2017 Annual Conference
2017 Annual Conference
Marcia Anderson, R.N, BSN, CCM, CDMS, PAHM, Chief of Medical Services, Inland Empire Health Plan Anne Crawford, RN, BSN, MS, FAHM, Director ATTAC Consulting Group
2017 Annual Conference
2
2017 Annual Conference
Background CMS Audit Building New Infrastructure Remediation Strategies Carrots and Sticks Delegation Oversight Quality and Training
Successes / Challenges 3
2017 Annual Conference
2017 Annual Conference
5
2017 Annual Conference
IEHP-Local Initiative Medi-Cal Managed Care Plan Joint Powers Agency of Riverside and San Bernardino Counties Organized as a Public Agency, Not-for-profit HMO Began Operations September 1, 1996 Serve the 1st and 4th largest counties in the country Mixed Model HMO: Independent Physician Association (IPA) 50 to 60% Direct Physician Contracting 40 to 50% 6
2017 Annual Conference
Currently over 1.245 million members enrolled: 1,220,388 Medi-Cal (Medicaid) Members 25,402 Cal MediConnect Plan (Medicare-Medicaid) Members Inland Empire Health Plan (IEHP) is the first of 65 MedicareMedicaid Plans (MMP) in the nation to reach 25,000 members Insure 1 in 4 people in the Inland Empire 7
2017 Annual Conference
Began operations with < 60,000 Medi-Cal Members
One of the 1st Medi-Cal only H.P. in CA to receive “Commendable” NCQA Accred.
Launches Healthy Families Program
Enrolls SPDs who have Medi-Cal into managed care
Launches the Open Access Program in SB Cty
1st full-service H.P. in the nation to receive full NCQA accred. for DM
IEHP launches Medicare SNP
ACA and CMC Program starts
8
2017 Annual Conference
9
2017 Annual Conference
• What type of Organization do you work for? • What best describes your organization’s largest line of business?
10
2017 Annual Conference
2017 Annual Conference
Marcia Anderson, R.N, BSN, CCM, CDMS, PAHM, Chief of Medical Services, Inland Empire Health Plan Anne Crawford, RN, BSN, MS, FAHM, Director ATTAC Consulting Group
2017 Annual Conference
2
2017 Annual Conference
Background CMS Audit Building New Infrastructure Remediation Strategies Carrots and Sticks Delegation Oversight Quality and Training
Successes / Challenges 3
2017 Annual Conference
2017 Annual Conference
5
2017 Annual Conference
IEHP-Local Initiative Medi-Cal Managed Care Plan Joint Powers Agency of Riverside and San Bernardino Counties Organized as a Public Agency, Not-for-profit HMO Began Operations September 1, 1996 Serve the 1st and 4th largest counties in the country Mixed Model HMO: Independent Physician Association (IPA) 50 to 60% Direct Physician Contracting 40 to 50% 6
2017 Annual Conference
Currently over 1.245 million members enrolled: 1,220,388 Medi-Cal (Medicaid) Members 25,402 Cal MediConnect Plan (Medicare-Medicaid) Members Inland Empire Health Plan (IEHP) is the first of 65 MedicareMedicaid Plans (MMP) in the nation to reach 25,000 members Insure 1 in 4 people in the Inland Empire 7
2017 Annual Conference
Began operations with < 60,000 Medi-Cal Members
One of the 1st Medi-Cal only H.P. in CA to receive “Commendable” NCQA Accred.
Launches Healthy Families Program
Enrolls SPDs who have Medi-Cal into managed care
Launches the Open Access Program in SB Cty
1st full-service H.P. in the nation to receive full NCQA accred. for DM
IEHP launches Medicare SNP
ACA and CMC Program starts
8
2017 Annual Conference
9
2017 Annual Conference
• What type of Organization do you work for? • What best describes your organization’s largest line of business?
10
2017 Annual Conference
2017 Annual Conference
