2021 Community Update

Royle and James (San Joaquin County residents)

Upward

Health Plan of San Joaquin (HPSJ) is enthusiastic about the future of Medi-Cal and forthcoming opportunities to expand our service to the community. As our country resiliently recovers from the pandemic, local health plans like HPSJ are uniquely positioned to support communities by meaningfully engaging members, providers, and various stakeholders. Looking beyond the pandemic, HPSJ remains committed to continually strengthening local partnerships as we coordinate quality care for our members.

We are proud to share with you our 2021 Community Update, which highlights our innovative partnerships to optimize the health of our region. This update reflects the dedication, passion and commitment of our more than 400 employees to the residents of San Joaquin and Stanislaus Counties. With more than 25 years of dedicated service, we remain committed to adapting to meet the needs of our community. As HPSJ looks ahead, we will continue to partner with our members and providers to coordinate access to quality health care.

HPSJ is collaborating across sectors to respond to the emerging needs of our community. With tremendous gratitude, we look forward to continuing our work to create a healthier future for our region.

Michael Schrader, Chief Executive Officer

A Message from our CEO

AS HPSJ LOOKS AHEAD, WE WILL CONTINUE TO PARTNER WITH OUR MEMBERS AND PROVIDERS TO COORDINATE ACCESS TO QUALITY HEALTH CARE.

Local Leadership for Your Local Health Plan

The San Joaquin County Health Commission provides public oversight and governance of HPSJ. Comprised of public officials, community representatives, and local physicians, our Commission is dedicated to guiding HPSJ to optimize the health of our region.

The San Joaquin County Health Commission - a diverse collaboration of local stakeholders who strategically direct HPSJ’s service to the community.

GREG DIEDERICH

Director of Health Care Services, San Joaquin County

JAY WILVERDING San Joaquin County Administrator

NEELESH BANGALORE, MD Medical Society Delegate

ELYAS PARSA, DO San Joaquin County Healthcare Services Director Nominee

KATHY MILLER

San Joaquin County Board of Supervisors

CHUCK WINN

San Joaquin County Board of Supervisors

MICHAEL HERRERA, DO Medical Society Delegate

JOHN ZEITER, MD

San Joaquin County Medical Society

BRIAN JENSEN

Hospital Council of Central & Northern California

CHRISTINE NOGUERA CEO of Community Medical Centers

FARHAN FADOO, MD Community Representative

Promoting Improvements in Public Health: A Message from the Commission Chair

The last two years have tested the resiliency of our safety net. Health Plan of San Joaquin exemplified flexibility and dedication – continuing with extraordinary commitment to serve our members.

We are confident and prepared to push forward, focusing goals on complex endeavors that align with our core values and support our mission.

We are proud of the contributions HPSJ has made towards improving wellness in our community and excited for future opportunities to grow and expand our work.

Greg Diederich, San Joaquin County Health Commission Chair

About

ETHNICITY

HPSJ collaborates with local health care providers and community-based partners to coordinate access to quality health care services for our members.

Vision Care provided by

Primary Care Providers

Contracts with

Specialists Behavioral Health services provided byLocal Network Hospitals

Financial Wellness

As a local health plan, HPSJ is uniquely committed to locally investing our resources to support the health of the communities we serve.

ANNUAL REVENUE

Revenue through state/federal funding

$1,200,000,000 $1,100,000,000 $1,000,000,000 $900,000,000 $800,000,000 $700,000,000 $600,000,000 $500,000,000 $400,000,000 $300,000,000 $200,000,000 $100,000,000

2019 2020 2021

Devoted more than $0.95 cents of every $1 revenue to expanding the accessibility of health care services for our members.

Awarded 16 first-year and 10 continuing Health Career Medical Scholarships to support the development of our local clinical workforce.

Contributed $152,974 to engage the community by sponsoring health events, outreaching to members, and supporting local health care providers.

We are stewards of public resources and honor the trust instilled in us to foster the delivery of quality health care. In addition to supporting HPSJ’s operations, we direct revenues to partnering in the community and growing our network of local safety-net providers. These unique efforts are core to the fabric of local health plans like HPSJ.

Michelle Tetrault, Chief Financial Officer

2021: A Year of Change

CalAIM: Transforming the Medi-Cal Delivery Landscape

HPSJ has launched the California Advancing and Innovating MediCal (CalAIM) initiative, which is a multi-year statewide strategy to integrate care coordination and case management for Medi-Cal beneficiaries across physical health, behavioral health, and social services.

The implementation of CalAIM has positioned HPSJ to partner in new ways with our community to manage care for our members while addressing the social drivers of health. As HPSJ operationalizes the transformative components of CalAIM, we are expanding our collaborations to coordinate a whole-person health care approach that prioritizes prevention and addresses the clinical and non-clinical needs of our members.

HPSJ initiated the first phase of CalAIM services in 2021, most notably expanding innovative programs that include Enhanced Care Management and Community Supports.

Enhanced Care Management is a new benefit available to high-need members who are living with the most complex health conditions, involving physical, behavioral, and social needs. The benefit will allow HPSJ to partner across sectors to meet the clinical and non-clinical needs of targeted populations through the coordination of health and healthrelated services.

Community Supports, such as housing supports and medically tailored meals, are also new services available to help many HPSJ members meet their social needs.

Prior to launching these services, HPSJ evaluated our operational capacity and partnered locally to implement Enhanced Care Management and Community Supports. Based on the assessed needs of our community, HPSJ was determined to provide access to the following new benefits for members with the highest need:

• Housing supports, including navigation, deposit assistance, and tenant services

• Post-hospitalization short-term housing

• Recuperative care services

• Sobering centers and substance use disorder services

• Meals and nutrition plans

HPSJ will continue to achieve greater levels of engagement by strategically addressing the health and social needs of our members as programs and initiatives of CalAIM are implemented in 2022 and beyond.

There are many new opportunities under the CalAIM initiative for HPSJ to improve health by engaging members, health care providers, and community-based organizations. In addition to bolstering longstanding clinical partnerships, HPSJ will build interdisciplinary teams to coordinate the delivery of innovative services that support our members and holistically address the social drivers of health.

Lizeth Granados, Chief Operations Officer

Community Supports is a unique opportunity for HPSJ to facilitate new ways for our diverse community-based organizations (CBOs) to engage in public health.

Collaborating with Federally Qualified Health Centers (FQHCs) to Improve Behavioral Health Services

HPSJ developed a Behavioral Health Integration (BHI) program in partnership with local FQHCs, including Community Medical Centers, Golden Valley Health Centers, and San Joaquin Health Centers.

BHI aims to improve health care outcomes by encouraging providers to integrate the delivery of behavioral and physical health care services in clinical encounters. As we collaborate on BHI with our provider network, more HPSJ members can access appropriate behavioral health screening and treatment services through a primary care provider.

10%

9 pilot programs in San Joaquin and Stanislaus Counties to improve behavioral health outcomes

10% increase in behavioral health screening services for members

More than 10,000 members accessed behavioral health care services through a network provider

INCREASING THE AVAILABILITY OF BEHAVIORAL HEALTH SERVICES TO SCHOOLCHILDREN

As part of the Children & Youth Behavioral Health Initiative, HPSJ is partnering with stakeholders in early childhood, K-12, and higher education to make school-linked and school-based behavioral health services available to some of our youngest members.

We are invested in prevention and early identification to enhance learning and student wellness, and have joined local efforts to bridge education and health care systems. By partnering with schools, medical providers, school-affiliated programs, county offices, and mental health providers, we will improve communications and referral processes that will better serve the youth in our communities.

Children comprise more than 40% of MediCal membership. As HPSJ partners to expand access to behavioral health services, we are especially focused on enhancing preventive behavioral health services for children to support wellness throughout the lifespan.

Madeleine, Daniel, and Stephanie (local students)

Perseverance Through A Pandemic

The pandemic magnified racial and ethnic disparities in health outcomes for San Joaquin and Stanislaus residents. Fewer health care facilities and providers in the region challenged access for people of color and low-income. Inaccurate information resulted in vaccine hesitancy, leading public health agencies, health plans, and community-based partners to find new ways to build trust.

HPSJ also collaborated with local health clinics, public health offices, hospitals and community agencies to increase COVID-19 vaccinations. Here are some of the ways that HPSJ overcame the challenges of COVID-19 in 2021:

Maximized vaccine adoption through a provider incentive program, engaging Federally Qualified Health Centers and individual providers

Participated in 69 local health events with over 20 partners

Launched the Ask. Learn. Decide. COVID education campaign – reaching more than 294,000 people through billboard, transit, and social media

Leveraged local media to maximize COVID education resulting in 16 Articles and Op-eds published and 1 television appearance

Developed an incentive program that resulted in 40,000 vaccinations for our members

Stayed connected to members and their families by sending 132,382 COVID education text messages.

Julian and Jeramie (San Joaquin County residents)

Creating A Culture of Quality

Health plan of San Joaquin strives to create effective partnerships with our members, providers, and employees to improve the delivery of quality health care.

HPSJ earned NCQA Accreditation and outperformed the National Committee for Quality Assurance measures for prenatal care, childhood weight monitoring and diabetic screening for members using antipsychotic medications.

Meeting the rigorous standards of NCQA is a demonstration of our long-standing commitment to quality service and coordinating care for our members. As a reflection of this:

Our providers indicate high satisfaction - HPSJ ranks in the top 5-10% of US Medicaid plans.1

HPSJ outperformed other Medicaid plans in these key provider satisfaction areas:

• Finance, 98th percentile 1

• Utilization Management, 96th percentile 1

• Customer Service, 100th percentile 1

MEMBERS GUIDE OUR WORK

HPSJ is guided by a Community Advisory Committee (CAC) made up of members and community partners. CAC reviews customer satisfaction, performance of quality programs, and member and health education materials. The feedback received from our CAC members is used to improve programs and services.

Lakshmi Dhanvanthari, MD Chief Medical Officer

For a third time, HPSJ received NCQA Health Plan Accreditation reaffirming our commitment to meet the rigorous standards that create a framework for providing high quality of care and services for our membership. Throughout the COVID-19 pandemic HPSJ has been nimble in collaborating with our partners to provide assistance to our members and the larger community we serve.

1. As of March 2021, Provider Satisfaction Report, 2020 Results, Symphony Performance Health, Inc.

Closing Care Gaps - Creating Equity by Utilizing New Technologies

HPSJ continues to develop and implement equitable systems of care that utilize innovative technologies to ensure the delivery of culturally appropriate services, support the secure exchange of health information for care coordination, and improve access to quality health care services. HPSJ invests in innovative technologies to:

ENSURE THE DELIVERY OF CULTURALLY APPROPRIATE CONTENT

HPSJ’s cultural and linguistics team implemented video remote interpreting (VRI) and over-the-phone interpretation (OPI) services in partnership with Community Medical Centers and San Joaquin Health Centers. Centers. More than 160,000 members have been able to access VRI and OPI services, creating a way for them to communicate with providers in their preferred language. Due to the success of these implementations, HPSJ is preparing to expand VRI and OPI services to include additional clinical locations.

SUPPORT THE SECURE EXCHANGE OF HEALTH INFORMATION FOR CARE COORDINATION

HPSJ’s Health Information Exchange (HIE) helps ensure that authorized health care providers can securely access medical records and other health information to provide effective whole-person care to our members. Additionally, the HIE is used by HPSJ to obtain critical metrics that guide our quality programs and new initiatives. HPSJ is partnering with our network of providers to expand the exchange of health information among health care entities.

IMPROVE ACCESS TO QUALITY HEALTH CARE SERVICES

HPSJ’s Population Health team works with several local providers to access their clinic schedules. This allows for members to be immediately scheduled during routine outreach calls by HPSJ staff. This collaboration has provided more than 11,100 immediate appointments for our members, making it easier for them to see their doctor for wellchild visits and other screenings.

From left: Annie, Madi, Tommy and Rachel (Stanislaus County residents)

A Look Ahead: Building A Stronger Foundation

Prioritizing the prevention of COVID throughout the pandemic, many individuals and families forewent routinely scheduled primary and preventive care visits. As our community recovers from the pandemic, HPSJ has strengthened our local partnerships by proactively supporting our members and provider network in the return to routine operations.

HPSJ remains committed to engaging our community to meet its evolving health care needs. Through our innovative partnerships, HPSJ is collaborating across sectors to:

• Reduce barriers through relationship building and innovation

• Address social determinants of health

• Promote access to health and wellness services in the community

Helping Members Retain Health Care Coverage Beyond the Pandemic

BACKGROUND: Following the federal PHE declaration for COVID and subsequent passage of related federal legislation, including the Families First Coronavirus Response Act, state Medicaid programs were authorized to implement many flexibilities to mitigate the impact of the pandemic on beneficiaries and health systems. Such flexibilities implemented in California include the temporary suspension of routine Medi-Cal eligibility operations to ensure continuous health care coverage for beneficiaries. While the Medi-Cal program experienced record growth as a result of its pause on the disenrollment of beneficiaries, we want to ensure that eligible members continue to receive MediCal benefits after the federal PHE ends.

The unwinding of the federal public health emergency (PHE) declaration for COVID and its related flexibilities for Medi-Cal beneficiaries will require a coordinated approach by HPSJ and county agencies to conduct outreach, process eligibility redeterminations, and support the continuity of health care coverage for our members through the transition.

To ensure that HPSJ’s members retain health care coverage beyond the PHE, we created a community engagement plan that includes strategies for:

Updating member contact information to ensure renewal documents are received and completed

Conducting member outreach and providing assistance during the renewal period

Preventing members from losing coverage for procedural purposes

Helping ineligible members enroll in Covered California or access another form of health care coverage

HPSJ is evolving to meet the needs of our community in the face of remarkable changes to the health care landscape.

Partnering to Foster Resilience Beyond the Pandemic and Engaging Members to Return to Care

Nancey and Amy (Stanislaus County residents)

Giana (San Joaquin County resident)

Ivan and Isaac (San Joaquin County residents)

Mahala and Illiana (Stanislaus County residents)

Koji and JanCarlo (Little Manila Rising staff)

Joan (San Joaquin Health Centers) and Shaunetta (HPSJ)