04/19/2304/19/23

Juanita M. Simmons, FACHEJuanita M. Simmons, FACHEExecutive DirectorExecutive Director

DemographicsDemographics

Other

4%

Hispanic

76%76%76%76%

Native Amer

.03%

White

14%14%14%14%

Black

5%5%5%5%

Asian

1%

DemographicsDemographics

Average age of enrollees:Average age of enrollees: CareCareLinkLink A- 42 years (14,464) A- 42 years (14,464) CareCareLinkLink B- 44.1 years (29,970) B- 44.1 years (29,970) CareCareLinkLink C- 46.5 years (7,548) C- 46.5 years (7,548)

28%

56%

16%

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

CareLink A(0-75% FPL)

CareLink B(76-150% FPL)

CareLink C(151-200% FPL)

Enrollees by CareLink Program

2007 Budget2007 Budget

5 9 %

3 %

2 6 %

6 %

6 %

H o s p it a l E x p e n s e $ 6 0 m il l io nA d m in is t ra t iv e O v e rh e a d $ 3 m il l io nP h y s ic ia n E x p e n s e $ 2 6 m il l io nA n c il la ry E x p e n s e $ 6 m il l io nP h a rm a c y E x p e n s e $ 6 m il l io n

EnrollmentEnrollmentMember Months Member Months

6 2 0 0 0 0

6 3 0 0 0 0

6 4 0 0 0 0

6 5 0 0 0 0

2 0 0 4 6 4 5 7 1 4

2 0 0 5 6 4 6 4 5 0

2 0 0 6 6 3 0 7 9 5

Financial ObligationsFinancial Obligations

Family of four:Family of four:

Monthly obligation at 75% FPL = $24.94Monthly obligation at 75% FPL = $24.94

Monthly obligation at 100% FPL = $44.34Monthly obligation at 100% FPL = $44.34

Monthly obligation at 150% FPL = $99.77Monthly obligation at 150% FPL = $99.77

Monthly obligation at 200% FPL = $177.38Monthly obligation at 200% FPL = $177.38

YTD Cash CollectionsYTD Cash Collections2004-20062004-2006

1 1 , 1 1 5 , 3 6 3

1 2 , 1 4 4 , 3 8 5

1 3 , 0 1 8 , 8 5 4

1 0 0 0 0 0 0 0

1 0 5 0 0 0 0 0

1 1 0 0 0 0 0 0

1 1 5 0 0 0 0 0

1 2 0 0 0 0 0 0

1 2 5 0 0 0 0 0

1 3 0 0 0 0 0 0

1 3 5 0 0 0 0 0

2 0 0 4 2 0 0 5 2 0 0 6

Principle: Make evidenced-based Principle: Make evidenced-based health care decisionshealth care decisions

InterQual clinical decision support Health risk reduction & education programCase management program

Case Management GoalsCase Management Goals Primary goal includes:Primary goal includes:

Reduction of health care costsReduction of health care costs Secondary goals that will support the Secondary goals that will support the

primary goal include: primary goal include: Increasing member/family understanding Increasing member/family understanding

of how to navigate and appropriately use of how to navigate and appropriately use health system services;health system services;

Increased member/family understanding of Increased member/family understanding of how to appropriately manage their disease;how to appropriately manage their disease;

Increased member/family opportunities to Increased member/family opportunities to receive education about the continuum of receive education about the continuum of care.care.

Target PopulationTarget Population

CareLink members with higher-than-normal CareLink members with higher-than-normal utilization of services utilization of services

High users of Emergency Care (EC) High users of Emergency Care (EC) Patients that incurred highest costsPatients that incurred highest costs Uncontrolled disease states that may lead to poor Uncontrolled disease states that may lead to poor

outcomes as defined by “Care Points”outcomes as defined by “Care Points” Physician and staff referralsPhysician and staff referrals

Case Management SavingsCase Management Savings

AVOIDED HOSP $381,107.80AVOIDED HOSP $381,107.80 AVOIDED ERAVOIDED ER $ 18,645.00 $ 18,645.00 AVOIDED MIS $ 9,670.00AVOIDED MIS $ 9,670.00 APPTS KEPTAPPTS KEPT 17,670 17,670 HOME VISITSHOME VISITS 2,530 2,530 CONTACTSCONTACTS 13,481 13,481

SAVINGSSAVINGS $409,422.80 $409,422.80

MetricsMetrics

Member access times Referrals to other funding sources Collection rate by CareLink group Authorizations Volume of filled prescriptions

Average Wait Times for New PatientsPCP: 1 week

Specialist: 6 weeks

Average Wait Times for New PatientsPCP: 1 week

Specialist: 6 weeks