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l Health Forms Behavioral Health  As a local Health Plan, Inland Empire Health Plan (IEHP) is committed to improving behavioral health services for our Members by developing direct relationships with select clinicians.     IEHP now has over 1,000,000 Members. Behavioral Health Clinicians are viewed as "Specialists" that are partners in improving the health status of our Members. IEHP Behavioral Health is an integrated essential partner with primary medical care. IEHP’s Direct Behavioral Health Program will offer our Behavioral Health Specialists: Streamlined Authorization & Claims Submission - via our fast and secure website. Competitive Reimbursement Rates - based on current Medicare rates. Speedy Payments - our track record is payment in less than 3 weeks (in most cases). Personal, Friendly Service - to ensure a successful and long-lasting working relationship. IEHP is committed to develop direct partnerships with Psychiatrists, Psychologists, LCSW's, LMFT's, Psychiatric Nurse Practitioners, Physician Assistants, and most recently, Licensed Professional Clinical Counselors (LPCC) who have met the couples and family qualifications. LPCCs without this qualification will not be considered eligible to join IEHP's Behavioral Health Network. For any questions or concerns, please email Contract@iehp.org. Requirements for this certification can be found here: https://www.bbs.ca.gov/pdf/publications/lpcc_couple-fam_courses.pdf In compliance with APL 17-019 (a DHCS regulation), IEHP now requires Behavioral Health Providers to begin the process of enrolling with Medi-Cal prior to contracting with IEHP. To ensure timely processing of your application, IEHP will accept your application to contract upon receipt of verification of Medi-Cal enrollment submission. Prospective Providers: QASP PLEASE NOTE, IEHP is now accepting new QASP Providers in all services areas.  Behavioral Health Behavioral Health Provider Letter and Application (PDF) Why You Should Contract with IEHP Directly for Behavioral Health (PDF) How IEHP Keeps You Informed and Drive Business to Your Practice (PDF) Medi-Cal Number (Physicians should be enrolled in the State's Medi-Cal Program) Existing Providers: Contracts Maintenance Request Form (PDF) W-9 Form (PDF) (Remittance advice address change) Medi-Cal Number (Physicians should be enrolled in the State's Medi-Cal Program) Frequently Asked Questions (FAQs) What is IEHP? How do I contract with IEHP? What are IEHP's compensation rates? What are IEHP’s minimum requirements to be considered for your BH Network? What if I have additional information about my practice, specialties or experience that is not covered on the survey; where can I send this information? When will I hear back from IEHP after I send my contract in? What services does IEHP offer online? What are the benefits and limitations for Medicare DualChoice Members? I am a Behavioral Health Treatment Provider for one or more of the following services, how do I contract with IEHP? (Services for Individuals (0-21) with Autism, Developmental Disabilities, or Specialized Behavioral needs; utilizing Applied Behavior Analysis and Behavior Modification treatment modalities) What is IEHP? IEHP stands for Inland Empire Health Plan. IEHP is a not-for-profit health plan that serves over 1,000,000 Members in public-sponsored health coverage programs including Medi-Cal and Medicare Special Needs Plan.  How do I contract with IEHP? The first step is to fill out the Behavioral Health Provider Letter and Application (PDF) and email Contract@iehp.org. We will contact you directly once we have evaluated our Member’s needs and are ready to proceed with contracting. What are IEHP compensation Rates? Reimbursement rates for Behavioral Health Services are based on Medicare rates. What are IEHP’s minimum requirements to be considered for your BH Network? A valid California License (LCSW, LMFT, LPCC, Psychologist, Psychiatrist, Nurse Practitioner) $1 million to $3 million Malpractice Insurance Must be enrolled with Medi-Cal Satisfy all IEHP’s standard credentialing requirements What if I have additional information about my practice, specialties or experience that is not covered on the survey; where can I send this information? You can send your information to: Inland Empire Health Plan Attention: Provider Relations P.O. Box 1800 Rancho Cucamonga CA 91729-1800 When will I hear back from IEHP after I send my contract in? Over the next two to three months we will be gathering information and determining our needs and as soon as we have determined what Providers we will need we will send out draft contracts with rate sheets for review. What services does IEHP offer online? Member Eligibility Verification Claims Submission Services Claims Status Authorization Status Medication Search Pharmaceutical Services Information Resources Provider Manuals; Benefit Manuals; EDI manuals  What are the benefits and limitations for Medicare DualChoice Members? Click here.  I am a Behavioral Health Treatment Provider for one or more of the following services, how do I contract with IEHP? (Services for Individuals (0-21) with Autism, Developmental Disabilities, or Specialized Behavioral needs; utilizing Applied Behavior Analysis and Behavior Modification treatment modalities) The first step is to fill out the Behavioral Health Provider Letter and Application (PDF) and email Contract@iehp.org. We will contact you directly once we have evaluated our Member’s needs and are ready to proceed with contracting. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

fornia Physician Orders for Life Sustaining Treatment (POLST) Registry (CPR) to connect a digital POLST network throughout the Inland Empire Healthcare System which includes independent physicians, hospitals, skilled nursing facilities, and the Health Information Exchange (HIE). The goal of this initiative is to provide a more effective means of documenting, communicating, and ensuring Member desired Treatment at the end of life is being honored.  By clicking on these links, you will be leaving the IEHP website. To login, visit Working Toward a Statewide POLST Registry in California | POLST (capolst.org) To sign up, simply go to POLST for Healthcare Providers | POLST (capolst.org) CPR Correspondence (PDF) CPR FAQ (PDF) For any questions, please contact Care Directives at (888) 621-4383 or email support@caredirectives.org. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

ols Menu Click on the following links to jump to that specific section: After Hours Care After Hours Phone Numbers IEHP Access Standards IEHP Direct Adult Hospitalists LabCorp Locations Urgent Care Clinics After Hours Care IEHP Providers can direct Members to access care after hours. After hour care includes the 24-Hour Nurse Advice Line, DocOnline and Urgent Care Clinics. Fever? Pain? Cold? Call our 24-Hour Nurse Advice Line --> Your Members can call the IEHP 24-Hour Nurse Advice Line for medical advice anytime, day or night: 1-888-244-IEHP (4347) DocOnline, an extension to the Nurse Advice Line, allows Members to speak with a board-certified Physician for advice after hours using telephonic and/or video devices. DocOnline Physicians will triage, assess, and provide diagnoses for minor acute conditions. Physicians may also give treatment advice, refill select prescriptions and refer Members for in-person care. DocOnline FAQs (PDF) Prescription Medication Refill List (PDF) (Back to Additional Resources Menu) After Hours Phone Numbers for Coverage Determination and Expedited Appeals IEHP DualChoice (HMO D-SNP) Members The following numbers are to be used for after hour requests: Coverage Determinations: Phone: (888) 860-1297 Expedited Appeals: Phone: (866) 223-4347  Fax: (909) 890-5748 (Back to Additional Resources Menu) IEHP Access Standards On an annual basis, IEHP conducts the Appointment Availability Access Study. All Members must receive access to all covered services without regard to sex, race, color, religion, ancestry, national origin, creed, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, sexual orientation, or identification with any other persons or groups defined in Penal Code Section 422.56, except as needed to provide equal access to Limited English Proficiency (LEP) Members or Members with disabilities, or as medically indicated. Appointment Standards for All Provider Types (PDF)| Last Revised: 12/12/2022 Appointment Standards for Behavioral Health (PDF)| Last Revised: 01/11/2023 (Back to Additional Resources Menu) IEHP Direct Adult Hospitalists Direct Adult Hospitalist (PDF) | Last Revised: 02/27/2023 (Back to Additional Resources Menu) LabCorp Locations A listing of LabCorp Patient Service Centers around the Inland Empire can be found below: LabCorp Patient Service Centers (PDF) LabCorp Patient Service Centers at Walgreens (PDF) (Back to Additional Resources Menu)   Urgent Care Clinics --> Any of your IEHP Members needing medical attention may visit an Urgent Care Clinic after regular business office hours and on weekends. A listing of all Urgent Care Clinics is found on the IEHP Doctor Search. (Back to Additional Resources Menu) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

als who are dual eligible for both Medicare and Medi-Cal in Riverside and San Bernardino counties, including the most vulnerable population. This also includes members transitioning from IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan). IEHP has identified the most vulnerable as the following: Age 21-70 Identified as High and Rising Risk Diagnosed with Cardiovascular Disease AND/OR Diabetes RUB Score of 4 & 5. *RUB is Resource Utilization Band which is a predictor of using acute or costly services. IEHP will identify the most vulnerable members assigned to IPAs IEHP and its IPAs must design care management specific interventions to demonstrate how they support these member's health and wellness goals. Examples of Specially Tailored Services for the Most Vulnerable Population Remote Patient Monitoring Medically Tailored Meals and Other Community Supports Nutrition Education Pharmacy Services (medication reconciliation and other programs) Long-Term Services and Supports (LTSS) Telehealth Behavioral Health Services Transportation More frequent care management contact IEHP DualChoice (HMO D-SNP) Model of Care Training   The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) and the National Committee for Quality Assurance (NCQA) require that IEHP staff and contracted consultants/vendors, our Medicare IPAs, Hospitals/SNFs, and Providers, receive training on the Plan’s Model of Care for our D-SNP Members: Interdisciplinary Care Team (ICT) Fact Sheet (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML)   *We recommend opening file in: Mozilla Firefox, MS Edge, Chrome or MS Internet Explorer    You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

gram, Prior Authorization Criteria, Clinical Practice Guidelines, Forms, IEHP Formulary, and Safety Resources with drug recall information. If you have any questions regarding services provided by the Pharmaceutical Services Department, please feel free to contact the IEHP Pharmacy Department at (909) 890-2049. Pharmaceutical Services

d range of topics for all types of Providers with questions regarding billing requirements and claims processing guidelines. Resources are not limited to webinars, computer based training, and webinars. Providers also have direct access to their Regional Representative and the Small Provider Billing Unit (SPBU) through this link (By clicking on this link, you will be leaving the IEHP website) https://learn.medi-cal.ca.gov/. Medi-Cal Rates and Codes By clicking on these links, you will be leaving the IEHP website. Medi-Cal Rates The file lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system. Resource: website CPT Codes This website is aimed at providing information to Providers on Medicare's National CCI edits, but will not address specific CCI edits. Resource: website Alpha-Numeric HCPCS Files These files contain the Level II alpha-numeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data. Resource: website ZIP code To Carrier Locality File This file is primarily intended for use by ambulance suppliers to map ZIP Codes to CMS carriers and localities. This file will also map ZIP Codes to their State and can determine whether the ZIP Code has a rural designation as determined by CMS. Resource: website Medicare Physician Fee Schedule Information on services covered by the Medicare Physician Fee Schedule (MPFS). Resource: website IEHP Fee Schedule IEHP Fee Schedule - December 08, 2020 (PDF) Provider Dispute Resolution Process For more information about the Provider dispute resolution process for contracted and non-contracted Providers, click here Other Health Coverage (OHC) Coordination of Benefits with Other Health Coverage (OHC) (PDF) Frequently Asked Questions (FAQs) - OHC (PDF)

OS June 30, 2022, payments will run out through June 2023. The Proposition 56 VBP Program provided direct payments incentivizing Providers to meet specific measures aimed at delivering key quality healthcare services that improve the quality of care to Medi-Cal beneficiaries. Targeted areas were behavioral health integration, chronic disease management, prenatal/post-partum care and early childhood prevention. For more information about the VBP Program, please visit the DHCS website at https://www.dhcs.ca.gov/provgovpart/Pages/VBP_Measures_19.aspx. By clicking on this link, you will be leaving the IEHP website.  Value Based Payments Program Guide Value Based Payments (VBP) Program Guide (PDF) - Published: January 01, 2022 Value Based Payments Dispute Forms Value Based Payments Program - Paid Claims Dispute Request (PDF) Published: January 19, 2022 Value Based Payments Program - Encounter Dispute Request (PDF) Published: January 19, 2022 Please e-mail completed forms to ValueBasedPaymentsProgram@iehp.org At-Risk Condition Codes The At-Risk Condition Codes list includes diagnosis codes to identify Serious Mental Illness, Substance Use Disorder or Homelessness Conditions for the VBP Program. These conditions qualify Providers for an additional payment amount for VBP services. Please refer to page 4 of the VBP Program Guide for additional details. At-Risk Condition Codes (PDF) Published: March 25, 2020 You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

ion residents, contracting with over 6,700 providers, and employing nearly 2,500 team members, the health plan is honoring this momentous milestone by continuing to embark on a strategic path forward. “In the last 25 years, we’ve had the incredible pleasure of connecting millions in our region to whole-person healthcare services,” said Jarrod McNaughton, IEHP chief executive officer. “With large initiatives like CalAIM underway and the ongoing COVID-19 pandemic, it is critical that we continue to meet our members, providers and team members where they are, so that we may effectively work together to deliver optimal care and vibrant health to residents in our region.” IEHP began its operation in 1996 with over 60,000 Medi-Cal members and worked proactively to provide coverage to uninsured children in working families who did not qualify for Medi-Cal by launching the Healthy Families program in 1998. By 2000, IEHP had become one of the first Medi-Cal only health plans in California to receive “Commendable” NCQA Accreditation and ranked the ninth largest Medicaid Plan in the United States.   With the development of several programs supporting children (Healthy Kids), seniors (Medicaid), persons with disabilities (Medicare DualChoice), and specific health conditions (like diabetes and asthma), IEHP was able to support the influx of Inland Empire Residents who became eligible for its health services through the Affordable Care Act, increasing the health plan’s membership to 1 million members by 2015. Recently, the health plan was mentioned as a model in California’s Master Plan for Aging and has contributed several ideas to the state’s multi-year transformational initiative to address many of the complex challenges impacting the state’s Medi-Cal population (CalAIM). Programs serving as models include the health plan’s innovating work around health and housing, like IEHP’s  Housing Initiative and Health Home programs. In addition to supporting transformative initiatives like CalAIM, IEHP is also working towards sustainable solutions to increase positive health outcomes of residents in the region. “While we celebrate the great work done in our region, our job as a community-based health plan is far from over,” said McNaughton. “Building and strengthening networks of providers in the I.E. to offset the on-going provider shortage and working with our partners to create an Electronic Medical Record system to better care for members, are only two of the large priorities we’re working through,” added McNaughton. “Accompanied by our mantra to always ‘do the right thing’ for our members, our mission to heal and inspire the human spirit will guide our thoughts, our decisions, and most importantly, our actions through these projects and at IEHP in the months and years to come.”

al services are to our well-being in this modern world. More than a dozen Inland Empire residents are now connected to the internet at discounted rates, thanks to Get Connected California! and the Affordable Connectivity Program (ACP) events recently held at Inland Empire Health Plan’s (IEHP) Riverside and San Bernardino Community Resource Centers.     The Affordable Connectivity Program is a Federal Communications Commission (FCC) benefit to help ensure households can afford internet services they need for work, school, health care and more.  The benefit provides up to $30 per month toward internet access and offers discounts on laptops, desktop computers or tablets for eligible households.     To participate, eligible households must be enrolled in Medi-Cal or other government assistance programs like CalFresh, Lifeline or Supplemental Security Income. In addition, households must have four people with an annual income of less than $53,000.    “The internet is so much more than connectivity, it’s a tool that can move entire communities forward,” said IEHP Community Resource Center Manager Maria Gallegos. “We’re so proud of this partnership and look forward to doing all we can to inspire future events like these.”   To learn more about the FCC’s Affordable Connectivity Program and to apply, visit affordableconnectivity.gov.    

vices PO Box 997413 Sacramento, CA 95899-7413 ContractPolicyAdmin@dhcs.ca.gov RE: Inland Empire Health Plan – Contractor and Grantee Report on Compliance with Economic Sanctions in Response to Russia’s Actions in Ukraine Dear Michelle, We have taken the following actions in response to Executive Order N-6-22 (EO) regarding sanctions in response to Russian aggression in Ukraine. We have reviewed our investments and contracts and confirmed they comply with economic sanctions imposed by the U.S. government in response to Russia's actions in Ukraine, as well as any sanctions imposed under state law. We have requested our contractors with agreements for commodities, services, and technology to comply with existing economic sanctions. We have notified all contractors and grantees of their obligations to comply with economic sanctions. We have directed grantees, and contractors with agreements valued at $5 million or more, to report to the agency or department regarding their compliance with economic sanctions. We have directed all grantees, and contractors with agreements valued at $5 million or more, to report on steps they have taken in response to Russia's actions in Ukraine, including, but not limited to, desisting from making new investments in, or engaging in financial transactions with, Russian entities, not transferring technology to Russia or Russian entities, and directly providing support to the government and people of Ukraine. Sincerely, Jarrod McNaughton, MBA, FACHE Chief Executive Officer

ren (ages 5-11) against COVID-19 as cases continue to surge across the state. The health plan is supporting access to the vaccine for Inland Empire families through sponsorships of child-friendly vaccine clinics across Riverside and San Bernardino counties. Members who receive their first COVID-19 vaccine are also eligible to receive a free $50 gift card at IEHP-sponsored clinics listed on the health plan’s website. IEHP is also providing fact-based information for parents and guardians on their website and across the plan’s social media accounts. “IEHP is joining forces with several partners to ensure the community has access to vaccines and clinical information to stay healthy,” said Dr. Priya Batra, IEHP’s Senior Medical Director for Family and Community Health. “Vaccinating children who are eligible can protect unvaccinated younger siblings and family Members who are vulnerable to COVID-19. The risk of hospitalization and health complications is greatly reduced in children who are vaccinated.”  According to the CDC, the approved complete Pfizer dose for children aged 5-11 is 20 micrograms (a third of the 60 micrograms for adults) – administered at 10 micrograms per dose 21 days apart – and has undergone rigorous testing to prove it is safe and effective.  “It’s no secret the vaccine is effective in dramatically reducing contraction of COVID-19 and symptoms requiring hospitalization,” said Dr. Takashi Wada, IEHP’s Chief Medical Officer. “Providing our children that protection is essential, especially as our communities continue to open and try to return to normal operations. Vaccinating children will encourage and allow the safe return of all our children’s favorite sporting activities, play dates, school functions and more.”  Click here to learn more about where to receive COVID-19 vaccines for you and your child.   

Maria found herself experiencing depression and longing for a purpose in life. Her home was missing the family bustle, boundless energy and joyful sounds from years past. “I would cry and cry there,” said Maria, 92, in Spanish about her modest, but empty, longtime San Bernardino home. As if an answer to her prayers, Inland Empire Health Plan (IEHP) opened their San Bernardino Community Resource Center in 2015 — just steps away from Maria’s too-quiet space. “Thank God they put this center here,” expressed Maria. “I said to myself, ‘Oh, they couldn’t have put it in a better location. I’ve got to go, I can go walking, I don’t need someone to take me.’ It was practically at my front door.” IEHP’S WHY So, every day for the last seven years, Maria puts on her workout attire – complete with a spiffy pair of Skechers sneakers – and takes the short stroll from her house to the Community Resource Center, where she’s become a “crowd favorite” of sorts. “Maria is definitely a beautiful example of IEHP’s core value of placing our members at the center of our universe,” said Cesar Armendariz, IEHP’s senior director of community health.   Fully embracing the center’s wide-ranging offerings – all free of charge to anyone in the Inland Empire – Maria has taken a variety of fitness classes including Zumba®, aerobic boxing, Latin dance and yoga. She’s also spent time in health education classes, learning about asthma, diabetes and nutrition.  The staff at IEHP’s San Bernardino Community Resource Center look to Maria as their inspiration and motivation of their “why.” “She fully embodies the reason we provide these services,” said Armendariz. “Knowing we provided connection and heartfelt space for Maria to enjoy her golden years, instead of suffering through them alone in a spiral of isolation, fuels our own purpose. This is what healing and inspiring the human spirit looks like!” As an added bonus, Maria brings smiles to everyone she encounters, always engaging with IEHP team members and fellow community residents.  “Eventually, she was very involved with whoever walked through the door,” said IEHP San Bernardino Community Resource Center Team Member Marjorie Chavez. “It’s been amazing to see how everyone welcomes Maria and how she embraces everyone who walks through the center.” PLACE & PURPOSE To watch Maria stepping, turning and moving to the spicy sounds of the latest Zumba® routine – never missing a beat – you’d never know she’s 92. To witness Maria’s current-day, happy interactions with other people at the center, you’d also never know about the sadness that once filled her heart. For Maria, the emptiness she felt before IEHP entered her life is gone – and so are the tears. She now knows IEHP’s San Bernardino Community Resource Center is the place and the purpose she craved all along. “My whole life has changed here. I feel renewed,” said Maria, then adding an encouraging invitation to other San Bernardino residents. “Come to the center, because there’s help here for everyone – for our bodies and our minds.”  Click here to learn more about IEHP’s three Community Resource Centers. 

spread awareness about Type 1 diabetes and the detection of the chronic health condition in children. Together, the two organizations will actively distribute and promote educational material and work to connect the community with supportive resources. According to the Centers for Disease Control, the frequency of both Type 1 and Type 2 diabetes in young people is a growing clinical and public health concern. While Type 2 diabetes is preventable, Type 1 diabetes is not. Type 1 diabetes is characterized by deficient insulin production and requires daily doses of the key hormone that converts glucose into energy. Diabetes has the potential to damage the heart, blood vessels, eyes, kidneys and nerves, according to the World Health Organization. EASE T1D is the joint effort of two mothers, Debbie George and Michelle Thornburg, who have children with Type 1 (T1D) diabetes. Through their more than 25 years of combined experience, they have come to recognize areas of significant need and have joined forces to apply their knowledge as parents of young diabetics through Education, Awareness, Support and Empowerment (EASE). “The goal of EASE T1D is to raise public awareness of what Type 1 diabetes is and the onset symptoms,” said Debbie George, who co-founded EASE T1D. “So many times, children go undiagnosed because a parent thought it was a simple virus.” “Excessive thirst, frequent urination, weakness and weight loss are the top four symptoms,” added George. “And because there are so many illnesses these symptoms could be attributed to, awareness is critical.”     The non-profit group is also active in shaping state law, recently partnering with Poison lead singer and reality TV star Bret Michaels – diagnosed with Type 1 diabetes at 6 years old – in support of California’s Senate Bill 97, which requires Type 1 diabetes information to be available on the California Department of Education’s website and to be distributed to parents and guardians of K-12 students. The bill was signed into law in October 2021 as a part of Gov. Gavin Newsom’s $123.9 billion K-12 package.   “Empowering parents and guardians with this information is a great step in extending preventive health care services to our community,” said Dr. Wada, IEHP’s chief medical officer. “This partnership will help us to fill in the gaps and truly meet our members where they are.” To learn more about EASE T1D, visit EASET1D.org.  

re’s first cross-county and cross-sector Community Health Assessment (CHA) this year. The assessment will shed light on the region’s most pressing health and social needs: mental health, homelessness, health equity and more.   Using a collaborative approach, IEHP is convening network hospitals, county public health departments, academic institutions, and community-based organizations to better coordinate ongoing regional health assessment efforts. The health plan will also provide sponsorship and recourses to ensure the collaborative assessment meets the needs of partners.  Historically, CHAs have paved the way for broad-based policy and system changes to promote community health. “The initiative will better align current Member and community assessments, including those conducted by our public health and hospital partners,” said Dr. Priya Batra, IEHP’s Senior Medical Director for Family and Community Health. “Working together, we can identify gaps and efforts needed to contribute to and move the region forward on a shared pathway towards vibrant health.” IEHP’s collaborative Community Health Assessment is currently underway and is expected to be completed in late 2022. “As a community-based health plan, it is our duty to connect Members to the care they need, as well as connect our partners to needed resources, all to ensure our Members and communities have the opportunity to improve their health and well-being,” said Dr. Takashi Wada. “We look forward to collaborating with stakeholders in our region to identify the most significant priorities for our communities.”

ers to consider assessments and support for their children. This includes evaluations to detect conditions such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).   IEHP Medi-Cal members can receive a free autism screening at centers like the Inland Empire Autism Assessment Center of Excellence (IEAACE) or from any IEHP network provider before the member reaches age 21. “Rapidly changing environments, like the COVID-19 pandemic and the social isolation tied to it, brought significant disruptions to the lives of our youth,” said IEHP Behavioral Health and Care Management Manager Heather Waters. “Given the circumstances, it’s completely normal for children to need additional support. What’s important is ensuring they receive the right care at the right time.” Waters highlighted that early treatment and recognition of symptoms, as early as 1 year of age and before a child enters school, can result in better health outcomes. Signs and symptoms vary and can range from obsessive or compulsive behaviors to poor social skills, delayed milestones and more.  What to Expect at IEAACE “Accurate assessment, diagnoses and subsequent treatment are critical to improving the lives of children and their families within the Inland Empire and beyond. The comprehensive diagnostic evaluation process at IEAACE results in more accurate diagnoses and the creation of effective treatment recommendations, which is critical to avoiding missed diagnoses, delays in intervention and misdiagnoses with inappropriate treatments,” said IEAACE Executive Director Zachary Ginder, MD. During the initial assessment appointment, caregivers/parents and their children will meet with an evaluation coordinator for interviews and observations. Information gathered during the appointment will be processed and reviewed by the IEAACE transdisciplinary team for next steps and follow up.  “IEAACE looks at the whole child from multiple clinical perspectives to ensure we give the child and their family the greatest opportunity for long-term health and prosperity,” added Dr. Ginder. “With IEHP as our primary managed care partner, children and their families now have greater access to these services, which will ideally result in reducing health disparities within our communities.”  To receive an evaluation or additional services, members are encouraged to call IEHP Member Services at 1-800-440-4347 and ask for the Behavioral Health Department. Members can also learn more about IEAACE by visiting autismassessment4ie.org.  

red location, the Inland Empire Health Plan (IEHP) team member knew he had to act. “For five years, my family and I have walked in memory of my sister Melanie and to advocate for suicide prevention and education,” said Lopez about the annual American Foundation for Suicide Prevention (AFSP) event. “We had been registered for months to take part in the walk and were deeply saddened to hear the walk wouldn’t be happening in the Inland Empire. I thought, ‘I know where the walk could be held.’” Lopez, an information technology specialist at IEHP, shared the event cancellation news with the company’s leadership team, who moved quickly to offer IEHP’s Rancho Cucamonga campus as the site for this year’s event. With a few signatures and approvals, the walk’s new location at IEHP was official.  So, in addition to sponsoring the event, IEHP was also a proud host of AFSP’s Inland Empire Out of Darkness Community Walk.  More than 500 Inland Empire community residents gathered on Oct. 29 and walked on IEHP’s Sixth Street campus in remembrance, hope and support of those impacted and lost by suicide. Together, the group walked 2 miles and raised more than $30,000 to fund research for suicide prevention, create and distribute education programs, advocate for public policy and support people affected by suicide.  “I take pride in working for IEHP, an organization that truly lives up to their mission,” added Lopez. “This event helps families find closure, support and hope. Helping others in our community was a large proponent of who my sister was, and I know how happy she would be to know we’re continuing to push forward to erase the stigma behind suicide and mental health, especially for those in underserved communities.” To learn more about AFSP and future events and walks, visit afsp.org.  

ices (DHCS) for their innovative Medi-Cal Primary Care Physician Auto-Assignment Redesign. On an annual basis, DHCS’s Innovation Award recognizes Medi-Cal Managed Care Health Plans (MCPs) that have excelled in improving the quality of health care for the millions of beneficiaries receiving Medi-Cal services through managed care.  This marks the fifth time IEHP has been honored by DHCS—more times than any other health plan in California. Prior recognitions for its forward-thinking efforts include utilizing location intelligence to reach Members (2020), creating the IEHP Housing Initiative (2018), developing Behavioral Health Integration Complex Care Initiative (2017), and organizing the Transitional Care Project (2015). “We are honored to be recognized for our efforts and unwavering commitment to serving our Members, Providers and communities,” said Jarrod McNaughton, IEHP Chief Executive Officer. “These efforts support the work we are doing as we recommit to our Mission to heal and inspire the human spirit.” This year’s recognition shines light on IEHP’s PCP auto-assignment process, which focuses on directing health plan Members to Providers with high quality scores, ensuring Members receive optimal care and incentivizing Providers’ great work. To do so, IEHP created an assignment algorithm incorporating over a dozen weighted provider attributes related to their quality scores.     “Innovation allows us to see beyond our present circumstances and barriers and expand our thinking to what is possible for our Members and Providers,” added McNaughton. “In every connection, we have the ability to inspire and empower them to achieve their fullest potential.”

ricans, this can be an incredibly stressful time.  Especially for people already struggling, the holiday season can heighten feelings of grief, loneliness and other emotional pain.   Inland Empire Health Plan (IEHP) Clinical Director of Community Behavioral Health Amrita Rai says holidays can elevate emotional highs and lows. “This time of year can add additional stress in our lives, and stress can possibly trigger conditions such as depression and anxiety,” said Rai. “Not everyone experiences the holidays the same; it’s OK to experience your feelings.” Rai offers the following tips for managing potential stress during the holidays: Breathe.  Set realistic expectations. Let yourself say no to new obligations. Set boundaries with others. Reach out for help. In addition, Rai recommends checking in often with those close to you, ensuring they are doing OK, especially when you notice a change in their mood or behavior. “It can be as simple as a text, a phone call or handwritten note,” added Rai. “Reach out and remind someone you love them, and you are there for them.”  If you or someone you love is feeling overwhelmed, Riverside and San Bernardino counties encourage use of the local crisis numbers below for help: RIVERSIDE: 1-800-273-TALK (951) 686-HELP (4357)  1-877-727-4747 and Crisis text line: 741-741. SAN BERNARDINO:  24-Hour Crisis Line: (760) 365-6558 East Valley: (909) 421-9233 West Valley: (909) 458-9628 High Desert: (760) 956-2345 Morongo Basin: (760) 365-6558 San Bernardino: 1-877-727-4747 988 also offers 24/7 access to trained crisis counselors who can help people experiencing mental health-related distress no matter where you live in the United States. For non-emergency support, IEHP Members can also call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7 a.m.–7 p.m., and Saturday–Sunday, 8 a.m.–5 p.m. TTY users should call 1-800-718-4347 and ask to speak with the Behavioral Health department.  

anagement (CMM) Pilot Program, utilizing artificial intelligence (AI) to manage medication use among Members was recently published in the Journal of Managed Care & Specialty Pharmacy. Using an advanced AI platform, health plan data, and clinical pharmacists, trained in disease management and CMM, were able to engage with Members via telephone and enhance care coordination, reducing serious drug interactions by 15.2%, emergency room visits by 15%, hospital admissions by 9%, and more.   Noting the pilot program’s ability to significantly improve Member health outcomes and reduce utilization, the Journal of Managed Care & Specialty Pharmacy estimates that California’s Medicaid (Medi-Cal) program could save more than $1B annually by applying the program’s measures to a similar group of patients. “This study affirms that Medication Therapy Management for Medicaid patients is essential for optimizing patient care,” said Dr. Michael Blatt, IEHP Clinical Director of Pharmacy and Product Strategy. Pilot program participants included 2,150 IEHP Members between 40 to 60 years old with an average of 25 medications prescribed to manage chronic conditions. “This comprehensive medication management program, created by pharmacists and aided by novel decision technology, enables us to engage a team of support around individual Members by connecting the right Members to the right resources at the right time,” said Dr. Edward Jai, IEHP Senior Director of Pharmaceutical Services. To share additional learnings from this effort and to support other health plans looking to leverage AI in a CMM program, Dr. Jai will be presenting program results and lessons at the 2021 Academy of Managed Care Pharmacy Nexus Conference on October 18. His presentation will also include details from IEHP’s Medication Reconciliation Program, which also decreased readmissions and hospitalizations. For more information about this study, visit jmcp.org.

Department of Child Support Services, Inland Empire Health Plan (IEHP) Community Resource Centers will host Roadshow Recruitment job fairs.  Events will be held at all three IEHP Community Resource Centers at the following dates and times:  Tuesday, Nov. 8, from 10 a.m.- 2 p.m. at IEHP’s Riverside center, 3590 Tyler St., Suite 101, Riverside, Calif., 92503 Wednesday, Nov. 9, from 10 a.m.- 2 p.m. at IEHP’s Victorville center, 12353 Mariposa Road, Suites C-2 & C-3, Victorville, Calif., 92395 Thursday, Nov. 10, from 10 a.m.- 2 p.m. at IEHP’s San Bernardino center, 805 W. Second St., Suite C, San Bernardino, Calif., 92410 Each event will have about eight employers on site, all accepting applications and conducting interviews for various roles. Industry positions include jobs in retail, education, transportation, manufacturing, logistics, hospitality, law enforcement, U.S. armed forces, administrative and more. Registration is required by filling out this form.  “With so many in need and right before the holidays, this job fair is greatly needed,” said IEHP Community Resource Center Manager Maria Gallegos. “We’re thrilled to connect our members and neighbors to trusted employers, who are actively looking to hire within our communities.” Attendees are encouraged to dress professionally and to bring several copies of their resumes. Workshops for resume building will also be offered by Goodwill of Southern California.  “Our centers are an invaluable resource for our region because of our community partners and their willingness to consistently collaborate with us to support our most vulnerable residents,” said IEHP Community Resource Center Manager Delia Orosco. “We are eager to help facilitate these connections and foster growth in our neighborhoods because of events like these.”