Program - Inland Empire Health Plan

Inland Empire Health Plan Improving the Delivery of Healthcare for Our Community
2012
Our Governing Board
Organized as a Joint Powers Agency, Inland Empire Health Plan (IEHP)
is a local, not-for-profit health plan serving residents of Riverside
and San Bernardino counties through the following government-sponsored
programs: Medi-Cal (including seniors and people with disabilities),
Healthy Families, Healthy Kids, and IEHP Medicare DualChoice (HMO SNP).
Our Governing Board is comprised of representatives from each county,
including four county supervisors and three appointed members
of the public, who provide direction and approval
for all phases of IEHP operations.
Monthly IEHP Governing Board Meetings are held in public at the
Board of Supervisors Chambers, alternating between the
San Bernardino and Riverside locations.
Chair, Robert A. Buster
Riverside County Supervisor
Vice-Chair, Eileen Zorn
San Bernardino County Public Member
Director, Gary Ovitt
San Bernardino County Supervisor
Director, Dr. Dan Anderson
Riverside County Public Member
Director, Brad Mitzelfelt
San Bernardino County Supervisor
Director, John Tavaglione
Riverside County Supervisor
Director, Andrew Williams
Joint County Public Member
Welcome
Today a mother has to choose between buying food or health insurance
for her family. A grandmother is unable to fill a prescription for her costly
heart medication – and a child is hospitalized for
a condition that could have been prevented,
if only he could have seen a doctor regularly.
Nearly one in four Inland Empire residents
lack health insurance, and live each day in fear
of losing their life savings if faced with a
medical emergency.
IEHP, a community-developed health plan,
provides families in Riverside and San Bernardino
counties with access to affordable, quality healthcare. IEHP started
in 1996 with roughly 62,000 Medi-Cal members. Today, we coordinate the
healthcare of over 575,000 low-income Inland Empire residents.
What sets IEHP apart from other health plans? How do we make a difference in
the Inland Empire? This report answers those questions and demonstrates how
we empower our community to live as healthy as possible.
Going forward, IEHP is committed to keeping members at the “center of our
universe” through a dynamic partnership with our providers,
award-winning service, and innovative products. Thank you for
your interest and support of IEHP, your Inland Empire Health Plan.
Bradley P. Gilbert, M.D., M.P.P.
IEHP Chief Executive Officer
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Our Core Values
Mission Statement
To organize and improve the delivery of quality, accessible and wellness based
healthcare service for our community.
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Our History Innovation, Collaboration, Community
In 1993, California shifted the delivery of Medi-Cal from a mainly
fee-for-service system to capitated managed care. In response, Riverside
and San Bernardino counties created IEHP as the local initiative HMO.
IEHP began operations in 1996 with the resolve to explore innovative
ways of meeting the healthcare needs of our community.
Participating in Healthy Families and partnering with local organizations to
launch our Healthy Kids Program was a natural extension of our commitment.
In 2002, IEHP became the first full-service health
plan in the nation to receive full NCQA accreditation
for Disease Management. A year later, IEHP sought to
improve health outcomes for children in foster care
and partnered with Riverside and San Bernardino
counties to develop the award-winning program,
Open Access.
Soon after, IEHP began implementing a wide range
of services for members with disabilities, leading to the
establishment of the nationally recognized initiative,
The Inland Empire Disabilities Collaborative, (IEDC).
Since 1996,
IEHP has organized
the healthcare of over
one million Inland
Empire residents.
Committed to ensuring quality healthcare, IEHP launched
the Medicare DualChoice (HMO SNP) Program in 2007 to help people with
both Medi-Cal and Medicare navigate the complex and often confusing public
healthcare system.
Looking ahead, IEHP is committed to continual improvement while
creating even more effective ways of meeting the healthcare needs
of families, children, adults, seniors, and people with disabilities
in the Inland Empire.
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Accreditation Setting the Standard for Excellence
IEHP has earned Commendable Accreditation, by the
National Committee for Quality Assurance (NCQA) for
our Medi-Cal and Healthy Families Programs. NCQA, a not-for-profit
organization, leads the nation in improving the quality of healthcare by
grading and monitoring performance among health plans.
IEHP was also one of the first health plans in America to earn Full
NCQA Disease Management Accreditation for its comprehensive
Health Management Program.
IEHP earned these distinctions for surpassing NCQA’s
rigorous standards in the following areas:
• Quality Improvement
• Utilization Management
• Physician Credentialing
• Member’s Rights and Responsibilities
These achievements are things all health plans strive for - but few obtain. With
the support of our community, providers, and team members, IEHP has.
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Our Products Medi-Cal
California’s Medicaid program for low-income
working families with children, low-income seniors,
adults, and people with disabilities. Today, we
coordinate the healthcare for over 500,000 Medi-Cal
members in Riverside and San Bernardino counties.
Healthy Families
The Healthy Families Program provides health, dental, and
vision coverage for uninsured children in working families
who do not qualify for Medi-Cal. IEHP has the highest
enrollment in the Inland Empire with over 55,000 members.
Healthy Kids
The Healthy Kids Program provides health, dental, and
vision coverage for low-income, uninsured children who do
not qualify for Medi-Cal or Healthy Families. IEHP currently
serves over 3,000 children.
IEHP Medicare DualChoice (HMO SNP)
Designed for people who have full-scope Medi-Cal and
Medicare Part A and B. IEHP Medicare DualChoice connects
Medi-Cal, Medicare, and pharmacy benefits into one simple
plan. Members need only one card for all their healthcare
needs. Currently, over 8,500 people are enrolled in
this program.
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Wellness Programs
Focus on Prevention
As a not-for-profit health plan, IEHP reinvests earnings into our members
through comprehensive health education and wellness programs, as well as
other support initiatives. At all levels of operation, our primary focus is
on the health and well-being of our members.
Our Wellness Department collaborates accross the organization to assess
the healthcare needs of our members and design programs geared
to help them lead healthier lives.
Through the following programs, IEHP members are learning
to build better habits for better health:
• Diabetes Self-Management
• Living Well with a Disability
• Blood Pressure Management
• Child Car Seat Safety
• Healthy Heart
• Stop Smoking
• Bicycle Safety
• Weight Loss
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• Healthy Babies
• Family Asthma
In Their Own Words
Roy is a pastor in a local church, where his
wife, Virginia, serves as the children’s director.
When their daughter’s asthma got out of
control, they called IEHP and enrolled in the
Family Asthma Program.
“We’re grateful for IEHP
and the Family Asthma
Program. We learned
so much through the
classes and Adriana
feels much better - it’s
almost like she doesn’t
have asthma any more.”
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Health Management
Helping Members Maintain Their Health
IEHP was one of the first health plans in America
to earn Full NCQA Disease Management Accreditation
for our comprehensive Health Management Program.
The IEHP Health Management team assists our
providers in coordinating care for members with
high-risk pregnancies and challenging
asthma and diabetes cases.
Our Health Management team helps
members understand and follow their doctors’ treatment
plans while keeping doctors informed of their patients’ progress.
Regular contact and support affords these members
an opportunity to take control of their health.
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Open Access For Children in Foster Care
Children in foster care often have significant health concerns that can
affect their ability to become healthy adults. The trauma of separation
from their families and placement in the foster care system often
compound these conditions.
An additional challenge is that children in foster care may face changing
placements – making it difficult to achieve continuity of care.
In 2003, IEHP partnered with Riverside and San Bernardino
counties to address these concerns by launching
the Open Access Program. Open Access
significantly improves access to
healthcare by allowing foster children
the freedom to change providers
whenever they need to do so.
Open Access also helps foster care
parents by providing them with
continuous tracking of immunizations,
medications, and other medical
history information.
In 2008,
Riverside County
was awarded the “California
Counties Innovation Award”
for its collaboration with IEHP
in improving healthcare for
foster children through the
Open Access Program.
Currently the Open Access Program
serves 3,500 foster children. Children
in this program have more regular well-child visits
and go to the emergency room less than those in a
straight Medi-Cal plan.
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Award Winning Service Member Focus
Member Services Department
The IEHP Member Services Representatives help
members get the services they need, when they need it.
Our friendly, bilingual team will help members
change their doctor, answer questions and help them
solve issues by working accross the organization.
The Medicare Member Services Representatives also
help any IEHP Medicare DualChoice members get
the help they need.
Our Member Services team has been recognized for their outstanding service:
• Rated in the 90th percentile in the national survey,
Consumer Assessment of Healthcare Providers and
Systems (CAHPS) for four consecutive years:
2006, 2007, 2008, 2009.
• Purdue University’s “Center of Excellence” 2005 Award
24-Hour Nurse Advice Line
The IEHP Nurse Advice Line operates around the clock,
7 days a week via voice and TTY.
After hours, our nurses offer free and confidential
advice to help members decide the best course of
action to meet their medical needs - all from the
comfort of their own homes.
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Engaging Members Member Focus
People with Disabilities
Workgroup (PDW)
IEHP invites our members with disabilities to
participate in our PDW. Their experience guides
our service and ensures
accessibility in all
programs and services.
Their feedback also
helps us develop
“AccessAbility,” a quarterly
newsletter for our
members with disabilities.
Public Policy Participation
Committee (PPPC)
IEHP encourages its members to voice their
opinions about IEHP public
policy, publications, and
services by joining the PPPC.
With their perspectives in
mind, we communicate with
our members through the
quarterly newsletter,
“The Pulse.”
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Our Network
IEHP contracts with more than 700 primary care physicians, 1,300 specialists,
580 pharmacies, and 25 major hospitals throughout the Inland Empire. Our wide
network ensures that our providers are located where our members live.
Victorville
San Bernardino
Riverside
Coachella
Valley
= Hospital
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= Provider
Provider
Partnership
PartnerEngaging Providers in Decision-Making
In our effort to improve the quality of healthcare for low-income families,
IEHP recognizes the necessity of a strong working relationship
with our providers - based on mutual respect, collaboration, and
constant improvement.
Committed to engaging our providers in decision-making and
keeping them informed about new policies, IEHP founded the
Provider Advisory Committee (PAC) in 2003. The PAC includes two
hospitals, two physicians, an optometrist, an IPA representative, and a
pharmacy representative.
IEHP also offers on and off-site training for providers. We hold
quarterly “Round Table” meetings, facilitating provider interaction with
IEHP senior management staff. Each of these meetings are followed by
Continuing Medical Education opportunities held on
site. Provider Services Representatives
visit provider facilities for on-site training.
Providers also have the opportunity to
participate in our Pharmacy &
Therapeutic Subcommittee (P&T).
This committee, composed of six
physicians, six pharmacists, and select
IEHP staff, meets four times a year to
discuss clinical practice guidelines,
drug trends, and formulary changes.
Supporting
the relationship
between our members
and providers
is the core of
our mission.
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Provider
Partnership
Keeping Our Providers Informed
IEHP holds IEHP University each year to ensure that our IPA and
hospital partners have the information and tools necessary
to best serve our members. We collaborate with the
Center for Disability Issues and the Health Professions to offer
specific training on disability and related health care issues.
IEHP also keeps our providers in the know about our newest
programs, incentive opportunities, and study results through
“The Heartbeat,” our provider newsletter, and “ScrubTalk,”
our newsletter for provider staff.
We also offer our primary care physicians the opportunity to earn
additional revenue through our Pay for Performance (P4P) Program.
Through P4P, physicians receive additional compensation for preventive
services such as children’s immunizations, asthma and diabetes care,
sprenatal and perinatal services, and PAP tests.
Through our website, providers can
also take advantage of convenient
online services, such as member
health records. From member
eligibility and medical history to claims
or authorization status the
information providers
need to properly care for
their patients is always on hand.
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In Their Own Words
Dr. Tarek Mahdi is an active member of the
IEHP Provider Advisory Committee. He
is proud of his partnership with IEHP and
their mutual commitment to putting the
needs of the community first.
“IEHP is known for taking
care of its providers,
and making sure we
have all we need to
care for our patients.
I’m pleased to work
with such a progressive
health plan.”
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Disability Collaborative
As a leader in accessible healthcare,
IEHP prides itself on more than a decade of
linking people with disabilities with quality
healthcare and support services.
Our dedication to improving the delivery of
healthcare for our growing population of seniors and
members with disabilities led to the creation of a
unique initiative called The Inland Empire
Disabilities Collaborative. Launched as a
networking tool, the Collaborative brings together
more than 88 regional organizations that
serve people with disabilities.
Through this joint effort, IEHP has led the way
in promoting equal opportunity and universal access
for people with disabilities through services and summits like
the Disability Resources Expo, a biennial event concentrated
on issues critical to independent living for people with
disabilities – health, jobs, transportation, advocacy, housing,
assistive technology, and education.
Disabilities Rights California (DRC), the nation’s largest
advocacy group for people with disabilities, recently honored
the IEHP-sponsored Disabilities Collaborative for its efforts
in uniting and mobilizing organizations to better serve
people with disabilities. Visit the IEDC website at
www.iedisabilitiescollaborative.org.
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Innovation Project IEHP has partnered with select healthcare clinics and providers in Riverside
and San Bernardino counties to develop an innovative delivery system
model. This model aims to increase healthcare access and improve the
health outcomes for IEHP members.
Enhanced Primary Care
IEHP and several select Primary Care practices reach out to members
who use the emergency department for avoidable visits, and explain the
services they offer. For example, some of the practices offer extended
office hours and an on-site clinic staff to help members access care.
Diabetes Management
The Diabetes Management model helps members with diabetes who are at
risk for developing medium to high risk diabetic conditions. To improve
health outcomes, and help control diabetic-related symptoms, diabetes
clinics offer resources like an on-site nutritionist, diabetic educator and
transportation for members to their medical visits.
Health Navigator
The IEHP Health Navigators show members how
to better use their benefits and guide
them to the right level of care. They visit
members in their home to understand their
barriers and emphasize the importance of
preventive care like annual check-ups.
Members learn their health care access options
like their doctor, the IEHP 24-Hour Nurse Advice
Line, after-hours clinics and urgent care clinics.
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Community Partners
IEHP has a responsibility to enrich the lives of our members
and neighbors alike. We partner with local schools, community
and faith-based organizations, Riverside and San Bernardino County
Public Health Departments, and many more to help uninsured
families get quality health coverage for their children.
Community Outreach volunteers participate in over 100 events annually.
During the last ten years, over 500 IEHP team members have
donated nearly 36,000 hours of volunteer time after hours
and on weekends to help spread IEHP’s message of health and
wellness to our community.
IEHP has also created unique ways to teach
children about safety and healthy living.
IEHP super heroes,
Super Nutricia, Eradicator
and Rad Rider, have made
special appearances at hundreds
of community events throughout
the Inland Empire - reminding
kids to eat healthy, stay away
from cigarettes and practice
bicycle safety. To date, we have
distributed nearly 100,000
bicycle helmets to children
throughout the Inland Empire.
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In Their Own Words
Like many families in the Inland Empire,
Jennifer found it challenging to afford
healthcare for her children. So she joined
IEHP, and has peace of mind, knowing that
her children have quality health coverage.
“My husband and I are
so grateful to have IEHP
for our family. Extra
services like the Nurse
Advice Line make all the
difference, especially
when you have active
little girls like mine.”
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Achievements
IEHP Named the Highest-Ranked
Medicaid Health Plan in California
IEHP is the highest-ranked Medicaid health plan in
California according to the 2008 “America’s Best Health
Plans,” conducted by U.S. News & World Report and
the National Committee for Quality Assurance (NCQA).
#1 HF Enroller in the State
IEH P - Cal i fornia’s
H ighest- Ranked
Medical plan
H P -been
Cal i fornia’s
For the last 7 years, IEHP IEhas
the top enroller in the
H ighest-Ranked
Inland Empire for the Healthy Families
Program. Each year,
Medical plan
we help nearly 17,000 families apply for health coverage
for their children.
National Customer Satisfaction Survey
For three years in a row, IEHP outscored most other Medicaid health
plans in a national customer service survey by Consumer Assessment
of Healthcare Providers and Systems (CAHPS).
2008 California Counties Innovation Award
Riverside County was awarded the “California Counties
Innovation Award” for its collaboration with IEHP in improving
healthcare for foster children through the Open Access Program.
Highest Rating for Medicare Part D
Out of hundreds of Medicare Advantage Prescription Drug (MA-PD)
plans in the nation, IEHP Medicare DualChoice (HMO SNP) is one of only
five plans across the country that earned a 5-star rating for its Part D quality
and performance from the Centers for Medicare and Medicaid Services (CMS).
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20
Achievements
National Committee for Quality Assurance (NCQA)
IEHP earned Commendable Accreditation by the National Committee for
Quality Assurance (NCQA) for Medi-Cal and Healthy Families based on our
well-established programs for service and clinical quality. IEHP was also one
of the first health plans in the nation to earn full NCQA Disease Management
Accreditation for its comprehensive Health Management Program.
Disabilities Rights California Honors IEHP
Disabilities Rights California (DRC), the largest advocacy group for people with
disabilities, honored The Inland Empire Disabilities Collaborative for its efforts in
uniting and mobilizing organizations to better serve people with disabilities.
IEHP Doctors gave IEHP Excellent Satisfaction Scores
Over 96% of IEHP doctors would refer IEHP to their peers, and patients, compared
to other health plans in provider relations, health management, website adequacy, and
more. This survey is conducted by the Myers Group, a National Committee for Quality
Assurance (NCQA) certified survey vendor.
IEHP Disability Program Receives many Distinctions
• Governor Schwarzenegger appoints Ben Jauregui, the IEHP Disability Program
Manager, to the State Independent Living Council (SILC).
• The Civil Rights Hero Award by the California Department of Fair
Employment and Housing.
• Honored by the Mayor’s Model Deaf Community Committee
• Award for supporting the education of parents of children with disabilities
by Fiesta Educativa.
• Award for supporting students with disabilities by the Youth Leadership Forum.
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303 W. Vanderbilt Way, San Bernardino, CA 92408
(909) 890-2000 Voice • (909) 890-2003 Fax • (909) 890-0731 For TTY Users
www.iehp.org Follow IEHP
©2009 Inland Empire Health Plan All Rights Reserved. MK 0012-1208-2