Questions (That most likely have been asked already)

I guess this is what I get for forgetting to do the blog entry earlier (this being the opportunity to pose questions that have probably already been asked in some way or another earlier).

What is it, in your opinion, that makes L.A. Care Health Plan different from different HMOs? And would you say that others outside of the organization feel the same way?

Have there ever been instances where exceptions have been made for individuals who fall just shy of the criteria for eligibility? Why or why not?

What are some of the most significant barriers to successfully running L.A. Care Health Plan?

Finally, what, in your opinion, are the greatest achievements that have been accomplished by L.A. Care Health Plan and what can be done to surpass such marks?

I took the time to review the questions of many of classmates (great questions I may add). I then took a look at your website, which did a great job at answering many of these questions. My question is not entirely related to the blog question. I am interested to know how L.A. Care Health Plan acts as a health "plan"? How is it different than the government programs in place? It seems as though the plan is in place to help you enroll in a federal health plan and to assist it's members in finding providers, but does the L.A. Care Health Plan subsidized costs? If so, what are the criteria for qualifying for this additional subsidization? Where does LACHP get its funding?

I realized I am one of the last ones who haven't come up with questions and most of my questions are already asked.

My questions are:
1. How do you deliver your health plan into vulnerable families? do you reach them?
2. What kind's services do you provide to them?
3. How much do you charge the vulnerable families?

Question

My motives for my question may be completely selfish, since it's related to my paper, but I believe it may also interest others :)

As a stakeholder, what is your opinion on universal health coverage?

Questions for LA Care Health Plan

1.) Aside from the educational component, how comprehensive is the dental treatment for patients seeking oral health coverage?

2.) In viewing the LA Care Health Plan website, I noticed that mental health services are mainly handled else where. Why is this?

3.)Why is it that some mental health cases need referral while others don't?

4.)Is there an approximate fiscal figure as to how much has been spent in rendering health services to the those who have taken advantage of the benefits offered through LA. Care Health Plan?

5.)As a Public Health student and/or recent MPH graduate what kind of employment opportunities are available?

Questions

What is your policy on obesity-related costs?

How are patients with addictions treated?

Are there any conditions that are not covered?

How is L.A. Care Health Plan promoted?

Questions

These are the questions I came up with...

Do they cover undocumented immigrants?

How is Healthy Kids different from SCHIP?

How long is the wait when calling for nurse advice?

What other languages do the workers speak?

Questions

Here are some questions I would ask:

-How long does each physician take with each patient?

-What is the drug coverage offered?

-What kind of preventive services are covered?

-Are alternative or culturally relevant treatments covered?

-How many languages is the material made in?

-What does the application process look like?

Questions for The HMO

A couple general questions that come to mind at the sound of "HMO:"

1. What services/medical procedures/medications do you provide (and perhaps more importantly, which do you NOT provide?)

2. Where does your funding come from, where does it go, and how much?

3. Describe the level of access that is available to your patients (i.e. where do they live, how far must they travel to receive care, and how many of them actually do so?).

4. Is there any focus on prevention education?

5. What are 3 major methods you use to control costs (maximize profits)? What is the most expensive ailment (for an HMO) that a patient could be diagnosed with?

6. How do you account for the stark contrast between the quality of health care received and the disparities in rates of disease between the community that you serve and other communities with lower rates of disease etc.?

I would like to ask the following:

1. I noticed that under LA Care, the Healthy Kids program is covered.  However, with the reauthorization of SCHIP, there are rumors that Healthy Kids will no longer be funded by the government and will become bankrupt.  Therefore, what will happen to the children covered by this program that receive services through your organization?  Will they now be extended to the Healthy Families network?  Will you continue to treat if they are not covered?

2. It is important to have both treatment and prevention programs/services in place.  What is the approximate distribution of services regarding prevention and/or treatment that LA Care offers?

3. One of the bigger topics plaguing the whole health care reform debate is that of illegal immigrants.  Does LA Care offer services to illegal immigrants, whether it is knowingly or not?

Any Preguntas (as Azen would Say...)???

What are common restrictions that HMOs implement in selecting a primary care physician, and is it possible for the patient to overcome some of these hurdles in being able to choose a PCP of his/her choosing?

How much of HMO funding to take care of patients is subsidized by federal/state/local government agencies, and how much of it is raised on private capital/profits based on business operations, monthly fees from patients, etc.?

Are your earnings/revenues/profits available to the public?

What would you say are some of the shortcomings/challenges that HMOs face in providing affordable and quality health care to their recipients? What are your greatest strengths that you feel you can build upon?

Why do HMOs have such a negative public perception?

L.A.Care Health Plan Possible Questions

Possible Questions:
1.    How is your HMO funded? 
2.   How will the budget cuts affect the amount of people you provided care for? If it does affect how many people you organization can care for, what are the qualifications needed to be considered a patient of this HMO?
3. What if you had a family that really need help. They do not qualify for your organization(don’t meet your requirements) and don’t fall into Healthy Families or Healthy Children.  What do you guys do?
4. What kind of services are offered through this HMO?  Is it just like any other HMO? 
5. Where are thenetwork of providers located?  How accessible are they to your patients?  Is a co-pay required?
6.    How much focus is there on prevention?  Are educational classes offered to your clients?

L.A. Care Health Plan

A lot of great questions have already been asked!

The first few things that come to mind are:

1. How does the funding work? What's the financial backing and how long will it be sustainable?

2. Many low-income families turn to alternative medical treatments because some tend to be cheaper than biomedicine. Is alternative treatment covered?

3. Define "vulnerable." 

4. What are the major obstacles of providing low-cost quality care? How were these obstacles overcome?

Questions for HMO Rep

I would like to know the following:

1: Are HMOs providing services that are sustainable over time? Meaning, can HMOs continue to operate as they do currently or will they need substantial overhaul in the coming years.  How many more years, based on financial analyses, can HMOs continue to operate?

2: To what extent are mental health services covered by HMOs?  Are diagnostics and psychiatric evaluations available to underserved and minority populations?

3: Have shady practices personally been witnessed, or are these mere myths and claims of HMO skeptics?

 

que pa so

in addition to the wonderful questions already addressed below, I have a few of my own.

1. Since the initiation of L.A. care health plan, what improvements in the community have there been?

2. They pledge for continuous improvement, so what are the main categories that they have improved most upon, and how have they done so?

3. I know it has also been asked, but it is so important that I'm asking it again: vulnerable? Vulnerable to what? I am vulnerable to a lot of things, so what type of vulnerability is in their target population? There has to be some sort of guidelines for this.

Questions for the LA Care Health Plan

In order for me to know that this HMO is delivering quality care for needy families I would like to know: What are the eligibility requirements? What are the circumstances that a patient is denied care? Are the qualifications inclusive of many families under federal poverty level (FPL)? How many children does it serve? What are the demographics of the population it serves? What are the benefits it covers? Does it have an emphasis on primary care or specialty care?

L.A. Care Health Plan

It would be interesting to find out what the criteria is for eligibility. And like others are asking who are actually included in these "vulnerable families"?

In what way is this plan focusing on current health issues in L.A.? And how is it different from any other HMO?

Is prevention emphasized? What kind of preventative care is covered in the plan?

How accessible is quality health care to their patients? Wait time? Costs?

Health Information Technology

I would be interested to know if L.A. Care is on board with the health information technology (HIT) movement. They offer personal assistance with application forms, but are they planning to replace this with an automated, web-based enrollment system? What has their experience with One-E-App, Health-E-App, or similar electronic healthcare applications been like? When helping low-income individuals or families apply for health programs, do they also refer them to social or welfare programs such as food stamps, housing, etc. in the same way that One-E-App does?

And finally, how do they plan to take advantage of the billions of federal stimulus dollars that will flow into California solely for the purpose of upgrading HIT? How will they balance this influx of federal dollars with state budget cuts?

On the LA Care Health Plan I noticed that it said that it had advisory committees ‘in your neighborhood’. Exactly what do you mean by advisory committees and who makes up these committees? It also mentions that nurses are available any time and day. Do the insurers know about these features? In addition, who is calling, what are the majority of the calls that are taken and it is effective in reducing emergency room visit care? It seems that most of the people served through LA Care Health Plan are low income families, women and children, are they at all followed up to determine how they perceive the quality of there services? On the website it also mentions that this plan is accredited, based on 60 standards what are those standards and what does this mean to the organization?

definition...

define "vulnerable families"? how do you outreach to those families?

(I have a lot of the same questions that have already been raised here). I wonder if there is a limit to how many people/families can be covered at any given time? Do they offer coverage to undocumented immigrants who do make money but are otherwise uninsured? How many paid employees do they have? From where do they receive funding? (How can they afford such a nice facility?!)

This certainly seems to be a great pathway for affordable health care for some of LA county's most vulnerable individuals.

I would be curious to know how many doctors are within their network (PCP's as well as specialists). Also, what is the average wait time that patients experience when they go in for a checkup? On average, what is the out-of-pocket expense that patients pay per year for their health care coverage? I would be curious to know what improvements still need to be made to make patients' health care coverage more efficient. Lastly, and probably the most important question of all, are the individuals within LA Care Health Plan satisfied with the health care that they are being provided?

L.A. Care Health Plan - Questions

How many people in L.A. County are still uninsured, after the implementation of the various government programs, plus L.A. Care? Is there a specific plan or mission in place to try to reach these people?

How is L.A. Care different from all the other programs? The website mentions that people will be pointed in the right direction to make sure that they get access to the relevant programs - how does this happen? Is there additional coverage that families or individuals receive by enrolling in LA care, versus just enrolling in MediCal or Healthy Families?

How are providers organized? Are there entire practices devoted to accepting the LA Care plan? What about hospitals - which ones in LA accept this plan? Are there any notable exceptions?

Where do you see the L.A. Care health plan in 10 years? What will change, what will remain the same? Are there any drawbacks to the way it operates currently?

Two Questions and a Suggestion

1) Some private insurances offer multi-tiered network designs for different class of patients in order to provide a range of premiums, which defeats the purpose of the insurance concept, of those with the need for health care being floated by the rest of society.
Does being a facilitator of existing government health benefits exclude LA Care Health Plan from classifying its own patients?

2) It seems that LA Care Health Plan serves as a network for people who already qualify for free or cheap health care. It also seems it provides its patients with auxillary services. How does LA Care Health Plan give patients more leverage rights?

For some reason it is difficult for one to switch health plans, just as much as moving. There is a waiting time when you sign up and you definitely need to sign up for the new one before you cancel the old one. Also there may be a new doctor, new hospital, new system, new phone numbers. Its worse than changing phone plans. I suggest that we create an all encompassing system for insurance agencies to be connected? It would be similar to STAR, the ATM and debit network that some how connects a diversity of bank ATM's.

Coverage, Recession, Mental Health Services?

L.A. Care Health Plan seems like a one-stop shop where families can obtain low and free health coverage with assistance and even get help finding providers in their areas. Looking over their website, I get the impression that this organization seeks to pull the most vulnerable families who may fall through the health insurance cracks ensuring they do receieve healthcare. L.A. Care Health Plan aims to assist families in applying for coverage in a simple manner amidst the complex, bureacratic healthcare system.

Due to the economic recession, has funding for your programs and the endowment been affected. If so, how has L.A. Care Health Plan assured coverage for families in this time of need as many more families are loosing health coverage from employers due to lay offs?

Is the "Children's Health Initiative of Greater Los Angeles" related to SCHIP? How are they different?

What types of mental health services are covered under the different health insurance programs for Medical, Medicare, & Health Families?

The family resource center offers assistance with filling out health insurance applications and provides health education classes. However, it is located in Lynwood. With the estimate of 8,000 Angelenos L.A. Care health Plan serves, how do the rest of your clientele who are not close to Lynwood receive one on one assistance considering language and cultural barriers which may stop many families from applying on their own?

LA Care Health Plan Questions

The LA Care Health Plan looks like a great way to serve the underserved community in Los Angeles County. However, there are a few questions I would like to pose...

The family resource centers that they offer looks like an excellent idea. However, I noticed that there is only one location (Lynwood) for this resource center. Since LA Care Health Plan does serve all of Los Angeles County, have they considered opening up a few more resource centers? Are the classes that are taught at the resource center being given in different languages to cater to the diverse population in Los Angeles County?

Do they have different income qualifications for families with special needs children?

Under the various health program benefits it lists that it will only "help" these families get dental, vision, and drug/alcohol abuse services. Does the Health Plan cover these at least partially, or is the help they provide merely to help them look for these services?

How is this HMO still able to stay afloat, much less provide these services considering the state of our economy, especially considering our budget crisis here in California. Have they had to make cuts anywhere in their services or lower the income requirements for eligibility? What are they most looking to gain after Obama's health care reform is officially passed?

It would be interesting to know with so many plans all under one roof at L.A. Care how do they achieve follow-up of patients especially as it is easy to loose vulnerable populations who may not have a stable source of income. Do they have a directive established to follow them up .

Who funds L.A. Care? What are the roadblocks they face since they provide quality care at extremely low costs.

How is a patient with no insurance coverage at all coupled with inability to pay handled by the healthcare plan?

I think they have such a large and firm footed presence in the Los Angeles County and have reached out to design programs in chronic diseases as well as oral health. Do they have any envisaged programs for acute care.

Questions

I would like to know what means they take to accommodate these families. For example do they provide translators for families in which English in not there first language? Also the families that they deal with are not very educated and I wonder if they provide any services to help the families enroll in health care and choosing their doctors. I would also like to know how accessible and where the doctor offices are located. Most of these families would not have the means to travel very far for a health care appointment. One of there big focuses is primary care, but it would be interesting what steps they take in educating and providing preventive care. I would also like to know how they feel about the new expansion of SCHIP and if they believe that there are any children still missing to cover and how they suggest we do that. I want to know there thoughts behind the health care reform proposed by Obama.

The Doctors and Patients of L.A. Care Health Plan

I would want to know about the doctors that treat the patients in this health plan. Are these physicians experienced? What is the average years of experience these physicians in this health plan have? How much do they get paid especially relative to the private sector physicians? What process do these physicians go through to get hired?

I would also want to know the demographics of the patients. What ethnicity are most of these patients? How do they find out about the L.A. Care Health Plan? What is their age range? How many patients get treated? What do the patients think about the quality of health care they are receiving in the L.A. Care Health Plan? These are just some questions that will indicate the quality care needy families are receiving.

Questions

Since these patients are from vulnerable populations, it's sometimes difficult to see how the system works, or to get the perspective that they have as patients themselves. There are a few questions that I would like to ask. First, what is the average wait time for patients to see a doctor? I would also like to know what their copay is? If a patient does end up seeing a specialist, are these extra services covered? And lastly, what happens when a patient travels outside of their coverage?

managed care for the public

In class we often refer to Kaiser and their questionable service to the private sector, however it will be very interesting to see how managed care works for the "vulnerable" population since one can assume it will be even less desirable.  I would specifically like to know how they initially screen patients for outpatient appointments since Kaiser was recently under scrutiny for their system of screening over the phone using a script-like method to filter patients into the correct category.  If an HMO as large and well known as Kaiser has problems at this primary level then I'm sure a managed care facility treating the greater public is just as, if not more, overburdened in that department.  It would also be interesting to find out how they handle the medication side and how pharmacy coverage works.  Finally, I would ask if there were any statistical figures calculated to measure misdiagnosis, incorrect treatment, and such to account for accuracy.  Overall, I am looking forward to learning about their system which will hopefully eliminate any negative generalizations that I have about managed care.

L.A. Care Health Plan

I would like to know how much emphasis L.A. Care Health Plan places on primary care. Are most of their patients already in advanced stages of illness/disease by the time they come in? Finding out how they promote preventive care would also be interesting to learn about. I would also like to know how long wait times are and whether seeing a specialist is difficult. Do patients have to jump through hoops to see who they really want or is it fairly easy?

LA Care Health Plan

Since providing quality health care for Los Angeles County's vulnerable and low income communities is their mission, I would like to know how they are keeping the balance of continuing providing quality health care and keeping the organization financially viable at the same time, especially during this tough time of global economic recession. There will definitely be more needy people seeking for LA Care Health Plan these days.

In particular, I would like to know how MDs are recruited into LA Care Health Plan and how they are paid so as to not only attract them but also keep them. Also, I would like to know the average waiting time of the patients to get appointment for their family doctor, and the types of medications they are going to get—ie either generic or branded medications— especially after total yearly drug cost limit of $4,350 is reached. I’m wondering whether the patients will continue getting their brand name drugs or the drugs will be substituted to their generic counterparts.

In their 2009 L.A. Care’s Medicare Advantage Special Needs Plan, they state that they will ask for “copayment of $3.20 for brand name drugs, up to $4,350. Once total out-of-pocket cost for brand name drugs reaches $4,350, the patient has to pay $0." This is modification from their 2008 policy where the patient has to "pay $0 for generic until total yearly drug costs reach $2,270. Then, pay $1.05 for generic drugs, and $3.10 for brand name drugs."

I would like to look more into their support to safety net as well and see whether they have future plans to expand their policy to include more members.

Last but not the least, I would also like to know what is the most challenging issue facing LA Care Health Plan right now and, the strategies they are using to accomplish their goals and missions.

Here is their website: http://www.lacare.org/home

Definitely take a look at it to get a better idea as to what L.A. Care offers and to help you brainstorm questions to ask when we visit them. Class will begin at 9:30am, but plan to arrive as early as 9am. If there are any questions, feel free to e-mail me. See you all Wednesday!