1 / 12

Juanita M. Simmons, FACHE Executive Director

Juanita M. Simmons, FACHE Executive Director. Care. Link. Asian. 1%. Black. Other. White. 4%. 5%. Native Amer. 14%. .03%. 76%. Hispanic. Demographics. 35,000. 56%. 30,000. Enrollees by CareLink Program. 25,000. 20,000. 28%. 15,000. 10,000. 16%. 5,000. 0. CareLink A

giacomo-bradley
Télécharger la présentation

Juanita M. Simmons, FACHE Executive Director

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Juanita M. Simmons, FACHE Executive Director Care Link

  2. Asian 1% Black Other White 4% 5% Native Amer 14% .03% 76% Hispanic Demographics

  3. 35,000 56% 30,000 Enrollees by CareLink Program 25,000 20,000 28% 15,000 10,000 16% 5,000 0 CareLink A (0-75% FPL) CareLink B (76-150% FPL) CareLink C (151-200% FPL) Demographics • Average age of enrollees: • CareLink A- 42 years (14,464) • CareLink B- 44.1 years (29,970) • CareLink C- 46.5 years (7,548)

  4. 2007 Budget

  5. EnrollmentMember Months

  6. Financial Obligations Family of four: • Monthly obligation at 75% FPL = $24.94 • Monthly obligation at 100% FPL = $44.34 • Monthly obligation at 150% FPL = $99.77 • Monthly obligation at 200% FPL = $177.38

  7. YTD Cash Collections2004-2006

  8. Principle: Make evidenced-based health care decisions • InterQual clinical decision support • Health risk reduction & education program • Case management program

  9. Case Management Goals • Primary goal includes: • Reduction of health care costs • Secondary goals that will support the primary goal include: • Increasing member/family understanding of how to navigate and appropriately use health system services; • Increased member/family understanding of how to appropriately manage their disease; • Increased member/family opportunities to receive education about the continuum of care.

  10. Target Population • CareLink members with higher-than-normal utilization of services • High users of Emergency Care (EC) • Patients that incurred highest costs • Uncontrolled disease states that may lead to poor outcomes as defined by “Care Points” • Physician and staff referrals

  11. Case Management Savings • AVOIDED HOSP $381,107.80 • AVOIDED ER $ 18,645.00 • AVOIDED MIS $ 9,670.00 • APPTS KEPT 17,670 • HOME VISITS 2,530 • CONTACTS 13,481 • SAVINGS $409,422.80

  12. Metrics • Member access times • Referrals to other funding sources • Collection rate by CareLink group • Authorizations • Volume of filled prescriptions Average Wait Times for New Patients PCP: 1 week Specialist: 6 weeks

More Related