blue shield/care1st and centene/health net … · blue shield/care1st and centene/health net...

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

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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

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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

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• 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

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Centene/Health Net Undertakings

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Questions?

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


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

Privileged & Confidential© 2014 – Health Net, Inc. 4

Advisory Committees


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


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


Community Investments

2017 Grant Cycle


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


Spring 2017 Grant Awards - $1.5M Total Funding

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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*

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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


Encounter Data Improvement

© 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


Thank You

© 2015 – Health Net, Inc.

• Carol Kim, VP of Community Investments & Public Affairs

[email protected]

• Stephanie Landrum, Community Grants Manager (No Cal)

[email protected]

• Mercy Siordia, Community Grants Manager (CV)

[email protected]

• Thomas Tran, Community Grants Manager (SoCal)

[email protected]

• Katherine Murphy, Community Grants Administrator

[email protected]

CII Team Contact List

mailto:[email protected]





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