UCLA PowerPoint Presentation - Blue Shield of California Foundation

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Provider Network Best Practices• Telemedicine, mobile clinics• On-site or mobile specialty care and/or ancillary services (10counties)• Pay for performance incentives for HIT use (1 county)• Pharmacy benefit management (6 counties)• Referral management policies (10 counties)• Clinical care guidelines (10 counties)• Training to extend primary care provider scope <strong>of</strong> practice (7counties)• E-referral and e-prescription tools• Third Party Administrator (TPA)
Provider Networks in LIHP• Open versus Closed network requirement• “Open” – county will reimburse any provider who provides services to anenrollee• “Closed” – county authorizes/contracts with specific providers to care forenrollees• Closed network is considered a managed care system by CMS, subject toMedicaid MCO requirements• Option to carve out Mental Health network• Must cover out-<strong>of</strong>-network emergency services for MCE enrollees• Requirements for timeliness/access to care established by DHCS
Page 5 and 6: HCCI Enrollment: Total Unduplicated
Page 7 and 8: HCCI Enrollment Churn• Length of
Page 9 and 10: Any ChronicDisease*DiabetesDyslipid
Page 11 and 12: Average Number of Inpatient Days pe
Page 13 and 14: Network Definition in HCCI“Streng
Page 15: Challenges to Creating Provider Net
Page 19 and 20: Medical Home Features• Personal p
Page 21 and 22: Medical Home Best Practices• Enfo
Page 23 and 24: LIHP Eligible Population• LIHP El
Page 25: Contact Us• Nadereh Pourat: Poura

UCLA PowerPoint Presentation - Blue Shield of California Foundation

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