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Member Advisory Committee - Public Policy Participation Committee

ces and feedback guide our services. As a result, we are able to improve how we deliver care and services. The PPPC meets every three months. We bring together IEHP staff and Members to give our Members a platform for open discussion. During the meetings, Members will have the opportunity to give feedback on member materials and their overall experience while receiving care with IEHP. We also discuss the IEHP Cultural and Linguistic (C&L) services program. Members who are selected to participate, will get $75 for each meeting they attend. All meetings will take place at IEHP headquarters from 12 p.m. - 2 p.m.   2023 Meeting Schedule March 15, 2023 June 21, 2023 September 20, 2023 December 20, 2023  

Helpful Information and Resources - Texting Program

Members using text messaging, this form of communication can reach our Members immediately. Although information isn't limited to this common communication channel, we may send you important healthcare notifications to: Inform you on how to get care and services with IEHP Remind you about key preventive care visits to help you stay healthy Let you know about health education and wellness programs that you are eligible for And much more To sign up, Members need to text “Healthy” to 90902. Message and data rates may apply. For help, text HELP to 90902 or email texthelp@iehp.org. Members can unsubscribe by replying STOP at any time. Message frequency varies.  This texting program is available to Members who are the subscribers of Boost, AT&T, T-Mobile®, Dobson, Verizon Wireless, U.S. Cellular, C Spire Wireless, Metro PCS, Cricket Communications, Virgin Mobile and other wireless carriers. Carriers are not liable for delayed or undelivered messages. Members must be 13 years of age or older to use this service. You also agree to IEHP Wireless Text Messaging Terms and Conditions.  We respect your privacy. Our privacy policy can be found here. Contact Info: 10801 Sixth Street Rancho Cucamonga, CA 91730 1-800-440-IEHP (4347) 1-800-718-IEHP (4347) for TTY Users 8AM-5PM PST texthelp@iehp.org www.iehp.org *This short code program is managed by mPulse. www.mpulsemobile.com  

Pharmacy Pain Management - Pharmacy Pain Management

ively manage members on multiple opioid therapies to prevent overutilization, identify unsafe and inappropriate opioid use, and address potential fraud, waste, and abuse. Identified members at risk of opioid overutilization will be evaluation through our Pharmacy Pain Management Program (PPM). A clinical team will be reviewing member therapy and reaching out to the primary provider to discuss the existence of multiple prescribing providers, member's total opioid utilization, appropriate level of opioid use for the member, and considerations for implementation of a member-level claim edit. After review and consultation with the prescribing provider, if the member's therapy is determined to be appropriate and medically necessary, no further action will be taken.  Results of consultation with provider and findings will be documented. After review and consultation with the prescribing provider, if the member's therapy is determined to be inappropriate, and the provider recommends member-level point of sale claim edit, the member will be mailed a notification letter-that entrails the provider's recommendation.  Medicare members will receive the notice 30 days in advance of the point of sale claim edit implementation. Member may also be referred for evaluation and monitoring by a pain management specialist.   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website. Resources and Tools: Pain Management CPG (PDF) Pain Quick Reference Guide (PDF) For convenience, the URL link to the State of California Department of Justice's Controlled Substance Utilization Review and Evaluation Systems (CURES), California Prescription Drug Monitoring Program (PDMP) site. By clicking on this link, you will be leaving the IEHP website. http://oag.ca.gov/cures-pdmp   Information on this page is current as of January 1, 2022  

Pharmacy Services - Pharmacy Network Lists

here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.   To view IEHP’s current Pharmacy Network under IEHP DualChoice (HMO D-SNP) - Medicare-Medicaid Plan, please use this link: Under “How to Access Care” tab, click on “2022 IEHP DualChoice Provider and Pharmacy Directory (PDF)".   To view IEHP’s future Pharmacy Network under IEHP DualChoice (HMO D-SNP), please use this link: Under “How to Access Care” tab, click on “2023 IEHP DualChoice Provider and Pharmacy Directory (PDF)".   Information on this page is current as of November 02, 2022.

Physician Wellness - Physician Wellness

th IEHP’s inspiring and compelling Mission to “Heal and Inspire the Human Spirit,” we are mindful of the cost of caring on clinician health and well-being and we want you to know we care about you, stand with you, and want to support you in ways that help you sustain joy in your work. We have provided best-practice and highly respected resources here for provider well-being. May you continue to find purpose and fulfillment in your calling to this very sacred work of health care.   Resources Standford Well MD A robust site of resources, courses, publications, self-assessments, research, innovation, conferences, and trainings. https://wellmd.stanford.edu/   National Academy of Medicine A compilation of key resources for improving clinician well-being. https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/   American Association of Physician Leadership (AAPL) Resources, courses, and tools for Physician Wellness, Physician Leadership, and more. https://www.physicianleaders.org/resources/wellness   Coalition for Physician Wellness Resources, mobile app, research, podcasts, books and publications. https://www.forphysicianwellbeing.org/   Healthcare Burnout Symposium – February 2023 Annual conference that addresses the multiple facets of burnout crisis and how to increase the well-being of physicians, nurses and administrators. Visit website to learn more about conference agenda and how to earn continuing education credits. https://www.stophealthcareburnout.com/   American Medical Association Alliance (AMA) Steps Forward Program: Improving Physician Resilience Resources for physicians to enhance their resiliency and prevent burnout. Visit website to learn more about the AMA’s Steps Forward guide and module. Physicians might be able to earn continuing education credits by completing the training. https://amaalliance.org/physician-burnout/   American College of Physicians Online learning center with webinar and videos available on physician well-being and professional fulfillment. https://www.acponline.org/online-learning-center/physician-well-being-and-professional-fulfillment   Los Angeles County Medical Association (LACMA) Interactive Wellness dashboard and resources for physicians. https://www.lacmainteractive.com/mdlifeline   National Suicide Prevention Hotline The lifeline provides 24/7, free and confidential support, prevention and crisis resources for anyone in need and best practices for professionals in the United States. https://988lifeline.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.

Community Partners - Community Partner Network Meeting

IEHP. The network includes approximately 100 representatives from community-based organizations, service agencies, clinics, and schools. Attendees share healthcare news, resources and discuss how to enroll uninsured children in a health program which they qualify for. Most of all — attendees bring their specialty to connect and collaborate on ways to help families in the Inland Empire. How can I join the IEHP Community Partner Network? If you are interested in joining the IEHP Community Partners Network, please email communityhealthreps@iehp.org for information. Click here if your organization is interested in becoming an IEHP Community Partner. When are the meetings held? The following is the schedule for the IEHP Community Partner meetings. 2023 Schedule Thursday, February 16 Thursday, April 20 Thursday, June 15 Thursday, August 17 Thursday, October19 Thursday, December 14 Location: Virtually Time: 11:00am - 12:30pm

Provider Manuals - General Information

EHP's contracted Providers understand how IEHP functions and understand the rules and regulations IEHP must comply with, as governed by the California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC), the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). The Delegate or Provider has the responsibility to ensure review, understanding, and attestation of the information contained in the Manual. Acknowledgement of Receipt (AOR) 2023 Providers: 2023 Provider eAOR Providers are encouraged to attest electronically using the following recommended browsers: Google Chrome, Microsoft Edge, Mozilla Firefox 2023 Hospital & IPA AORs For more information regarding 2023 Manuals, click here.

P4P - Proposition 56 - GEMT - PHDP-EPP Program

pating Network Provider private hospitals through uniform dollar increases for select inpatient and outpatient services based on actual utilization of qualifying services as reflected in encounter data reported to DHCS. PHDP utilization-based payments will be calculated by DHCS in accordance with the CMS approved preprint, and must be issued by IEHP to private hospitals, in six-month increments: January through June, and July through December Enhanced Payment Program (EPP) EPP provides supplemental reimbursement to Network Provider DPHs through uniform dollar increases for select inpatient and non-inpatient services, based on the actual utilization of qualifying services as reflected in encounter data reported to DHCS. In addition, for Network Provider DPHs that are primarily reimbursed on a capitated basis, DPH EPP provides supplemental reimbursement through uniform percentage increases to their contracted capitation rates. EPP utilization-based payments and Capitation based payments will be calculated by DHCS in accordance with the CMS-approved preprint and must be issued by to DPHs, in six-month increments: January through June, and July through December For more information about PHDP and EPP Programs, please visit the DHCS website at https://www.dhcs.ca.gov/services/Pages/DirectedPymts.aspx. District and Municipal Public Hospital Quality Incentive Pool and Designated Public Hospital Quality Incentive Pool QIP provides supplemental incentive payments to participating DPH and DMPH systems based on their performance on specified quality measures that address primary, specialty, and inpatient care, including measures of appropriate resource utilization. QIP payments are linked to delivery of services under MCP contracts. For additional details on QIP incentive program please visit DHCS website at https://www.dhcs.ca.gov/services/Pages/DP-DPH-QIP.aspx or contact DHCS at qip@dhcs.ca.gov. For disputes of payments issued under Private Hospital Directed Payment Program (PHDP) and or Enhanced Payment Program (EPP)- Hospital is to send email to PHDP-EPP@iehp.org stating the service period and dispute reason in detail. Hospital has six months from IEHP’s payment check date to dispute payment. FAQ’s on Hospital Directed Payments Please e-mail any inquiries related to the PHDP or EPP Program to PHDP-EPP@iehp.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.

Pharmacy Services - Pharmacy Forms

BM) handles all Medicare pharmacy and provider prior authorization and pharmacy benefit related questions. Providers and pharmacies can call MedImpact Customer Contact Center at (800) 788-2949. Health care providers can submit prior authorizations via fax (858) 790-7100, or download forms at the MedImpact Website. Request for Redetermination of Medicare Prescription Drug Denial - English (PDF) Request for Redetermination of Medicare Prescription Drug Denial - Spanish (PDF) Coverage Determination Form - Retroactive prior authorization requests (PA requests dated before 1/1/2023) should be faxed to (909) 890-5766.   Drug Request Supplemental PER Form for Compounded Prescription (PDF) Medicare Hospice Form for Medicare Part D Plans (PDF) Medicare Prescription Drug Coverage and Your Rights - English (PDF) Medicare Prescription Drug Coverage and Your Rights - Spanish (PDF) Mail Order Mail-Order Service Fax Form (PDF) Other Pharmacy Provider Forms Appointment of Representative - English (PDF) Appointment of Representative - Spanish (PDF) Nutritional Evaluation Form - Adult (PDF) Nutritional Evaluation Form - Infant (PDF)  Opioid Edit Error Report Form (PDF) WIC Program Forms (California Department of Public Health) Pediatric Referral Form (PDF) WIC Referral For Pregnant Women (PDF) WIC Referral For Postpartum/Breastfeeding Women (PDF)   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.   Information on this page is current as of January 05, 2023.

Leadership Team - Jarrod McNaughton, MBA, FACHE

aboratively with the IEHP Governing Board to set the strategic vision and provide executive leadership for one of the 10 largest Medicaid health plans and the largest not-for-profit Medicare- Medicaid Plan in the U.S.  He cultivates IEHP’s strong partnership with Providers, hospitals and hundreds of community partners to deliver quality whole-person care to more than 1.6 million Members.  

Leadership Team - Keenan Freeman, MBA

responsible for the overall financial management of IEHP, its financial reporting and transparency, and for multiple plan financial functions, including accounting, purchasing, capitation, cost recovery, risk management and the coordination of fiscal and other operational audits. He also oversees contracting, product system configuration, facilities/property management development and security teams.

Leadership Team - Edward Juhn, MD, MBA, MPH

advancement of IEHP’s strategic focus on quality through transformative payment incentives, data driven initiatives, innovative solutions, program connections and strong internal and external partnerships. In this role, Dr. Juhn also ensures the health plan’s commitment to providing the highest quality of care.  

Leadership Team - Michelle Rai, MS

2020. She oversees IEHP’s communications and marketing programs and guides the development of long-term communication and marketing strategies.  In this role, Ms. Rai oversees the strategic execution of IEHP’s branding, advertising, media relations, internal communications, digital and social media initiatives to align with IEHP’s Mission, Vision and Values.  

Leadership Team - Takashi Wada, MD, MPH

clinical strategic leadership for IEHP in partnership with the Chief Quality Officer through collaborative, accountable processes to improve the quality-of-care delivery and drive improved health outcomes for IEHP Members.  He is responsible for the health services division, including utilization management, behavioral health and care management, pharmacy, community health and health education, population health, health services special initiatives and health equity.   

Leadership Team - Susie White, MBA

ork sphere and was appointed Chief Operating Officer (COO) in July 2019. As COO, Susie is responsible for IEHP’s overall day-to-day operations. She is highly regarded for her commitment to driving IEHP’s team culture, serving the plan’s 1.6 million Members and advancing the plan’s Provider experience through the implementation of strategic initiatives that support the plan’s Mission, Vision and Core Values.    

Member Advisory Committee - Persons with Disabilities Workgroup

uide our services. As a result, we are able to improve how we deliver care and services. If you are an IEHP Member with a disability, you can request to be a Member of our PDW.  The PDW meets every three months at IEHP. During the meetings, Members will have the opportunity to give feedback on member materials and their overall experience while receiving care with IEHP. We also discuss any communication needs and access issues that Members may have. To apply for membership in this workgroup, please call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. 2023 Meeting Schedule March 22, 2023 May 10, 2023 August 30, 2023 November 8, 2023 Time: 12pm - 2pm

Leadership Team - Vinil Devabhaktuni, MBA

e, Mr. Devabhaktuni provides leadership for the overall information technology architecture, as well as the design, development, implementation and support of IEHP’s systems.  His focus includes maintaining the organization’s connection to Providers, collaborating closely with IT leadership, and aligning initiatives with IEHP’s overall strategic plan.  

Governing Board Meetings - 2023 Meeting Schedule and Locations

n to the public. We invite you to join us at the next board meeting. You can also download a copy of our most current monthly board report. Dr. Bradley P. Gilbert Center for Learning and Innovation 9500 Cleveland Avenue Rancho Cucamonga, CA 91730 Click here to view the meeting room map.  Inland Empire Health Plan Dates & Times Monday, January 30, 2023 9:00 a.m. February - NO MEETING Monday,  March 6, 2023 9:00 a.m. Monday, April 10, 2023 9:00 a.m. Monday, May 8, 2023 9:00 a.m.  Monday, June 5, 2023 9:00 a.m.  Monday, July 10, 2023 9:00 a.m.  Monday, August 14, 2023 9:00 a.m.  Monday, September 11, 2023 9:00 a.m.  Tuesday, October 10, 2023 9:00 a.m. Monday, November 13, 2023 9:00 a.m.  Monday, December 11, 2023 9:00 a.m. 

Health Navigator Program - Health Navigator Program

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