Coverage Initiative Healthy Way LA Focus Groups. Outline Introductions Focus Group Process Background of CI Eligibility Timeline Enrollment issues/barriers.

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Presentation transcript:

Coverage Initiative Healthy Way LA Focus Groups

Outline Introductions Focus Group Process Background of CI Eligibility Timeline Enrollment issues/barriers Suggestions to alleviate/overcome barriers Other comments

DHS 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 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 OR- −At least two primary care visits in the past year

Enhanced 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 (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 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 c ont’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 c ont’d Develop database & mechanism for PPP data entry Develop and translate member brochures, and other educational/informational documents And lots more!

Focus Group Discussion

Next Steps Comments to be written up in 1-2 page summary CI protocol to participants Summary to be distributed via to participants for comments/clarifications Possible focus group with patients Final summary integrating comments from all focus groups submitted to DHS