0 Governance and Start-Up in a Public Plan Howard Kahn October 13, 2010

Experience with Two Public Plans in California One is a public monopoly. One is competitive with private plan. 1

2 California’s Public Plans Core attributes of public plans in CA (serve Medicaid enrollees, safety net protection, stakeholder board, lower admin costs, etc) create: –Transparency –Level playing field (more or less) –Quality and efficiency

3 Managed Care Market Models – COHS, GMC, and Two Plan Expansion of Medi-Cal managed care models –County Organized Health System (COHS) – locally organized for specific regions –Geographic Managed Care (GMCs) - State contracts with several plans in a specific region –Two Plan Model – Competition in counties with developed health systems

L.A. Care Product Lines Medi-Cal –Plan Partners network –Direct provider network Healthy Families (SCHIP) Healthy Kids Medicare Advantage Special Needs Plan (SNP)

5 L.A. Care’s Mission “To provide access to quality health care for Los Angeles County’s vulnerable and low- income communities and residents, and to support the safety net required to achieve that purpose.”

L.A. Care – Not Just an HMO Focus on strengthening health care safety net Community-accountable – public advisory committees Community investments and leadership to improve community health Health policy leadership …but is also an HMO that is performing well.

Formation and Governance Established by enabling legislation in 1994 Public Agency, independent from county Separate Health Authority - Local Initiative - Brown Act provisions - Community/stakeholder input 13 member stakeholder Board

Stakeholder Board Composition 4 - Representing Los Angeles County (including a Board of Supervisors representative) 2 – Private hospitals (with and w/out Medicaid DSH) 1 – Free and community clinics 1 – Federally Qualified Health Centers 1 – Physician representative 1 – Children’s health care provider 1 – Knox Keene licensed health plan 2 – Health care consumers 8

Advisory Groups Technical Advisory Committee Children’s Health Consultant Advisory Committee Regional Community Advisory Committee (11) Executive Community Advisory Committee 9

Licensure Knox Keene (HMO) licensed April 1997 Fiscal solvency/TNE requirements Creates level playing field among participating health plans Oversight by Department of Managed Health Care and Department of Health Care Services 10

Health Plan of San Mateo Licensed as a Health Insuring Organization Exempt from Knox-Keene licensing requirement Operational in 1987 Eventually was licensed Medicare SNP that competes with private plans 11

Start-up Financing L.A. Care - Plan Partners, County, State, and lines of credit Health Plan of San Mateo - hospitals, county, HFFA, grants, loans 12

13 Questions