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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

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Juanita M. Simmons, FACHE Executive Director

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  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

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