physicians advisory group agenda

F:\winset\HLTHSERV\PAG\PAG 2012\060712\agenda_PAG_06072012.docx

PHYSICIANS ADVISORY GROUP AGENDA

DATE: Thursday, June 7, 2012 TIME: 12:00 PM – 1:30 PM

PLACE: Video Conference at Alliance Offices (Scotts Valley, Merced, Salinas) ***************************************************************************************************************** Members: John Jameson, MD, Jose Chibras, MD, Jennifer Hastings, MD, James Rabago, MD,

Robert Streeter, MD, Brian Moore, MD, Roy Schindelheim, MD, Sara Liu, MD, Cristina Mercado, MD, Larry DeGhetaldi, MD (Board Member)

Alliance Staff: Richard Helmer, MD, Julio Porro, MD, David Altman, MD, Kathy Neal, RN, Barbara

Flynn, RN, Christine Gerbo, RN, Stephanie Sonnenshine, Jennifer Mockus, Kathy Dean, RN, Mary Brusuelas, RN, Kaite McGrew

A. Call to Order and Welcome 5 min Dr. Helmer 12:00 B. Roll Call 5 min Kaite McGrew 12:05 C. Oral Communications 5 min Public 12:10

• Members of the public may address the PAG Committee on items not listed on today’s Agenda, which are within the jurisdiction of the PAG Committee. Presentations must not exceed five minutes in length and individuals may speak only once during Oral Communications.

• If any member of the public wishes to address the PAG Committee on any item that is listed on today’s agenda, they may do so when that item is called.

D. Consent Agenda 5 min Dr. Helmer 12:15

• Minutes for PAG Meeting, March 8, 2012 (attached) E. Update:

• State Budget 5 min Dr. Helmer 12:20 F. New Business

• Expanded Provider Portal Demonstration 30 min Tricia Jennings 12:50 • E-Consults (attached) 25 min Dr. Helmer 1:20

G. Open Discussion 15 min Group 1:45 • Group may discuss any urgent items

H. Adjourn 1:30 The Physicians Advisory Group is a public meeting governed by the provisions of the Ralph M. Brown Act. As such, items of discussion and/or action must be placed on the agenda prior to the meeting.

Next Meeting: September 13, 2012

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Members In Attendance:

Roy Schindelheim, MD Jose Chibras, MD Sarah Liu, MD Robert Streeter, MD

Brian Moore, MD Patrick Meehan, MD

Absent: Valerie Barnes, MD John Jameson, MD Cristina Mercado, MD Jennifer Mockus

Jennifer Hastings, MD James Rabago, MD

Community Attendees: Tim Johnston, MD Spencer Hoh, PhD Michael Molesky

Alliance staff:

Richard Helmer, MD David Altman, MD Barbara Flynn, RN Christine Gerbo, RN

Stephanie Sonnenshine Kathy Dean, RN Mary Brusuelas, RN Julio Porro, MD

Kathy Neal, RN

TOPIC DISCUSSION ACTION

A. Call to order, Roll Call,

Oral Communications

Physician Advisory Group

MINUTES

Thursday, March 8, 2012

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Central California Alliance for Health

Physicians Advisory Group Meeting Minutes

March 08, 2012

Page 2 of 4

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B. Consent Agenda:

1. Minutes from PAG 12/15/11

Decision: Minutes approved as written

None

C. Updates:

1. ADHC/CBAS Program Update

2. Care Transition Coordination

Update

Discussion: Kathy Neal, RN, reviewed the changes coming on April 1st

as the Adult Day Health Care program ends and the Community Based

Adult Services begin. Eligible Alliance members will be enrolled in

CBAS and Alliance members who are ineligible for CBAS will need

enhanced care management plans. Currently there are approximately

nineteen Alliance members who have been identified as ineligible.

Discussion: Dr. Helmer reviewed the components of the Care

Management Care Transition Coordination program. Areas of need

include coordination of medications, scheduling appointments, and

connecting the PCP with the discharge plan in order to prioritize the

member’s follow up appointment.

Suggestion: Group advised that when the messaging from the

pharmacy states “not covered” for non-formulary drugs, it does not

offer alternative formulary substitutions. It was suggested that we

customize that language accordingly.

Discussion: Group wondered if the Alliance had more leverage in

obtaining SNF placement, since we have the SNF pilot program in

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March 08, 2012

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place. The Alliance does have a unique vantage point, in that we

receive communications from all providers involved in the patient’s

care so we are uniquely able to coordinate.

Action: Kaite M. to send handout to the group via email.

Distribute handout to

group via email

D. New Business:

1. 400-1109 PAG Policy

2. Provision of Telehealth Services

Discussion: Group reviewed the annual updated to Policy 400-1109

Physician’s Advisory Group Policy which contained no substantial

revisions.

Decision: Policy approved as written.

Discussion: Dr. Altman gave the group an overview of Assembly Bill

AB415 and the new requirements for the provision of Telehealth

Services. Group reviewed the current draft of the Alliance Policy

outlining the provision of telehealth services to Alliance members. We

anticipate that the program will provide better access for our members

and develop into a more robust program over time. Group discussed the

HEDIS requirement for diabetic eye exams that only counts dilated

exams. Group also discussed potential legal issues that could

accompany the provision of telepsychiatry. Currently the state

telepsychiatry under fee for service and do not anticipate any legal

barriers.

Action: Dr. Altman will bring back the final approved policy and an

update to the retinal eye exam issue at the next meeting.

Bring back final

approved policy and

update on retinal eye

exam issue

- Dr. Altman

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March 08, 2012

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3. Skilled Nursing Pilot Program

Discussion: Dr. Porro reviewed the current Skilled Nursing Pilot

program in detail, including the PCP role, the facility role and the

Alliance’s role in the provision of services to Alliance members. Also

discussed were facility requirements and services provided. The group

reviewed the Level of Care (LOC) matrix and discussed LOC

classification requirements. Group also discussed the efficacy of the

program and the impact in terms of utilization, as the program moved

into all three counties of the Alliance service area. The Alliance

maintains very stringent requirements for facilities who want to

participate, and anticipates even greater use of this level of care as we

begin to work more closely with hospitals and hospitalists via the Joint

Operations Committees.

Suggestion: group suggested that the Alliance look into working more

closely with the Ombudsman Service, and that we target particular

diagnoses that are best served by the program.

E. Adjourn

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Initial information entered (with or

without attachments)

Is the request valid?

Specialist evaluates information

Type of follow up needed?

Provide specific information

regarding care

Recommendations regarding additional pre-visit PCP services

PCP provides services and enters

information in referral

Member seen by SCP

SCP bills for first level e-consult

No

End

Specialist is notified by

email of pending referral

Yes

Office consult or other services not requiredOffice visit may be required after additional PCP services

Specialist is notified by

email of pending

information

Specialist evaluates information

Follow up needed?

Office consult not required

Provide specific information

regarding care

SCP bills for second level e-consult

Office consult required

SCP bills for office visit

Specialist provides findings and

recommendations via portal

PCP is notified by email of

pending information

E Consult and Referral ProcessMember eligible, services requires

referral, etc.

Consider adding SCP evaluation and feedback to PCP of quality of

referral


pending information


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PHYSICIANS ADVISORY GROUP MEETING CALENDAR FOR 2012

Thursday, March 8, 2012 12:00 PM to 1:30 PM

Thursday, June 7, 2012 12:00 PM to 1:30 PM

Thursday, September 13, 2012 12:00 PM to 1:30 PM

Thursday, December 13, 2012 12:00 PM to 1:30 PM

All Meetings will be held via Video Conference at Alliance offices listed below:

Alliance Main Office: 1600 Green Hills Road, Suite #101, Scotts Valley, CA 95066 Alliance Salinas Office: 339 Pajaro Street, Suite E, Salinas, CA 93901 Alliance Merced Office: 530 West 16th Street, Suite B, Merced, CA 95340

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physicians advisory group agenda

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