESULTED IN INCREASED
FUNDING TO THE DENTAL
TRANSFORMATION.
INITIATIVE PROP FIFTY SIX RATE
INCREASES AND STREAMLINE
PROVIDER ENROLLMENT.
IN ADDITION AN ANALYSIS OF DH CS
BILLING DATA FOUND THAT BETWEEN
TWENTY TWELVE AND TWENTY SIXTEEN
APPROXIMATELY THREE QUARTERS.
OF THE STATE'S TWELVE AND TWENTY
FUND TWENTY FOUR MONTH OLD
CHURCH.
CHILDREN ON MEDI CAL DID NOT
RECEIVE BLOOD LEAD SCREENING
DESPITE FEDERAL AND STATE
REGULATIONS MANDATING BLOOD LEAD
SCREENINGS FOR THESE CHILDREN.
THEREFORE THE AUDITOR'S FINDINGS
IS NOT A SURPRISE TO FAMILIES
ARE ADVOCATES.
WE AGREE WITH THE AUDITOR'S
FINDING THE DH CS DELEGATES
RESPONSIBILITY TO MEDI CAL
PLANTS BUT FAILS TO PROVIDE
EFFECTIVE GUIDANCE AND OVERSIGHT
SO RECOMMENDS.
DH CS PROVIDED MORE AFFIRMATIVE
GUIDANCE.
DH CS IS IN THE PROCESS OF
REVISING ITS THE PST T. ALL PLAN
LETTER.
AND ONE REQUEST FROM HEALTH
PLANS IS FOR DCF TO PROVIDE THE
INTERVAL FREQUENCY FOR SCREENING
VISION DENTAL AND HEARING
SERVICES.
THIS INDICATES THE CLEAR NEED
FOR GREATER GUIDANCE SO
RECOMMEND THE ALL PLAN LETTER
CONTRACT AND IN ROWLEY HANDBOOK
INCLUDE MORE SPECIFICITY ON E.
P. STT.
WE ALSO RECOMMEND THE DH CS
REQUIRE MEDI CAL PLANS TO DO
MORE AFFIRMATIVE OUT REACH TO
INFORM IN ROWLEY'S ABOUT BPD.
E. P. S. T. T. RIGHTS AND
NECESSARY SCREENING AND
PREVENTATIVE SERVICES WHICH IS
WRITTEN INTO THE HEALTH PLAN
CONTRACT IN MANY OTHER STATES.
IN ADDITION DCS NEEDS TO MAKE
CLEAR TO THE PLANS THAT THEY ARE
RESPONSIBLE FOR COORDINATING ALL
CARE FOR THEIR CHILD ENROLLEES.
EVEN WHEN THEY NEED SERVICES
THAT ARE CARVED OUT LIKE DENTAL
AND SPECIALTY MENTAL HEALTH. TOO
OFTEN THE PLANS HAVE FAILED TO
EFFECTIVELY COORDINATE ARVED
OUT SERVICES FOR CHILDREN
LEAVING GAPING HOLES IN THEIR
CARE.
ALTHOUGH 90% OF MEDI CAL
CHILDREN ARE IN MANAGED CARE WE
WOULD NOTE THE LOWER UTILIZATION
RATE FOR THOSE REMAINING IN FEE
FOR SERVICE.
AT LESS THAN 37% AND URGE DH CS
TO ADDRESS THIS AS WELL AS
THROUGH CARE COORDINATION GROUP
OR OTHER EFFORT.
WE RECOGNIZE THE HEAVY LEFT TO
IMPLEMENT THE TWENTY SIXTEEN
FEDERAL MANAGE CARE RULES AND
THE DEPARTMENT'S FOCUS ON
COMPLYING WITH THESE RULES
INCLUDING REVIEWING OVER EIGHTY
THOUSAND ALTERNATIVE ACCESS
STANDARDS AND ULTIMATELY
APPROVING TEN THOUSAND OF THE
STANDARD.
OF THESE REQUEST FOR CONTRACTED
PROVIDERS WHO ARE LOCATED BEYOND
THE TIME AND DISTANCE STANDARD
STEP SET IN STATUTE.
SUFFICIENT TIME HAS PASSED AND
DH CS IS FOCUS SHOULD NOW BE ON
ENSURING MEDI CAL ENROLLEES ARE
RECEIVING THE QUALITY SERVICES
THEY'RE ENTITLED TO YOU IN A
TIMELY MANNER.
WE APPRECIATE DR WOODS AB
SIXTEEN FORTY TWO IN RESPONSE TO
THE AUDITOR'S RECOMMENDATION
WHICH WOULD ASSIST MEMBERS.
WITH FINDING AND OUT OF NETWORK
PROVIDER WHO MEETS REASONABLE
TIME AND DISTANCE STANDARDS IN
ADDITION WE RECOMMEND.
THE DEPARTMENT REQUIRE PLANS TO
INFORM ENROLLEES OF THEIR RIGHT
OF THIS RIGHT AND TIMELY ACCESS
STANDARDS WE APPRECIATE THE
DEPARTMENT'S EFFORT AROUND
QUALITY INCLUDING INCREASING THE
MINIMUM PERFORMANCE LEVEL FROM.
TWENTY FIVE TO FIFTY IF
PERCENTILE NATIONAL MEDICAID AND
THE NUMBER OF PERFORMANCE
MEASURES BUT ALSO RECOMMEND DH
CS REQUIRED PLANS TO COLLECT AND
REPORT DEMOGRAPHIC DATA TO BE
MEASURED AGAINST.
IN ORDER TO REDUCE HEALTH
DISPARITIES.
THE AUDITOR'S REPORT FOUND
GENERAL PREVENTIVE UTILIZATION
RATES RANGE BASED ON LANGUAGE
AND RACE ETHNICITY HIGHLIGHTING
THE NEED FOR GREATER DATA
SPECIFY THE CITY ON ACCESS TO
INDIVIDUAL PREVENTIVE SERVICES
AND APPROPRIATE FOLLOW UP CARE.
MEDI CAL IS A STATE WIDE PROGRAM
AND CHILDREN'S ACCESS TO
PREVENTIVE SERVICES SHOULD NOT
DEPEND ON PLAN REGION OR OTHER
DEMOGRAPHIC.
FACTORS BUT UNFORTUNATELY BASED
ON ON EVEN PLAN AND GEOGRAPHIC
PERFORMANCE AS WELL AS LACK OF
OVERSIGHT AND GUIDANCE IT DOES.
WE PROVIDE IT RECOMMENDATIONS
THAT SEEK TO ADDRESS THIS AND
INCREASED PREVENTIVE UTILIZATION
THANK YOU.
THANK YOU PLEASE PROCEED GOOD
AFTERNOON MY NAME IS DOCTOR
CASEY NAGEL I'M A PHYSICIAN AND
A PEDIATRICS INTERNAL MEDICINE
RESIDENT AT UCLA.
TODAY I'M SPEAKING ON BEHALF OF
THE AMERICAN ACADEMY OF
PEDIATRICS CALIFORNIA
REPRESENTING OVER FIVE THOUSAND
PEDIATRICIANS STATEWIDE.
OUR MISSION IS TO PROMOTE THE
HEALTH AND WELL BEING OF ALL
INFANTS CHILDREN.
ADOLESCENTS AND YOUNG ADULTS IN
CALIFORNIA.
I'D LIKE TO THANK THE CO CHAIRS
THE COMMITTEE AND STAFF FOR
HOLDING THIS IMPORTANT HEARING.
THANK YOU ALSO TO THE AUDITORS
AND STAFF FOR THEIR CRITICALLY
IMPORTANT WORK.
CALIFORNIA STANDING NEAR THE
BOTTOM AND FORTY S. IN THE
COUNTRY AND PROVISION OF
PREVENTIVE CARE SERVICES TO A
POPULATION THAT COMPRISES OVER
HALF THE CHILDREN THE STATE.
WHICH IS FLATLY UNACCEPTABLE.
PREVENTIVE CARE INCLUDING WELL
CHILD VISITS SCREENINGS LIKE
THOSE THAT CAN PREVENT THE
TERRIBLE SIDE EFFECTS OF LEAD
POISONING IN CHILDREN AN INMATE
IMMUNIZATIONS ARE THE
CORNERSTONE OF GOOD HEALTH FOR
DEVELOPING CHILDREN AND YOUTH.
WE LOOK FOR TO PARTNERING WITH
THE STATE THE PLANS THE FAMILIES
AND CHILDREN AND OTHER PROVIDERS
UNDER THE GUIDANCE N OVERSIGHT
OF THIS COMMITTEE AND DH CS. TO
ADDRESS THE CHALLENGES TWO X.
ACCESS HIGHLIGHTED IN THE AUDIT
REPORT.
WE'VE HEARD TODAY THAT THERE ARE
MANY CONTRIBUTING FACTORS TO
CALIFORNIA'S CLEAR NEED TO
IMPROVE ITS PROVISION OF
PREVENTIVE CARE SERVICES TO
CHILDREN ENROLLED IN MEDICARE.
PERSONS EXPERIENCE THESE
CHALLENGES EVERY DAY AS WE
STRIVE TO PROVIDE THAT CARE THAT
CONTRIBUTES TO THE GROWING
HEALTH OF THIS GREAT STE.
STATE'S POPULATION WE AGREE THAT
A MULTI PRONGED APPROACH IS
NEEDED THEREFORE WE ENDORSE AND
STRONGLY SUPPORT THE STATEMENT
MADE MY CHILDREN NOW.
INCREASED AND MORE TRANSPARENT
DATA COLLECTION MONITORING
ENFORCEMENT AND ACCOUNTABILITY
OUTREACH AND EDUCATION AS WELL
AS ENHANCE CARE COORDINATION IN
THE FORM OF STANDARDIZED
CLINICAL CARE MEASURES.
AND SUPPORT SERVICES ARE ALL
ESSENTIAL TO CLOSING CARE GAPS
THAT ARE EXTREMELY COSTLY TO THE
STATE AND DETRIMENTAL AND EVEN
DEVASTATING TO FAMILIES.
AS OPPORTUNITIES FOR PREVENTION
EARLY DIAGNOSIS AND TREATMENT
ARE MISSED WONDERFUL RARE
FACTORS MUST BE ADDRESSED I WILL
FOCUS BRIEFLY ON THE LACK OF
ADEQUATE NUMBERS OF PHYSICIANS
CARING FOR MEDI CAL CHILDREN IN
BOTH URBAN AND RURAL.
AREAS IN THE STATE NOT ONLY
BECAUSE THAT'S MY AREA OF
EXPERIENCE AND EXPERTISE AND
THAT OF THE AMERICAN ACADEMY OF
PEDIATRICS.
BUT ALSO BECAUSE IT IS CALLED
OUT IN THE AUDITOR'S REPORT
LOUDLY AND REPEATEDLY.
USING TERMS SUCH AS THE KEY
REASON AND MAJOR COST OF
CALIFORNIA'S DISMAL STANDING IN
PROVIDING PREVENTIVE CARE
SERVICES TO CHILDREN UNDER MEDI
CAL.
THE REPORT HIGHLIGHTS NOTABLE
DEFICIENCIES IN BOTH THE NUMBER
AND LOCATION OF PROVIDERS.
FORTUNATELY A MAJOR SOLUTION
PROVIDED IN AUDITOR'S REPORT TO
POOR PHYSICIAN AVAILABILITY IN
MEDI CAL IS NOT COMPLICATED IT
IS CLEAR.
BY THE AUDITOR'S REPORT THE ONLY
POLICY TOOL ASSOCIATED WITH AN
INCREASE IN PROVIDERS ACCEPTING
MEDICAID BENEFICIARIES AS
MEDICAID PAYMENT RATES.
AS STATE MEDICAID RATES
INCREASED THE PERCENTAGE OF
PHYSICIANS ACCEPTING MEDICAID
PATIENTS INCREASE.
PAYMENT RATES WERE THE ONLY
SIGNIFICANT FACTOR THAT HAD AN
IMPACT ON PROVIDE A WILLINGNESS
TO ACCEPT NEW MEDICAID PATIENTS.
ME AND SEVERAL OF MY CLOSE
COLLEAGUES GREATLY ENJOYED
CARING FOR THESE PATIENTS
BECAUSE WE CAN MAKE A TRUE AND
LASTING DIFFERENCE IN THESE
PEOPLE WHO HAVE -- ESSENTIALLY
VERY LOW HEALTH LITERACIES BUT
SOMETIMES AND BASED ON MEDICAL
SCHOOL DATA AND MYRIAD OF OTHER
FACTORS WERE UNABLE.
TO GOING TO A PRACTICE THAT --
PROVIDES CARE ONLY FOR THEM.
SO AND THEN ALSO A COMPOUNDING
FACTOR IS THE LACK OF
INCOHERENCE TO ACCEPTABLE TIME
AND DISTANCE STANDARDS AS
EXHIBITED BY THE OVER AND EIGHTY
THOUSAND EXCEPTION REQUEST
SUBMITTED BY MEDI CAL MANAGED
CARE PLANS.
WHICH WE TALKED ABOUT TODAY DH
CS APPROVED OVER TEN THOUSAND OF
THOSE IN TWO THOUSAND AND
SEVENTEEN IN SOME CASES
RESULTING IN FAMILIES NEEDING TO
TRAVEL MANY HOURS.
AND HUNDREDS OF MILESIN ORDER
TO SEE AN IN NETWORK PHYSICIAN
IT IS NO SURPRISE THAT MANY DID
NOT FOLLOW THROUGH EVEN WHEN
THEY WERE ABLE TO GET AN
APPOINTMENT.
WHETHER IT WAS A GENERAL WELL
CHILD CHECK WERE SUBSTANTIAL
SUBSPECIALTY APPOINTMENT.
THIS ACCESS ISSUE IN LIGHT OF
THE RESURGENCE OF MEASLES AS
WELL A DEADLY VACCINE
PREVENTABLE DISEASE -- SHOWS
JUST -- A LARGE PROBLEM WITH THE
ACCESS THAT WE'RE FACING SO THE
PICTURE PAINTED OF LACK OF
ACCESS TO THE MOST BASIC
IMPORTANT HERE.
IS NOT WHEN ANY OF US WOULD WANT
TO ENTER FOR ANY PERSON'S CHILD
NIECE NEPHEW OR GRAND CHILD.
THE AMERICAN ACADEMY PDF OF
PEDIATRICS CALIFORNIA STRONGLY
URGES THE LEGISLATURE TO MAKE
POSSIBLE IMPROVEMENTS.
IN OUR PREVENTIVE CARE NUMBERS
BY SUPPORTING DH CS AND THE
PLANS TO ALLOCATION OF STABLE
FUNDS.
INCLUDING THE ONES -- FOR LOAN
REIMBURSEMENT WHICH WOULD
ENCOURAGE YOUNG PHYSICIANS TO
CARE FOR THESE PATIENTS
EXCLUSIVELY AND WHILE THEN
SUPPORTING THEM AFTER THEY'VE
PAID OFF THEIR LOANS.
WHICH WOULD HELP TO MAINTAIN AN
ADEQUATE PROVIDER NETWORK THAT
CAN OFFER A TRUE MEDICAL HOME TO
THESE CHILDREN WHETHER IN PERSON
OR THROUGH TELEMEDICINE
INITIATIVE.
MY COLLEAGUES AND I AND EIGHT P.
A CALIFORNIA STAFF LOOK FORWARD
TO WORKING WITH YOU ON THIS
CRITICALLY IMPORTANT PIECES TO
THE SOLUTION BEING IDENTIFIED
TODAY.
CALIFORNIA'S CHILDREN DESERVE
NOTHING LESS THEY'RE COUNTING ON
US THANK YOU.
THANK YOU THANK YOU GUYS FOR
YOUR TESTIMONY APPRECIATE IT --
YOU HAS HEARD THE TESTIMNY
PREVIOUSLY OF DCH US IN THE
AUTHORED SEEMS LIKE NOBODY'S IN
DISAGREEMENT ABOUT THE AUDIT
FINDINGS.
AND THE RECOMMENDATIONS THAT
CAME OUT FROM IT I THINK FROM
EACH YEAR TESTIMONIES THINK
YOURS ARE TOUCHING ON DIFFERENT
ASPECTS.
OF THAT BUT LET ME JUST ASK.
WHO COULD DO THIS FAIRLY QUICKLY
AND JUST KIND OF RUN DOWN --
READ DOWN THE LINE IS LIKE. FOR
THE IF YOU CAN ADD A
RECOMMENDATION IN THE
PERFORMANCE METRICS OF THE
PERFORMANCE -- ACCOUNTABILITY
STANDARDS.
AS WE MOVE FORWARD WHAT WOULD
THAT BE TO HELP GET TO MAKE SURE
THAT WE'RE NOT LEAVING CHILDREN
BEHIND AND IN RECEIVING THESE
PREVENTIVE SERVICES.
I COULD JUST SAY BROUGHT BE
LOOKING FOR A BROAD AND STABLE --
FORM OF FUNDING FOR INCREASED
FROM THE FUNDING -- FOR
PROVIDERS WHO WANT CARE FOR MEDI
CAL PATIENTS.
LIKE THE MEDICARE REIMBURSEMENT
RATES WHICH WE GET THROUGH
PROPOSITION FIFTY SIX ARE BUT ON
TOP OF THAT AS WELL [inaudible]
YES.
YOU WERE SPECIFICALLY ASKED
ABOUT PERFORMANCE MEASURES YES --
I THINK I THINK THAT THE COURSE
THAT THAT WERE ADOPTED IS AS A
MORE ROBUST SET -- IT'S KIND OF
AN ONGOING DISCUSSION NATIONALLY
ABOUT WHAT THE RIGHT MEASURES
ARE BUT I THINK TO THE POINT
THAT -- MY COLLEAGUE MADE HAVING.
MAKING SURE THAT THEIR SOME
MINIMUM PERFORMANCE AND THAT
THERE'S ROOM FOR GROWTH AND THAT --
THERE'S SORT OF A A PATH TO
IMPROVEMENT AND SO HAVING SOME
OF THOSE -- CHECKPOINTS ALONG
THE WAY -- SO THAT THERE CAN BE
COURSE CORRECTIONS IF NEEDED
WILL BE REALLY IMPORTANT FOR
HELPING PLANS DELIVER GOT IT AND
I THINK WE'RE GONNA LOOK FORWARD.
TO THAT FROM THE CHS OF THE
INTERNAL CHECK INS WITH THE
STATE AUDITOR ON THE
RECOMMENDATIONS OUTLINED.
THANK YOU.
PLEASE.
I WOULD CERTAINLY AGREE WITH AND
THE THINGS THAT ALREADY WERE
SAID I I DO THINK SPEAKING TO
RATES MATTER BUT I THINK IT'S
OVER IT'S THE OVERALL FUNDING IT
IS WHETHER OR NOT THERE IS.
OPPORTUNITY SOME FOR SOME
FLEXIBILITY TO INCENTIVIZE SOME
OF THE THINGS THAT.
THAT HAVE NOT BEEN AS MUCH IT
HERE TOO THAT THAT REQUIRE A
MORE HERE IT'S AND AND ACTUALLY
BUILDING IN SOME OF THE
INFRASTRUCTURE TO MAKE SURE
THOSE METRICS ARE.
FOLLOWED CAPTURED AND REPORTED
IN -- AND THAT THE AND THAT THE
PLANTS CAN ACTUALLY PARTNER WITH
WITH OUR PROVIDERS IN ORDER TO
DO THAT AND AND WORK WITH THE
STATE AS WELL.
ON THAT AND THEN ALSO AS WELL
BUILDING IN SOME OF THOSE
PROCESS OUT COMES TO MAKE SURE
WE ARE HEADED THE RIGHT
DIRECTION AND SOTHEIR INTERIM
WAYS TO HOLD PEOPLE ACCOUNTABLE
ACCOUNTABLE IN BETWEEN -- BEFORE
JUST -- SANCTIONING FOR NOT
MEETING OVERALL OUTCOME.
SO WOULD THAT BE LIKE
PERFORMANCE METRICS FOR MAYBE
ALLOCATING ADDITIONAL DOLLARS.
BASED ON OUTCOMES.
IT COULD BE ATTACHED TO THAT AS
WELL I I WOULD ARGUE THAT
SOMEONE IT IS ACTUALLY ALLOWING
FOR AN APPROPRIATE TIME LINE FOR
THAT INFRASTRUCTURE BUILD AND
FOR THOSE METRICS. TO BE
CAPTURED REPORTED CORRECTLY SO
FOR EXAMPLE THE AT PRESENT TIME
THE RECOMMENDATIONS FOR
SANCTIONS TO START NEXT YEAR FOR
THE WHAT IS BEING MEASURED THIS
YEAR AND THOSE EXTRA METRIC OR
ALREADY PUT IN JUST FOR THIS
YEAR.
RIGHT SO TO HAVE THAT SORT OF
LARGE DICK PUT ON JUST ONE YEAR
AFTER ADDING IN NEW METRICS THAT
ARE JUST HAVE NOT BEEN BUILT
INTO.
THE NORMAL REPORTING STRUCTURE
AND A STANDS -- I WOULD I WOULD
ARGUE IS IS -- MORE SEVERE AND
ACTUALLY WOULD PROBABLY LEAD TO
A DID A DIS INCENTIVIZING SOME
OF THE BEHAVIOR I ALSO WANT TO
KNOW YOU KNOW WHERE THAT
SANCTION MONEY GO BECAUSE
THEORETICALLY YOU WANT THAT
MONEY TO BE USED -- TO FIND
ACTUALLY MEETING THOSE METRICS
AND MAKING SURE THOSE PROVIDERS
ARE CONSISTENTLY DOING SO AND
EMPOWERING ALL THE ENTITIES THAT
ARE NEEDED IN ORDER TO MAKE THAT
HAPPEN -- SO I WOULD ARGUE THAT
YOU KNOW YOU YOU WOULD HAVE -- A
GREAT IS SCHEDULE AND AND
ACTUALLY HAVE SOME.
SOME IN A ROOM I'M STEPS THAT
NEED TO BE MET TO MEET THAT
OVERALL OUTCOMES -- AT AS RIGHT
NOW THE RECOMMENDATIONS JUST TO
JUMP FROM 25250% MINIMUM
PERMISSIBLE ON ALL METRICS
INCLUDING ALL THE NEW METRICS.
AND FOR A PLAN LIKE OURS THAT --
SERVICE TWENTY NINE COUNTIES --
THAT IS IT THAT'S A THAT'S A
LARGE CHANGE IT AT ONE TIME NOT
ONE THAT WE'RE ACTUALLY PUSHING
BACK ON YOU KNOW WITH THE
INTENTION AND THAT IT SHOULD BE
DONE IT'S JUST THAT.
WE ACTUALLY KNOW WHAT IT TAKES
TO TO TO ACTUALLY MEET THOSE
METRICS AND AND HAVE THAT HAPPEN
IN THAT TIME LINE IS A LITTLE
BIT MORE THAN JUST.
NEXT YEAR FOR SANCTIONS.
THANK YOU.
PLEASE.
I WOULD OFFER A FEW SUGGESTIONS --
I THINK FIRST DOCTOR LOWEST
POINT IF WE'RE GOING TO BE FOR I
THINK WE SHOULD WE NEED IS PLANS
VERY VERY SPECIFIC AND WELL
DEFINED WHAT WHEN A NEW
MEASUREMENTS WOULD BE.
AND ALSO THE TIME ALLOWED TO SET
UP -- WHATEVER SYSTEMS ARE
PROCESSES THAT WE CAN.
GO TO ATTACK THOSE MEASURES FOR
EXAMPLE.
IF OUR PLAN WAS TO DECIDE TO WAY --
TO HELP INCREASE DEBT LEVELS
WOULD BE TO ALTER OPPOSITION
INCENTIVE PROGRAM TO REWARD
PHYSICIANS FOR GETTING MEMBERS
AND TO MEET THESE.
NEW GUIDELINES THAT WORKED
COLLECTED BEFORE WE NEED TIME TO
SET THAT UP AND CHANGE PROVIDER
CONTRACTS AND ALL THAT SO -- I
DON'T THINK BY AS WAS STATED
EARLIER THAT WERE ALREADY
TOMORROW WILL BE AND FOUR MONTHS
INTO THE YEAR AND WE DON'T EVEN
HAVE THINGS FINALIZED I DON'T
THINK NEXT YEAR'S RESULTS.
CAN BE A WHOLE LOT DIFFERENT
THAN THIS YEAR'S -- AND THEN THE
SECOND THING I WOULD SAY IS AS
WE'RE LOOKING AT THESE SPECIFIC
THINGS I WOULD DRILL DOWN AS TO
ON THIS SPECIFIC AREAS FOR
EXAMPLE.
YOU KNOW ZERO FIVE FOR THE MOST
PART TO READ THE RESULTS ARE ARE
PRETTY WELL PRETTY GOOD IT'S THE
ADOLESCENCE THAT ALWAYS BEEN
DIFFICULT AND THAT THEY HAVE
ADOLESCENT WELL VISITS HAVE
ALWAYS BEEN DIFFICULT NAY BEEN
HE JUST MEASURE FOR A LONG TIME.
IT IS CONCEALING DIFFICULT TO
GET THESE KIDS IN TO THE
DOCTOR'S OFFICE AND I THINK
THERE NEEDS TO BE -- EITHER AT A
KNOWLEDGE MEANT THAT OR I'LL
FOCUS ON HOW WE CAN --
COLLECTIVELY FIGURE OUT WAYS TO
DO THAT BECAUSE I THINK GETTING
ADOLESCENT WELL DOES IT'S UP
250% WILL BE AN EXTREME
CHALLENGE OTHERWISE I THINK WE
NEED TO LOOK AT VERY SPECIFICS
AND AND TO FOCUS OUR EFFORTS AND
SO AND TO HOW WE CAN BEST OBTAIN.
WHAT WE'RE SHOOTING?
FOR AND TO THOSE POINTS DO YOU
SEE THAT HAPPENING SOLELY
THROUGH EDUCATION OR IS IT TOO
YOU KNOW YOU MENTIONED IN YOUR
TESTIMONY AS WELL -- INCREASED --
YOU KNOW MEDICARE REIMBURSEMENT
RATES ARE INCREASED REACH FOR
THOSE DOCTORS ARE PROVIDING THE
SERVICES OF THE HARD TO SERVE
AREAS.
I SEE IT IS THAT LIKE A PUSH
PULL STRATEGY WHICH IS AFTER
HOPEFULLY PROVIDERS AT THE
REWARDED I WOULD DO IT IN A
SENTENCE.
BUT THEY WOULD BRING A MAN.
TO BRING A MAN WE AND WE PUSH
OUT -- MEMBER NOTIFICATIONS OR
YOU KNOW TO THE MEMBER
NEWSLETTERS OR FOR I KNOW
THERE'S BEEN TALK ABOUT USING
TEXTING PROGRAMS -- GETTING TO
MEMBERS AT AS MICRO LEVEL AS
POSSIBLE THAT'S VERY DIFFICULT
BECAUSE A LOT OF TIMES THE
INFORMATION WE HAVE ON THEM.
IT'S NOT ACCURATE CELL PHONE
NUMBERS ON ACKER THEY'VE CHANGED
SO WE GET TO THE MEMBERS
THEMSELVES OF THEIR HEAD OF THE
HOUSEHOLD OF THE PARENTS.
IS ARE ON A MICRO LEVEL IS VERY
DIFFICULT I MEAN WE'RE A SMALL
PLAN WE HAVE. HUNDRED THOUSAND
KIDS -- SO IT'S IT'S A CHALLENGE
BUT I WOULD DO THAT I WOULD I
WOULD FOCUS ON THE MEMBER SITE
PUSHING OUT GETTING.
IS MUCH INFORMATION OUT AS WE
CAN BUT THEN ENCOURAGE THE
PROVIDERS ON THE OTHER END TO
HELP ENCOURAGE AND TO PULL THEM
IN TO SAY HEY ONE IT'S TIME FOR
YOUR YOUR SON YOUR DAUGHTERS --
WELL YOU KNOW WELL I LESSEN
VISIT LET'S SCHEDULE SOMETHING
[inaudible]
THANK YOU.
IN CONTRAST TO SOME OF THE
PREVIOUS COMMENTS REGARDING MORE
TIME WE'D ARGUE THAT THERE HAS.
BEEN LONG STANDING REQUIREMENTS
OF FEDERAL AND STATE OF
SPECIFICALLY THINKING UP THE
BLOOD LEAD TESTING REQUIREMENT
FOR ALL MEDI CAL CHILDREN AGE
TWELVE AND TWENTY FOUR MONTHS.
AND THE THE THE REALLY ABYSMAL
RATE OF OF TESTING AND SO THIS
IS BEEN A LONGSTANDING
REQUIREMENT -- PLANS -- DATA CAN
RANGE FROM LESS THAN A HALF TO A
QUARTER OF CHILDREN -- RECEIVING
THE ACTUAL TESTING AND SOAK
CERTAINLY GREATER OVERSIGHT
ACCOUNTABILITY IF NEEDED -- AS
WELL AS EDUCATION TO TO
PROVIDERS AS THIS IS SPECIFIC TO
TO MEDI CAL CHILDREN OTHER
CHILDREN ARE.
ARE NOT NECESSARILY REQUIRED --
TO AT TO HAVE THIS THIS BENEFIT
THERE IS THE RECOGNITION THAT
LOW INCOME CHILDREN LIVE IN
OLDER HOUSES ARE MORE.
SUSCEPTIBLE TO TO LEAD POISONING
AND SO THIS IS A REQUIREMENT IN
SO I WOULD SAY GREATER
ACCOUNTABILITY AS WELL AS
EDUCATION TO PROVIDERS.
UP AND PLANTS.
UNTIL THAT POINT I BELIEVE
THERE'S A I REQUEST OR SOME
LEGISLATION ON THAT POINT
EXACTLY.
SO AND I THINK THAT'S MOVING
FORWARD AND YOU KNOW THERE'S
SOME OTHER SOLUTION DR WOODS GOT.
ASSEMBLY BILL SIXTEEN FORTY TWO
TO HELP ADDRESS SOME OF THE
GUEST IMPROVING ACCESS REALLY
EVELYN DOCTOR WOULD SPEAK TO
THAT -- ACTUAL WE JUST GO IN.
THE DOCTOR WOULD [inaudible]
THANK YOU -- I USED TO BEING
CUED UP LIKE THAT BUT I
CRESCENTA -- I JUST -- I GUESS
WHEN I GO BACK TO THE PHONE YOU
BACK MORE TO QUESTIONS TO THE
DIRECTLY TO THE PLANTS AND ON
THIS AND I APPRECIATE APPRECIATE
APPRECIATE EVERYONE'S TESTIMONY
BUT I'M I'M.
BROKE ONE OF FOCUS HERE FOR A
MINUTE -- WHEN YOU'RE SETTING UP
YOUR NETWORK -- PROVIDERS -- YOU
HAVE TO FIGURE OUT HOW TO PAY
YOUR PROVIDERS.
WHAT'S THE STARTING POINT FOR
NEGOTIATIONS WERE YOU START YOU
START AT THE MEDICAL RATE DO YOU
STARTED A COMMERCIAL RATE I MEAN.
IT'S OBVIOUSLY DIFFICULT TO GET
PROVIDERS -- IN IN SOME OF THESE
PLANS SO WHERE DO YOU START.
WELL IT DEPENDS ON THE PROVIDER
CLASSIFICATION FOR PRIMARY CARE
PROVIDERS WE WE CAPITATE THEM
AND THE CAPITATION RATES BASED
ON THE ACUITY OF THEIR THEIR
PATIENTS SO WE CAN GO UP OR DOWN.
AND THEN WE ALSO -- DO A
POSITION IN CENTER PROGRAM WORK
GROUP THAT REWARDS THE
PHYSICIANS FOR DOING ACTIVITIES
THAT WE SUPPORT LIKE HAVING --
LATE HOURS OR OR BEING OPEN THE
WEEKENDS SENATE ON THOSE LINES
AND THAT'S FAIRLY STANDARD --
IT'S IT'S AN ACTUAL I ARE BASED
ON THE SPECIALISTS -- IT'S
BASICALLY A CALM IT'S A
COMBINATION OF HOW MUCH.
IN DEMAND THEY ARE AND SO WE PAY
OFF THE MEDICARE FEE SCHEDULE.
AND DEPENDING ON HOW -- MUCH
BELOW OR ABOVE THEN IT DEPENDS
ON THE SCARCITY OF THE PROVIDER
AND DEMAND FOR THEIR SERVICES.
IT ALSO INVOLVES THE DESPITE THE
THE SPECIALTY MEANING WE CAN
CERTAINLY PAY A NEUROLOGIST MORE.
BECAUSE WE DON'T USE THEM.
HIS OFTEN THEY WOULDN'T BE SHE
SAID SHE WOULD LIKE AND BUT I
WILL BE.
SO IT'S IT'S BASED ON THE DEMAND
FOR THEIR SERVICES --
COMPETITION.
AND THEN -- YEAH THE THOSE TWO
THINGS IN THERE AND WE WE'RE
WE'RE PRETTY FLEXIBLE IN TERMS
OF WITH DIFFERENT PROVIDERS
[inaudible]
THE LET'S SAY THAT THE PROVIDERS
NOT WILLING TO THE CONTRACT MEDI
CAL SCHEDULE -- YOU KNOW -- YOU
HAVE TO HAVE A SPECIALIST YOU
HAVE TO HAVE THE NAME OF THE
HOSPITAL IN YOUR NETWORK -- YOU
DO YOU CAN YOU THEN.
BEGIN [inaudible]
TO NEGOTIATE UPWARD.
DEPENDING YES DEPENDING ON HOW
MUCH WE NEED THAT POSITION IN
OUR NETWORK ABSOLUTELY -- SO
WHAT HAPPENS -- WHAT HAPPENS
WHEN YOU DO THAT WHAT'S THE
RESPONSE FROM THE STATE AS THEY
GO BACK AND EVALUATE WHAT'S BEEN
YOUR EXPERIENCE AS WELL?
MY EXPERIENCE AND I'M NOT -- I
DON'T DEAL WITH THE THE RATE
PEOPLE SPECIFICALLY MY
EXPERIENCE AS THEY LOOK AT OUR
PHYSICIAN COSTS IN TOTALITY.
AND THEY MAY LOOK AT DIFFERENT
SPECIALTIES -- INDIVIDUAL DOWN
USUALLY THEY'LL SAY HEY HOW COME
YOU'RE PAYING -- THIS
NEUROSURGEON SO MUCH AND ALSO
HE'S THE ONLY ONE IN A HUNDRED
MILES -- AND AND THEY HAVE A
FULL WAITING ROOM.
WITH OR WITHOUT MEDI CAL
PATIENTS SO THIS IS WHAT WE HAD
TO DO TO ENSURE ACCESS AND
THAT'S USUALLY SUFFICIENT -- I
THINK IF IT WAS ON A A BROAD
BASIS WHERE YOU'RE -- THAT I
WOULD SAY OVER PAIN BUT PAIN
PROVIDERS.
IN AND SIGNIFICANT EXCESS OVER
YEAH HE IS MEDI CAL OR MEDICARE
FEE SCHEDULE SO YOU WOULD YOU
WOULD LIKELY GET MORE IN DEPTH
QUESTIONS -- INTEREST
INTERESTING SO.
IF YOU COULD JUST IN GENERAL --
HAD TO CATEGORIZE YOU KNOW THE
THE CHALLENGES YOU HAVE WITH --
PHYSICIANS AND NUMBERS OF
PHYSICIANS THAT SORT OF THING --
IS IT THE SPECIALIST THAT YOU
HAVE THE HARDEST TIME.
YOU KNOW AS FAR AS GETTING
PROVIDERS OR IS IT PRIMARY CARE.
I MEAN I MEAN OBVIOUSLY WITH
SPECIALTY PROVIDERS LIKE A YOU
KNOW A PEDIATRIC CARDIOLOGIST
OR NO FRAUD JUST OR SOMETHING
YOU KNOW OR NEUROLOGISTS
SPECIFICALLY AROUND PEDIATRICS
THAT'S A DIFFERENT ISSUE BUT
IN GENERAL -- WHERE ARE YOU
WHERE IS THE WORD WHERE IS THE
MOST DIFFICULT TIME YOU HAVE
IT AS FAR AS PROVIDER BASE I
DON'T NOW I THINK SPEND THE
WRIST TO SPEAKING TO THAT I
LEAD THE CLINICAL ARM MOSTLY AT
THE PLAN AND SO I PURPOSEFULLY
STATE OUT OF THE SPECIFICS
OF THE RATES CONVERSATION
ALTHOUGH I KNOW I KNOW MR
EVEN THOUGH THE MORE THAN I
DO -- BUT I'D SAY -- AS FAR AS
EXPERIENCE WITH -- THE PROVIDER
SIDE OF THINGS -- PRIMARY
CARE IS NOT IS NOT TYPICALLY
THE ISSUE IT IS MUCH MORE
THE SPECIALTY CARE AND EVEN
THE SUB SUB SPECIALISTS FOR
PARTICULAR COMPLEX CONDITIONS
-- AND THINGS THAT NEED A
NO TERTIARY CARE SETTINGS
OUR PARTICULAR -- INPATIENT
FACILITIES -- AND FOLLOW UP
-- AND THAT'S SOMETIMES --
HARDER TO FIND IN THAT VERY
MUCH VARIES INDEFINITELY IS
-- ACCOUNTED FOR BASED ON
GEOGRAPHY WITHIN THE STATE WE
WE HAVE LESS PROBLEM FINDING
THAT IN LOS ANGELES OBVIOUSLY
THAT ANY OF OUR RURAL COUNTIES
AND SO THOSE THINGS GO INTO
ACCOUNT WHEN WHERE YOU KNOW
CONTRACTING AND -- AS WE --
FEEDBACK FEED MEMBERS TO THOSE
OF PROVIDERS BASED ON THOSE
NEEDS BUT IT'S DEFINITELY THE
SPECIALTY CATEGORY JEFF I CAN
ADD IT IN OUR AREA WE HAVE
A NAPA ANY WILLING PROVIDER
PHILOSOPHY WHICH MEANS YOU
LEADER TERMS CONDITIONS WILL
CONTRACT WITH YOU AND AS I SAID
WE BASICALLY HAVE CONTRACTUAL
RELATIONSHIPS WITH ALMOST EVERY
PROVIDER IN THE TWO COUNTIES
THE ONES WE WOULDN'T HAVE
WOULD BE PROVIDERS THAT HAVE
A CONCIERGE SERVICE OR MAYBE
WORK AT UNIVERSITIES -- SO WE
REALLY ALMOST HAVE EVERYBODY
AND AND IF A PROVIDER MOVES
IN THE AREA WE KNOW ABOUT IT
AND ARE KNOCKING ON THE DOOR
WITH YOU KNOW MY FRIENDS TO
INTRODUCE OURSELVES SO WE
-- WE WE CERTAINLY ARE VERY
AGGRESSIVE THAT MAKING SURE
THAT OUR NETWORK IS A ROBUST
AS POSSIBLE LOCAL THEIR WAR
MY FRIENDS BECAUSE YOU KNOW
NO NO NO ONE WANTS A COLD
STILL ONE SO -- WELL I REPORT
THANK YOU -- I APPRECIATE
YOUR YOUR PERSPECTIVES ON ON
THE SIDE THANK YOU VERY MUCH
-- I JUST -- WE GET IT PUBLIC
THAT WE'RE GONNA OPEN THIS TO
PUBLIC COMMENT THANK YOU ALL
THANK YOU HERE THIS IS BEEN
REALLY REALLY HELPFUL THANK
YOU THANK YOU VERY MUCH I GET
THIS POINT WOULD LIKE TO GO
AHEAD AND OPEN THIS TO PUBLIC
COMMENT -- TO HOW MANY PEOPLE
ARE WANTING TO SPEAK A PUBLIC
COMMENT THESE KIND OF RAISE
YOUR HANDS I GUESS AND ROUGH
IDEA OKAY YOU CAN LIMIT YOU
KNOW TO A COUPLE MINUTES EACH
THAT WOULD BE GREAT THINGS
OF THE LADY ONE REPRESENTING
CALIFORNIA SCHOOL NURSES
ORGANIZATION I THINK ABOUT
A WEEK AGO I MADE SIMILAR
COMMENTS AND THE ISSUE I THINK
IS THAT THE SCHOOLS ARE HIDDEN
HEALTHCARE SYSTEM WHAT WE'RE
TALKING ABOUT PREVENTION IF
YOU LOOK AT THE BRIGHT FUTURES
EVERY ONE OF THESE IS LISTED
IN THE AD CODE PRIOR TO KIDS
COMING INTO SCHOOL THEY HAVE
TO SHOW PROOF OF IMMUNIZATIONS
NO SCHOOLS NO SCHOOL NO SHOTS
NO SCHOOL AND THEY HAVE TO
SHOW PROOF OF PHYSICAL EXAMS
THERE APPEARED IT PERIODICITY
ALL SCALES WITH IN THE ED
CODE THAT COVERAGE EACH ONE
OF THESE IT'S SO THE SCHOOL
CERTAINLY OUR PLACE WHERE YOU
CAN HAVE -- PREVENTION AND
EARLY INTERVENTION SERVICES
AND PROGRAMS AND IN FACT THEY
ARE PROVIDED THE -- -- I ALSO
THINK THAT SCHOOLS ARE GREAT
COLLABORATORS AND SO THAT IF
WE CAN SET UP A PROCESS WHEREBY
WE CAN INTERACT IN CORAL AUG
COLLABORATE WITH THE HEALTH
PLANS IS ENTIRELY POSSIBLE
THAT SOME OF THE -- SOME OF
THE PROGRAMS AND SERVICES THAT
ARE NOT BEING PROVIDED THROUGH
MEDICARE ON OUT BY THE HEALTH
PLANS WE CAN START TO ADDRESS
THOSE AND SO -- I'M NOT SAYING
TO YOU THAT SCHOOL HEALTH HAS
BEEN IN THE SCHOOLS FOR WELL
OVER A HUNDRED YEARS STARTED
IN NINETEEN OH FIVE AND CITY
OF NEW YORK AND ESSEX CERTAINLY
HAS EXPANDED WE HAVE THOUSANDS
OF OF SCHOOL NURSES SCHOOL
COUNSELOR SCHOOL PSYCHOLOGIST
AND SO YOU KNOW WE STAND
READY TO TO ASSIST IN LOOKING
AT THE SIX POINT TWO MILLION
KIDS IN THE SCHOOLS IN TERMS
OF PROVIDING PREVENTION AND
EARLY INTERVENTION SERVICES AND
PROGRAMS THANK YOU APPRECIATE
THAT I THINK THAT WHAT'S ONE
-- SOMETHING THAT ONE OF THE
ASSEMBLY MEMBERS MENTIONED
EARLIER WAS SAYING THE
CORRELATION BETWEEN THE GRAPHS
AND WHEN KIDS GO TO SCHOOL
IN TERMS OF ACTUALLY KNOWING
WHICH SERVICES ARE OUT THERE
TO TAXES WE SHOULD THAT PLEASE
PROCEED GOOD AFTERNOON ON A
HOUSE OF THAT -- WITH UNITED
WAYS OF CALIFORNIA -- AND WE
JUST WANTED TO SAY FIRST OF ALL
THANK YOU TO DOCTOR WOULD AND
-- THEN SENATOR CANNELLA FOR
REALLY BRING FORTH THIS AUDIT
MAKING THE REQUESTED J.
LACK -- AND AND WE WERE
PROUD PARTNERS OF OF THAT
PROCESS -- WITH CHILDREN NOW
THE CHILDREN'S PARTNERSHIP
CHILDREN'S DEFENSE FUND --
AND UNITED WAYS ALONG WITH
FOR FIVE FIRST FIVE -- AND WE
ANTICIPATED AS ADVOCATES AS IS
ON THE WAY WITH WESTERN CENTER
SAID SO CLEARLY YOU KNOW WE
ANTICIPATED SOMETHING LIKE THIS
COMING OUT -- WHAT WE REALLY
WANTED WAS IT TO BE ON PAPER
SO THAT WE HAVE SOMETHING TO
MOVE FORWARD WITH SO THAT WE
CAN SAY WE ARE ALL LOOKING AT
THE SAME THING HAVING THE SAME
DEFINITIONS AND UNDERSTANDING
OF A VERY COMPLEX SYSTEM -- BUT
THAT WE CAN THEN USE THAT --
TO CREATE PATHWAYS FORWARD --
WE THINK IN PARTICULAR CALLING
OUT THROUGH THIS PROCESS THE
-- NEEDS OF A MENTAL HEALTH
-- ISSUES FOR CHILDREN IS OF
PARTICULAR IMPORTANCE -- AND
THAT THERE IS AN OPPORTUNITY
HERE TO COALESCE AROUND WHOLE
CHILD HEALTH -- TO MAKE SOME
OF THE PROMISES THAT WE'VE MADE
TO CHILDREN AND FAMILIES TRUE
AND ACCURATE TO THE BEST OF
OUR ABILITIES AND WE STAND AS
READY PARTNERS ALWAYS THROUGH
THIS PROCESS -- AND WE THANK
YOU FOR CONVENING THIS HEARING
-- AND WE WILL BE OFFERING MORE
DETAILED PERSPECTIVE -- AND
THOUGHTS AND -- OPPORTUNITIES
TO MOVE FORWARD -- IN THE
VERY NEAR FUTURE IN WRITTEN
FORM THANK YOU AGAIN THANK YOU
GOOD AFTERNOON KELLY BEING
ON BEHALF OF THE CALIFORNIA
MEDICAL ASSOCIATION GOOD
TO SEE YOU ALL -- I WANTED
TO SECOND -- DOCTOR ABLE
NICHOLS TESTIMONY EARLIER
AND NOTE AS SOME WOMEN SALAS
MENTIONED -- ALL OF PROPOSITION
THIRTY SIX WAS RETURNED BY
THE GOVERNOR TO SUPPLEMENT
PROVIDER REIMBURSEMENT RATES
IN VARIOUS FORMS -- INCLUDING
BABIES PAYMENTS AND TRAUMA
SCREENING MEASURES WE SEE THE
SUPPLEMENTAL PAYMENTS AS A
WAY TO LEAPFROG THE CAREFULLY
DESIGNED CAPITATED RATE
DETERMINATION SYSTEM THAT DH
CS DESCRIBED BUT IT SHOULD
NOT BE THE ONLY TOOL HOWEVER
-- OVERSIGHT OF THE MANAGED
CARE PLANS ADMINISTRATION OF
THESE PAYMENTS IS CRITICAL
IN ATTRACTING NEW PROVIDERS
RETAINING EXISTING PROVIDERS
NEARING RETIREMENT AND ALSO
INCREASING EXISTING PROVIDERS
MEDI CAL PATIENT MIX -- I ALSO
WANTED TO MENTION THE LOAN
REPAYMENT UNDER PROP FIFTY
SIX -- THOSE APPLICATIONS
CLOSE ON FRIDAY THE SYSTEM WAS
OVERWHELMED AND WE EXTENDED THE
DEADLINE FOR A FEW DAYS -- BUT
IT DOES SHOW RECENT GRADUATES
WILLINGNESS TO SERVE MEDICAL
POPULATION WITH THE FINANCIAL
CHALLENGE OF GRADUATING WITH
ESSENTIALLY A HOUSE PAYMENT
-- TODAY AS OF TODAY THEY'VE
PROCESS AND REVIEWED OVER
EIGHT HUNDRED APPLICATIONS
WITH -- SEVEN HUNDRED PENDING
ALMOST SEVEN HUNDRED WYOMING
SO -- THEY'VE INDICATED THAT
A HUNDRED FIFTY ORTIZ WILL
BE ANNOUNCED AT THE END OF
JUNE -- AND I LOOK FORWARD
TO SEEING HOW MANY OF THOSE
AREN'T PHYSICIAN SHORTAGE
AREAS LIKE SAN COME MENTIONED
AND I'M SAN LUIS OBISPO COUNTY
AND WE STAND READY WITH YOU
ALL TO EVALUATE DIFFERENT
PROPOSALS AND INCREASING AB
POSITIONS IN CERTAIN AND --
UNDERSERVED AREAS THANK YOU
THANK YOU LOOK FOR THEM SERVING
AN FQHC SITES GOOD AFTERNOON
-- MY OUR ALVAREZ AND WITH
THE CHILDREN'S PARTNERSHIP
FOR STATEWIDE CHILD POLICY
AND ADVOCACY ORGANIZATION
THANK YOU TO THE CO CHAIRS FOR
HAVING THIS IMPORTANT HEARING
A DOCTOR WOULD FOR HAVING
REQUESTED THIS AUDIT AS YOU
HAVE HEARD THERE IS SUBSTANTIAL
WORK TO DO TO IMPROVE ACCESS
TO PREVENTIVE SERVICES FOR
CHILDREN ENROLLED IN MEDICARE A
POPULATION OF CHILDREN THAT IS
DISPROPORTIONATELY LOW INCOME
CHILDREN OF COLOR WE OFTEN HEAR
FROM THE DEPARTMENT OF HEALTH
CARE SERVICES IF EVERYTHING
IS A PRIORITY NOTHING IS A
PRIORITY CLEARLY AS THIS AUDIT
HAS SHOWN CHILDREN HAVE NOT
BEEN A PRIORITY IN OUR MEDICAL
PROGRAM IS THE THE COVERAGE
MODEL HAS EMPHASIZED HIGH USERS
THOSE WITH MULTIPLE CHRONIC
CONDITIONS THOSE WITH THE
MOST COSTLY HEALTH CARE TO OUR
MEDI CAL PROGRAM AN IMPORTANT
POPULATION TO THOUGHTFULLY
MANAGE THEIR CARE HOWEVER THE
REALITY HAS BEEN THAT CHILDREN
FOR THE MOST PART WERE GIVEN
INSUFFICIENT ATTENTION AS WE
EXPECT AND REQUIRE CALIFORNIA
FAMILIES TO JUGGLE MULTIPLE
PRIORITIES SO TOO SHOULD
WE EXPECT OUR DEPARTMENT OF
HEALTH CARE SERVICES TO ALSO
DO THE SAME THANKFULLY THE NEW
ADMINISTRATION HAS EXPLICITLY
SAID CHILDREN AS A PRIORITY
RECOGNIZING THAT AND INVESTMENT
IN CHILDREN'S WELL BEING IS
ULTIMATELY AND INVESTMENT IN
ALL OF CALIFORNIA FOCUSING ON
EARLY CHILDHOOD DEVELOPMENT
NOT ONLY SAID CHILDREN OFF FOR
A RIGHT EARLY START IN THEIR
LIFE IT ALSO ENSURES THAT
GENERATIONS OF CHILDREN THAT
BECOME HEALTHIER ADULTS WHO
WILL OSTENSIBLY HAVE FAR FEWER
COMORBIDITIES TO MANAGE A LONG
TERM GAIN FOR MEDI CAL PROGRAM
OVERALL AND WHILE THE AYE IT
OUTLINES A SOBERING SITUATION
FOR CHILDREN IN MEDIC HOW IT
ALSO OFFERS GREAT OPPORTUNITY
ITS RECOMMENDATIONS TRULY SERVE
AS A BLUEPRINT FOR ACTION WITH
THE NEW SIM ADMINISTRATION'S
FOCUS ON HEALTHY EARLY
CHILDHOOD DEVELOPMENT AND THE
LEGISLATURE'S COMMITMENT AND
CLEAR INTEREST IN ADDRESSING
THE RECOMMENDATIONS WE CAN
MAKE TREMENDOUS STRIDES IN
IMPROVING CHILDREN'S CARE THE
CHILDREN'S PARTNERSHIP LOOKS
FORWARD TO WORKING WITH YOU AND
THE ADMINISTRATION TO FULFILL
THE PROMISE OF HEALTH AND
WELL BEING FOR EVERY CHILD IN
OUR STATE THANK YOU THANK YOU
MARTY EMOTO FROM A FAMILY
MEMBER MY OLDER SISTER
DEVELOPMENTAL DISABILITIES
WITH THE CALIFORNIA DISABILITY
SENIOR TO ME ACTION NETWORK
AND THE CALIFORNIA PERSON
CENTERED ADVOCACY PARTNERSHIP
FIRST WANT TO THANK THE THE
JOINT BUDGET JOINT LEGISLATIVE
AJ AUDIT COMMITTEE AND THE
-- SOMEBODY HEALTH COMMITTEE
FOR DOING THIS HEARING AND
ALSO FOR THE -- THE REPORT
-- AND I ALSO WANT TO THANK
THE DEPARTMENT OF HEALTH CARE
SERVICES -- EVEN THOUGH THE
THE REPORTED INDICATES A MAJOR
PROBLEMS YOU KNOW IN TERMS
OF -- CHILDREN'S -- ACCESS
TO PREVENTIVE HEALTH CARE WE
ALSO HAVE WORK WITH DEPARTMENT
ON OTHER ISSUES AND THEY HAVE
BEEN REALLY RESPONSIVE UP
THIRD I'M I'M ON THE DEPARTMENT
OF DEVELOPMENTAL SERVICES
-- DIRECTORS DISPARITIES --
ADVISORY COMMITTEE I JUST
WANT TO COMMENT ON THE ISSUE
OF REDUCING DISPARITIES AND
ITS IMPACT ON CHILDREN'S
ACCESS TO PREVENTIVE HEALTH
CARE IS A MAJOR ISSUE IN IT
WAS BROUGHT OUT IN THE AUDIT
REPORT I WOULD STRONGLY SUGGEST
-- THAT THE LEGISLATURE AND
ALSO THE DEPARTMENTS REALLY
START WORKING TOGETHER
TO THAT EFFORTS TO REDUCE
DISPARITIES AREN'T SIDELOAD
IN ONE DEPARTMENT NONE OTHER
WORDS I SERVE ON THE DIRECTORS
DISPARITIES ADVISORY COMMITTEE
WITHIN THE DEPARTMENT OF
BUILT MOST SERVICES TO REDUCE
DISPARITIES WITHIN THE REGIONAL
CENTER SYSTEM BUT THOSE EFFORTS
REALLY DON'T CROSS OVER TO THE
OTHER HEALTHCARE SYSTEMS PEOPLE
WITH DEVELOPMENTAL DISABILITIES
INCLUDING CHILDREN ACCESS
MEDI CAL WHITE SUCCESS IN ALL
AND MANY OTHER SERVICES BUT
EACH DEPARTMENT TENDS TO HAVE
THEIR OWN EFFORTS TO REDUCE
DISPARITIES AND IF YOU LOOK AT
THE MODELS OF WHOLE PERSON CARE
MY FAMILY AND OTHER FAMILIES
DON'T OPERATE IN SILOS ONLY THE
STATE AND FEDERAL GOVERNMENT DO
AND SO REALLY WOULD URGE THAT
EFFORTS TO REDUCE DISPARITIES
CROSSOVER THE DEPARTMENTS
AND THE SYSTEMS AND AGAIN
PRECIADO ALL THE EFFORTS OF
BY THIS COMMITTEE THANK YOU
THANK YOU VERY MUCH -- JUST GOT
OFF A COUPLE CLOSING REMARKS
AND THEN TURN IT OVER TO MY
-- -- CO CHAIR -- PERSONAL
THANKED EVERYONE FOR THEIR
PARTICIPATION HERE TODAY I
THINK WE -- CAN ACKNOWLEDGE
THAT THERE'S A LOT OF ROOM
FOR IMPROVEMENT AND HOW THE
STATE SO MEDI CAL MANAGED CARE
PROGRAM -- DELIVERY SYSTEM
WORKS FOR THE FIVE AND A HALF
MILLION CHILDREN RECEIVING
SERVICES WE CAN DO MUCH BETTER
BUT I AM ENCOURAGED BY THE
DEPARTMENT'S RESPONSE WITH THE
CABBIE OUT I THINK INCREASING
THE NUMBER OF QUALITY MEASURES
-- INCREASING THE MINIMUM
PERFORMANCE LEVEL PLANS HAVE
TO ME -- AND EMPLOYING A
STRONGER STICK ENFORCEMENT
ARE GOOD STEPS -- WE ALSO
NEED TO IMPROVE HOW WE MONITOR
TIMELY ACCESS TO SERVICES
ENSURE OUR REACH TO CHILDREN
AND FAMILIES -- IS TAKING
PLACE AND WE NEED TO TAKE INTO
ACCOUNT -- BENEFICIARY TRAVEL
TIMES -- WHEN PLANS FILE FOR
ALTERNATIVE REQUEST BUT I WAS
ALSO A BELIEVER THAT SOMETIMES
THE STICK ISN'T ALWAYS THE
BEST APPROACH -- I I I'M A
BIG BELIEVER IN CARROTS AS
WELL -- I THINK AT THE END OF
THE DAY WE WANT TO KNOW THAT
THOSE THAT THE THE THE CARE THE
STATE IS PAYING FOR IS BEING
PROVIDED -- AND INCONSISTENT
WITH THE RECOMMENDED STANDARDS
FOR CARE -- AS WE COVER MORE
MORE PEOPLE AND STRIVE TO GET
HAVE UNIVERSAL COVERAGE HERE
IN CALIFORNIA -- IT'S CLEAR
WE HAVE SERVICES TO A SERIOUS
CHALLENGES WITH PROVIDERS WITH
RATES -- AND -- WHAT I FEAR
AND I'VE SAID THIS MANY TIMES
IS THAT AS WE GET CLOSER AND
CLOSER TO WHAT WE CONSIDER TO
BE UNIVERSAL COVERAGE THAT WE
DON'T HAVE THE ACCESS THAT WERE
NOT DELIVERING THE CARE AND
THAT WE'RE SIMPLY GOING TO BE
BE DELIVERING AN EMPTY PROMISE
AND THAT WOULD BE THE BIGGEST A
SERVICE OF ALL TO CALIFORNIANS
THANK YOU THE RIGHT TO WANT TO
THANK EVERYONE FOR TESTIFYING
HERE TODAY SHE THE AUDITOR'S
REPORT AND HER STAFF TIME
IN IDENTIFYING THESE ISSUES
AND LIKE PREVIOUS TESTIMONY
STATED BEFORE I BELIEVE
THAT'S A BLUEPRINT TOWARDS
TRYING TO ADDRESS SOME OF
THESE -- INADEQUACIES AND
MAKING SURE THAT WE'RE NOT
LEAVING MILLIONS OF CHILDREN
BEHIND THAT CAN RECEIVE THESE
PREVENTIVE SERVICES I KNOW
THERE'S LOTS OF STUDIES OUT
THERE THAT SHOW US THAT WHEN
YOU CATCH THINGS EARLY ON ON
THE PREVENTATIVE SIDE IT SAVES
CALIFORNIANS MILLIONS ON THE
BACKEND ESPECIALLY WHEN WE SEE
THEM AND EMERGENCY ROOMS AND SO
I'M LOOKING FORWARD TO SEEING
THE SIXTY DAY -- CHECKUP WHICH
WILL BE IN A COUPLE OF WEEKS
-- BUT REALLY THE SIX MONTH
AND ONE YEAR AND SEE WERE GOING
I THINK WE HEARD TESTIMONY
EARLIER ABOUT LOTS OF PEOPLE
THAT WANT TO PARTNER AND TRY
TO GET AT THE GOAL WOULD OUR
GOAL IS MAKING SURE THAT WERE
-- INSURING THAT MILLIONS OF OF
CHILDREN AND AND CALIFORNIANS
ARE ACTUALLY RECEIVING THE
PREVENTATIVE CARE -- THAT THEY
NEED AND SO I'M LOOKING FORWARD
TO WORKING WITH D.
CH US AND MY CO CHAIR DOCTOR
WOULD AND EVERYONE THE
TESTIFIED HERE TODAY AND
ENSURING -- THOSE OUTCOMES
FOR CHILDREN I THINK THAT'S
VERY IMPORTANT ONLY JUST
CONCLUDE BY ALSO THINKING --
THE MEMBERS I SHOWED UP FOR
TODAY'S -- HEARING OBVIOUSLY
DOCTOR WOULD WAS HERE --
ASSEMBLY MEMBER VOEPEL ASSEMBLY
WOMAN ANGER CURRY ASSEMBLY
WOMAN WALDRON ASSEMBLY MEMBER
RAMOS AND SENATOR MORE LOCK
IN WITH THAT WE WILL GO AHEAD
AND CONCLUDE AT TODAY'S JOINT
HEARING IT'S FOUR THIRTY
AND THANK YOU FOR BEING HERE