Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to the Agreement with San Mateo Health Commission dba the Health Plan of San Mateo for Medi-Cal Primary Care Physicians Medical Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with the San Mateo Health Commission, dba the Health Plan of San Mateo, for Medi-Cal Primary Care Physicians Medical Services to create a shared savings agreement for the term of January 1, 2019, through December 31, 2019.
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BACKGROUND:
On September 9, 2008, your Board approved an agreement with the San Mateo Health Commission, dba the Health Plan of San Mateo (HPSM), for Primary Care Medical Services for eligible HPSM members receiving services at the San Mateo Medical Center (SMMC), for the term of January 1, 2008, through December 31, 2008. Pursuant to its terms, the agreement renews each year for a new one-year period, subject to either party's right to give notice to terminate the agreement. The agreement has been amended multiple times, most recently on July 10, 2018, to amend the reimbursement rates beginning on July 1, 2018.
DISCUSSION:
This amendment includes an Alternative Payment Model (APM) to ensure compliance with the State of California's Medi-Cal 2020 section 1115 waiver. This waiver requires a contractual mechanism for sharing either risk or a reduction in the cost of care and requires payments to be tied to quality performance. The amendment will help SMMC manage medical costs associated with HPSM patients who are assigned to SMMC by separating its shared savings into distinct lines of business: Medi-Cal, Medi-Cal Expansion, and Medicare Cal-Medi Connect.
Subject to compliance with the shared savings agreement and APM amendment, SMMC will be entitled to r...
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