Agenda

Return

C.16

To:	Board of Supervisors
From:	Ted Cwiek, Human Resources Director
Date:	January 17, 2012

Contra

Costa

County

Subject:

Add one Health Plan Director of Provider Relations and Credentialing position in the Health Services Department.

APPROVE	OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR	RECOMMENDATION OF BOARD COMMITTEE

Action of Board On: 01/17/2012

APPROVED AS RECOMMENDED

OTHER

Clerks Notes:

VOTE OF SUPERVISORS

AYE:

John Gioia, District I Supervisor
Gayle B. Uilkema, District II Supervisor
Mary N. Piepho, District III Supervisor
Karen Mitchoff, District IV Supervisor
Federal D. Glover, District V Supervisor

Contact:	Terrina C. Manor, 957-5248
cc:	Gladys Reid Roxana Mendoza Debbie Cho

I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown.
ATTESTED: January 17, 2012
David Twa,

BY:	, Deputy

RECOMMENDATION(S):

Adopt Position Adjustment Resolution #21039 to add one Health Plan Director of Provider Relations & Credentialing position (VRGD) at salary level ZA5 ($7307.57 - $8882.40) in the Health Services Department.

FISCAL IMPACT:

Upon approval, this action will result in an annual cost of approximately $170,839, including pension costs of $37,839, and will be funded with health plan member premiums.

BACKGROUND:

The Contra Costa Health Plan (CCHP) has been without a position in this classification for approximately two years. However, during that time, membership of the health plan has increased from 85,000 to approximately 106,000 and will continue to grow.

BACKGROUND: (CONT'D)

The State of California now requires Seniors and Persons with Disabilities (SPD) to join a managed care plan. Since June 2011, these SPD's are being added at the rate of approximately 1000 new lives per month. Because of this huge influx of Medi-Cal patients and a severe access problem for new members using Contra Costa Regional Medical Facility (CCRM) facilities, CCHP has had to recruit and credential many new primary care providers in the community in order to care for the new members. This process is ongoing and expected to continue as the needs for more providers increase with member enrollment.

In addition to adding more that a 1000 extra new SPD members monthly, CCHP's Medi-Cal line of business has exploded due to the poor economy, increasing the number of Medi-Cal members over 20% in the past 2 years. This calls for additional recruitment and credentialing of all types of medical providers such as Durable Medical Equipment vendors, Oxygen vendors, Skilled Nursing Facilities, Home Health, Hospice, dialysis, and non emergency transportation.

Further, because of patient access difficulties at CCRMC, the health plan is charged with the recruitment of many new hospitals and specialty care providers. The unit has already recruited and credentialed more than 97 new specialists to care for the increased patient demands and the the need will continue.

The Provider Relations and Credentialing unit has played a much bigger role in overseeing contracts generated for the Health Plan. With the addition of the SPD's, the unit must process an additional 20-25 contracts per month based upon continuity of care if the member had been receiving services from a provider not currently in the CCHP network.

Due to the increasing size of CCHP's membership, additional reporting requirements, ongoing recruiting and training of providers, and increases in contracts, the ability to appropriately handle provider issues and complaints and the ability to ensure a stable network is critical. A Director level position is needed to run this unit.

CONSEQUENCE OF NEGATIVE ACTION:

If this action is not approved, the Health Plan will not have a position in the appropriate classification to perform the required job duties.

CHILDREN'S IMPACT STATEMENT:

N/A