humboldt county mom / phc member · the um team continues to manage hospital admissions and lengths...

Humboldt County Mom / PHC Member“This is the safest my family has feltin my children’s entire lives.”Onyx Apartments in Eureka (shown here) was oneof the projects supported by PHC’s $25 million inhousing grants. The complex celebrated its grandopening last year and is now home to 10 families.

One of those families is led by the single mom andPHC member quoted above. When she moved in, she had spent the previous nine months in shelters, sober living homes, and transitional housing. Her children were wards of the state, and the last piece she needed for them to return home was permanent housing.

“Onyx has given us the stability that we needed,” she says She and her children are domestic violence survivors, and having a stable permanent home has given them not just a place to live, but also the opportunity to receive the support and therapy they needed to address past traumas.

They no longer regularly miss appointments and finally feel safe in their own home.

CEO Report

Wildfires UpdateoPHC staff & offices

CERT meetings Alert Media Platform

oMember Information Shelters Few calls into MS Member Outreach

oProvider Network Reporting to DHCS daily

oCounty OES Planning Meetings

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CEO Report

Continued COVID-19 ResponseoStaff

Telework “Return to Office” Protocols Timing Management Retreat/Feedback

oMembers Remote Monitoring Equipment Pilot Early health equity data

oProviders Network reporting to DHCS Testing Status Telehealth & Virtual Care Support

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CEO Report

Racism and Health Equityo Staff Forumso Health Equity Teamo Population Needs Assessment

Wellness and Recovery Programo Drug Treatment Benefito Member Outreacho Provider Network

State Legislative VisitsoKey MessagesoSeptember?

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CEO Report

DHCS Prioritieso Long Term Care at Home” Programo MediCalRx (“Pharmacy Carveout”) January 1, 2021 Data Concerns

o CalAIM Waiver Statuso Behavioral Health Integration Grants Funding through Prop 56 Timing

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CEO Report

Federal Issues & AdvocacyoHealth and Human Services (HHS) Final Rule on DiscriminationoMedicaid Fiscal Accountability Rule oPublic ChargeoMedicaid Funding during PandemicoTelehealth FlexibilitiesoPresumptive Eligibility

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CEO Report

NCQA/HEDIS Scoreso January 2021 Surveyo Managed Care Accountability Set (“MCAS”)o PCP QIP Dashboard/County

Housing GrantsoProjects in ProgressoReport in Packet

Board Calendar oOctober 28th Meeting - virtualoDecember 2nd MeetingoBoard 1:1s Continue

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Disclaimer: Data presented in the following slides are a snapshot moment in time. There may be some differences between what is presented below and what you’ve seen in other presentations.

Executive DashboardDate: August 26, 2020

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Membership Dashboard

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Delegation Dashboard

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Health Services Dashboard

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The UM Team continues to manage hospital admissions and lengths of stay through the Utilization Management process which includes

concurrent hospital review and frequent meetings with hospital discharge planners and/or Case Managers to discuss alternative placements and

services for members. It is noted that this quarter included winter months (Jan, Feb) and the COVID outbreak began in mid-March which may have

contributed to the statistical increase.

Noted increased ED visits for homeless and housed members with acute upper respiratory infection. PHC Housing initiative is working to provide

housing for members experiencing homelessness. Will work with identified PCPs to increase use of primary care services for respiratory

infections in winter months.

Treatment Authorization Request (TAR) Dashboard

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SR Pharmacy has made

changes with staffing for P&T,

improved workflow

monitoring, and improved processes.

Grievances Dashboard

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One (1) State Hearing overturned by DHCS during

this reporting period.

Four (4) late cases of the 834 closed, results in 99.52% performance

standard. Initial deployment and impact

of COVID-19 on staff resulted in late cases. All

late cases occurred in April. May and June had

(0) late cases. (This metric is under review and may have

future threshold adjustments.)

Member & Provider Service Dashboard

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Claims Dashboard

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There were many promotions and

back-filling of staff early in the year.

Additionally, training was

restructured and improved leading

to improved outcomes.

Human Resources Dashboard

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Due to budget concerns, PHC has implemented a hiring freeze until further notice.

Specialty Access Dashboard

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PHC’s Specialty Access

Workgroup meets 4/year.

We also have a Team Goal to address these

issues. PHC has heavily

promoted the use of

telehealth which resulted

in an increase in specialty visit

utilization.

Quality Rankings Dashboard

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In 2019, the new MPL under which healthplans are held accountable, increased from the 25th percentile to the 50th percentile as this was the basis for calculating the most current update per HEDIS 2020 results.

No change from prior report. Due to COVID-

19, DHCS is not reporting QFS in 2020 so

this metric is being re-visited for FY20-21.

IT Dashboard

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CMO Report on Quality

Robert Moore, MD MPH MBA

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Topics

1. Hospital Readmission Rates2. Lead Screening Rates3. HEDIS 2019 Results

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Mount Konocti, Lake County

Rate of Growth of Cases (past 3 weeks)Yearly Trend in All Cause Adult (No Risk Adjustment)

PHC-wide rate

2020 data: partial year

Yearly Trend in All Cause Adult (No Risk Adjustment)

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Yearly Trend in All Cause Adult (No Risk Adjustment)

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Lowest Readmissions Highest Readmissions

Lead Screening: 2019 regional data

Region Denominator Numerator Rate National HMO Medicaid Benchmarks Not Available

Southeast 2968 574 19.34%

Southwest 3491 708 20.28%

Northeast 1508 44 2.92%

Northwest 988 146 14.78%

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Lead Screening: 2019 regional data

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Composite HEDIS Performance by Reporting Year

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HEDIS: Future Predictions

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This year (Measurement year 2020):

• Performance on all HEDIS measures will drop dramatically. NCQA thresholds are meaningless.

• Likely no penalties or public reporting of data

Board of Commissioners

Meeting

June 24, 2020

Northern Region Update and Workforce Development Overview

Workforce Development Background Assessment and Input Strategies Plan for moving forward

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Current status of Northern Region PHC Services and Community

Questions

Membership Providers NR Region Employees County Overview & Community Health Quality Innovations and Implementations

Northern Region Stats at a Glance

PHC membership totals 577,338 Medi-Cal members, of which 158,102 are in the Northern Region

Shasta: 60,467 Siskiyou: 17,104 Lassen: 7,413 Modoc: 3,611

Humboldt: 53,566 Trinity: 4,635 Del Norte: 11,307 The Northern Regions equates to 27% of the PHC’s total population

On average PHC Members make up 35% of each county total population, with Del Norte and Siskiyou totally over 40% of their total population.

There are 200 employees in the Northern Region 185 in Redding and 15 in Eureka

The Northern Region had 100% participation in the most recent Employee Engagement Survey and a 99% score on PHC is a great place so work.

Provider Network- 477 18 Hospitals

49 PCP’s

127 Ancillary

283 Specialists

23% Increase in Provider Numbers since 2014

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PHC Medi-Cal - Enrollment Summary

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Community and Regional Determinants of Health

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Northern Region Counties continue to rank in the bottom for important determinants of health. Of the 58 counties in California the NR counties rank 42 or lower. Modoc, Trinity and Siskiyou ranking 55, 56 and 57 respectively in overall Health Outcomes.

Statistics of Note Include: Less then 30% of Lassen 9th graders graduate high school compared to 83% statewide 67% of Modoc driving deaths and 44% of Trinity are due to alcohol, compared to 30%

statewide. Over 25% of children live in poverty in 3 out of 7 of our counties. (Trinity is over 30%) Obesity and Adult Diabetes also exceed state averages

o Over 40% obesity rate in Lassen County compared to statewide average of 24%o Modoc and Lassen have twice the state average of adult diabetes at 19% and 20%

Community Health: Health Status

34*All data gathered from County Health Rankings

Quality Improvement – JLI’s

Despite the low county health rankings however, PHC has been successful in collaborating with our Providers and Communities to improve our over all Quality Scores

Over calendar year 2019, both the Northwest and Northeast regions achieved significant improvement gains in regional composite HEDIS performance scoring! The NW achieved an 11% improvement gain over prior year and the NE an 8% gain!!

The NW demonstrates strong performance in Diabetes Care and improved in Controlling High BP. The NE improved from <25th to the 50th percentile in the 3-6 yr. old Well Child Visit measure!! The NE and NW made great progress in Perinatal Care, achieving scores in the 90th percentile.

Although we are making progress we still have a lot of work to do! Immunizations – Babies and Adolescents Well Child Visits – Expanding to virtually the entire 0-21 year old age range Asthma Care – Caring for 5-64 year olds with persistent asthma Women’s Health Screenings - Cervical Cancer, Breast Cancer, and Chlamydia Screening

Joint Leadership Initiative: A special collaborative focus on Quality Improvement was launched involving senior PHC leaders and the Executive teams of our largest providers.

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Quality Improvement – Regional Partnering & Support

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As we emerge from COVID-19, PHC aims to support its providers and members as they return to a greater focus on preventive care services.

Provider Educations & Technical Assistanceo Priority HEDIS/QIP measures – asthma care, women’s health, well child/IZso Best practice sharing in utilizing telehealth visits o Top QIP Performers sharing tips/trickso Applying QI methodologies and tools

Member Engagement & Outreach Support

Member Incentive Program Offerings - Pregnant members and young children

County Partnerships

Del Norte• 42% of population on M/Cal• Support for smoking cessation, homeless

count; community baby shower• Facilitate Del Norte Opioid Collaborative • $493, 000 in Housing grants

Modoc• 32% of population on M/Cal • Opioid/Pain management coalition• $143,00 in Housing Grants

Humboldt• 38% of population on M/Cal• Long term care pilot• Leveraging joint opportunities to improve

well child visits, immunizations, and women’s health screenings

• $2.3 M in Housing Grants

Trinity• 33% of population on M/Cal• Participating in Healthcare Collaborative • Opioid Coalition • Homeless Outreach event • Peds preventive services initiative w/PHC• Mammography Bus Success – Moving to Expand!

Lassen• 24% of population on M/Cal• Participate in Lassen Collaborative – and

successful opening of LVN program at Lassen Community

• Participate in Provider Access Committee• $342,000 in Housing Grants

Shasta• 33% of population on M/Cal • Many Strong partnerships – SHARC/United Way• Partnering with Public Health & Middle Schools to

improve Adolescent Immunization rates• Immunizations for Babies Media Campaign – Fall ’20• PIP focused on 3-6 yr old Well Child Visits• ER Navigator • Outreach to probation• $2.6M in Housing Grants

Siskiyou• 40% of population on M/Cal• Participate in HealthCare Collaborative• Leveraging joint opportunities to promote

well child visits and immunizations• $779,000 in Housing Grants

Innovations and Implementations

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Innovations

Implementations Wellness and Recovery go-live and Claims processing Rx Carveout

Virtual Site Reviews ePrompts Pilot Expansion of NR Clinic Ops Meetings and

Provider Scorecards ED Navigator PSPS Education during CC Calls Transportation Efficiency Improvements

Workforce Development

Background Why are we focusing efforts on Workforce Development California Future Health Workforce Commission – Liz Gibboney Impact on Quality and Equity

What we have done so far Assessed and LISTENED!

o Met with over 100 stakeholders and potential partnerso Gathered Data and Information

• Consolidated the data and organized it so we can really understand the challenges• Identified Resources

How we are going to move this work forward Continue to assess and gather feedback, information, and resources CHW- Community Health Worker Program HPSA Score Support Recruitment Academy Enhance Provider Recruitment Program based on feedback

Who is going to lead this work Chloe Shafer- NW Regional Manager Kathryn Power- Community XXXX Cody Thompson- Project Coordinator- Provider Recruitment Program

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Workforce Development Background

What is driving this work?

We hear you! o At the recent Strategic Planning Meeting

in January, Workforce was identified as a primary driver for our providers to meeting quality and service goals

Not a new problemo California Future Health Workforce

Commission – Liz Gibboney

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Healthcare Qualityo A workforce shortage is a major

challenge for our quality measures

Healthcare Equity

Workforce Development Background

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What is driving this work? We hear you! At the recent Strategic Planning Meeting in January, Workforce was identified as a primary

driver for our providers to meeting quality and service goals Not a new problem

o California Future Health Workforce Commission – Liz Gibboney

Healthcare Quality A workforce shortage is a major challenge for our quality measures

Healthcare Equity

What we have done so far

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Met with over 100 providers, community stakeholders, board members, educators, members and key external partners, and captured their challenges, suggestions and preferences.

Resources/ Community Partners

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Gap Analysis by Region

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Workforce Development Assessment

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Review, Assess and organize data and resources by county, region and geographical area

What we are doing

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Continue to assess and analyze the needs and resources that existCHW- Community Health Worker Program

A CHW is a frontline health worker who is a trusted member of and generally has a solid understanding of the community served. This enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality of cultural competence of service delivery. o Potential Roles include

• Patient /Health Navigators• Care Manager/Case Worker• Health Educator• Enrollment Specialist• Patient Educators

Assess and endorse existing program Develop scholarship program – establish process to incorporate members into program Partner with providers to establish internship program

HPSA (Health Professional Shortage Areas) Score support External consultant to assist providers with HPSA Scoring Increase

Recruitment Academy Enhance the Provider Recruitment Program

Inclusion of Behavioral Health Prescribers Expansion and increase of payout to be spread over 3 years versus one

Introducing our Workforce Development Team

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Cody ThompsonProject Coordinator II

Kathryn PowerManager of Community

Relations & Policy

Chloe SchaferRegional Manager

What we need from you…

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Continue to provide feedback on your needs and the progress of our initiatives.

Support the CHW program through partnerships and development of internships

Participate in the Recruitment Academy

Utilize the Provider Recruitment Program

Partner with our Workforce Development Team

Questions?