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Provider Resources - Additional Resources & Tools
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.
Provider Resources - IEHP DualChoice - Model of Care
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.
Provider Resources - Pharmacy
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
Provider Resources - Claims
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)
Provider Resources - Non-Contracted Providers
s for Contracted and Non-Contracted Providers Emergency and Post-Stabilization Care for IEHP Members IEHP DualChoice (HMO D-SNP) Model of Care Training for Non-Contracted Providers Provider Dispute Resolution Process for Contracted and Non-Contracted Providers Definition of a Provider Dispute A provider dispute is a written notice from the provider to Inland Empire Health Plan (IEHP) that: Challenges, appeals, or appeals, or requests reconsideration of a claim (including a bundled group of similar claims) that has been denied, adjusted, or contested Challenges a request for reimbursement for an overpayment of a claim Seeks resolution of a billing determination or other contractual dispute What is not Considered to be a Provider Dispute Claims denied for missing or additional documentation requirements such as consent forms, invoices, Explanation of Benefits from primary carrier, or itemized bills are not considered Provider Disputes Corrected Claims Pre-Service Authorization Denials Provider Dispute Time Frame IEHP accepts disputes from providers if they are submitted within 365 days of receipt of IEHPs decision (for example, IEHPs Remittance Advice (RA) indicating a claim was denied or adjusted). Submission of Provider Disputes When submitting a provider dispute, a provider should use a Provider Dispute Resolution Request form. If the dispute is for multiple, substantially similar claims, complete the spreadsheet on page 2 of the Provider Dispute Resolution Request Form All Provider Disputes and supporting information must be submitted to: IEHP Claims Appeal Resolution Unit PO BOX 4319 Rancho Cucamonga, CA 91729-4349 Acknowledgement of Provider Dispute IEHP acknowledges receipt of each provider dispute, regardless of whether the dispute is complete, within 15 business days of receipt. Resolution Timeframe IEHP resolves each provider dispute within 45 business days following receipt of the dispute, and provides the provider with a written determination stating the reasons for determination. PDR Determination Resulting in Additional Payment If IEHP determines to pay additional monies based on information originally provided and/or available at the time the claim was first presented to IEHP for adjudication, or a result of a processing error IEHP will automatically include the appropriate interest amount if payment is not issued within required regulatory timeframes. Non-Contracted Provider Disputes Resolution Process for IEHP DualChoice (HMO D-SNP) A non-contracted provider, on his or her own behalf, is permitted to file a standard appeal for a denied claim only if the non-contracted provider completes a waiver of liability statement, which provides that the non-contracted provider will not bill IEHP DualChoice (HMO D-SNP) Plan Members. Who to Call with Questions on IEHPs PDR Process Contracted providers may visit our online secure provider portal at www.iehp.org for more information. Providers may also call the IEHP Provider Call Center at (909) 890-2054 or (866) 223-4347 Monday-Friday, 8:00 am to 5pm PST. (Back to Non-Contracted Providers Menu) Emergency and Post-Stabilization Care for IEHP Members Triage and Advice Systems IEHP provides Members triage, screening, and advice services by telephone 24 hours a day, 7 days a week through its Nurse Advice Line (NAL). By calling the NAL, Members receive assistance with access to urgent or emergency services from an on-call physician, or licensed triage personnel. IEHP Members can reach this 24/7 Nurse Advice Line at (888)-244-IEHP (4347) or 711 (TTY). Post-Stabilization Care IEHP requires contracted and non-contracted hospitals to obtain prior authorization for post-stabilization care for Members (patients). IEHP requests the patient’s diagnosis as indicated by the treating physician or surgeon and any other information reasonably necessary for the Plan to decide on whether to authorize post-stabilization care or to assume management of the patient’s care by prompt transfer to another facility. The hospital should request prior authorization from IEHP’s Utilization Management (UM) Department by: Phone at (866) 649-6327; or Fax at (909) 477-8553 to send clinical notes for medical necessity review. IEHP makes every effort to respond to requests for necessary post-stabilization care within thirty (30) minutes of receipt. The services are considered approved if IEHP does not respond within this timeframe. All subsequent hospital day are subject to review for medical necessity. IEHP will inform the provider of the Plan’s decision and will coordinate the transfer of the Member if IEHP denies the request for authorization of post-stabilization care and elects to transfer the Member to another health care provider. Non-Emergency Services If a Member presents at the emergency department for non-emergency services, please refer the Member to their IEHP Member Handbook, section 3 (How to Get Care), which outlines the process for obtaining a referral. Claims Reimbursement Complete facility claims for authorized health care services must be sent to: Inland Empire Health Plan Attn: Claims Department – IEHP Direct PO BOX 4349 Rancho Cucamonga, CA 91729-4349 Complete professional claims for authorized health care services must be sent to: For IEHP-Direct Members, please send to address above. For IEHP Members assigned to an IPA, please click for here for more information on how to send to the appropriate IPA. Billing IEHP Members Providers under the Medi-Cal program must not submit claims to, demand or otherwise collect reimbursement from a Medi-Cal beneficiary, or from other persons on behalf of the beneficiary, for any service included in the Medi-Cal program’s scope of benefits in addition to a claim submitted to the Medi-Cal program for that service. IEHP DualChoice (HMO D-SNP) Model of Care Training for Non-Contracted Providers The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS), and National Committee for Quality Assurance (NCQA) requirement that out-of-network providers routinely seen by IEHP DualChoice (HMO D-SNP) Members, receive training on IEHPs Model of Care for our D-SNP Members: 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 2023 IEHP DualChoice (HMO D-SNP) Model of Care eAOR 2023 IEHP DualChoice (HMO D-SNP) Model of Care Non-Contracted Provider AOR (PDF) Report an Issue To report any issues with this system or process or for any questions, please send an email to DGHospitalRelationsServiceTeam@iehp.org (Back to Non-Contracted Providers 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.
P4P - Proposition 56 - GEMT - Prop 56 - Value Based Payment
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.
Latest News - IEHP Celebrates 25 Years of “Doing the Right Thing”
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.”
Latest News - Community Gardens Nourish with Food, Fish and Fellowship
at involves fish – are providing access to fresh fruits and vegetables for neighbors facing food insecurity. For the last year, Inland Empire Health Plan (IEHP) has worked closely with community partners to support these gardens, including an inspiring collaboration with Music Changing Lives (MCL) Chief Executive Officer Josiah Bruny, to bring a new community garden to San Bernardino. Located on the corner of Electric Avenue and North 40th Street in San Bernardino – once one of the largest dumping sites in the city – the land has been transformed into MCL’s Urban Garden. In addition to addressing food insecurity, the garden aims to provide a safe space where neighbors can come together to learn, exercise, eat, explore, relax and have fun. Home to Soulful Sunday events every fourth Sunday of the month, local residents are invited to visit the garden for gardening workshops and various volunteer opportunities, while enjoying music, food and more. Information on Soulful Sunday events can be found on MCL’s Facebook page. “The best part about this project is that it’s all led by the community,” said Bruny. “Working together, we can bring more love to the region and those who need it most. We look forward to leveling up in our efforts to make the Inland Empire a better place for us all.” In addition to sponsorship, IEHP supports the garden by providing volunteers through the company’s team member Helping Hearts program and Health Education team. Volunteers work alongside program leaders pulling weeds, planting trees, spreading mulch, building garden beds and irrigating crops. “Through the right partnerships, compassion and drive to heal and inspire the human spirit, these gardens are thriving and bringing a diversity of wellness opportunities to our neighbors,” said IEHP Senior Community Health Director Cesar Armendariz. “We appreciate the love Music Changing Lives has for the Inland Empire and the people who live here and look forward to continuing to plant and harvest more gardens for a healthier community.” The health plan also provided sponsorship to “Jardín Comunitario de la Salud” – Spanish for “Community Garden of Health” – to help support a large aquaponics garden at the Loma Linda University Health SACHS clinic in San Bernardino. The first of its kind in the Inland Empire, the garden is home to a large quantity of fish that work symbiotically, nourishing garden beds and working to create food that can be harvested and consumed by the community. Gardens are located in Rancho Cucamonga, Ontario, Jurupa, Perris and San Bernardino. For more information on local community gardens, visit: riversidefoods.org.
Latest News - Medi-Cal families receive discounted internet services
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.
Latest News - Poverty Symposium Hosted at IEHP Headquarters
, Inland Empire Health Plan (IEHP) hosted Community Action Partnership of San Bernardino County’s (CAPSBC) fourth annual 2022 Poverty Symposium Friday, July 29 at its headquarters. The event gathered elected officials, policy makers and community leaders to share innovative solutions that tackle poverty-related issues in the county. The symposium also included a keynote address from University of California Riverside’s Professor of Public Policy, David Brady, and panel presentations comprised of experts from the housing industry, youth providers and more. “We are so grateful for the IEHP team’s hospitality in allowing us to host this year’s Poverty Symposium at their facilities,” said Xiomara Henriquez-Ortega, Administrative Support Manager. “Community Action Partnership of San Bernardino County values our long-term partnership with IEHP, and we appreciate their continued support to help us further our mission of helping people and changing lives. This event was an important component of our advocacy efforts to impact change in our communities, and it is a collective effort we are working on with our key partners.” IEHP’s 400,000-square-foot Atrium building is no stranger to hosting positive, impactful events. In addition to being a home base for more than 2,800 IEHP employees, the ENERGY STAR® certified facility has served internal team members, industry professionals and the community for celebrations and in great times of need. Past events at the Atrium have included the health plan’s annual Mission Conference, innovative health information technology showcases, COVID-19 personal protective equipment distributions, super vaccine clinics and more. “Events like the CAPSBC Poverty Symposium stimulate critical discussions and connections that move our communities forward,” said IEHP Senior Director of Community Health Cesar Armendariz. “We are extremely grateful for our strong partnership with CAPSBC and the great work they do and look forward to hosting future collaborations with our many community partners at our beautiful Atrium site as we work together to heal and inspire the human spirit.”
Latest News - IEHP Responds to the Department of Health Care Services
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
Latest News - IEHP Earns Rancho Cucamonga Fire District’s Business Partner of the Year Award
re District at the City’s Fire and Police Recognition Celebration on September 9. The distinguished award recognizes the health plan’s partnership with the City and County of San Bernardino to host an ongoing super vaccine clinic at the health plan’s headquarters. Located in Rancho Cucamonga, IEHP’s 400,000-square-foot headquarter building (known as the Atrium) was transformed into a super vaccination site in February 2021 where more than 36,900 COVID-19 vaccines have been administered to date. “We are incredibly humbled to receive this recognition from the Rancho Cucamonga Fire District,” said Jarrod McNaughton, IEHP Chief Executive Officer. “Hosting the vaccine clinic is very important to us. As a health plan, a partner of the city and county, we knew we needed to do our part to make these vaccines accessible.” Rancho Cucamonga Fire District’s Business Partner of the Year is traditionally awarded to a community business who assists the district as a problem solver. “This award is our humble way of expressing our gratitude for the partnership in this historic effort. We thank IEHP for opening their doors and making a difference in thousands of lives within our community during these unprecedented times,” said Ivan Rojer, Rancho Cucamonga Fire District’s Fire Chief. IEHP has been a Rancho Cucamonga Business Partner since relocating from San Bernardino in 2013. Prior to March 2020, IEHP’s ENERGY STAR® certified Atrium building supported more than 2,400 Team Members (IEHP employees), who have temporarily transitioned to full-time work-from-home schedules during the pandemic. “In addition to addressing the needs of our Members and residents throughout the Inland Empire, it means so much to us that we were able to open our building to provide more access for our friends and neighbors in Rancho Cucamonga as well,” said Dr. Takashi Wada, IEHP Chief Medical Officer. “We are incredibly grateful for the recognition and the ongoing support pouring into the vaccine clinic. And we look forward to continuing our partnerships to help increase vaccine rates in our region.” The clinic is located at 10801 Sixth Street in Rancho Cucamonga and is scheduled to run for the rest of the year. Appointments and walk-ins can be accommodated. Appointments can be made at SBCovid19.com/vaccine.
Latest News - IEHP Physicians Encourage COVID-19 Vaccines for Youth
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.
Latest News - Meet Maria: 92-Year-Old Finds Wellness and Renewal at IEHP Community Resource Center
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.
Latest News - Nominations Now Open: IEHP Living the Mission Awards
er place for all? Inland Empire Health Plan (IEHP) is currently collecting nominations for its 2023 Living the Mission Awards, which will be announced next spring. Nominations can be made until Feb. 15, 2023, by visiting LivingTheMissionAwards.IEHP.org. Categories for the awards include Creativity and Innovation, Vibrant Health, Optimal Care and Inspire. The Creativity and Innovation Award will honor a provider, entity or community partner that exemplifies the courage to “break the mold” in pursuit of innovative ways to address health concerns for Inland Empire residents. IEHP’s Vibrant Health Award will recognize a provider, entity or community partner that exemplifies engagement with the well-being and joyful life of residents in the Inland Empire. The health plan’s Optimal Care Award will celebrate a provider or entity that exemplifies world-class care and outcomes in preventive care, chronic care or hospital care. In addition, the Inspire Award will acknowledge a provider, an entity or community partner that exemplifies IEHP’s mission, “We heal and inspire the human spirit.” Earlier this year, Community Action Partnership of San Bernardino County (CAPSB) and SAC Health System earned IEHP’s first Living the Mission Awards. This recognition highlighted CAPSB’s dedication to eliminate effects of poverty and SAC Health System’s tireless support and service to residents in both Riverside and San Bernardino counties. “The work we do each and every day to fulfill our mission to heal and inspire the human spirit is made possible through the innovative and courageous contributions of our providers and partners,” said IEHP Chief Executive Officer Jarrod McNaughton. “We look forward to honoring these groups and continuing our collaborative work to make the Inland Empire a healthier place for all.” Awards will be announced at IEHP’s annual Mission Conference scheduled for May 5, 2023. To learn more, visit missionconference.iehp.org.
Latest News - IEHP Partners with Special Needz Coffee to Honor Diversity Awareness
h Diversity Awareness and National Disability Employment Awareness Month. SNC is a mobile coffee shop in Ontario, California, that provides work opportunities to adults with intellectual and developmental disabilities. Nearly 95% of the staff at SNC identify as persons with disabilities. “This is the first time IEHP has partnered with SNC, but it will not be the last,” said Marisol Pilotin, IEHP Community Health Representative. “Every October, our Independent Living and Diversity Services teams organize informational workshops and trainings for our Team Members that highlight the importance of equity and inclusion. SNC is an incredible model of that, and the positive impacts on both their extraordinary employees and the community are undeniable.” The partnership includes the purchase and distribution of SNC coffee vouchers for IEHP Team Members (employees) who participate in various trainings and events throughout the month. Employees from SNC will also join the health plan as guest speakers at a virtual workshop titled, Social Inclusion for People with Disabilities. "Partnering with IEHP during Diversity Awareness Month helps us fulfill our mission of raising awareness and empowering individuals with special needs and/or mental illnesses,” said Mia Humphreys, SNC Administrative Director. “Special Needz Coffee and IEHP share the common goal of promoting acceptance of everyone's differences, whether they are based on racial, cultural, religious, or political beliefs, and, most importantly, their mental or physical abilities. We are both working toward providing individuals with special needs an equal opportunity to work at organizations that promote diversity and inclusivity.” SNC’s mobile coffee shop sets up in Ontario at 2920 Inland Empire Blvd. Suite 108 (in the parking lot near the freeway). The shop is open to the public from 7:30 a.m. to 3:30 p.m. Monday through Friday, and from 9 a.m. to 1 p.m. on Saturday. “We’re really looking forward to continuing our partnership with SNC beyond this month’s celebration,” said Jose Solorzano, IEHP Community Health Representative. “Diversity should be celebrated every day, and we really appreciate that SNC reminds adults with disabilities that, through challenges and differences, they are able to make a positive impact in this world.” To learn more about SNC, visit specialneedzcoffee.com.
Latest News - Together with EASE: IEHP Partners to Promote Awareness and Early Childhood Detection of Diabetes
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.
Latest News - IEHP’s Women in Leadership Engage with Local Students
articipated in Chaffey College’s Center for Culture and Social Justice Panel titled, “Celebrating Women in Healthcare Leadership,” which educated students of the current roles and contributions made to healthcare by women in the Inland Empire. The panel, conducted over Zoom, included several IEHP leaders, including Susie White, Chief Operating Officer; Dr. Priya Batra, Senior Medical Director for Family and Community Health; Shelly LaMaster, Director of Integrated Care; and Anna Wang, General Counsel. “The event was wonderful and hearing from IEHP’s women leaders was impactful for all who attended,” said Dr. Leticia Romo, Chaffey College’s Director of Student Equity and Engagement. “We had the opportunity to hear real and authentic stories, wisdom, and encouragement. Our students learned about mentorship, management responsibilities, leadership development, and overcoming imposter syndrome. We definitely look forward to connecting with the IEHP leaders in the future.” The panel also provided students with stories about their own educational journey and career background and offered advice for future healthcare leaders. “Our work as a community-based health plan goes well beyond traditional health services,” said White. “It also includes making sure the next generation of leaders are equipped with the necessary support, tools and information to make even greater contributions to the healthcare space in the future.” In 2020, the health plan launched a Healthcare Scholarship Fund, partnering with Loma Linda University Medical School, University of California Riverside, and California University of Science and Medicine, to help remove the barrier of debt for local medical students and develop a growing workforce for healthcare professionals to care for the Inland Empire’s growing Medi-Cal population. In addition, amid the pandemic, IEHP provided internships to local public health students at Claremont Graduate University and Western University of Health Sciences to assist in developing program curricula at the plan’s Community Resource Centers. “Sharing knowledge and guidance with Inland Empire learners just entering the health care workforce is another way we can positively impact health and wellness,” said Dr. Priya Batra, IEHP’s Senior Medical Director for Family and Community Health. “Supporting the advancement of diverse health care professionals will help us achieve vibrant health in our region.”
Latest News - IEHP Leads First Cross-County Community Health Assessment
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.”
Latest News - IEHP Members Receive Free Autism and ADHD Screenings
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.