Health Net Duals Advisory Committee Survey Results

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1 Health Net Duals Advisory Committee Survey Results To: Health Net Duals Advisory Committee Member As we move forward with the Duals Pilot, Health Net wants to capture the diversity, needs, and requirements your clients have. This survey is part of that process. I have allowed for a top 3 list, but feel free to add more. The Health Net Duals Advisory Committee is our meeting, and as the environment evolves so shall the meeting. Having said that, please send suggestions of how else Health Net can help you address the needs of you clients. Top Needs 1. Adequate access to specialty care for chronic illnesses like multiple sclerosis, i.e. a diverse array of neurologists within the network 2. Adequate coverage of Medi-Cal optional services such as incontinence supplies, physical/occupational therapy, emotional health counseling, vision care, DME 3. Adequate and effective notice to consumers of any policy plan changes related to clinical services provided and pharmaceutical coverage. There should also be a timely and precise appeals process for denied claims. 4. Clarity for clients around available services from health plan and contracted providers 5. Caregiver support 6. Support for mental health needs 7. In-home independent living skills training 8. Access to appropriate rehabilitation for sensory impairments

2 9. Accessible educational materials and self-care equipment (e.g., talking glucometers) 10. Care managers (and other health care providers) who are education in the special needs of the cognitively impaired population 11. Assessment for dementia in annual wellness visits & health risk assessments 12. A system of care that refers all people with dementia to dementia-trained care managers and the Alzheimer s Association 13. One assessment form to be used by all-specific sections may be applicable to individual types of providers but all should be able to access the info 14. Assure that client and/or caregiver understand the role of the health plan and of each agency that is providing service and how they will all work together 15. Allow for a 3-6 month adjustment phase during which NO denials will be issued, but rather, HNET staff will work with members/agencies if there is no clear understanding of the requirements of the new program. 16. Clear, easy to understand information about what the pilot means to consumers, how it will affect their healthcare, and what choices they need to make. 17. Providers are already telling FFS MediCal patients that they will not join an HMO under any circumstances and will not be able to take care of them if they enroll in managed care. Happened this past week to a neighbor of mine. Having just gone through serious surgery with this doctor, she is terrified of losing him. How do we help these folks? We need a comprehensive plan. 18. Get ahead of the frail senior freak-out curve! Stop the predatory providers.

3 19. Assessment for dementia in HRAs and in the Annual Wellness Visits 20. Provider training in dementia care for physicians, nurse care managers and social work care managers to assure network adequacy 21. Availability of Dementia Care Managers to provide disease education, family caregiver support, care planning and referral to internal and community-based resources to every plan member diagnosed with dementia. 22. A Fax-Referral system to assure that every patient diagnosed with dementia is referred to the Alzheimer s Association. 23. Seamless continuum of care from community based/preventative services to tertiary care. 24. Accessible comprehensive patient medical history at all stages of the continuum. 25. Reduction in unnecessary/duplicative/conflicting treatments 26. Smooth continuity and transition of care 27. Repeated clear communication and advertising 28. Easy access to information and counseling on the process (telephone, online, in person) 29.

4 Pros and Cons: Please list the pros and cons to Managed Care Pros 1. Consumer knows exactly what providers are in their network 2. Greater potential to be client directed and client centered 3. Potential for different service providers to be part of the same team 4. Greater coordination of care 5. Opportunities to receive longterm care supports 6. Improved quality of care 7. Supplemental programs i.e. health education. 8. More accountability by the provider for care that is rendered 9. Focus on outcomes and results 10. Multiple options for appeal if not able to get service 11. Access to specialists 12. Access to Alzheimer s Disease Research Centers 13. Patients are familiar with processes 14. Straight-forward enrollment process 15. Reduction in costs Cons 1. Often limited on # of providers including specialists 2. Can be difficult to obtain consults outside of network 3. Difficult to manage the appeals process 4. Disruption of current client service delivery system 5. Clients might not understand the alternatives they are facing and the implications of their choices 6. Differing administrative (billing) procedures among HMOs 7. Barriers to the use of CBAS 8. Plan may be approving service request of a subcontracted plan under HNET or a physician group that s delegated by the plan 9. Different rules for different parts of the same city 10. Provider opposition. 11. Rising costs 12. Fragmented care risk of denial of needed services

5 Pros and Cons: Please list the pros and cons to Fee-For-Service (regular Medi-Cal) Pros 1. Good coverage for pharmaceuticals, most of the time 2. Many do not have share of cost, or share is very low 3. Clients understand how to access system 4. Greater access to wider range of specialists (including mental health) 5. Standardized billing process 6. Maintains patient/doc relationship. 7. Cost containment 8. Possible integration with home and community-based services 9. Possible care management including dementia and other supplemental services (disease education) 10. Potential reduced hospitalization and enhanced wellness. 11. Client able to individualize their care independently Cons 1. Limited on covered services including maintenance services 2. Few providers in more rural/outlying areas as well as culturally and linguistically competent providers 3. Frequent denials of service request 4. Low fees discourage providers 5. Poor coordination of patient care 6. Reimbursements delays predicated on status of state budget 7. California can no longer afford it 8. Law says it must change 9. No accountability on the part of providers 10. Too much reliance on activated patients advocating for themselves. Doesn t work for the frail or cognitively impaired. 11. High cost savings projections 12. Magnitude and scope of Duals Demonstration 13. Potential change in assigned provider(s) 14. Complicated and unfamiliar enrollment requirements/process

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