Position Specification

Chief Operating Officer

French Camp, California

CONFIDENTIAL

Prepared by

Elaina Genser May 30, 2014 This Position Specification is intended to provide information about Health Plan of San Joaquin and the position of Chief Operating Officer. It is designed to assist qualified individuals in assessing their interest.

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The Organization

Operating since February 1996, Health Plan of San Joaquin (HPSJ) is a publicly-sponsored, not-for-profit, managed care health plan. Licensed as a Health Maintenance Organization (HMO) under the State of California Knox-Keene Act, HPSJ contracts with the State Department of Health Care Services for care of persons on Medi-Cal (California’s Medicaid program) in San Joaquin and Stanislaus Counties. HPSJ’s current HMO Knox-Keene licensure includes the counties of San Joaquin, Stanislaus, Merced, and Sacramento.

Background

In March 1993, the California Department of Health Care Services (DHCS) introduced its Expanding Medi-Cal Managed Care – Protecting Vulnerable Populations plan (the “Two-Plan Model”). HPSJ was one of the plans developed by 12 counties in the state targeted to participate in the Two-Plan Model. Under this program, two HMO plans operate in each of the selected counties. HPSJ operates as the community-based entity, a local health initiative; the other is operated as a private HMO selected by DHCS through

competitive bid and serves as the commercial plan. The two plans are directly administered by DHCS and must comply with the same contract requirements. HealthNet serves as the alternative plan in both counties.

Today, HPSJ serves approximately 235,000 members in San Joaquin and Stanislaus Counties. The provider network includes over 500 primary care physicians, 3,000 specialists and ancillary providers, most acute care hospitals and area clinics, and several referral centers in San Francisco and Sacramento for specialized care.

HPSJ’s primary focus is on improving the health and well-being of those they serve. Because of this commitment, HPSJ has experienced the lowest member disenrollment rate of all the state’s local initiatives. Moreover, the organization maintains a low turnover rate and high commitment to its mission, highlighted by its objective to be an employer of choice in the region.

The organization provides community support and reinvestment in the form of full-time grants administration for HPSJ and community health partners with over $16.5 million brought into the service area since 2001. Community Health support is provided to various area agencies such as school health projects, the Salvation Army, Catholic Charities, and the like. Reinvestment in programs to serve vulnerable populations, such as the Children’s Health Initiative, is ongoing.

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Purpose and Mission

The mission and purpose of HPSJ is to provide high quality, culturally-sensitive, linguistically-appropriate health care services to Medi-Cal recipients and the underserved in conjunction with community providers and in partnership with public/private providers and open-door safety-net providers. Their vision and mission statement are:

Continuously improve the health of our community. We provide healthcare value and advance wellness through community partnerships.

Foundational values include: accountability, dedication, diversity, integrity, stewardship, and team work.

Governance

HPSJ is governed by an 11-member San Joaquin County Health Commission, formed and appointed by the San Joaquin County Board of Supervisors. The board is comprised of two county supervisors, the director of county health care services, the County Administrative Officer, four physicians, two community representatives, and one representative of the Hospital Council of Northern and Central California that oversee policies and programs that reflect the diverse health care needs of the community. Members, except ex-officio members, are appointed to three-year terms. As a public entity, HPSJ Health Commission meetings are open to the public at large as required by the Open Meeting Laws of the Brown Act. HPSJ welcomes, encourages and receives wide public input. The organization type and governance of HPSJ promotes the efficiencies of a business, while maintaining an openness and accountability to the community. Board members: HPSJ Board Members. County Board of Supervisors: San Joaquin County Board of Supervisors.

Programs and Services

HPSJ offers two products to serve its members including:

Medi-Cal Managed Care (Over 230,000 members) – State and federally funded comprehensive health coverage for families and individuals that provides health, dental and vision coverage. Health Plan of San Joaquin has offered Medi-Cal Managed Care to members of San Joaquin County since 1996, and began serving Stanislaus County residents in 2013. HPSJ’s market share is approximately 95% San Joaquin County, and 65% in Stanislaus County.

San Joaquin Health Administrators (approximately 4,500 members) – Under its current non-HMO operations, HPSJ, dba San Joaquin Health Administrators, provides the function of a Third Party Administrator (TPA) to San Joaquin County for the county’s employee self-funded insurance program. It is responsible for claims payment, customer service and utilization management for the County’s program, serving county employees and

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dependents. The program received licensure from the California Department of Insurance in November 2002.

Operations

Since its inception, HPSJ has maintained a positive financial position and grown revenues each year with revenues of approximately $807 million in FY 2013-2014. HPSJ currently has total equity of $39 million. French Camp headquarters are located in a 40,000 square foot facility with additional office space in Modesto. FY 2014-2015 Budget Highlights:

Member Months 3,225,000

Revenue $807 million

Total Expenses (Medical, Labor, Non-Labor) $791 million

Net Income (including interest) $16,000,000

Medical Loss Ratio 94%

Administrative Loss Ratio 4.2%

Net Income Ratio 1.8%

As the health care delivery system in the state of California continues to evolve, HPSJ remains committed to the rich tradition and cultural diversity of members and to the provision of healthcare services to vulnerable populations. For additional information about Health Plan of San Joaquin, visit: HPSJ Web site

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Opportunity and Summary of Position

The Chief Operating Officer role is a key member of the executive leadership team and is designed to provide executive leadership, direction and administration of health plan. This individual will be responsible for provider contracting and network development, new product implementation and successful operationalization and must have great project management skills, ability to improve existing processes; evaluate how the areas managed are structured and the quality of the teams in place. HPSJ seeks a leader who embraces being involved in strategic issues of the organization, as well as day to day responsibilities, advancing performance management. HPSJ is also expecting the Chief Operating Officer will create open lines of communication internally and externally. Externally, the COO will assume a key leadership role and will be an active and visible participant in the context of provider contracting and relations. He/She must be a credible contributor and help build long lasting relationships with providers, partners and employers, as well as being a knowledgeable contributor and spokesperson in the community.

Working closely with the Chief Executive Officer and the leadership team, the Chief Operating Officer will be responsible for leading operations and maintaining accountability for ensuring that the ongoing operations of HPSJ are optimized and aligned to consistently deliver strategic and tactical business objectives, consistent with applicable regulations. This is an exciting time to join HPSJ as the plan is growing with additional Medi-Cal Expansion lives in San Joaquin and Stanislaus Counties, evaluating expansion into Medicare risk, applying for NCQA accreditation, implementing the new version of QNXT to accommodate ICD-10 implementation, and alpha testing in-home technologies to improve members’ care. The organization has historically embraced innovation and plans to do so in the future creating new lines of business consistent with HPSJ’s mission.

Reporting Relationships

The Chief Operating Officer reports to the Chief Executive Officer, Amy Shin. Reporting to the Chief Operating Officer are the Director, Customer Service, Director, Network Development & Contracting, and two Account Executives. See organizational chart attached.

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Goals and Objectives

To be considered successful in the role, the Chief Operating Officer will have achieved the following in the first 18 to 24 months:

Enhance Provider Relations and Contracting: Evaluate the current strategies for Provider Contracting and Provider Relations and create mutually beneficial outcomes to address provider relationships and needs. Explore new relationships such as fully delegated models, a range of reimbursement methodologies, performance incentive based contracts, strategically evaluating provider partnerships, etc. The goal is to have a fully developed strategy in place for provider contracts within a year.

Improve operational processes: Achieve maximum member and provider satisfaction and position the organization to increase volumes in the various product lines as demonstrated through the CAHPS and HEDIS scores and member and provider satisfaction surveys.

New Product Development and Oversee External Relationships: Working with the Vice President, External Affairs, work to successfully operationalize expansion of existing and new product lines based on profitability and return on investment. Fully engage in creation of new products to meet market demand. Oversee relationships with fully delegated providers (Kaiser) and partners in care (for mental health, vision and dental services).

Integrate Successfully into the Organization: Smoothly adapt to the organization and develop excellent working relationships and strong credibility with the CEO, Board, senior management team, managers and staff. Be viewed as an approachable, open, trustworthy, self-confident and effective leader who is inclusive and can effectively make change in a rapid fashion.

Establish Self as Operations Leader: While keeping the Chief Executive Officer apprised and involved as appropriate, oversee the day-to day operations of the areas managed including managing new product implementation, meeting financial and budget goals, monitoring productivity and leading special projects, implementing performance measures to meet member needs, and ensuring that productivity and service performance are being continuously improved as demonstrated by comparison to established industry benchmarks, historical data and regulatory agency compliance.

Lead the team: Be viewed as a respected, respectful, collaborative, team leader and excellent communicator who has the ability to coach, and inspire others to accomplish their goals efficiently and effectively. This will include bringing a business process improvement orientation to the work, removing inefficiencies from the work flow, effectively preparing the team for change, creating a more responsive, fast paced culture, assessing the existing team, mentoring and coaching those that need further development, filling existing vacancies with an eye towards succession planning, and making changes as necessary.

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Responsibilities

• Identifies, develops and oversees the implementation of network development and contracting strategies that ensure a robust provider network and financially sound and collaborative contractual terms.

• Identifies, develops and oversees the implementation of strategies that grow HPSJ’s TPA business.

• Identifies, develops and oversees the implementation of grant strategies that secure sufficient funding for HPSJ’s internal and external initiatives.

• Identifies and oversees the implementation of customer service strategies that support membership satisfaction, growth and provider network objectives.

• Oversees the development and management of department budgets.

• Oversees and provides direction to operational teams as they make decisions that affect day-to-day operations and the fulfillment of strategies and plans.

• Provides key content expertise for organization-wide initiatives.

• Manages relationships with external vendors and customers; monitors and evaluates performance. Oversees the identification, preparation and maintenance of appropriate and required data, records, reports and other documentation.

• Promotes, and ensures that direct reports promote, an environment that supports and encourages the adoption of HPSJ’s stated values.

• Represents HPSJ in a manner that promotes a positive image of HPSJ in the community; serves on internal and external committees and other leadership forums.

• Hires, develops and retains, and ensures that direct reports hire, supervise and retain a competent staff.

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Candidate Qualifications

Health Plan of San Joaquin is seeking a new COO with the following qualifications:

Education

Bachelor’s Degree in Business, Public Administration or similar required. Masters Degree in Business, Public Health or similar is preferred.

Experience/Knowledge/Skills

At least eight years progressively responsible leadership positions in healthcare insurance settings, ideally having experience with Medi-Cal managed care and/or other government sponsored programs.

Knowledge and understanding of the safety net and the health care issues of vulnerable (at risk and disadvantaged) populations is preferred. He/she would have demonstrated experience interfacing effectively with government officials, regulators and other public officials.

Leadership experience overseeing network development and contracting and provider services. Experience in customer service and TPA management would be ideal.

Demonstrated experience in change management, business process improvement and performance improvement processes. Able to work with a management team that is fast paced and expecting the same of the employees who must be further developed to respond to the fast evolving market.

A self starter who takes initiative, follows through, is an out of the box thinker and well networked in the managed care community.

Demonstrated leadership, vision, and strategic skills will be important. The individual must

have a proactive approach, strong negotiation skills, customer service orientation, exercise good judgment, be flexible yet accountable. Should also be an honest, trustworthy facilitator, and a fast learner.

Quantitative skills with an understanding of how to manage and measure performance by

metrics.

Resonates with the mission of HPSJ, yet is able to balance margin with mission effectively and ask the difficult questions. Demonstrated ability to articulate and embrace organizational values, integrate into management practices, and foster their manifestation among staff.

Leadership style that engenders the trust and confidence of employees, customers, regulators, providers and the business community. Demonstrates the ability to maintain a motivated and productive staff and inspire the confidence of the management team. Very strong collaboration skills, with demonstrated ability to create and foster a collaborative

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work environment, maintain effective, high performance teams, and organize people and resources to solve problems and identify business opportunities. Encourages training and employee education.

Ability to establish direction, build alliances, negotiate effectively, facilitate discussion and resolve conflict. Very strong interpersonal skills, with the ability to establish and maintain effective working relationships with diverse individuals at all levels inside and outside of HPSJ.

Very strong project management skills, with the ability to function as a sponsor and owner on complex projects; a track record of successful large project implementations.

Politically astute and demonstrates a high level of personal and professional integrity and honesty.

Experience leading in a diverse environment with strong diversity initiatives for its members/customers and staff is preferred.

Capable of identifying, planning, leading and executing appropriate and successful health care business strategies to meet changing organizational and community needs, and regulatory requirements.

Strong knowledge of health care core administrative systems, their strategic impact and integration with other health care functions.

Strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions and identify implications.

Strong skills in budget development and management.

Excellent oral and written communication skills, including the ability to communicate professionally, effectively and persuasively both orally and in writing to diverse individuals and groups inside and outside of HPSJ. Good presentation skills, with the ability to tailor presentations to a specific audience, and address and interact with large groups.

In-depth knowledge of state and federal regulatory guidelines as they relate to assigned areas of responsibility within a managed care environment.

Familiarity with political, business, education, non-profit and other community leaders in San Joaquin and Stanislaus Counties and/or surrounding areas would be ideal.

Demonstrated ability to articulate and embrace organizational values, integrate into management practices, and foster their manifestation among staff.

Strong customer service orientation.

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The Community

San Joaquin County, California French Camp is located in San Joaquin County (San Joaquin County information), part of the Central Valley of California, and one of the original counties of the state, formed in 1850. With a 2010 Census population of 685,306, this is a dynamic, multi-ethnic and multi-cultural community situated along the San Joaquin Delta waterway that connects to the San Francisco Bay and the Sacramento and San Joaquin Rivers. San Joaquin County is located 60 miles east of the San Francisco Bay Area, 83 miles east of San Francisco, and 45 miles south of Sacramento, the capital of California.

San Joaquin County offers an excellent quality of life for its residents with a number of beautiful residential communities along waterways, with single-family homes being highly affordable. San Joaquin County also has extensive recreational opportunities and is within close proximity to world famous scenic attractions including the California Coast, Napa Valley, San Francisco, Lake Tahoe and Yosemite National Park. The community offers many local recreational opportunities related to the Delta, which provides thousands of miles of waterways for water skiing, sailing and other water activities. There are also many opportunities to enjoy music, theater, dance, literary events, and other cultural and entertainment activities throughout the year. San Joaquin County is home to an array of learning institutions from preschool to higher education to private and vocational

schools. The University of the Pacific, California State University, Stanislaus, Humphreys College and School of Law, National University, and the San Joaquin Delta Community College provide a variety of choices for higher education. The county's 17 school districts offer families a number of outstanding school districts and educational options.

Incorporated cities and towns of San Joaquin County (based on 2010 US Census information):

City Population Size Web Site

Stockton 291,707 Stockton information

Tracy 82,922 Tracy information

Manteca 67,096 Manteca information

Lodi 62,134 Lodi information

Lathrop 18,023 Lathrop information

Ripon 14,297 Ripon information

Escalon 7,132 Escalon information

Unincorporated areas of the county, including French Camp, make-up the remaining population of nearly 142,000.

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Stockton

The City of Stockton, the county seat, is the 13th largest city in California. It is a large, culturally-diverse urban center that underwent a tremendous economic expansion at the end of the last decade, with aggressive revitalization of its downtown area. With the economic collapse in 2008, along with subsequent high unemployment and downturn of the housing market, Stockton filed a petition for Chapter 9 bankruptcy protection in June 2010. Under the reorganization plan, some city services were cut, but a restructuring of

debt should allow the City to reclaim their strong financial footing.

Lodi

Lodi is located in the northern part of the Central Valley and is best known for being the center of wine production and the "Zinfandel Capital of the World.” At the heart of the city, Mondavi Winery is considered one of the most influential in the American wine industry. With roots in agriculture and a diversified workforce, premium wine grape production is the engine that drives the economics of the Lodi-Woodbridge region. Lodi is home to many businesses from large manufacturers to small business ventures, has a local hospital, and is poised for further expansion in the high-tech area. Its central location and close proximity to major interstates connect the Bay Area and Sacramento/Capital region.

Tracy

Tracy is a growing San Joaquin Valley city strategically located near several major regional markets and attractions, and offers its own unique flavor, bringing together a “small-town” friendliness and progressive development. Tracy, with its roots in agriculture and the railroad, has placed itself among the leading Northern California cities. It’s a community with award-winning schools, an advanced hospital campus, diversified economy,

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well-maintained parks, rich culture, and fine neighborhoods. These advantages continue to be enhanced through the well-planned measures of the City of Tracy and area organizations. Notably, ongoing revitalization is in motion downtown, along I-205, and within several business and industrial parks in town.

Manteca

Manteca is 76 miles east of San Francisco and fashions itself the "Family City." It lies at a crossroads of major highways and railroads. The continuing rise in Bay Area housing prices has caused residents to look further eastward for affordable places to live, and hence, Manteca has become a popular choice for commuters. The population of Manteca continues to increase, with housing being constructed on what was once farmland to the north and southeast.

San Joaquin County is close to Sacramento and the East Bay of San Francisco, known as the Tri-Valley. For information on neighboring Tri-Valley communities such as Livermore and Pleasanton, visit: Livermore information Pleasanton information Tri-Valley information

Stanislaus County, California Stanislaus County is a neighboring, growing county with an overall population of 514,453 (per 2010 US Census) and nine incorporated cities. The county seat is Modesto (Modesto information), the 16th largest city in California with over 202,751 citizens. Modesto prides itself on quality of community life, educational opportunities and multi-cultural lifestyles with mild weather year-round and some of the world’s richest soil. It offers the diversity and facilities of a metropolitan city while maintaining an atmosphere of old-fashioned hospitality and small town charm. Modesto offers the full spectrum of arts and entertainment from talented local artists and resident companies to international touring stars. The city boasts family-friendly attractions, festivals, museums, agriculture tours and tastings to first-class hotels and four-star restaurants. In many ways, it is considered the culture hub of the Central Valley. For additional information about Stanislaus County, visit: Stanislaus County information.

Sacramento, California Sacramento is the capital of the State of California and the county seat of Sacramento County. Located in California’s expansive Central Valley, it is the seventh most populous city in California. Sacramento is located 90 miles northeast of San Francisco, 383 miles north of Los Angeles, and 100 miles southwest of Lake Tahoe. It is also the core cultural and economic engine of a four-county metropolitan area exceeding 2.1 million residents (El Dorado, Placer, Sacramento and Yolo counties). The Sacramento Metropolitan Area is the largest in the Central Valley and the fourth-largest in the state. Greater Sacramento has been cited as one of the five most livable regions in America. Sacramento County encompasses approximately 994 square miles in the middle of the 400-mile long Central Valley, which is California’s prime agricultural region. Sacramento is one of the Golden State’s fastest growing and most desirable places to live, work and raise a family. Several of the local school districts are recognized throughout California and the nation as a leader in progressive education. Housing prices are affordable

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with many fine homes available in the $350,000 range and above. Additional information about Sacramento can be obtained at: City of Sacramento information or Sacramento County information.

Procedure for Candidacy

Please direct all nominations, expressions of interest and résumés to executive search consultants supporting this search preferably via e-mail to: Elaina Spitaels Genser Witt/Kieffer 1900 Powell Street, Suite 840 Emeryville, CA 94608 Phone: 510/420.1370 Fax: 510/420.0363 Email: elainag@wittkieffer.com

Christopher Neumann or Michelle Lee Witt/Kieffer 2 Park Plaza, Suite 1140 Irvine, California 92614 Phone: 949/851.5070 Fax: 949/851.2412 Email: cneumann@wittkieffer.com

Health Plan of San Joaquin is an equal opportunity employer.

The material presented in this position specification should be relied on for informational purposes only. This material has been copied, compiled, or quoted in part from Health Plan of San Joaquin documents and personal interviews and is believed to be reliable. While every effort has been made to ensure the accuracy of this

information, the original source documents and factual situations govern.

Chief Executive Officer

Executive Assistant

Chief Information Officer

Chief Medical Officer

Chief Operating Officer

Chief Financial Officer

Compliance Officer

Vice President,

Human Resources Vice President, External

Affairs

Director, Application

Services

Manager, IT

Operations

Director,

IT Planning

Director, Project

Management

Medical Director

Director, Case &

Utilization

Management

Director, Quality &

Disease

Management

Director, Pharmacy

Director, Clinical

Programs

Controller

Assistant Controller

Director,

Customer Service

Director, Claims

Director, Network

Development &

Contracting

Director, Product

Development

Manager, Grants

Field Director

Director, Marketing

Manager,

Communications

Account Executive

(2)

Manager, Financial

Planning & Analysis

Privacy Officer

Executive Division 2014

Manager, Business

Intelligence

Manager,

Application

Development

Manager,

Configuration

Manager,

Provider Services

Manager, Claims

Manager,

Provider Contracts

Manager, Care and

Utilization

Management

Manager, Case

Management

Facilities

Coordinator

Manager, QM

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