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MediCal - Health and Wellness

and achieve health goals. IEHP’s Health & Wellness Programs help Members learn how to manage their health and make healthy lifestyle changes. You can refer your IEHP Members to these programs anytime by logging into the Secure Provider Website and completing the Health Education Program Request Form. Health Resources Kids and Teens Managing Your Illness Pregnancy and Postpartum Senior Health Weight Management Health & Wellness Brochures and Handouts Inland Empire Health Plan (IEHP) offers many Wellness Programs that focus on the health and well-being of our Members. All of our programs are free, join us at our next session and learn ways to stay healthy.  Get information on important health topics through our health education brochures and handouts: Controlling Asthma (PDF) Diabetes. What's next? (PDF) Eat Healthy, Feel Better (PDF) Fever in Children (PDF) Flu Decision Guide (PDF) Flu Shot (PDF) High Blood Pressure (PDF) Immunizations - English (PDF) Immunizations - Spanish (PDF) Immunizations - Chinese (PDF) Immunizations - Vietnamese (PDF) PAP and HPV Tests: What to Expect (PDF) Diabetes Prevention Program (DPP) - Live the Life You Love Format: Online (small group) Duration: One year Ages: 18 years and over This online year-long lifestyle change program helps you make real changes that last.  During the first 6 months, you will meet weekly with a small online group to learn how to make healthy choices into your life. In the second 6 months, you will meet monthly to practice what you have learned. No person is alike, so the program will be tailored to meet your needs and honor your customs and values. You will also be paired with a health coach for one year to help you set your goals, such as how to: Eat healthier Add physical activity into your daily life Reduce stress Improve problem-solving and coping skills Studies have shown that those who finish the program can lose weight and prevent Type 2 Diabetes. Small changes can have big results! Let's start living the best version of you and living the life you love. Find out if you qualify! Click here to visit the Skinny Gene Project online, or Call Skinny Gene Project at (909) 922- 0022, Monday - Friday 8am – 5pm., or Email For Providers DPP Rx Pad (PDF) Educational Resources 2021 Population Needs Assessment (PNA) Report IEHP’s Population Needs Assessment (PNA) identifies Member health status and behaviors, Member health education priorities, cultural/linguistics needs, health disparities, and gaps in service related to these issues. The findings of the PNA may help Providers better understand and serve our Members. For questions, please contact IEHP Health Education Department at 2021 Population Needs Assessment (PNA) Report Loving Support Program IEHP supports and sponsors the Loving Support Program that is run by Riverside University Health System (RUHS). Loving Support is a program committed to helping mothers achieve their breastfeeding goals. This service offers help and support with the first days at home, return to work, support groups, and timely answers to challenges nursing mothers face. Members can directly contact the Loving Support 24/7 Helpline at 888-451-2499. No referral is necessary. English and Spanish-speaking certified lactation specialists and Internationally Board Certified Lactation Consultants (IBCLCs) are available 24 hours a day, 7 days a week to answer questions. Messages are recorded after hours and promptly addressed. Member Education Resources The following websites are good sources of easy-to-read patient information that can be downloaded, printed, or ordered. By clicking on these links, you will be leaving the IEHP website.  RESOURCE  DESCRIPTION Medline Plus A service of the US National Library of Medicine and the National Institutes of Health. Easy to read information and audio tutorials on many health topics in English and Spanish. Topics are available in multiple languages. Food and Drug Administration - Office of Women's Health Easy-to-read handouts in English, Spanish and other languages on nutrition, diabetes, depression, and other topics related to women’s health. Learning About Diabetes, Inc. Easy to read “Handouts and Visual Aids” in color on diabetes care and nutrition to help patients eat the right foods to control blood sugar. Weight Control Information Network An extensive list of health education materials about healthy weight and physical activity in English and Spanish. Materials can be printed or ordered. Health Information Translations Easy-to-read educational handouts on many health topics and in multiple languages.   You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Plan Updates - Updates

l Notes for DY 2 to 8 (PDF) Core Quality Withhold Technical Notes for DY 2 to 10 (PDF) Riverside University Health System - Health Advisory Public Health Advisory - Respiratory Viruses (PDF) A Message From IEHP Medical Director, Dr. Takashi Wada The 2022-2023 influenza season continues to coincide with circulation of COVID-19 virus (SARS-CoV-2). As of August 2022, approximately 94.2 million cases of COVID-19 had been reported in the United States. Influenza vaccination remains an important tool for the prevention of potentially severe respiratory illness, which helps decrease the stress on the U.S. health care system. IEHP DualChoice members who are 18 years of age or older may obtain flu vaccines through the IEHP Pharmacy Vaccine Network. Vaccine Notice: Access to Pharmacy Vaccine Network (PDF) Mpox Vaccination Locations San Bernardino County: Monkeypox (mpox) – Department of Public Health Riverside County: Mpox Vaccine Locations – Riverside University Health System Please advise members to call before going in for a vaccination as some locations are only available with appointments. Members may make appointments for the JYNNEOS vaccine at Mpox Testing As of December 8, 2022, no commercial testing is available for the diagnosis of Mpox. Providers may contact CDC in the diagnosis, management of patients with suspected Mpox, and for any additional information regarding Mpox connect with the CDC Emergency Operations Center. Phone: 1-770-488-7100, Monday through Friday, 8:00 AM to 4:30 PM EST After Hours Phone: 1-404-639-2888 Treatment Mpox patients usually recover fully within 2-4 weeks without the need for medical treatment. While there are no treatments specifically for Mpox, the virus that causes Mpox is similar to the smallpox virus and therefore antiviral drugs developed to protect against smallpox may be used. The antiviral drug, tecovirimat (TPOXX), has been approved by the FDA to treat smallpox in adults and children. If you prescribe tecovirimat to treat members with Mpox the member must sign a consent form stating tecovirimat is an investigational drug that has not yet been approved by the FDA for treatment of Mpox. More information about tecovirimat visit Frequently Asked Influenza (Flu) Questions: 2022-2023 Season (CDC Recommendations) What’s New for 2022-2023  By clicking on these links, you will be leaving the IEHP website. The composition of flu vaccines has been updated. For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. The recommended timing of vaccination is similar to last season. For most people who need only one dose for the season, September and October are generally good times to get vaccinated. Vaccination in July and August is not recommended for most adults but can be considered for some groups. While ideally it’s recommended to get vaccinated by the end of October, it’s important to know that vaccination after October can still provide protection during the peak of flu season. The age indication for the cell culture-based inactivated flu vaccine, Flucelvax Quadrivalent (ccIIV4), changed from 2 years and older to 6 months and older. Pre-filled Afluria Quadrivalent flu shots for children are not expected to be available this season. However, children can receive this vaccine from a multidose vial at the recommended dose. Preventive Services Immunizations  By clicking on these links, you will be leaving the IEHP website. CDC ACIP Vaccine Recommendations and Guidelines: CDC ACIP Immunization Schedule for Children: CDC ACIP Immunization Schedule for Adults: USPSTF Task Force's Immunization Recommendations: California Immunization Registry Portal (CAIR): Immunization Timing 2022 (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.

MediCal - Tobacco Cessation Services

acco Cessation Services   Provider Education Resources Smoking Cessation Resources - Help your patients quit Tobacco The CDC's Brief Tobacco Intervention ASK In a caring manner, at each visit, ...if your patients use tobacco If they do not, congratulate them If they do, proceed to next step ADVISE Patients who use tobacco to consider quitting. Tobacco products can lead to health problems such as...  Heart and Lung Disease Diabetes Stroke Ongoing infections and colds Cancer People exposed to secondhand smoke can also experience these health problems REFER If the patient is interested in quitting, connect them to KICK IT CA and any other local resource (below) Prescribe medications (if appropriate) Congratulate your patient on the decision to quit If patient is not ready to quit, user personalized motivational messages to encourage quitting. Let them know you are here when they are ready. Kick it CA How it works:  Patient will receive services from a Coach that has undergone rigorous training & apprenticeships, participates in weekly monitoring and case reviews, and attend continuing education courses on cultural competency. To enroll, patients can call, chat, or complete an online web form. The patient will then receive a Kick-Off call to collect their basic information and find out what they are trying to quit. Right after kick-off, coaching begins. The patient will receive clinically sound motivational interviewing. The coach will help patient put together a quit plan and set a quit date. The patient will then receive check-ins at times they are most susceptible to relapse. The coach will see if their quit-plan is working and help them modify as needed. Phone Number:  English - 1 (800) 300-8086 Spanish - 1 (800) 600-8191 Website: KICKITCA.ORG Text:  For English: Text "Quit Smoking" or "Quit Vaping" to 66819 For Spanish: Mande "Dejar de Fumar" o "No Vapear" to 66819 Other Smoking Cessation Resources: Link to Resources on Member page: Resources in the Inland Empire: Connect IE Information and Training for Providers: Local Tobacco Control Projects: Tobacco Free San Bernardino County: Tobacco Free Riverside County: (Back to Tobacco Cessation Services Menu) Tobacco Cessation Services By clicking on these links, you may be leaving the IEHP website. Training: Comprehensive Tobacco Cessation Services for Medi-Cal Members (PDF) The Smoking Cessation Leadership Center's (SCLC): Recordings Available for CME/CE Credit Kick it CA Education, Training and Technical Assistance: 5 Major Steps to Intervention: Tobacco Cessation CPT Codes for Identification ACA Facts Sheets and Resources (American Lung Association): Helpline: (also available in Spanish, Chinese, Korean, and Vietnamese) Continuing Medical Education California courses offered through UC Schools of Medicine: Tip: Use key word in search: Tobacco Cessation Centers for Disease Control Coverage for Tobacco Use Cessation Treatments: Patients Not Ready to Make a Quit Attempt Now (The “5 R’s”): University of California San Francisco’s Smoking Cessation Leadership Center’s Tools and Resources: USPSTF-Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions: USPSTF-Tobacco Use in Children and Adolescents: Primary Care Interventions: (Back to Tobacco Cessation Services 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.

Member Testimonials - Our Members

group of students from the Inland Empire. More than 30 recipient students grew up in the Inland Empire and more than 50% are first generation medical students and grew up in low-income households. Through the scholarship fund, aspiring healthcare professionals will be guided through the system and connected to the health plan’s provider network. This allows students to pursue successful careers in healthcare immediately after graduation to help support the region’s growing population. Loma Linda University School of Medicine Inland Empire Medical Community Service Awardees Class of 2022 Ye Jin Jeon Ye Jin's Why: “I applied for the Inland Empire Medical Community Service Award because the goal and priority to expand access to care and healthcare provider options for the Southern California region aligns with my calling. As a child growing up in the San Bernardino County, I saw the economic disproportion within my own neighborhood, and this compelled me…God has led me pursue my medical career” Class of 2024 Edwin Choque Edwin's Why: “Simply put, my heart lies in the Inland Empire. This community of individuals have fostered me and loved me since I was a child and all I can hope is to pay that love and care forward. . . . My dream is to be on the front lines as a representative for these individuals who frequently become marginalized…” University of California, Riverside Dean's Mission Recipients Four Year Award Elizabeth Celaya-Ojeda Elizabeth's Why: “I want to work particularly with the underserved in this area because I truly believe that being a physician is a privilege and with that there is a responsibility to be an advocate for those who are facing health disparities. I am particularly interested in providing care to underserved Native American and Hispanic communities. Not many healthcare providers are aware of the disparities these two communities face and I want to be an advocate for them, especially in the Inland Empire.” Alfonso Parocua Alfonso's Why: “Growing up, my family lacked meaningful access to healthcare and relied on a local free clinic as our only means of interacting with a physician. Through my personal experience with the free clinic, I developed a passion for service to the underserved communities who lack meaningful access to basic healthcare amenities due to low socioeconomic status. I sought opportunities that would allow me to pay my gratitude forward by becoming part of the solution to healthcare disparities in Inland Southern California. Through my volunteer efforts in free clinics and other community involvement programs, I witnessed the passion and dedication that health care providers and volunteers in the area have towards the underserved community. This realization deepened my connection to Inland Southern California because I was reminded so much of the health care professionals that helped my family when they couldn't help themselves.” Two Year Award Cesar Fortuna Cesar's Why: “A San Bernardino native, I have had the opportunity to volunteer in my community as a Spanish language translator for free clinics. Most patients I have spoken with fell into the category of uninsured, underinsured, or undocumented. It became clear the extent of need in this region when I would translate to the providers that this was the first-time dozens of our patients had ever seen a medical professional; however, this wasn’t uncommon. To these patients and their stories, I thank them because they inspire me to pursue Emergency Medicine where I can become a valuable player in providing care, providing resources, or providing comfort.” Lavinia Mitroi Lavinia's Why: “My goal of pursuing a career at the intersection of medicine and public health is driven by a desire to put patients and communities at the center of our health care system in the U.S. This desire was sparked most poignantly by my own experiences as an IEHP patient growing up in the Inland Empire. As I prepare for a future career as a pediatrician in this region, I hope to serve as an advocate for children and families, providing direct health services but also creating systems change.” Armando Navarro Armando's Why: “The earliest memory of my grandfather is him telling me, “Mijo, tienes que aprender Español para ayudar tu comunidad, you have to learn how to speak Spanish to help your community”. These words were often repeated to me by my grandfather who lamented the fact that he only spoke Spanish. I witnessed the health disparities affecting my community; doctors who did not speak Spanish, parents who could not afford a trip to the doctors’ office, and a healthcare system that was not inclusive of my community’s culture. I have a duty to give back to a school, a community, that has given me so much.” Christ Ordookhanian Christ's Why: “I see the medical profession through the lens of an individual who had lived through challenging times and witnessed how one individual provider can make such and impact when their heart is in the right place. My dedication to our underserved community stems from that of a lifelong mission I have set for myself which is to ensure I give back to a community that I am deeply associated with, they are my founding roots in the United States, and I vow to be at the forefront of the next generation of physicians that care and give the underserved hope.” University of California, Riverside Dean's Mission Recipients Daphne Du Daphne's Why: “I spent most of my life in underprivileged areas and saw firsthand how difficult healthcare access could be through inadequate financial resources, transportation, or translation services. Thanks to this investment in my studies, there is less stress in my life. I can focus on my studies and eventually give back to the community by becoming a physician who will advocate for patients without meaningful access to health care.” Judith Gonzales Judith's Why: “As a first-generation college student, there have always been many barriers in my path to higher education. I am the eldest daughter of an immigrant family, and it is truly an honor to be able to reach this point in my education and in my career, and to give back to my parents who have sacrificed so much for me and my sisters. Growing up in an underserved community showed me the long-lasting impacts of health inequities and strengthened my resolve to pursue a career in medicine. Working in the Inland Empire, I hope to not only address, but actively work towards combating the health inequity present in our communities.” Jordan Hough Jordan's Why: “Despite disadvantages encountered when living in a low-income community, I am grateful for the privilege I had in meeting physicians dedicated to their practice and willing to share that love through mentorship. These individuals have served as exemplary medical professionals and have encouraged me to follow in their footsteps. As a future physician, I aspire to empathetically care for patients by allowing my past experiences to enhance my understanding of their needs. I also plan to incorporate teaching into patient care by presenting opportunities for students to shadow and be mentored for a career in medicine.” Diana Martinez Diana's Why: “I am the daughter of Mexican Immigrants and grew up in Compton, California where I unfortunately was quickly desensitized to violence and was able to tell the difference between a firework and a gun shot. My mother had to travel a significant distance to ensure we had adequate healthcare. Despite these conditions, my parents always stressed education and did their best to give me what I needed. These life circumstances ignited my passion to serve those in disadvantaged communities, which I interacted with throughout my educational career. The Inland Empire Health Program Scholarship means I can achieve my dream –by practicing medicine in a community that deserves adequate, equitable, and accessible healthcare. I will serve as a bilingual physician in the Inland Empire that can serve families like my own and many more.”

Testimonios - Betty Daniels

de experiencia como obstetra y ginecóloga, la Dra. Betty Daniels ha tenido una cantidad respetable de pacientes de alto riesgo. Ser una buena doctora significa saber qué necesitan esas pacientes para poder sobrevivir, aun cuando esto signifique hacer cosas que no son parte del plan de atención normal.  La Dra. Daniels recordó la situación de una paciente con antecedentes de embolia. Sabía que esta Miembro de IEHP necesitaría un nivel de atención más alto que el que podía ofrecer un hospital de la comunidad cuando llegara el momento del parto. La Dra. Daniels solicitó un traslado al Centro Médico de Loma Linda University e IEHP estuvo de acuerdo.  “Esto es lo que hace un defensor de pacientes”, explicó la Dra. Daniels, quien ejerce en dos clínicas operadas por Woman to Woman OB/GYN Medical Group. “IEHP es uno de los mejores defensores de pacientes que hay”. Desde el compromiso de ayudar a los Proveedores a bajar los índices de cesáreas hasta el reciente lanzamiento de un programa de doula, la Dra. Daniels dijo que consideraba a IEHP su socio para prestar atención de calidad a sus pacientes.  “Me sorprenden constantemente las iniciativas de IEHP porque siempre se concentran en la calidad y en lo que es mejor para el paciente. No veo otros planes de salud que ofrezcan estos tipos de soluciones o recursos”, señaló. La Dra. Daniels dijo que el personal de su consultorio agradece especialmente el rápido proceso de autorización y referencia de IEHP, dado que ayuda a los Miembros a recibir los medicamentos y los servicios que necesitan, cuando más los necesitan. Incluso el proceso de queja formal de IEHP desempeña un rol para mejorar la calidad, dado que se ocupa de los problemas y las quejas de los Miembros. Puede contribuir a dejar en claro cuáles son las carencias en la atención o las fallas de comunicación. Y, aun cuando no haya problemas para resolver, al menos los pacientes saben que alguien los escucha.  “Hace que los pacientes se sientan bien porque saben que su plan de salud se preocupa por ellos”, dijo. 

Recursos para la Salud - Dejar de fumar

iesgos de fumar y el humo de segunda mano, el medicamento correcto para ayudarlo a dejar de fumar y el manejo del estrés. A continuación, encontrará recursos que le ayudarán a dejar de fumar. Al hacer clic en los enlaces a continuación, abandonará el sitio web de IEHP. Recursos Comunitarios Sitio de la línea de ayuda para fumadores de California ¿Listo para dar los siguientes pasos para dejar de fumar, mascar o inhalar vapor a través de un cigarrillo electrónico ahora? La línea de ayuda para fumadores de CA tiene todo lo que usted necesita para alcanzar su objetivo. Además, muchos de sus servicios son gratuitos, como asesorías por teléfono, mensajes de texto y referencias a otros programas locales. También pueden brindarle ayuda para hacer su propio plan para dejar de fumar, consejos sobre cómo lidiar con los factores desencadenantes y el apoyo para que siga adelante sin fumar. ¡Llame al 1-800-600-8191 y proporcione el código de promoción 84 para comenzar ahora mismo! O visite su sitio web en Arrowhead Regional Medical Center 400 N. Pepper Avenue, Colton Haga clic aquí para visitar su sitio web. 909-580-6167 Kaiser Permanente 2055 Kellogg Avenue, Corona Haga clic aquí para visitar su sitio web. (866) 883-0119 (No cost for Kaiser Members only) Rim Family Services 28545 Highway 18, Skyforest Haga clic aquí para visitar su sitio web. (909) 336-1800 Beaver Medical Group 1150 Brookside Avenue, Redlands Haga clic aquí para visitar su sitio web. (909) 335-4131 Kaiser Permanente 17296 Slover Avenue, Fontana Haga clic aquí para visitar su sitio web. (909) 609-3000 (No cost for Kaiser Members only) Loma Linda University Health - Center for Health Promotion  2475 Steward Street, Loma Linda Haga clic aquí para visitar su sitio web. (909) 558-3264 Sitios Web American Heart Association  Una guía paso a paso para que viva una vida sin fumar, conozca los beneficios, haga un plan, supere los impulsos y no vuelva a fumar. Centros para el Control y la Prevención de Enfermedades (CDC)  Encontrará todo lo que necesita para elaborar un plan para dejar de fumar, este sitio también lo conecta con las redes sociales para obtener asistencia continua durante el proceso para dejar de fumar. Además, podrá ver videos de personas que dejaron de fumar, escuchar sus historias y aprender a través de sus experiencias. Apoyo y herramientas que le ayudan a usted o a un ser querido a dejar de fumar. También puede optar por versiones orientadas a veteranos, mujeres, adultos mayores y adolescentes. Aplicaciones Móviles iOs Apps Smoke Free QuitNow! Quit Guide Kwit no butts No Vape Android Apps Quit Now Quit Guide Kwit no butts No Vape Herramienta Interactiva Dejar De Fumar Usted debe tener Adobe Acrobat Reader 6.0 o una versión más reciente para acceder a los documentos en PDF. Descarge Adobe Acrobat Reader.

Fondo de Becas de Atención Médica

olarship Fund, HSF) de Inland Empire Health Plan (IEHP) es la colaboración del plan de salud con instituciones académicas locales para ayudar a eliminar la barrera de la deuda que adquieren los estudiantes de medicina con el propósito de desarrollar una creciente fuerza laboral para que los profesionales en el área de atención médica ofrezcan sus servicios a la creciente población de Medi-Cal en Inland Empire. ¿Por qué es necesario el HSF? De acuerdo con California Health Care Foundation, Inland Empire tiene uno de los índices más bajos de Doctores de Cuidado Primario (Primary Care Physician, PCP) y médicos especialistas por cada 100,000 personas en California. Además, Inland Empire carece de la capacidad adecuada de profesionales médicos especialistas y de salud del comportamiento para atender a la creciente población actual. Debido a que el costo promedio de un título médico de cuatro años se mantiene en $276,800, la posibilidad de desarrollar una carrera en el área médica está fuera del alcance para más personas cada año. El HSF ayudará a que los estudiantes eliminen la carga financiera de la escuela de medicina, ya que esta deuda frecuentemente restringe las opciones de muchos que aspiran a ser profesionales de la atención médica y además permite a los beneficiarios desarrollar una carrera profesional en la atención médica de inmediato. Soy estudiante y me interesa ser Doctor, ¿qué debo hacer? Se recomienda que los alumnos interesados en el HSF de IEHP se comuniquen con las instituciones académicas que aparecen a continuación para obtener información adicional sobre cómo presentar una solicitud. Si bien cada institución tiene diferentes requisitos de elegibilidad, todas las becas para el HSF requieren que los estudiantes se comprometan a ejercer su profesión en Inland Empire durante cinco años después de su graduación. Las escuelas y los programas participantes incluyen: Loma Linda University Medical School University of California Riverside California University of Science and Medicine

Fondo de Becas de Atención Médica

olarship Fund, HSF) de Inland Empire Health Plan (IEHP) es la colaboración del plan de salud con instituciones académicas locales para ayudar a eliminar la barrera de la deuda que adquieren los estudiantes de medicina con el propósito de desarrollar una creciente fuerza laboral para que los profesionales en el área de atención médica ofrezcan sus servicios a la creciente población de Medi-Cal en Inland Empire. ¿Por qué es necesario el HSF? De acuerdo con California Health Care Foundation, Inland Empire tiene uno de los índices más bajos de Doctores de Cuidado Primario (Primary Care Physician, PCP) y médicos especialistas por cada 100,000 personas en California. Además, Inland Empire carece de la capacidad adecuada de profesionales médicos especialistas y de salud del comportamiento para atender a la creciente población actual. Debido a que el costo promedio de un título médico de cuatro años se mantiene en $276,800, la posibilidad de desarrollar una carrera en el área médica está fuera del alcance para más personas cada año. El HSF ayudará a que los estudiantes eliminen la carga financiera de la escuela de medicina, ya que esta deuda frecuentemente restringe las opciones de muchos que aspiran a ser profesionales de la atención médica y además permite a los beneficiarios desarrollar una carrera profesional en la atención médica de inmediato. Soy estudiante y me interesa ser Doctor, ¿qué debo hacer? Se recomienda que los alumnos interesados en el HSF de IEHP se comuniquen con las instituciones académicas que aparecen a continuación para obtener información adicional sobre cómo presentar una solicitud. Si bien cada institución tiene diferentes requisitos de elegibilidad, todas las becas para el HSF requieren que los estudiantes se comprometan a ejercer su profesión en Inland Empire durante cinco años después de su graduación. Las escuelas y los programas participantes incluyen: Loma Linda University Medical School University of California Riverside California University of Science and Medicine

Premios y Reconocimientos

ndar acceso a la atención médica a la clase trabajadora y de bajos ingresos que reside en Inland Empire. Estos reconocimientos dignifican nuestro firme compromiso de mejorar el acceso a servicios de atención médica de calidad basados en el bienestar, cuando y donde los Miembros los necesiten. Acreditación del NCQA IEHP fue el primer plan de salud “sólo de Medicaid” en California en ganar la acreditación de National Committee for Quality Assurance (NCQA) para su plan de salud Medi-Cal en 2000. Desde ese año conservamos la acreditación NCQA.  Premios a la Innovación En 2018, IEHP recibió el Premio a la Innovación otorgado por el Departamento de Servicios de Atención Médica (Department of Health Care Services), este es un reconocimiento por promover el Acceso a la Vivienda, el cual ofrece apoyo a través de alojamiento permanente y asistencia con servicios intensivos para coordinar los casos de los Miembros sin hogar con un alto nivel de utilización de servicios. En octubre de 2017, IEHP ganó el Premio a la Innovación del Departamento de Servicios de Salud de California (Department of Health Care Services, DHCS) por mejorar la salud de los Miembros de bajos ingresos a través de un programa que coordina sus necesidades complejas de atención médica para la salud física y del comportamiento, por medio del sistema de atención médica en los Condados de Riverside y San Bernardino. En 2015, IEHP ganó el primer Premio a la Innovación anual de DHCS por su Programa de Asistencia de Transición, este programa se concentra en reducir el uso de la sala de emergencias y limita las tarifas de readmisión de los Miembros recién dados de alta del hospital. IEHP recibe el premio al Socio Comercial del Año del Distrito de Protección contra Incendios de Rancho Cucamonga En septiembre de 2021, el Distrito de Protección contra Incendios de Rancho Cucamonga otorgó a IEHP el premio al Socio Comercial del Año en la celebración del reconocimiento a la policía y los bomberos de la ciudad. El distinguido premio reconoce la asociación del plan de salud con la ciudad y el condado de San Bernardino para albergar una clínica continua de vacunación masiva en las oficinas centrales del plan de salud. IEHP DualChoice Cal MediConnect Plan Obtiene un Alto Reconocimiento en Satisfacción al Cliente a Nivel Nacional IEHP DualChoice Cal MediConnect obtuvo la tercera calificación más alta a nivel nacional en la encuesta CAHPS de MMP 2016 de los Centros de Servicios de Medicare y Medicaid (Centers for Medicare and Medicaid Services, CMS), los cuales evalúan las experiencias de los pacientes con sus respectivos planes de salud. En 2016 participaron 40 Planes de Medicare-Medicaid (Medicare-Medicaid Plans, MMP) en el país (llamados Cal MediConnect plans in California).  Premio Anual a la Excelencia En 2016, IEHP recibió el Premio a la Excelencia que otorga Pharmacy Benefit Management Institute (PBMI) por su Programa de Pago por Desempeño para Farmacias (Pharmacy Payment for Performance), el cual ofrece educación clínica a sus Miembros a través de las farmacias de la red de IEHP. Alto Nivel de Satisfacción de los Doctores  Los Doctores y otros proveedores médicos posicionaron a IEHP en o por encima del 90% en la mayoría de las áreas en una encuesta de satisfacción de 2016 dirigida por un proveedor independiente de encuestas. IEHP fue calificado de la siguiente manera:  99% “IEHP Comparado con Todos los Demás Planes de Salud” 98% “Satisfacción General con el Personal del Centro de Llamadas” 98% “Satisfacción General con los Servicios Financieros”   97% “Recomendarían a IEHP con Otros Proveedores de Atención Médica” IEHP Recibe el Premio al Lugar de Trabajo del Año por Parte del Comité Asesor en marzo 2018 Inland Empire Health Plan (IEHP) ganó el premio al Lugar de Trabajo del Año 2018 del Comité Asesor (Advisory Board 2018 Workplace of the Year Award). El premio anual reconoce a hospitales y sistemas de salud a nivel nacional que obtienen calificaciones sobresalientes en relación al compromiso de los empleados. IEHP es una de las tan solo 20 organizaciones en todo el país que han recibido este premio.    Empresa Favorita  En 2014, Angeles News Group Readers votó por IEHP como “Empresa Favorita en General para Trabajar”, “Programa de Capacitación Favorito” y “Cultura Empresarial Favorita” en una encuesta llamada “Winning Workplaces”. Premio “Acceso a la Atención” En 2014, Western University of Health Sciences reconoció a IEHP por marcar una diferencia en el acceso avanzado a la atención médica y a la disponibilidad para las personas con discapacidad. Premio Energy Star por su Sobresaliente Desempeño en el Área Energética La oficina corporativa de IEHP (“The Atrium”) en Rancho Cucamonga, California, ganó la certificación ENERGY STAR® de la Agencia de Protección Ambiental de los EE. UU. (U.S. Environmental Protection Agency) por su sobresaliente desempeño energético en 2017, demostrando así el compromiso de IEHP con el ahorro continuo de energía y la responsabilidad con el medio ambiente. Certificación “Gold Standard” por Proceso Electrónico de Pagos y Reclamaciones En 2016, IEHP recibió la certificación de la Fase III por su precisión y eficiencia en pagos electrónicos de proveedores y conciliación de reclamaciones por parte del Council for Affordable Quality Healthcare (CAQH) y del Committee on Operating Rules for Information Exchange (CORE). La certificación voluntaria es ampliamente considerada como la “regla de oro” para procesamiento de pago de proveedores y reclamaciones.    

MediCal - High Risk Medications

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) 02/11/2013 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.

Interoperability API Terms Of Use

IEHP GOVERNING YOUR USE OF THE DEVELOPER PORTAL AND THE IEHP APIS (DEFINED BELOW). BY CLICKING “I AGREE” OR ACCESSING THE DEVELOPER PORTAL OR USING IEHPS APIS YOU ARE AGREEING TO BE BOUND BY THE TERMS OF THIS DEVELOPER AGREEMENT AND ANY OTHER APPLICABLE TERMS AND CONDITIONS POSTED ON IEHPS WEBSITE LOCATED AT WWW.IEHP.ORG/EN/ABOUT/PRIVACY-POLICY. IF YOU DO NOT AGREE TO THE TERMS OF THIS AGREEMENT, YOU MAY NOT ACCESS THE DEVELOPER PORTAL OR USE THE IEHP APIs. By entering into this Agreement, you affirm that you are at least 13 years old and of legal age to enter into this Agreement and are authorized to enter into this Agreement on behalf of your Company. No legal partnership or agency relationship is created between IEHP and you or your Company by virtue of this Agreement. We may update this Agreement by posting the updated version(s) on this Website. Updated versions of the Agreement will apply to your use of the IEHP APIs occurring on or after the date of the last update. The "Last Updated" legend above indicates when this Agreement was last changed. You should periodically review this page to determine if this Agreement has been updated. Your continued use of the IEHP APIs following any updates to this Agreement shall constitute notice and acceptance of any such updates. PERMISSIBLE USE OF IEHP APIS We provide access to Our application programming interfaces (“APIs”), including Our Patient Access API, Provider Directory API and Promoting Interoperability API, and their associated documentation and sandbox (collectively, the “IEHP APIs”) on the Developer Portal. We may update, change, discontinue or add IEHP APIs or functionality or features to the IEHP APIs in Our discretion with or without providing notice to you. Subject to the terms of this Agreement, IEHP grants you a limited, non-sublicensable, non-assignable, non- transferable, royalty-free, non-exclusive license only to use: (a) the Patient Access API to retrieve certain health plan information maintained by Inland Empire Health Plan, a local public entity of the State of California, and its subsidiary health plans with the approval and at the direction of the applicable member or their personal representative consistent with applicable law; (b) the Provider Directory API to retrieve certain provider and pharmacy directory information; and (c) the Promoting Interoperability API to retrieve certain health care information with the consent of the applicable patient or their personal representative consistent with applicable law. You may only access the Patient Access API and Promoting Interoperability API by means of an application that has been registered with IEHP to access them. You agree to comply with all applicable laws, regulations, and governmental issuances. RESTRICTIONS You may not: (a) decompile, disassemble, reverse engineer, or otherwise attempt to derive, reconstruct, identify, or discover any source code, underlying ideas, or algorithms of the IEHP APIs by any means, except to the extent that the foregoing restriction is prohibited by applicable law; (b) remove any proprietary notices, labels, or marks from the IEHP APIs; (c) interrupt or attempt to interrupt the operation of the IEHP APIs in any way, including, without limitation, by restricting, inhibiting, or interfering with the ability of any other user to use the IEHP APIs (including by means of hacking or defacing any portion of the IEHP APIs, or by engaging in spamming, flooding, or other disruptive activities); (d) disrupt, interfere with, modify, bypass, or otherwise circumvent IEHP APIs functionality or features, limitations, security measures, technical processes, availability, integrity, or performance (or attempt the same); (e) transmit or attempt to transmit data over a IEHP APIs unless such transmission is authorized and formatted in accordance with applicable specifications in the IEHP APIs implementation guide; (f) transmit or otherwise make available through or in connection with the IEHP APIs any malicious, harmful or invasive code; (g) attempt to exceed IEHP APIs rate limits; (h) conduct security research on or testing against IEHP APIs, services, applications, systems, devices, or networks without prior written approval from IEHP; or (i) use the IEHP APIs (1) for any unlawful purpose or in any manner not authorized or intended in the IEHP APIs implementation guide, (2) in any way that could pose a threat to, disrupt, interfere with, harm, or impair the IEHP APIs, IEHP or other IEHP services, applications, systems, devices, or networks, or Inland Empire Health Plan members’, patients’, customers’, or other users’ use of IEHP APIs, (3) in any manner that, in IEHP’s reasonable determination, constitutes excessive or abusive usage, (4) to gain unauthorized access to any IEHP service, application, system, device, or network, or (5) to transmit malicious code or exploit security flaws, vulnerabilities, or deficiencies. MONITORING Your use of this Website and the IEHP APIs may be monitored by IEHP to ensure compliance with this Agreement. You consent to such monitoring. REPORTING SECURITY ISSUES You agree to promptly report to IEHP any security flaws, vulnerabilities, or deficiencies identified through normal use of IEHP APIs by calling the Inland Empire Compliance Hotline at 1-866-355-9038. You may not publicly disclose security flaws, vulnerabilities, or deficiencies in the IEHP APIs or other IEHP applications, systems, devices, or networks of which you become aware. ACCOUNTS/REGISTRATION You agree to promptly report to IEHP any security flaws, vulnerabilities, or deficiencies identified through normal use of IEHP APIs by calling the Inland Empire Health Plan Compliance Hotline at 1-866-355-9038. You may not publicly disclose security flaws, vulnerabilities, or deficiencies in the IEHP APIs or other IEHP applications, systems, devices, or networks of which you become aware. PROPRIETARY RIGHTS IEHP or its licensors own the IEHP APIs and the content on this Website and all intellectual property rights therein. You may not use any Inland Empire Health Plan entity’s name, trademarks, service marks, tradenames, logos or other distinctive brand features except as necessary to comply with your obligation, above, and agree not to remove any proprietary notices, labels, or marks from the IEHP APIs, and, in any case, you may not use those notices, labels or marks to imply affiliation with or endorsement by Inland Empire Health Plan. You have only those rights to access and use the IEHP APIs as are expressly granted by IEHP under this Agreement and all other rights in the IEHP APIs are reserved to IEHP or its licensors. You acknowledge that these rights are valid and protected in all forms, media, and technologies existing now or hereinafter developed. “Inland Empire Health Plan, a local public entity of the State of California,” means the health care organization doing business as Inland Empire Health Plan including, without limitation, Inland Empire Health Plan, and the subsidiaries, partners, and successors of the foregoing. PUBLIC ENTITY STATUS; BROWN ACT/PUBLIC RECORDS ACT The parties hereby acknowledge and agree that IEHP is a local public entity of the State of California subject to the Brown Act, California Government Code Sections 54950 et seq., and the Public Records Act, California Government Code Sections 6250 et seq. PRIVACY Your submission of information through the Website is governed by our Privacy Policy. RESPONSIBILITY FOR HARDWARE, SOFTWARE, TELECOMMUNICATIONS AND OTHER SERVICES You are responsible for obtaining, maintaining, and paying for all hardware, software, and all telecommunications and other services, needed for you to use the IEHP APIs. DISCLAIMER OF WARRANTY IEHP AND ITS SERVICE PROVIDERS DISCLAIM ALL EXPRESS OR IMPLIED REPRESENTATIONS OR WARRANTIES REGARDING THE IEHP APIS, INFORMATION, CONTENT, SERVICES, FUNCTIONALITY, AND ANY OTHER RESOURCES AVAILABLE ON OR ACCESSIBLE THROUGH THIS WEBSITE, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON- INFRINGEMENT. ALL SUCH IEHP APIS, INFORMATION, CONTENT, SERVICES, FUNCTIONALITY AND RESOURCES ARE MADE AVAILABLE "AS IS" AND "AS AVAILABLE", AT YOUR SOLE RISK, WITHOUT WARRANTY OF ANY KIND. IEHP DOES NOT WARRANT THAT THE WEBSITE OR IEHP APIS WILL BE ACCURATE OR OPERATE WITHOUT INTERRUPTION OR ERROR. LIMITATION OF LIABILITY TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, IN NO EVENT SHALL IEHP, INLAND EMPRIE HEALTH PLAN OR THEIR SERVICE PROVIDERS, LICENSORS OR RESPECTIVE EMPLOYEES, OFFICERS, DIRECTORS, AGENTS, AFFILIATES, SUPPLIERS, VENDORS, LICENSORS, CO-BRANDERS OR PARTNERS (COLLECTIVELY, THE “INLAND EMPRIE HEALTH PLAN PARTIES") BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL, PUNITIVE, INCIDENTAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES, OR ANY DAMAGES WHATSOEVER RESULTING FROM ANY LOSS OF USE, LOSS OF DATA, LOSS OF PROFITS, BUSINESS INTERRUPTION, LITIGATION, OR ANY OTHER PECUNIARY LOSS, WHETHER BASED ON BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE), PRODUCT LIABILITY, OR OTHERWISE ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE USE, OPERATION OR PERFORMANCE OF THE IEHP APIS, WITH THE DELAY OR INABILITY TO USE THE IEHP APIS, ANY DEFECTS IN THE IEHP APIS, OR WITH THE PROVISION OF, OR FAILURE TO MAKE AVAILABLE, ANY INFORMATION, SERVICES, PRODUCTS, MATERIALS, OR OTHER RESOURCES AVAILABLE ON OR ACCESSIBLE THROUGH THE IEHP APIS, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. You acknowledge and agree that the limitations set forth above are fundamental elements of this Agreement. INDEMNIFICATION You agree to indemnify, defend, and hold the Inland Empire Health Plan Parties harmless from any liability, loss, claim, and expense (including reasonable attorneys' fees) actually or allegedly related to or arising out of your use of the IEHP APIs or this Website, your use or disclosure of information obtained through the IEHP APIs, your violation of this Agreement, and/or your violation of the rights of any other person. TERM, TERMINATION, SUSPENSION AND REVOCATION This Agreement is effective until terminated by either party. If you no longer agree to be bound by this Agreement, you must cease your use of the IEHP APIs. If you breach any provision of this Agreement, then you may no longer use the IEHP APIs. IEHP may suspend or revoke your Credentials or access to the IEHP APIs without prior notice for your failure to comply with this Agreement or if IEHP determines that your access to the IEHP APIs would present an unacceptable level of risk to the security of IEHP’s systems. IEHP may terminate this Agreement if you fail to comply with its terms and, to the extent permitted by law, for any or no reason. If this Agreement is terminated for any reason, then: (a) this Agreement will continue to apply and be binding upon you in respect of your prior use of the IEHP APIs (and any unauthorized further use of the IEHP APIs); and (b) any rights granted to us under this Agreement will survive such termination. GENERAL LEGAL TERMS This Agreement constitutes the entire agreement between you and IEHP with respect to its subject matter IEHP’s failure to exercise or enforce any right or provision of this Agreement shall not constitute a waiver of such right or provision. If a court of competent jurisdiction rules that any provision of the Agreement is invalid, then that provision will be removed from the Agreement without affecting the rest of the Agreement and the remaining provisions will continue to be valid and enforceable. There are no third- party beneficiaries to this Agreement. The rights granted in this Agreement may not be assigned or transferred by You without the prior written approval of IEHP. You may not delegate your responsibilities or obligations under this Agreement without the prior written approval of IEHP. This Agreement shall be governed by the laws of the State of California without regard to its conflict of laws provisions. You agree to submit to the exclusive jurisdiction of the courts located within the county of San Bernardino, California to resolve any legal matter arising from this Agreement. IEHP may, notwithstanding this, seek injunctive remedies in any jurisdiction.

MediCal - Compliance

h plan operations in compliance with ethical standards, contractual obligations under State and Federal programs, laws, and regulations applicable to Medi-Cal and IEHP DualChoice. This commitment extends to our business associates and delegated entities that support IEHP’s mission to organize and improve the delivery of quality, accessible, and wellness based healthcare services for our community.   Our Compliance Program is designed to: Ensure we comply with applicable laws, rules, and regulations Reduce or eliminate Fraud, Waste, and Abuse (FWA) Prevent, detect, and correct non-compliance Reinforce our commitment to culture of compliance for which we strive Establish and implement our shared commitment to honesty, integrity, transparency, and accountability Code of Business Conduct and Ethics Inland Empire Health Plan (IEHP) expects Team Members and business entities doing business with IEHP to conduct business activities in an ethical and professional manner that promotes public trust and confidence in the integrity of IEHP. The Code is meant to provide guidance about the compliance culture at IEHP and the role that each Team Member, including management, Chief Officers and the Governing Board, plays in building and preserving that culture. IEHP Code of Business Conduct and Ethics (PDF) Compliance, Fraud, Waste, and Abuse (FWA), and Privacy Program Training The IEHP Compliance, FWA, and Privacy Training Program focuses on the elements of an effective Compliance Program, conduct & ethics, and the Fraud, Waste and Abuse and Privacy Programs. IEHP requires delegated entities to provide Compliance Training to their employees, Providers, downstream entities, Board of Directors, and Contractors within 90 days of hire/start, and annually thereafter. IEHP is committed to a culture of compliance, ethics, and integrity. The goal of Compliance Training is to provide all associated parties the ability to demonstrate awareness of IEHP’s requirements, including regulations and policies & procedures associated with Compliance as it relates to daily work. If you have questions or additional suggestions, please e-mail the IEHP Compliance Department at Compliance Training FWA HIPAA Privacy and Security (PDF) Eligibility to Participate in Federal and State Health Care Programs Inland Empire Health Plan (IEHP) is prohibited from issuing payment for services provided, ordered, or prescribed by an individual or entity that is excluded, ineligible, or terminated from participation in State and Federal health care programs in accordance with regulatory and contractual requirements. IEHP conducts regular reviews of Federal and State exclusionary databases and lists, including but not limited to: Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE list) GSA Excluded Parties List System (EPLS) DHCS Medi-Cal Suspended and Ineligible Provider List CMS Preclusion List Restricted Provider Database (RPD) Exclusion Screening IEHP has implemented a screening process to identify individuals and entities that appear on the DHHS OIG LEIE, the GSA EPLS, the CMS Preclusion List and the DHCS Medi-Cal Suspended and Ineligible Provider List prior to appointment, contracting, and/or employment and monthly thereafter to ensure that none of these individuals or entities are excluded, ineligible or terminated from participation in State and Federal health care programs. Delegated entities must implement a screening program for employees, Board Members, contractors, and business partners to avoid relationships with individuals and/or entities that tend toward inappropriate conduct. This program includes but is not limited to: Prior to contract and monthly thereafter, review of the GSA System for Award Management (SAM), the Department of Health Care Services Medi-Cal Suspended and Ineligible list, and the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) that are excluded from participation in government health care programs (42 CFR §10011901). A monthly review of the Department of Health Care Services Medi-Cal Suspended and Ineligible list. Criminal record checks when appropriate or as required by law. Review of the National Practitioner Databank (NPDB). Review of professional license status for sanctions and/or adverse actions. Reporting results to Compliance Committee, Governing Body, and IEHP as necessary. Fraud, Waste, and Abuse (FWA) IEHP has established a Fraud, Waste, and Abuse Program to detect, correct, and prevent fraud, waste, and abuse on part of Team Members, IEHP Members, Providers, Vendors, delegated entities and any other entity doing business with IEHP. Fraud Prevention Fraud Prevention, it’s a Team Effort In an effort to prevent fraud and abuse, IEHP encourages Providers and their staff to report any suspicious circumstances when they arise. You may want to ask for another form of identification in addition to the IEHP Member identification card. Identification with both a picture and a signature, such as a valid driver’s license or State identification card, are suggested. We are informing Members of this concern and are requesting that they have additional identification available when they come to you. To obtain more compliance guidelines, the Department of Health and Human Services (HHS) offers assistance (by clicking on this link you will be leaving the IEHP website). Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program, or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program. Examples include: Knowingly billing for services or prescriptions not furnished or supplies not provided Knowingly altering claim forms for a higher payment Selling medicine, medical equipment, or other things received through IEHP Waste includes overuse of services, or other practices that, directly or indirectly, result in unnecessary costs. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources. Examples include: Conducting excessive office visits Writing excessive prescriptions or ordering excessive tests Prescribing more medications than necessary for the treatment of a specific condition Abuse includes actions that may, directly or indirectly, result in unnecessary costs and improper payment or services. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment. Examples include: Billing for unnecessary medical services or medical equipment Billing for brand name drugs when generics are dispensed Misusing codes on a claim, such as upcoding and unbundling codes. Report potential FWA Click Here (By clicking on this link, you will be leaving the IEHP website). Privacy Incident/Breach IEHP has established a HIPAA Privacy Program to ensure that Member’s health information is properly protected while allowing the flow of health information needed to provide and promote high-quality health care. A privacy breach is defined as unauthorized acquisition, access, use, or disclosure of protected health information (PHI) which compromises the security or privacy of such information. PHI is health information that relates to a Member’s past, present or future physical or mental health or condition, including the provision of his/her health care, or payment for that care and contains personally identifiable information (PII) such as name, SSN, DOB, Member ID, address, or any other unique identifier related to the Member. This generally means that a breach occurs when PHI is accessed, used, or disclosed to an individual or entity that does not have a business reason to know that information. The law does allow information to be accessed, used, or disclosed when it is related to treatment, payment, or healthcare operations directly associated with the work that we do at IEHP on behalf of our Members. Report a Privacy Incident/Breach Click Here (By clicking on this link, you will be leaving the IEHP website). Reporting Information IEHP has the following resources available for reporting fraud, waste or abuse, privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Online: (By clicking on this link, you will be leaving the IEHP website) Report a Compliance Issue: Click Here Report a Privacy Incident/Breach: Click Here Report potential FWA: Click Here Frequently Asked Questions (FAQs) What are some common examples of fraud? Providers Billing for services not rendered Paying a "kickback" in exchange for a referral for medical services or goods Unbundling Overcharging for services or goods  Using false credentials Members Allowing unauthorized individuals to use ID card to obtain benefits Altering prescriptions Falsifying residence information to obtain benefits Drug seeking or doctor shopping to obtain narcotics What do I do if I suspect an IEHP Member is engaging in possible fraud, waste, or abuse? First, document your suspicions. Then, contact IEHP’s Compliance Department at (866) 355-9038 and make a report with one of our Representatives. At times, IEHP may request additional information that is necessary to investigate. IEHP also has the following resources available for reporting fraud, waste or abuse, privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Online: (By clicking on the following links, you will be leaving the IEHP website) Report a Compliance Issue Click Here Report a Privacy Incident/Breach Click Here Report potential FWA Click Here What do I do if my facility has made some billing errors? If you suspect that errors in billing may have occurred, contact your IEHP Provider Services Representative at (909) 890-2054. What are some other things I can do as a Provider? Periodically perform internal audits of billing practices and compare billing records with payments received. Do not leave prescription pads, which include a Provider's identification and license number, out in the open. For example, do not store prescription pads in exam room cabinets or leave on office counters. 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 or MS Internet Explorer Contact the OIG The Office of the Inspector General (OIG) is there to assist you and maintains a hotline, which offers a confidential means for reporting vital information. For information on confidentiality, please contact the hotline and ask about their confidential source program. Each caller is encouraged to assist the OIG by providing information on how they can be contacted for additional information but the caller may remain anonymous. Contacting the Office of the Inspector General Phone: (800) HHS-TIPS (447-8477) E-mail: Additional Hotlines DHCS Medi-Cal Fraud Hotline Phone: (800) 822-6222 E-mail: Web:  The recorded message may be heard in English and 10 other languages: Spanish, Vietnamese, Cantonese, Armenian, Hmong, Cambodian, Laotian, Farsi, Korean and Russian. The call is free and the caller may remain anonymous.    You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.

Equipo Ejecutivo - Vinil Devabhaktuni, MBA

tubre de 2021. En su puesto, Vinil dirigirá la arquitectura general de tecnología de la información, y el diseño, el desarrollo, la implementación y el soporte para los sistemas de IEHP. Vinil vino a IEHP de Health New England, donde trabajó más recientemente y donde sirvió como Director Ejecutivo de Informática y Tecnología, y fue responsable de manejar una cartera de clientes única y de elevar el rol de la tecnología de una función de soporte a un socio estratégico que jugó un papel fundamental en el crecimiento de la organización.  Vinil también desarrolló y ejecutó un mapa integral de operaciones para ventas, evaluación de riesgos y contabilidad. Además, rediseñó y agilizó las operaciones de soporte a la producción y de desarrollo de aplicaciones para traer estabilidad y predictibilidad a la organización y optimizarla. Antes de su puesto en Health New England, Vinil se desempeñó como vicepresidente y director de transformación digital en AIG en Nueva York. Allí dirigió una iniciativa de transformación digital global de $50 millones, que incluyó migrar y consolidar las propiedades digitales de 140 países de todo el mundo. Vinil tiene una maestría en administración de empresas de Bay Path University en Longmeadow.

Equipo Ejecutivo - Jarrod McNaughton, MBA, FACHE

utive Officer, CEO). En este cargo, trabaja en colaboración con la Junta Directiva de IEHP con el propósito de establecer una visión estratégica y proporcionar un liderazgo ejecutivo para uno de los 10 planes de salud más grandes de Medicaid y el mayor plan sin fines de lucro de Medicare-Medicaid en los EE. UU. EL Sr. McNaughton fomenta la sólida asociación de IEHP con los proveedores, hospitales y cientos de socios de servicios para la comunidad a fin de brindar una atención integral de calidad a más de 1.5 millones de Miembros. Asegura la administración y la estabilidad financiera del presupuesto operativo de IEHP de más de $5.4 mil millones. El Sr. McNaughton, un líder visionario en el área de la atención médica, se unió a IEHP en 2018 como Director Ejecutivo de Operaciones. En este cargo, fue responsable de los departamentos de Operaciones, Quejas, Contratos con Proveedores, Inscripciones y Elegibilidad, así como de Servicios para Miembros; además apoyó el área directiva de la organización de IEHP, fomentó la transformación LEAN de IEHP y reafirmó la misión de IEHP de brindar un servicio de calidad a nuestros Miembros y proveedores de forma efectiva y eficaz. Antes de IEHP, el Sr. McNaughton se desempeñó en diversos cargos incrementando sus responsabilidades, en hospitales y grandes sistemas hospitalarios. Durante casi 20 años, ha dirigido la innovación y las estrategias operativas en fases múltiples que han generado máximos resultados de forma consistente. El Sr. McNaughton, goza de una excelente reputación al crear equipos dinámicos, impulsar el desarrollo de líderes y fomentar relaciones clave en la comunidad. Su capacidad para eliminar obstáculos y fortalecer a cada individuo, desde los Miembros del equipo en primera línea hasta los Doctores, ayudará a apoyar la fuerte posición de IEHP en el entorno de la atención médica, el cual es siempre cambiante. Los cargos del Sr. McNaughton como presidente de Kettering Medical Center y Vicepresidente Ejecutivo de Kettering Health Network, demostraron su ingenio para las estrategias de negocio, así como su empatía y liderazgo visionario. Desarrolló una estrategia coordinada y detallada para toda la red, además de que dirigió diversos cambios progresistas en los servicios y la prestación de atención para los pacientes en dichos establecimientos. Kettering Health Network en el suroeste de Ohio incluye ocho hospitales, nueve departamentos de emergencias, numerosas clínicas para pacientes ambulatorios y más de 11,000 empleados. Antes de desempeñar este cargo en Kettering Medical Center, el Sr. McNaughton fue vicepresidente en el San Joaquin Community Hospital. Entre todos los logros que ahí alcanzó, desarrolló e implementó una nueva misión y un departamento de servicio, lo cual ayudó a incrementar las calificaciones del nivel de satisfacción de los pacientes del 40 al 85 por ciento en menos de un año. El fuerte compromiso del Sr. McNaughton con la comunidad se ajusta adecuadamente a la misión de IEHP y a la cultura de la empresa. Es Profesor Clínico Asistente en Loma Linda University y miembro de la junta de diversas agencias educativas y sin fines de lucro. Como voluntario de Global Medical Missions, una organización de ayuda internacional, dirigió equipos de misión a corto plazo para Kenia, Malaui, Nigeria, India, Nepal, Honduras y México. En su tiempo libre le gusta cantar, disfrutar del teatro musical y de volar aviones monomotores. El Sr. McNaughton asistió a Pacific Union College, donde obtuvo su título de licenciatura. Obtuvo su título de maestría en Business Administration de University of La Verne. Además, forma parte de American College of Healthcare Executives.  

Equipo Ejecutivo - Keenan Freeman

e de 2016. En este rol ejecutivo, el Sr. Freeman es responsable de la administración financiera general de IEHP, los informes financieros y la transparencia del plan, y múltiples funciones financieras del plan, que incluyen contabilidad, compras, capitación, recuperación de costos, manejo de riesgos y la coordinación de auditorías fiscales, así como de otras auditorías operacionales. Keenan Freeman aporta a IEHP más de 28 años de experiencia profesional en el área financiera, que comprende 16 años de liderazgo estratégico en numerosas funciones, incluido el desarrollo financiero, operacional y de estrategias en un plan de salud de propiedad de los proveedores y un grupo médico de múltiples especialidades con más de 4,000 proveedores. Más recientemente, el Sr. Freeman prestó servicios como Director Ejecutivo Financiero para Providence Medical Group en Oregon, donde dedicó 5 años a brindar liderazgo operacional y financiero a más de 1,200 médicos, asistentes médicos y a equipos de enfermería con práctica médica. Además, se desempeñó como Director Ejecutivo Financiero durante ocho años y como Director Ejecutivo de Operaciones durante dos años para First Care Health Plans en Austin, Texas. El Sr. Freeman entiende la importancia de desarrollar relaciones externas con médicos clave, sistemas de salud y entidades gubernamentales. Disfruta de crear equipos con funciones interdisciplinarias para lograr objetivos a corto y largo plazo, y valora la importancia de desarrollar relaciones externas con médicos clave, sistemas de salud y entidades gubernamentales. El liderazgo del Sr. Freeman en estas áreas, así como en el proceso de presupuesto anual, mantendrá a IEHP estable, desde el punto de vista financiero, en medio de los cambios de la atención médica y la volatilidad económica. El Sr. Freeman cuenta con un título de Licenciado en Administración y Contabilidad, y una Maestría en Administración de Empresas (MBA) de Texas Tech University.

Equipo Ejecutivo - Edward Juhn, MD, MBA, MPH

junio de 2021. El Dr. Juhn se encargará de dirigir el progreso en los métodos y las estrategias enfocadas en proporcionar un servicio de calidad en diferentes aspectos para asegurar que el compromiso del plan de salud sea proveer una calidad máxima en atención médica a las comunidades que recibirán los servicios. El Dr. Juhn aporta más de 15 años de experiencia en la optimización simultánea de los servicios clínicos, la salud pública, los datos y la tecnología. Como líder de servicio basado en objetivos, cuenta con una amplia experiencia en diferentes áreas del sistema de atención médica, incluida la responsabilidad de pagos, el grupo médico y el hospital. Ha participado tanto en la estrategia empresarial como en las operaciones tácticas y ha desarrollado con éxito asociaciones entre el sector público y privado.   Previo a su posición en IEHP, el Dr. Juhn fue Director Médico Sénior en Blue Shield of California, donde trabajó en iniciativas innovadoras que aprovechaban los datos a gran escala, los análisis avanzados y las ofertas de servicios facilitados por la tecnología; siendo estas iniciativas las que repercutieron para lograr un objetivo cuádruple y la equidad en los servicios de salud. Teniendo la  responsabilidad de pagos, también administró las organizaciones de los grupos ACO y non-ACO en el norte de California y participó en el grupo asesor clínico a nivel nacional de Blue Venture Fund. Adicionalmente, Dr. Juhn ha participado como científico clínico en una empresa emergente financiada por Intel-Funded. Anteriormente, se desempeñó como Director Ejecutivo de Innovación y Estrategia de Atención Médica en Premier HealthCare, donde formó parte de la Coalición para el Cuidado Responsable (Accountable Care Coalition, ACO) en el Área Metropolitana de New York, en la cual ayudó a establecer una de las primeras ACO a nivel nacional, enfocada en brindar apoyo a las personas con discapacidad intelectual y del desarrollo.   El Dr. Juhn obtuvo su licenciatura y doctorado en el área de medicina en George Washington University, la Maestría Ejecutiva en Administración de Empresas en New York University y la Maestría en Salud Pública en Johns Hopkins University. Cuenta con una certificación en Medicina Interna de la Junta Médica, es miembro de American College of Physicians, además prestó sus servicios como instructor clínico en Stanford Medicine. También fue miembro del equipo de trabajo de Interoperability Standards Priorities Task Force a nivel nacional, un subcomité que depende de Health Information Technology Advisory Committee (HITAC).    

Equipo Ejecutivo - Michelle Rai, MS

municaciones en marzo de 2020. Desde esta función, supervisará las comunicaciones y los programas de mercadotecnia de IEHP y guiará el desarrollo de estrategias de mercadotecnia y comunicaciones a largo plazo. Además, la Sra. Rai también supervisará la ejecución estratégica de las relaciones de IEHP con la comunidad y los medios de información, así como las comunicaciones internas y el uso de las redes sociales y los medios de comunicación digitales. La Sra. Rai se une a IEHP con más de 20 años de experiencia en relaciones públicas, comunicaciones, mercadotecnia y las relaciones con los medios de información. Anteriormente se desempeñó como Presidenta del Departamento de Comunicaciones de Pacific Union College en el Valle de Napa, California. Antes de desempeñarse como presidenta, la Sra. Rai actuó como Directora de Relaciones Públicas de la Universidad y Encargada de Información Pública. La Sra. Rai tiene una maestría en comunicaciones integradas de mercadotecnia de Golden Gate University. Obtuvo el título de licenciada en periodismo y comunicación en Pacific Union College, donde en 2016 recibió el prestigioso galardón de Educador del Año. El liderazgo de la Sra. Rai permitirá que IEHP aumente el alcance de su marca y su presencia en los medios sociales y, a la vez, incremente la percepción de la organización y fortalezca el lugar de la organización como líder de opinión de la industria.  

Equipo Ejecutivo - Takashi Wada, MD, MPH

nio de 2021. Es responsable de la dirección clínica y estratégica, a través de procesos responsables y colaborativos destinados a mejorar la calidad de la atención médica, como lo demuestra la optimización de las mediciones de calidad externas. El Dr. Wada lidera y dirige soluciones innovadoras para el desarrollo y la implementación de programas con el objetivo de mejorar el acceso, la satisfacción y los resultados de la atención que sean sostenibles y expansibles.   Dr. Wada se se unió a IEHP en 2019 como Vicepresidente de Salud de la Población. En esta función, supervisó los departamentos internos de Salud del Comportamiento y Coordinación de la Atención Médica, Salud Comunitaria y Familiar, Educación para la Salud y Transformación de Prácticas. También desempeño una función clave en diversas iniciativas de salud de la población a nivel estatal y regional.   Antes de su cargo en IEHP, el Dr. Wada se desempeñó como director ejecutivo médico/director ejecutivo médico suplente de CenCal Health y director/responsable de salud del Departamento de Salud del Condado de Santa Barbara.  El Dr. Wada tiene un título universitario en ciencias biomédicas por University of California, Riverside, y una maestría en salud pública por University of California, Los Angeles, UCLA. Después de obtener su grado médico en la UCLA, concluyó su educación médica de posgrado en el Centro Médico Los Angeles de Kaiser Permanente.    

Junta Directiva - Eileen Zorn

tica clínica, la educación, la gestión operativa, la investigación y las mejoras en la calidad. En enero de 2003, fue designada Miembro de la Junta Directiva de IEHP. La Sra. Zorn publicó diversos artículos relacionados con la atención médica y ha recibido varios reconocimientos y premios durante su carrera profesional. Obtuvo su título de Licenciada en Enfermería en Columbia Union College de Takoma Park, Maryland, y una Maestría en Enfermería en Loma Linda University en 1976.

- Well-care Visit

our child stay healthy. During the well-care visit, the Doctor will complete a physical exam, and make sure you or your child are up to date on all shots. Please call your Doctor today and set up a well-care visit to get needed shots, screenings or exams. What do you need to do? Get a well-care visit with your or your child’s Doctor by 12/15/23.* The Doctor will send proof of the visit to IEHP. Once IEHP receives proof of the visit, a reward certificate will be mailed.** Choose your gift card from the list of major companies online, over the phone or by mail, and your $25 gift card will be mailed to you.*** Questions? 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.   *Member must be eligible with IEHP on the day of the exam and at the time of gift card distribution. **Reward certificate may be mailed up to two weeks after IEHP receives proof of your exam. ***After choosing your gift card, please allow two to three weeks for delivery. Note: Gift card cannot be used to purchase alcohol, tobacco or firearms.