Juanita M' Simmons, FACHE

1
Care
Link

• Juanita M. Simmons, FACHE
• Executive Director

2
Demographics
3
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