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