Delannia Caldwell

The committee discussed the CEO update regarding financial performance and quality measures, as well as state budget and policy implications. The Cultural and Linguistic Services annual review, along with a detailed grievance and appeals report for 2025, were presented for input. Additionally, the committee reviewed the Alameda County Community Health Assessment findings, discussed a new initiative for non-specialty mental health services, and planned for future community outreach and engagement through the Community Conversations initiative.

This document, released on the occasion of Alameda Alliance for Health's 30th anniversary, outlines its historical impact and future commitment to providing comprehensive, high-quality, and accessible healthcare services. The Alliance has expanded services from its founding in 1996 to serve over 400,000 members across Medi-Cal, Medicare, and dual-eligible plans. It emphasizes enhancing access to care beyond traditional medical services, focusing on addressing social determinants of health such as mental health, substance use, housing, and food insecurity through community partnerships and innovative programs like Recipe4Health. The overarching goal is to reduce health disparities and build healthier, stronger communities in Alameda County.

The board packet for the February 13, 2026 meeting included several reports, notably the CEO Report and Finance Report, both reflecting activity through December 2025. Key discussion points included financial performance, showing a Net Income of $968,000 for December and reserves at 238% of the required Tangible Net Equity minimum. The CEO Report highlighted the successful launch of the Medicare D-SNP product on January 1, 2026. Regulatory metrics indicated challenges, with missed processing timelines for claims (87% compliance vs. 90% target) and member grievances (89% compliance vs. 95% target). Legislative tracking focused heavily on federal and state impacts of H.R. 1 on the Medi-Cal program, including updates on eligibility redeterminations and upcoming work requirements. The Finance Report detailed enrollment decreases, favorable variance in Premium Revenue, and analysis of Medical Loss Ratio (95.4% for the month) and Administrative Expenses, which ran favorably to budget.

The Quality Improvement Health Equity/Utilization Management Committee meeting agenda covered multiple key operational and clinical oversight areas. Discussions included updates on the combined QIHEC/UMC structure, introduction of new members, and presentation of DMHC audit findings. Significant time was dedicated to the review of the QIHEC/UMC Charter and the Annual Confidentiality Statement, as well as the review of numerous Policies and Procedures related to Quality Improvement, Utilization Management, and Complex Case Management, many of which saw revisions or annual review. Other topics included a DSNP Update, a Utilization Management Workplan Update detailing metrics like Paid Days, Average Length of Stay, and Denial Rates for inpatient and outpatient services, and a presentation on the Alameda County Community Needs Assessment findings, identifying key health needs such as chronic diseases, behavioral health, and social determinants of health. Furthermore, updates were provided on the Medi-Cal/Group Care Pay-for-Performance Program measures, Medicare Star Rating progress, results from the Initial Health Appointment and Preventive Screenings Chart Review (noting deficits in risk assessment documentation and outreach attempts), and the PQI Dashboard, which detailed Potential Quality of Care Issues from 2025.

The committee meeting covered several key areas across multiple linked meetings. Discussions included the status of NCQA Health Equity Accreditation, where both lines of business achieved accreditation, and progress on addressing a finding in grievances and appeals for health plan accreditation. Updates were provided on DHCS quality sanctions, specifically regarding asthma remediation, blood pressure control, and topical fluoride, with contestation pending for the latter. A major topic was the planned merger of the Quality Improvement Health Equity Committee (QIHEC) and the Utilization Management Committee (UMC) in preparation for Dual Eligible Special Needs Plan (DSNP) implementation effective January 1, 2026. The committee also reviewed updates from the DHCS Quality Conference, focusing on children's preventive health and maternal health equity. Furthermore, the Health Equity Roadmap milestones were reviewed, and an extensive packet of Policies & Procedures, including numerous quality improvement and DSNP-related documents, was presented for review. Utilization Management metrics were detailed, covering ED utilization, acute admissions, denial rates, and the critical issue of readmission rates remaining above the 18% goal. Updates on the DSNP overview highlighted its structure as an exclusively aligned HMO for Alameda County dual-eligible members. Finally, results from the CAHP survey on access to care, indicating mixed results for appointment scheduling, and the Language Access and Interpreter Services survey were presented and discussed.