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Stay Informed with SCFHP's Provider e-News

Issue 1 - March 8, 2017

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From the CEO's Desk

SCFHP CEO Christine M. Tomcala
Welcome to the inaugural issue of Santa Clara Family Health Plan’s Provider eNews! We are excited to introduce this bi-monthly communication to share SCFHP news, regulatory information, and important reminders. This is a milestone year for SCFHP as we celebrate 20 years of serving the residents of Santa Clara County. Thank you for your ongoing support and for believing in our mission.

Though it is only March, this year already has been marked by change as the new federal administration contemplates the future of the Affordable Care Act (ACA) and California develops its budget for 2017-2018. To help illustrate the potential impact on our community of an ACA repeal and replacement that rolls back Medi-Cal expansion, we’ve prepared this flyer.

At the state level, the Governor’s draft 2017-2018 budget reflects the Administration’s commitment to the principles and value underlying the Coordinated Care Initiative (CCI) and to implementing changes to make the program stronger. In accordance with statutory provisions, the budget technically discontinues CCI as of January 1, 2018. At the same time, the budget continues Cal MediConnect, mandatory enrollment into Medi-Cal managed care for dual eligible beneficiaries, and the integration of long-term services and supports into managed care (with the exception of IHSS).  Assuming no significant changes in the Governor’s May Revise budget, our members and your patients will continue to benefit from care coordination and will not have to experience disruptive plan changes.  You can read the full CCI budget update here.

As we all navigate this changing landscape of healthcare, SCFHP’s executive team, our governing board, and employees are committed to supporting our members and providers.  We value our continued partnership with you, and our work together to ensure access to comprehensive health coverage for residents of Santa Clara County.
 
Christine M. Tomcala
CEO
Santa Clara Family Health Plan



 

Your Help Needed for 2017 HEDIS Data Collection

We are requesting your cooperation by providing access to specific member medical records in your office in support of SCFHP’s 2017 Healthcare Effectiveness and Data and Information Set (HEDIS) project.  HEDIS is an important annual project that measures the efficiency of the health plan and our providers in delivering preventive care.
SCFHP has contracted with Verscend Health Technologies to retrieve medical records for this process. In the coming weeks, Verscend Health Technologies will contact your office to request the necessary records and set up the most efficient way to retrieve them. 

State confidentiality laws [Cal. Civil Code §56.10(c) (4)] and Health Insurance Portability and Accountability Act (HIPAA) regulations allow providers to release medical information to a patient’s health plan (or the plan’s authorized representative) for purposes of quality improvement, without the need of a signed medical record release from the patient. All medical records and information submitted to SCFHP will be kept confidential in accordance with federal, state, and HIPAA laws.

We look forward to your cooperation with this medical record review and will work with you to minimize disruptions in patient care activities.

For more information, please contact Mai Chang (MChang@scfhp.com) in our Quality Improvement department at 408-874-1823.


 

SCFHP Celebrates 20 Years of Serving Santa Clara County Residents

SCFHP 20year logo block



SCFHP enrolled its first Medi-Cal members on February 1, 1997. Many of you have been with us since the very start. Thank you for partnering with us to now serve more than 275,000 members across Medi-Cal, Cal MediConnect and Healthy Kids programs! SCFHP leadership and its employees are as determined and dedicated to our mission today as we were in the beginning
.
Our Mission:
Our mission is to provide high quality, comprehensive health care coverage for those who do not have access to, or are unable to purchase good health care at an affordable price.

Working in partnership with select providers, we act as a bridge between the health care system and those who need health coverage.

To learn more about our journey and history, click here.


 

SCFHP By the Numbers

Santa Clara Family Health Plan Members  (As of March 3, 2017)
Medi-Cal 267,540
Cal MediConnect 7,622
Healthy Kids 2,752
Total 277,914
 


Santa Clara Family Health Plan Providers (As of January 2017)
Primary Care Providers Medi-Cal Healthy Kids Cal MediConnect
Total 766 751 532
 
Specialists Medi-Cal Healthy Kids Cal MediConnect
Total 3461 3459 2403
 
Ancillary Providers
 
Medi-Cal Healthy Kids Cal MediConnect
Total 490 507 399
 
 

SCFHP Cal MediConnect Model of Care

Cal MediConnect (CMC) is a pilot program that integrates medical care, long-term care, and mental health and substance use disorder programs into one health plan. Working in partnership with social services, members who are dually eligible for Medicare and Medi-Cal benefit from a single, individualized coordinated care plan.
A primary objective of the Cal MediConnect program is to help seniors and people with disabilities remain at home and in their communities as long as possible, by delivering coordinated and patient-centered care, including Long-Term Services & Supports, through a system that is seamless and easy to navigate. Under this model, both members and providers should experience improved care coordination.

SCFHP is required to develop and implement a Model of Care (MOC) that is specific to meeting the needs of our CMC enrollees. Providers help ensure success of the MOC through increased communication and collaboration with SCFHP’s Case Management staff.

Model of Care Guidelines Include:
  • Staff structure and care management roles
  • Interdisciplinary care team and related roles and responsibilities, including   member & PCP
  • Provider network having special expertise and use of Clinical Practice Guidelines
  • Individualized health risk assessments at time of enrollment and at least annually thereafter
  • Individualized care plans shared with member’s assigned PCP
  • Ongoing assessment (medical and psychosocial) and care management of member’s needs, especially during transitions of care
  • Facilitating communication among members, caregivers, and providers. Providers are encouraged to update member care plans during patient visits and share those updates with SCFHP Case Managers by fax or telephone
  • Integration of the PCP into the care coordination process
  • Measurable program goals.

SCFHP trains and educates contracted providers annually on the MOC. You can access the MOC overview training here from our website.


 
Copyright © 2017 Santa Clara Family Health Plan, All rights reserved.

Our mailing address:
210 E. Hacienda Avenue, Campbell, CA - 95008-6617.
Reach our Customer Service Department at (408) 874-1788.


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