Inland Empire Health PlanInland Empire Health Plan Improving the Delivery of Healthcare for Our Community

Organized as a Joint Powers Agency, Inland Empire Health Plan (IEHP) is a local, not-for-profit health plan serving residents of Riverside

and San Bernardino counties through the following government-sponsored programs: Medi-Cal (including seniors and people with disabilities),

Healthy Kids, IEHP Medicare DualChoice (HMO SNP), and the new IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan).

Our Governing Board is comprised of representatives from each county, including four county supervisors and three appointed members

of the public, who provide direction and approval for all phases of IEHP operations.

Monthly IEHP Governing Board Meetings are held in public at the Board of Supervisors Chambers, alternating between the

San Bernardino and Riverside locations.

Gary Ovitt, ChairSan Bernardino County Supervisor

Marion Ashley, Vice-ChairRiverside County Supervisor

Dr. Dan Anderson Riverside County Member

Janice RutherfordSan Bernardino County Supervisor

John Tavaglione Riverside County Supervisor

Andrew WilliamsJoint County Public Member

Eileen ZornSan Bernardino County Member

Today a mother has to choose between buying food or health insurance for her family. A grandmother is unable to fill a prescription for her costly heart medication – and a child is hospitalized for a condition that could have been prevented, if only he could have seen a doctor regularly.

Nearly one in four Inland Empire residents lack health insurance, and live each day in fear of losing their life savings if faced with a medical emergency.

IEHP, a community-developed health plan, provides families in Riverside and San Bernardino counties with access to affordable, quality healthcare. IEHP started in 1996 with roughly 66,000 Medi-Cal members. Today, we coordinate the healthcare of over 990,000 low-income Inland Empire residents.

What sets IEHP apart from other health plans? How do we make a difference in the Inland Empire? This report answers those questions and demonstrates how we empower our community to live as healthy as possible.

Going forward, IEHP is committed to keeping members at the “center of our universe” through a dynamic partnership with our providers, award-winning service, and innovative products. Thank you for your interest and support of IEHP, your Inland Empire Health Plan. Bradley P. Gilbert, M.D., M.P.P. IEHP Chief Executive Officer

WelcomeWelcomeOur Governing BoardOur Governing Board

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Innovation, Collaboration, Community

In 1993, California shifted the delivery of Medi-Cal from a mainly fee-for-service system to capitated managed care. In response, Riverside and San Bernardino counties created IEHP as the local initiative HMO.

IEHP began operations in 1996 with the resolve to explore innovative ways of meeting the healthcare needs of our community. Participating in Healthy Families and partnering with local organizations to launch our Healthy Kids Program was a natural extension of our commitment. In 2002, IEHP became the first full-service health plan in the nation to receive full NCQA accreditation for Disease Management. A year later, IEHP sought to improve health outcomes for children in foster care and partnered with Riverside and San Bernardino counties to develop the Open Access program.

Soon after, IEHP began implementing a wide range of services for members with disabilities, leading to the establishment of the nationally recognized initiative, The Inland Empire Disabilities Collaborative, (IEDC).

Committed to ensuring quality healthcare, IEHP launched the Medicare DualChoice (HMO SNP) Program in 2007 and IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) in 2014 to help people with both Medi-Cal and Medicare navigate the complex healthcare system.

Looking ahead, IEHP is committed to continual improvement while creating even more effective ways of meeting the healthcare needs of families, children, adults, seniors, and people with disabilities in the Inland Empire.

Since 1996, IEHP has organized

the healthcare of over one million Inland Empire residents.

Our HistoryOur History

Mission StatementTo organize and improve the delivery of quality, accessible and wellness based healthcare service for our community.

Our Core ValuesOur Core Values

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Medi-CalCalifornia’s Medicaid program for low-income adults, working families with children, low-income seniors, and people with disabilities. Today, we coordinate the healthcare for approximately 968,000 Medi-Cal members in Riverside and San Bernardino counties.

Healthy KidsThe Healthy Kids Program provides health, dental, and

vision coverage for low-income, uninsured children who do not qualify for Medi-Cal or Healthy Families. IEHP currently serves more than 900 children.

IEHP Medicare DualChoice (HMO SNP)Designed for people who have full-scope Medi-Cal and Medicare Part A and B. IEHP Medicare DualChoice connects Medi-Cal, Medicare, and pharmacy benefits into one simple plan. Members need only one card for all their healthcareneeds. Currently, more than 11,000 people are enrolled in this program.

Our Products Our Products Setting the Standard for Excellence

AccreditationAccreditation

IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan)

Designed for people who have full-scope Medi-Cal and Medicare Part A and B. IEHP DualChoice connects Medi-Cal, Medicare, pharmacy, behavioral health and Long-Term Support Services benefits into one simple plan.

IEHP has earned “Accredited” Accreditation by the National Committee for Quality Assurance (NCQA) for

our Medi-Cal Program. NCQA is a not-for-profit organization dedicated to grading and monitoring performance among health plans and improving

health care quality.

IEHP was also one of the first health plans in America to earn Full NCQA Disease Management Accreditation for its comprehensive

Health Management Program.

IEHP earned these distinctions for surpassing NCQA’s rigorous standards in the following areas:

• Quality Improvement • Utilization Management • Physician Credentialing

• Member’s Rights and Responsibilities

These achievements are things all health plans strive for - but few obtain. With the support of our community, providers and team members, IEHP has.

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As a not-for-profit health plan, IEHP reinvests earnings into our members through comprehensive health education and wellness programs, as well as

other support initiatives. At all levels of operation, our primary focus is on the health and well-being of our members.

Our Wellness Department collaborates accross the organization to assess the healthcare needs of our members and design programs geared

to help them lead healthier lives.

Through the following programs, IEHP members are learning to build better habits for better health:

• Diabetes Self-Management • Living Well with a Disability

• Blood Pressure Management • Child Car Seat Safety

• Healthy Heart• Stop Smoking

• Bicycle Safety • Weight Loss • Healthy Babies • Family Asthma

Wellness ProgramsWellness ProgramsFocus on Prevention

“ We’re grateful for IEHP and the Family Asthma Program. We learned so much through the classes and Adriana feels much better - it ’s almost l ike she doesn’t have asthma any more.”

Roy is a pastor in a local church, where his wife, Virginia, serves as the children’s director. When their daughter’s asthma got out of control, they called IEHP and enrolled in the Family Asthma Program.

In Their Own WordsIn Their Own Words

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Open Access Open AccessFor Children in Foster Care

IEHP was one of the first health plans in America to earn full NCQA Disease Management Accreditation for our comprehensive Health Management Program.

The IEHP Health Management team assists our providers in coordinating care for members with

high-risk pregnancies and challenging asthma and diabetes cases.

Our Health Management team helps members understand and follow their doctors’ treatment

plans while keeping doctors informed of their patients’ progress. Regular contact and support affords these members

an opportunity to take control of their health.

Helping Members Maintain Their Health

Children in foster care often have significant health concerns that can affect their ability to become healthy adults. The trauma of separation from their families and placement in the foster care system often compound these conditions.

An additional challenge is that children in foster care may face changing placements – making it difficult to achieve continuity of care.

In 2003, IEHP partnered with Riverside and San Bernardino counties to address these concerns by launching the Open Access Program. Open Access significantly improves access to healthcare by allowing foster children the freedom to change providers whenever they need to do so.

Open Access also helps foster care parents by providing them with continuous tracking of immunizations, medications, and other medical history information.

Currently the Open Access Program serves 4,800 foster children. Children

in this program have more regular well-child visits and go to the emergency room less than those in a

straight Medi-Cal plan.

In 2008, Riverside County

was awarded the “California Counties Innovation Award”

for its collaboration with IEHP in improving healthcare for foster children through the

Open Access Program.

Health ManagementHealth Management

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Member FocusAward Winning ServiceAward Winning Service

People with Disabilities Workgroup (PDW )

IEHP invites our members with disabilities to participate in our PDW. Their experience guides our service and ensures accessibility in all programs and services.

Their feedback also helps us develop “AccessAbility,” a quarterly newsletter for our members with disabilities.

Public Policy Participation Committee (PPPC)

IEHP encourages its members to voice their opinions about IEHP public policy, publications, and services by joining the PPPC.

With their perspectives in mind, we communicate with our members through the quarterly newsletter, “The Pulse.”

Engaging MembersEngaging Members

Member Focus

24-Hour Nurse Advice LineThe IEHP Nurse Advice Line operates around the clock, 7 days a week via voice and TTY.

After hours, our nurses offer free and confidential advice to help members decide the best course of action to meet their medical needs - all from the comfort of their own homes.

Member Services DepartmentThe IEHP Member Services Representatives help members get the services they need, when they need it.

Our friendly, bilingual team will help members change their doctor, answer questions and help them solve issues by working accross the organization. The Medicare Member Services Representatives also help any IEHP Medicare DualChoice members get the help they need. Our Member Services team has been recognized for their outstanding

service:

• Rated in the 90th percentile in the national survey, Consumer Assessment of Healthcare Providers and Systems (CAHPS) since 2006 to now.

• Purdue University ’s “Center of Excellence” 2005 Award

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Provider Partner-Provider PartnershipOur NetworkOur Network

In our effort to improve the quality of healthcare for low-income families, IEHP recognizes the necessity of a strong working relationship with our providers - based on mutual respect, collaboration, and constant improvement.

Committed to engaging our providers in decision-making and keeping them informed about new policies, IEHP founded the Provider Advisory Committee (PAC) in 2003. The PAC includes two hospitals, two physicians, an optometrist, an IPA representative, and a pharmacy representative.

IEHP also offers on and off-site training for providers. We hold quarterly “Round Table” meetings, facilitating provider interaction with IEHP senior management staff. Each of these meetings are followed by Continuing Medical Education opportunities held on site. Provider Services Representatives visit provider facilities for on-site training.

Providers also have the opportunity to participate in our Pharmacy & Therapeutic Subcommittee (P&T). This committee, composed of six physicians, six pharmacists, and select IEHP staff, meets four times a year to

discuss clinical practice guidelines, drug trends, and formulary changes.

IEHP contracts with more than 1,150 primary care physicians, 2,300 specialists, 676 pharmacies, 30 major hospitals, and 314 vision providers throughout the Inland

Empire. Our wide network ensures that our providers are located where our members live.

Engaging Providers in Decision-MakingProvider PartnershipProvider Partnership

= Hospital = Provider

Victorville

San Bernardino

RiversideCoachella

Valley

Supporting the relationship

between our members and providers is the core of our mission.

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Provider PartnershipProvider Partnership In Their Own WordsIn Their Own Words

“IEHP is known for taking care of its providers, and making sure we have all we need tocare for our patients. I ’m pleased to work with such a progressive health plan.”

Dr. Tarek Mahdi is an active member of the IEHP Provider Advisory Committee. He is proud of his partnership with IEHP and their mutual commitment to putting the needs of the community first.

IEHP holds IEHP University each year to ensure that our IPA and hospital partners have the information and tools necessary

to best serve our members. We collaborate with the Center for Disability Issues and the Health Professions to offer

specific training on disability and related health care issues.

IEHP also keeps our providers in the know about our newest programs, incentive opportunities, and study results through “The Heartbeat,” our provider newsletter, and “ScrubTalk,”

our newsletter for provider staff.

We also offer our primary care physicians the opportunity to earn additional revenue through our Pay for Performance (P4P) Program.

Through P4P, physicians receive additional compensation for preventive services such as children’s immunizations, asthma and diabetes care,

sprenatal and perinatal services, and PAP tests.

Through our website, providers can also take advantage of convenient online services, such as member

health records. From member eligibility and medical history to claims

or authorization status the information providers

need to properly care for their patients is always on hand.

Keeping Our Providers Informed

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Disability CollaborativeDisability Collaborative Innovation ProjectInnovation Project

As a leader in accessible healthcare, IEHP prides itself on more than a decade of linking people with disabilities with quality

healthcare and support services.

Our dedication to improving the delivery of healthcare for our growing population of seniors and

members with disabilities led to the creation of a unique initiative called The Inland Empire

Disabilities Collaborative. Launched as a networking tool, the Collaborative brings together

more than 88 regional organizations that serve people with disabilities.

Through this joint effort, IEHP has led the way in promoting equal opportunity and universal access

for people with disabilities through services and summits like the Disability Resources Expo, a biennial event concentrated

on issues critical to independent living for people with disabilities – health, jobs, transportation, advocacy, housing,

assistive technology, and education.

Disabilities Rights California (DRC), the nation’s largest advocacy group for people with disabilities, recently honored

the IEHP-sponsored Disabilities Collaborative for its efforts in uniting and mobilizing organizations to better serve

people with disabilities. Visit the IEDC website at www.iedisabilitiescollaborative.org.

IEHP has partnered with select healthcare clinics and providers in Riverside and San Bernardino counties to develop an innovative delivery system model. This model aims to increase healthcare access and improve the health outcomes for IEHP members.

Enhanced Primary CareIEHP and several select Primary Care practices reach out to members who use the emergency department for avoidable visits, and explain the services they offer. For example, some of the practices offer extended office hours and an on-site clinic staff to help members access care.

Diabetes ManagementThe Diabetes Management model helps members with diabetes who are at risk for developing medium to high risk diabetic conditions. To improve health outcomes, and help control diabetic-related symptoms, diabetes clinics offer resources like an on-site nutritionist, diabetic educator and transportation for members to their medical visits.

Health NavigatorThe IEHP Health Navigators show members how to better use their benefits and guide them to the right level of care. They visit members in their home to understand their barriers and emphasize the importance of preventive care like annual check-ups. Members learn their health care access options like their doctor, the IEHP 24-Hour Nurse Advice

Line, after-hours clinics and urgent care clinics.

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Like many families in the Inland Empire, Jennifer found it challenging to afford healthcare for her children. So she joined IEHP, and has peace of mind, knowing that her children have quality health coverage.

In Their Own WordsIn Their Own Words

“My husband and I are so grateful to have IEHP for our family. Extra services l ike the Nurse Advice Line make all the difference, especially when you have active l ittle girls l ike mine.”

Community PartnersCommunity Partners

IEHP has a responsibility to enrich the lives of our membersand neighbors alike. We partner with local schools, community

and faith-based organizations, Riverside and San Bernardino County Public Health Departments, and many more to help uninsured

families get quality health coverage for their children.

Community Outreach volunteers participate in over 100 events annually. During the last 10 years, more than 680 IEHP team members have

donated nearly 46,000 hours of volunteer time after hours and on weekends to help spread IEHP’s message of health and

wellness to our community.

IEHP has also created unique ways to teach children about safety and healthy living.

IEHP super heroes, Super Nutricia, Eradicator and

Rad Rider, have made special appearances at hundreds

of community events throughout the Inland Empire - reminding

kids to eat healthy, stay away from cigarettes and practice

bicycle safety. To date, we have distributed nearly 100,000

bicycle helmets to children throughout the Inland Empire.

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AchievementsAchievements

IEHP Named the Highest-Ranked Medicaid Health Plan in California

IEHP is the highest-ranked Medicaid health plan in California according to the 2008 “America’s Best Health

Plans,” conducted by U.S. News & World Report and the National Committee for Quality Assurance (NCQA).

National Customer Satisfaction Survey For several years in a row, IEHP outscored most other Medicaid health plans on the Plan Customer Services

category in a national customer service survey by Consumer Assessment of Healthcare Providers and Systems

(CAHPS), which evaluates the interpersonal aspects of healthcare.

2008 California Counties Innovation Award Riverside County was awarded the “California Counties

Innovation Award” for its collaboration with IEHP in improving healthcare for foster children through the Open Access Program.

Highest Rating for Medicare Part D in 2010

Out of hundreds of Medicare Advantage Prescription Drug (MA-PD) plans in the nation, IEHP Medicare DualChoice (HMO SNP) is one of only five plans across the country that earned a 5-star rating for its Part D quality

and performance from the Centers for Medicare and Medicaid Services (CMS).

IEHP - Ca l i forn ia ’s H ighest-Ranked

Medical p lan

IEHP - Cal i forn ia ’s H ighest-Ranked

Medical p lan

National Committee for Quality Assurance (NCQA)IEHP earned “Accredited” Accreditation by the National Committee for Quality Assurance (NCQA) for Medi-Cal based on our well-established programs for service and clinical quality. IEHP was also one of the first health plans in the nation to earn full NCQA Disease Management Accreditation for its comprehensive Health Management Program.

Disabilities Rights California Honors IEHPDisabilities Rights California (DRC), the largest advocacy group for people with disabilities, honored The Inland Empire Disabilities Collaborative for its efforts in

uniting and mobilizing organizations to better serve people with disabilities. IEHP Doctors gave IEHP Excellent Satisfaction Scores in 2013 Over 98% of IEHP doctors would refer IEHP to their peers, and patients, compared to other health plans in provider relations, health management, website adequacy, and more. This survey is conducted by the Myers Group, a National Committee for Quality Assurance (NCQA) certified survey vendor.

IEHP Disability Program Receives many Distinctions • Governor Schwarzenegger appoints Ben Jauregui, the IEHP Disability Program Manager, to the State Independent Living Council (SILC).

• The Civil Rights Hero Award by the California Department of Fair Employment and Housing.

• Honored by the Mayor’s Model Deaf Community Committee

• Award for supporting the education of parents of children with disabilities by Fiesta Educativa.

• Award for supporting students with disabilities by the Youth Leadership Forum.

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AchievementsAchievements

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10801 Sixth St., Suite #120, Rancho Cucamonga, CA 91730(909) 890-2000 Voice • (909) 890-2003 Fax • (909) 890-0731 For TTY Users

www.iehp.org

©2014 Inland Empire Health Plan All Rights Reserved. MK-14-00786

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