Bridge2Access Statewide Advisory Committee December 09, 2014 Meeting Minutes - Approved

Transcription

1 Date December 09, 2014 Facilitator Richard Chambers Time 11:30 PM 2:30 PM PST Scribe Danica Lusser Location Molina Center 200 Oceangate, Suite 100- Long Beach, CA Invited: In Attendance: James Cruz, MD Richard Chambers Yunkyung Kim Deborah Miller Jennifer Rasmussen Megan Dankmyer James Novello Paul Stuessy Rosa Hidalgo Sabra Matovsky Bertha Poole Louis Frick Liz Helms Steven Soto Paula Crano Joy Bland Tina Padron Terrance Henson Brenda Premo Ruthy Argumedo Mary Rios Sergio Calderon Janet Vadakkumcherry Pete Benavidez Cecilia Burch Sal Pineda Gina Semenza Larisa Crossno Danica Lusser Julieta Rosales Karla Gutierrez Andrew Lacroux Terrance Henson Danica Lusser Sal Pineda Oscar Narro Cecelia Burch Pete Benevidez Stephanie Buhir John Nolan Paul Stuessy Gina Semenza Martha Villar Megan Dankmyer Bertha Poole Ruthy Argumedo Brenda Maroney Marjorie Benesh Rosa Hildalgo Gloria Hunter Karla Gutierrez Lisa Hayes Julieta Rosales Richard Chambers Deb Miller Jennifer Rasmussen Yunkyung Kim Jon Roohan Isaac Valles Larisa Crossno Donald Brock Liz Helms

2 Oscar Narro Stephanie Williams Denny Chan Janet Vadakkumcherry Mary Rios Sergio Caulderon Attachment: Meeting PowerPoint Presentation Time Agenda Item Discussion Leader 11:30-12:17 Lunch & Mingle All 12:17 Welcome, Call to Order Opening Remarks 1. Welcome by Richard Chambers, thanks all for attending 2. Called to order 12:17pm Richard Chambers B2A Presentations_ :17-12:23 Introductions All 12:23 Approval of May 29, 2014 Minutes Motion to approve: Pete Benavidez 2 nd Motion: Mary Rios (on phone) Approved: Approved by Committee at 12:23pm Richard Chambers 12:25-12:45 Richard then discusses the agenda and transitions to Molina updates Molina Updates 1. Will talk about 2014 achievements - exciting year 2. Membership growth - MHC crosses 1/2 million member mark. Nationally, 12 health plans exist, (Puerto Rico coming soon) 3. Launched Duals Demonstration plans (Molina Dual Options Cal MediConnect) 4. Very exciting time for CMC, despite high opt-out rate 5. Later Deb and Jen will discuss how the California Coordinated Care Initiative (CCI), is changing lives. 6. LIP transition in January was seamless -those previously uninsured now get managed care services and this is progressing Richard Chambers

3 successfully. Molina is meeting previously unmet healthcare needs 8. ACA expansion meant lots of growth - 20% growth in Marketplace Plan taking off and looking to expand in the future 10. Amazing growth in the Molina s California Health Plan itself: a. Over 700 employees b. In 2015 nearly 1000 are expected i. Resulted from Healthcare Services department hiring, 1. Needed more Case Managers & Community Connectors 12. New Leadership in the Health plan Finance, Rajeev Narula 13. Quality Improvement focus a. Improved rates on HEDIS and CAHPs b. Molina is the highest rated in the counties we serve (NCQA) 14. Expanding Provider network, including: a. Scripps In negotiation with their physician groups b. In LA - Dignity c. In SAC - Dignity 15. Medi-Cal Expansion: Goal is to serve and grow membership a. Choose Molina initiative b. DHCS CAL fresh transition. With second notice to Cal Fresh recipients for Medi-Cal: 1. DHCS got 50% response rate 2. Second mailing just took place 3. Medi-Cal expansion continues into Medicare Expansion a. Coachella Valley - Medicare plan available in D SNP Medicare Advantage Plan b. Passive enrollment will take place throughout 2015 i. We need to make sure that message is communicated about enrollment options. 19. Looking Ahead a. Autism & ABA benefits - Implementation is taking place; the state is still trying to figure out the payment system b. Quality i. Focused on improving scores ii. CCEPD - Molina agreed to commit to increase employment rate of people with disabilities. c. LTSS education i. Molina wants to improve quality of care and support for caregivers 1. Sal comments - In our experience disability

4 employment rate is unacceptable, applauds Molina for taking a step in this direction. a. Richard notes very happy to implement this, sometimes we need to step back and look at the big picture to recognize what we re doing 12:45-12:55pm Long Term Care Updates John Roohan MD - Introduction a. Family Doctor b. Wants to implement CCI and help get members appropriate care, at the right time, in the right place 1. Find out what services are needed and where access issues are 2. Megan Dankmyer There are case managers for members in SNFs a. Case Manager (CM) does HRA in person at the SNF b. One CM to one Facility i. When new Molina members are identified SNFs - SNF staff will call Molina. This has become a very collaborative effort. c. SNF will also call Molina for help transitioning back into community i. All CMs trained in CCT d. Interdisciplinary Care Teams (ICTs) collaborate with SNF staff Brenda Premo makes a comment - Language is important and the term custodial members" is an issue We should look at different way to describe this that encompasses the whole individual. Response: Jen R. States that we can start making those changes at the health plan level. Molina needs B2A committee members to make recommendation to state also. Custodial is a tech term that s used for payment of claims. Molina will start changing terminology, but will need the state to do so as well in order for it to be fully integrated. Sal Pineda - Question For Medi-Cal SNF, the health plan is responsible for cost, but then the member is transitioned back to FFS Megan Dankmyer John Roohan, MD

5 medical. Response: John H. States that now members will stay in the plan while in a SNF. Paul Stuessy -How do you decide what level of care a member is categorized as? Response: John states this is a clinical determination based on the needs of the care. Sal Pineda - confirms his understanding Sal Pineda - Question - Are interpreters provided at ICTs and other meetings? Treated the same way, members are provided with interpreter Sal Pineda - who pays for the ASL interpreters Molina: the health plan we do. 12:55-1:05 Autism Services Change for Medi-Cal 1. Deborah is standing in for Doris Doss 2. Discusses Molina s Community Connectors a. Staff living in the community and familiar with culture and resources. They help find members. b. Story Community connector encounters a man with a gas can. The man is a person with diabetes who was hungry and living in his van. i. He was a Molina member by chance 1. Helped member in the moment and got his phone number. Community Connector called next day and now in touch with member to help solve issues. 3. Medi-Cal Autism Benefits i. ALL Plan Letter/Dual Plan Letter - gives instructions on Autism benefits program b. Autism training at Molina i. Training Member Service representatives ii. Training for Case Managers, Clinical staff, and others iii. iv. Physician training is also provided Molina has weekly phone calls with DHCS and is always revising training material with any new updates d. Rates - still waiting to hear more on this topic from the state e. Provider network - increasing ABA providers in the Molina provider network Deborah Miller

6 f. Regional Center Outreach - Training for transition plans i. All transitions will be completed by June 2015 Sal Pineda requests an with more information on ABA i. Deb says she or Lisa will follow up with him 1:05-1:35pm Healthcare Services Update 1. Meeting the HRA challenge - Jennifer Rasmussen 2. Overview of the HRA process a. Identify members i. Each month there a wave of enrollments 1. Passive and Voluntary voluntary 3. Thousands passive ii. Molina stratifies enrollees high risk and low risk 1. See PowerPoint for high 2. See PowerPoint for low risk type 3. If we don t have enough information, we classify them as high risk b. Timeframes i. Depends on level of risk 1. Notes committee members/attendees can see this in packet provided today ii. Molina does more than just minimum to help identify members c. Outreach - Divide and Conquer approach i. Hired staff in the all communities we serve ii. Member names go right to the staff in the community and gets to member very quickly. Often next day face to face in community iv. Staff knows the community in which they serve 1. Bus stops, languages, services, culture, languages 2. Hired staff from sister organizations because of familiarity with community d. Low-Risk Outreach i. Done over the phone. The call is made and a face to face HRA is offered in person ii. Can do HRA over the phone if preferred by member iii. Mail HRA is also an option e. HRA challenges - finding the member i. We receive many files on a members Jennifer Rasmussen

7 1. Often receive wrong numbers 2. May get person who screens calls 3. We try to identify preferred language ahead of time but this is not always possible. f. What do we do to combat these challenges? Turning over Stones 1. Look at historical claims data a. Contacts providers in history for more recent contact info b. IHSS can also help c. Claims data once they start using Molina 2. When contacting members, we try different days and different time of day. 3. If we are still unable to contact, we send a letter that asks member to call us. 4. Have relationships with SNFs in place. 5. Will also refer to Community Connector team. Community Connectors can: a. Have a one on one connection with member b. Help navigate and show resources c. Community connector program is based on New Mexico model. Started with 11 staff and now up to 54 staff members. 7. Calling from non-molina identified phones, getting leads, leaving cards/info a. Will do assessment whenever and wherever possible b. Goal is to get them connected with care they need g. What s under the stones 1. Some don t want to be found 2. Some not in service area 3. Sometime BH can make this more difficult 4. Homelessness, or near homelessness 5. Low on cell phone minutes 6. Sometimes shared family cell phones 7. Some don t want case management (werespect this choice) h. Engaging members 1. Explaining why they re in Molina 2. Offer resources

8 3. Give HCO if member wants it 4. Explain Continuity of Care (COC) 5. Explaining benefits (emphasizing that member is not losing benefits but getting more with CMC) 6. Offering HRA 7. Listening plays important part of role a. Hearing member s concerns b. Using motivational interviewing c. Prioritizing goals Questions - a. Sal Pineda If the member does not speak the same language as the person reaching out, how long is the wait to get an interpreter? i. Jennifer Answers - If on the phone, just a few minutes. If in person and it s a common language, also a few minutes. If it s not a common language and in person, then the wait time for an interpreter is longer. Molina is continuing to update this process. b. Sal Pineda - How do you deal with HIPAA compliance when contacting third parties to find members? Like contacting doctors to get a member s new address. i. Jennifer Answers - Data comes from state and claims contact with doctors. All of this contact is HIPAA compliant because Molina is payer of claims. c. Liz Helms - States there was a meeting in Sacramento she attended where she met a met woman who has daughter in need of services. i. Lisa will send HCO number to caller so they can provide this to the individual. Lisa notes that plans can t enroll members Cal MediConnect (CMC) plans ii. Lisa to call Liz off line. 1:35-2:15 Local CCI Advisory Committee Updates 1. Lisa discusses Inland Empire (IE) and Los Angeles county CCI advisory committee updates a. Advisory boards are required by CMS and the state b. IE and LA advisory committees are collaborative groups Lisa Hayes

9 that include the health plans serving the area, consumers, and community based organizations. c. Meetings are monthly in LA. d. Meetings are bimonthly in the IE. 2. Communications subgroups exist for each advisory committee. a. Jan 2015 enrollment wave - continuing to working on messaging b. Cal Duals Cal MediConnect Toons have also been created to increase awareness. [Lisa shows one of the several cartoons to the B2A committee]. c. Need to provide feedback on accessibility and subtitles. i. Committee recommends subtitles/and colors be changed a. Lisa will share this at next communication meeting. ii. Cecelia comments: says video was confusing. Recommends cutting the acronyms and notes the characters talk too fast. iii. Sal Pineda comments: From a vision-related disability perspective - I thought the ladies voice was man s neighbor and the video became confusing. Suggests that people like him review these videos iv. Brenda Premo- comment: states that video is not accessible to people with sensory disabilities. Concerned that people won t watch. v. Sal Pineda states that internet access is limited and this could be sent out on DVDs. 3. There is a new video in the making by the health plans currently the script is still being finalized. a. Looking into incorporating a signing interpreter circle for the health plan created video 4. Lisa then discusses the contents of the gift bags presented to the committee a. Artwork was done by person with autism. As a child he was hard to reach. However, art seemed to work for him. Now the artist is 21 and doing art professionally. b. Molina purchased the frames and cards from him for the Bridge2Access committee. 5. Jan enrollment wave - see chart in the attached PowerPoint. a. Molina D-SNP members will get cross-walked into our Cal MediConnect plan (CMC)

10 i. Letter goes out to member. ii. Very little change to member experience. iii. Matching networks took a tremendous effort to accomplish iv. Near or at 100% matching in the counties Molina serves b. Part D Reassignees i. These are member of a Medicare Advantage D-SNP plan whose plan starts charging a premium or is ending. These individuals will be cross walked into a CMC plan. c. Takeaway - this is the biggest enrollment wave we ll ever see in the duals demonstration. Committee members are encouraged spread the word about choices to their consumers. Resources include: i. The Health Plans - they are working to get information out to the community ii. Calduals.org iii. HICAP iv. CMC Ombudsman 6. Los Angeles CCI stakeholder advisory committee updates a. When this group meets in January, we will discuss how the January enrollment wave is going and whether the meetings can move to a quarterly schedule. b. Communications subgroup meets every 3 weeks now and big achievements include: i. TeleTown halls via PASC callers for Molina s event, 6000 callers for all plans event ii. Recent Tele-forum a. 24 people in a room answering calls, different languages spoken. b. Mailer sent out for people to call in c. Got a chance to answer individual questions iii. Continued plan outreach 7. IE CCI stakeholder advisory committee updates a. Continued preparation for January enrollment wave b. Currently conducts meetings on a bimonthly schedule, may move to quarterly in c. Communications committee has proposed a TeleTown hall 8. Lisa briefly discusses Molina Ombuds program and notes we are continuing to gauge the IE population s concerns.

11 9. Lisa invites community based organizations to contact Molina about how we can better reach out and help their consumers. 2:15-2:20pm Covered California Enrollment Update 1. Close to 7000 in CA for Covered California 2. Enrollment pathways include: a. Online enrollment i. Note: There were issues with state site. As such, health plans developed more methods for enrollment. b. Phone enrollment c. In-person enrollment i. Enrollment events ii. Offers to have person come to their home d. Enrollment lead cards in contracted providers offices. e. Enrollment at San Bernardino Inland Center Mall - Molina Info Center f. Enrollment at Molina clinics 3. In January 2015, Moreno Valley Mall Molina Info Center is expected to open. Ruthy Argumedo 2:20-2:25 Future Meeting Dates/Times 1. Asking committee members to get consumers involved in our advisory committee 2. Molina s Disability and Senior Access Services staff is made up of 75% people with disabilities 3. Lisa Reiterates CCEPD initiative Molina s focus on it. a. Sal Pineda - States interpreter process should be set up with HR i. Lisa yes and we are working on this ii. Sal also states that at job fair interviewers were asking how deaf people communicate to deaf people 5. Lisa proposes quarterly meetings for 2015 a. Twice in LA and Twice in IE (inland Empire); Senior Leadership will be present at both b. To coincide with CCI meetings and bring that feedback, i. Sal Pineda -says that he likes this idea and has sister agency in the IE that could become involved. ii. Brenda Premo. says this is a good idea. Gets folks from the IE involved so they don t have to always sit on the phone. All

12 c. Lisa states that she will speak with Richard and get a communication out to the group. 2:25 2:27 Open Forum/Agency Announcements 1. GLAD will host 1 Cal MediConnect event with the five health plans. Starting with events in January. Will update the group soon. 2. No other announcements. 3. Meeting adjourned 2:27pm All Recommendations to Molina Senior Leadership Team Agenda Item Due Date Recommendation By Whom Use more appropriate word for "custodial" Find a more appropriate word and use it. Brenda P.