BUILDING A HEALTHY COMMUNITY. Working together, growing together.

Transcription

1 BUILDING A HEALTHY COMMUNITY Working together, growing together.

2 FOREWORD IEHP started in 1996, we had 62,000 Medi-Cal members. Today, our membership exceeds 500,000 through four programs: Medi-Cal, Healthy Families, Healthy Kids and Medicare DualChoice (HMO SNP). To our members, providers and community partners: Fifteen years of changes in healthcare have catapulted IEHP to new heights. We can trace our growth process as early as 1996, when California transferred delivery of care for most Medi-Cal beneficiaries to a managed care system. That transfer would alter healthcare in the Inland Empire. It turned the wheels of change, moving IEHP to become a provider of quality healthcare services and wellness programs to thousands of families in San Bernardino and Riverside counties. When On September 1, 2011 we celebrate our 15-year anniversary under the theme, working together, growing together. In this book, we highlight our evolution, teamwork and Team Culture, which drives us to do the right thing for our members, providers and fellow Team Members. We also spotlight our collaborations. Thanks to our providers and community-based partners, IEHP has reached 15 years of providing quality care. As the future unveils a transformed healthcare landscape stemming from the historic federal healthcare reform bill, teamwork will play an even bigger role. IEHP is ready to pursue tomorrow with vision, courage and perseverance. We have just begun. Bradley P. Gilbert, M.D., M.P.P. IEHP Chief Executive Offi cer Working together, growing together. 1

3 Mission Statement To organize and improve the delivery of quality, accessible and wellness based healthcare services for our community.

4 CONTENTS HOW IEHP STARTED 06 Our community 07 How IEHP was created 15 YEARS OF EVOLUTION & GROWTH BUILDING FOR THE FUTURE 34 The changing healthcare landscape 38 Governing board 40 Closing words from the heart 10 Key events in time 14 Our team culture: doing the right thing 16 Forming our provider network & partnerships 18 Provider support services 20 Healthcare programs Working together, growing together. 3

5 David Tamayo (standing far left), Dr. Bradley Gilbert (standing third from left), Richard Bruno (seated far left), Phil Branstetter (seated third from left), and Lynn Borup (seated far right). Circa 1996: This picture includes several individuals of the original IEHP leadership team. 4

6 HOW IEHP STARTED 5

7 OUR COMMUNITY 6 Stretching 27,000 square miles, the Inland Empire (IE) which includes Riverside and San Bernardino counties is one of the largest and fastest growing metropolitan areas in the nation. With over 4.3 million people, according to the U.S. Census, the Inland Empire is home to our members. Refl ecting a rainbow of ethnic backgrounds, our members include over 500,000 working families with children, adults, seniors and people with disabilities, all enrolled in state-sponsored programs. As the region grows, it faces a shortage of physicians. For example, according to a California HealthCare Foundation study released in June 2009, 60 to 80 active primary care physicians per 100,000 people are in the range of what is needed. However, San Bernardino County has only 44 active primary care physicians per 100,000 people; Riverside County has just 34. And because of low reimbursement rates from the state program, fewer doctors are accepting Medi-Cal or other public programs. This stark fact underscores the value of hundreds of San Bernardino County Riverside County There are currently 4.4 million people living in both Riverside and San Bernardino counties including over 1 million Medi-Cal and Healthy Families benefi ciaries. our physicians and other providers who have stepped forward to give the underserved population needed care. We salute our providers. Because with Healthcare Reform on the horizon, more Inland Empire residents will qualify for medical insurance, further elevating the value of our providers in the Inland Empire.

8 HOW IEHP WAS CREATED The year was To control rising healthcare costs and improve access to care, the state proposed transferring the delivery of care for most of the Medi-Cal population from fee-forservice to capitated managed care. The original idea came from the California Department of Health Care Services (DHCS) which had issued a State Strategic Plan for Medi-Cal Managed Care. The Plan allowed 12 selected counties including Riverside and San Bernardino a chance to develop a managed care program. In the Inland Empire, the managed care program was developed as the 2-plan model. On July 26, 1994, IEHP was created as the Local Initiative under that 2-plan model and as a Joint Powers Agency, a public entity that is not-for-profi t. By the spring of 1995, IEHP established its headquarters on East Washington Street in Colton. Mr. Richard Bruno took the helm as the fi rst Chief Executive Offi cer. Soon after, Phil Branstetter came aboard as Chief Operations Offi cer, followed by Dr. Bradley Gilbert as Chief Medical Offi cer. These three, and others, led the start-up team, which was putting the fi nishing touches on IEHP. The team obtained a Knox-Keene license. It completed the business plan. And by linking IEHP to IPAs that were accustomed to serving Medi-Cal benefi ciaries, IEHP opened with a large provider network, resulting in 62,000 Medi-Cal members. Working around the clock, IEHP opened on September 1, On Day One, minutes after midnight, IEHP completed its rite of passage by answering its fi rst phone call from a member. Today, IEHP shows the shape of things to come. In contrast to Day One, Member Services now handles 50,000 calls a month. And the IEHP Team now exceeds 500. Working together, growing together. 7

9 8 In the days before we opened our doors, IEHP had about 40 Team Members. Today, our team exceeds 500. Join us as we celebrate our growth, achievements, evolution and 15-year anniversary.

10 15 YEARS OF EVOLUTION & GROWTH 9

11 KEY EVENTS IN TIME Created on July 26, 1994, and established fi rst headquarters on Washington Street in Colton. Moved to Cooley Drive, Colton in 1995 and began operations on September 1, The State of California creates a managed care system Established fi rst headquarters on Washington Street in Colton, later moved to Cooley Drive in Colton Completed a DDA, and received a Knox-Keene license and a Medi-Cal contract from the California Department of Managed Health Care (DMHC) Began operations with 62,000 Medi-Cal members Moved to current headquarters (see page 15) at 303 Vanderbilt Way in San Bernardino (building purchased in 2002); and reached 100,000 members. Created the Public Policy Participation Committee (PPPC), a member advisory committee Launched the Healthy Families Program. Launched Rad Rider, a superhero who teaches kids about bike safety.

12 One of the fi rst Medi-Cal-only health plans in California to receive Commendable NCQA Accreditation in Established the IEHP Disability Program in One of the fi rst Medi-Cal-only health plans in California to receive Commendable NCQA Accreditation Launched the Eradicator, a superhero who helps kids say no to smoking Received full NCQA accreditation for Disease Management. Launched the Riverside Healthy Kids Program Created the Persons with Disabilities Workgroup (PDW), a member advisory committee Launched the San Bernardino County Healthy Kids Program. Reached 250,000 members Launched the Open Access Program, a special program for foster care children. Working together, growing together. 11

13 IEHP MOVING FORWARD THROUGH THE YEARS Ranked the #1 Medicaid Plan in California by U.S. News and World Report in In 2009, launched Super Nutricia, a superhero who helps kids eat healthy Launched IEHP Medicare DualChoice (HMO SNP) for members with both Medi-Cal and Medicare. Assisted over 100,000 uninsured children to apply for healthcare coverage since Expanded our location to 301 Vanderbilt Way, San Bernardino Ranked the #1 Medicaid Plan in California by U.S. News and World Report Rated in the 90th percentile by CAHPS for Member Services for four consecutive years. Launched Super Nutricia, a superhero who teaches kids about healthy-eating Received highest national rating of 5-stars for Medicare Part D quality and performance. Developed an in-house Behavioral Health Department & new Innovation Projects Diabetes Management, Enhanced Primary Care Access, and the Health Navigator Program.

14 Reached 500,000 members in With healthcare reform, over 550,000 people in the I.E. will have access to affordable healthcare coverage Expanded offi ce space to 550 Hospitality Lane, San Bernardino. Participated in the development of the Inland Empire Electronic Health Resource Center (IEEHRC). Seniors and people with disabilities who have Medi-Cal only are required to enroll in a managed care plan Provided some services to Riverside County, and possibly San Bernardino, for the Low Income Health Program (LIHP).counties. Reached 500,000 members Implementation of healthcare reform across the nation, including Medicaid expansion and the California Health Exchange Projected to reach 900,000 members. Working together, growing together. 13

15 OUR TEAM CULTURE: DOING THE RIGHT THING The IEHP Team Culture embodies our values, beliefs and approach to interacting with people inside and outside our organization. Our Team Culture sees Team Members as people of value. It supports the idea that everyone on the Team counts and everyone can make a difference. It drives us to do the right thing for our members, our providers and fellow Team Members. But for our Team Culture to be a success, our Team Members must sustain it. Here are 10 key traits to sustain the IEHP Team Culture: Focus on the needs of our members and providers Create ideas that move IEHP forward Aspire to make a difference every day Strive to improve what you do every day Always work with others in a cooperative and collaborative manner Treat fellow Team Members with courtesy, respect and in a professional way Mix hard work with fun you should look forward to coming to work Be a positive infl uence on everyone you interact with See your role as vital to our success Take pride in IEHP and your accomplishments. You re part of a winning team! Practice these everyday. Aim for success, because what makes us different is you! When you do that, you re helping our winning Team - and making IEHP a great organization and a great place to work. Never forget that we are here to do the right thing for our members, our providers and for each other. 14 Like our Team Culture, the IEHP headquar ters in San Bernardino refl ects our high ideals and our aim for success.

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17 FORMING OUR PROVIDER NETWORK & PARTNERSHIPS 16 The strong foundation of any health plan in the era of managed care starts with its network of physicians and other providers. Since IEHP opened its doors, our network of physicians, Independent Physician Association (IPA) groups, hospitals and other healthcare providers have played the key role in caring for our members. The IEHP network was built as an IPA model because of its ability to provide continuity of care and to service a large number of members. It allowed IEHP to serve 62,000 members on our fi rst day of operations. Most IEHP providers are safety net providers that serve low-income families. And since most IEHP members are low-income families, this experience is essential. These providers understand the socio-economic challenges of our members. As IEHP has grown and changed, so has our network. In 2001, due to the sudden fi nancial failure at one of our largest IPAs, our network switched to a mixed-model, allowing us to directly contract with primary care physicians and specialists. With this change, IEHP continued its commitment to a strong working relationship with our existing and new providers. THE IEHP NETWORK TODAY 700 PRIMARY CARE PHYSICIANS 1,300 SPECIALISTS 580 PHARMACIES 230 VISION PROVIDERS 25 HOSPITALS To keep our alliance with our physicians and other providers strong, IEHP created the Provider Advisory Committee (PAC), consisting of hospitals, physicians and vision providers. Through PAC, IEHP and its providers share information on new policies and collaborate to drive constant improvement. This drive has helped the IEHP network meet and exceed the regulatory quality of care requirements from the Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS). Thanks to the strong desire to serve the community, while ensuring access to care, the IEHP network continues to grow and fl ourish.

18 + = HOSPITAL = PROVIDER VICTORVILLE SAN BERNARDINO RIVERSIDE COACHELLA VALLEY To care for our members in Riverside and San Bernardino counties, IEHP has amassed a network of 3,000 physicians and other providers. Working together, growing together. 17

19 PROVIDER SUPPORT SERVICES 18 Building a strong network of providers is a key component in providing accessible healthcare to IEHP members. When IEHP began, our network included 676 providers (PCPs, specialists, hospitals, pharmacies, OB/GYNs, behavioral health providers and vision providers). Today, approximately 3,000 providers throughout Riverside and San Bernardino counties have joined the IEHP network. To support this growth, IEHP develops tools and services relevant to the needs of our providers. All IEHP Team Members play a part in caring for members and supporting our providers. For example, our IT team has consistently developed applicable support tools, improving our systems and services and keeping up with technological innovations in the healthcare industry. A major necessity to our providers has been access to timely, comprehensive, relevant care information. To address this need, IEHP transitioned from a paper-based system to a reliable online system. Providers can view the status of authorizations and claims and a wide variety of patient information, such as member health records, eligibility and lab results from a secure login. These services are valuable to providers who use the site regularly; the site receives close to 7 million visits a year. As our online systems evolve, our providers must understand and utilize the added services. Through extensive efforts by the Provider Services team, providers receive training at their offi ces and our IPAs and hospitals are invited to participate in IEHP University, a yearly training and educational event. Providers can also call the Provider Call Center, a central unit that receives all provider calls made to IEHP. Moving forward, IEHP will continue to develop new services to help streamline processes and further assist our providers. At the end of the day, we must ensure providers have access to the tools and services that allow them to do what they do best care for our members. PROVIDER WEBSITE YEARLY VISITS: 7 MILLION TOP THREE ONLINE SERVICES 4,500,000 Eligibility Verifications 600,000 Authorization Status Views 404,000 Claims Status Views

20 Suppor ting our providers is about listening to their needs, developing the right tools and building a relationship based on mutual respect and collaboration. Working together, growing together. 19

21 HEALTHCARE PROGRAMS IEHP has proudly served both Riverside and San Bernardino counties for 15 years. On Day One, we began with 62,000 Medi-Cal members. Since then, we ve grown to over 500,000 members in four programs: Medi-Cal, Healthy Families, Healthy Kids and a Medicare Advantage Special Needs Plan. Overall, we ve provided care to over 1.4 million people. As healthcare reform is implemented, IEHP will continue to grow and is expected to reach 900,000 members by Amid these changes, IEHP will remain committed to deliver affordable healthcare to the Inland Empire through strong provider partnerships IEHP ENROLLMENT GROWTH 62, , , , ,000 20

22 Medi-Cal, California s Medicaid program, covers low-income working families with children, adults, seniors and people with disabilities. Today, we serve over 440,000 Medi-Cal members. In 2003, IEHP created the Open Access Program for foster care children. Now over 4,500 foster care children receive coordinated care. The Healthy Families Program, California s Children s Health Insurance Program (CHIP), covers uninsured children who do not qualify for Medi-Cal. Today, 58,000 children receive coverage. The Healthy Kids Program covers uninsured children who do not qualify for Medi-Cal or Healthy Families. Since 2002, IEHP has partnered with Riverside County, First 5 Riverside and First 5 San Bernardino to provide care to over 5,000 children. IEHP Medicare DualChoice (HMO SNP), a Medicare Advantage Special Needs Plan, covers people with both Medi-Cal and Medicare by connecting these programs with pharmacy benefi ts. Today, over 5,000 members receive coordinated care. Healthy Kids 1% (4,680) IEHP Medicare DualChoice (HMO SNP) 1% (5,330) Healthy Families 11% (58,040) Medi-Cal 87% (441,720) Working together, growing together. 21

23 RESPONDING TO MEMBERS NEEDS 22 At IEHP, the member is the center of our universe. Through the years, IEHP has done what s right for its members, creating a framework based on their ever-changing health needs. The following are programs and services that IEHP has developed and continues to strengthen for its members: Member Services: At IEHP we strive to provide service that evokes a spirit of care and responsiveness. Each call is answered by a live Member Service Representative (MSR). Most are bilingual in English and Spanish, making it easy for members to communicate and get the service they need. Investment in training helps MSRs provide a high level of service that has been ranked in the 90th percentile by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for four consecutive years. Care Coordination: Care Coordination symbolizes the strengths of managed care. Members have access to a Care Team: doctors, nurses, Member Service Representatives, social workers and others. Our Care Coordination has transitioned from a reactive coordination of care to a proactive, multi-disciplinary approach to better care for our members healthcare needs. Wellness Programs: Since the beginning, IEHP has provided educational programs to assist members in managing their health. Starting with just three programs, IEHP now has a comprehensive Wellness Program that offers 18 types of educational classes and at-home programs. Disability Program: In 2002, IEHP established the Disability Program to improve access, communication and health services for members with a disability. Today, over 32,000 members with a disability access many program services, such as coordination of care and sign language interpreters. Behavioral Health: To address the lack of direct dialogue among PCPs, psychiatrists, psychologists and therapists, IEHP developed an in-house Behavioral Health Department in Reintegrating behavioral health specialists back into our model of care has helped to build real-time coordination of care among all types of providers. Pharmacy: While keeping up with the latest clinical advancements and treatments, the IEHP pharmacy team actively works to build a pharmacy program centered on the member s health and safety.

24 The voice of IEHP: As the catalyst to linking members with their health services, the IEHP Member Services Team answers more than 50,000 calls a month and always with a smile. Working together, growing together. 23

25 QUALITY OF CARE IS OUR FOCUS 24 The word quality can mean different things to different people. But at IEHP, quality is about keeping our focus on the healthcare needs of our members. And we work diligently to create programs and services to meet those needs. We are committed to quality, participating in voluntary accreditation programs through the National Committee for Quality Assurance (NCQA), the nation s premier quality monitoring organization for health plans. Quality drives us, which is why IEHP is one of the top rated Medicaid plans in the state. Since 2000, NCQA has awarded IEHP an Accreditation status for our Medi-Cal and Healthy Families programs. This status is only given to health plans that have clinical and service programs that meet or exceed NCQA standards. IEHP was also one of the first health plans in the U.S. to earn Full NCQA Disease Management Accreditation ( ) for its comprehensive Health Management Program. With the continued support from our providers and Team Members, IEHP will continue to put our members fi rst, seeking ways to improve the quality of healthcare. Together, we can keep our members healthy. NCQA awarded IEHP a Commendable Accreditation status for our Medi-Cal and Healthy Families programs. This status is only given to health plans that have clinical and service programs that meet or exceed NCQA standards.

26 AIMING FOR INNOVATION From Day One, IEHP has created innovative approaches, developed partnerships and built new programs to improve the health of our members. Today, IEHP continues that pursuit through many innovative initiatives. Partnering with select healthcare providers, IEHP aims to develop an innovative delivery system that improves healthcare access, heath outcomes and communication between IEHP members and their providers. Current initiatives focus on three areas: Primary Care Access, Diabetes Care Management and Health Navigator. ENHANCED PRIMARY CARE ACCESS Through the Enhanced Primary Care Access project, members (assigned to select providers) gain more options for getting care. This project partners with several primary care practices, boosting access to primary care services, such as extended office hours, same day appointments and on-site clinic staff to help members. DIABETES MANAGEMENT MODEL To improve health outcomes, the Diabetes Management model helps members with diabetes. Clinics offer members resources to help control their diabetes including, an on-site nutritionist and nurse educator. During a home visit with an IEHP family, a Health Navigator shows the right ways to access medical care. HEALTH NAVIGATOR Designed to help IEHP members better understand how to navigate the healthcare system, the Health Navigator program has taught IEHP members the basics of how, when, and where to get medical care. IEHP is one of the fi rst health plans in the nation to have a full-time team dedicated to helping its members navigate the healthcare system. Working together, growing together. 25

27 EMPOWERING MEMBERS 26 At IEHP we focus on what matters the health needs of our members. Throughout the years, we ve upheld this philosophy by evolving and improving services. An important part of this continual improvement is member input. To foster feedback, IEHP started member advisory groups, inviting members to take an active part in their healthcare. The purpose of the member advisory groups is to promote a dialogue between IEHP and members. During these meetings members share their experiences, advise on member materials and discuss communication needs, educational priorities, healthcare services, and coordination of care. IEHP listens to these recommendations, allowing our members wisdom and experiences to guide our services. Also, IEHP reviews updates on state policy. This keeps our members upto-date on actions that may impact their healthcare. The fi rst open forum for members began in 1997, called the Public Policy Participation Committee (PPPC). This advisory group includes Medi-Cal and Healthy Family members. As IEHP s membership grew to include more seniors and people with disabilities, it was imperative that we gathered feedback from these members. To facilitate this goal, IEHP established the Persons with a Disability Workgroup (PDW) in These advisory groups empower members to establish a voice and share their opinions. Through open communication, IEHP is strengthening its relationship with members and the community and understanding how to best improve the delivery of care. Members of PDW gather for a group photo after a meeting in 2007.

28 Engagement through advisory committees, such as the PPPC shown above, allows members a place to voice their opinions, while learning about new programs and resources. With this information, members return to their communities and share their knowledge. Working together, growing together. 27

29 HELPING KIDS IN SUPER WAYS In an era of health-conscious movements, IEHP has emerged as a visible leader in the community by championing children s health on the public stage. Throughout its history, IEHP has taken a community approach to healthcare, spreading its messages of wellness and safety at festivals, expos and health fairs all over the Inland Empire. Every year, IEHP participates in more than 70 community events and health fairs throughout the Inland Empire. At these events, IEHP reaches out to kids with its cast of masked avengers known to everyone as the IEHP superheroes: RAD RIDER After seeing a rise in head injuries among kids riding bicycles, IEHP created Rad Rider in 1998 to lead its Bicycle Safety Program. MISSION: He teaches kids about bicycle safety, starting with his emphasis on wearing a bicycle helmet. RESULTS: IEHP has given away over 100,000 bicycle helmets to kids ages THE ERADICATOR In 2001, IEHP took on the leading cause of death in the U.S. smoking. Enter the Eradicator. MISSION: To inspire kids to say no to cigarette smoking, he warns them about the evils of Big Tobacco. RESULTS: With his live appearances and his comic book, Eradicator has educated thousands of kids on the dangers of smoking. SUPER NUTRICIA In 2009, childhood obesity reached epidemic levels, so IEHP created its first female superhero Super Nutricia. MISSION: She rescues kids from the evils of junk food by teaching them about healthy-eating habits and staying active. RESULTS: Her popular comic book and website have taught thousands of kids the keys to healthy-eating habits. 28 Since kids look up to superheroes, IEHP will go on promoting its cast of fun heroes to send kids a healthy message.

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31 REACHING OUT TO SERVE THE COMMUNITY 30 For community based organizations, serving seniors and people with disabilities is a noble mission. But although they have dedicated staff and valuable resources, these organizations can provide only so much of the support a person needs. For seniors and people with disabilities, navigating services and resources across a wide area and from a slew of organizations can be a challenge, often overwhelming. Because these resources are fragmented, people can miss out on the full-scope of services in their area. At IEHP, we believe the answer is collaboration. After all, we serve the same population. Collaboration allows organizations to pool resources. It allows them to assume a leadership role in bringing the community together. And by joining forces, organizations develop a bond with one another and the community they serve. For example, we have spearheaded the formation of a collaborative to serve seniors and people with disabilities and another to serve children. BRINGING PEOPLE TOGETHER The Inland Empire Disabilities Collaborative (IEDC): IEHP was the fi rst health plan in California to unite organizations in promoting equal opportunity and universal access for people with disabilities. Formed in 2006, the IEDC is made up of over 300 organizations serving people with disabilities in Riverside and San Bernardino counties. IEDC members meet not only to share resources and healthcare news, but also to plan events, such as the Disabilities Resources Expo, a showcase of over 100 vendors of products and services to enhance independent living. Healthy Kids Info Network: Each month, IEHP hosts a gathering of over 65 representatives from community based organizations, service agencies, clinics and schools, to name a few. Attendees share healthcare news, resources and discuss how to enroll uninsured children in a health program which they qualify for. Most of all attendees bring their specialty to connect and collaborate on ways to help families in the Inland Empire.

32 IEDC, one of the most unique collaborations in California, doing what it does best: bringing the community together to foster universal access. Working together, growing together. 31

33 32 To prepare for the future, IEHP plans on designing new, bigger and better ways to provide quality healthcare for the community.

34 BUILDING FOR THE FUTURE 33

35 THE CHANGING HEALTHCARE LANDSCAPE The Inland Empire and the nation are witnessing an unprecedented change in the healthcare landscape. Most of it is a prelude to Federal Healthcare Reform and state policy changes. At IEHP, we re preparing and welcoming the challenges while looking ahead to the opportunities with great enthusiasm. 34 CALIFORNIA 1115 WAIVER MANDATORY ENROLLMENT OF SENIORS AND PEOPLE WITH DISABILITIES When: June May 2012 Snapshot: Seniors and people with disabilities (SPDs) with Medi-Cal only are required to enroll in a managed care plan. Impact: About 55,000 SPDs in Riverside and San Bernardino counties will enroll in a plan. LOW INCOME HEALTH PROGRAM (LIHP) When: Fall 2011 Snapshot: As a bridge to Healthcare Reform, LIHP allows the county to get federal matching funds to augment the county s medically indigent assistance program. Who: Adults with income up to 133% of the federal poverty level (FPL) for Riverside County and up to100% FPL for San Bernardino County. Impact: Preliminary estimates indicate 40,000-50,000 residents could benefit from this program. FEDERAL HEALTHCARE REFORM When: January 1, 2014 MEDI-CAL EXPANSION Snapshot: More uninsured adults (mostly childless) will qualify for Medi-Cal with income up to 133% FPL about $14,404 for an individual, or $29,326 for a family of four. Impact: Over 250,000 residents in San Bernardino and Riverside counties could be eligible. HEALTH EXCHANGE Who: Any individual and small business, but individuals with incomes between % FPL will be eligible for federal subsides (based on a sliding scale) for premium assistance. Impact: Over 320,000 residents in San Bernardino and Riverside counties could be eligible. With these changes, there will be challenges, such as access to care. But there are also opportunities. Healthcare Reform will give more uninsured individuals and families access to affordable health coverage.

36 1,000,000 Total Medi-Cal Enrollment Regional IEHP 990,000 1,000,000 Total Uninsured 990, , , , , , , , , , , , ,000 0 Pre-Reform Post-Reform 0 Pre-Reform Post-Reform As a result of Medicaid expansion, more than 250,000 residents of San Bernardino and Riverside counties could be eligible. Healthcare reform will significantly reduce the number of uninsured from 990,000 to 335,000. Most of the remaining uninsured will be undocumented individuals. 400, ,000 Total Health Exchange Enrollment Regional 320,000 IEHP 900, ,000 Projected Total IEHP Enrollment 880, , , , , ,000 0 Post-Reform 71,000 0 Current Enrollment (July 2011) Pre-Healthcare Reform (Dec 2013) Post Medi-Cal Expansion & Health Exchange (Jan 1, 2015) The California Health Exchange will help over 320,000 individuals and small businesses obtain health coverage in IEHP enrollment will climb to almost 900,000 by 2015, illustrating the need to prepare and build for the future. 35

37 BUILDING FOR THE FUTURE The upcoming changes in the healthcare landscape will directly impact IEHP. We project our membership will reach 900,000 by And we will be ready. To prepare for the future, IEHP has mapped out its blueprint and zeroed in on these key areas: Organizational Development: Reviewing and reorganizing our staff structure, adding Team Members and increasing training. Network Development: Reviewing our network policies to expand our provider network. Technology Development: Internal Information Technology planning and implementing a strategic road map including, upgrades to current systems. Regional Technology Initiatives partnering with local medical societies to develop the Inland Empire E.H.R Resource Center (IEEHRC), which will help physicians and other providers access patient information at the point-of-care. Delivery of Care: Model of Care Program organizing a specialized, integrated Care Team to help improve care coordination and quality of care for members with chronic illnesses. These four key factors, among others, will be crucial for IEHP to deliver quality healthcare to the community. 36 Inland Empire Health Information Exchange (IEHIE) participation in the IEHIE to enhance access to patient health information.

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39 GOVERNING BOARD IEHP delivers quality and accessible care to members through visionary leadership in healthcare. Compassion, diligence and commitment to the community defi ne our Governing Board and Executive Team. Each individual contributes in-depth knowledge to healthcare, working together to improve the health outcomes for members. The IEHP Governing Board is comprised of highly accomplished individuals who are committed to the mission of IEHP. As a public health plan, the Governing Board oversees all decisions and operations. By appointing public offi cials, a layer of quality assurance and transparency is established, benefi ting all members and community partners. GARY OVITT, Chair San Bernardino County Supervisor DR. DAN ANDERSON, Vice-Chair Riverside County Public Member ROBERT A. BUSTER, Director Riverside County Supervisor BRAD MITZELFELT, Director San Bernardino County Supervisor JOHN TAVAGLIONE, Director Riverside County Supervisor ANDREW WILLIAMS, Director Joint County Public Member EILEEN ZORN, Director San Bernardino County Public Member 38

40 EXECUTIVE TEAM WILLIAM HENNING, D.O. KURT HUBLER CHET C. UMA Chief Medical Offi cer Chief Network Offi cer Chief Financial Offi cer SUSAN ARCIDIACONO BRADLEY P. GILBERT, M.D., M.P.P PHILLIP W. BRANSTETTER Chief Marketing Offi cer Chief Executive Offi cer Chief Operations Offi cer The driving force behind the accomplishments and milestones at IEHP has been its Executive Team. Under this leadership, IEHP has successfully delivered quality care to the community and will continue to play a signifi cant role in the lives of members and in the future of healthcare.

41 CLOSING WORDS FROM THE HEART To our providers and community par tners: We stand in the midst of a new frontier in healthcare. To get here, IEHP has fulfi lled the hard-working low-income family s need for access to quality healthcare services. Because you share our vision, that work will go on. So we say, from our hearts, thank you. 40

42 Health & Quality Before Cost Stewardship of Public Funds Core Values Team Culture Par tner with Providers Foster TQM Environment

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