The Community Advisory Board (CAB) is a liaison committee reporting directly into CenCal Health’s Board of Directors 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.
The CAB reviews and comments on proposed policies and actions of the Board of Directors that pertain to arrangements for health care.
Members of CenCal Health’s CAB for 2015 are:
- Caro Stinson, Public Health Nutritionist - WIC Santa Barbara PHD
- Tara Dooley - SB County Educational Office/Doorway to Health
- Gary Clancy - HICAP - Area Agency on Aging
- Jonathan Nibbio, MA, LMFT - Director Clinical Services, Family Care Network
- Ana Stenersen, Public Health Nurse, Manager - Santa Barbara PHD CCS
- Georgene Lowe, - SBCEO Health Linkages
- Sandra Copley, Public Health Nurse, Manager - Santa Barbara PHD CHDP
- Karen Johnson, Member - CenCal Health Board Member - BOD Liaison
- Dana Gamble, LCSW - Santa Barbara Health Care Clinic, Manager
- Pamela Dudley, Public Health Nurse, Manager - San Luis Obispo PHD - CHDP CCS
- Open - Social Security Administration
- Petra Lowen, Subscriber, Independent Living Center
- Pamela Crabaugh, MSW - Tri-Counties Regional Center
- Laura Alcala, Quality - Community Health Centers Central Coast
- Mario Velasco, Division Chief - Department of Social Services
The purpose of the PAB is twofold:
- To offer input to the Board of Directors regarding major policy decisions.
- 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:
- Barbara Brown-Ramirez, C.P.N.P., M.S.N., Network Provider - Pediatrics Ste. B (Robert S. Barry, M.D., Inc.)
- Pamela Challis, Director of Branch Operations - Sansum Clinic
- Vince Surra, CPHQ, COO - Community Health Centers of the Central Coast
- Marie Moya, Controller - Compass Health, Inc.
- Rob Janeway, Industry Relations and Contracts Manager - MedBridge (Summit and Premier Surgery Centers of SB)
- Emma Mayer, Chief Financial Officer - Planned Parenthood
- Dan Herlinger, Board Liaison - CenCal Health
- Leslie Kearney, QI and Compliance Manager - SB Neighborhood Clinics
- Lisa Reich (Replacement TDB), Executive Director - Santa Barbara County Medical Society
- Suzanne Jacobson, Deputy Director, Administration and Finance - Santa Barbara County Public Health Department
The QIC is responsible for the monitoring and enhancement of organization-wide quality improvement processes to ensure the delivery of quality customer service and access to high quality medical services. It is the responsibility of the QIC to assure that all QI activities represent the entire range of care provided, including all demographic groups, care settings, and types of service. The committee also reviews policy recommendations from the Healthcare Operations Committee (HOC) and appropriately advises the Board of Directors.
The QIC also 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.
The QIC continually strives for excellence and quality in health care delivery and service to CenCal Health’s members, providers, internal customers and the community by pursuing meaningful and measurable activities to improve processes, outcomes, and satisfaction.
The objectives of the committee are:
- Advise CenCal Health’s leadership to assure the relevance, applicability and soundness of clinical policy, to proactively promote excellence in quality of care, service and patient safety.
- Oversee the activities of the Pharmacy & Therapeutics Committee, and the Provider Credentials & Peer Review Committee, to proactively promote excellence in quality of care, service and patient safety.
- Ensure the proper delegation of responsibilities by the HOC to the appropriate quality committees.
- Ensure quality committees have access to timely information regarding requirements to ensure prompt implementation of processes.
- Ensure QIC members can have a candid discussion about barriers to achieve quality goals and objectives, and to facilitate the removal of such barriers.
The QIC oversees the activities of the Pharmacy & Therapeutics Committee, and the Provider Credentials & Peer Review Committee. In addition to this oversight responsibility, the QIC's responsibilities include review and input on the following topics:
- Recommend pertinent policy decisions to CenCal Health’s Administration and Board of Directors.
- Review of Pharmacy & Therapeutics Committee formulary design and quality improvement initiatives
- Review of Provider Credential & Peer Review Committee summary-level statistics regarding network management, provider quality improvement, and provider corrective action
- Review of reports from the HOC regarding monitoring of health plan functions and activities, including clinical and non-clinical activities to improve quality of care. The QIC advises CenCal Health of topic-specific strategies to achieve ongoing improvement in clinical practice among CenCal Health’s provider network, including but not limited to facility site review.
- Annual approval of CenCal Health’s adoption of clinical guidelines, preventive health recommendations, utilization management coverage criteria, clinical condition support strategies, and new medical technologies when requested by the Benefits Committee.
- Oversight of the development and annual review of the QAIP, quality improvement activities (QIAs), Work Plan, Work Plan Evaluation, and UM Program Description.
- Annual analysis and evaluation of the effectiveness of quality improvement activities, and achievement of Work Plan goals.
- The activities, findings, recommendations, and actions of the QIC shall be reported to the CenCal Health’s Board of Directors in writing on a scheduled basis.
The QIC is comprised of at least eight practitioners from CenCal Health’s provider network, and CenCal Health’s Chief Medical Officer, who chairs the committee. The QIC’s voting membership also includes CenCal Health’s Chief Executive Officer, Chief Operating Officer, Medical Director, and Director of Quality/Decision Support. A quorum is a minimum of 7 QIC members or greater than 50% of the prevailing membership, including at least 4 network practitioners.
The QIC’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 management objectives. The term of network physician QIC membership is 2 years. The Committee may, from time to time, create and appoint ad hoc committees as deemed necessary. No more than six or more than a majority of the current committee members, whichever is less, may serve on any one ad hoc committee. The Committee may call in experts (non-committee members) to provide expertise relevant to the Committee’s goals.
The membership of the QIC is comprised of:
- Chief Medical Officer (Quality Improvement Committee Chair)
- Board Liaison (Pediatrician, non-staff)
- Chief Executive Officer
- Chief Operating Officer (Health Care Operations Committee Chair)
- Director of Quality/Decision Support, Quality Officer
- Medical Director, County Public Health Department (Family Physician, non-staff)
- Primary Care Physician (Pediatrics, non-staff)
- Specialist Physician, Community Health Centers of the Central Coast (Obstetrician/gynecologist, non-staff)
- Primary Care Physician (Santa Barbara Neighborhood Clinics, Family Medicine)
- Specialist Physician (Emergency Medicine, non-staff)
- Specialist Physician (Emergency Medicine, non-staff)
- Specialist Physician (TBD, non-staff)
The QIC reports to the Board of Directors on a quarterly basis. A physician member of the Board of Directors serves as liaison to the QIC and is a voting member of the committee. The Chair of the QIC ensures quarterly reports from the QIC to the Board are submitted in accordance with CenCal Health’s contract with the Department of Health Care Services (DHCS) as a component of CenCal Health’s monthly submission of Board of Directors materials to its Contracting Officer at 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 formulary to ensure optimal efficacy, safety, and cost-effectiveness of drug therapy.
The objective of the P&T is:
- Maintenance of a drug formulary based on an objective evaluation of efficacy, safety and cost-effectiveness of medications.
- 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.
- Review and evaluation of analyses including but not limited to population demographics, morbidities, health risks, and provider-specific and plan-wide utilization patterns for enrolled members.
- Any other issues related to pharmacy quality and usage.
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., Director of Pharmacy, CenCal Health, - Committee Chair
- Stephanie Lem, Pharm.D., Clinical Manager of Pharmacy, CenCal Health
- Mark Maddox, M.D., Chief Medical Officer, CenCal Health
- Julio Bordas M.D., Associate Medical Director CenCal Health, Physician at American Indian Health
- Buck Sharp, R.Ph., Pharmacist Lompoc, Valley Hospital
- Sandeep Antani, R.Ph., Pharmacist, Marian Medical Center
- Allen Cohen, Director of Pharmacy, Cottage Hospital
- Chad Signorelli, Pharm.D., Director of Pharmacy, Lompoc Valley Hospital
- Cecelia Ramos, M.D., Medical Director, Santa Ynez Tribal Health
- Frank Lagatutta, M.D., Pain Management Physician
- Cindy Blifeld, M.D., Pediatrician
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 of six (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:
- Himat Tank, MD - Chair
- Larry Paikoff, MD
- Luis Diaz, DC
- N. Birrell Smith, MD
- Shan Thomas, MD
- Tushar Yadav, MD
- Deborah Kramer
- Sheila Thompson
- Marina Owen
- Beverly Dolberg, MD
- Caitlin Larsen