Clinical Advisory Panel

The purpose of the Clinical Advisory Panel is to engage providers in the PrimaryHealth service area to build networks that enhance the Triple Aim goals of:

  • Better experience of care
  • Better population health and outcomes
  • Reduced costs

Clinical Advisory Panel Roster

Andy Luther – Grants Pass Clinic/PrimaryHeatlh, Family Practice
Belle Shepherd – OHA, Innovator Agent, Invited Guest
Brandi Fields – Siskiyou Community Health Center, Director of Operations
Dan McDonnell – SCHC Behavioral Health, Psychiatric Nurse Practitioner
Dawn Cogliser – Options Hillside, Nurse Practitioner
Diane Hoover – Josephine County Public Health, Community Program Manager
Faith Tuttle – Grants Pass Clinic, Medical Home Coordinator
Jennifer Johnstun – PrimaryHealth, Health Strategy Officer
Kathie Young – Senior and Disability Services, District Manager
Kevin Molteni – Grants Pass Clinic, Pediatrician
Kristin Miller – SCHC, Medical Director
Lisa Redfern – Women’s Health Center, Executive Director
Liz Bardon – PrimaryHealth, Director of Medicare Programs
Jon Ireland, MSN, RN – Asante Three Rivers Medical Center, Manager, Resource
Michelle Belcher – Grants Pass Pharmacy, Pharmacist
Rich Booth – Chief Operations Officer, Siskiyou Community Health Center
Rick Jones – Choices, Executive Director
Shelly Uhrig – Options, Chief Operations Officer
Tamara Falls – Advantage Dental, Resource Manager/Community Liaison
Amanda Singh Bans – SoHealth-E, Health Care Coalition of Southern Oregon, MA Equity Coordinator

Clinic Advisory Panel Charter

PrimaryHealth Clinical Advisory Panel (CAP). The CAP is authorized and sponsored by the PrimaryHealth Governance Board.

I. PURPOSE OF CLINICAL ADVISORY PANEL

The Clinical Advisory Panel is created for the purpose of engaging providers in the PrimaryHealth service area to build networks that enhance the Triple Aim-better experience of care, better population health and outcomes, and reduced costs.

The CAP provides oversight and direction of the clinical initiatives driving care transformation and their associated metrics.

II. OVERALL ROLES AND RESPONSIBILITIES

  • Assuring evidence based best practices and/or community standards are adopted and utilized by the CCO.
  • Analyzing utilization patterns, data and metrics, including identification of patterns. When opportunities to
    improve clinical outcomes are noted, the CAP will be responsible for creating strategies to address deficiencies and setting targets for ongoing performance.
  • Evaluate coordination and integration of services within the provider network, including transitions of care. When opportunities are identified, the CAP will work on strategies to enhance coordination and integration, and optimal transition.
  • Evaluation and monitoring of Performance Improvement Projects (PIPs)
  • Monitoring the expansion and development of Patient Centered Primary Care Homes in the PrimaryHealth
    network.
  • Evaluation of case management and disease management programs provided by the CCO.
  • Oversight of a portion of the CCO’s Annual Work Plan
  • Provide oversight of the CCO’s Quality Improvement Plan Effectiveness.

III. PROCEDURAL RULES

a. Meetings

During the initial transformative stage of the CCO, the CAP will meet at an increased frequency. In time, CAP meetings will become less frequent. Meetings will occur over lunch and generally be 1.5 hours.

CCO Face-to face meeting frequency will be as follows:

  • 2013-2014 Every other month
  • 2015 and beyond-Quarterly

b. Minutes

Minutes of each meeting will be kept. The minutes of the meetings shall be reviewed and approved at the next regular CAP meeting and shared with the PH Governance Board, CCO administrators, and other committees as necessary.

c. Dismissal

Members who are absent without reasonable cause from three successive meetings will be considered to have
resigned their seat. The CAP will move to fill the position.

d. Confidentiality

CAP members should be aware of Primary Health’s need for consumer confidentiality and discretion related to CCO Specific business. Members shall not report opinions expressed in meetings outside the committee.

e. Decision making

The majority of members of the CAP will constitute a quorum. Consensus decision making processes will be used as much as possible. At the request of any CAP member a of show of hands vote can be requested.

f. Conflict of interest

It is recognized that CAP members and the organizations they represent may be personally, professionally, and
financially impacted by the decision of the CAP. Transparency in sharing potential conflicts of interest is essential to ensure the integrity of the Panel’s decision making. CAP members are required to disclose any potential conflicts of interest by completing a conflict of interest declaration form, submitting it to the CCO staff and updating as necessary.

g. Subcommittees

The CAP will charter subcommittees or project teams as needed.

IV. ORGANIZATIONAL STRUCTURE

The CAP is an advisory panel of the PrimaryHealth Governance Board and is sponsored by PrimaryHealth. Initial
members of the CAP will be appointed by the Governance Board. When positions on the CAP are vacated, the CAP will recommend to the Board individuals to fill vacancies. The Board shall give final approval for all CAP positions. This is a standing and ongoing panel. At least one member of the Governance Board shall also serve on the CAP. The CAP is one of four sub-committees of the Board. The other three other advisory panels that include the:

  • Community Advisory Council (CAC): Comprised of at least 51% consumer members along with community representatives. The CAC will advise the CCO on issues such as member satisfaction, member engagement, and community health assessments. At least one member of the CAC shall also serve on the CAP.
  • Quality and Compliance Committee (QCC): Oversight of Appeals, the Grievance System, Flexible Services, and compliance with OARs, CFRs, and contract. At least one member of the QCC shall serve concurrently on the CAP.
  • Pharmacy and Therapeutics Sub-Committee (P&T): Oversight of the CCO pharmacy program and evidence based guidelines adopted and used by the health plan. Comprised of clinicians from both the QCC and CAP.

The PrimaryHealth CAP will provide CCO oversight as specified in section II above and will report regularly to the PrimaryHealth Governance Board.

V. MEMBERS

a. Composition

The CAP shall be comprised of a representative cross-section of the medical community. Total membership is not
explicitly capped, however, it is recommended that membership not exceed 20 participants.

Representatives may include agencies such as:

  • Primary Care Providers (Pediatricians, FP or IM)
  • CCO Administration
  • Skilled Nursing Facilities
  • Hospice
  • Home Health
  • Women’s Healthcare Providers
  • Hospital
  • Emergency Department
  • FQHC
  • Dental
  • CMHP (crisis services, residential, clinical)
  • Community Pharmacy
  • Public Health
  • Chemical Dependency
  • AAA/APD

The CAP shall be staffed with appropriate management and analytic services representation. At the discretion of the Chair, representatives of any participant may attend CAP meetings as observers. The CAP may extend temporary membership to individuals who bring particular expertise needed for their work.

b. Term

There is no specified term of membership.

c. Chair and Vice Chair

The initial chair will be assigned by the CCO Board. The vice chair will be elected by the Clinical Advisory Panel. Both the CAP chair and vice chair will hold positions for a two year term. Following the initial term, the CAP will assume the responsibility of electing the chair and vice chair. The current chair and vice chair may be nominated for reappointment by the CAP at the end of term for an additional term.

VI. REPORTS

Committee recommendations and reports requiring Board level oversight will be submitted in writing to the PrimaryHealth Governance Board. Documents will reflect both suggested action and justification for suggestions. The board will respond to such recommendations/reports in minutes.

VII. ANNUAL GOALS

The CAP will provide an annual report to the Governance Board. This shall include a summary of projects and actions. It shall also include current goals, and evaluation of previous goals set by the CAP.

VIII. DATE CHARTERED

March 15, 2013