Leadership Letter                                        Alameda Alliance for Health differs greatly from the organization...
Passion Drives the Alliance    Alameda Alliance for Health is accountable to the community and driven by its    social mis...
The Beginning    In 1993, California’s Department of Health Services reformed its Medi-Cal program    by moving 3.2 millio...
To alleviate the growing anxieties, the Alliance needed to implement the plan    as quickly as possible. The planning proc...
Serving the Underserved     Alameda Alliance for Health serves 90,000 Alameda County residents who     choose from more th...
Alameda Alliance for Health Programs     Medi-Cal     Medi-Cal is a federal- and state-funded health insurance program for...
Alliance Group Care     In 2001, the Alliance launched Alliance Group Care, an employer-sponsored plan that     provides a...
Leadership and Governance     An independent Board of Governors, appointed by the Alameda County Board     of Supervisors,...
2006 Alameda Alliance for Health Committees     The Alliance recognizes the value of the diverse perspectives and interest...
Making a Difference in the Community                                                     The Alliance Health Education Dep...
Challenges Become Opportunities     The costs of delivering comprehensive health care have continued to rise over the     ...
Financial Facts 1996-2006                                                                    Using Reserves for Good Works...
By FY 2006, the Alliance became concerned with its reduced level of reserves and        Successfully Managing Medical Expe...
Sense of Purpose     Alameda Alliance for Health is dedicated to making a difference in the quality and     delivery of he...
Alameda Alliance for Health Staff     Summer 200630                                       31
Alameda Alliance Staff Summer 200632                                        33
Alameda Alliance for Health 10 year report final
Alameda Alliance for Health 10 year report final
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Alameda Alliance for Health 10 year report final


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Community Report celebrating 10 years of service to Alameda County, CA

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Alameda Alliance for Health 10 year report final

  1. 1. Leadership Letter Alameda Alliance for Health differs greatly from the organization it was on January 1, 1996. We opened our doors that day with a small staff, one health coverage program, and two members. Ten years later, the Alliance has 90,000 members, four health coverage programs, and 130 employees. Through the years, we have enhanced services to our members, broadened our community partnerships, and strengthened our relationships with local health care providers. We’ve also confronted many challenges. At times, these challenges appeared overwhelming, but we addressed them with expertise, innovation, and the same determination that is at the foundation of the Alliance. Most recently, the Alliance dealt with five years of operating deficits. In a period of climbing medical costs, we took bold steps to manage these expenses throughout the organization. From 2004 to 2006, we instituted a number of cost-management strategies focusing on operations, medical management, and provider agreements. For example, we initiated intensive care management of targeted patient groups, primarily members with chronic illnesses and the growing senior and disabled populations, and utilized available social services to reduce these patients’ medical expenses. We established regular meetings with Alliance providers to learn about and respond to their concerns, include them in our decision-making processes, and strengthen our relationships with them. We also increased efforts to reach out to community advocates who work with senior and disabled populations to seek effective medical management alternatives and service considerations. All these measures helped to reduce our expenses while improving quality services, and, in the fiscal year ending June 30, 2006, Alameda Alliance for Health emerged from the five-year period of operating losses. Thanks to the collective efforts of our Board of Governors, management and staff, providers, and community supporters, we have achieved impressive results over the last ten years. We have also evolved into a mature organization with a solid track record for supporting Alameda County’s safety net system and providing health care services to underserved populations in our community. We are not only committed to fulfilling our mission, but eager to take on the future, to expand our products and services, and to reach more Alameda County residents. Ingrid Lamirault Michael Mahoney Chief Executive Officer Chair, Board of Governors Alameda Alliance for Health Staff Summer 20062 3
  2. 2. Passion Drives the Alliance Alameda Alliance for Health is accountable to the community and driven by its social mission as a public entity. The Alliance was established by the Alameda County Board of Supervisors to serve low-income Alameda County residents and play a vital role in the county’s health care safety net system. Although part of the county’s public health care system, the Alliance is an independent, not-for-profit organization. Throughout its first decade, the Alliance thrived on innovation, demonstrating agility in its capacity to take calculated risks, to learn and grow, to evolve with changing needs and opportunities. Today, the Alliance resolves to operate on proven business principles, seek continuous improvement, learn from its mistakes, and rely on objective results to judge its performance. The organization emphasizes the values of communication and collaboration. Staff members take personal responsibility to understand and embrace the Alliance’s mission. The Alliance’s Board of Governors and management employ a leadership style that aims to solve problems, achieve common goals, dismantle organizational barriers, and cultivate effective working relationships. This philosophy extends beyond Alliance staff to their relationships in the community. Collaboration with providers, elected officials, health care advocates, and many other community stakeholders has been vital to the organization’s success. And it always will be.4 5
  3. 3. The Beginning In 1993, California’s Department of Health Services reformed its Medi-Cal program by moving 3.2 million Medi-Cal recipients from fee-for-service plans to managed care. The department presented the concept of the “Two-Plan” model, which would establish two local health plans—a county-developed plan and a commercial plan selected through a bidding process. Competition, the state reasoned, would improve the delivery of managed care and provide better protection for vulnerable populations. The state chose twelve counties to pioneer the new model. Alameda County was among them. The county created a steering committee led by Shahnaz Nikpay, Ph.D., and Health Care Services Agency Director Dave Kears. They hired consultants, conducted a feasibility study, and coordinated meetings with key stakeholders—hospitals, physicians, community groups, and potential members–and hired staff to develop the Alameda County Local Initiative. Alameda Alliance for Health would be the only health plan created for and by the people of Alameda County—and the first Two-Plan model to begin operations in the state. Stakeholders recognized that it would mean fundamental changes to the delivery of Medi-Cal services. Potential members worried about keeping their own doctors, while doctors were concerned about losing patients. Alliance founders were also anxious. Would providers sign on? Would members join the Alliance? “Since this was a model proposed by the state with no precedents, everyone wondered how this experiment was going to unfold,” says former Alliance CEO Irene Ibarra. “There was a lot of pressure to make sure it would meet everyone’s needs, and also concern over moving so many families into a managed care plan with new benefits, a new health plan card, and a new family physician. It was important to our existence to answer the public’s concerns about the unknown.” Community residents attend a meeting in Berkeley to celebrate the launch of Alameda Alliance for Health. Alliance founding employee Nina Maruyama is at the podium. From left: Michael Mahoney, Dr. Shahnaz Nikpay, and Dave Kears.6 7
  4. 4. To alleviate the growing anxieties, the Alliance needed to implement the plan as quickly as possible. The planning process was expensive and, until it started generating revenue, the organization had a financial imperative to begin operations. The group worked with a focused purpose, establishing positive relationships with the county’s physicians, community clinics, and hospitals. Physicians on the Board called their colleagues, assuring them that the Alliance would be reliable. Critical to the Alliance’s success, a large network of providers, who had personal relationships with patients, ensured that enrollees would be able to keep their previous providers or choose from a wide selection of other providers throughout the county. The very aspect that caused anxiety, however, was also the organization’s key advantage: It was new. It could invent itself, create an organization that would be dedicated to the community. Alliance founding CEO Dave Kears shared his vision, which articulated the organization’s essential philosophy. “Why should we be just another HMO?” Kears would ask his colleagues. “Let’s be a health plan that makes a difference!” With creative leadership and resolve, the team was determined that Alameda Alliance for Health would be the first of the Two-Plan counties to “go live.” On January 1, 1996, the Alliance began operations, the first local health plan under California’s “Two-Plan” model. The Alliance enrolled more members than its competitor, which began operations six months later. Entering its second decade, the Alliance continues to be true to its original philosophy: to be a health plan that makes a difference.8 9
  5. 5. Serving the Underserved Alameda Alliance for Health serves 90,000 Alameda County residents who choose from more than 1,700 doctors, 140 pharmacies, 29 community health centers, and 15 hospitals. Offering four health programs and additional services for its members, the Alliance routinely evaluates member satisfaction and monitors quality through focus groups, random telephone surveys, the annual Health Plan Employer Data and Information Set (HEDIS), and the Consumer Assessment of Health Plans. The Alliance also makes significant investments in staff development, ensuring that employees understand the latest health care innovations and information. The Alliance is strongly committed to providing culturally and linguistically appropriate services. In fact, the U.S. Department of Health and Human Services selected the Alliance as the only health plan nationally to be the subject of a case study for the application of Culturally and Linguistically Appropriate Services (CLAS) standards. Implementing these standards, the Alliance provides interpreter services for members and providers, free of charge. Many network doctors speak a variety of languages, and the Alliance offers providers free cultural and linguistic training. The Alliance translates all member materials into a number of languages, member service representatives help members in several languages—including Spanish, Cantonese, Mandarin, and Vietnamese—and telephone interpreters assist members with other language needs. The Alliance also invests in health education for members, providers, and the general community. To promote healthy lifestyles, the Health Education Department provides free videos, DVDs, group interventions, and printed materials in many languages. State and federal funds jointly support three of the programs the Alliance offers: Medi-Cal, the Healthy Families Program, and Alliance Group Care (which is also funded with county support). For children who do not qualify for public health programs because of immigration status or income, the Alliance offers coverage through Healthy Kids, which is supported by county and philanthropic funds.10 11
  6. 6. Alameda Alliance for Health Programs Medi-Cal Medi-Cal is a federal- and state-funded health insurance program for low-income families and children, persons with disabilities, and seniors who qualify for help. The program provides primary, acute, and long-term care. There are no premiums or co-payments for lowest-income beneficiaries. Alliance Membership by Program* Medi-Cal 75,013 Healthy Families 7,986 Group Care 4,420 Healthy Kids 1,050 Total Members 88,469 *Alliance Eligibility Data, June, 2006 Alliance Members by Ethnicity* African-American 25,085 Hispanic 25,066 Other Asian and Pacific Islander 10,831 Caucasian 9,037 Chinese 6,269 Other 6,161 Vietnamese 6,020 *Alliance Eligibility Data, June, 2006 Healthy Families Program The Alliance began serving children through the Healthy Families Program in 1998. The program provides low-cost health coverage to California children up to age nineteen, whose family incomes are too high to qualify for Medi-Cal, but are below 250 percent of the federal poverty level (about $41,500 for a family of three). Benefits include health, dental, and vision coverage. The Alliance is the Community Provider Plan in Alameda County. As the Community Provider Plan for the Healthy Families Program, the cost is $4 to $12 per child, with a maximum of $36 per household per month. Members pay co-payments (usually $5) for most services. Maximum out of pocket cost per family for co-payments is $250 per benefit year.12 13
  7. 7. Alliance Group Care In 2001, the Alliance launched Alliance Group Care, an employer-sponsored plan that provides affordable and comprehensive health care coverage to In-Home Supportive Services (IHSS) workers in Alameda County. The Alameda County Public Authority for IHSS workers, SEIU Local 616, Alameda County Health Care Services Agency, Alameda County Social Services Agency, and the Alliance collaborated on Alliance Group Care. State and federal funds with Alameda County funding that include Tobacco Master Settlement funds support the program. Alliance Group Care provides medical, dental, and vision coverage. Members’ monthly cost is $8 to $15, with co-payments of $5 for most services. There are no co-payments for preventative care, pregnancy and maternity care, and inpatient hospital services. To qualify for the program through the Public Authority, IHSS workers must be paid for two consecutive months and for an average of forty-five hours in those two months. Alliance Members by Language* English 50,634 Spanish 18,091 Chinese Languages 7,858 Vietnamese 5,014 Other Non-English 3,782 Other Asian and Pacific Islander Languages 1,746 Farsi 1,344 *Alliance Eligibility Data, June, 2006 Healthy Kids In October 2005, the Alliance established the Healthy Kids Program to provide comprehensive medical, vision, and dental care to uninsured children. To qualify for the program, children must be under age nineteen, live in Alameda County, be ineligible for public programs, and have a household income up to 300% of the federal poverty level ($49,800 for a family of three). Healthy Kids covers all children who meet eligibility criteria, regardless of immigration status. Premiums are $10 per child per month and co-payments range from $5 to $15. There are no co-payments for preventative care, family planning, and inpatient hospital care. Generous grants from The California Endowment, California HealthCare Foundation, Alameda County Tobacco Settlement funds, First 5 Alameda County, and First 5 California support Healthy Kids. Healthy Kids programs are a vital component of Children’s Health Initiatives (CHIs) across the state. CHIs are a nationally recognized model for health coverage expansion and systems change, including streamlining enrollment into public programs, maximizing resources and coordinating with public health coverage programs, and cultivating broad-based partnerships to support children’s coverage expansion. Currently 22 counties operate Healthy Kids programs, and ten more are in development. The Alameda County Children and Families Health Insurance Task Force serves as the Advisory Group for the Alameda County CHI.14 15
  8. 8. Leadership and Governance An independent Board of Governors, appointed by the Alameda County Board of Supervisors, provides the Alliance with diverse perspectives and extensive expertise to ensure that the organization meets its commitments. Alliance Board meetings are open to the public, as required by law for a public entity. Affirming the organization’s dedication to community collaboration, the Alliance welcomes, encourages, and responds to public input, at Board meetings as elsewhere. 2006 Alameda Alliance for Health Board of Governors 1 Ingrid Lamirault 8 Marty Lynch, CEO, LifeLong Medical Care Alameda Alliance for Health CEO, ex officio Member At Large, Health Care Expert on Seniors and Persons with Disabilities 2 Linda Price, MD Alameda County Medical Center 9 Charlie Ridgell, Assistant Director, Hospital Division, SEIU United Healthcare Workers West 3 Jane Garcia, CEO, La Clinica de La Raza, Member At Large, Labor Alliance Board Vice Chair Community Clinic 10 Pamela Gumbs, Pharm.D., Pharmacist, United/ Royal Medical Pharmacy 4 Gail Steele, Alameda County Board of Supervisors, Member At Large, Pharmacist District 2 County Board of Supervisors 11 John Norton, MD, Sinkler Miller Medical Association and Alameda-Contra Costa Medical 5 Michael P. Mahoney, CEO, St. Rose Hospital, Alliance Association Board Chair Physician Hospital 12 Julian Raymond Davis, Jr., MD, East Oakland 6 Wright Lassiter, III, CEO, Alameda County Pediatrics Medical Group, Inc., Medical Center Immediate Past Alliance Board Vice-Chair The Board is comprised of fourteen seats, including physicians, hospital directors, clinical Hospital Physician providers, consumers, a county supervisor, labor representatives, pharmacist, and the Alliance CEO. This composition provides a high level of public health care management 7 Damita Davis-Howard, Executive Director, SEIU Local 535, Immediate Past Alliance Board Chair expertise, as well as input from various stakeholders with diverse interests. Labor Michael Mahoney serves as current Board Chair. As President and CEO of St. Rose *Two Alliance member seats are currently vacant. Hospital in Hayward, Mr. Mahoney has worked in hospital administration since 1982, and served as the first Chair for the Alliance Board of Governors from July 1994 through June 1996. He also serves on the Hayward Chamber of Commerce 6 11 8 Board of Directors and the Hayward Rotary Club Board of Directors. 2 5 12 9 3 7 10 1 4 Overseeing overall management of Alameda Alliance for Health, Ingrid Lamirault serves as Chief Executive Officer. Selected in December 2003, Lamirault brought significant experience in public health care as well as expertise in health system strategic planning, policy development, and other functional areas. 1716
  9. 9. 2006 Alameda Alliance for Health Committees The Alliance recognizes the value of the diverse perspectives and interests of its stakeholders, from providers and plan members to health care advocates and other community participants. Vital to the organization’s ability to attain its goals, the committees listed below play an important role in the Alliance’s governance structure and strategic planning. Member Committee The Member Committee advises the Alliance on issues related to programs, health education materials, and member-related publications. This group offers recommendations to the Board and participates in establishing Alliance public policy. Peer Review and Credentialing Committee This physician panel considers issues and makes recommendations to the Board regarding provider credentialing and recredentialing, patient safety events, peer review, and provider-related grievances and complaints. Pharmacy and Therapeutics Committee Comprised of physicians and pharmacists, this committee reviews matters related to Community Advisory Committee therapeutic drugs and certain medical supplies, and makes policy recommendations to the Board. This committee seeks to ensure patient access to a quality-driven, cost- Comprised of health care professionals and community advocates, this committee effective drug benefit. advises the Alliance on policy decisions related to educational, operational, and cultural competency issues for people who speak a language other than English. Finance Committee This committee addresses issues and makes recommendations to the Board regarding rate structure, budget, fiscal strategy and policy, financial projections, investment, selection of banks and depositories, and other financial matters. Health Care Quality Committee Strategic Planning Committee Fourteen members, primarily physicians, discuss issues pertaining to quality of The Strategic Planning Committee reviews business policies, recommends strategic care. This committee documents quality of care reviews and designs and supervises direction for the Alliance, and weighs program expansions and development of new follow-up action to improve care. Monitoring the provision and utilization of business lines. services, this committee addresses any quality concerns regarding accessibility, availability, and continuity of care. Utilization Management Committee A subcommittee of the Health Care Quality Committee, the Utilization Management Committee approves and oversees the Utilization Management program. The Committee provides guidance on policy decisions, medical necessity criteria, studies, and improvement activities. It also reviews the results of improvement activities and studies, including the Health Plan Employer Data and Information Set (HEDIS) performance measures.18 19
  10. 10. Making a Difference in the Community The Alliance Health Education Department participates in many local activities, such as promoting the Bay Area Immunization Registry, sharing expertise with Believing that healthy families build healthy communities, Alameda Alliance for the Fetal Infant Mortality Review Community Action Team, working with the Health has invested in numerous initiatives in Alameda County, interacting with Breastfeeding Taskforce, and contributing data and expertise to the Perinatal the community in several ways. Substance Abuse Taskforce. In 1998, the Alliance launched its Community Health Investment Fund (CHIF), through which it partnered with other health care organizations to expand services to underserved populations. Supporting important and innovative community programs, the Alliance awarded more than $4.5 million in CHIF grants through 2002. The organization also established the Alliance Community Team (ACT), which encourages Alliance employees to serve the community. Through ACT, Alliance staff members have donated thousands of pounds of food to the Alameda County Food Bank, collected coats for homeless people in the county, supported the American Red Cross with blood donations, contributed toys through Toys for Tots, raised funds to combat diabetes, and volunteered with many other charitable endeavors. Community Partnerships Program Initiatives Alameda Alliance for Health reaches out to the community by working with many The Alliance works closely with the county’s Public Health Department and health care organizations and advocates in the county. Among other endeavors, community organizations to better serve its members and improve the community’s activities include: health. For example, the health plan contracts with the Asthma Start program, a • Participating in the Alameda County Children and Families Health Insurance county public health project, to provide case management for families with an Task Force, which also serves as the Advisory Group for the Alliance’s Healthy Kids program; asthmatic child. In addition, the Alliance has been an active participant in two • Serving on the Access to Care Collaborative; asthma quality improvement initiatives. The first is a countywide asthma database • Participating in the Alameda County Health Coverage for Children Coalition; that provides various aggregate and individual level reports. The reports assist • Working with the California Children’s Health Initiatives Coalition; providers in identifying and following-up on patients, monitoring medication use • Contributing to Alameda Health Consortium’s Health Resources and Information and misuse, and assessing the success of medical interventions. The second initiative, Forum, a training program for Social Services Agency eligibility workers; Asthma Tools and Training Advancing Community Knowledge (ATTACK), is • Joining efforts with the Community Health Councils/Covering Kids and Families designed to improve asthma management within the primary care setting. This Statewide Coalition; initiative includes training of clinicians and non-clinicians in private medical • Serving on the Steering Committee for the American Lung Association on Oakland offices and community clinics to increase their scope of practice and expertise in Kicks Asthma; asthma. Nine of the Alliance’s provider practices have participated in this program • Working with the Child Health and Disability Prevention Provider Training Collaborative; impacting almost 2,000 Alliance members (children) with asthma. • Teaching in the Ambulatory Care asthma classes at Children’s Hospital and Research Center Oakland; The Alliance is pleased with the success of an initiative for high risk care • Participating in the Health Care Sector Committee of the Healthy Eating – Active management through a contract with Healthways (a nationally recognized care Living grant project; enhancement company). The program involves highly trained nurses delivering • Planning with the Ethnic Health Institute’s Advisory Committee and the intense care management programs to members at risk for hospitalizations. Using Asthma Subcommittee; this type of medical intervention is not unique for health plans as an approach • Leading the Oakland Berkeley Asthma Coalition; for improving health for high risk members. However, what is unique is the • Contributing to The Pediatric Diabetes Coalition of Alameda County; Alliance and Healthways partnership to include a strong focus on identifying and • Participating in the Alameda County Committee on Children with Special Needs; addressing social and psychological challenges that make patients more susceptible • Contributing to and developing the implementation strategy for the Oakland Unified to a growing dependence on the medical system. The care management nurses School District’s Wellness Policy; help patients by coordinating their medical care and assisting them to strengthen • Providing community health education programs through public schools and community-based organizations; interdependence with family and friends, stimulating mental capabilities, and • Working on La Clinica de La Raza’s Pediatric Obesity Subcommittee; and encouraging community involvement and purpose. • Partnering in enrollment events with community-based and faith-based organizations throughout Alameda County.20 21
  11. 11. Challenges Become Opportunities The costs of delivering comprehensive health care have continued to rise over the years while financial resources remained limited. The Alliance faced budget shortfalls, experiencing operational losses for five consecutive fiscal years. But, during this period, a most significant asset continued to sustain the Alliance: a solid commitment to making a difference in the community. Working with its Board and staff, the Alliance instituted several measures to manage costs. The organization’s turnaround strategy included four primary initiatives: formulating administrative efficiencies to reduce operating costs, renegotiating provider rate contracts, eliminating financially unsustainable programs, and improving medical management practices. Reduce Operating Costs Improve Medical Management The turnaround plan called for the organization to shift some of its resources, The Alliance updated its information systems to provide leadership with reallocating them to establish specific expertise in critical areas: pharmacy, medical comprehensive and accurate information regarding the factors underlying increasing management, finance, and compliance and government relations. In addition, expenses. With appropriate tools to define and clarify the issues, medical management management improved claims processing and eliminated operational inefficiencies devised solutions, enacting innovative changes to improve medical management and to decrease overhead costs. reduce inefficiencies in delivering quality care to Alliance members. Renegotiate Provider Contracts Accomplishments Measure Success Recognizing the organization’s importance to the community, many providers In the end, what had begun as a significant test became not just a financial cooperated with Alliance initiatives to improve its performance and, indeed, its turnaround, but also an opportunity. With a strong commitment from its providers, viability. Through contract changes, physicians, hospitals, pharmacies, and other stakeholders, members, and community partners, the Alliance has emerged stronger, providers made substantial contributions to the Alliance’s financial turnaround. smarter, and better prepared to realize its vision. Eliminate Unsustainable Programs In 2000, the Alliance launched Alliance Family Care. Another first by a local California health plan, this program expanded coverage to the uninsured in Alameda County. Regardless of immigration status, Alliance Family Care covered low-income children and parents who lacked employer-sponsored insurance and did not qualify for public health care programs. The Alliance raised external funds from statewide foundations and local sources for Alliance Family Care, which, at its peak, covered more than 7,500 children and their parents. Due to high demand, increasing program costs, and limited funding, however, Alliance Family Care operated at a loss. Committed to helping this population, the Alliance subsidized the program with funds from its own reserves for five years, but the program was still too expensive and, in the end, it was unsustainable. Alliance First Care, a program for individuals seeking affordable coverage, also proved unsustainable and closed in June 2005. To minimize the affect of these changes and contribute to policy efforts that support coverage expansion for children, the Alliance secured funds to launch its Healthy Kids program in October 2005. The program provides coverage to uninsured children in low-income families who do not qualify for public programs due to immigration status or income.22 23
  12. 12. Financial Facts 1996-2006 Using Reserves for Good Works While the Alliance was building its reserves, those funds were viewed as a community Ten-Year Financial Performance asset. It was at this time that the Alliance disbursed funds to support initiatives Alameda Alliance for Health’s financial performance was positive from 1996 that strengthened Alameda County’s health care system and improved community through 2000. This allowed the plan to build equity and introduce new managed health. This was possible because, as demonstrated in Figure 2 below, the plan’s care products. By Fiscal Year (FY) 2001, the plan began experiencing annual reserves were more than adequate to meet the State’s financial requirements for operating losses (see Figure 1). The losses were due to rising medical expenses viability known as Tangible Net Equity. and flat premium payments from the plan’s largest payor (Medi-Cal), and losses Figure 2 in two product lines that did not reach projected financial targets and were being subsidized by plan reserves. The Alliance Board of Governors and management team instituted several measures to manage costs beginning in FY 2004 that eventually resulted in a successful financial turnaround. Figure 1 In 2003, Mercer Government Human Services Consulting studied the financial viability of Medi-Cal participating health plans using projections of flat or Activities funded through the Alliance’s reserves included: declining capitation rates. The study indicated that as a whole, the plans would show improved performance, but projections of financial viability were less positive. • Allocating $18 million for Alliance Family Care, a health care plan that provided comprehensive coverage for up to 7,500 low-income, uninsured Alameda According to the study: County families who did not qualify for public programs due to income or immigration status. “…if revenue growth continues to lag behind medical expense trends, the Medi-Cal participating health plans whose primary membership is Medi-Cal members will • Allocating $9.2 million to support three Disproportionate Share Hospitals in begin to fall out of compliance with California’s Tangible Net Equity (TNE)…” Alameda County during a period of escalating hospital costs and a potential collapse of the hospital safety net system. Mercer Government Human Services Consulting, “The Impact of California’s • Granting $4.5 million through the Community Health Investment Fund (CHIF) for Fiscal Crisis on Medi-Cal Plans,” report prepared for the Medi-Cal Policy Institute, competitive grants to community-based organizations for innovative programs that Oakland, CA, September 2003. improved the health of Medi-Cal and uninsured or underserved populations. • Reimbursing primary care physicians, specialists, and other providers higher than what Medi-Cal and other payors would pay on a fee-for-service basis. Implementation increased the number of access points for traditionally underserved populations and helped providers cross-subsidize for uncompensated care provided to low-income, uninsured populations. All contract providers received rate increases from 1999-2003, with annual increases ranging from 7% to 25%.24 25
  13. 13. By FY 2006, the Alliance became concerned with its reduced level of reserves and Successfully Managing Medical Expenses unrelenting medical care trends that portended higher costs. With support from its The Alliance has worked aggressively to contain medical and administrative costs. In a broad base of community partners, the Alliance made a case to the state for increased climate where medical costs are perpetually rising, the Alliance’s medical costs declined premium payments for its Medi-Cal program. The state legislature approved a rate 4% overall from the prior fiscal year. This resulted from the combined efforts of the Alliance’s contracting physicians, hospitals and other providers supported by the work increase for the Alliance; however, it was later vetoed by the governor. Fortunately, of Alliance management and staff. the cost management strategies implemented by the Alliance began to show positive results. Those strategies relieved financial pressures, enabling the Alliance to emerge from financial peril without assistance from the state. After five years of financial challenges and operating losses, the Alliance’s first decade ended on a high financial note. Financial Results For Fiscal Year 2005-06 Operating Results For the fiscal year July 1, 2005 through June 30, 2006, the Alliance recorded net income of $7.3 million, a remarkable turnaround from the prior year net loss of $5.7 million. The following are highlights of the fiscal year: • Instituted innovative utilization management practices. • Reduced expenditures for high-cost tertiary inpatient care. • Increased the effectiveness of administrative operations. • Launched Healthy Kids to expand coverage to uninsured children.26 27
  14. 14. Sense of Purpose Alameda Alliance for Health is dedicated to making a difference in the quality and delivery of health care in the community. This commitment is driving the following organizational priorities for our future: • Influencing public policy to support the continuation, expansion, and improvement of health coverage for vulnerable populations; • Reinvesting reserves gained from positive operating margins for health care delivery for the uninsured and vulnerable populations through support of the county’s safety net system; • Advocacy and promotion of best medical practices and community health practices; and • Participating in the Medicare market with a focus on improving access and quality care for the Medicare/Medi-Cal dual eligible population. Through this decade, the Alliance overcame many challenges, learned many lessons, and emerged stronger than ever. With commitment and expertise at its core, the Alliance stands prepared to take on the challenges and opportunities of the future.28 29
  15. 15. Alameda Alliance for Health Staff Summer 200630 31
  16. 16. Alameda Alliance Staff Summer 200632 33
  17. 17. iv