HealthHelp.ca.gov
Blue Shield/Care1st and
Centene/Health Net Undertakings
IHA Stakeholder Meeting
1
Presented by:
Shelley Rouillard
Director
September 19, 2017
HealthHelp.ca.gov
• DMHC’s activities on provider directories
• Blue Shield / Care1st Merger
• Centene / Health Net Merger
2
Overview
HealthHelp.ca.gov
Increased Call
Volume in Help
Center
-
Media Inquiries
Began
Jan. 2014
Jun. 2014
Non-Routine Surveys Began
Deficiencies Referred to
DMHC Office of Enforcement
2015
Jan. 2015
SB 137 Sponsored by
Consumer Advocates
Settlement of Enforcement
Action-
Follow-up Surveys Began
-SB 137 Passed
-Undertakings
Approved
Oct. 2015
Jul. 2016
SB 137 Implementation
Blue Shield Advisory
Committee
Sep. 2016
Dec. 2016
DMHC Released
Draft Standards
Health Plans To Comply
With Standards
Jan. 2018
11
HealthHelp.ca.gov
On October 8, 2015, DMHC approved Blue Shield’s acquisition of
Care1st
• $1.2 billion transaction
• Brought Blue Shield into the Medi-Cal program
• Public Meeting for stakeholder input
• Negotiated undertakings related to plan operations, quality
improvements and community investments
12
Blue Shield/Care1st Merger
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• Provide $200 million in community investments
o $10 million to locally based consumer assistance programs
o $50 million to develop a statewide centralized provider
directory database
o $140 million to the Blue Shield Foundation
13
Blue Shield/Care1st Undertakings
HealthHelp.ca.gov
Centene / Health Net Merger On March 22, 2016, the DMHC approved Centene’s acquisition of
Health Net and its subsidiaries.
• $6.8 billion transaction involving several states.
• Public meeting for stakeholder input
• Negotiated undertakings related to plan operations, quality
improvements and community investments.
14
HealthHelp.ca.gov
• Provide $340 million in community investments over 5 years
o $5 million for consumer assistance
o $10 million to improve enrollee health outcomes in
rural/underserved areas
o $50 million to strengthen the Medi-Cal delivery system
o $75 million infrastructure investment to provide capital to
entities in underserved areas
o $200 million to build a service center and create 300 jobs
15
Centene/Health Net Undertakings
Privileged & Confidential
Community & Infrastructure Investments
Undertakings 29
Integrated Healthcare Association
Annual Stakeholders Meeting
Presented By Carol Kim
Vice President
Community Investments & Public Affairs
September 19, 2017
© 2015 – Health Net, Inc. Confidential: Do not distribute
Merger of Centene and Health Net
2
• Merger contingent on fulfilling a set of Undertakings
• Undertaking 29 focuses on Community & Infrastructure Investment (CII)
Undertaking 29 Purpose Target Region(s)
Community
Investments$65M
a) Locally-based consumer assistance programs
($5M over 5 years)Statewide
b) Improved health outcomes in rural and/or
underserved communities
($10M over 5 years)
Statewide with focus on Central Valley:
Kern, Kings, Fresno, Madera, Merced,
Tulare, Stanislaus, San Joaquin
c) Improved completeness & accuracy of
encounter data
($50M over 5 years)
Statewide
Infrastructure
Investments$75M
g) Capital investments for health care
infrastructure and care delivery improvementsStatewide
© 2015 – Health Net, Inc. Confidential: Do not distribute
Getting to work
3
Community & Infrastructure
Investment (CII) Team Responsible for the framework and
execution of the grant program•Carol Kim, VP of Community Investments & Public Affairs
• Stephanie Landrum, Community Grants Manager (NoCal)
•Mercy Siordia, Community Grants Manager (CV)
• Thomas Tran, Community Grants Manager (SoCal)
• Katherine Murphy, Community Grants Administrator
Health Care ExpertsComposed of Health Net business
leaders and health care experts with
diverse and deep experience in
health care
Community Investment Advisory CommitteeRequired by Undertaking 29(d) to advise as well as provide expertise and guidance
for the development and implementation of the grant program
Infrastructure Investment Advisory CommitteeRequired by Undertaking 29(g) to advise as well as provide expertise and guidance
for the development and implementation for investments
© 2015 – Health Net, Inc. Confidential: Do not distribute
Advisory Committee: Community Investments
5
Patrick Johnston, Committee Chairman and Former State Senator
Sean Atha, SVP Business & Network Development for River City Medical Group
Jennifer Kent, Director of the California Department of Health Care Services
Carol Kim, Vice President of Community Investments & Public Affairs for Health Net
Jim Lott, Management Consultant, former Chief Strategy Officer of MLK Community
Hospital
Louise McCarthy, President & CEO of Community Clinic Association of LA County
Chris Perrone, Director of Improving Access of California Health Care Foundation
Shelley Rouillard, Director of the California Department of Managed Health Care
Stephen Schilling, Chief Executive Officer of Clinica Sierra Vista
Committee advises Health Net on the Five-Year
$65M Community Grants Program
© 2015 – Health Net, Inc. Confidential: Do not distribute
Advisory Committee: Infrastructure Investments
6
• 12-member Advisory Committee to be chaired by Sandra Shewry,
VP of External Engagement at California Health Care Foundation
• Undertaking Requires representatives from:
– CA HHS: Secretary Diana Dooley
– DMHC: Shelley Rouillard, Director of DMHC
– Centene: Christopher Isaak, SVP, Corporate Controller
– Health Net: Carol Kim, VP of Community Investments & Public Affairs
• Undertaking Requires an Independent Investment Advisor
– McDonnell Investment Management selected by Centene
• Additional Committee Members represent providers, health information
technology, health care policy and foundations/philanthropic entities
Inaugural Meeting scheduled for early October 2017
Committee will advise Health Net on
the $75M Infrastructure Investments
© 2015 – Health Net, Inc. Confidential: Do not distribute
Community Investments2017 Grant Cycle
8
• 2017 Grant Cycle is a start-up year affording Health Net an
opportunity to achieve the following:
– Test and pilot grant approach
– Collect data to inform future grant programs
– Meet key milestones
• $6M-$10M total target grant funding amount for 2017*
* Pending Centene Budget Approval and Allocation
Grant Cycle Funding Focus Undertaking Addressed Status
Spring 2017
Enhanced Access
($1M)
Outreach, Enrollment
& Retention(a) Consumer Assistance Completed
Culture of Quality
($500K)
Quality Improvement
Technical Assistance(b) Improve Health Outcomes Completed
Fall 2017
Culture of Quality
($1.5M)Health Workforce (b) Improve Health Outcomes In Progress
Encounter Data
Improvements
($3M-$7M)
Encounter Data Pilot(c) Improve Encounter Data
Completeness & AccuracyIn Progress
© 2015 – Health Net, Inc. Confidential: Do not distribute
Spring 2017 Grant Awards - $1.5M Total Funding
9
Enhanced Access: Outreach, Enrollment & Retention
$1M total over 18-months
NO
RTH
ERN
C
ALI
FOR
NIA Ampla Health
Sacramento Covered
CEN
TRA
L V
ALL
EY Community Health Initiative of Kern County
Centro La Familia Advocacy Services
SOU
THER
N
CA
LIFO
RN
IA
East Valley Community Health Center
Maternal and Child Health Access
Northeast Valley Health Corporation
Southside Coalition of Community Health Centers
The Children's Clinic
Culture of Quality:
Quality Improvement Technical Assistance
$500K total over 18-months
GR
AN
TEE • Bridget Cole, Institute for High Quality Care
• Bobbie Wunsch, Pacific Health Consulting
Group
SCO
PE
OF
WO
RK
• Assess QI Capacity for 6-10 PCPs/ FQHCs• Create improvement roadmap for each• Customize and facilitate QI learning• Produce QI improvement dashboard
CO
UN
TIES • Sacramento
• San Joaquin
• Los Angeles
HED
IS
MEA
SUR
ES • Cervical Cancer Screening
• Childhood Immunizations
• Prenatal Care
© 2015 – Health Net, Inc. Privileged & Confidential
Proposed Fall 2017 Grant Cycle*
10
Culture of Quality
• RFP released on July 14, 2017 and proposals currently under review
• $1.5M total target funding to support Health Workforce Development in rural
and underserved areas
• Focuses on Training, Retention and Recruitment
• $100K-$150K over 18-month per grantee
Encounter Data Improvement
• $2.5M-$3M total target funding to improve short-term, immediate encounter
data needs
• Advisory Committee engaged in thoughtful, deliberate and informed
approach for the $50M over 5 years for Encounter Data Improvement efforts
• The Committee has invited key experts and leaders for in-focus discussions
to help inform future long-term investment opportunities and strategies
* Pending review and guidance by Community Investment Advisory Committee
© 2015 – Health Net, Inc.
Multi-Year, Multi-Phase Grant Approach*
* Pending consultation with Health Net Leadership and Community Investment Advisory Committee.
Contingent on Consultation with Health Net Leadership &
Community Investment Advisory Committee
Considering short-term, one-time investments to help address
immediate needs for encounter data
• Potential funding considerations include Infrastructure, Capacity Building
and Training to improve encounter data
• Looking to support Medi-Cal Managed Care Provider Organizations: – FQHCs/Clinics
– Individual Private Medical Practices
– Provider Groups
– Management Services Organizations
Exploring long-term approach for plurality of $50M to improve
encounter data
• Multi-Year, Multi-Phased Approach:– Phase I, Assessment
– Phase II, Design
– Phase III, Implementation
© 2015 – Health Net, Inc.
• Carol Kim, VP of Community Investments & Public Affairs
• Stephanie Landrum, Community Grants Manager (No Cal)
• Mercy Siordia, Community Grants Manager (CV)
• Thomas Tran, Community Grants Manager (SoCal)
• Katherine Murphy, Community Grants Administrator
CII Team Contact List