Medi-Cal Managed Care Quality Improvement
Issues, trends and strategies for success
May 6, 2019
Registration is now closed.
California’s local health plans work tirelessly to improve quality of care for their members. From data collection and measurement to interventions and reporting, local plans are advancing quality improvement (QI) efforts that will lead to better care, better outcomes and better performance.
Improving health care quality is no simple feat; rather, it is a multifaceted, plan-wide endeavor that crosses departments and functional areas. To successfully improve processes and outcomes, plan staff must have a greater understanding of the various concepts, components, drivers and key measures that comprise the quality framework.
Join us for the course where you will learn strategies and considerations for driving quality forward. Topics for discussion include:
- Foundational concepts of quality
- Successes and challenges in improving HEDIS scores
- Improving the member experience
- New DHCS quality requirements
- Prioritizing measures and opportunities for improvement
- And more …
Who should attend:
Local health plan staff across all departments who perform functions that are connected to or impacted by quality improvement initiatives and activities.
*May be subject to change
9:30 a.m. – Noon
Foundational Concepts of Quality Improvement
- Why quality is the touchstone of health care, importance for key stakeholders
- How quality drives better health outcomes and lower costs
- Challenges in measuring quality in managed care
- Setting the stage for QI — measurement, intervention, reporting and analysis
- Perspectives on the future of quality in Medi-Cal managed care
Experiences in Improving HEDIS Scores
- Challenges to improving HEDIS scores
- Plan strategies and interventions
- Lessons learned along the way
Improving the Member Experience and CAHPS Scores
- Effectively engaging members and providers
- Employing plan-wide strategies to support CAHPS
- Current experiences and strategies for moving forward
Noon – 1:00 p.m. | Hosted Luncheon
1:00 – 4:00 p.m.
New DHCS Quality Requirements: A Dialogue Among Plans
- New quality measures — how plans are incorporating them into their QI programs
- Issues and challenges in addressing the new measures
- Raising the bar — what the 50% national minimum performance level benchmark means for plans
- How plans can work with providers to meet new QI goals
- Group sharing — collaborate with your local plan colleagues on strategies to address the new quality requirements
Building a Roadmap to Success
- Identifying and prioritizing measures and opportunities for quality improvement
- Addressing challenging measures
- Assessing the impact of interventions and return on investment
Dale Bishop, MD
Chief Medical Officer
Central California Alliance for Health
Dr. Dale Bishop joined the Central California Alliance for Health as Chief Medical Officer (CMO) in July 2013, having previously served as CMO at the Health Plan of San Joaquin and in a number of other leadership roles. He is responsible for assuring the availability and quality of health care services for the health plan’s members through leadership of the Health Services department, medical management policies and data, and communicating key data and findings to the health plan, governing board and the Alliance provider network. In addition to his physician leadership experience, Dr. Bishop provided direct patient care to the underserved population in the Central Valley for 25 years. He received his medical degree from the University of California, Irvine, and holds a Bachelor of Science in Psychobiology from the University of Southern California.
James Glauber, MD, MPH
Chief Medical Officer
San Francisco Health Plan
Dr. Glauber has served as CMO of San Francisco Health Plan (SFHP) since 2014. Prior to joining SFHP, he was Senior Medical Director of Neighborhood Health Plan, Inc. where was responsible for the development and operation of a range of innovative disease management and care management, pharmacy, quality and quality measurement, and reporting initiatives and programs. Dr. Glauber has more than 20 years of clinical experience and administrative guidance, and served as an asthma consultant for Harvard Vanguard Medical Associates’ Pediatric Asthma Program. Dr. Glauber earned his medical degree from the University of California, San Francisco School of Medicine and completed his pediatric residency training at the University of Pennsylvania. He completed fellowship training at Harvard Medical School in the Clinical Effectiveness Program and earned a Master of Public Health from the Harvard School of Public Health.
Betsy Chang Ha, RN, MS, MBB
Executive Director, Quality & Analytics
As Executive Director of Quality & Analytics, Ms. Ha is responsible for oversight of several departments, including Quality Analytics, Quality Improvement, Population Health Management and Behavioral Health Integration. Her work is focused on improving the member experience, promoting optimal health outcomes and ensuring efficient care. Ms. Ha brings a background in quality improvement practices and is a certified Master Black Belt in Lean Six Sigma. Prior to joining CalOptima, she held senior leadership positions with OptumCare, Monarch Health Care and AltaMed Health Services. She also brings a unique perspective to her management roles as a registered nurse who worked in patient care for Children’s Hospital Los Angeles for several years. Ms. Ha holds a bachelor’s degree in nursing from University of Maryland and a master’s degree in healthcare management from the California State University, Los Angeles.
Richard Helmer, MD
Medical Management Consultant
Dr. Helmer is currently an independent medical management consultant. Most recently he was the Chief Medical Officer for CalOptima in Orange County California. Dr. Helmer has also served as Chief Medical Officer at the Central California Alliance for Health, Corporate Vice-President and Chief Medical Officer for Molina Healthcare and President of Pacific Healthcare Group, Inc. He is a surveyor for the National Committee for Quality Assurance and serves on NCQA’s Review Oversight Committee. Dr. Helmer received an undergraduate degree from the University of California Santa Barbara, a medical degree from the Medical College of Wisconsin and trained in Family Medicine at the University of Miami.
Health Management Associates
Linda has more than 20 years of experience in the managed care industry. She joined HMA most recently from L.A. Care Health Plan where she was responsible for analyzing and improving Medicare performance and clinical operations for a Medicare Advantage Special Needs Plan (SNP) and Cal MediConnect duals demonstration project. She also conducted an analysis of performance measures including HEDIS, Consumer Assessment of Health Plan Provider and Systems (CAHPS), and Health Outcomes Survey (HOS) survey results, while identifying priority areas and implementing improvement plans. Linda worked at CalOptima for 12 years, during which she was responsible for quality improvement activities. She led the organization in achieving its initial health plan accreditation by NCQA, improved HEDIS scores, and developed various member and provider quality improvement and incentive programs. Linda has a master’s degree in public health and a bachelor’s degree in molecular biology from UCLA.
Manager, Access and Care Experience
San Francisco Health Plan
Amy Petersen is the Access and Care Experience Manager with San Francisco Health Plan (SFHP). Her team oversees appointment access monitoring, telemedicine initiatives, provider grants and quality improvement training, Health Plan CAHPS and member grievances. She works with plan members and their families, medical group leadership and care teams to ensure high quality care. Amy finds value in insights gained from member feedback and is energized by work that allows plans and providers to act on information members share about their care. Amy is trained in Lean and design thinking. She has worked in health care delivery systems and holds a master’s degree in public health from the University of Michigan, Ann Arbor.
Director of Claims Administration
Community Health Group
Nora Pintado has more than 30 years of experience in the health care industry. Her areas of expertise include HEDIS, Customer Service, Health Plan Operations, Provider Services and Claims.
David Ramirez, MD
Chief Medical Officer
As Chief Medical Officer, Dr. Ramirez oversees CalOptima’s health care delivery system, including development and implementation of strategies, programs, policies and procedures. He is responsible for leading key CalOptima departments, including Clinical Operations, Utilization Management, Case Management, Long-Term Support Services, Enterprise Analytics and the Program of All-Inclusive Care for the Elderly. A board-certified internist, Dr. Ramirez brings a diverse background of leadership in both clinical and health plan settings. Most recently, he worked for a national Medicare plan for six years in positions of increasing responsibility from Medical Director to Chief Quality Officer. His distinguished medical education includes a bachelor’s degree in human biology from Stanford University and a medical degree from Harvard Medical School.
Community Health Group
Gabriela Rubalcava has nearly 30 years of experience in managed care. Her experience span the areas of quality improvement, project management, data analysis, outcomes management, compliance reviews, provider relations and claims. Ms. Rubalcava’s expertise and experience include HEDIS, Medicare STAR rating, HCC risk adjustment, quality improvement strategy, claims, data research and development, and provider relations.
505 City Parkway West
Orange, CA 92868
For attendees who will require overnight accommodations, discounted rooms are available at ALO Hotel & Resort:
ALO Hotel & Resort
3737 W. Chapman Ave.
Orange, CA 92868
(714) 978-9168 (reservations)
Note: To receive the discounted rate, mention “CalOptima rates” when booking.
A shuttle bus should be available to transport guests between the hotel and CalOptima.
Registration Fees: $21.59 per registrant
Registration Details: The course will accommodate up to 80 participants. Each plan may elect to send no more than five (5) participants. If more than five individuals from a plan are interested in attending, they are encouraged to sign up for the waitlist. Waitlisted individuals will be admitted should space become available.
Registration Deadline: Registration closes May 1 at 5:00 p.m or once capacity is reached.
Registration Confirmation: Registrants will receive an email notification confirming their registration.
Presentation Materials: Presentation materials will be made available electronically only via the program resource web page that will be provided to confirmed registrants. Attendees are encouraged to download the materials in advance to their mobile device or print a copy to bring to the event.
Special Accommodations: Please contact the LHPC Institute at firstname.lastname@example.org should you require special accommodations pursuant to the Americans with Disabilities Act.
Cancellation Policy: Cancellation notification must be submitted in writing to email@example.com seven or more days prior to the course date. Refunds will not be given after that date. Substitutions are encouraged.