Optimizing Child Health & The Quadruple Aim: A Partnership between an FQHC and

Children’s Hospital

Mona Patel, MD, FAAPACHD Annual MeetingSeptember 14, 2018

Framework for Discussion

I. Importance of Quadruple AimII. Partnership of an FQHC and a Children’s HospitalIII. Three innovative care models of care achieving quadruple aim

measuresIV. Moving from traditional FFS payment systems towards shared

savings modelsV. Investment in education, research, quality, advocacy and clinical

services to align with quadruple aim measures

2

I. Importance of Quadruple Aim

• Care Team Wellness as a prerequisite for Triple Aim = Quadruple Aim– 46% of practicing physicians report burnout1– Principal driver of provider satisfaction = ability to provide quality care2

• How can we move pediatric health care delivery systems towards achieving the Quadruple Aim?

3

Increasing provider

administrative workload

Provider Burnout

Decreased Patient

Satisfaction

Diminishing Health

Outcomes

Increased healthcare

cost

II. Partnership of an FQHC and a Children’s Hospital

• Children’s Hospital Los Angeles + University of Southern California (USC) Keck School of Medicine + CHLAMG

– Academic General Pediatrics and Subspecialty Clinical Care– Teaching Facility- Subspecialty fellowships, pediatric residency,

medical student education– Research infrastructure with Saban Research Institute, CTSI, USC

• AltaMed Health Services Corporation

– Largest Independent Federally Qualified Center in US– Serves population of >300,000 underserved, uninsured and primarily

Latino patients in Los Angeles and Orange County• 65,000 children served in Los Angeles by AltaMed• Mix of pediatricians, family practitioners and mid-level

providers providing pediatric care 46 community clinics in Los Angeles and Orange County

4

Phases of Relationship with CHLA and AltaMed

Phase I: CHLAMG Pediatricians

Consult in AltaMed

Community Clinics

Phase II: AltaMedCHLA General

Pediatrics Outpatient Clinic

Phase III: AltaCHLA IPA

Phase IV: AltaMed-

CHLAMG-CHLA Model of Care

5

1995 2005 2011 2017

Phase I: CHLAMG Pediatricians in the Community

• Phase I (1995-Present)

– Academic Pediatric care in FQHC clinics in East Los Angeles—started with 0.4 FTE

– 2017-18: 20 CHLA pediatricians providing 9.3 FTE pediatric primary care support in FQHC community sites

6

Phase II: Outpatient Clinic within a Children’s Hospital

• Phase II (2005-Present)– Establishment of General Pediatrics Outpatient Clinic at CHLA– >27k pediatric lives; 12% complex needs population– Clinical, Education, Advocacy and Research services in primary care– Expansion and integration of onsite specialty care– Enhancement of ancillary support services

7

Phase 2: AltaMed CHLA General Pediatrics Primary & Subspecialty Care Clinic

• Onsite Subspecialty care– Allergy & Immunology– Optometry– Developmental Behavioral

Pediatrics– Oral Health– Gastroenterology– Neurology– Orthopedics– Dermatology– Cardiology– Pulmonary– Genetics– Pediatric Dentistry

8

• AltaMed CHLA Clinic Hours: • 7 days per week access• 24/7 live person access to nurse/physician

triage for all patients

• Ancillary Support Programs:• Patient Centered Medical Home• Social Work• Psychology services• Childhood Obesity Group Classes/Lifestyle

Redesign & Nutrition Services• Newborn Services

• Lactation Services• Home Phototherapy Program• Circumcision Clinic• Prenatal Classes

• Incredible Years Parenting Group• Immunization Clinics

Phase 3: Delegated Risk Model with AltaCHLA IPA

9

• Phase III (2011-Present)– Blended Capitation model

(FFS + Carveouts)– Shared risk between FQHC

partner and Hospital medical group

• Risk Arrangement:– Professional fee: ED/IP– Non capitated labs– Subspecialty visits– Medications (until stop loss)– Non-CCS (Title V) program

Planning Planning Timeline

Multiple planning meetings between AltaMed, CHLA and CHLAMG leadership over previous 3-4 years with various consultant

groups involved

CHLA Enterprise Strategic Plan Refresh FY 2018-2020:

January 2017-June 2017

Strategic Plan #3: Optimize Care for Key Populations CHLA Board Approval: June 2, 2017

10

Multiple planning meetings between AltaMed, CHLA and CHLAMG leadership over previous 3-4 years with various consultant

groups involved

AltaMed Leadership Plan: Broaden CHLA and AltaMed

Partnership

AltaMed Pediatric Strategic Plan AltaMed Executive

Team Approval: June 12, 2017

Pediatric Services Joint Venture Agreement:

AltaMed, CHLAMG, CHLA

July 18, 2018

III. Three Innovative Models of Care Achieving Quadruple Aim Measures

11

Model #1: Developmental Screening for Children

12

Background Information

• Prevalence of Developmental Delay in Children ages 0-5 years has increased 17.1% in past 12 years• 6.3% of Hispanic children have developmental delay compared

to 2.4% of non-Hispanics (up to 15% in impoverished communities)

• Often undiagnosed as a result of lower screening rates and lack of parental understanding of diagnostic features

• The American Academy of Pediatrics recommends developmental screening using a validated tool for all children• In California, only 14% of children receive developmental

screening using these tools

13

Importance of Recognition of Developmental Delay in Children#1:

• Inspiration to create path for change:

• Camilla’s Story

14

Model #1: Developmental Screening for Children

• First 5 LA: Early Identification of and Referrals to Early Intervention Services for Autism and Other Developmental Delays

• Goal: Increasing developmental screening and referrals for early services for children identified as being developmentally delayed or autistic in underserved communities

• Six Year, $780,000April 10, 2014-2020

15

Well Child VisitRegistration

9mos, 18mos, 24mos

Tablet given to family to complete

MCHAT-R +/-ASQ-3

MA collects Tablet; screen results auto-populate and

track to NextGenEMR

AltaMed staff to aid completion of screen;

language services available upon request

Normal Development

Partial Delays

Developmental Delay

IT generated algorithms and templates for tracking/database

generation

Age appropriate developmental

surveillance

Re-screen with PMD in 1-2months

- DBP Referrals- Case

Management- Community

Resource LinksProvider/Staff

Training

TA

TA

TA

First 5 LA Developmental Screening Workflow(With Technical Assistance from CHLA)

START:

Developmental Screening Using Validated Tools

1. Total number of screened children at 6 AltaMed clinic sites = 10,836

2. Total number of referrals made into early intervention services = 1,733*

3. Prevalence of developmental delay in primarily Latino population = 16%

17

Chart1

427674276742767427674276742767

427954279542795427954279542795

428264282642826428264282642826

428564285642856428564285642856

428874288742887428874288742887

429174291742917429174291742917

429484294842948429484294842948

429794297942979429794297942979

430094300943009430094300943009

430404304043040430404304043040

430704307043070430704307043070

431014310143101431014310143101

431324313243132431324313243132

Boyle Heights

CHLA

Commerce

El Monte

Pico Rivera

Westlake

61.5

91.6

95

87.5

70

92

87.5

80

75

91

66

95

63

72.7

66

50

55

100

65

90

70

65

45

77

75

83

72

69

49

100

50

76.5

77

65

41.6

96

45

85.9

78

57

24

79

72

84

74

70

51

82

28

80

65

90

68.5

89

58

89

81

77

40

85

37.5

88.7

80

41

60

88

100

76.8

57

50

50

93

75

70

75

56

60

92

Sheet1

Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17Sep-17Oct-17Nov-17Dec-17Jan-18Feb-18

Boyle Heights61.5087.5063.0065.0075.0050.0045.0072.0028.0058.0037.50100.0075.00

CHLA91.6080.0072.7090.0083.0076.5085.9084.0080.0089.0088.7076.8070.00

Commerce95.0075.0066.0070.0072.0077.0078.0074.0065.0081.0080.0057.0075.00

El Monte87.5091.0050.0065.0069.0065.0057.0070.0090.0077.0041.0050.0056.00

Pico Rivera70.0066.0055.0045.0049.0041.6024.0051.0068.5040.0060.0050.0060.00

Westlake92.0095.00100.0077.00100.0096.0079.0082.0089.0085.0088.0093.0092.00

Sheet1

Boyle Heights

CHLA

Commerce

El Monte

Pico Rivera

Westlake

Sheet2

Sheet3

Advocacy & Education for Developmental Screening

1. Pediatric Academic Societies 2016: Accepted Poster2. Help Me Grow 2016-Present: Involvement in Leadership Council,

Provider Group, Community Outreach Group3. AAP Town Hall Meetings 2016-2017: Educate pediatric providers (Studio

City, Santa Monica, Pomona, AltaMed Corporate)4. First 5 CA video: AltaMed media team with First 5 team to create online

videos for developmental screenings5. AB 11 (McCarty, Bonta, Carillo, Nazarian) 2018: Assembly health

testimony 1/9/2018; accountability for universal screening for Mcalpopulation (CHDP)

6. Publications to advance knowledge in literature: 1. Manuscript #1: 4 year data review for developmental screening 2. Manuscript #2: Rates of referral by type; linkage timeline to CBR3. Manuscript #3: Early Intervention impacts on delay (ASQ-3 comparison)4. Manuscript #4: Community based intervention: Hablamos Juntos Pilot

18

Future Efforts

•* Based upon our work, we are able to innovate linkage to cost-effective early intervention (Contracting SLP with AltaCHLA IPA for direct services)

•* Year 5 & 6 Goals: Hardwire screening at 6+ AltaMed clinic sites with staff led accountability and train-the-trainer modelling; dissemination of data information for policy change

19

Model #1: Developmental Screening for Children

20

Reduction in Cost(Innovation in early intervention; align with

CBO; reduction in education costs)

Improved Patient Satisfaction (Families

better informed; access to therapy)

Satisfied Providers (Recognition of early intervention and impacting patient health

outcomes in streamlined way)

Improved Patient Outcomes

(Early Intervention reduces developmental

delay; mainstream education)

Model #2: PCMH for Children with Medical Complexity

21

Pediatric Patient Centered Medical Home

• Children with Special Health Care Needs (CSHCN) are defined as having or being at increased risk for a chronic physical, developmental, behavioral or emotional condition and require health and related services beyond other children

• 15% of children in California are CSHCN

• 77.6% have public health insurance, and most of these children do not receive comprehensive, coordinated medical care in the state of California (**only 38% have access to a medical home)

• CSHCN account for >80% of pediatric health care expenditures

22

Model #2: Patient Centered Medical Home (PCMH) for Children with Complex Needs

• PCMH = A partnership between pediatric health care professionals and patient families to identify, access and coordinate medical and non-medical services to help a child achieve their maximum potential

• Provides a model of health care service delivery which is:

– Accessible– Continuous– Comprehensive – Family-Centered– Coordinated– Compassionate– Culturally Effective

• Model of care which is integrated in primary care

• 1450 actively managed children with complex needs/6 FTE case managers

• Coordination of healthcare, community based services; education; mental health; social needs

• Use of case management score algorithm to allocate appropriate support for patient and their families

• Data analytics integration systems to review utilization

24

Pediatric Patient Centered Medical Home

• Current enrollees: 1450 patient families with CSHCN– One hour intake scheduled

with each family (Care plan creation)

• Initial 10 minutes –self-empowerment

• Care plan creation• Goal setting

– Follow up at least every 6 months (or more depending

on situation); 3 month follow up phone calls– M-S 8a-7p access to Case

Management

Patient and Family are seen by their rician

25

Patient and Family are seen

by their Pediatrician

A Referral is made to PPCMH based on

Family’s Needs; Case Management Score Assessment

Completed

The Clinical Care Coordinator

contacts the family and schedules a one hour intake

appointment

An individual care plan is created and

All About Me notebook is

created

The Family contacts their

assigned coordinator who works with the

Pediatrician for all patient needs

Patient Centered Medical Home Utilization Review

• Health Care Utilization Cost Analysis: 1/1/2010-12/31/2015

26

Chart1

All PatientsAll Patients

High UtilizersHigh Utilizers

Pre-PCMH

Post-PCMH

# of days per year

Average LOS per year before and after PCMH program implementation

26.3

4.5

35.9

5.6

Sheet1

Before PCMH( in gen peds service w/o enhanse medical home servise)After PCMH (in gen peds service w/ enhansive medical home services

patient_namePre-PCMH LOS (# of days)Post-PCMH LOS (# of days)Pre Years in PCMHPost Years in PCMHPre-PCMH rate of Stay/yearPost-PCMH rate of Stay/yearPre-PCMH inpatient cost/yearPost-PCMH inpatient cost/yeardate_of_birthAge at enrollmentEthinicityRacePreferred LanguageGenderTime interval (PostPCMH- PrePCMH)PCMH_DiagDateInsuranceER visitInpatientER visitInpatientpre-ED visit total per yearpost-ED visit total per yearpre-inpaitent visit total per yearpost-inpatient visit total per yearpost-clinic visit totalpost-clinic visit total per year

NAME_FULL_FORMATTEDRNGFOToRNGFOToRNGFOToRNGFOTo

1Amy RodriguezRodriguez Amy159980.993.93160.624.9401515.262341.01/21/111.0HispanicWhiteSpanishF2.91/26/12Mcal0000001100240010014000590.000.254.042.294812.21

2Betsy BernalBernal Betsy83740.782.89106.425.6266025.664013.82/16/121.0HispanicOtherSpanishF2.12/10/13Mcal10230650003820010390001107.691.0410.263.465519.03

3Cameron BangBang Cameron101510.472.95214.917.3537234.043220.312/30/111.0Non-HispanicAsian/PacificEnglishM2.51/19/13Mcal0000000000115100067010190.002.032.133.054214.24meeting 12/8, next meeting 12/16 at 3pm

4Damare DanielsDaniels Damare19730.994.37199.00.7497474.71716.28/8/101.0Non-HispanicBlackEnglishM3.48/18/11UNMCAL0000000000220020021010020.000.462.020.4651.141. All inpatient and highutilizer show decrease

5Jimenna PallarezPallarez Jimenna9031.182.2976.31.3190678.03275.19/7/121.0HispanicWhiteEnglishF1.19/16/13Mcal0000005000050000002000020.000.004.240.87146.112. Research questions: Complex care management shows decrease ED visit

6Laura BerriosBerrios Laura94330.952.598.913.2247368.433000.07/13/121.0HispanicOtherSpanishF1.67/2/13Mcal0000003000253000033000140.001.205.261.603212.803. High utilizer ( ED>3) show decrease, but ED 3 or Inpatinet > 2)

10Adriana LopezLopez Adriana20220.644.1831.35.378125.013157.99/20/101.1HispanicOtherSpanishF3.510/27/11Mcal1010020000220110111300802103.133.113.132.3900.007. clinic visit: can see if PCMH and high utilizer will increase over time

11Andres GutierrezGutierrez Andres9801.085.3490.70.0226851.90.07/31/091.1HispanicOtherSpanishM4.38/31/10BCMCal5011181010351122280000227.411.504.630.3700.008. Reference: PCMH internal medicine Duke Jackson Williams

12Dannel RamirezRamirez Dannel541.152.044.32.010869.64902.010/23/121.1HispanicOtherSpanishF0.912/17/13Mcal0000000000110002020010010.000.980.870.49209.809. Clinic will decrease ED or inpatient at Post PCMH

13Elijah GunterGunter Elijah167571.133.63147.815.7369469.039256.23/17/111.1Non-HispanicBlackEnglishM2.55/14/12CFMCal50001640111794431215001395.315.796.192.487119.5611. Posssible regresion: clinic visit vs ED/inpatient visit at post PCMH patient

14Enrique CortezCortez Enrique014.350.00.20.0574.77/10/101.1HispanicOtherEnglishM0.08/26/11Mcal0000000000000000220100010.000.460.000.2340.9212. Complex care criteria: number of diagnosis per patient, what diagnosis, Alameda score and new case management score is using now to enrolled patient.

15Freddy Sanchez-ReyesSanchez-Reyes Freddy024.790.00.40.01043.81/21/101.1HispanicOtherEnglishM0.03/18/11CFMCal0000000000000000001000010.000.000.000.2181.67

16Jayden SalvadorSalvador Jayden13150.733.3179.51.5448630.13787.97/23/111.1HispanicOtherSpanishM2.69/14/12HNMCAL0000000000110000000002020.000.001.370.6110.30

17Joshua RojasRojas Joshua4841.144.0642.11.0105263.22463.110/20/101.1HispanicOtherEnglishM2.912/10/11Mcal0000000000331011031000010.000.742.630.25102.46

18Aldren Santa ClaraSanta Clara Aldren2101.252.2816.80.042000.00.06/19/121.2Non-HispanicAsianEnglishM1.09/20/13HNMCAL0000000000221000230000110.001.321.600.44104.39

19Amanda PenunuriPenunuri Amanda4.570.00.00.00.03/16/101.2HispanicOtherEnglishF0.06/6/11CFMCal0000000000000000000000000.000.000.000.0020.44

20Angel BarralesBarrales Angel149314.16149.00.7372500.01802.97/8/101.3HispanicOtherSpanishM3.211/4/11HNMcal0000001000012022061000230.001.441.000.725412.98

21Antonio MendozaMendoza Antonio0382.130.017.80.044600.911/8/121.0HispanicOtherSpanishM0.011/12/13HNMCAL1000010000001010130000110.001.410.000.47125.63

22Emily TellezTellez Emily56221.273.2444.16.8110236.216975.36/29/111.2HispanicOtherEnglishF2.010/4/12HNMcal0000000100122140181000010.002.471.570.31175.25

23Hailey Flores MendozaFlores Mendoza Hailey43361.212.8435.512.788843.031690.112/12/111.2HispanicOtherEnglishF1.62/27/13Mcal0010120200130110021010571.650.702.482.46196.69

24Ivylynn RodriguezRodriguez Ivylynn02324.660.049.80.0124463.53/3/101.2HispanicOtherEnglishF0.05/5/11Mcal0000000000001092113002006260.002.790.005.58245.15

25Madison HowardHoward Madison129141.34.9399.22.8248076.97099.411/10/091.2HispanicOtherEnglishF3.61/28/11Mcal0000000000110000110020130.000.200.770.61112.23

26Melody MartinezMartinez Melody560.564.218.91.422321.43562.97/23/101.2HispanicWhiteSpanishF3.710/17/11CFMCal10101310101380137190020025.364.515.360.48266.18

27Michael WilliamsWilliams Michael631.853.953.20.88108.11898.73/11/101.8Non-HispanicBlackEnglishM2.11/18/12Mcal0000000000110100120000110.000.510.540.25102.53

28Thomas RobinsonRobinson Thomas5120.775.4766.20.4165584.4914.110/5/090.8HispanicOtherEnglishM4.77/12/10Mcal0000000000330000000010120.000.003.900.3700.00

29Anthony HongleeHonglee Anthony062.410.02.50.06224.111/4/120.7Non-HispanicAsianEnglishM0.08/5/13Mcal0000000000000000110010010.000.410.000.412510.37

30Daniel JimeneJimene Daniel0573.050.018.70.046721.310/8/111.2HispanicOtherSpanishM0.012/12/12Mcal0000000000002000024000040.000.660.001.31309.84

31Desery MacielMaciel Desery11661.015.3910.912.227227.730612.24/27/091.3HispanicOtherEnglishF4.48/12/10CFMCal01100201000120700930800111.981.670.992.0400.00

32Kevin AlonsoAlonso Kevin5901.285.1546.10.0115234.40.07/1/091.3HispanicOtherEnglishM3.911/8/10BCMCal0000001000010000000000110.000.000.780.19336.41

33Larsendo MayMay Larsendo72430.622.56116.116.8290322.641992.22/10/121.3Non-HispanicAsianEnglishM1.96/9/13BCMCAL0010010000330000000000111.610.004.840.3910.39

34Marvin AlecioAlecio Marvin932.62.273.51.38653.83304.06/11/091.3HispanicOtherSpanishM-0.39/23/10HNMcal1010020000000041271010240.773.080.001.763615.86

35Nicole DiazDiaz Nicole0.93.360.00.00.00.05/13/111.3HispanicOtherSpanishF2.58/20/12Mcal00000002001333100736002110.002.083.333.273811.31

36Omar LuengasLuengas Omar4130.992.4241.41.2103535.43099.28/4/121.0HispanicOtherSpanishM1.48/1/13Mcal0000000000111000231000120.001.241.010.833614.88

37Ryan GillilandGilliland Ryan1891151.284.72147.724.4369140.660911.012/30/091.3HispanicWhiteEnglishM3.44/13/11Mcal0000000031913103621220648200.002.5410.164.2440.85

38Symphony BlasherBlasher Symphony2.620.00.00.00.01/20/121.3Non-HispanicWhiteEnglishF0.05/17/13HNMCAL0000000000000000220000000.000.760.000.0051.91

39Ashley MenjivarMenjivar Ashley2610.512.2451.00.4127451.01116.14/17/121.4HispanicOtherSpanishF1.710/6/13BCMCal0000000200020432090100010.004.023.920.45114.91

40Christopher AstorgaAstorga Christopher6501.344.0648.50.0121268.70.06/28/101.4HispanicWhiteSpanishM2.712/9/11Mcal0000000000110000001000010.000.000.750.25174.19

41David SierraSierra David2.060.00.00.00.06/29/121.4HispanicWhiteEnglishM0.012/8/13Mcal0002020000000000000000000.000.000.000.00136.31

42Deron AranaArana Deron4300.634.4168.30.0170634.90.010/1/091.4HispanicWhiteEnglishM3.83/8/11Mcal0000000000330000000000000.000.004.760.00163.63

43Jesus AcostaAcosta Jesus1900.622.2630.60.076612.90.07/5/121.2HispanicOtherSpanishM1.69/27/13HNMcal0012030000330000110000004.840.444.840.003415.04

44Kc CastroCastro Kc2451.32.3818.52.146153.85252.12/3/121.5HispanicOtherSpanishF1.18/13/13Mcal343051504201700510611001311.542.525.381.26125.04

45Kena CisnerosCisneros Kena37451.172.9431.615.379059.838265.38/15/111.4HispanicOtherEnglishF1.81/22/13Mcal0000000000335020294020280.003.062.562.726020.41

46Luis IbarrasIbarras Luis0413.340.012.30.030688.63/20/111.4HispanicOtherSpanishM0.08/28/12SMCal0000000000004011011660202100.004.790.002.995717.07

47Omar AstorgaAstorga Omar7101.344.0653.00.0132462.70.06/28/101.4HispanicWhiteSpanishM2.712/9/11Mcal0000000000110000000000000.000.000.750.00256.16

48Stacy ValenciaValencia Stacy750.482.1714.62.336458.35760.411/6/121.0HispanicOtherEnglishF1.710/29/13Mcal0020020000220000330000114.171.384.170.46104.61

49Aiden PizanaPizana Aiden140161.532.0691.57.8228758.219417.55/29/121.5HispanicOtherEnglishM0.512/8/13Mcal10220500003370431151000233.277.281.961.462311.17

50Anurag BaruaBarua Anurag7981.065.3574.51.5186320.83738.32/3/091.5HispanicOtherEnglishM4.38/26/10Mcal0042170001230030030010126.600.562.830.37203.74

51Aramais GasparyanGasparyan Aramais8001.584.550.60.0126582.30.011/12/091.6Non-HispanicWhiteEnglishM2.97/2/11HNMcal0030031011140100010000001.900.222.530.00143.11

52Brian ChavezChavez Brian1901.042.1418.30.045673.10.04/22/121.5HispanicOtherSpanishM1.111/9/13Mcal2020151000010000110000004.810.470.960.002210.28

53Damian CrespoCrespo Damian053.620.01.40.03453.01/11/102.3HispanicOtherEnglishM0.05/18/12CFMCal0000000000000000001000010.000.000.000.28184.97

54Damien ColacionColacion Damien9601.983.8648.50.0121212.10.02/8/102.0Non-HispanicOtherEnglishM1.92/21/12BCMCAL0000006000060100120000110.000.523.030.2661.55

55Daniel ColindresColindres Daniel1.485.320.00.00.00.03/17/091.5HispanicOtherEnglishM3.89/7/10Mcal0130040100011101141010132.700.750.680.56112.07

56David GalindoGalindo David10651.545.2268.81.0172077.92394.63/21/091.5HispanicOtherEnglishM3.710/11/10Mcal0011022020260000000000111.300.003.900.1940.77

57Jose AvaroaAvaroa Jose3.270.00.00.00.01/3/111.7HispanicOtherSpanishM0.09/25/12Mcal0031040000000002020000000.000.610.000.00257.65

58Joshua ReahleReahle Joshua13220.085.34162.54.1406250.010299.63/4/091.5Non-HispanicWhiteEnglishM5.38/30/10Mcal01300400200200200220101450.000.3725.000.75163.00

59Josseny HernandezHernandez Josseny014.80.00.20.0520.88/23/091.5HispanicOtherSpanishF0.03/16/11Mcal0000000000000000000000110.000.000.000.21122.50

60Kevin HernandezHernandez Kevin2321.464.1615.80.539383.61201.95/13/101.5HispanicOtherSpanishM2.711/4/11Mcal0000001000013000141000010.000.960.680.24122.88

61Kevin SandovalSandoval Kevin1690.723.3122.22.755555.66797.69/3/111.0HispanicOtherEnglishM2.69/10/12Mcal0000003000030000221000010.000.604.170.30133.93

62Medhane BeyeneBeyene Medhane6411.432.4244.80.4111888.11033.11/16/121.5Non-HispanicBlackEnglishM1.07/31/13Mcal1070080000110040040000115.591.650.700.41177.02

63Allison RamosRamos Allison2.390.00.00.00.03/1/121.4HispanicOtherEnglishF0.08/11/13Mcal0000000000000020020000000.000.840.000.00125.02

64Betsi CarrionCarrion Betsi0293.030.09.60.023927.45/5/111.6HispanicOtherSpanishF0.012/19/12Mcal1001020000000023050000110.001.650.000.333310.89

65Katherine MoralesMorales Katherine1.52.160.00.00.00.02/3/121.7NANAEnglishF0.711/2/13BCMCAL0000000000000000000000000.000.000.000.002812.96

66Leslie RoqueRoque Leslie1381.583.268.22.520569.66135.02/25/111.6HispanicOtherSpanishF1.79/28/12Mcal0000000000110000000000110.000.000.630.3130.92

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313Antonio JaramilloJaramillo Antonio013.890.00.30.0642.73/20/065.8HispanicOtherEnglishM0.02/10/12Mcal0000000000110000330000220.000.770.000.51164.11

314Candace StokesStokes Candace042.340.01.70.04273.510/18/075.8Non-HispanicBlackEnglishF0.08/30/13HNMcal0000000000001010020000000.000.850.000.003615.38

315Carlos GarmaGarma Carlos043.590.01.10.02785.57/7/065.8HispanicWhiteEnglishM0.05/29/12Mcal0000000000000000001000230.000.000.000.84133.62

316Cristian GalvanGalvan Cristian7190.123.3158.35.7145833.314350.510/25/065.8HispanicOtherSpanishM3.29/10/12Mcal0000001000230000002200150.000.0025.001.51257.55

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323Vincent HernandezHernandez Vincent14370.455.0931.17.377777.818172.96/9/046.4HispanicWhiteEnglishM4.611/30/10Mcal02100310000180131135000166.672.552.221.18234.52

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344Jayline HernandezHernandez Jayline7010.874.930.60.01609.90.01/29/0010.8HispanicWhiteSpanishF-5.91/26/11lacarem0000000000110000000000000.000.000.090.0071.42

345Owen NguyenNguyen Owen5787.944.937.21.617947.14056.82/13/037.8Non-HispanicAsian/PacificVietnameseM-3.01/26/11Mcal00000088300190100120300030.000.412.390.61153.04

346Jamie HanHan Jamie43010.954.933.90.09817.40.08/25/9812.3Non-HispanicAsian/PacificEnglishF-6.01/27/11HNMCAL0000003001150000000000000.000.000.460.0000.00

347Joseph CuerboCuerbo Joseph4.930.00.00.00.02/18/046.8Non-HispanicOtherEnglishM0.01/28/11Mcal0000000000000000000000000.000.000.000.0040.81

348Harold MartinezMartinez Harold1215.824.80.24.4429.610937.52/13/056.0HispanicOtherSpanishM-1.03/15/11Mcal310120161310051000011000012.750.210.860.21418.54

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350Rebecca NoriegaNoriega Rebecca3010.664.90.30.0703.60.03/21/0010.7HispanicOtherEnglishF-5.82/6/11BCMCAL0000000000330000000000000.000.000.280.0061.22

351Christopher ContrerasContreras Christopher6008.614.897.00.017421.60.03/30/028.7HispanicOtherEnglishM-3.72/9/11Mcal0000001010240020020000000.000.410.460.0040.82

352Dyna JaramilJaramil Dyna046.284.880.00.80.02049.211/3/046.2HispanicOtherEnglishF-1.42/14/11Mcal0000001000230011020011020.000.410.480.4151.02

353Tiyani AndrewsAndrews Tiyani630.594.8810.20.625423.71536.93/16/046.8Non-HispanicBlackEnglishF4.32/15/11HNMcal0000000010010010010100010.000.201.690.20102.05

354Andrew PinzonPinzon Andrew01810.824.870.03.70.09240.24/24/0010.7HispanicWhiteEnglishM-6.02/16/11LACAREM0000000000110000000000330.000.000.090.62112.26

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358Carlisa WareWare Carlisa707.054.841.00.02482.30.09/8/9713.3Non-HispanicBlackEnglishF-2.22/28/11Mcal0001012000020000000000000.140.000.280.0081.65

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360Kevin GarciaGarcia Kevin2.790.00.00.00.01/29/076.1HispanicOtherEnglishM0.03/18/13Mcal0002350000000000000000000.000.000.000.0093.23

361Miguel MartinezMartinez Miguel19202.862.1567.10.0167832.20.08/29/076.1HispanicOtherSpanishM-0.711/6/13CFMCal1104174030290000110000002.450.473.150.00209.30

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363Christopher LopezLopez Christopher13104.724.82.82.16885.65208.310/24/019.3HispanicWhiteSpanishM0.13/14/11BCMCal50310911100350600111010131.912.290.640.63214.38

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365Angel RivasRivas Angel192511.354.81.75.24185.013020.86/24/9812.6HispanicWhiteSpanishM-6.63/16/11BCMCal0000002000020000111200140.000.210.180.83214.38

366Giovanni ArenasArenas Giovanni16109.074.781.82.14410.15230.15/20/9317.6HispanicWhiteSpanishM-4.33/21/11CFMCal0000001000120000001000010.000.000.220.21102.09

367Anthony AguirreAguirre Anthony307.324.780.40.01024.60.09/12/037.4HispanicWhiteEnglishM-2.53/22/11Mcal0000001300150010010000000.000.210.680.00122.51

368Edward OsorioOsorio Edward145711.214.7812.91.532337.23661.14/7/9812.8HispanicOtherEnglishM-6.43/23/11Mcal00000090004131000011010020.000.211.160.4220.42

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370Frank MoreyraMoreyra Frank1310.614.750.10.6235.61578.99/3/9416.4HispanicOtherEnglishM-5.94/4/11Mcal0000000000110010010010010.000.210.090.21102.11

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372Dalila HernandezHernandez Dalila309.134.730.30.0821.50.01/26/029.1HispanicOtherSpanishF-4.44/10/11HNMCAL4001051000010000000000000.550.000.110.0000.00

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376Brianna MonterrosoMonterroso Brianna158308.454.7118.76.446745.615923.610/27/028.4HispanicOtherSpanishF-3.74/18/11Mcal300047804118311001021010790.830.423.671.91306.37

377Arlene AyalaAyala Arlene141.354.680.70.91851.92136.811/24/046.3HispanicOtherSpanishF3.34/29/11CFMCal0000000010010000000000330.000.000.740.6461.28

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382Michael GomezGomez Michael108.824.590.10.0283.40.06/25/9713.7HispanicWhiteEnglishM-4.25/31/11HNMCAL0000000000330000000000110.000.000.340.2200.00

383Steven SanchezSanchez Steven8618.214.5810.50.226187.6545.95/29/9812.8HispanicOtherSpanishM-3.66/4/11Mcal0000000500160100010100010.000.220.730.22275.90

384Cathy LemusLemus Cathy4.580.00.00.00.04/23/9614.9HispanicOtherSpanishF0.06/5/11CFMCal0000000000000000000000000.000.000.000.0081.75

385Passion RencherRencher Passion8.54.550.00.00.00.06/15/9713.8Non-HispanicBlackEnglishF-4.06/14/11HNMcal0000000000110000000000000.000.000.120.00112.42

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399Eva BermejoBermejo Eva381200.164.38237.527.4593750.068493.212/12/100.7HispanicWhiteEnglishF4.28/16/11Mcal0000001010021251312031003160.002.7412.503.65204.57

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404Gabriel CovingtonCovington Gabriel43208.454.335.14.612721.911547.39/1/9812.8Non-HispanicBlackEnglishM-4.19/2/11HNMcal2412011920203730223100101132.252.310.830.69235.31

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409Samuel GasparGaspar Samuel405.594.280.70.01788.90.06/1/9219.0HispanicOtherSpanishM-1.39/19/11Mcal0000000000110000000000000.000.000.180.0000.00

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429Jonathan AriasArias Jonathan242276.052.6940.010.0100000.025092.96/19/066.8HispanicOtherEnglishM-3.44/24/13Mcal0000005100395020073020050.002.601.491.86124.46

430Elden FloresFlores Elden2235.124.074.30.710742.21842.82/20/9417.5HispanicWhiteSpanishM-1.112/5/11Mcal0000002400170000001000120.000.001.370.49122.95

431Cristopher TorrecillasTorrecillas Cristopher24846.974.0635.61.088952.72463.111/23/047.0HispanicOtherSpanishM-2.912/10/11Mcal180101130901031350230101000014.302.461.870.25409.85

432Rafael CruzCruz Rafael0174.060.04.20.010468.03/31/9615.5HispanicOtherSpanishM0.012/10/11Mcal1011030000000000000000110.000.000.000.2581.97

433Jackie VazquezVazquez Jackie4.040.00.00.00.05/26/9714.4HispanicWhiteEnglishF0.012/16/11HNMCAL0000000000000000000000000.000.000.000.00143.47

434Karla Asij- SernasAsij- Sernas Karla1248.6441.41.03472.22500.05/15/038.5HispanicOtherSpanishF-4.61/2/12Mcal0000001000560000000010010.000.000.690.25153.75

435Kaitlyn AdamsAdams Kaitlyn16689.073.991.817.04410.142606.57/16/0011.3HispanicOtherEnglishF-5.11/6/12Mcal00000000003340002660104110.001.500.332.7600.00

436Samantha GonzalezGonzalez Samantha098.073.980.02.30.05653.33/19/0011.6HispanicOtherSpanishF-4.11/10/12HNMCAL0000000000000000000000220.000.000.000.50102.51

437Neyla EspinozaEspinoza Neyla2.420.00.00.00.06/21/067.0HispanicOtherEnglishF0.07/31/13BCMCal0100120000000000110000000.000.410.000.00218.68

438Ramon LopezLopez Ramon6107.032.618.70.021692.70.04/27/067.0HispanicOtherSpanishM-4.45/23/13Mcal110713221000120000000000003.130.000.280.00145.36

439Remigio TamayoTamayo Remigio9717.782.2112.50.531169.71131.21/9/067.7HispanicOtherEnglishM-5.610/17/13Mcal0000001010350000000010010.000.000.640.45125.43

440Manuel CatalanCatalan Manuel73174.313.8816.94.442343.410953.67/1/038.5HispanicWhiteSpanishM-0.42/13/12Mcal0000006010071120151030150.001.291.621.29164.12

441David KinneyKinney David503.613.841.40.03462.60.08/31/9714.3Non-HispanicBlackEnglishM0.22/28/12Mcal0000002000020000000000000.000.000.550.0082.08

442Tayler RippeRippe Tayler3.050.00.00.00.09/10/9813.3Non-HispanicWhiteEnglishF0.03/12/12Mcal0000000000000000000000000.000.000.000.0000.00

443Elias DraperDraper Elias0112.920.03.80.09417.811/14/057.1HispanicWhiteEnglishM0.01/30/13HNMCAL0000000000000100120001010.000.680.000.34134.45

444Victor AltamiranoAltamirano Victor013.180.00.30.0786.28/25/057.1HispanicWhiteSpanishM0.010/26/12Mcal0000000000110100120100010.000.630.000.31206.29

445Aaron MendezMendez Aaron21364.283.794.99.512266.423746.76/13/038.6HispanicOtherSpanishM-0.53/19/12Mcal0000000010340000110010340.000.260.931.06133.43

446Saeed ErazoErazo Saeed3.780.00.00.00.07/8/9813.5HispanicWhiteSpanishM0.03/20/12Mcal0000000000110020020000110.000.530.000.2651.32

447Silvestre MoralesMorales Silvestre11.313.770.00.00.00.05/1/9120.6HispanicOtherSpanishM-7.53/26/12Mcal0000000000220000000000000.000.000.180.0000.00

448Zachary PereyraPereyra Zachary643310.533.756.18.815194.722000.09/1/0110.4HispanicWhiteEnglishM-6.84/1/12Mcal0000003010590010013010590.000.270.852.40215.60

449Phillip LiuLiu Phillip151262.333.7464.87.0162017.217379.72/18/0111.0Non-HispanicAsian/PacificEnglishM1.44/4/12Mcal00000022407150020020110350.000.536.441.34215.61

450Daniel SilvaSilva Daniel43104.733.749.12.722727.36684.53/23/9021.7HispanicOtherEnglishM-1.04/6/12BCMCAL0000000110021000121000230.000.530.420.80143.74

451Antonio GrimaldoGrimaldo Antonio3.720.00.00.00.07/18/0011.6HispanicOtherSpanishM0.04/12/12Mcal0000000000000100010000000.000.270.000.00174.57

452Michael TaingTaing Michael58114.383.7213.23.033105.07392.55/9/0011.8Non-HispanicAsian/PacificCambodianM-0.74/12/12Mcal0000001030150001121000230.000.541.140.8171.88

453Daisy ReyesReyes Daisy3.690.00.00.00.08/22/0011.5HispanicOtherEnglishF0.04/24/12Mcal0000000000110000000000000.000.000.000.0082.17

454Judy MayenMayen Judy3.640.00.00.00.010/6/9615.4HispanicOtherEnglishF0.05/12/12Mcal0000000000000100010000000.000.270.000.0082.20

455Rosaline Sanchez-NavaSanchez-Nava Rosaline2207.063.613.10.07790.40.01/19/9715.1HispanicWhiteEnglishF-3.55/23/12SMCAL00000010704120000001000010.000.001.700.2871.94

456Tomas ContrerasContreras Tomas12.643.590.00.00.00.011/18/9813.3HispanicOtherEnglishM-9.15/30/12Mcal0000000000000000000000000.000.000.000.0000.00

457Daniel AyalaAyala Daniel6800.553.54123.60.0309090.90.011/26/9714.4HispanicWhiteEnglishM3.06/18/12Mcal0000000000110000000000000.000.001.820.00164.52

458Vianney EmilianoEmiliano Vianney193.540.02.50.06355.93/2/9814.1HispanicWhiteSpanishF0.06/18/12CFMCal0000000000330000111000120.000.280.000.5692.54

459Karina AlcalaAlcala Karina029.953.50.00.60.01428.61/24/9616.2HispanicOtherSpanishF-6.56/30/12BCMCal0000000000000000110001010.000.290.000.293710.57

460Leorby SotoSoto Leorby260.962.082.12.95208.37211.511/6/067.0HispanicOtherSpanishM1.112/3/13HNMcal0030030010011042070000003.133.371.040.003114.90

461Michelle MendezMendez Michelle2.940.00.00.00.07/18/057.4HispanicOtherSpanishF0.01/22/13BCMCal0000000000001000010000000.000.340.000.003210.88

462Henry MendezMendez Henry11211.953.460.13.5209.28670.59/6/9912.7HispanicOtherSpanishM-8.57/17/12Mcal0000001100131000011000010.000.290.250.29144.05

463Anthony RazuraRazura Anthony2423.753.440.512.21333.330523.35/29/039.0HispanicWhiteSpanishM-0.37/25/12BCHMO0000000200133000141000010.001.160.800.29174.94

464Josue CucCuc Josue3.420.00.00.00.04/19/0210.1HispanicOtherSpanishM0.07/30/12Mcal0000000000000000000000000.000.000.000.0061.75

465Christopher HallHall Christopher3.410.00.00.00.05/2/9418.0Non-HispanicWhiteEnglishM0.08/2/12CFMCAL0000000000000000000000000.000.000.000.0000.00

466Darrely HallHall Darrely15010.223.411.50.03669.30.08/20/9912.8Non-HispanicBlackEnglishM-6.88/2/12HNMCAL0000000020350000000000000.000.000.490.0061.76

467Jocelyn GalvanGalvan Jocelyn3.40.00.00.00.011/11/9318.5HispanicOtherSpanishF0.08/6/12BCMCAL0000000000000000000000000.000.000.000.0000.00

468David GonzalezGonzalez David86604.383.3819.617.849086.844378.76/16/9913.0HispanicOtherEnglishM-1.08/14/12BCMCal00000030211730301740403110.002.071.603.25308.88

469Jaylen GambleGamble Jaylen26280.723.3636.18.390277.820833.310/24/038.7Non-HispanicBlackEnglishM2.68/20/12HP0000000000110000000000330.000.001.390.8982.38

470Nancy FajardoFajardo Nancy503.693.361.40.03387.50.03/12/048.3HispanicWhiteSpanishF-0.38/20/12BCMCal0000000300030000110000000.000.300.810.00113.27

471Jaevion WilsonWilson Jaevion17467.883.3622.11.855203.04464.39/24/047.8Non-HispanicBlackEnglishM-4.58/21/12HNHMO0000003490420