Roadmap to the Future 2015|16 Annual Report to the Community

Roadmap to the future...

2015 16 Annual Report to the Community

Leadership

Dale Villani

Chief Executive Officer

Ruth Watson

Chief Operating Officer

Patricia Mowlavi

Chief Financial Officer

Melissa Scrymgeour

Chief Information and Strategy Officer

C. Albert Reeves, MD

Chief Medical Officer

Nancy R. Whar eld, MD

Associate Chief Medical Officer

Jean K. Halsell

Executive Director Human Resources

Douglas C. Freeman

Chief Diversity Officer

Directors

Brandy Armenta Compliance Officer

Bob Bushey Procurement Officer

Anne Freese

Director of Pharmacy

Lupe Gonzalez Director of Health Education

Christianne Hodina Director of Operations

Steven Lalich

Director of Marketing and Communications

Vickie Lemmon

Director of Health Services

Helen Miller

Director of Information Technology

Kim Osajda

Director of Quality Improvement

Steve Peiser

Senior Director of Network Management

Lyndon Turner

Director of Financial Analysis

Dale Villani, CEO, Gold Coast Health

Plan

Our focus: Always on you

On July 1, 2011, Gold Coast Health Plan began operations with less than 25 employees and welcomed nearly 100,000 members into a newly created County Organized Health System. This past year, we celebrated our fifth anniversary. Today, the Plan serves more than 200,000 members, employs nearly 200 full-time employees and has contributed just under $2 billion to support the work of more than 5,000 doctors, specialists, pharmacists and other health care providers in our network.

We provide coverage for half of all children ages 5 and under and one in five adults in Ventura County. As our membership grows, so does our commitment to raising quality outcomes of care to our members. Delivering health care services with a member-first focus reflects our ongoing commitment to our members.

This Annual Report to the Community not only highlights the Plan’s accomplishments during the last fiscal year, but demonstrates continued financial stability, exceptional health services and strategic collaborative partnerships, as we position ourselves for the future. Thank you for supporting and working hand-in-hand with us as we continue to serve the Medi-Cal members of Ventura County.

Dale Villani

Our mission

To improve the health of our members through the provision of high-quality care and services.

MEMBERSHIP BY AGE

Chief Executive Officer

OUR MEMBERS

49% - ages 18-64

29% - ages 6-17

14% - ages 0-5

8% - ages 65+

Our vision

positioning for the future

Strategic plan

Our strategic plan is built on a framework that supports the key objectives of being a collaborative community and strategic business partner, a responsible fi scal steward of public funds, an employer of choice committed to diversity and an organization that is anchored by our mission.

Our core values

“It’s important for us to step back from dayto-day operations and position ourselves for the future.” –Melissa Scrymgeour

58 % 27% 10% 5%

Families

Duals: Dually Eligible for Medicare and Medi-Cal SPD: Seniors and Persons with Disabilities

Collaborative Community Partners

Alzheimer’s Association

American Cancer Society

American Heart Association

Child Health and Disability Prevention

Child Development Resources

Clinicas Del Camino Real Inc.

Community Action of Ventura County

Community Memorial Health System

Consulate of Mexico in Oxnard Ventanilla de Salud

First 5 Ventura County

Food Share Inc.

Housing Authority of the City of San Buenaventura

Human Services Agency

Kids and Families Together

La Hermandad

MICOP

Mil Mujeres

Oxnard Police Department

Oxnard Union High School District

Planned Parenthood

Rainbow Connection

Shield Health Care

St. John’s Dignity Health

The Partnership for Safe Families & Communities

Tri-County GLAD

United Parents

Ventura County Behavioral Health

Ventura County Behavioral Health/Alcohol & Drugs Program

Ventura County Department of Child Support Services

Ventura County Health Care Agency

Ventura County Public Health

Collaborative community

Community outreach

In touch with our members

Our Health Education and Outreach Department attended

outreach events

and connected with more than

10,000 member s

Alternative Resources for Community Health

Improving your care

ARCH provides incentives to our network providers for valuebased performance, enhanced clinical benefits, grants and sponsorships to community-based organizations by building on the Institute for Healthcare Improvement’s Triple Aim of improving the patient’s experience of care, improving the health of certain populations, and reducing the per capita cost of health care as it relates to the social determinants of health.

"We're going the extra mile by incentivizing providers to keep our members healthy." –Ruth Watson

Daren Lee, Kelly Bruno, Barry Fisher, Dale Villani

Benefit

"Our

A health care leader committed to...

Quality

Gold Coast Health Plan was awarded the seal of approval from the National Committee for Quality Assurance (NCQA) for passing the Health Effectiveness Data and Information Set’s (HEDIS®) Compliance Audit for the fourth consecutive year.

Committed to:

● Educating members and providers

● Collaborating with community organizations

● Providing member outreach

● Improving childhood immunization

● Piloting texting and telephone outreach projects

● Scheduling preventive care exams and screenings

Access

Network Operations is committed to an increased collaboration between payers and providers by implementing a suite of value-based incentive programs geared toward rewarding caregivers for improvements in quality and efficiency.

Driven to:

● Expanding our provider network

● Implementing a suite of value-based incentive programs

● Supporting systems that integrate cost, quality and outcomes

● Enhanced communication and education

● Relaunching our provider advisory committee

It’s about the people

Human Resources supports the organization in meeting its goals through its most valuable resource—its PEOPLE.

Focused on

● Employee satisfaction

● Training programs and instructors

● Updated onboarding and new employee orientation

● Launch of diversity hotline and recruitment for chief diversity officer

Governance

Ventura County Medi-Cal Managed Care Commission consists of locally elected officials, providers, hospitals, clinics, the county health care agency and consumer advocates. Our member-first focus centers on the delivery of exceptional service to our members by enhancing the quality of health care, providing greater access and improving member choice.

Commissioners

Darren Lee (Chair) St. John’s Pleasant Valley Hospital and St. John’s Regional Medical Center

Antonio Alatorre (Vice Chair) Clinicas del Camino Real, Inc.

Shawn Atin County of Ventura

Lanyard Dial, MD Ventura County Medical Association

Narcisa Egan Ventura County Health Care Agency

Laura Espinoza League of United Latin American Citizens

Peter C. Foy Ventura County Board of Supervisors

employer of choice

Michelle Laba, MD Ventura County Medical Center Executive Committee

Gagan Pawar, MD Clinicas del Camino Real, Inc.

Catherine Rodriguez County of Ventura

Jennifer Swenson Simi Valley Hospital

Board of Supervisors

Steve Bennett Supervisor, District 1

Linda Parks Supervisor, District 2

Kelly Long Supervisor, District 3

Peter C. Foy Supervisor, District 4

John C. Zaragoza Supervisor, District 5

General Counsel

Scott H. Campbell BB&K Law

Consumer Advisory Committee

Rita Duarte-Weaver (Chair)

Ventura County Public Health Department

Pedro Mendoza (Vice Chair)

Tri-Counties Regional Center

Alicia Flores

La Hermandad

Norma Gomez Mixteco/Indigena Community Organizing Project

Frisa Herrera Casa Pacifica

Paula Johnson ARC of Ventura County

Laurie Jordan Rainbow Connection/ Tri-Counties Regional Center

Ruben Juarez County Health Care Agency

Gilda Macias Member Beneficiary

Katharine Raley County of Ventura Area Agency on Aging

Curtis Updike County Human Services Agency (HSA)

Top: John Shi, Johner Torio, Michael Abdon

Middle: Chris Martinez, Harry Mapanda

Bottom: Soledad Barrera, Kathleen Phillips, Shyleen Sandoval, Jeppy Caliboso

Provider Advisory Committee

Inna Berger Oxnard Family Circle Adult Day Health Care Center

Joan Buck-Plassmeyer Los Robles Homecare Services Inc.

Fred Deharo Clinicas del Camino Real Inc.

David A. Fein Shield Healthcare

Will Garand Community Memorial Health System

Sim Mandelbaum U.S. Skilled Serve Inc.

Richard Montmeny Dignity Health

Marsha S. Smith Option Care—Ventura

Bryan Wong, MD Ventura County Medical Center

“

“We negotiated lower administration fees with our pharmacy benefit manager that resulted in almost $1 million in savings in the last six months of the fi scal year.” –C. Albert Reeves, MD

Lisa Redding, Stacy Luney and Susana Enriquez-Euyoque

Front row, from left: Jennifer Magana, Adrianna Sandoval-Jimenez, Stacy Nava; back row, from left, Connie Harden, Luis Aguilar, Tami Lewis

“I believe that you are an angel here on earth.” –Steve Soto

“I cannot imagine what I would have done without your help.”

–John

“Kevin” Argue

“You helped me get my vision back.” –Christina Cordova

“I feel that you guys saved my life.” –Nicole Jarron

“You inspired me to not give up.” –Thomas Obeid

We’re your guide to the best possible care

Our Disease Management program provides members with targeted interventions to help manage chronic conditions, like diabetes and asthma, by partnering with our network of providers to deliver evidence-based care.

Our Care Management team collaborates with primary care providers, specialists and members to reduce long-term complications and manage the member's care for the best health outcomes.

Our Utilization Management department is committed to ensuring that the services being performed and the medical equipment being ordered are appropriate.

Standing: Laura Riggs Deborah Roberts Edgar Santos

Sitting: Thomas Obeid John Argue