Care1st CCI Advisory Committee Meeting Thursday, April 30, :00-2:00 p.m. Care1st Offices Monterey Park, California & San Diego, California

Transcription

1 Care1st CCI Advisory Committee Meeting Thursday, April 30, :00-2:00 p.m. Care1st Offices Monterey Park, California & San Diego, California

2 Care1st CCI Advisory Committee Meeting Thursday, April 30, 2015, 12:00 2:00 PM Advisory Committee Members Present: Sue Arnold, Care1st Member Gloria Behn, Care1st Member Wilma Burns, Care1st Member Zena Garcia, Care1st Member Debra Cherry, Alzheimer s Association Janet Heinritz-Canterbury, Personal Assistance Services Council (PASC) Lorie Van Tilburg, Southern Caregiver Resource Center Norma Jean Vescovo, Independent Living Center of Southern California June Simmons, Partners in Care Foundation Dr. Hassan Kafri, MD Annie Lee-Houang, California Long Term Care Education Center (CLTCEC) Care1st Staff Present: Paola Aguilar, Director of Member Services Justin Bottger, Provider Network Administrator Roxann Breazile, Director of A&G Steven Chang, Director of Social Services Janet Eisenberg, AVP of Corporate Compliance Alejandra Gaona, IHSS Liaison - SD Rosa Hernandez, Health Education Liaison Hannah Kim, Social Worker Kim Fritz, GMC Administrator - SD Pamela Mokler, VP of LTSS Eddy Moreno, Director of Community Outreach & Enrollment Dr. Deborah Ratliff, MD, Medical Director - SD Catrina Rodriguez, Behavioral Health Manager Noah Solomon, LTSS Provider Relations Liaison SD Elizabeth Strong, Manager of Ambulatory Services Dr. Martha Tasinga, MD, M.D., CCI Medical Director Jamie Ueoka, VP of Program Development MMP Plans Josie Wong, VP of Medical Health Services - SD 2

3 I. Call to Order Pamela Mokler, Committee Chair, called the meeting to order. Meeting commenced at 12:08 p.m. II. Introduction III. Presentations & Discussions Pamela Mokler welcomed Care1st CCI Advisory Committee Members and Care1st Staff to the second quarterly meeting of 2015 and opened with introductions. Pamela Mokler presented a brief review of the purpose of the CCI Advisory Committee that included: Clarification about the Committee Policy & Procedure Distinction regarding Board Members Explanation of the Committee s functions Jamie Ueoka, VP of Program Development MMP Plans, presented an update on CCI Operations and Enrollment that included: An analysis of the State Dashboard on Cal MediConnect Enrollment for the previous month. An explanation of how enrollment works (passive, voluntary, opt-outs, etc.) A discussion regarding the steps we can take to counteract the opt-outs: o Education o Media Coverage o Community Outreach - spreading the word in the community An update on our partnerships and collaborations with other Plans, DHCS, CMS and CMT. Paola Aguilar, Member Services Director, presented an update on the Member Services Call Center that included: An update on the Call Center due to high call volume in January, Member 3

4 Services cross-trained additional staff to be able to take more calls which helped to decrease the number of calls in February and March. An update on the collaborations with other departments to make sure all calls are answered and questions are adequately addressed. An analysis of the most frequent types calls. Jamie Ueoka also provided an update on our improved member ID cards based on the feedback we received from the members, Pamela Mokler followed up with an update on the various LTSS Programs and current departmental initiatives and projects. Key Items Discussed: List of LTSS department responsibilities (programs, contracts, LTSS and Care Plan Options (CPO) provider relations, etc.) Update on new staff, IHSS, MSSP, CBAS, SNF/NF and provider trainings LA CCI All Plan & AAA Workgroup Project Update Chronically Homeless High-Utilizers Project Update Brief update on upcoming conferences and presentations Question: Aside from the data you are receiving on IHSS, CBAS and MSSP, are you also getting any data on family caregivers and coordination of care? (Debra Cherry) o Yes, we are currently working with and coordinating with caregivers in our Interdisciplinary Care Team (ICT) meetings. (Dr. Martha Tasinga, MD) Dr. Martha Tasinga, MD, CCI Medical Director provided an update on Cal MediConnect that included case examples of how our collaboration with IHSS, MSSP, etc.,has helped facilitate care coordination and the delivery of services to our members. Question: Is there a way that the PCPs can be included and/or notified of the care 4

5 coordination activities by the Plan? (Debra Cherry) o Yes, ICT meetings bring the PCP, specialists, network of providers and caregivers for the member together. (Dr. Martha Tasinga, MD) Question: What is the Plan s relationship with the IHSS Social Workers? (Janet Heinritz-Canterbury) o The IHSS Social Workers have been participating in our ICT meetings and have helped to increase the number of approved hours for some of our members. We work with both the IHSS Social Workers and the IHSS Providers. (Dr. Martha Tasinga, MD) Questions for Committee/Open Forum: What can we do to better serve our members and do you have any recommendations for other services and/or providers we should be working with? How does Care1st target who gets an ICT meeting and how often do these meetings occur? (Annie Lee) o We identify member needs through various methods, including but not limited to, Care Plans generated via members responses to Health Risk Assessments (HRAs), care coordination activities, Predictive Modeling software, calls with members and/or family caregivers, etc. The Care Navigators also call the members to get more information and a better idea of their living situation. ICT meetings occur every two (2) weeks, but there are also ad-hoc ICT meetings periodically. Additionally, the social workers recommend members for ICT meetings. (Dr. Martha Tasinga, MD) Are the Plans preparing a process for members who cannot direct their own care or make their own decisions? (Debra Cherry) o The Social Services Department works to help identify individuals who can Recommendations: Sue Arnold suggested that the Plans need to find a way to make information clear and simple for the members without confusing them. Many members are unable to advocate for themselves and they have to fill out paperwork that is unclear, and they have to read through fine print language that is confusing. Sue also recommended that Plans can help advocate for their members, especially the ones who are vulnerable. Gloria Behn suggested that Care1st should consider including member education in their newsletters about the services that are offered at Care1st because members are probably unaware of what services are out there and available. 5

6 help to make decisions on our members behalf. (Dr. Martha Tasinga, MD) For a member with dementia, how does the Plan determine the appropriate party to facilitate person-directed care? (Debra Cherry) o We use various methods, including but not limited to, Case Managers, Home Health, Wound Care & Extended Case Management teams, who go into the member s home to help us assess and monitor the member. (Dr. Martha Tasinga, MD) Most of the time beneficiaries who receive IHSS may not even recognize that they are disabled. Sometimes the members are not aware or they do not recognize the true extent of their issues, and it becomes even more difficult when the Plans and doctors say they cannot do anything to assist. (Norma Jean Vescovo) o Sometimes it is difficult for the Plans when the doctors do not want to cooperate or work with us. (Dr. Martha Tasinga, MD) People have a difficult time asking for help, and sometimes people don t want to admit that they need help. (Sue Arnold) I really appreciate the assistance that I receive from Care1st, and I believe that sometimes people need to put aside their pride and ask for help. (Gloria Behn) Rosa Hernandez, Health Education Liaison, presented an update on Health Education which included: Information about the Alzheimer s Association Caregiver Education Success of Care1st s Evidence-Based Programs that are offered in multiple languages to our members Information about Care1st s Adult Weight Management Program Care1st has been participating in the Los Angeles Alliance for Community Health & 6

7 Aging (LAACHA) Workgroup, which is focused on increasing accessibility of Evidence-Based Health Promotion Programs for at-risk, marginalized, older adults, caregivers and families in Los Angeles County by fostering improved collaboration among community organizations and health systems. Partners in Care Foundation currently maintains the State website for Evidence-Based Programs, and can provide information about locations for members who are unable to travel. (June Simmons) Care1st s Living Healthier with Chronic Conditions Program has been very useful and really builds a community and connects members to others with similar conditions. More people could benefit from these programs if they knew about them. (Gloria Behn) Janet Eisenberg, AVP of Corporate Compliance, presented a Compliance update. Key Items Discussed: Explanation of an effective compliance program Explanation of reporting, fraud, investigations, etc. Recommendations: Sue Arnold suggested that we need to provide quicker resolutions and better assistance with Pre- Authorizations for medications because there are a lot of issues with prescriptions. Eddy Moreno, Director of Community Outreach & Enrollment, gave a brief update on Community Outreach initiatives, which included: An update on outreach activity and partnerships with community organizations Partnering with Health Education to bring Evidence-Based Programs to the community and senior housing Information on the Care1st Resource Center and its services for the community (not just limited to Care1st members) An update on future outreach projects. Health Plans have not been able to outreach and market to beneficiaries during the first year of the demonstration. As of June 1, 2015, this will change. Care1st will be working with the other LA CCI 7

8 Health Plans to create cohesive messaging, and will work with grassroots organizations to connect with beneficiaries in the community to spread the word. Roxann Breazile, Director of Member Appeals & Grievances, gave a brief update on Appeals and Grievances including a report on first quarter data. Janet Heinritz-Canterbury, from the Personal Assistance Services Council of LA County (PASC), presented a recap of the Peer Sessions conducted by the Public Authority. Key lessons learned from these sessions are that there is still a lot of confusion and misunderstanding among the beneficiaries and that there is a lot of negativity coming from the physicians. Members want one person inside the Health Plan that they can go to, to help them with their services and care coordination. The fear of losing their doctors and providers is what seems to drive many beneficiaries decisions. (Janet Heinritz-Canterbury) o It s not so much about losing the doctors themselves, but rather it s a fear of losing what you know. For example, it is frustrating for members to have to constantly repeat their situation to a new staff person multiple times when they call the Health Plan. (Sue Arnold) o Care Navigators do try to work with the members to assist and ease the members through their transitions. (Elizabeth Strong) o Members get so many mailings; it is often difficult to understand all the changes. (Wilma Burns) IV. Meeting Concluded Meeting was concluded at 2:25 PM. The next meeting will be in July. 8