1. health and fitness

First Quarter Edition: Volume 1
April 2015
Health Care LA, IPA
Inside This Issue:
Newsletter “Express
Information Monthly Update”
1. HCLA Summary for 2014
2. HCLA Goals for 2015
3. Electronic Funds Transfer
4. HEDIS Measure Compliance
5. Redetermination of Medi-Cal Expansion Members
6. HCLA Dinner Meeting – Tuesday, March 31, 2015
7. In Memoriam – Risë Phillips
8. PCP Perspective
9. Communications Corner
As part of the ongoing organizational improvement efforts of Health Care LA, IPA, the Board of Directors has developed this
update for member organizations regarding IPA activities. The Board appreciates your partnership with HCLA, and is committed
to improving communication with all IPA members. If you would like to suggest future topics for the update, please email Iris
Weil at [email protected].
HCLA Summary for 2014:
HCLA Goals for 2015:
2014 represented a significant year for both HCLA and the
Health Care industry as a whole.
 New lines of businesses were introduced:
o LIHP- Low income Health Plan Participants
o Medi-Cal Expansion Patients
o Covered California (California Exchange Patients)
o Cal-MediConnect Patients (Medi-Medi patient
population)
 As a result of the added membership, HCLA grew 63%
 HCLA stepped up its Transition of Care process with
the Health Center Members
 We worked with Health Centers to improve overall
IPA financial performance.
 HCLA’s medical expense ratio improved 3.6%
 17 Health Centers qualified for the 2013 IPA bonus
program, and the IPA distribution totaled $500,000.
 Improve management of patients with Ambulatory Sensitive
conditions who received care in ER Department.
 Focus on reducing hospital readmissions
 Tracking and trend specialty referrals
 Increase focus on the transition of care from the hospital and
ER discharges
 Find new ways to engage Health Center leadership and
patients in preventive health screening adherence in order to
improve quality of care in HEDIS and Stars performance
metrics.
 Continued emphasis on member satisfaction for improved
patient retention
 Continued emphasis on encounter data submission
compliance
 Continued emphasis on HCC coding compliance
Electronic Funds Transfer:
HEDIS Measure Compliance:
HCLA now has the capability of paying monthly cap checks
electronically. If you have not signed up for this feature
and would like to, please contact Donna Castonguay at
[email protected]. She will
provide you with the necessary paperwork to begin the
process.
Health Net provided MedPOINT with a list of Medi-Cal members
assigned to your facilities who have been identified as missing
certain HEDIS preventive measures.
MPM will be forwarding these lists to your Health Centers. Please
begin to review the list, and develop a workflow at your facility to
reach out to those patients to schedule preventive screenings
before year-end.
Your participation and cooperation is greatly appreciated.
Health Care LA, IPA
Newsletter
“Express Information Monthly Update”
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Volume 1:
April 2015
Spring Edition
Redetermination of Medi-Cal Expansion Members:
HCLA Dinner Meeting – Tuesday, March 31, 2015:
Since the first of the year, many Health Centers have
inquired as to the disenrollment of Medi-Cal Members.
Thank you to all that joined the HCLA meeting at the
Cathedral. The well attended dinner was lead with discussion
by Bernadette Loftus, a Kaiser Permanente physician leader,
who shared how physician leadership and employee
engagement can drive performance. Please see email dated,
April 7, 2015, for a copy and summary of the presentation.
There has been a major effort by the State on the
redetermination of the Medi-Cal Expansion members. We
believe that the State was so overwhelmed with the number
of applicants, that they may not have done a complete
determination of member eligibility, which they are now in
the process of doing.
As a result, HCLA has seen a drop in membership since the
first of the year. We are told that things should be completed
sometime in April.
We recognize the inconvenience, but unfortunately, we have
not control of the situation. We are reporting out the
information we receive from the various Health Plans. Any
further updates will be shared to our entire membership.
PCP Perspective:
It is important for PCP’s to have specialist results on file when
the patient returns for an exam, in order to ensure proper
coordination of care and timely access to specialty evaluation
findings and results.
Take advantage of MPM’s NEW feature and attach your
consult notes directly to the original authorization.
If you are providing results to the referring physician as soon
as they are available, we thank you. If not, we ask that you
make this a priority, evaluate your office processes and
consider putting protocols in place to insure that the reports
are regularly sent to PCPs as soon as available using our web
feature. You are a strategic part of a care coordination
system that will not work without your attention to this.
In Memoriam – Risë Phillips:
HCLA is saddened by the recent passing of Risë Phillips. Risë a
true advocate and active leader for the IPA; worked both as a
Board Member and member of the Finance Committee. She
was an asset to our Community and will be greatly missed.
Communications Corner:
2/25/2015: Schedule for Health Net 2015 Provider
Teleconferences (email distributed to HCLA CEO, CMO, COO, CFO
and Executive Assistants)
3/4/2015: Cervical Cancer Screening Assistance Needed to
Maximize HN Quality Improvement Incentive (email distributed
to HCLA CEO, CMO, COO, CFO and Executive Assistants)
3/5/2015: HCLA Health Net Dinner Invitation (email distributed
to HCLA CEO, CMO, COO, CFO and Executive Assistants)
3/9/2015: New Feature to Submit Consult Notes Online (email
distributed to HCLA CEO, CMO, COO, CFO and Executive
Assistants)
3/11/2015: HCLA 1st Quarterly UM Focused Meeting Invitation –
3/27/2015 (email distributed to HCLA CEO, CMO, COO, CFO and
Executive Assistants)
If you missed any of the HCLA Notices referenced above, please
feel free to email Joy Say at [email protected] for
another copy.
We want to help keep you informed.
Attaching notes onto an authorization provides ease to
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3/18/2015: LA County Regional Centers – Early Start
Criteria_01/01/15 (email distributed to HCLA CEO, CMO, COO,
CFO and Executive Assistants)