Inside San Francisco Health Plan. Sean Dongre, Provider Relations Supervisor July 15, 2015
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1 Inside San Francisco Health Plan Sean Dongre, Provider Relations Supervisor July 15, 2015
2 Agenda 1. Brief History 2. Improving Quality 3. SFHP Member Benefits 4. Provider Network 5. Community Support
3 Historic Timeline 1994 SFHP is created as one of California s Local Health Plans an initiative to provide affordable health coverage to low and moderate-income families residing in San Francisco In addition to our Medi-Cal and Healthy Workers programs, SFHP launches the Healthy Kids Program, a City and County funded program, which moved San Francisco one giant step closer to universal health care coverage for all uninsured children SFHP partners with the San Francisco Department of Public Health to develop and implement Healthy San Francisco. Today SFHP provides affordable health care coverage to over 130,000 low and moderateincome families.
4 Improving Quality San Francisco Health Plan (SFHP) designs and manages many programs that focus on improving the health of our members and their overall care experience. Our Goals: Provide Universal Coverage High Quality Care and Access to Care Exemplary Service Financial Viability for the Plan and the Safety Net Types of Contracted Provider Trainings: 1. Improving Patient-Provider Communication 2. Customer Service 3. Staff Experience Building Blocks Practice Coaching Program 5. Coleman s Rapid Dramatic Process Improvement
5 Member Incentives: Improving Quality
6 Member Benefits and Services Medi-Cal provides medical, dental, and vision coverage. San Francisco Health Plan offers members: Doctor Visits 600 Primary Care Providers to choose from Vision Care (glasses* and eye exams) 90 vision service providers Hospital and Emergency Room Care nine of the best San Francisco hospitals Prescription Drugs 200+ pharmacies throughout San Francisco Regular Check-ups and Immunizations (shots) OB/GYN Services and Pregnancy Care Family Planning Mental Health Services Specialty Care 2,000+ Specialists in our network
7 Member Benefits and Services 24/7 Nurse Help Line - Members with urgent medical questions can call anytime 1(877) Behavioral Health Treatment for ASD - Adults or children diagnosed with autism spectrum disorder (ASD) who need behavioral health treatment 1(855) Care Coordination - SFHP members who need help with the medical or social service system SFHP s Care Coordination 1(415) Vision - Medi-Cal members needing vision services 1(800) Mental Health Services - Mental health services such as individual or family therapy or help managing medication 1(855) Dental - Medi-Cal members needing dental services 1(800)
8 Our Provider Network
9 Our Provider Network SFHP Contracted Hospitals:
10 Community Support
11 Member-centered facility. Community Support Serves primarily as an enrollment site for Medi-Cal, Healthy Kids and Healthy San Francisco programs (appointment only at this time). It is an information center for members, HSF Participants, and San Francisco residents can learn what health care access options are available to them. All Service Center Clients will receive exemplary service in a culturally respectful manner, in the language of their choice.
12 Community Support Golden Gate to Health Insurance (GGHI) Network The GGHI Network was created by the San Francisco Health Plan as a resource for working professionals who help individuals and families living in San Francisco obtain health coverage. Our Goal: Be a trusted source of information about public health coverage programs and resources in San Francisco. We Accomplish this by: Providing a bi-monthly meeting wherein network participants may come together to learn and network about changes in health care eligibility and enrollment from our expert panel of speakers Hosting the Annual Stronger Bridges to Health Forum We have over 600 Network Participants!
13 Questions?
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