Care1st CCI Advisory Committee Meeting Friday, April 28, :30-2:30 p.m. Care1st Offices Monterey Park, California & San Diego, California

Transcription

1 Care1st CCI Advisory Committee Meeting Friday, April 28, :30-2:30 p.m. Care1st Offices Monterey Park, California & San Diego, California

2 Care1st CCI Advisory Committee Meeting Friday, April 28, 2017, 12:30PM 2:30 PM Advisory Committee Members Present: Sue Arnold, Care1st Member Marco Cordova- Diaz, Care1st Member Eugenia Milian, Care1st Member Zena Garcia, Care1st Member Mandy Qandil, Care1st Member Heriberto Loya Garcia, Care1st Member Gloria Behn, Care1st Member Fernando Garces, Care1st Member Jennifer Schlesinger, Alzheimer s Greater Los Angeles Anwar Zoneiln, Partners in Care Foundation Care1st Committee Members Theresa Stanley, VP Medical Management Rebecca Huff, LTSS Operations Supervisor and Secretary, CCI Advisory Committee Araceli Garcia, LTSS & HCBS Contracting Manager Care1st Staff Present: Oscar Marroquin, Member Services Manager Rosalba Contreras, LTSS Administrative Assistant Roxann Breazile, Director of Member Appeals & Grievances Crystal Burrous, Corporate Director of Social Services Rina Cruz, CMC Program Manager Steven Dubin, LTSS Clinical Social Worker LA Linda Fleischman, Director of Health Education and C&L Alejandra Gaona, IHSS Liaison Araceli Garcia, LTSS Provider Relations Liaison LA Itzel Hernandez, CCI Community Outreach Manager Leiloni Herrera, LTSS Clinical Social Worker SD Rebecca Huff, LTSS Operations Supervisor Adolfo Jacobo, LTSS Liaison Hannah Kim, Manger of Social Services Alan Lert, Behavioral Health Director Eddy Moreno, Director of Community Outreach & Enrollment Patience Niemoth-Coleman, Social Services Manager Deborah Schutz, Director of Medical Services SD Theresa Stanley, VP Medical Management Martha Tasinga, CCI Medical Director Yolanda Tenorio, LTSS Disability Liaison Tanya Dansky, Chief Medical Officer Alex Luevano, Member Education Specialist Irma Eligio, Field Education Specialist Supervisor Melissa Garcia, Clinical Programs Manager Linda Luna, Social Services Specialist Kimberly Fritz, AVP Medi-Cal Contracts Manager Deborah Ratliff, AVP Medical Director 2

3 I. Call to Order Theresa Stanley, Divisional VP Medical Management, called the meeting to order. Meeting commenced at 12:32 p.m. II. Introduction III. Presentations & Discussions Greg Buchert M.D., MPH, President and CEO, Welcomed Care1st CCI Advisory Committee Members and Care1st Staff opened with a warm welcome to the meeting introductions. Rina Cruz, Duals Program Manager, Medicare Operations provided updates on CCI operations which included the following: Focus on CMC enrollment & Deeming o Eligibility to enroll into CMC. o Our membership as of April is 6,535. o Deeming this means that CMC members have 2 months to re-establish their Medi-Cal eligibility (you need both to qualify for CMC). o As of April, we have 89 members that are in deeming status. o If they do not get their Medi-Cal re-instated, they will be disenrolled from the program. o We have an entire business enrollment unit currently assisting our members with this. o A sample letter that goes out to the member to notify them of this process/change was shared with those in attendance. o Care1st is working with stakeholders and advocates to help convey the importance of this to consumers and to provide feedback to DHCS on the content of the letter currently being sent out to those on deeming. o Question: How do you find out if you are one of those 89 [in deeming status]? (Member 2) o You will get a letter from Care1st or you can call Care1st member services department. (Rina Cruz) 3

4 Question: I didn t know anything about this and I haven t checked my mail. Is this something that happens every year? (Member 2) o Yes, every year you will need to renew your membership during the initial month that you applied. (Eddy Moreno) Itzel Hernandez, CCI Community Outreach Manager, shared information on their campaign to reach out to Medi-Cal members: Host outreach efforts out in the community so that our members understand how their benefits work. Explanation of the various buckets of eligibility and what they mean: o 1. Medicare & Medi-Cal & you have joined CMC o 2. Medicare & Medi-Cal, kept original Medicare & you have joined CMC o 3. Medicare & Medi-Cal, joined Medicare Advantage & you have joined CMC Doing more outreach events at senior centers and senior living facilities. Question: Will provide calendars to the committee of upcoming events? Is there anything we can do to help? (Member 1) o Yes, we are facing challenges when trying to get in touch with our members to invite them to these meetings. (Itzel Hernandez) o Why don t you look at having some of your members who already have these services share their experience from a customer perspective? Engage your existing membership and let them speak to their peers. (Member 1) Question: What are the differences between buckets 1 & 3? (Jennifer Schlesinger) o They will have 2 different ID cards. (Itzel Hernandez) o There are differences between the benefits under CMC vs. Coordinated Choice Bucket 3. (Rina Cruz) o For someone who does not understand bucket 1 vs. 3, make sure you make the differences (if they are the benefits) well known to the member so they 4

5 can understand the difference between the two; because they look the same. (Janet Henritz-Canterbury) o We do work with the members on the subtle nuances and we make sure we look at what benefits are important to the beneficiaries so that they choose the right plan that works best for them. (Eddy Moreno) o There are some members that are excluded from CMC and they could then qualify for Bucket 3 - Coordinated Choice. (Theresa Stanley) Dr. Martha Tasinga, CCI Medical Director, and Melissa Garcia, Clinical Programs Manager, presented information on the CMC and Utilization Management Health Risk Assessments which included the following: The HRA is the foundation of the care planning process (person-centered) and we want our members to participate in the process. The HRA is completed when you first enroll in the health plan (36 questions) and they are completed annually thereafter. This is to help the Plans get a better understanding of where the member is with their health and how we can help connect them to the services they need HRA trend data was shared with the committee. Care1st is doing very well overall with completing HRAs and contacting our members to get them completed. Care1st also categorizes its members into high and low risk, based on their needs. What has been working well: o Added a second mailing to the members. o o SD team reaches out to the members in addition to the vendor call. Care Navigator outreach process has been updated for increased efficiency. Challenges: o Members change their phone numbers or numbers don t work 5

6 o Not willing to participate o Length of survey (too long) Any ideas on other ways we can get members to participate and engage? o s; the response can be immediate. People tend to be better about answering s. (Member 1) o We will look to see if Member Services is capturing s. (Melissa Garcia) Question: Is there a way to sum up or categorize the surveys? (Member 3) o You can call into our member services and they can send you to the care navigators who can help you fill them out and they can summarize it and input it for you. (Melissa Garcia) Question: Do you have members who request to do this in person? (Itzel Hernandez) o Yes, we have a vendor we can use with LVNs who can go out and help the members fill them out in person. (Melissa Garcia) Question: If you have a member with cognitive issues, what is being put in place to assist those members? (Jennifer Schlesinger) o We allow for the POA to assist with completing the HRAs on the member s behalf. (Melissa Garcia) Question: For the annual reassessments, is there a mechanism that can be put in place to flag the members with cognitive impairment? (Jennifer Schlesinger) o That is something we can look into. The LTSS Dept does have a mechanism in place for this but this is something we can look into for the rest of the population. (Melissa Garcia) o Most of the members with cognitive issues are in our complex case management but we can look to do something like this for any members we may miss. (Dr. Tasinga) 6

7 Oscar Marroquin, Member Services Manager, presented an update on the Member Services Call Center that included: o o An update on 1 st Quarter Call Center statistics: 98% of calls were answered within 30 seconds Average talk time is just over 5 minutes Shared language statistics on the types of calls received. Statistics showed a majority of the calls received are either English or Spanish language calls. Michael Fell, Director of Operations and Contracting Call the Car, gave a brief introduction to Call the Car and provided some background information which included the following: Emphasis on healthcare transportation Rigorous training for all the drivers and dispatchers, etc. Working with Care1st for 7 years CTC has a case management specialist team o Know that the members have complex issues and important medical appointments they need to get to Own and operate their own fleet of vehicles which include new vehicles with state of the art features. Use dual branded vans All vans are ADA compliant and have GPS tracking Vehicles are used for marketing events as well Types of training include: Screening, HIPAA, Confidentiality, Fraud, Waste & Abuse, Ride Along program, Recurrent training program, etc. Certified driver training program o CPR, senior/disability/dialysis sensitivity, etc. 7

8 Reach out to the facilities to speak with the Case Managers and Social Workers to understand how the transportation service is running and what they can do to improve Share updated demographic information with Care1st like phone #s, etc. Participate in and sponsor community outreach events Irma Eligio, Field Education Specialist Supervisor, and Alex Luevano, Member Education Specialist, gave a brief update on Health Education and CMC outreach efforts. The Education Specialist s goal is to educate the members on their benefits and identify preferred methods of communication, etc. Current outreach strategies: o Postcards o Phone calls o Home visits o Group meetings Summary of key findings: o Concern about coverage o Confusion about coverage o Billing issues o Too many phone calls o Dental coverage issues We go above and beyond to try to assist our members with their needs We have been having challenges getting our members to attend the meetings Roxann Breazile, Appeals & Grievances Director, provided some information on and examples of A&G which included the following: 8

9 Review of the definitions for Appeals vs. Grievances A&G stats for 1st quarter Appeal rate for CMC is lower in comparison to other lines of business Breakdown of grievance types: o Billing/financial o Attitude/service o Quality of care o Access (getting the help you need) Examples of each type of grievance, with resolutions for each scenario Comment: I have to say that Care1st has really helped me out in the past. And they have helped in such a quick and efficient manner. [Care1st employees] helped me to get my meds, late on a Friday. (Member 1) Open Forum: Was this valuable? This should be your meeting. We get our best feedback from our members because you experience the services we deliver on a daily basis. We need you to tell us, good or bad, what is going on so we can do a better job to improve. (Theresa Stanley, VP Medical Management) I have no problem with Care1st; I have a problem with the doctors. There is not a human side to them and you feel like you are just a cattle going through the motions. Specialists are even worse and I feel like I have left the office not knowing more than when I first got there. Doctors don t seem to be listening to what the patients are saying and not everything is just by the textbook. They don t seem to have the heart. (Member 2) 9

10 I would like to see more engagement/activities (Member 4) o Have you been to any senior centers? (Theresa Stanley) o I still feel isolated and I think that others may feel the same. (Member 4) o One benefit we have for some of our members is CBAS. They are all over LA County and they do social activities and some exercise. (Dr. Tasinga) o CBAS is a program that is offered to Medi-Cal beneficiaries and it is something that we can look at for you. (Hannah Kim) IV. Meeting Concluded Theresa Stanley, Divisional VP Medical Management, concluded the meeting at 2:32 PM. The next meeting will be on July 24,