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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.

ican residents through a series of local public service announcements (PSAs) that encourage navigating family health matters, including COVID-19 vaccines. Actors/entrepreneurs Boris Kodjoe and Nicole Ari Parker, currently starring on ABC’s “Station 19” and HBO Max’s “And Just Like That,” respectively, have been supporting health and wellness initiatives for years through their Kodjoe Family Foundation. Today they continue to help share fact-based health information with their community. “The truth is, our community is still being hit hardest by this virus and vaccines lower our risk of getting sick or even dying of COVID-19,” said Parker in one of the campaign segments, which were funded in partnership with San Bernardino County’s COVID Equity Grant. Nearly three years after the start of COVID-19 pandemic, the Inland Empire continues to report low vaccine rates, especially among Black residents, resulting in increased hospitalizations and deaths. “We understand the concerns our Black and minority residents have in regards to the vaccine,” said Inland Empire Health Plan (IEHP) Chief Medical Officer Dr. Takashi Wada. “It isn’t enough to just tell community members to get vaccinated and that the vaccines work, we’re inviting them to empower themselves through awareness and gathering information from trusted sources.” Like the celebrity couple of Boris and Nicole, Dr. Wada further encourages all Inland Empire residents to get the facts about COVID-19 vaccines and boosters directly from reliable sources such as official websites and licensed medical experts. “The best thing you can really do to support the health and wellness of your family is to read the data and ask your doctors questions, so you CAN make sound decisions regarding the health and wellness of your family,” Dr. Wada added. Topics of the “Boris and Nicole” PSAs include various messages about protecting the Inland Empire community and family health as well as encouraging residents who have doubts to visit IEHP’s COVID-19 website to gather accurate and timely information. The announcements began running on KMIR Palm Springs stations and IE Spectrum stations and will continue through summer 2023.

ing earthquakes rocked the rural desert community nearly four years ago, many of the residents couldn’t recover, shuttered their homes and simply walked away. Others who stayed just haven’t been able to replace the broken glass. But make no mistake – the Trona citizens who remain love their town. They’re Trona Strong. Despite the damaged windows, the door to welcome partners like Inland Empire Health Plan (IEHP) – and the help and resources it can offer – is wide open. ‘BRING NEW HOPE’ “We’re isolated out here in a lot of different ways and it’s a struggle to get many services,” said Trona resident Julia Pitman, who recently attended a special in-person meeting with IEHP CEO Jarrod McNaughton at the Trona Community Senior Center. “I was pleased to hear that we had a visit from your team (to) bring new hope to the community.” IEHP was eager to show up for Trona. “The questions that came up, the suggestions that came up today – none of that, I don’t believe, we would have received if we had done some kind of a virtual call or something,” said McNaughton later that day. “I think you have to come in person to really feel what folks are going through, to feel their passion for their community as well.” Even before the 6.4, then 7.1 temblors that hit the town just one day apart, July 4 and 5, 2019, Trona struggled with the changing landscape of its dwindling population (now less than 2,000) and employment opportunities.  Searles Valley Minerals is still the largest employer in Trona. Trona was “born” a company town – literally. In 1914, the American Trona Company established its namesake for the mineral found in the Searles dry lakebed. The community and its residents flourished for the next 60 years, until a series of unfortunate events including factory buy-outs, production cuts and massive layoffs. Thousands of people left Trona. Then, in 2019, the double-whammy of the double quakes, followed by the COVID-19 pandemic less than a year later. Then more residents moved away. BRIGHT SPOTS Along Trona’s timeline, there are bright spots. Football is still a big draw, including games at Trona High School’s all-dirt gridiron – known as the “Pit” –home to the Tornadoes’ eight-man football team. The unique surface mix of sand, grit and rocks is famous: It’s been featured in national media outlets. Future athletes are only a short pass away at the neighboring elementary school whose mascot is the Twisters and where students and teachers alike occasionally dress up as their favorite character for Disney Days. The nearby Trona Pinnacles and surrounding areas – with their otherworldly look and feel – appear as unusual scenic landscapes in various TV shows and Hollywood films, mostly of the sci-fi variety. And sometimes, news crews and photographers pass through town to document Trona’s struggles and steadfast devotion. Much to diners’ delight, Trona’s only eatery – Esparza’s Family Restaurant – recently reopened in a new location, but still serving everyone’s favorite Mexican fare. Its previous spot remains red-tagged from the earthquakes. LOOKING AHEAD Nowadays, Trona residents say it’s time to look forward and find solutions for current gaps like health care access and potential career development for its young people. On Dec. 14, IEHP hosted Winter Wonderland, a large resource fair with dental services, vaccines and other health information. The well-attended event also featured a regular bi-weekly fresh produce distribution, established after ongoing feedback sessions with residents. This collaboration started in 2021, before IEHP officially expanded its health plan coverage area to rural areas, including outlying areas along the borders of San Bernardino County, in January 2022. At the community meeting with IEHP’s CEO McNaughton – which included a lunch catered by Esparza’s – Trona residents were asked to share their town’s top needs. “The biggest thing is how can we get health services in Trona,” said Priscilla Benadom, a longtime Trona resident and recent retiree as the senior center’s program coordinator. Following the meeting, McNaughton wanted to see the area and some of its logistical challenges firsthand, so he took a tour of the city. McNaughton also stopped for a brief visit with those Twisters at the elementary school, distributing IEHP swag bags and chocolate chip cookies. And because it was Disney Day, he even broke out into a booming rendition of the theme song, “Let It Go” from the mega hit movie “Frozen” for one of several Elsas in the classroom. “It’s an honor for IEHP to be connected now – finally – into this community where we can do some pretty cool things together with them,” McNaughton said.  

y’s 2023 Meritorious Service Award recipient. McNaughton – who has served as CEO since 2019 – formally accepted the award during the university’s School of Public Health commencement ceremony held Friday, June 9. McNaughton earned the award for his commitment to lead with integrity in fulfilling IEHP’s mission “to heal and inspire the human spirit,” university officials stated. “I am thrilled to receive Loma Linda’s prestigious Meritorious Service Award,” McNaughton said. “I am honored to be part of an organization that puts its members at the center of its universe by ensuring they have access to the quality health care services they need. I share this award with my remarkable team. Everything we achieve together is because of their incredible passion for serving our community.” In his role, McNaughton is responsible for establishing a strategic vision and providing executive leadership for the Rancho Cucamonga-based organization. Today, IEHP is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country, serving 1.6 million members in both Riverside and San Bernardino counties. The Meritorious Service Award is given annually to individuals who align with the university’s mission of providing world-class health care and services to patients and their families, especially in underserved communities, through a commitment to excellence.  “Jarrod McNaughton’s understanding of the complex issues facing health care today is key to IEHP’s mission to providing individuals needing care the best possible outcomes,” said Richard H. Hart, MD, DrPH, president of Loma Linda University. “His innovative approaches to creating care networks has enhanced healthcare in the Inland Empire’s marginalized neighborhoods.”

ural areas are disproportionately impacted by negative health outcomes, according to a newly released Community Health Assessment focusing on the Inland Empire region.  The 2022 Inland Empire Community Health Assessment Stakeholder Committee, comprised of over 40 representatives across 25 community organizations, united over the past year to collect and analyze the region’s health and wellness data. The collaborative group identified four at-risk population groups in need of additional support, as well as six priority areas of focus: Basic Needs for Health and Safety, Humane Housing, Meaningful Work and Wealth, Cardiovascular Disease and Diabetes, Maternal and Infant Health and Mental and Behavioral Health. The committee shared the findings in a regional Community Health Assessment report. The report is uniquely positioned for its cross-sector involvement and multiple sources of data collection, including focus groups.   “We all know that health happens across zip codes,” said Jarrod McNaughton, chief executive officer at Inland Empire Health Plan (IEHP), which sponsored the Inland Empire Community Health Assessment. “Sickness and disease don't care where you live, but it is clear that certain geographic communities and subpopulations experience significant disparities when it comes to influences on health and health outcomes. This community health assessment is the first step in learning how we as health care providers, community partners and advocates can work better together to address the true health needs of our connected communities.” In addition to health and hospital data, the Community Health Assessment also included interviews with 10 community leaders and focus groups in nine communities.  “Every Inland Empire community member deserves the opportunity to live their best life, and many local organizations are already working to make that possible” added Michelle Decker, president of the Inland Empire Community Foundation, one of the involved organizations. “We are now magnifying that work by uniting our efforts toward key priorities and populations.” To view the Inland Empire Community Health Assessment, visit  VibrantInlandEmpire.org. To raise awareness of community work in the region, organizations are invited to share information about their projects in the Inland Empire through a form on the website. Projects will then be shared with others through the website.  

he challenges it brings – can be overwhelming. After the birth of her daughter, Gerti struggled with her mental health and recognized she needed help – so she turned to IEHP.  Through her connection to Katia, a behavioral health specialist on IEHP’s maternal mental health team, Gerti learned she was experiencing postpartum depression and was connected to various resources, including supportive therapy.  Although common (the CDC cites 1 in 8 women who recently gave birth suffer from it), postpartum depression is more severe and long-lasting than the “baby blues,” which can include short-lived bouts of mood swings, crying spells, anxiety and difficulty sleeping.  “I was just really looking for help, because it gets overwhelming – especially becoming a new mom,” explained Gerti. “Sometimes the depression just catches you. I just want to get through this, so I can push through for my baby, for my sanity, for my happiness.” As Katia explains, no mother with these challenges should ever feel ashamed. Feeling anxious, overwhelmed and depressed are all considered typical emotions during pregnancy and after birth.  “It’s normal [for new moms] to feel the way they do; there is nothing wrong with feeling that way,” said Katia, who also personally experienced postpartum depression. “They should be proud of themselves for reaching out for help – and that is where we come in.” IEHP’s maternal mental health team is a small, but mighty unit within the behavioral health department that connects Members with mental health services such as therapy and psychiatry.  The maternal mental health team regularly checks in with Members to ask how they are feeling, what they need and to help them make those sometimes hard, but life-altering first steps of scheduling and attending therapy appointments.  The team supports Members like Gerti through every step of their recovery and journey through motherhood – even if it’s to simply ask how they are doing.   “If I am able to take care of myself better, I will be able to take care of my baby much more,” explained Gerti. “I know that every time I am having trouble, help is just one phone call away.” To learn more about Gerti’s story, visit: https://youtu.be/8IRKPmIk2CM If you or someone you know is struggling with postpartum depression or mental health, IEHP is here for you. IEHP Members can call Member Services to connect with our behavioral health team. For a mental health emergency, please call the Mental Health and Suicide Crisis Hotline at 988.  

lle Community Resource Center on-site partner, is hosting housing support workshops for county residents.  These free workshops will offer residents a wide range of information on housing assistance resources, including how to sign up for rental assistance and learn more about the county’s housing voucher program. Each workshop is open to the public and will be held at the Victorville Community Resource Center located at 12353 Mariposa Road, Suites C-2 & C-3.  The workshops are scheduled from 9-10 a.m. on the following Wednesdays: Aug. 3 Aug. 17 Sept. 7 Sept. 21 By providing housing resources workshops at the Victorville Community Center, customers can learn about affordable housing services offered by HACSB and access supportive services from other community partners in one location,” said HACSB Director of Policy and Public Relations, Nicole Beydler. “Our hope is that this partnership helps to connect affordable housing and related services, and that customers will be able to leverage these services toward achieving their goals.” HACSB focuses on providing housing assistance through resources authorized and funded through the U.S. Department of Housing and Urban Development. Through this work, HACSB is one of the most progressive housing authorities in the country and the largest provider of affordable housing in San Bernardino County. Currently, HACSB assists about 26,000 people, most of whom are seniors, individuals with disabilities, veterans and children. “We are proud to partner with IEHP to bring these housing resource workshops to the community. Safe and stable housing is fundamental, but it takes more than housing to achieve an enriched quality of life,” added Beydler. Through IEHP and HACSB’s collaboration, the health plan’s Victorville Community Resource center was also designated as a United States Department of Housing and Urban Development (HUD) EnVision Center last year. This highlights the center's ability and commitment to empower households with resources and support needed to become self-sufficient. Resources pertain to economic empowerment, educational advancement, health and wellness and character leadership.  “Knowledge and information are power,” said IEHP Victorville Community Resource Center Manager Delia Orosco. “In collaboration with HACSB and our other center partners, we can empower our communities with information needed to truly inspire positive change in their own lives.” In addition to HACSB, IEHP’s Victorville center currently hosts five, on-site partners to support community residents. Partners include Young Visionaries Youth Leadership Academy, TODEC Legal Center, Community Action Partnership of San Bernardino County and the Goodwill of Southern California.  Click here for more information on IEHP’s Community Resource Centers.   

ed benefit solely for Members Diagnosed with Autism Spectrum Disorder. The coverage criteria have been expanded to include IEHP Members who meet ALL the below: Under 21 years of age Have a recommendation from a licensed physician and surgeon or a licensed psychologist that evidence based BHT services are medically necessary. Be medically stable Not need 24-hour medical/nursing monitoring or procedures provided in a hospital or intermediate care facility for persons with intellectual disabilities. Behavioral Health Treatment (BHT) is the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the direct observation, measurement and functional analysis of the relations between environment and behavior. BHT services teach skills using behavioral observation and reinforcement, or through prompting to teach each step of targeted behavior. BHT services are based on reliable evidence and are not experimental. Treatment may or may not include Applied Behavioral Analysis (ABA). BHT is medically necessary after the Provider has completed a comprehensive developmental surveillance and screening, and have recommended BHT services is clinically warranted to treat persistent developmentally inappropriate behavior and/or diagnoses that may be able to be corrected or ameliorated with BHT services. Aberrant behaviors include but are not limited to self-injury, aggression, and deficits in language skills, daily living skills, and social skills. PCPs will continue to referral a Member directly to IEHP Behavioral Health for any BHT services and/or diagnostic needs regardless of IPA. If you have any questions or ask your PCP for screening, diagnosis and treatment, you can 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. Cost to Member There is no cost to the Member for these services. Visit IEHP's Mental Health page for general mental health information.   

ly contracted provider. PLEASE NOTE, IEHP is currently not accepting new: DME Hospice Specialty Pharmacy Clinical Laboratories Non-Emergent Medical Transportation (NEMT) Community Based Adult Services (CBAS) outside of the Inland Empire Please check monthly for updates on Network Availability. Prior to extending a contract, we must receive the following documents: 1. Ancillary Provider Network Participation Request Form (PDF) 2. W-9 Form A current Taxpayer Identification Number and Certification Form 3. Liability Insurance Certificate Professional general liability in the minimum amount of One Million Dollars ($1,000,000) per occurrence. Three Million Dollars ($3,000,000) aggregate per year for professional liability. 4. Ownership Information (PDF) Name, Title and Percentage of Ownership 5. Provider Accreditation Certificate 6. CMS/DHCS Passing Site Survey (Approval Letter) Required for each facility 7. California State License (if applicable) Required for each facility 8. Urgent Care Minimum Qualifications (if applicable) All Ages (PDF) Pediatrics (PDF) 9. Medi-Cal Number Ancillary Providers need to successfully enroll in the State's Medi-Cal Program 10. Provider Acknowledgment of Receipt (AOR) (PDF) IEHP is required by State and Federal regulators to maintain an AOR form on file for our Providers signifying your receipt and review of the Policy & Procedure manuals, including annual updates 11. Electronic Remittance Advice (ERA) Form (PDF) Ancillary Providers must complete the ERA form   Contracts Maintenance Request Form can be found here (PDF). Any delay in receiving the above stated documents will affect the effective date of the contract that will be mailed to you.  The contract collateral and other supporting contract documents should be e-mailed to contract@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.

rting our providers. We are committed to quality, driving us to create programs and services to meet the needs of our members and providers. In fact, IEHP is one of the top-rated Medicaid plans in California. Determined by both the Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), NCQA has awarded IEHP an Accreditation status for Medi-Cal. This status is only given to health plans that have clinical and service programs that meet or exceed NCQA standards. Learn more about how IEHP delivers quality services and care below.  Quality Report Inside the 2023 Quality Report, we take you through our quality journey by looking at our performance over the past year with critical measures. We show you how that data translates into tangible outcomes for our Members, Providers and Team Members. While there were many areas where we excelled, there were also places where we found opportunities for improvement. The goal of this Quality Report is to be transparent—with you and with ourselves. This journey is ongoing, and we hope to learn from it so we can do better and be better for those who rely on us the most. 2023 Annual Quality Report (PDF) 2022 Annual Quality Report 2020 Annual Quality Report (PDF) Quality Management IEHP supports an active, ongoing, and comprehensive quality management program with the primary goal of continuously monitoring and improving the quality of care, access to care, patient safety, and quality of services delivered to IEHP Members. The Quality Management (QM) Program provides a formal process to systematically monitor and objectively evaluate, track and trend the health plan’s quality, efficiency and effectiveness. Quality Management Evaluation 2022 Quality Management Annual Evaluation (PDF) Quality Management Program Description 2023 Quality Management Program Description (PDF) HEDIS Every year, IEHP assesses the overall quality of health care experienced by IEHP members. To achieve this IEHP uses  NCQA, a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS® which provides: a set of standardized performance measures based on statistically valid samples of members the public with information to compare health plan performance HEDIS Rate: 2021 Medi-Cal HEDIS Rates (PDF) 2021 Medicare HEDIS Rates (PDF) Physician Satisfaction IEHP values a strong partnership with our providers. To support them we offer many services from online support to a call center, to a dedicated service representative. That's why doctors think highly of IEHP. In fact, according to the 2022 Provider Satisfaction Survey conducted by SPH Analytics, 98.2% of physicians would recommend IEHP to other physicians. See the full results of the 2022 Provider Satisfaction Survey (PDF). Population Needs Assessment Every year, IEHP sends out a Population Assessment Survey to IEHP Members to learn more about their needs. View the results below.  2020 Population Needs Assessment Results  You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Download Adobe Acrobat Reader. 

d is to support the hiring of PCPs, Specialists, and Advanced Practice Providers that will serve the Medi-Cal population in the Inland Empire. Entities that hire qualified candidates are eligible to receive a subsidy up to $75,000 for Advanced Practice Providers, $100,000 for PCPs, and $150,000 for Specialists. All candidates must be a new access point in IEHP's network and not have prior history in the Inland Empire. Please take note of the following: The NEF Program will be targeting specific Provider types. The Provider types and corresponding regions displayed below comprise the list of positions that are currently eligible to receive a subsidy through the NEF Program.   The funding disbursement schedule is as follows:  50% when the qualified candidate completes credentialing 25% when the candidate completes six (6) months of service 25% when the candidate completes one (1) year of service Entities that are interested in receiving support through the NEF Program must submit a complete application to be considered for the funding opportunity. Completed applications and questions should be e-mailed to NEFProgram@iehp.org NEF Program Description (PDF) NEF Application (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here. Click on the following links to jump to that specific section: Corona/Temecula/Hemet High Desert Low Desert Mohave Valley Palo Verde Valley Riverside San Bernardino Proper West San Bernardino Corona/Temecula/Hemet Dermatology Family Practice Internal Medicine Pediatrics Cardiac/Thoracic Surgery General Surgery Genetics Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Pulmonary Medicine Plastic Surgery Psychiatry Urology   High Desert Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiac/Thoracic Surgery Cardiology Dermatology General Surgery Genetics Neurology Neurosurgery OB/GYN Oncology/Hematology Ophthalmology Orthopedic Surgery Otolaryngology Pain Management Pediatric Subspecialties Physical Therapy Podiatry Psychiatry Psychology Pulmonary Medicine Rheumatology Speech Therapy Urology   Low Desert Dermatology Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology General Surgery Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Pain Management Pediatric Surgery Physical Therapy Psychiatry Pulmonary Medicine Rheumatology Urology   Mohave Valley Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology Dermatology Gastroenterology General Surgery Nephrology Neurology OB/GYN Oncology Oncology/Hematology Ophthalmology Orthopedic Surgery Otolaryngology Pain Management Psychiatry Pulmonary Medicine Rheumatology Urology   Palo Verde Valley Family Practice Internal Medicine Pediatrics Allergy and Immunology Cardiology Dermatology Endocrinology Gastroenterology General Surgery Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Otolaryngology Pain Management Physical Therapy Podiatry Psychiatry Pulmonary Medicine Speech Therapy Urology   Riverside Family Practice Internal Medicine Pediatrics Cardiology Dermatology General Surgery Genetics Neurology OB/GYN Occupational Therapy Oncology Ophthalmology Orthopedic Surgery Pain Management Podiatry Psychiatry Speech Therapy Urology   San Bernardino Proper Family Practice Internal Medicine Pediatrics Allergy and Immunology Dermatology Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Pain Management Pediatric Surgery Psychiatry Pulmonary Medicine Urology   West San Bernardino Dermatology Family Practice Internal Medicine Pediatrics Genetics Neurology OB/GYN Oncology Ophthalmology Orthopedic Surgery Pediatric Surgery Plastic Surgery Psychiatry Urology   Updated July 25, 2023    

ame on the list — Inland Empire Health Plan (IEHP). The Rancho Cucamonga-based not-for-profit organization will be among the list of options available on the exchange for those seeking coverage in 2024, Covered California officials announced yesterday. With four levels of coverage available to consumers, IEHP will offer the lowest-cost silver plan in Region  17. Open enrollment begins Nov. 1 and continues through Jan. 31, 2024. IEHP Chief Executive Officer Jarrod McNaughton shared the company is excited to join Covered California pending additional state approval from the California Department of Managed Health Care. “IEHP will be only the second public managed care plan to go into the exchange,” he said. “Joining Covered California is an important step to ensuring our members and others in the community can continue to access the quality health care services they need.”  IEHP officials estimate every year approximately 15,000 to 20,000 of its members in Riverside and San Bernardino counties could lose their Medi-Cal coverage due to an increase in income through the current eligibility renewal process. According to new state guidelines, these individuals will be automatically enrolled into their region’s lowest-cost silver plan. Covered California is the only place Californians can go to receive financial help to make their coverage more affordable. Right now, 90% of Covered California's 1.6 million enrollees receive financial help, with many people paying $10 or less per month for their health insurance. Based on pre-pandemic trends, nearly half of the consumers who transition from Medi-Cal to Covered California will be able to get quality coverage at little to no cost. “We’re thrilled that Inland Empire Health Plan will be joining Covered California in 2024, giving consumers and our over 155,000 enrollees in Riverside and San Bernardino counties another great option for their health care coverage,” said Jessica Altman, executive director of Covered California. “IEHP is joining the marketplace at a perfect time, giving more consumers transitioning from Medi-Cal the option to keep the same plan.” To learn more about Covered California, visit CoveredCA.com or call 800-300-1506. Since its founding in 1996, IEHP has grown into one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. Today, IEHP serves more than 1.6 million members in San Bernardino and Riverside counties, with 7,000 providers and 3,000 team members addressing crucial health needs daily. More information on IEHP and its benefits can be found online at iehp.org or by phone at 800-440-IEHP (4347).  

mance and quality measures to help Medicare beneficiaries make informed decisions regarding health and prescription drug plans. As part of this effort, CMS adopted measures for High Risk Medication (HRM) endorsed by the Pharmacy Quality Alliance (PQA) and the National Quality Forum (NQF). The HRM was developed using existing HEDIS measurement “Drugs to be avoided in the elderly”.  The HRM rate analyzes the percentage of Medicare Part D beneficiaries 65 years or older who have received prescriptions for drugs with a high risk of serious side effects in the elderly. 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. Notices 12/10/2021 IEHP Pharmacy Times (PDF) 01/13/2016 IEHP Pharmacy Times (PDF) 06/17/2013 IEHP Pharmacy Times (PDF) 02/19/2013 IEHP Pharmacy Times (PDF)   Reference IEHP High Risk Medication Drug Alternative(s) Reference Guide (PDF) AGS Beers Criteria 2019 (PDF)   Information on this page is current as of December 10, 2021.

e-based muralist leaves his mark on communities and organizations serving diverse populations with each swipe of his paint brush. One of those groups includes Inland Empire Health Plan (IEHP), a Rancho Cucamonga-based not-for-profit health organization serving 1.6 million members in San Bernardino and Riverside counties through its mission of healing and inspiring the human spirit. Navarro hopes to do the same with his art, partnering with IEHP to create multiple full-scale murals that celebrate the tapestry that makes the Inland Empire special. The first is underway in a central part of IEHP’s headquarters – its atrium – where hundreds of people travel through daily.  “I did want to create something that people gazed at and felt, ‘Yeah, this a great place for art,’” Navarro said. “We went through a lot of different versions of topics … but this one [an homage to a tree-lined street in Riverside] was the best that fit for this space, and we decided to focus on the regions IEHP serves across Riverside and San Bernardino counties.” This collaboration is part of a company re-branding project that has been in the works and planning stages since 2022. IEHP launched a public procurement process to seek bids and potential artists, who were asked to submit a proposal of potential artwork. Navarro’s passion for the area and his reputation as a well-respected, young Latino leader in the community were among the many attributes that placed him at the top of the list, and there are discussions to incorporate Navarro’s art in other IEHP-branded materials suitable for future use. “There’s just something incredibly inspiring about having art in one’s surroundings,” said Yahya Dawood, director of brand design and experience at IEHP. “And in many ways, our rebranding journey culminates with these beautiful murals in IEHP’s atrium space. Now our team members and visitors will be greeted – and hopefully, inspired – by these colorful scenes of the places we know and the people who we serve wholeheartedly in the Inland Empire.” Navarro is looking to do a lot more with his art, like encouraging the next generation of artists to share their own stories through a medium of their choosing. He hopes to especially reach those living a similar story to his – because like them, Navarro grew up with little to his name as the child of an immigrant mother who moved to the U.S. from Mexico to create a better life. “Coming from a space where there’s not a lot of hope to calling myself a ‘full-time artist’ brings me a lot of joy. To have that chance, this type of opportunity that is not available to everyone, I am so grateful,” he said. “I want to inspire others that were born with less to remember there’s always a way to grow if you dedicate your heart to something. “Art is a luxury that adds to the human experience.” Inland Empire Health Plan (IEHP) and Riverside-based artist Juan Navarro have partnered to create new murals for IEHP as part of its re-branding campaign. Navarro and his team from Eastside Arthouse in Riverside will complete multiple murals for the not-for-profit health care organization and the community as part of the agreement.

e Health Plan by searching for the exact name of the medication or by browsing our formulary database. You can also view the IEHP Medicare Formulary (PDF)  Additional resources to help you understand drug coverage information are available via your desktop at https://www.formularylookup.com or download the free mobile app from http://ios.formularylookup.com or http://android.formularylookup.com, If the prescription is not in IEHP's Formulary, providers may print and submit a new Prescription Drug Prior Authorization (Rx PA) Request Form or submit the Prescription Drug Prior Authorization Online.

of Lisa Wright as its new interim president.    Wright brings a wealth of experience and expertise, having recently served as President and CEO of Inland So Cal United Way and Inland So Cal 211+.    "We are pleased to have Lisa join us to help the Foundation through the transition as we complete a search for a new CEO/president," said Board Vice Chair Karen Scott, who led the search for this position.     "I am grateful and honored to serve as the IEHP Foundation interim president," said Wright. "As a proud community member of the Inland Empire and longtime local nonprofit leader, I am excited to embark on this journey and work collaboratively with the board and staff to help advance the Foundation's mission – to inspire and ignite the health of the IE."    The search for the new president has begun using a national search firm, which is expected to take six months to complete.   About IEHP Foundation    IEHP Foundation is on a mission to inspire and ignite the health of the Inland Empire. It was created by Inland Empire Health Plan (IEHP) in 2021 as a separate 501c3 public charity.     The Foundation will provide more information regarding its strategy and community engagement over the next few months.    To learn more as the organization moves forward, please visit iehpfoundation.org and follow IEHP Foundation on Instagram and LinkedIn.   ###     Press Contact Deanna Hendrick Marketing and Communications Manager, IEHP Foundation Deanna.hendrick@iehpfoundation.org 909-204-1673

the region, Inland Empire Health Plan (IEHP) and University of La Verne are collaborating to create a brand-new resource: the IEHP Health Career Academy. The not-for-profit health plan has committed $1.5 million to launch the academy under the University of La Verne Randall Lewis Center for Entrepreneurship, Innovation and Social Impact — a pillar of the university’s emerging education and innovation corridor located off D Street, between North Sultana and North Plum avenues in Ontario. The academy’s goal is to fill critical workforce needs and retain talent to address health disparities within one of the fastest-growing population regions in the country. Funding will support the creation of certification for three critical frontline career fields: nursing assistants, medical assistants and central service technicians. The first program cohorts are expected to launch late spring 2024. “This seed funding will support and enhance the great work University of La Verne is already doing to educate the next generation of frontline health care workers,” said Jarrod McNaughton, IEHP’s chief executive officer. “The new IEHP Health Career Academy will help to bolster the emerging workforce for the future of health care in the Inland Empire.” The academy complements and aligns with the vision for the corridor, which will include programs that focus on entrepreneurship, law, public service, health equity, community well-being and educational advancement in historically underserved communities, according to the university. “The new IEHP Health Career Academy will help address the critical shortage of frontline health care workers and accelerate professional training and certification in new and emerging subdisciplines requiring technological and interdisciplinary expertise in addressing patient and community challenges,” said University of La Verne President Devorah Lieberman. One highlight of the new academy will be the Earn-to-Learn program, which provides students the opportunity to pursue necessary field certification while working in related entry-level positions and earning experience and pay. This model is a “practical way of alleviating a burden by providing a more financially inclusive and accessible education,” according to both entities. Participants can also receive entrepreneurial skills in the healthcare industry to support related start-up businesses, officials said.  

d services as a Member of IEHP. Your covered services are at no cost if they are medically necessary, and you get the approved services from our Provider network. “Medically necessary” means it is reasonable and needed to protect life, to keep you from becoming seriously ill or disabled, or to reduce pain from a diagnosed disease, illness or injury. To learn more about IEHP’s benefits and services, read Chapter 4 of the IEHP Medi-Cal Member Handbook (PDF) or 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. IEHP offers these types of services: Outpatient (ambulatory) services* Emergency services Transgender services* Hospice and palliative care* Hospitalization* Maternity and newborn care Mental health services Prescription drugs Rehabilitative and habilitative services and devices* Laboratory and radiology services, such as X-rays* Preventive and wellness services and chronic disease management Sensitive services Substance use disorder treatment services Pediatric services Vision services* Non-emergency medical transportation (NEMT) Non-medical transportation (NMT) Long-term services and supports (LTSS) Telehealth services Some of the services listed are covered only if IEHP or your IPA approves first. Covered services that may need an approval from IEHP or your IPA or medical group first are marked by an asterisk (*). Vision services The plan covers: Routine eye exam once every 24 months; IEHP may pre-approve (prior authorization) additional services as medically necessary. Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical conditions such as aphakia, aniridia and keratoconus  Limitations Single vision lenses only. Members under 18 automatically get polycarbonate lenses. Contacts in lieu of glasses only if medically necessary. Dental services The Medi-Cal Dental Program covers some dental services, such as: Diagnostic and preventive dental hygiene (e.g., examinations, x-rays, and teeth cleanings) Emergency services for pain control Tooth extractions Fillings Root canal treatments Prosthetic appliances Orthodontics for children who qualify Members can access dental services through providers enrolled in the Medi-Cal Dental Program. They will advise you on the best course of treatment and when these services may be attained. To learn more about dental services, call the Medi-Cal Dental Program at 1-800-440-IEHP (4347) / TTY (800) 718-4347. You may also visit the Denti-Cal website at www.smilecalifornia.org. Transportation services Your Medi-Cal benefits include round trip transportation for plan-covered health services and Medi-Cal-covered services, such as mental health, substance abuse and dental, within San Bernardino and Riverside counties. The plan covers: Visits to your Primary Care Doctor, Specialists and urgent care clinics. Visit for dental, mental health, substance abuse and other services. Exclusions and Limitations IEHP does not cover: One-way trips and non-medical visits. Visits to Social Security, Workers Compensation Claims, Personal Injury cases, Courts, Parole or Probation or Social Services Offices. IEHP offers two types of transportation: Bus passes* for Non-Medical Transportation (NMT): approved when you do not have any physical or medical issue that does not allow you to travel by bus, car, taxi or other forms of public transportation. Uber for Non-Medical Transportation (NMT): approved when your area doesn’t support bus passes, or you are crossing counties. For this type of transportation, you need to wait for your ride at the curb. Non-Emergent Medical Transportation (NEMT): approved when your medical or physical issue does not allow you to travel by bus, car, taxi or other forms of public transportation. For this type of transportation, your Doctor must submit a Physicians’ Certification Statement online. Effective March 1, 2020, transportation for routine medical visits including Behavioral Health and Substance Use must be scheduled five business days before your appointment. To set up transportation, call IEHP Transportation Department at 1-800-440-4347 (option two), Monday – Friday, 8am – 5pm. TTY users should call 1-800-718-4347 (option two). *For bus passes, call our transportation vendor Call the Car (CTC) at 855-673-3195 select option 1. Once you get your bus pass, you can use this for all of your health care visits. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. To download a free copy click Adobe Acrobat Reader.  The Postpartum Care Extension Program The Postpartum Care Extension Program provides extended coverage for Medi-Cal members during both the pregnancy and after pregnancy. The Postpartum Care Extension Program extends coverage by IEHP for up to 12 months after the end of the pregnancy regardless of income, citizenship, or immigration status and no additional action is needed. Rapid Whole Genome Sequencing Rapid Whole Genome Sequencing (rWGS), including individual sequencing, trio sequencing for a parent or parents and their baby, and ultra-rapid sequencing, is a covered benefit for any Medi-Cal member who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit. rWGS is an emerging method of diagnosing conditions in time to affect ICU care of children one year of age or younger. If your child is eligible for California Children’s Services (CCS), CCS may be responsible for covering the hospital stay and the rWGS. Referrals For some types of care, your PCP or specialist will need to ask IEHP for permission before you get the care. This is called asking for prior authorization, prior approval, or pre-approval. It means that IEHP must make sure that the care is medically necessary or needed based on appropriateness of care and services and existence of coverage. Care is medically necessary if it is reasonable and necessary to protect your life, keeps you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For some services, you need pre-approval (prior authorization). Under Health and Safety Code Section 1367.01(h)(2), IEHP will decide routine pre-approvals within 5 working days of when IEHP gets the information reasonably needed to decide. For requests in which a provider indicates or IEHP determines that following the standard timeframe could seriously jeopardize your life or health or ability to attain, maintain, or regain maximum function, IEHP will make an expedited (fast) pre-approval decision. IEHP will give notice as quickly as your health condition requires and no later than 72 hours after receiving the request for services. If IEHP does not approve the request, IEHP will send you a Notice of Action (NOA) letter. The NOA letter will tell you how to file an appeal if you do not agree with the decision. IEHP will contact you if IEHP needs more information or more time to review your request. Continuity of Care  If you now go to providers who are not in the IEHP network (out-of-network), in certain cases you may get continuity of care and be able to go to them for up to 12 months. If your providers do not join the IEHP network by the end of 12 months, you will need to switch to providers in the IEHP network. If you are a new Member, you may request to keep getting medical services from an out of network provider if you were getting this care before enrolling in IEHP. IEHP will decide if this treatment with an out of network provider is medically appropriate. Continuity of care does not extend to select ancillary services, carved out services or services not covered by Medi-Cal. To learn more about continuity of care and eligibility qualifications, call IEHP Member Services at 1-800-440-IEHP (4347). Prescription drugs Most prescription drugs are covered by Medi-Cal Rx, some drugs may be covered by IEHP. Your provider can prescribe you drugs that are on the Medi-Cal Rx Contract Drugs List. To find out if a drug is on the Contract Drug List or to get a copy of the Contract Drug List, call Medi-Cal Rx at 1-800-977-2273 (TTY 1-800-977-2273 and press 5 or 711), visit the Medi-Cal Rx website at www.MediCalRx.dhcs.ca.gov/home/, or call IEHP Member Services at 1-800-440-IEHP (4347), Monday-Friday, 8am-5pm. TTY users should call 1-800-718-4347 or 711. Pharmacies If you are filling or refilling a prescription, you must get your prescribed drugs from a pharmacy that works with Medi-Cal Rx. You can find a list of pharmacies that work with Medi-Cal Rx in the Medi-Cal Rx Pharmacy Directory at www.Medi-CalRx.hcs.ca.gov/home/. You can also find a pharmacy near you by calling Medi-Cal Rx at 1-800-977-2273 (TTY 1-800-977-2273 and press 5 or 711). Or call IEHP Member Services at 1-800-440-IEHP (4347), Monday-Friday, 8am-5pm. TTY users should call 1-800-718-4347 or 711.  

gural graduating class of its Community Health Worker (CHW) Residency Program during a special celebration at its Rancho Cucamonga-based headquarters. The spotlight was placed on eight CHWs who completed the weeks-long program focused on the mission of reducing barriers to health care services in marginalized and underserved communities. “I know [going through the program] was a journey and you’ve learned a lot and brought your experience, your wisdom and your connections to the community and really helped shape our program going forward,” said Dr. Takashi Wada, IEHP’s chief medical officer, during the ceremony on July 27. “We’ve been learning along with you in how to deliver a meaningful program that’s going to provide value to our communities and give you the experience and tools that you’ll need to be successful in any role as a community health worker.” IEHP’s CHW program launched in March, with the first cohort beginning their studies on May 6. CHWs participated in six weeks of in-person training, followed by three weeks of field practicum training, explained IEHP Community Behavioral Health Manager Belinda Hernandez. “We developed training around the community health worker core competencies and enhanced training by including an introduction to health care services,” she said. “Topics covered focused on foundational skills with enhanced training on specific areas such as quality measures, health outcomes and evidence-based approaches and techniques.” CHWs will receive ongoing training to ensure they stay up to date on any new resources. They also will be paired with a provider in the community to address chronic conditions, preventative health care needs and health-related social needs throughout Riverside and San Bernardino counties.  Estrella Garcia, among the eight graduates, summed up the CHW program as an “eye-opening journey filled with growth, empathy and empowerment that has not only opened my perspective but also has equipped me with invaluable skills in challenging situations.” “My team has been so supportive and have inspired me to embrace who I am and love myself the way I am,” she continued. “They are truly, truly community health workers at heart.” In addition to Garcia, IEHP’s inaugural CHW cohort included Astin Medina Carranza, April Watkins, Serena Hong, Jackiie Tovar-Sandoval, Princess Egiebor, Dre Graves and Lizette Olmedo. The next cohort is expected to begin their studies on Aug. 21.   For more information on the CHW benefit, go to www.dhcs.ca.gov/community-health-workers. Inland Empire Health Plan celebrated the first graduating class of its Community Health Worker Residency Program. Students began their studies earlier this year to reduce barriers to health care services in marginalized and underserved communities. Eight CHWs were part of the inaugural group.   Estrella Garcia speaks at a graduation ceremony on July 27 to celebrate Inland Empire Health Plan’s inaugural Community Health Worker Residency Program cohort. Garcia was one of eight CHWs to complete the program focused on the mission of reducing barriers to health care services in marginalized and underserved communities.

P’s human resources functions by developing best practices and strategies to advance IEHP’s efforts to be a high-performance organization fueled by a skilled, engaged and diverse workforce. In this role, Ms. Sood oversees talent acquisition, compensation administration and benefits (total rewards), HR operations, and learning and development. Additionally, Supriya will lead the department’s efforts that support IEHP’s Mission, Vision, Values, and strategic direction.