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

3. 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 2006
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4. 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.
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5. 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.
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6. 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.
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7. 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.
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8. 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.
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9. 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.
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10. 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
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Board of Directors and the Hayward Rotary Club Board of Directors. 2 5
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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.
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11. 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.
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12. 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.
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13. 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.
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14. 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%.
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15. 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.
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16. 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.
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17. Alameda Alliance for Health Staff
Summer 2006
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18. Alameda Alliance Staff Summer 2006
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19. iv