Now known as the Inland Empire Opioid Crisis Coalition.
Community Resources Platform Project
Problem: As IEHP’s experience grows, we have come to recognize that the condition in which people are born, grow, live, work and age, otherwise known as Social Determinants of Health, play a very significant role in shaping the health and outcomes of our Members. These social determinants range from unstable housing, food insecurity, and access to community supports. All these factors, and many others, have been shown to have a profound impact on health in industry literature, and in IEHP’s experience with our Membership. A seminal article in The New England Journal of Medicine highlights that health care itself represents only about 10% of the potential impact on life expectancy, whereas behavioral, social and environmental factors comprise close to 60%. Our Members’ inability to link to resources is a barrier to improved health outcomes.
Proposed Solution: Develop a tool for social workers, health navigators, promotores, discharge planners, housing navigators, case managers, and probation officers to link people in need with appropriate social services providers in real time at the point of care. This same tool can be used by individuals to self evaluate, discover and refer.
Program Details: IEHP gathered community input to develop specifications and included community stakeholders in a selection process for a vendor to develop a comprehensive Community Resources Platform. IEHP will fund implementation and then transfer operations to a community trusted entity. The Community Resources Platform is expected to be operational in early 2018. It will be a web-based software as a service application that can be accessed and used by anyone in the Inland Empire with a computer, tablet or smart phone. It will allow users to search for resources by type, using common language rules, and provide results by geographic area, eligibility criteria and service time availability. Professionals in health care, social work and law enforcement will be able to link to the Platform from their case management systems, if they want to configure.
Program Background: Key collaborators on this project include 2-1-1, hospitals, community clinics, Probation, primary care providers, clinical social workers/discharge planners, behavioral health providers, San Bernardino County Medical Society, Riverside County Medical Association and the Clinton Health Matters Initiative.
Program Innovative Features/Benefits: The Platform will:
- Real-time access to community resources.
- Provide a closed loop referral function to participating partners.
- Identify resource gaps in the community by tracking and reporting searches that do not have results and referrals that did not get fulfilled due to lack of resources.
Bridging for Health
Problem: The public health departments, hospital community benefit organizations, health systems, some cities and local school districts have health programs and initiatives in place with similar objectives. Uncoordinated efforts distributed across a large geographic area have minimal measureable impact on the regional health outcomes. These organizations are challenged to find funding to sustain their efforts.
Proposed Solution: Use the Bridging for Health Initiative framework to convene community stakeholders, identify issues that negatively impact health in the region, implement an intervention to address the issue(s) and utilize an innovative financing mechanism to fund and sustain the intervention.
Program Details: Bridging for Health is a Robert Wood Johnson Foundation (RWFJ) funded program administered by the Georgia State University Health Policy Center. The Inland Empire has been selected to be one of five communities to participate in the program. The other sites are Yamhill, OR; Bexar County, TX; Allegheny County Health Department; and Spartanburg, SC. IEHP was selected to be the lead agency. IEHP contracts with Partners for Better Health (PBH) to manage the project. Key stakeholder participants include: Riverside and San Bernardino Public Health Departments, Riverside and San Bernardino County Schools, the Hospital Association of Southern California, Riverside Community Health Foundation, and Arrowhead United Way.
The Inland Empire collaborative took information collected by the health departments and hospital community benefit associations to identify the biggest issues that impact health in the region. It conducted a process with community stakeholders to reach consensus on one issue at/near the top of each list to target. The community chose to target diabetes/obesity.
Intervention and financing workgroups were created. The Intervention workgroup explored and evaluated interventions to reduce diabetes and obesity rates. The Finance workgroup explored innovative financing mechanisms that would be acceptable to the community and support a recommended intervention.
An enhanced version of the CDC Diabetes Prevention Program will be the first intervention supported by blended and braided funding within a wellness trust is expected to launch in late 2018.
Program Background: The Georgia Health Policy Center heard about community collaboration in the Inland Empire and interviewed multiple stakeholders. They offered to fund IEHP as the lead entity due to near universal consensus that IEHP is a trusted partner and integrator. This is the largest site participating in the Bridging for Health Initiative.
Program Innovative Features/Benefits: Focus is on three main areas:
- Stewardship and collective impact
- Innovations in financing
- Health equity
Provider Network Expansion Fund (NEF) Program
Problem: The Inland Empire (IE) has one of the lowest ratios of Primary Care Physicians (PCPs) and Specialty Physicians per 100,000 people in California. It has been well documented that the IE does not have adequate PCP capacity to serve currently insured people, let alone the additional large number of individuals who continue to gain coverage through the Affordable Care Act.
Proposed Solution: The purpose of the Provider Network Expansion Fund is to support the hiring of PCPs, Specialists and Midlevel Practitioners that will serve the growing Medi-Cal population in the Inland Empire.
Program Details: Due to the lack of resources and expertise in actual recruitment of providers, IEHP has contracted with three physician recruiting firms that will be utilized by approved entities/groups that have been selected for funding. The recruitment fees charged by the firm(s) will be drawn from available NEF funds and the firm(s) will work directly with the entity/group attempting to recruit the Provider.
The criteria to be reviewed by IEHP for consideration of funding approval are:
- The contracted entity involved – relationship with IEHP, track record and stability
- Geographic region (need for PCPs)
- Type of PCP (Family Practice, Internal Medicine, Pediatrics)
- Practice Setting – Organized clinic, small group, etc.
The funding available for 130 new PCPs, Specialists and Midlevel providers is:
- Primary Care Physicians (PCPs) – 50% of one-year cost up to $100,000 and $25,000 sign-on bonus
- Specialist Physicians (SPs) – 50% of one-year cost up to $150,000 and $25,000 sign-on bonus
- Physician Assistants (PAs) and Nurse Practitioners (NPs) – 50% of one-year cost up to $75,000
- Rural or other hard-to-contract areas or specialties – $50,000 sign-on bonus
Program Background: Although IEHP is now at its highest level of PCP participation ever with 1168 PCPs serving Medi-Cal Members and 856 serving Medicare (with overlap), additional capacity is needed for both PCPs and certain specialties in specific geographic regions as enrollment surpasses the one million mark.
Program Innovative Features/Benefits: The first program of its kind in California, the NEF meaningfully addresses the provider shortage in the Inland Empire and significantly improves access to care for IEHP Members.
Autism Assessment Center
Problem: There is a significant disparity in Autism Spectrum Disorder (ASD) screening and diagnosis for families in the Inland Empire. Diagnosis can be reliable and valid at age two. The national average diagnosis age is four. The average ASD diagnosis in the Inland Empire happens at age five. The average age of ASD diagnosis for Latino and African American children in the Inland Empire is age seven. Delayed and incorrect diagnosis leads to diminished life-long function.
Solution: The Inland Empire ASD Collaborative created the Inland Empire Autism Assessment Center of Excellence (AACE). www.autismassessment4ie.org The AACE provides comprehensive multi-disciplinary assessments specifically designed to diagnose ASD and provide custom treatment plans for children in the Inland Empire.
Program Details: The AACE is a collaborative, organized, integrated and trans-disciplinary assessment resource for Autism. It provides a single location for children to be assesses for ASD. The assessment meets all the criteria required by agencies responsible to fund or provide ASD therapy. These agencies have all agreed to accept the AACE assessment. They also participate in and collaborate on a coordinated treatment plan based on the child’s needs and best available resources.
Program Background: In 2013, ASD therapy became a commercial health plan benefit and IEHP forecast that it would eventually become a Medi-Cal benefit. The system to assess, diagnose and treat ASD was fragmented and siloed. Stakeholders created the Inland Empire ASD Collaborative in order to understand who is responsible for services, identify service gaps and develop a family/child centered system to meet the autism community’s needs. Founding Collaborative members include: Autism Society Inland Empire, Children’s Network, Loma Linda Department of Pediatrics, Desert Mountain Special Education Local Plan Area, IEHP, San Bernardino Department of Behavioral Health, Riverside County Office of Education, Riverside County Mental Health Department, Inland Regional Center, First 5 Riverside and First 5 San Bernardino. The AACE opened in early 2016 and ASD therapy became a Medi-Cal benefit in 2016.
Program Innovative Features/Benefits:
Clinton Health Matters Initiative’s 5-year Celebration (PDF)
- Inter-agency collaboration to improve referrals and align with providers and educators.
- Comprehensive assessment to eliminate wasted time and duplicative efforts.
- “One stop shop” to reduce parent’s burden to advocate and coordinate across multiple agencies.
- Early intervention to access treatment at an early age in order to increase quality of life and function.