Post on 05-Jan-2016
transcript
Coverage Initiative
Healthy Way LAFocus GroupsFocus Groups
Outline
• Introductions• Focus Group Process• Background of CI• Eligibility• Timeline• Enrollment issues/barriers• Suggestions to alleviate/overcome barriers• Other comments
DHS Award DetailsDHS Award Details
• $54 million per year x 3 years
• Implement by September 1, 2007
• Provide coverage to 94,000 enrolled patients (from 149,000 potentially eligible)
• Can only bill for verified costs at outpatient facilities
• Funds will not roll over to following year
Target PopulationTarget Population• Existing DHS/PPP patients
– income below 133% FPL – not eligible for other coverage– citizens or legal residents 5+ years
-AND-
• Diagnosis of one or more of the following:− Diabetes, CHF, HTN, Asthma/COPD, Dyslipidemia
-OR-− Age 63-64
-OR-− At least two primary care visits in the past year
Enhanced Benefits for EnrolleesEnhanced Benefits for Enrollees
• Assigned Medical Home/Primary Care Provider
• Access to Member Services Line
• Access to 24/7 multi-lingual Nurse Advice Line
• Chronically ill patients will be stratified by disease burden and utilization, and placed into appropriate care
• Greater emphasis on preventive care
Enhanced Benefits for Enrollees Enhanced Benefits for Enrollees (cont.)(cont.)
• Nurse-driven protocols for uncomplicated HTN, dyslipidemia
• Telephone-based care managers for appropriate patients
• Automated appointment reminders
• Case management pilot for homeless patients
System EnhancementsSystem Enhancements
• Additional primary care slots
• Additional optometry, ophthalmology, and podiatry slots
• Provider access to Encounter Summary Sheets
• Provider access to Web Referral
• Health education staff on site
Timeline:Timeline: Plan for April - August
• Develop process for citizenship verification and enrollment (DHS and PPP)
• Link with OMC member services
• Develop financial tracking mechanisms
• Contract for Nurse Advice Line, Care Management
• Finalize and implement HTN and Lipid protocols (DHS and PPPs)
Timeline:Timeline: Plan for April – August cont’d
• Contract for additional specialty care
• Finalize Encounter Summary Sheets & provide computer access to DHS and PPPs
• Contract case managers for homeless care pilot
• Hire additional staff: NPs, health educators, administrative, member services & enrollment
• Implement vital statistics entry into Affinity
Timeline:Timeline: Plan for April – August cont’d
• Develop database & mechanism for PPP data entry
• Develop and translate member brochures, and other educational/informational documents
• And lots more!
Focus Group DiscussionFocus Group Discussion
Next StepsNext Steps
• Comments to be written up in 1-2 page summary• Email CI protocol to participants• Summary to be distributed via email to
participants for comments/clarifications• Possible focus group with patients• Final summary integrating comments from all
focus groups submitted to DHS