Care1st CCI Advisry Cmmittee Meeting Thursday, January 28, 2016 12:00-2:00 p.m. Care1st Offices Mnterey Park, Califrnia & San Dieg, Califrnia Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 1
Care1st CCI Advisry Cmmittee Meeting Thursday, January 28, 2016, 12:00 2:00 PM Advisry Cmmittee Members Present: Sue Arnld, Care1st Member Glria Behn, Care1st Member Wilma Burns, Care1st Member Zena Garcia, Care1st Member Lenre Lee, Care1st Member Debra Cherry, Alzheimer s Assciatin Lynn Daucher, Frmer LA State Assemblywman & Directr, CA Dept. f Aging Janet Heinritz-Canterbury, PASC Annie Lee-Huang, The Califrnia Lng Term Care Educatin Center Dr. Hassan Kafri, MD Lrie Van Tilburg, Suthern Reginal Resurce Center Nrma Jean Vescv, Independent Living Center f Suthern Califrnia Anwar Zueihid, Partners in Care Fundatin Care1st Staff Present: Pala Aguilar, Directr f Member Services Desiree Brittain, Clinical Scial Wrker SD Crystal Burrus, Directr f Scial Services Kelly Chang, Prject Specialist Supervisr Linda Fleischman, Directr f Health Educatin & C&L Alejandra Gana, IHSS Liaisn Araceli Garcia, LTSS Prvider Relatins Liaisn LA Rebecca Huff, LTSS Operatins Supervisr Adlf Jacb, LTSS Liaisn Alan Lert, Behaviral Health Directr Pamela Mkler, VP LTSS and Chair, CCI Advisry Cmmittee Eddy Mren, Directr f Cmmunity Outreach & Enrllment Maribel Pearsn, UM Manager - SD Debrah Ratliff, Medical Directr - SD Martha Tasinga, CCI Medical Directr Ylanda Tenri, LTSS Disability Liaisn Nra Tmassian, Pharmacy Directr Jamie Ueka, VP Prgram Develpment MMP Plans Janette Villanueva, Manager f MLTSS & ICT Clinical Ops Jsie Wng, VP Medical Health Services - SD Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 2
I. Call t Order Pamela Mkler, CCI Advisry Cmmittee Chair, called the meeting t rder. Meeting cmmenced at 12:03 p.m. II. Intrductin III. Presentatins & Discussins Pamela Mkler welcmed Care1st CCI Advisry Cmmittee Members and Care1st staff t the first quarterly meeting f 2016 and pened with intrductins and a brief update n the varius audits that Care1st has undergne in the past quarter. Pala Aguilar, Member Services Directr, presented an update n the Member Services Call Center that included: An update n the 4th Quarter Call Center stats: 94% f calls were answered within 30 secnds r less Average talk time was 2-3 minutes A list f the mst frequent call tpics which includes: Prvider inquiries Benefit inquiries Eligibility inquiries Questin: Can yu give mre specific examples f hw yu assist the members? (Janet Heinritz-Canterbury) We prvide additinal infrmatin t ur members abut their benefits, we let them knw if they are still eligible with the Plan, and we let them knw what they shuld d with the letters they receive. If there is a questin we cannt answer, we direct them t their care crdinatr t better assist them with their needs. (Pala Aguilar) Pamela Mkler, VP f LTSS, prvided an update n LTSS prgrams, as well as varius Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 3
cllabrative effrts and prjects including: An update n LTSS prgram enrllment stats A brief summary f the department s new respnsibility with regards t cnducting Health Risk Assessments (HRAs) fr members in SNF/LTC facilities An update n sme f the upcming cnferences Cmment: With regards t MSSP, I assume that yu are als prviding the services t members that are nt enrlled in the MSSP prgram and/r nt eligible. (Lynn Daucher) We have the waiver prgram and we als have vendrs wh can prvide similar services, depending n the members needs. (Dr. Martha Tasinga) We have cntracts in place with ther prviders and sme f the MSSPs t prvide these services. (Pamela Mkler) Questin: D the Plans get mney t prvide these services? (Lynn Daucher) We d if the member is in ne f the LTSS prgrams like IHSS, MSSP waiver r CBAS. If we use a Care Plan Optin (CPO) service, the Plan is nt reimbursed fr thse services. (Dr. Martha Tasinga) Questin: Is smene studying their Medicare csts and hw it may be affected by them ging in and ut f the hspitals fr the first 100 days? (Lynn Daucher) This is smething that we shuld lk int. We are currently wrking n setting up sme pilt prjects t help with the transitin f these members. Once a member transitins t Medi-Cal lng term days, it becmes mre difficult t mve them ut, s we are lking at ways t transitin them during the first 90 days/medicare skilled shrt stay days. (Pamela Mkler) Ylanda Tenri, LTSS Hmeless and Disability Liaisn, presented an update n sme f the Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 4
wrk Care1st has been ding n behalf f its hmeless members such as: Wrking n extended case management cntracts t prvide services fr the hmeless, especially thse with chrnic cnditins Attending all the hmeless and husing-related meetings in Ls Angeles and San Dieg Cmment: We try t prvide as many wrap-arund services as pssible and try t address any issues that may have an impact n the member s mental health. (Dr. Alan Lert) Questin: Sme f the ther Health Plans have mentined that they have been encuntering a significant amunt f cgnitive impairment and dementia issues amng the hmeless ppulatin. Has Care1st als encuntered similar issues? (Debra Cherry) Yes, we ve encuntered thse issues as well as members with substance abuse issues. (Dr. Alan Lert) When we have a member with cgnitive impairment that needs t be placed, there are very few facilities that will take these types f members s we have t make sure t infrm the facilities f the member s needs prir t their transitin in rder t ensure that they will receive the care they need. We always try t lkut fr any special needs amng ur members which is why the UM team lks clsely at all the different assessments. (Dr. Martha Tasinga) We are als wrking n getting access t LAHSA s Hmeless Management Infrmatin System (HMIS) database t help us track where ur hmeless members were fund and assessed, and the services they may be receiving. (Pamela Mkler) Jamie Ueka, VP f Prgram Develpment MMP Plans, presented an update n CCI Operatins that included: Ntificatin f the State s decisin t extend the CMC prgram int 2017, t cntinue t increase the membership and imprve the prgram. With this extensin, Care1st plans t Recmmendatins: Debra Cherry suggested that we put tgether a gd differential diagnsis and assessment t help distinguish between the varius causes f cgnitive impairment. She als recmmended that there are peple in LA & SD that have expertise in teaching abut differential diagnses. Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 5
fcus n the fllwing areas: Care Navigatr utreach and educatin Reviewing best practices Sharing psitive stries and narratives t get peple t recnsider their decisin t pt ut Cmment: Cming int a new Plan can be daunting because there is a lt f infrmatin t g thrugh and understand. Care1st has helped t take ut the cnfusin and simplify the prcess. The mre yu can spread the wrd, the better ff the cnsumer will be. (Sue Arnld) We will cntinue t imprve ur prcesses. (Jamie Ueka) It can be beneficial fr sme lder adults t have smene wrk with them t help them navigate thrugh all f the materials they receive. (Lynn Daucher) One f ur main gals is t facilitate mre ne-n-ne interactin with ur members, as well as ur prviders, t help them better understand the benefits f the prgram. (Jamie Ueka) Peple with disabilities als get cnfused with all f the letters they receive. It wuld be helpful t have better explanatins fr these letters because it takes time t really understand all f the infrmatin that is being circulated. (Nrma Jean Vescv) Questin: What is yur plan fr recruiting members and what is the timeframe fr enrlling them? Are yu still enrlling? (Janet Heinritz-Canterbury) Our apprach is that every day cunts and if yu knw f any interested parties, we wuld be happy t have them jin Care1st and can give yu infrmatin abut wh they can cntact t get mre infrmatin. (Jamie Ueka) Have yu implemented any f yur new ideas yet? (Janet Heinritz-Canterbury) Yes, we have and we are currently in the prcess f hiring a member educatin Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 6
specialist wh can help with these questins and mre. (Jamie Ueka) Questin: What wuld prevent yu frm using members t help cnnect with ther CMC members? There seems t be a trust and understanding between individuals in the same peer grup. (Sue Arnld) We agree with that apprach and are wrking with the ther Health Plans n this. We like the idea f using a spkespersn wh can relate t ur members. (Jamie Ueka) I may nt knw all f the detailed facts and figures, but I can certainly share my experience with thers. (Sue Arnld) Dr. Martha Tasinga, CCI Medical Directr, prvided an verview f Care1st s Patient Navigatr Prgram: Wh is a Care Navigatr? A healthcare representative Smene wh prvides supprt t the member t help them navigate the system Smene wh plays a key rle in care crdinatin A prgram like this cannt be successful withut supprt frm all the ther departments in the plan Fr this reasn, we put the Care Navigatr in the center f a team that can supprt them and help them t quickly and efficiently address the member s care cncerns and needs Questin: Is a Care Navigatr assigned t every CMC member? (Raffie Barsamian) Yes, each Care Navigatr has their grup f members. Apprximately 800 850 members are assigned t each Care Navigatr. (Dr. Tasinga) Is there a direct cnnectin t this department r des the member have t g thrugh member services? (Raffie Barsamian) Initially, they may g thrugh member services, but after they are transferred t the Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 7
Care Navigatr, he/she will share their cntact infrmatin with the member s they can g directly t them the next time they call. (Dr. Tasinga) If a member is passively enrlled and desn t knw abut their Care Navigatr, what happens? (Janet Heinritz-Canterbury) The member will call their dctr and their dctr will direct them t the Plan r member services, and we will cnnect them t the care navigatr frm there. (Dr. Tasinga) Eddy Mren, Directr f Cmmunity Outreach and Enrllment, prvided an update n the fllwing: The All-Plan CMC vide the Health Plans have been cllabrating n. Vide shuld be cmpleted sn and will hpefully be ready by the next meeting Vide was initially meant t be used t educate members n what changes t expect with the arrival with CMC, but has nw evlved int an educatinal vide n CMC The cllabratin between the Health Plans regarding utreach effrts Care1st s Cmmunity Outreach and Health Educatin Departments cllabratin with the Califrnia Chapter f the American Assciatin f Service Crdinatrs (AASC) t cnduct educatinal sessins at ne f their senir husing facilities. Questin: Hw did yu pick the specific lcatin t cnduct yur training? (Janet Heinritz- Canterbury) We wrk with TELACU and they brught this request t ur attentin. (Eddy Mren) Linda Fleischman, Health Educatin & C&L Directr, gave a brief update n ne f the prgrams ffered thrugh the Health Educatin Department. Key Items Discussed: The Alzheimer s Caregiver class that was specifically tailred fr Cantnese speaking individuals: Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 8
22 participants (nrmal grup size ranges frm 8-12 participants) Over the 6 week curse, 21 ut f the 22 participants successfully attended all the trainings Participants learned strategies t deal with depressin and lneliness IV. Meeting Cncluded Cmment: Peple tend t bnd ver shared experiences s the mre we can d t facilitate these types f cmmunities, the better ff ur members will be. (Sue Arnld) Open Frum: Under CPOs, ther Plans are ffering respite. Is Care1st als ffering this? (Debra Cherry) Yes, Care1st des ffer respite under CPOs. (Pamela Mkler) Hw d yu determine wh needs it and can we get an estimate r reprt f hw many yu have authrized fr the next meeting? (Debra Cherry) Yes, we can give an update at the next meeting. (Pamela Mkler) One f the prblems we cntinue t face is that the needs f the ppulatin are greater than the resurces available t address these needs. While LTSS is fr bth CMC and MLTSS, CPOs are fr CMC members nly, which limited what we can d fr thse wh d nt qualify and are Medi-Cal nly. (Pamela Mkler) Hw successful have yu been in infrming members wh are Medi-Cal nly that they culd ptentially receive mre services and benefits if they jined CMC? (Lynn Daucher) We can infrm the members f their ptins but we cannt market CMC t them. (Pala Aguilar) The Plans are limited in what they can d. If a member states that they want t enrll with us, we can help them thrugh the prcess. Hwever, if a member just wants help with their enrllment, they have t g thrugh Health Care Optins. Pamela Mkler cncluded the meeting at 2:00 PM. The next meeting will be in April 2016. Care1st Health Plan January 28, 2016 - CCI Advisry Cmmittee Minutes Page 9