So Many Changes-

Lisa M. RhodesSr. Administrative Associate

UNOS Region 5 Spring MeetingMarch 18-19th 2015

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Many Changes

There have been many changes for our patients, With OBAMA Care, Some Good, Some Bad

•Covered CA

•Cal MediConnect

•Medi-Cal Mandatory HMO enrollment

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The Impact

The changes came fast and furious. Our patients didn’t know or understand that changes were happening?

Their Insurances were changing rapidly, the financial coordinators and the clinical teams were trying to keep up with this on a daily basis.

•Medical care was delayed •Patients couldn’t get their medications as they did before•Services were being denied•Contracting issues

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How did we handle this turmoil

The financial coordinators started running eligibility and benefits every time the patients were scheduled to receive medical care. If there were changes they were working with the patients to help them through it by:

•Educating the patients to their new plan

•Opting out of the Medi-Cal HMO back to straight Medi-cal for Transplant patients

•Requesting Continuity of Care for long term post patients •Established LOA’s with the payers if necessary.

Positive changes that we have seen for the community and patients

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1.Increase in patient referrals

2.More patients with creditable insurance

3.Payer mix is changing

4.Payers are reaching out to contract with programs, which is good for all.

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