March 2018 -
In This Issue:
Letter to the Community from Bob Freeman,
Chief Executive Officer
Member Engagement Event
Our 10 Year Anniversary in San Luis Obispo County
California Children Service's (CCS) program
Non-Emergency Medical Transportation
& Non-Medical Transportation Benefit
4050 Calle Real
Santa Barbara, CA 93110
SAN LUIS OBISPO
1288 Morro Street
San Luis Obispo, CA 93401
Toll Free: (800) 421-2560
Tel: (805) 685-9525
A Letter to the Community from Our CEO, Bob Freeman
2017 brought us not one, not two, but three attempts to significantly alter the nation's health care system. They did not come to pass; however, it's clear that:
1) those proposing such alterations will try again, and
2) in this country we currently have radically different ideas as to what health care "reform" should entail.
Regardless of anyone's political philosophy, there are truisms that we must take into account when really talking about health care reform (or, more precisely, health care financing reform).
- First, people will continue to get sick regardless of insurance coverage, so reducing health care revenues, or eliminating existing coverage, doesn't correspondingly reduce health care expense...someone else just pays for it.
- Second, modern western society, or human society for that matter, doesn't morally allow people to die on the street because they either didn't purchase or can't afford health coverage.
- Third, health care is not a commodity, product or service where price alone rules. It's potentially life and death. If someone is seriously sick, they don't shop for the lowest priced physician, they search for the best physician.
If you accept that the above three tenets are indeed accurate, then health care reform becomes much more straightforward in a practical sense. For example, Medicare Advantage plans (Medicare benefits administered by private health plans but financed and regulated by CMS provides for the following on a national level:
- One set of payment, quality and utilization standards that all payers (health insurance plans) providers (physicians, hospitals, etc.) must follow.
- Payers, physicians and hospitals are all rewarded for providing quality care (Star Ratings) and penalized for bad practices.
- There is a robust auditing, and waste fraud and abuse component that help safeguard premium payments and taxpayer dollars.
- High levels of patient satisfaction are a significant measurement that all parties must meet.
- In most cases, people can keep their favorite physician, hospital, health plan, etc. To be clear, I'm not advocating we force everyone in the nation into a Medicare Advantage plan. My point is that if we seek to address the above tenets and focus the discussion on cost effectiveness, high quality of care, patient choice and satisfaction and effective oversight, there are systems that currently exist and work fairly well that can be used as a starting point for truly making health care better. I only hope people can. If not, at least do not call it health care reform.
Robert S.Freeman, CEO, CenCal HEALTH
Member Engagement Event "Journey of Learning"
CenCal Health held our first ever Member Engagement Event, which was titled "The Journey of Learning." The Community Action Commission generously donated their Santa Maria facility for the day.
We invited new members, specifically families with children to participate. Our staff provided educational materials and resources to assist our members to learn how to be "the best patients they can be."
This event not only gave our staff the opportunity to communicate face-to-face with our members, but also afforded them the ability to truly connect with our members and our mission.
Several Community Based Organizations participated such as Departments from Santa Barbara Public Health, Family Service Agency, Santa Maria Promotorres, Bici Centro and Community Action Commission.
In line with our mission of improving nutrition amongst our members, a healthy snack was provided.
In addition to live entertainment by Latin Dancers, there was a raffle with donated gifts to promote healthy living such as gift certificates to Bici Centro, which allows the recipient to learn how to restore and fix their own bike. This experience promotes self-esteem, strong work ethic and a healthy way of life for our local youth.
We plan to host several more Member Engagement Events throughout Santa Barbara and San Luis Obispo County in 2018.
CenCal Health Celebrates 10 Years
in San Luis Obispo County
On March 28, CenCal Health held an event to thank the local providers and community members that have supported our Managed Care Program in San Luis Obispo County. We gratefully recognize the community and provider network, who have provided service and supported our members for the last ten years.
What began as a small pilot program, over 34 years ago, has grown into a community health plan with a service area of 2 counties and about 178,000 members. The program that began in 1984 is now acknowledged as the oldest Medicaid-only managed care program of its kind in the country. We take pride and will continue to be a local solution to a national problem.
CenCal Health presented awards to Primary Care Providers that have given their service to CenCal Health members for 10 years. Legislative Proclamations where bestowed from Senator William Monning's office, Congressman Salud Carbajal's office, and Assemblyman Jordan Cunningham's office. Those honored providers were:
- Central Coast Pediatricians
- Community Health Centers of the Central Coast
- William S. Morgan, M.D.
- Pismo Family Practice
- Bravo Pediatrics
- Garry R. Kolb, M.D.
- Warren H. Frankel, M.D.
- Robert S. Firestone, M.D.
- Jeffrey M. Bloom, M.D.
Upcoming Changes to the California Children Service's (CCS) program
Beginning July 2018, CenCal Health members who are California Children's Services (CCS) eligible will receive care coordination by CenCal Health for both Santa Barbara and San Luis Obispo Counties. This change is part of the Whole Child Model of care implementation; improving integration of services and coordination of care across providers. CenCal Health will be responsible for case management and authorizing medically necessary covered services, such as pediatric referrals, hospital stays, medications, supplies, and durable medical equipment.
Care coordination of non-CenCal Health members, will remain under the responsibility of the local County CCS office. The County CCS Medical Therapy Program will not change and will continue to provide medical therapy services to CCS members.
CenCal Health is establishing a Pediatric Clinical Advisory Board (PCAB) to be comprised of CenCal Health's Chief Medical Officer, Santa Barbara and San Luis Obispo CCS Medical Directors and local CCS paneled providers to provide input for medical policy, review treatment authorization procedures as well as pediatric care and quality improvement processes.
CenCal Health is also forming a Family Advisory Committee to involve families in the CCS transition. If you would like to participate, and you are a parent of a CCS child or in the CCS program, contact CenCal Health or County CCS.
If you have questions about the CCS transition or the Family Advisory Committee:
- Call the County CCS office: Santa Barbara 805-681-5360 or San Luis Obispo 805-781-5527
- Call CenCal Health at 1-877-814-1861
Non-Emergency Medical Transportation and Non-Medical Transportation Benefit
The Department of Health Care Services (DHCS) established additional coverage for Non-Medical Transportation ("NMT"), effective October 1, 2017 to ensure transportation for medically necessary service to Medi-Cal members. Effective January 1, 2018, CenCal Health implemented the NMT benefit in addition to the existing transportation benefit to members who require transportation under a prescription for Non-Emergency Medical Transportation ("NEMT").
In an effort to ensure appropriate intake and coordination of member transportation services, CenCal Health has partnered with Ventura Transit System (VTS) to assist in the arrangement and management of transportation services. All NEMT and NMT services will be arranged for by VTS who will coordinate with CenCal Health's current contracted providers, Easy Lift, Smooth Transportation and Ride-On.
Members requiring NMT or NEMT can contact VTS directly at (855) 659-4600 or CenCal Health's Member Services Department at (877) 814-1861 to arrange for covered transportation services.
A screening will be completed upon the transportation request to ensure the level of need. VTS and CenCal Health will coordinate along with the Member's Physician to determine the type of transportation required.
NEMT services will require an authorization from CenCal Health. A Physician Certification Statement (PCS) will be completed based on the member needs and faxed to the referring physician for approval.
April 21st - Family Care Network, Inc.
"Miracle Miles for Kids"
April 25th - Transition House
"Mad Hatter Luncheon"
May 8th - UCSB Economic Forecast project
"2018 UCSB Economic Summit"
May 11th - Visiting Nurse and Hospice Care
"17th Annual Mother's Day Luncheon
May 12th - Meals That Connect
"Night of a Million Meals"
May 17th - Community Action Commission of Santa Barbara County
May 24th - County of San Luis Obispo Department of Social Services
"Mobile Assistance Serving Homelessness (M.A.S.H.)