Dear Providers,

Welcome to 2010!  In 1966, President Kennedy quoted an ancient Chinese curse “May he live in interesting times.” The quote was not Chinese, and probably not ancient, but it is as timely now as it was then. “Like it or not, we live in interesting times...”

New Year’s Resolutions

• Universal coverage for all San Franciscans: we are proud of our work to help save Healthy Families last year, and to support access for adults, as third party administrator of Healthy San Francisco. In the new year, we will continue to advocate for the survival of Healthy Families and Healthy Kids, despite budget challenges. We will continue improving service for Healthy San Francisco participants (49,107 participants as of mid December 2009).  
  
• Quality and Access. We will continue to partner with providers to help patients get the care they need, when they need it. We will be starting new pilots exploring how practice coaching can impact the patient experience of care. We continue our excellent track record in Quality, winning the Medi-Cal Gold Medal among California Health Plans for the second year in a row. We are also (for the second year) the BEST Medicaid plan in the nation for childhood immunizations. And we have seen significant improvements in LDL and A1c testing with our Healthy San Francisco Strength in Numbers program.
  
• Exemplary Service. Every year, we measure ourselves to see how we perform in terms of customer service to patients and providers.  In the last two years, this is how we scored (in terms of % satisfied with their interaction with SFHP)

• 71% of Medi-Cal (adult) 2007
• 90% of Medi-Cal (child) 2007
• 85% of Healthy Families 2007
• 97% of Healthy Kids 2009
• 90% of Healthy Workers 2009
• 86% of HSF participants 2009
• 66% of providers are “in general, satisfied with SFHP” (22% neutral, and 12% dissatisfied)

Every year, we will aim to improve. In particular, we have worked hard this year to improve our services to providers. We will report on the results of our 2009 provider satisfaction survey in our next newsletter.

• Financial viability of the plan and the safety net. Last year, we distributed two million dollars in provider bonuses while maintaining the 10% rate increase that we gave in 2008. Additionally, we are providing a guaranteed bonus of 6.5% to our Medi-Cal providers from October, 2009 to September, 2010. We brought in grant funding to support chronic disease care in Healthy San Francisco (“Strength in Numbers”) and provider networking and education (Sharing/Learning/Improving/Measuring – SLIM Network). We also secured funding to support our patient experience pilots. We will continue to seek out ways to financially support improvement and innovation in the safety net.

Provider Dinner

Please check out the pictures of our celebration honoring our innovative provider community and the list of awardees in our "2009 Provider Recognition Dinner and Awards Ceremony" article. We were delighted with a large turnout this year, despite bridge closures, H1N1 vaccine campaigns, and heavy workloads.    

Staff Updates

We have a new team of leaders at San Francisco Health Plan: 

• John Gregoire, Chief Financial Officer
• Sunny Cooper, Chief Information Officer
• Deena Louie, Operations Officer
• Tammy Fisher, Director of Quality and Performance Improvement (will be leading our new pilots on Improving Patient Experience)
• Kimberly Higgins Mays, Director of Clinical Informatics (will be working to improve our data management and reporting)

HEDIS Updates

In 2010, the health plan will be judged on how well we score on new quality measures:

• Pediatric BMI measurement, and counseling on nutrition and exercise
• Pediatric immunizations: flu, Hepatitis A, and Rotavirus
• Low back pain – evidence of imaging
• Comprehensive Diabetes Care BP Control

The following measures are no longer in place:

• Chlamydia screening
• Well-Child visits in the first 15 months of life

Right now, the better our scores, the more members we attract through the auto-assignment process for members who do not select a health plan. San Francisco Health Plan received a 71% auto assignment rate compared to Anthem Blue Cross’ 29% rate. This means that San Francisco Health Plan will automatically receive 71% of Medi-Cal enrollees that do not choose a health plan for themselves. Typically, about 30% of enrollees do not select a plan within 30 days of enrollment. In the future, our rates may depend on our scores, according to recent conversations at the State. These new measures will be a challenge, despite our excellent track record in Quality. We urge our provider network to help us continue our reputation for excellence by documenting BMI percentile measurement, as well as documenting counseling for nutrition and exercise at least once a year. And we will continue our efforts to incentivize our families to complete their vaccinations through our gift card program.

Once again, SFHP thanks you for being a part of the San Francisco safety net, and happy New Year!