CCI Stakeholder Advisory Committee June 9, 2016 Go to: Meeting Number: Participant Code: To join by

Transcription

1 CCI Stakeholder Advisory Committee June 9, 2016 Go to: Meeting Number: Participant Code: To join by phone dial:

2 Contents of this presentation is for stakeholder meeting purposes only. Information and PowerPoint slides are not to be distributed without written L.A. Care Health Plan consent. 2

3 L.A. Care s Mission To provide access to quality health care for Los Angeles County's vulnerable and low income communities and residents and to support the safety net required to achieve that purpose. 3

4 Welcome and Introductions Bobbie Wunsch Facilitator 4

5 Agenda Welcome and Introductions CCI/CMC Program Updates L.A. Care Medicare Operations: Updates Transportation- Latest Updates Inter-departmental meeting with Peg Bernardy L.A. Care Homeless Health Programs and Initiatives Questions/Public Comments Review of Action Items for Sept. 8,

6 March 10 th Meeting Follow Up Rina Cruz Medicare Operations Specialist L.A. Care Health Plan 6

7 Follow up Topics: Ad hoc meeting with Peg Bernardy, representative for the Hospital Association of Southern California (HASC). Transportation-Latest Update 7

8 CCI/CMC Program Updates Sarah Brooks Executive Director, Health Care Delivery Systems Department of Health Care Services (DHCS) 8

9 L.A. Care Medicare Operations Garrison Rios, Executive Director,Cal MediConnect L.A. Care Health Plan 9

10 CMC and LA Care High Level Product Roadmap Garrison Rios June 9, 2016

11 The Path Objective Assessment Phase Product Direction Regulatory Road Map CMC Marketing Campaign Clinical Road Map CMC Provider Strategy 11

12 Objective Level Set LA Care is currently participating in the Cal MediConnect demo. Since the launch of the product, there have been many challenges both internally and externally that have resulted in: Lower than expected enrollment (13,000 members currently) High member opt out rate Cal MediConnect Product countywide has seen a decrease in membership over the last year The goal will be to build the correct support at L.A. Care in order to lesson/remove the obstacles and challenges the organization has faced. Additionally, we will increase voluntary enrollment by enhancing brand awareness of the CMC product within the community and with providers. By strengthening our internal and external operations, we will be able to improve the overall health outcomes and experience for our dual members. 1

13 Assessment Phase Within the first 30 days the following will occur: Assessment Product Performance Meet and learn all supporting departments that are working to improve the CMC product performance Realignment of organization and resources to synch up with movement towards core services Within the first 60 days the following will occur: Determine root causes related to Product s poor performance Build work teams to address rood cause issues (Compliance, Provider, Member Services, Clinical, Sales & Marketing) Release the project plans on the HRA transition project, (June 1 st ), Model of Care project, CSP+ project (enrollment), and further flush out a more streamlined better coordinated on boarding experience for the member 1

14 Product Direction 1

15 Regulatory Road Map Medicare Operations Regulatory Strategy The overall strategy for the Medicare Operations and Regulatory department is to improve processes that result in a better member experience. A better member experience will result in greater member engagement in his/her healthcare, a more involved and better informed member provider, and increased member retention. Cal MediConnect will accomplish these goals by focusing on many areas including the following core areas: Member Enrollment L.A. Care is aware of the confusion and difficulty with the current enrollment process into the Cal MediConnect plans. Through working with regulators and members, L.A. Care intends to improve the method for enrolling and provide more clear information to the enrollee. Provider engagement L.A. Care is working closely with its Medical Groups and Providers to ensure they are apprised of the most current member information and plan guidance. Provider/Pharmacy Directory The importance of up-to-date and easy to understand provider information is essential for a better member experience. L.A. Care is committed to improving its directory layout and provider data integrity.

16 CMC Marketing Campaign The growth strategy for CMC is to increase voluntary enrollment and to work with our providers and community to support the CMC program. Cal MediConnect Hot Zone Marketing Campaign Utilize demographic density mapping data Establish targeted Hot Zone marketing pilot campaigns focused on dual eligible beneficiaries through direct mail, provider/patient communications, outdoor and grassroots level touch points Impact choice through product awareness and education Utilize product education as the cornerstone and building blocks of a comprehensive L.A. Care CMC brand and tactical marketing and targeted advertising campaign Engage providers To educate them about the value added benefits that CMC provides for their patients and their practice Results review, revise, and repeat Implement key learnings from pilot campaigns into an effective marketing model for future outbound campaigns 1

17 Clinical Road Map The overall strategy for the CMC Clinical department is to improve member engagement, access to appropriate and timely care, and member health outcomes. We will accomplish this goal by focusing on the following core areas: Improved Model of Care. We will implement a high touch, one touch model of care process that accurately assesses each member s needs, develops an individualized care plan and care team, and coordinates care to ensure improved member health outcomes and achievement of care goals. Health Risk Assessment: We will enhance the HRA process to improve the provision of face to face assessments to better determine each member s needs, assess member needs for managed long term services and supports, and engage members to be active participants in their care process. Reporting: partner with business departments to ensure accurate and timely reporting of Part C, Part D, and core reports; ensure achievement of regulatory and audit standards for each measure; and improve our ability to provide timely and actionable feedback to contracted PPGs. 1

18 CMC Provider Strategy The provider strategy for CMC will be to improve provider engagement with the CMC member and LA Care driven by performance based metrics. Phase 1 of the provider strategy for CMC is to engage all providers currently servicing a high volume of CMC eligible MCLA members. We will target those providers who have been identified in our network. Already contracted providers through our existing CMC PPG network. Agreeable to participating in a CMC outreach campaign to their CMC eligible MCLA patients. Affiliated with high performing PPGs, as determined by L.A. Care s PPG Scorecard. Open to provider education through our Provider Relations team. Phase 2 of the provider strategy for CMC will introduce a CMC direct network model. This will enable providers averse to affiliating with our existing CMC PPG network to contract directly with L.A. Care and invite their CMC eligible MCLA members to participate in the program. 1

19 Medi-Cal Only Duals Initiative Maria Lackner Maria Lackner, Director, Medi-Cal Product Administration L.A. Care Health Plan 19

20 Updates from March 10 th : Meeting with HASC Judy Cua-Razonable, Director, Managed Long Term Services and Supports (MLTSS) L.A. Care Health Plan 20

21 L.A. Care Homeless Health Programs and Initiatives Dr. Clayton Chau Medical Director, Behavioral Health L.A. Care Health Plan 21

22 L.A. Care Homeless Health Programs and Initiatives Clayton Chau, MD, PhD Medical Director, Health Services Maria Calleros Director, Safety Net Initiatives Prepared by: Jessica Jew, Project Manager, Safety Net Initiatives

23 Homelessness in L.A. County Highlights from L.A. County s 2016 Homeless Count Map: 2015 data. Highlights: 2016 Data Overall homelessness in LA County in 2016 increased by 5.7% 74% of overall homeless population is unsheltered in LA County, a 5% increase from % increase in most visible form of homelessness - encampments, tents, and vehicles 75% of total increase in homelessness is due to a more comprehensive youth count African-Americans are disproportionately represented amongst homeless persons 39% of homeless population but only 9% of general population 72% of adults experiencing homelessness have been living in LA county for more than 20 years SAC June 9,

24 L.A. Care s Homeless Members How many homeless members does L.A. Care have? The Economic Roundtable estimated that 3% of Medi-Cal beneficiaries in Los Angeles are homeless at some point during each year. L.A. Care is also working to better estimate our homeless membership and to identify and address these members medical and behavioral health needs: 1. Data Match with the Los Angeles Homeless Services Authority (LAHSA) 2. Obtaining read-only access LAHSA s Homeless Management Information System (HMIS) database 3. Developing homeless identification algorithm 4. Improving ability to track homeless members in L.A. Care s information systems Economic Roundtable, All Alone: Antecedents of Chronic Homelessness, August Available at: SAC June 9,

25 Homeless Member Needs Key Themes from Homeless Consumer Listening Sessions: Make access to care easy & welcoming Build trust, communicate, and coordinate Support the whole person Partner with trusted organizations to outreach and engage Based on two listening sessions w/formerly homeless individuals held in November Conducted by the Integrated Behavioral Health Partners in collaboration with Corporation for Supportive Housing & L.A. County Department of Mental Health ECAC Presentation May 11,

26 SAC June 9, L.A. Care s Homeless Health Coordinating Council: Goals 1) Improve identification of L.A. Care members who are homeless 2) Improve coordination among L.A. Care departments to better assist homeless members 3) Educate external stakeholders to increase awareness of L.A. Care s strategic role in connecting homeless individuals to health plan and other services 4) Link providers who specialize in homeless health with members who are homeless

27 Participation & Partnership in External Initiatives L.A. Care actively supports County and local efforts, such as: Blue Shield Health Neighborhoods Joint Planning Collaborative Grant L.A. County CEO Homeless Initiative Whole Person Care (1115 Medi-Cal 2020 Waiver) Affordable Care Act Section 2703 Health Homes Initiative Spreading Community Accelerators through Learning and Evaluation (SCALE) Grant with Downtown Women s Center Managed Care 101 Trainings for Homeless Service Providers Homeless Resource Fairs sponsored by local homeless coalitions SAC June 9,

28 SAC June 9, Sponsorships and Grants L.A. Care supports homeless health through sponsorships and grants, such as: Sponsorship: Hope of the Valley Recuperative Care (pictured) Grant: Corporation for Supportive Housing 10 th Decile Project, to provide intensive, in person care management & housing to homeless high utilizers Grant: Brilliant Corners, to provide move-in assistance to homeless individuals in L.A. County s Housing For Health program

29 SAC June 9, L.A. Care Strategic Plan L.A. Care tracks our efforts to improve homeless health as part of our strategic plan: Strategic Initiative 4.5 Foster innovative approaches to improving health status of our members and the quality of care provided by the safety net. Photo: Participants in the CSH 10 th Decile project

30 Comments, Questions, Public Comments 30

31 Upcoming Events & Meetings Bobbie Wunsch Facilitator 31

32 Next Meeting Next L.A. Care Stakeholder Advisory Committee Meeting: Thursday, September 8, 2016 LA Care Health Plan 1:00pm- 3:00pm For Information Contact Rina Cruz, Medicare Operations at x