Provider Advisory Group Meeting September 15, 2017

Lunch: 12:00 Meeting: 12:30 – 1:30 Agenda

Meeting Locations:

Host: Partnership HealthPlan Main Office: 4665 Business Center Drive, Fairfield

Video conferencing is available at our regional offices:

Southwest Regional Office at 495 Tesconi Circle, Santa Rosa

Northeast Regional Office at 3688 Avtech Parkway, Redding

Northwest Regional Office at 1036 5th Street, Suite E, Eureka

1. Standing Agenda Items

1.1. Welcome – Kelley Sewell

1.2. Review of Minutes

1.3. Review of Agenda

1.4. Introduction of Presenter-Susan Foster, FNP-BC, Chief Medical Officer at Hill

Country Health & Wellness

2. Presentations

2.1. Childhood Obesity – Presenter: Jeff Ribordy, MD

3. Old Business

3.1 None

4. New Business

4.1.1. PHC Update – Kelley Sewell

4.1.2. Report from Physician's Advisory Committee – Dr. Ribordy

4.2. Report from the Claims Department – CHDP immunization modifiers and place

of service codes for UB04 – Claims Staff

4.3. Report from Member Services – Jennifer Wickberg, Associate Director of Call

Center, Member Services

4.4. Report from Provider Relations, Education Team – C & L Reminder on Cultural

Competencies for Healthcare providers – Denise Surrette

5. Provider Topics of Interest

5.1. Topics of Interest, Upcoming Events, Health Fairs and Trainings: All Attendees

PARTNERSHIP HEALTHPLAN OF CALIFORNIA

MEETING MINUTES

Committee: Provider Advisory Group (PAG)

Date/Time: July 21, 2017 12:30 p.m. – 1:30 p.m.

Guests Present: Fairfield: Tara Sharifzadeh, David Lopez, Pat Zarate, Flaco Zonatis, Pam Sakamoto, Bridget Oduni, Wendy Wink, Celine Regalia, Christy Grills,

Andrea Badillo, Jennifer Adams, Lisa Chin, Minerva Arellano, Cinda Ortega, Maya Sioso, Michelle Rodriguez, Kim Rizzi, Brittany Speer

Santa Rosa: Claudia Nola, Linda Bohn, Brittany Ruane, Isabel Soriano, Natalie Douglas, Maria Madrigal, Kenneth Chambers, Brittany Curtright,

Teri Ortiz, Melinda Medeiros, Elena Pardini, James Hurbin, Robert Powell, April Treble, Laura Andrews

Eureka: Julie Levy, Kier Flicker, Sandra Jones, Chris Cody, Michael Franklin,

Redding: Candy Stockton, MD, Jeff Bosworth, Fang Chen, Leanna Williams, Shelly Polink

PHC Staff Present: Fairfield: Liz Gibboney, Mary Kerlin, Robert Moore, Mark Netherda, Ledra Guillory, Betsy Campbell, Maria Cabrera, Araceli Gutierrez, Rebecca

Mannella, Tondenisha Coleman, Denise Surette, Rebecca Garcia, Carol Parker

Santa Rosa: Mark Netherda, MD, Gloria Turner, Stephanie Phipps, Melissa Perez

Eureka: Jeff Ribordy, Shell Swift, Sommer Halligan

Redding: David Ho, MD, Nai Chadderdon, Kris Devan, Kim Palfini, Sharon McFarlin,

AGENDA ITEM

DISCUSSION/CONCLUSIONS

RECOMMENDATIONS /

ACTION

DATE

RESOLVED

1. Standing Agenda

Items

1.1. Welcome and

Introductions

1.2. Review of

Minutes

1.3. Review of

Agenda

1.1. Meeting called to order by Chairperson Tara Sharifzadeh, NorthBay Home Health &

Hospice

1.2. Minutes from 05/19/2016 reviewed.

1.3. Agenda was reviewed.

1. Presented as information

only

07/21/2017

2. Presentations

2.1. Betsy Campbell, Senior Health Educator at Partnership HealthPlan of

California gave a presentation on Heat Related Illness.

Heat exhaustion causes symptoms such as: excessive thirst, muscle cramps, heavy

sweating and weakness. Heat Stroke is more serious, and can cause rapid heartbeat,

shortness of breath, and loss of consciousness. Infants and the elderly are particularly

at risk.

It is important to stay hydrated, protected from the sun, and stay cool to avoid both

heat exhaustion and heat stroke.

2. Presented as information

only

07/21/2017

3. Old Business 3.1. None. 3. Presented as information

only.

07/21/2017

4.1. PHC Updates

4.2. Report from

Claims

4.1.1. Liz Gibboney, CEO at Partnership HealthPlan of California reported on recent

activities at PHC.

The American Health Care Act (AHCA) would repeal or modify many provisions

of the Affordable Care Act (ACA). The Congressional Budget Office (CBO)

estimates that in 2018, 14 million more people would be uninsured than are currently,

and that this number would rise to 24 million by 2026 if the ACA were repealed.

There is a great deal of uncertainty surrounding the issue, and PHC continues to

monitor the situation.

The Fiscal Year 2017-18 Budget has been completed. PHC has included a fairly

static membership model, and we anticipate very little change in our membership

over the next year.

The 3-year Strategic Plan was approved. Initiatives include NCQA Accreditation

and a Substance Use Disorder Treatment "Drug Medi-Cal" Program.

PHC is working with transportation provider MTM to implement the State-

mandated transportation benefit, and asks that our provider network use this benefit

judiciously.

4.1.2. Robert Moore, MD, MPH, Medical Director at Partnership HealthPlan of

California reported on the recent Physicians Advisory Committee (PAC) Meeting.

PHC has expanded its Partners in Palliative Care Benefit program.

PHC will continue our Intensive Outpatient Care Management Program, but the larger

State Health Home pilot program has been put on hold because of anticipated

changes to state and federal healthcare programs.

Pay-for-performance programs such as PHC's Quality Improvement Program are being

re-evaluated at the State level, and changes are anticipated. PHC’s Long Term Care

pay for performance program is in its second successful year.

4.2.1. Rebecca Mannella, Claims Resolution Manager, spoke to the group regarding

Claims issues.

PM-160 CHDP Claims Conversion: Please refer to Important Provider Notice #277

on the PHC Website.

Beginning on July 1, 2017, CHDP claims should be billed using the CMS-1500 form,

UB04 form or the electronic 837 HIPAA compliant claim format.

4. Presented as information

only.

07/21/2017

4.3. Reports from

Member Services

4.4. Report from

Provider Relations

4.3.1. Araceli Guttierez, Member Services Rep Supervisor, shared information about

the recent meeting of the Consumer Advisory Committee.

The Consumer Advisory Committee (CAC) drafted a letter to our State Senators in

regards to their support of the Affordable Care Act.

La Clinica Vallejo gave a presentation on their Social Determinants of Health Grant

recipient, Transitions Clinic, which provides care and support resources for

recently incarcerated people returning to society.

4.4.1. Denise Surette, Provider Education Specialist, shared information about the recent

Child Health and Disability Prevention (CHDP) Program HIPAA Code Conversion and

Claim Form Transition

The PR Education Team has traveled to all service areas conducting provider

trainings regarding the PM-160 Information Only billing form and the 2-digit local

procedure codes currently used for CHDP program claims. A webinar training is

being held August 9, and will be recorded. More information is available on the

Partnership HealthPlan of California website at www.partnershiphp.org.

5. Provider

Questions, Topics of

Interest,

Announcements, and

Upcoming Events

5.1. None

5. Presented as information

only.

07/21/2017

Meeting Adjourned

PHC – Provider Advisory Group – July 21, 2017

Minutes prepared and submitted by: Carol Parker

Tara Sharifzadeh 7/21/2017

Chairperson Date

9/15/2017

1

Pediatric ObesityA Growing Problem

Jeff Ribordy, MD, MPH, FAAPRegional Medical DirectorPartnership HealthPlan of California

Current Stats (CDC data, 2011-14)

Children 2-19 years: Obesity prevalence ~17%, stable (1970s ~5%)

Higher rates among Hispanic (21.9%), African American (19.5%) vs. Caucasian (14.7%), Asian (8.6%)

Prevalence increases with age: 2-5 years (8.9%), 6-11 (17.5%), 12-19 (20.5%)

Some good news: for 2-5; 2003-4 (13.9%) -> 2013-14 (9.4%)

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Typical 70s Kids

Typical Modern Kid

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Definitions

BMI – Body Mass Index Some drawbacks

Overweight: 85%-95%tile

Obesity: >95%tile

Risk Factors

Prenatal (Placental nutrition, GDM, high BW) Fewer family dinners Fast food, processed foods (sat’d fats, trans fats, HFCS), Low access to and intake of fruits & veggies, Fewer safe outside play sites, lower school PE requirements More screen time Media/advertising

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4

Protective Factors

Breastfeeding Families with active lifestyles Minimal screen time (NO TV IN BEDROOM) Non-obese parents

● Hypertension (2.9x higher)● Type 2 diabetes (2.9x higher)● Coronary artery disease● Hypercholesterolemia (2.1x higher)● Other hyperlipidemias● Left ventricular hypertrophy● Obstructive sleep apnea● Increased severity of asthma● Mechanical stress on joints, slipped capital femoral epiphysis● Blount disease (tibia vara)● Pseudotumor cerebri● Hepatic steatosis (fatty liver), cholelithiasis● Gastroesophageal reflux● Insulin resistance, acanthosis nigricans● Social stigma, depression, low self-esteem

Medical Complications of Pediatric Obesity

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Role of Provider

Evaluate/diagnose Labs, imaging

Overweight – quarterly visits, Obese – monthly Medication? Metformin Sibutramine Diet pills, stimulants, caffeine pills Orlistat

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Child/Family – ready for change Motivation interviewing Avoid weight shaming, body dissatisfaction Weight Watchers – Point system Avoid most diets, esp. “Fad diets” Atkins-like (Protein-sparing modified fast) – 30-50 lbsweight loss possible

Bariatric surgery

Interventions

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41 children had fructose in diet replaced with starches.

Liver fat measured before and after

There was a median reduction of liver fat from 7.2% to 3.8%

After 9 days…

Programs

Based on “5-2-1” or “5-2-1-0” approach with individual program modifications

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Cleveland Clinic5 to Go!

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References https://www.nichq.org/resource/healthy-care-healthy-kids-obesity-toolkit

http://www.une.edu/mhprc/projects/maine-youth-overweight-collaborative

http://www.une.edu/sites/default/files/Ped-Obesity-flip-chart_Maine_FINAL.pdf

https://portals.clevelandclinic.org/ungc2014/Community/CommunityEngagement/5toGo!trade;/tabid/8624/Default.aspx

http://www.letsgo.org/toolkits/

http://www.pediatrics.org/cgi/doi/10.1542/peds.2009-1955

Pediatrics in Review Vol.32 No.9 September 2011