AGENDA FINANCE COMMITTEE MEETING. KERN HEALTH SYSTEMS 9700 Stockdale Highway 1st Floor Board Room Bakersfield, California 93311

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1 AGENDA FINANCE COMMITTEE MEETING KERN HEALTH SYSTEMS 9700 Stockdale Highway 1st Floor Board Room Bakersfield, California Friday, August 8, :30 A.M. All agenda item supporting documentation is available for public review at Kern Health Systems in the Administration Department, 9700 Stockdale Highway, Bakersfield, during regular business hours, 8:00 a.m. 5:00 p.m., Monday through Friday, following the posting of the agenda. Any supporting documentation that relates to an agenda item for an open session of any regular meeting that is distributed after the agenda is posted and prior to the meeting will also be available for review at the same location. PLEASE REMEMBER TO TURN OFF ALL CELL PHONES, PAGERS OR ELECTRONIC DEVICES DURING MEETINGS. COMMITTEE TO RECONVENE Members: Deats, Casas, McGlew, Rhoades, Sidhu CONSENT AGENDA/OPPORTUNITY FOR PUBLIC COMMENT: ALL ITEMS LISTED WITH A "CA" ARE CONSIDERED TO BE ROUTINE AND NON- CONTROVERSIAL BY KERN HEALTH SYSTEMS STAFF. THE "CA" REPRESENTS THE CONSENT AGENDA. CONSENT ITEMS WILL BE CONSIDERED FIRST AND MAY BE APPROVED BY ONE MOTION IF NO MEMBER OF THE COMMITTEE OR AUDIENCE WISHES TO COMMENT OR ASK QUESTIONS. IF COMMENT OR DISCUSSION IS DESIRED BY ANYONE, THE ITEM WILL BE REMOVED FROM THE CONSENT AGENDA AND WILL BE CONSIDERED IN LISTED SEQUENCE WITH AN OPPORTUNITY FOR ANY MEMBER OF THE PUBLIC TO ADDRESS THE COMMITTEE CONCERNING THE ITEM BEFORE ACTION IS TAKEN. STAFF RECOMMENDATION SHOWN IN CAPS 1 / 62

2 Agenda Page 2 Finance Committee Meeting 8/8/2014 Kern Health Systems PUBLIC PRESENTATIONS 1) This portion of the meeting is reserved for persons to address the Committee on any matter not on this agenda but under the jurisdiction of the Committee. Committee members may respond briefly to statements made or questions posed. They may ask a question for clarification, make a referral to staff for factual information or request staff to report back to the Committee at a later meeting. Also, the Committee may take action to direct the staff to place a matter of business on a future agenda. SPEAKERS ARE LIMITED TO TWO MINUTES. PLEASE STATE AND SPELL YOUR NAME BEFORE MAKING YOUR PRESENTATION. THANK YOU! COMMITTEE MEMBER ANNOUNCEMENTS OR REPORTS 2) On their own initiative, Committee members may make an announcement or a report on their own activities. They may ask a question for clarification, make a referral to staff or take action to have staff place a matter of business on a future agenda (Government Code Section (a)(2)) CA-3) Minutes for KHS Finance Committee meeting on July 11, APPROVE 4) Presentations by the accounting firms Brown Armstrong; Daniells Phillips Vaughan & Bock; and Mayer Hoffman McCann to perform financial audit services for calendar years (Fiscal Impact: None) RECEIVE AND FILE; REFER TO KHS BOARD OF DIRECTORS 5) Proposed renewal and binding of employee benefit plans for medical, dental, life insurance, long-term disability, accidental death and dismemberment, long-term care, and short-term disability effective September 1, 2014 (Fiscal Impact: $3,389,211 Estimated; Budgeted) APPROVE; REFER TO KHS BOARD OF DIRECTORS 6) Proposed Amendment to Agreement with Velocity Partners, to provide remote technical resources to augment the KHS technology staff to complete the 2014 regulatory and medical management projects from August 14, 2014 through December 31, 2014, in an amount not to exceed $77,520 (Fiscal Impact: $77,520; Budgeted) APPROVE; REFER TO KHS BOARD OF DIRECTORS 7) Proposed Agreement with Coffey Communications, for development, printing, postage and mailing of quarterly member newsletters in English and Spanish from August 14, 2014 through August 14, 2016, in an amount not to exceed $213,466 (Fiscal Impact: $213,466; Budgeted) APPROVE; REFER TO KHS BOARD OF DIRECTORS 2 / 62

3 Agenda Page 3 Finance Committee Meeting 8/8/2014 Kern Health Systems 8) Proposed Agreement with Nurse Response, Inc. dba NurseWise, to provide 24/7/365 Phone Nurse Triage Services from November 1, 2014 through October 31, 2016 (Fiscal Impact: $Amount not to exceed $0.17 pmpm (Per Member Per Month); Budgeted) APPROVE; REFER TO KHS BOARD OF DIRECTORS 9) Report on Kern Health Systems and Kern Health Systems Group Health Plan financial statements for June 2014 (Fiscal Impact: None) RECEIVE AND FILE; REFER TO KHS BOARD OF DIRECTORS 10) Report on Accounts Payable Vendor Report and non-claims paid through MHC system for June 2014 (Fiscal Impact: None) RECEIVE AND FILE; REFER TO KHS BOARD OF DIRECTORS ADJOURN TO FRIDAY, SEPTEMBER 5, 2014 AT 8:30 A.M. AMERICANS WITH DISABILITIES ACT (Government Code Section ) The meeting facilities at Kern Health Systems are accessible to persons with disabilities. Disabled individuals who need special assistance to attend or participate in a meeting of the KHS Finance Committee may request assistance at the Kern Health Systems office, 9700 Stockdale Highway, Bakersfield, California, or by calling (661) Every effort will be made to reasonably accommodate individuals with disabilities by making meeting material available in alternative formats. Requests for assistance should be made five (5) working days in advance of a meeting whenever possible. 3 / 62

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5 SUMMARY OF PROCEEDINGS FINANCE COMMITTEE MEETING KERN HEALTH SYSTEMS 9700 Stockdale Highway 1st Floor Board Room Bakersfield, California Friday, July 11, :30 A.M. COMMITTEE RECONVENED Members present: Deats, Casas, McGlew, Rhoades, Sidhu (arrived at 8:34 a.m.) NOTE: The vote is displayed in bold below each item. For example, Rhoades-Deats denotes Director Rhoades made the motion and Director Deats seconds the motion. CONSENT AGENDA/OPPORTUNITY FOR PUBLIC COMMENT: ALL ITEMS LISTED WITH A CA WERE CONSIDERED TO BE ROUTINE AND APPROVED BY ONE MOTION. COMMITTEE ACTION SHOWN IN CAPS PUBLIC PRESENTATIONS 1) This portion of the meeting is reserved for persons to address the Committee on any matter not on this agenda but under the jurisdiction of the Committee. Committee members may respond briefly to statements made or questions posed. They may ask a question for clarification, make a referral to staff for factual information or request staff to report back to the Committee at a later meeting. Also, the Committee may take action to direct the staff to place a matter of business on a future agenda. SPEAKERS ARE LIMITED TO TWO MINUTES. PLEASE STATE AND SPELL YOUR NAME BEFORE MAKING YOUR PRESENTATION. THANK YOU! NO ONE HEARD COMMITTEE MEMBER ANNOUNCEMENTS OR REPORTS 2) On their own initiative, Committee members may make an announcement or a report on their own activities. They may ask a question for clarification, make a referral to staff or take action to have staff place a matter of business on a future agenda (Government Code Section (a)(2)) 5 / 62

6 SUMMARY Page 2 Finance Committee Meeting 7/11/2014 Kern Health Systems DIRECTOR RHOADES COMMENTED ON AN ARTICLE THAT WAS PUBLISHED IN THE BAKERSFIELD CALIFORNIAN ON JULY 1, 2014 REGARDING AB 2546; THE ARTICLE WAS WRITTEN BY TONY BORROMEO, RETIRED FORMER CFO OF KERN HEALTH SYSTEMS; DIRECTOR RHOADES STATED THE ARTICLE WAS ON TARGET NOTE: DIRECTOR CASAS LEFT THE DAIS AT 8:31 A.M. AND WAS NOT PRESENT WHEN THE VOTE WAS TAKEN ON THE CONSENT AGENDA NOTE: DIRECTOR SIDHU ARRIVED AT 8:34 A.M. AND WAS NOT PRESENT WHEN THE VOTE WAS TAKEN ON THE CONSENT AGENDA CA-3) Minutes for KHS Finance Committee meeting on June 6, APPROVED Rhoades-Smith: 3 Ayes; 2 Absent Casas Sidhu 4) Proposed Agreement with DST John Hopkins Adjusted Clinical Group (ACG) System, to provide the John Hopkins ACG predictive modeler software and technical support to Kern Health Systems, from July 17, 2014 through July 17, 2017, in an amount not to exceed $246,240 (Year 1: $74,240; Year 2: 86,000; Year 3: $86,000 (Fiscal Impact: $246,240; Budgeted) APPROVED; REFERRED TO KHS BOARD OF DIRECTORS McGlew-Sidhu: 4 Ayes; 1 Absent - Casas 5) Proposed membership renewal with Local Health Plans of California for the period July 1, 2014 through June 30, 2015, in an amount not to exceed $70,000 (Fiscal Impact: $70,000; Budgeted) APPROVED; REFERRED TO KHS BOARD OF DIRECTORS Rhoades-Sidhu: 4 Ayes; 1 Absent - Casas 6) Request to expand the role of Walter Mortensen to assist with the KHS Employee Medical Insurance Renewal for the period September 1, 2014 through August 31, 2015 (Fiscal Impact: None) APPROVED; REFERRED TO KHS BOARD OF DIRECTORS Rhoades-McGlew: 4 Ayes; 1 Absent - Casas 7) Report on Kern Health Systems and Kern Health Systems Group Health Plan financial statements for May 2014 (Fiscal Impact: None) RECEIVED AND FILED; REFERRED TO KHS BOARD OF DIRECTORS Rhoades-Sidhu: 4 Ayes; 1 Absent - Casas Request to reschedule the August 1, 2014 Finance Committee Meeting to August 8, APPROVED McGlew-Rhoades: 4 Ayes; 1 Absent - Casas 6 / 62

7 SUMMARY Page 3 Finance Committee Meeting 7/11/2014 Kern Health Systems 8) Report on Accounts Payable Vendor Report and non-claims paid through MHC system for May 2014 (Fiscal Impact: None) RECEIVED AND FILED; REFER TO KHS BOARD OF DIRECTORS Sidhu-McGlew: 4 Ayes; 1 Absent - Casas 9) Report on Emergency Room Diversion Grant Program A) Review of Grant Request from Riverwalk Pediatric Clinic for the Emergency Room Diversion Program (Fiscal Impact: $82,000; Not Budgeted) HASMUKH C. AMIN, M.D., HEARD; APPROVED; REFERRED TO KHS BOARD OF DIRECTORS McGlew-Rhoades: 4 Ayes; 1 Absent - Casas B) Review of Grant Request from Arvin Medical Clinic for the Emergency Room Diversion Program (Fiscal Impact: $128,245; Not Budgeted) IF THE BUDGET ALLOWS, INSTRUCTED STAFF TO INCLUDE AN ADDITIONAL $29,487; APPROVED; REFERRED TO KHS BOARD OF DIRECTORS Sidhu-McGlew: 3 Ayes; 1 Noe Rhoades; 1 Absent - Casas C) Review of Grant Request from Kern Medical Center for the Emergency Room Diversion Program (Fiscal Impact: $1,518,000; Not Budgeted) JAYCEY COOPER, KERN MEDICAL CENTER, HEARD; APPROVED; REFERRED TO KHS BOARD OF DIRECTORS Rhoades-Sidhu: 4 Ayes; 1 Absent - Casas D) Review of Grant Request from Clinica Sierra Vista for the Emergency Room Diversion Program (Fiscal Impact: $1,911,000; Not Budgeted) STEVE SCHILLING AND PRITIKA RAM, CLINICA SIERRA VISTA, HEARD; JAYCEE COOPER, KERN MEDICAL CENTER, HEARD; APPROVED; REFERRED TO KHS BOARD OF DIRECTORS Rhoades-Sidhu: 4 Ayes; 1 Absent - Casas ADJOURN TO FRIDAY, AUGUST 8, 2014 AT 8:30 A.M. 7 / 62

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9 To: KHS Finance Committee From: Robert Landis, CFO Date: August 8, 2014 Re: Proposals to Provide Financial Audit Services Background In June 2014, Kern Health Systems ( KHS ) issued a Request for Proposal ( RFP ) to provide Financial Audit Services. Brown Armstrong has been the external auditors for KHS for the past three years. Discussion KHS received proposals to provide financial audit services for the calendar years ending December 31, 2014; December 31, 2015; and December 31, 2016 from the following accounting firms: 1) Brown Armstrong 2) Daniells Phillips Vaughan & Bock 3) Mayer Hoffman McCann. All three accounting firms have been invited to make presentations and to answer questions at this month s Finance Committee meeting. I have attached a Bid Matrix listing the proposed annual costs to perform the financial audit by each firm. Requested Action Recommend accounting firm to provide financial audit services for calendar years to the KHS Board of Directors. 9 / 62

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11 TO: Kern Health Systems Finance Committee FROM: Robert Landis, Chief Financial Officer Date: August 8, 2014 SUBJECT: Employee Benefits Renewal Background Kern Health Systems ( KHS ) annually reviews and evaluates the employee benefit package. During the evaluation period factors taken into consideration are the improvements of benefits, cost of premium, feasibility of continuation of current plan(s), comprehensive administrative services provided by the carrier(s), plan documents, summary plan descriptions and the employee communication process i.e. clearly written program material including comprehensive summary of benefits, etc. In 2013 KHS made material changes to its employee benefits with the mandated share of cost provisions initiated for employee health benefits and the retirement plan. For 2014 management is proposing retaining all existing benefit plans and adding one new benefit plan. Proposal Existing Benefit Plans: Maintain current Life Insurance, Long Term Disability, and Accidental Death and Dismemberment plans with Lincoln. These policies had no change in premium. The current monthly premium based on current staffing levels is $4, or $55, annually. Maintain current Dental Insurance with Lincoln. Renewal increase was 5%. Based on current staffing levels, the monthly premium will be $22, or $271, annually. Maintain current Long-term Care Policy with Unum. This policy had no change in premium. The current monthly premium based on current staffing levels is $1, or $20, annually. 11 / 62

12 Maintain current Employee Medical Insurance with Kaiser Permanente. KHS will continue to offer two Kaiser health plans. KHS will continue to pay 100% of the lower cost plan. Employees electing the higher cost plan will continue to pay the difference between the two plans. For the 2014 renewal period, KHS retained Walter Mortensen ( WM ) to assist with the Kaiser renewal. WM was able to lower the rate increase from 12.87% to 9.50%. Based on current staffing levels, the monthly premium will be $252, or $3,024, annually. New Benefit Plan: Add Short-term Disability Insurance plan with Lincoln. Benefit will pay 60% of an employee s weekly income ($2,500 weekly income maximum) beginning after a 7 day waiting period. There is maximum benefit duration of 13 weeks. Based on current staffing levels, the monthly premium would be $1, or $17, annually. Requested Action Approval of the renewal and binding of employee benefit plans for medical, dental, life insurance, long-term disability, accidental death and dismemberment, long-term care, and shortterm disability and refer to KHS Board of Directors. 12 / 62

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31 To: KHS Finance Committee From: Robert Landis, CFO Date: August 8, 2014 Re: June 2014 Financial Results The June results reflect a $394,000 loss which is a $404,000 unfavorable variance to the budget. Listed below are the major variances for the month: 1) Total Revenues reflect a $1.4 million unfavorable variance primarily due to: A) $2.2 million unfavorable variance due to slower than anticipated Expansion membership enrollment. There is an unfavorable enrollment variance of 3,479 for the Expansion Membership. B) $.4 million favorable variance relating to higher than expected Family and Other enrollment. C) $.4 million favorable variance relating to higher than expected SPD enrollment. 2) Total Medical Costs reflect a $.8 million favorable variance primarily due to: A) $1.8 million favorable variance in in overall medical costs due to lower than expected Expansion membership mentioned in 1 A) above. B) $.5 million favorable variance for Other Professional Services due primarily to lower than expected mental health utilization. C) $.2 million unfavorable variance in Emergency Room due to higher than expected usage. Our emergency room diversion program will help reduce the over utilization on a going forward basis. D) $.7 million unfavorable variance in Other Medical due primarily due to greater usage of observation rooms. E) $1.7 million unfavorable variance for Expansion Risk Expense due to lower than expected medical expense utilization for the Expansion membership population. F) $1.2 million favorable IBNR adjustment from the prior year. The results for the 6 months ended June, 2014 reflect a net loss of $2.2 million. This is a $.4 million favorable variance to budget and includes approximately $ 2.6 million of favorable adjustments from the prior year. The Medical Loss Ratio is 94.4% which is equal to the budgeted amount. The Administrative Expense Ratio is 7.1% which is favorable to the 7.2% budgeted amount. 31 / 62

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