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					     Polk HealthCare Plan
Citizens HealthCare Oversight Committee
                Meeting

              Neil Combee Bldg.
                Boardroom
              October 20, 2006

             Administered by:
Community Health and Social Services Division

               Sponsored by:
 Polk County Board of County Commissioners
       MANAGEMENT TEAM

           Edgar I. Smith, Jr.
                      Director

     Debi Curry                           Wilma Daniels
 Office Manager IV                       Program Manager
CHSS Administration                    Social Services Section


Jo Ann Fioravanti                            Gwen Hall
 Project Manager                    Risk and Compliance Manager
   HCAP Grant                         Provider Relations Section


                       Steve Yaskal
                      Fiscal Manager
                  Fiscal Services Section
Information on Low Income
    Pool (LIP) Program

 Edgar I. Smith, Jr., Director
 Community Health & Social
           Services
    INFORMATION ON LOW INCOME POOL (LIP)
                 PROGRAM
•   The Agency for Health Care Administration (AHCA) announced the appointment of the Low
    Income Pool (LIP) Council. The council, as authorized through HB 3B of the 2005-2006
    Special Session, will replace the Medicaid Disproportionate Share Council effective July 1,
    2006.

•   The Florida Legislature mandated the composition of the council to include three
    representatives of statutory teaching hospitals, three representatives of public hospitals, three
    representatives of private non-profit, three representatives of private investor-owned, two
    representatives from rural hospitals two representatives of units of local government which
    contribute funding, and one representative of family practice teaching hospital.

•   The LIP Council is charged with advising AHCA on the development of the low income pool
    program required by the federal Centers for Medicare and Medicaid Services pursuant to the
    Medicaid reform waiver. The low income pool was established to ensure continued
    government support for the provision of health care services to Medicaid, underinsured and
    uninsured populations. The low income pool consists of a capped annual allotment of $1
    billion. Funds from the pool may be used for health care expenditures which may be incurred
    by hospitals, clinics, or other provider types for uncompensated medical care costs of medical
    services for the Medicaid, underinsured and uninsured populations.
  INFORMATION ON LOW INCOME POOL (LIP)
           PROGRAM - continued


•The LIP Council will make recommendations on the financing and distribution of funds of the
low income pool and the Disproportionate Share Hospital program. The Agency will also seek the
advice of the council on the distribution of the funds used to adjust inpatient hospital rates, rebase
rates, or other wise exempt hospitals from reimbursement limits as financed by intergovernmental
transfers.

•Low Income Pool Permissible Expenditures. Funds from the LIP may be used for health care
expenditures (medical care cost or premiums) that would be within the definition of medical
assistance in Section 1905(a) of the Act. These health care expenditures may be incurred by the
State, by hospitals, clinics, or by other provider types for uncompensated medical care costs of
medical services for the uninsured, Medicaid shortfall (after all other Title XIX payments are
made) may include premium payments, payments for provider access system (PAS) and insurance
products for such services provided to otherwise uninsured individuals, as agreed upon by the State
and CMS.
POLK HEALTHCARE
    ALLIANCE

  Connie Kinnick, COC
        Member
Polk HealthCare Alliance
        Liaison
   FISCAL YEAR 2006




“A CELEBRATION OF SUCCESS”
Plan Eligibility & Enrollment

        Wilma Daniels
      Program Manager
    Social Services Section
                                       Polk HealthCare Plan
                                      Unduplicated Enrollment
20,000                                                                                                          1,231
                                                                                                                     14,365
18,000                                                                                                 1,391
                                                                                               969            13,134
16,000
                   YTD Increase in Enrollment                                                        11,743
14,000                                                                             1,208
                       11,436     390.4%                                       1,216 10,774
12,000
                                                                     1,223
                                                                                     9,566
10,000                                                       1,181         8,350
                                                     819
 8,000                                      547                    7,127
                        524       538                      5,946
              589
 6,000                                  4,580 5,127
                    3,518 4,042
 4,000    2,929
 2,000

      0

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   SOCIAL SERVICES OVERVIEW OF
  CLIENTS SERVED FISCAL YEAR 2006


• A total of 23,102 client interviews were conducted..

• Calls In and calls out totaled: 69,330

• Referrals to other Agencies were: 2,722

• Case Management Services: 15, 670

• Total Outreach Contacts: 9,227
    SOCIAL SERVICES OUTREACH EVENT HELD
                   FY 2006
April 1, 2006     Health Fair, Haines City               51 people received information


May 2, 2006       Town Hall Meeting, Winter Haven        30 people received information


June 1, 2006      Town Hall Meeting, Lakeland            40 people received information


June 3, 2006      Ft. Meade Health Fair                  30 people received information


June 17, 2006     Hurricane Expo, Winter Haven           250 people received information


June 17, 2006     Juneteenth Celebration, Bartow         55 people received information


July 27, 2006     Education & Employment Fair            150 people received information
                  Winter Haven
August 31, 2006   Hearth Advocate – Polk County          130 people received information
                  School Board Auditorium, Bartow


Sept. 20, 2006    Lakeland Housing Authority Job Fair,   300 people received information
                  Lakeland
Sept. 21, 2006    Health Summit, Winter Haven            100 people received information
 Provider Relations

       Gwen Hall
  Risk and Compliance
        Manager
Provider Relations Section
   Community Health and Social Services Division
          Incoming Call Volume Comparison – Main Line

10000
 9000                                                                                         8,945

 8000
7000
6000            5,966
                                                                                                 4,890
5000
4000
3000            2,434
2000
1000
   0
          Oct     Nov     Dec     Jan   Feb     Mar      Apr     May      Jun      Jul    Aug      Sep


        2004/05         2005/06                         Main Switchboard Activities Only
                                              Note: 268% increase in call volume monthly since 04/05.
                      Customer Contacts
                            Fiscal Year Comparisons
12000


                                                                                       10,396
10000



 8000



 6000
             4,781                                                                        5,083


 4000

         2,457                                                                            2,082
 2000
             2,378

    0
        Oct     Nov    Dec    Jan   Feb     Mar      Apr    May     Jun     Jul     Aug    Sep

  FY 03/04       FY 04/05     FY 05/06                         Managed Care Unit Only
                                                        (Authorizations, Referrals & Case Mgmt)
                                          Note: 397% increase since 03/04. Addition of one (1) FTE in 04/05 only.
          Ambulatory Surgical Center
                    Fiscal Year Comparisons
600

500                                                                                       482

400

300

200

100

  0          0          0          0          0             0              1
        FY 99-00   FY 00-01   FY 01-02   FY 02-03      FY 03-04       FY 04-05      FY 05-06


      FY 05-06 = 10/1/05 – 9/30/06            Note: New contracts for outpatient surgery.
                                              Alternative to being performed at a hospital.
       Outpatient Hospital Authorizations
                        Fiscal Year Comparisons
3500
                                                                                            3,149
3000

2500

2000

1500                     1,351
                                                                                1,499
                                      1,087          1,230

1000                                                              1,025
              813

 500

   0
        FY 99-00    FY 00-01     FY 01-02       FY 02-03     FY 03-04      FY 04-05     FY 05-06


                                              Example: Surgery, hospital based testing, etc.
  FY 05-06 = 10/1/05 – 9/30/06                Note: 287% increase since 99/00. Addition of one
                                              (1) FTE in 04/05 only.
                  Behavioral Health Services
                              Fiscal Year Comparisons

80
                                                                                         69
70

60
50

40
30

20

10
 0          0           0             0          0          0            0
       FY 99-00    FY 00-01      FY 01-02   FY 02-03   FY 03-04     FY 04-05      FY 05-06

     FY 05-06 = 10/1/05 – 9/30/06                        Note: New Benefit for Members
         Emergency Room Authorizations
                          Fiscal Year Comparisons
6000                                                                                       5,474

5000

4000

3000

2000
                                                                                1,678
                          1,477
1000                                                1,052         1,055
              637                      855

   0
        FY 99-00    FY 00-01      FY 01-02     FY 02-03      FY 03-04     FY 04-05      FY 05-06


  FY 05-06 = 10/1/05 – 9/30/06           Requires 100% review and approval by Registered Nurses or
                                         Manager only. Comprehensive & detailed process.
                                         Note: 759% increase since 99/00 with no additional FTE’s.
          Inpatient Hospital Authorizations
                         Fiscal Year Comparisons
2000
                                                                                           1,852
1800

1600

1400

1200

1000
                                                                               736
800
                       612
                                                   502         475
600
                                   406
           302
400

200

   0
       FY 99-00   FY 00-01   FY 01-02       FY 02-03      FY 03-04      FY 04-05     FY 05-06
                                        Requires 100% review and approval by Registered Nurses or
  FY 05-06 = 10/1/05 – 9/30/06          Manager only. Comprehensive & detailed process.
                                        Note: 513% increase since 99/00 with no additional FTE’s.
          Medical Service Authorizations
                           Fiscal Year Comparisons
25000
                                                                                                                21,850

20000


15000


10000                                                                                             9,082


 5000
                                                            4,462              4,564
                           3,842        3,656
              1,750
    0
         FY 99-00     FY 00-01     FY 01-02         FY 02-03            FY 03-04           FY 04-05          FY 05-06
                                              Example: Specialists (Orthopedics, Cardiology and General Surgery);
  FY 05-06 = 10/1/05 – 9/30/06                            Physical Therapy, CT Scans, Ultrasounds, etc.
                                              Note: 1,149% increase since 99/00. Addition of one (1) FTE in 04/05 only.
               Total Medical Authorizations
                             Fiscal Year Comparisons
                                                                                                 33,133
35000

30000

25000

20000

15000                                                                                13,030
                                                        7,246
10000                       7,282
                                                                   7,119
                                          6,004
              3,502
 5000

    0
         FY 99-00     FY 00-01      FY 01-02         FY 02-03     FY 03-04     FY 04-05       FY 05-06

                                               Note: 846% increase since 99/00. Addition of one (1) FTE
  FY 05-06 = 10/1/05 – 9/30/06                 in 04/05 only.
                                Provider Relations Section
                                       FY06/07 Workload Indicators

                                                               FY 04/05               FY 05/06            % of
                                                                Actual                  YTD             Increase
Polk HealthCare Plan Unduplicated Enrollment                             2,929              14,101            381%

WORKLOAD INDICATORS
Customer Contacts*                                                      75,595            141,027               87%
Provider Recruitment (Goal: 15% Increase)                                  114                 298            161%
Authorizations/Referrals
      Ambulatory Surgery Center                                               1                463            462%
      Outpatient Hospital                                                1,496               3,149            110%
      Behavioral Health                                                       0                  69             69%
      Emergency Room                                                     1,678               5,474            226%
      Emergency Room Professional                                            37                257            596%
      Inpatient Hospital                                                   736               1,852            152%
      Medical Services (Non-Hospital)                                    9,082              21,850            141%
Total Authorizations                                                   13,030             33,133             154%

YTD Total is October 1, 2005 to September 30, 2006. Percentage (%) of increase is based on FY 04/05 Actual compared to
 FY 05/06 Actual. PHP Enrollment FY 04/05 is Beginning Actual. *Customer Contacts YTD is October 1, 2005 – August 30,
       2006, and is not all inclusive at this time – pending I.T. data reports for accurate totals (volume will be higher).
Fiscal Services

  Steve Yaskal
 Fiscal Manager
          Polk HealthCare Plan
                  Enrollment Ethnicity
         October 1, 2005 – September 30, 2006

60.00%

50.00%

40.00%

30.00%         57.55%       21.19%      19.58%      1.68%
20.00%

10.00%

0.00%

         Caucasian   African American    Hispanic   Other
                            Polk HealthCare Plan
                        Value of Services Provided vs. Amount Expended
                             October 1, 2005 – September 30, 2006

        $120,000,000
        $100,000,000
         $80,000,000

         $60,000,000                                                      Value of Services
                                                                          Provided
         $40,000,000                                                      Amount Expended
         $20,000,000
                   $0
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                                  Total        Hospitals                  Physicians        Total Rx's
Amount Billed by Provider       $114,583,938 $86,020,620                 $24,563,318      $ 4,000,000
Amount Paid to Provider         $ 15,976,114 $ 7,181,647                 $ 6,345,249      $ 2,449,218

 Total Cost per Unduplicated Enrollee for the period: $1,390 per year, $115.83 per month.
      Polk HealthCare Plan
            Claims Processed
  October 1, 2005 – September 30, 2006

150,000           128,920
140,000                                      113,617
130,000
120,000
110,000
100,000
 90,000
 80,000
 70,000
 60,000
 50,000                                                              15,303
 40,000
 30,000
 20,000
 10,000
      0
            Total Claims           Claims Approved             Claims Denied
             Reviewed                for Payment
   There were 250 working days during this period. An average of 516 claims processed per
   working day.
               Indigent Health Care Fund
                Expense Budget Analysis
   For the Period October 1, 2005 thru September 30,
                         2006
                             Actual YTD    Budget YTD     Variance

Salaries & Related Expense   $ 1,381,002   $ 1,690,304   ($   309,302)
Claims Paid                  $13,465,051   $30,514,227   ($17,049,176)
Medicine & Drugs             $ 2,238,032   $ 1,740,000   $    498,032
We Care                      $    45,000   $    60,000   ($    15,000)
Health Department            $   289,000   $   289,000   $           0
Substance Abuse              $   278,063   $   305,000   ($    26,937)
Mental Health                $   722,254   $   722,254   $           0
H.C.R.A.                     $    62,537   $   125,000   ($    62,463)
Other Expenses               $ 1,410,085   $ 1,638,441   ($   228,356)
Indirect Expense             $    74,119   $   335,619   ($   261,500)
       TOTAL                 $19,965,143   $37,419,845   ($17,454,702)
                Indigent Health Care Fund
            Half-Cent Sales Surtax Revenues
   For the Period October 1, 2005 thru August 31, 2006
                               Received by Polk County

October                                          $ 2,747,407
November                                           2,628,477
December                                           2,772,586
January                                            3,920,559
February                                           2,815,425
March                                              2,796,411
April                                              3,892,190
May                                                2,848,579
June                                               2,866,294
July                                               3,584,613
August                                             2,636,585
September
TOTAL TO DATE                                    $33,509,126
11-Month Budget                                  $28,967,596
             Polk HealthCare Plan Expense
             Analysis October 1, 2005 – September 30, 2006

                       14.8%
                                                                                 32.9%




21.5%

                                                                               3.6%
                        13.9%
                                                      6.3%         2.1% 4.8%

 Hospital Inpatient        Hospital Outpatient       Emergency Room      Hospital Diagnostic

 Pathology/Radiology       Primary Care Physicians   Specialists         Rx
                           Polk HealthCare Plan
                                   Provider Costs by Specialty
                              October 1, 2005 – September 30, 2006
                                       1.2% 1.2% 0.9%
                               1.6%1.6% 0.6%            5.7%
                          3.1%
                 2.9%                                                         13.0%
       4.2%
   3.3%                                                                                     1.6%
 4.5%                                                                                        5.6%




0.7%
                                                                                              5.4%


                                                                                     7.1%
               26.0%                                                   3.5%
                                                               6.5%
        Anesthesiology 5.7%           Cardiology 13.0%            Dermatology 1.6%
        Emergency Medicine 5.6%       Gastroenterology 5.4%       General Surgery 7.1%
        Gynecology 3.5%               Family Practice 6.5%        Internal Medicine 26.0%
        Internal Med. Hospital 0.7%   Neurology 4.5%              Opthalmology 3.3%
        Orthopedics 4.2%              Other 2.9%                  Pain Management 3.1%
        Podiary 1.6%                  Pulmonary Disease 1.6%      Pulmonology - 1.2%
        Surgical Oncology - 0.6%      Urology 1.2%                Vascular Surgery 0.9%
Healthy Communities Access
          Program
      JoAnn Fioravanti
       Project Manager
                    2ND ANNUAL PARTNERS
                            FOR A
                       HEALTHIER POLK

The Healthy Communities Access Program (HCAP) partnering with the Polk
Health Care Alliance put on the 2nd annual Partnerships for a Healthier Polk.
The conference was held on September 21, 2006 at the Best Western Admirals
Inn in Winter Haven was a huge success providing community education,
gaining some new ideas and help to gather perspectives on things that can be
accomplished. The keynote speaker was Dr. Pedro Jose Greer, Jr. of the
University Of Miami School Of Medicine; who runs a primary care clinic and
is an author and received the Presidential Service Award in 1997. Other
speakers were Mr. Thomas Arnold Deputy Secretary for Medicaid, Agency
for Health Care Administration and Catherine Peper, Vice President of e-
medical technology, Blue Cross Blue Shield of Florida to talk about how
information technology can improve the Quality and Affordability of Health
Care.
                      HCAP FISCAL YEAR 2006
                        ACCOMPLISHMENTS


1. The Healthy Community Access Program (HCAP); held a Diversity Training in
   November 2005. Over 100 people attended this very successful program held at
   Polk County Community College; Dr. Nat Thomas, Director of Diversity was
   the trainer.

2. HCAP has been very busy over the past year the following is some of the things
   they were able to accomplish: Implemented the Shared Electronic Health
   Information System (SEHIS) in January with We Care and Haley Center being
   the first, they now have 17 health and social service contracts signed to link
   together. This will provide a single entry point for the residents to access health
   and social service benefits.

3.    Worked with Florida Health Department’s Polk County Health Department in
     a process to link SCIS with Tallahassee’s electronic information system.
      HCAP FISCAL YEAR 2006 ACCOMPLISHMENTS

4. HCAP partnered with Polk Health Care Alliance to complete a Bilingual
   educational video on Primary Health Care. “Having Your Own Personal
   Physician, a Key to a Healthy You, a Healthy Community”. This was
   distributed to all Polk County’s Health and Social Service Providers and
   several organizations and businesses to assist in increasing access to
   primary health and reducing inappropriate emergency room visits.
5. Worked with the software vendor to develop a Internet Web Browser piece
   of the electronic information system that allows anyone who can access
   internet services to determine if they are eligible for any health and social
   service benefits and how to access them, even giving maps to get there. It is
   currently being translated and will be available in English and Spanish.
   This was highlighted at the Vendors Annual Users Conference.
6.    Finally they held the first all volunteer Dental Clinic with several of the
     community partners. The plan for next year is to have more of these types
     of clinics throughout Polk County.

				
Fighting Yank Fighting Yank
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