Advisory Committees | CenCal Health Insurance Santa Barbara and San Luis Obispo Counties (2024)

CenCal Health is an integral part of the community and as such has structured its committees to enable community based organizations, network providers and physicians, advocates and members to participate and provide guidance throughout its structure.

Our Quality Improvement Structure also provides for participating physicians within the Quality Improvement, Credentialing and Peer Review Committees. The Provider and Community Advisory Boards also have participation by providers and members that also Liaison with the Board of Directors.

NOTICE OF REGULAR MEETING OF THE COMMUNITY ADVISORY BOARD OF CENCAL HEALTH

Community Advisory BoardMeetingAgenda

Date&Time:July 11, 2024 12:00 pm (Lunch), Regular Agenda 12:30 pm – 2:00 pm

Locations:

Arroyo Grande: 850 Fair Oaks Ave Ste 120, Arroyo Grande, CA 93420, Matthew Wil Memorial Medical Center

Santa Barbara: 4050 Calle Real, Santa Barbara, CA 93110, Hart Auditorium

MeetingFacilitator:MaryEllen Rehse, Chair, Executive Director, Children & Family Resource Services, Health Linkages

CAB Coordinator:Eric Buben, Chair, Director of Member Services, CenCal Health

AdministrativeSupport:Teri Amador, Sr. Administrative Assistant in Member Services, CenCal Health

Public Participation: Members of the public will be allowed to provide public comment in real time during the public comment portion of the Community Advisory Board (CAB) meeting.If you require any special disability-related accommodations, please contact the CenCal Health CAB Administrative Assistant at (805) 685-9525 x-1680 or via email attamador@cencalhealth.orgatleast twenty-four (24) hours prior to the scheduled board meeting to request disability related accommodations.

To View the CAB Agenda for July 11, 2024 please clickhere

To view past CAB Meeting Minutes, click here

The Community Advisory Board (CAB) is a liaison committee reporting directly into CenCal Health’s Board of Directors and Chaired by the Director of Member Services, that provide a forum for member and community input to CenCal Health regarding issues such as access, member rights and responsibilities, member education, services provided through the Plan’s call center and quality improvement.

CAB Responsibilities:

• Provide advice and consultation to the Plan with respect to the administration of Medi-Cal membership and the services provided by the Plan to the entire membership.
• Promote collaboration among Community Based Organizations (CBOs), advocates, agencies and Plan providers to execute State requirements of the Medi-Cal Program.
• Identify and make recommendations on process improvement opportunities related to the Medi-Cal Program.
• Advise the Plan of emerging trends relating to services and community focus activities and events for all Medi-Cal membership.
• Provide feedback on health education and preventative guidelines developed by regulatory agencies for all membership.

The CAB meets on a quarterly basis or as needed.

The CAB is comprised of the following members:

• Dana Gamble
• Maria Jauregui-Garcia
• Susan Liles
• Michelle Shoresman
• Jennifer Nitzel
• Julie Posada
• Jonathan Nibbio
• Quynh Nguyen, DDS
• MaryEllen Rehse
• Tamika Harris
• Jose Clemente
• Sara Macdonald
• Robert Gibson
• Norma Alonso
• Olga Mendoza De Bravo
• Alejandra Rodriguez-Lind
• Krystle Kaden
• Eustolia Garcia
• Yolanda Navarro
• Chris Burke
• Eusebio Soto-Meza
• Soledad Soto
• Carmen Garcia, LMFT

CenCal Health Staff:

• Van Do-Reynoso, PhD
• Eric Buben
• Gabriela Labraña
• Zena Chafi-Aldwaik
• Diana D. Robles
• Elia Rodriguez
• Nicolette Worley Marselian
• Denise Filotas
• Teri Amador
• Citlaly Santos
• Karina Negrete
• Caitlyn Hopkins
• Tommy Curran

Guests:

• Javi Infante Varas (Spanish-English Interpreter)
• Nayra Pacheco (Spanish-English Interpreter)

The purpose of the PAB is twofold:

1. To offer input to the Board of Directors regarding major policy decisions.
2. To provide staff with input regarding how the provider community perceives new rollouts and ongoing operations.

The PAB does the following:

provides guidance for enhancements to maintain and continually improve CenCal Health’s service to the provider network, to ensure provider satisfaction with health plan processes; provides nput regarding provider communications materials and education; making recommendations regarding provider quality improvement activities (e.g. provider access survey, network management, corrective action, provider contracting) and reviews aggregate data related to service delivery, access, and compliance with corrective actions.

The PAB Membership is comprised of five or more physician or non-physician members, each of whom is contracted with at least one of CenCal Health’s programs, or is an administrator of a community partner. In addition, Ex-officio, non-voting members consist of the Director of Provider Services, the Provider Services Manager, and on an ad-hoc basis, the Provider Services Representatives.

The committee meets on a quarterly basis or as needed.

The committee is comprised of the following members:

• Adam Butler, MPP
• Barbara Brown-Ramirez
• Carmen Obregon
• Cathy Slaughter
• Chelsee Elliott
• Christine Nichols
• Dana Goba
• Dusty Keegan
• Jordan Turetsky
• Karina Orozco
• Kathleen Sullivan, RN, MSN
• Kieran Shah
• Lauren Geeb
• Marie Moya
• Michael Bordofsky, MD
• Nancy Vasquez, MPA
• Rahul Vinchhi
• Robert Janeway
• Sheila Thompson, RN, CPHQ
• Steven Clarke
• Suzanne Jacobson
• Yolanda Robles

Upcoming Meeting:

NOTICE OF REGULAR MEETING OF THE COMMUNITY ADVISORY BOARD OF CENCAL HEALTH

ProviderAdvisoryBoardMeetingAgenda

Date & Time:July 15, 2024, 11:30 am – 1:00 pm

Locations:
• SB Members: CenCal Health,4050 Calle Real, Santa Barbara, CA 93110
• SLO Members: Matthew Will Memorial Medical Center,850 Fair Oaks Ave Ste 120, Arroyo Grande, CA 93420(Third Floor)

MeetingFacilitator: Luis Somoza,PABChair,Provider Services Director, CenCal Health
AdministrativeSupport:Carmen Obregon,Provider ServiceAdministrative Assistant

Attendees: PAB Members:Amber Bermond; Barbara Brown-Ramirez, CPNP, MSN; Dana Goba; Jo Ann Mack; Kieran Shah, CHPCA; Kathleen Sullivan, Ph.D.; Mahdi Ashrafian, MD, MBA; Marie Moya; Michael Bordofsky, MD; Rahul Vinchhi; Steve Clarke, MD; Yolanda Robles.

PAB Guest:Dana Gamble

CenCal Health Staff:Amber Sabiron; Carlos Hernandez; Carmen Obregon; Cathy Slaughter; Chris Hill; Dona Lopez; Gisela Taboada; Lauren Geeb, MBA; Luis Somoza; Nancy Vasquez, MPA; Van Do-Reynoso, PhD.

Public Participation: Members of the public will be allowed to provide public comment in real-time during the public comment portion of the Provider Advisory Board (PAB) meeting.If you require anyspecialdisability-relatedaccommodations,please contact the CenCal Health Provider Services Department at (805) 562-1676 or via email atProviderServices@cencalhealth.orgat least twenty-four (24) hours before the scheduled board meeting to request disability-related accommodations.

Next Meeting:October 14, 2024, in-person only

Locations:
• CenCal Health, Santa Barbara, and
• Matthew Will Memorial Medical Center, Arroyo Grande

To View the PAB Meeting Agenda for July 15, 2024, please clickhere

QIHEC is responsible for the monitoring and enhancement of organization-wide Quality Improvement (QI) processes to ensure the delivery of quality customer service and access to high quality medical services. It is the responsibility of QIHEC to assure that all QI activities represent the entire range of care provided, including all demographic groups, care settings, and types of service. QIHEC oversees the development and implementation of the QIHETP and QI functions in the organization.

QIHEC is CenCal Health’s medical advisory body charged with evaluating clinical policies and reviewing and approving all significant clinical initiatives and programs to assure appropriate clinical input from contracted provider network practitioners prior to and/or during implementation.

QIHEC continually strives to ensure the provision of quality and equity in health care delivery and service to CenCal Health’s members, providers, internal customers, and the community through pursuit of meaningful and measurable activities to improve processes, outcomes, and satisfaction.

The objectives of the committee are:

• Analyze and evaluate the results of QI and Health Equity activities including annual review of the results of performance measures, utilization data, consumer satisfaction surveys, and the findings and activities of other CenCal Health committees such as the Community Advisory Board.
• Institute actions to address performance deficiencies, including policy recommendations.
• Ensure appropriate follow-up of identified performance deficiencies.
• Ensure practitioner participation in the QIHETP through planning, design, implementation or review.
• Advise CenCal Health’s leadership to assure the relevance, applicability, and soundness of clinical policy to proactively promote excellence in quality of care, health equity, service, and patient safety.
• Review of Pharmacy & Therapeutics Committee formulary design and QI initiatives.
• Review of Provider Credential & Peer Review Committee summary-level statistics regarding network management, provider quality improvement, and provider corrective action.
• Review of policy recommendations from the Customer Experience Committee (CEC), previously referred to as the Healthcare Operations Committee (HOC) and appropriately advises the Board of Directors.
• Review of reports from the CEC regarding monitoring of health plan functions and activities, including but not limited to non-clinical activities to improve quality of care, if any.
• Annual approval of CenCal Health’s adoption of preventive health guidelines, utilization management coverage criteria, clinical condition support strategies, clinical practice guidelines, and new medical technologies when requested by the Benefits
• Oversight of the development and annual review of the QIHETP Program
• Oversight of the development and annual review of the PHM Strategy and Program Description.
• Oversight of the evaluation of the previous year’s Work Plan including analysis and evaluation of the effectiveness of QI
• Oversight and the development of the current year’s Work Plan to determine priorities and goals regarding quality of care, health equity, service, and patient

QIHEC is comprised of at least seven practitioners from CenCal Health’s provider network, and CenCal Health’s Chief Medical Officer. QIHEC’s voting membership also includes CenCal Health’s Chief Executive Officer, Chief Health Equity Officer/Chief Customer Experience Officer, Chief Operating Officer, Board of Directors Liaison, Quality Officer, Hospital Representative and a Health Plan Member. A quorum is a minimum of 7 QIHEC members or greater than 50% of the prevailing membership, including at least 4 network practitioners.

Participating Subcontractors, Downstream Subcontractors, and Network Providers are representative of the composition/specialties of CenCal Health’s Provider Network and include, at a minimum, Network Providers who provide health care services to:

1. Members affected by Health Disparities
2. Limited English Proficiency (LEP) members
3. Children with Special Health Care Needs (CSHCN)
4. Seniors and Persons with Disabilities (SPDs)
5. Persons with chronic conditions

QIHEC’s representation is appropriate to CenCal Health’s practitioner network, and the committee’s representation is changed as necessary to provide expertise relevant to CenCal Health’s quality improvement objectives.

The membership of the QIHEC is comprised of:

QIHEC Voting Members:

• Emily Fonda, MD, MMM, CHCQM (Committee Chair)
• Michael Collins, DO, MPH, MS
• Van Do-Reynoso, MPH, PhD
• Marina Owen, CEO
• Ed Bentley, MD* (Board Liaison)
• Bethany Blacketer, MD*
• Carlos Hernandez
• Douglas Major, OD*
• Jeffrey Kaplan, MD*
• Joseph Freeman, MD, FACEP*
• Mazharullah Shaik, MD*
• Neil Adams, MD, MPH
• Noemi Doohan, MD, PhD, MPH*
• Polly Baldwin, MD*
• Jordan Turetsky, MPH
• Elizabeth Snyder, MHA
• Sara Macdonald*External practitioner

QIHEC Staff Members:

• Chris Hill, RN, MBA
• Eric Buben
• Lauren Geeb, MBA
• Seleste Bowers, DHA, LCSW
• Sheila Thompson, RN, CPHQ
• Stephanie Lem, PharmD

Committee Recorder:

• Mimi Hall

QIHEC reports to the Board of Directors on a quarterly basis. A physician member of the Board of Directors serves as liaison to QIHEC and is a voting member of the committee. The Chair of QIHEC ensures quarterly reports from the QIHEC to the Board are submitted in accordance with CenCal Health’s contract with DHCS.

The P&T Committee serves as the advisory committee to CenCal Health for the development and implementation of a plan-wide medication management program. The P&T Committee is responsible to provide guidance on development of a medical-pharmacy benefit formulary to ensure optimal efficacy, safety, and cost-effectiveness of drug therapy. Additionally, the P&T Committee will serve as the plan’s Drug Utilization Review (DUR) board and oversee the plans activities to ensure quality medication management that meets the contractual requirements related to Medi-Cal DUR program.

The objective of the P&T is:

• Service in an advisory capacity to CenCal Health for all matters pertaining to the use of medication, including development of prescribing guidelines, protocols and procedures to promote high quality and cost-effective drug therapy to the medications the plan has responsibility for contractually

The P&T Committee members include but are not limited to CenCal Health’s Chief Medical Officer, or physician designee, Director of Pharmacy Services (Chairperson), two to four physicians, and two to four pharmacists.

• Jeff Januska, Pharm.D.
• Karen Hord, MD, MPH
• Stephanie Lem, Pharm.D.
• Steve Clarke, M.D.
• Cindy Blifeld, M.D
• Sandeep Anantani, R.Ph., MBA
• Chad Signorelli, Pharm.D.
• Estella Wu, Pharm.D.

The Provider Credentials & Peer Review Committee provides guidance and peer input into CenCal Health’s provider peer review and credentialing processes. The PCC is responsible for providing guidance and peer input into CenCal Health’s provider credentialing process.

To review member and provider clinical complaints, grievances, and issues involving clinical quality of care concerns, as deemed appropriate by the Chief Medical Officer.

• To determine corrective action when necessary.
• To periodically review different areas of care provided to members as deemed appropriate by the Chief Medical Officer.
• Review and processing of requests of potential providers for initial and reappointment for participation in CenCal Health’s provider network.
• Approval of providers’ initial or subsequent credentials based on clinical competency and/or professional conduct.
• Review the provider credentialing policy annually and make recommendations for change, if any, to the Board of Directors.
• Review of provider research related to clinical performance.

The PCC consists of licensed practicing physicians. CenCal Health’s Chief Medical Officer and/or Associate Medical Director attend as non-voting members. To assure due process in the performance of peer review investigations, the Chief Medical Officer shall appoint other physician consultants as necessary to obtain relevant clinical expertise and representation by an appropriate mix of physician types and specialties.

The PCC will consist ofsix (6) physician and one (1) chiropractic provider voting members who are contracted providers with CenCal Health and the following non-voting members: the Director of Provider Services, the Chief Medical Officer or physician designee, the Director of Legal Affairs, the Provider Services Manager, and the Credentialing Specialist. A Chairperson and a Co-Chairperson are elected from among the voting members, by the voting members. The Committee may request input from credentialed network physicians that are not Committee members as subject matter experts to assist in evaluating an applicant’s ability to meet CenCal Health’s credentialing criteria. To select members, staff make recommendations for committee appointment based on factors including, but not limited to, attendance, contribution, regional and professional representation, relevant expertise, and knowledge of the credentialing process. All members must sign a confidentiality statement.

The voting members of the PCC consist of the following people:

• Alan Bernstein, MD
• Luis Diaz, DC
• Karen Hord, MD
• Terri Howell
• Deborah Kramer
• Robert Price, MD
• Nubia Siordia
• N. Birrell Smith, MD
• Himat Tank, MD – Chair
• Shan Thomas, MD
• Sheila Thompson
• Dena Tilley, RN
• Takashi Wada, MD
• Tushar Yadav, MD

Non-Voting Members

• Adam Butler, MPP
• Barbara Brown-Ramirez
• Carmen Obregon
• Cathy Slaughter
• Chelsee Elliott
• Christine Nichols
• Dana Goba
• Dusty Keegan
• Jordan Turetsky
• Karina Orozco
• Kathleen Sullivan, RN, MSN
• Kieran Shah
• Lauren Geeb
• Marie Moya
• Michael Bordofsky, MD
• Nancy Vasquez, MPA
• Rahul Vinchhi
• Robert Janeway
• Sheila Thompson, RN, CPHQ
• Steven Clarke
• Suzanne Jacobson
• Yolanda Robles

• Ana Cabrera
• Ana Stenersen
• Arlene Hernandez-Tapia
• Ashley Smee
• Daisy Ramirez
• Dena Davis
• Diana Robles
• Eli Rodriguez
• Felisa Strickland
• Francesca Peterson
• Gina Stabile
• Jane Harpster
• Jennifer Griffin
• MarcyJochim
• Mariana Murillo
• Natalie Angelo
• Patty Moore
• Rea Goumas
• Sara McGrath
• Sarah Sullivan
• SharleneAgrusa
• Stephanie Lem
• Tamika Harris
• Tanesha Castaneda