Kern Medical Center Health Plan

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Transcription:

Managed By UCLA Spring Convening on HCCI Kern Medical Center Health Plan Vision An integrated healthcare network Neighborhood access to primary care Enhanced access to specialty and diagnostic care Coordination of primary care with inpatient and outpatient specialty and diagnostic services Goals Decrease avoidable utilization of high-cost emergency department, inpatient and specialty care services Improve patient health and ability to self-manage care Improve the financial sustainability of the safety net Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 2

Question 7 What are the barriers (internal and external) you experience that impact expeditious implementation of the Coverage Initiative program in your County? Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 3 Program Timeline - Original Apr. 07 Sep. 07 Sep. 08 County and State Contract Finalized Implementation of KMCHP Goal: Enroll 3500 Patients Six Month Planning: Hire Staff Communication Contract with Clinics Upgrade Patient Care Systems Implementation and Planning: Enroll Patients Begin Grand Rounds Assign Patients ID Cards and Primary Care Home Begin Care Management Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 4

Barriers and Challenges Delayed Contracting with State Contracting and Building Relationships with Community Clinics Leadership Changes: County and State Delayed Enrollment Information Technology Building a Health Plan Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 5 Program Timeline Actual Apr 07 Sep 07 Feb 08 Sep 08 County and State Contract Finalized Implementation of KMCHP Actual Enrollment: 3,923 State County Contract Delays Abbreviated planning Hire Staff Enroll Patients Create Contracts with Clinics Upgrade Patient Care Systems Begin Care Management Begin Grand rounds Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 6

Delayed Contracting with State The CI demonstration timeline was designed to include a six-month period of developing networks and getting systems of care in place. Kern County s state contract was not finalized until late November 2007 Resulting in a shorter dedicated planning and development period Began enrolling patients in February 2008 Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 7 Contracting and Building Relationships with Community Clinics Kern County had no prior association with community clinics for the provision of primary care services. Required 12 months to agree on a contract with a large clinic system in Kern County Another large clinic system has not yet engaged Limits to Community and County Clinic Capacity Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 8

Overcoming Barriers: Accomplishments and Successes Secured contracts with two Community Clinic networks. By contracting with these community clinics, Kern Medical Center has geographically extended its reach, so patients do not have to drive hours to seek primary care services. 100% of CI Enrollees are assigned a Primary Care Home Expanding specialty care to community clinics Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 9 Leadership Changes: County and State County and State needed time to understand, develop, and clarify certain logistics of the CI program. This in turn created delays or changes to the CI implementation. Change in leadership at the State level Change in leadership at Kern Medical Center CEO CFO CMO Administrator of Outpatient Services COO Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 10

Delayed Enrollment Specific Patient Enrollment Challenges: Loss of planning/recruitment time Citizenship Documentation Requirements under the Deficit Reduction Act of 2005 Patients without adequate contact information (Limits follow-up and outreach) Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 11 Overcoming Barriers: Accomplishments and Successes KMCHP Enrollment Retro-enrollment and aggressive financial screening: KMCHP was able to enroll 3,923 patients Year 1 Goal: Enroll 3,500 patients Online verification of California birth (Ancestry.com) By January 2009, all patients received a KMCHP ID Card In order to respond specifically to CI patient issues, a member services representative was stationed at KMC. Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 12

Information Technology Multiple Systems that do not communicate with each other Example: KMC Pharmacy uses separate unique identifier for patients than hospital Challenges tracking Medi-Cal conversions (DHS and County) Software Applications in need of upgrading E-referral system not used to its full capacity Information system upgrades Reliance on paper-based process Enrollment Referrals Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 13 Information Technology Requirements for reporting of data that is not currently electronically collected: KMCHP Enrollment Eligibility Dates Enrollment Denials and Disenrollment Complaints Contracted services Pharmacy cost information year 1 Quality data Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 14

Overcoming Barriers: Accomplishments and Successes Utilizing IT to Coordinate Care Created enrollment database to track CI patients Primary Care Home placed on patient face sheets Process to expand KMC s medical records viewing system to contracted community clinics, allowing access to clinical documentation, lab results, x-ray results, and digital films. Implementing E-Referral System upgrade On-line claims management system (ikasystems) Implement NaviLinx for Care Managed Patients Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 15 Current Challenge: Building a Health Plan Development of health plan systems and operational components Coordination of care between the community clinics and the county facility County resident clinics Contracting with community clinics: Global fee Pharmacy, Lab, Radiology Credentialing Claims processing Authorizations Specialty referrals Care Management Information exchange Quality plan Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 16

Overcoming Barriers: Accomplishments and Successes Implemented a web based claims processing system Contracted with Local Initiative for credentialing Advisory Board Community Grand Rounds Oversight Committee Working with Greater Bakersfield Legal Assistance (GBLA) to address patients social and legal problems Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 17 Questions? Kern Medical Center Health Plan - Managed by COPE Health Solutions Thursday, April 15, 2009 18

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