INLAND EMPIRE HEALTH PLAN STANDARD MONTHLY REPORTS Supplemental to: Board Report #256
ADMINISTRATION (Bradley P. Gilbert, M.D.) 1. Standard IEHP Monthly Reports a. IEHP Finance Reports (Attachment A) 1) Income Statements 2) Capitation Income And Expense 3) Purchasing Transaction History Report** b. IEHP Operations Reports (Attachment B) 1) Claims Summary Report 2) Claims Processing Turnaround Time 3) PCP Member Allocation Report 4) Member Services Telephone Activity Report 5) Provider Automated Eligibility Contact Report 6) Member Eligibility Verification Report c. IEHP Provider Reports (Attachment C) 1) IPA Consolidated Membership Report 2) Hospital Consolidated Membership Report 3) New Enrollment Trend Report By Consolidated IPA d. IEHP Marketing Reports (Attachment D) 1) All Medi-Cal Aid Codes Enrollment Report 2) Medi-Cal Mandatory Families Aid Codes Enrollment Report 3) Medi-Cal Mandatory Seniors & Persons With Disabilities (SPD) Aid Codes Enrollment Report 4) IEHP s Medi-Cal Non-Mandatory Aid Codes Enrollment Report 5) IEHP s Medi-Cal Expansion Aid Codes Enrollment Report 6) IEHP s Healthy Kids Program Enrollment Report 7) IEHP Medicare Enrollment Report **(Reports not available due to system conversion)
ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Year-To-Date Income Statement for the Nine Months Ended March 31, 2016 Medi-Cal Healthy Kids Medicare Actual Budget Variance $ Actual Budget Variance $ Actual Budget Variance $ Organizational Expenditures Grand Total Capitation Revenue 2,473,309 2,445,550 27,758 707 599 108 218,145 226,625 (8,480) - 2,692,161 Capitation Revenue - Retro 50,775-50,775 - - - - - - - 50,775 Supplemental 224,290 418,457 (194,167) - - - - - - - 224,290 Other Revenue (1) - (1) 437 487 (51) 40,041 44,135 (4,095) - 40,476 Net Revenue 2,748,372 2,864,007 (115,635) 1,144 1,086 58 258,186 270,760 (12,574) - 3,007,702 Facility Claims 771,707 713,798 57,909 101 184 (82) 82,013 96,313 (14,301) - 853,821 Capitation Expense 529,719 448,221 81,498 313 243 70 79,182 82,935 (3,753) - 609,214 Professional 202,867 147,797 55,070 41 28 13 26,717 15,967 10,750-229,624 Pharmacy 393,202 437,702 (44,500) 49 245 (196) 62,069 102,910 (40,842) - 455,320 Incentives 112,747 294,709 (181,961) 24 21 3 1,450 583 867-114,222 IEHP Responsible 389,287 410,276 (20,988) 15 133 (118) 13,942 9,177 4,765-403,244 Other Expenses 4,986 168,638 (163,652) 424 487 (64) (1) (57,359) 57,358-5,409 G & A Expenses - Medical - - - - - - - - - 41,058 41,058 Behavior Health Allocations 750-750 - - - 1,047-1,047 (1,797) - Medical Cost Allocations 34,691 46,581 (11,891) 46 18 29 4,558 3,623 935 (39,294) - DSNP Co-Insurance Allocation MD 634-634 - - - (634) - (634) - - Total Medical Costs 2,440,590 2,667,721 (227,131) 1,013 1,358 (345) 270,341 254,150 16,192 (33) 2,711,911 Gross Margin 307,782 196,286 111,496 131 (272) 402 (12,155) 16,611 (28,766) 33 295,791
ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Year-To-Date Income Statement for the NineMonths Ended March 31, 2016 (Continued) Medi-Cal Healthy Kids Medicare Actual Budget Variance $ Actual Budget Variance $ Actual Budget Variance $ Organizational Expenditures Grand Total Operating Expenses Administrative Expense 39,842 108,947 (69,105) 13 41 (28) 3,900 8,474 (4,574) (43,756) - Administration 4,347-4,347 4-4 136-136 6,257 10,744 Finance 1,848-1,848 2-2 37-37 3,129 5,016 Information Technology (IT) 19,289-19,289 19-19 387-387 11,866 31,561 Marketing 4,088-4,088 4-4 644-644 3,454 8,190 Medical Services 5,029-5,029 57-57 1,867-1,867 4,883 11,836 Network Development 2,941-2,941 3-3 59-59 2,007 5,009 Operations 17,713-17,713 18-18 355-355 12,930 31,016 Total Operating Expenses 95,098 108,947 (13,849) 119 41 78 7,386 8,474 (1,089) 769 103,372 Operating Surplus (Deficit) 212,684 87,339 125,345 11 (313) 324 (19,541) 8,136 (27,677) (735) 192,419 Other Income (Expense) - - - - - - - - - 1,032 1,032 Property Management Income (Expense) - - - - - - - - - (3,356) (3,356) Behavioral Health Clinic - - - - - - - - - 1,169 1,169 Hospital Community Fund - - - - - - - - - 250 250 ED Navigator Project - - - - - - - - - 30 30 Net Surplus (Deficit) 212,684 87,339 125,345 11 (313) 324 (19,541) 8,136 (27,677) (4,508) 188,646
ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Income Statement for the Month Ended March 31, 2016 Medi-Cal Healthy Kids Medicare Actual Budget Variance $ Actual Budget Variance $ Actual Budget Variance $ Organizational Expenditures Grand Total Capitation Revenue 283,684 281,022 2,663 90 67 24 27,598 25,224 2,373-311,372 Capitation Revenue - Retro 13,741-13,741 - - - - - - - 13,741 Supplemental 22,395 47,967 (25,571) - - - - - - - 22,395 Other Revenue - - - 39 54 (15) 5,801 4,837 964-5,840 Net Revenue 319,821 328,988 (9,167) 129 121 9 33,399 30,061 3,337-353,349 Facility Claims 86,451 82,225 4,226 30 21 9 6,994 10,713 (3,718) - 93,476 Capitation Expense 62,345 51,375 10,969 40 27 13 11,144 9,339 1,805-73,529 Professional 23,475 16,666 6,809 6 3 3 3,042 1,740 1,302-26,523 Pharmacy 48,961 48,677 284 6 29 (22) 6,739 12,116 (5,378) - 55,706 Incentives 6,893 32,745 (25,853) 3 2 1 309 57 252-7,205 IEHP Responsible 46,321 47,077 (756) 8 15 (7) 1,302 1,076 226-47,631 Other Expenses 653 18,670 (18,017) (15) 54 (69) - (6,316) 6,316-638 G & A Expenses - Medical - - - - - - - - - 5,566 5,566 Medical Cost Allocations 4,858 5,617 (759) 9 2 7 699 437 262 (5,566) - Total Medical Costs 279,957 303,053 (23,096) 88 153 (65) 30,229 29,161 1,068-310,275 Gross Margin 39,864 25,935 13,928 41 (33) 74 3,170 900 2,270-43,075
ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Income Statement for the Month Ended March 31, 2016 (Continued) Medi-Cal Healthy Kids Medicare Actual Budget Variance $ Actual Budget Variance $ Actual Budget Variance $ Organizational Expenditures Grand Total Operating Expenses Administrative Expense - 12,377 (12,377) - 5 (5) - 963 (963) - - Administration 874-874 1-1 26-26 - 901 Finance 546-546 1-1 11-11 - 557 Information Technology (IT) 5,367-5,367 5-5 104-104 - 5,477 Marketing 1,072-1,072 1-1 100-100 - 1,173 Medical Services 889-889 13-13 474-474 - 1,376 Network Development 665-665 1-1 13-13 - 679 Operations 3,743-3,743 4-4 73-73 - 3,819 Total Operating Expenses 13,156 12,377 779 25 5 21 800 963 (162) - 13,982 Operating Surplus (Deficit) 26,708 13,559 13,149 16 (37) 53 2,369 (63) 2,432-29,093 Other Income (Expense) - - - - - - - - - 94 94 Property Management Income (Expense) - - - - - - - - - (213) (213) Behavioral Health Clinic - - - - - - - - - 290 290 ED Navigator Project - - - - - - - - - 30 30 Net Surplus (Deficit) 26,708 13,559 13,149 16 (37) 53 2,369 (63) 2,432 (439) 28,654
ADMINISTRATION (Dr. Gilbert) 1. Review of the Standard IEHP Monthly Reports a. Finance Reports 2) Capitation Income and Expense for the Period Ended March 31, 2016 March Year-to-Date Riverside SB Total Riverside SB Total Membership: Medi-Cal 559,203 565,902 1,125,105 4,920,325 5,005,894 9,926,219 Healthy Families - - - - - - Healthy Kids 1,095 34 1,129 8,456 264 8,720 Medicare - - - 3,168 3,172 6,340 CMC 11,047 10,785 21,832 100,337 98,774 199,111 Total Members: 571,345 576,721 1,148,066 5,032,286 5,108,104 10,140,390 Revenue: Medi-Cal 154,880,796 153,707,801 308,588,596 1,325,428,381 1,313,587,059 2,639,015,440 Healthy Families - - - - - - Healthy Kids 87,160 42,023 129,183 689,803 453,975 1,143,778 Medicare 907-907 4,251,664 4,978,452 9,230,116 CMC 23,675,819 20,954,583 44,630,402 181,578,903 176,733,630 358,312,533 Net Revenue: 178,644,682 174,704,406 353,349,088 1,511,948,751 1,495,753,116 3,007,701,867 Medical Costs: Medi-Cal 137,848,760 134,231,518 272,080,279 1,192,777,018 1,173,277,887 2,366,054,906 Healthy Families (19) - (19) (19) - (19) Healthy Kids 100,476 (12,364) 88,112 572,633 440,571 1,013,204 Medicare (4,267) 16,511 12,245 4,643,521 3,501,824 8,145,345 CMC 18,017,842 20,076,092 38,093,934 159,962,848 176,768,045 336,730,893 Total Medical Costs: 155,962,793 154,311,757 310,274,550 1,357,956,001 1,353,988,327 2,711,944,329 Gross Margin: 22,681,889 20,392,649 43,074,538 153,992,750 141,764,789 295,757,539
ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 1) Claims Summary Report (March 2016) Month End March 2016 Inland Empire Health Plan Claims Beginning Claims Claims Claims Claims Ending Category Inventory Received Paid Denied Capitated Inventory Professional IEHP Responsible 10,002 101,608 92,046 4,182 2,320 13,062 IEHP Direct 113,275 276,172 215,235 24,025 29,392 120,795 Per Diem Hospital Contract 471 11,112 10,320 631 2 630 Vision 1,897 20,567 19,218 242-3,004 Pay For Performance (P4P) 1,731 5,624 5,191 524 1 1,639 Mental Health 8,487 21,454 19,606 2,529 121 7,685 Member Reimbursement 6 - - - - 6 Redirected 139 69,655 5,593 61,876 1,933 392 Decaps 62 11 9 - - 64 No Category - - - - - - Professional Subtotal 136,070 506,203 367,218 94,009 33,769 147,277 Institutional IEHP Responsible 11,708 20,737 18,479 895 17 13,054 IEHP Direct 33,069 15,163 12,001 1,235 2,115 32,881 Per Diem Hospital Contract 6,385 93,627 84,379 5,540 6,057 4,036 Vision - - - - - - Pay For Performance (P4P) - - - - - Mental Health 512 284 189 58-549 Member Reimbursement - - - - - - Redirected 3,392 14,681 2,242 12,332 14 3,485 Decaps 17 10 9 1-17 No Category - - - - - - Institutional Subtotal 55,083 144,502 117,299 20,061 8,203 54,022 Total Claims in Diamond 191,153 650,705 484,517 114,070 41,972 201,299
ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 2) Claims Processing Turnaround Time (March 2016) Claim Processing Turnaround Time 1-30 Days 31-45 Days 46-90 Days Over 90 Days Total Professional IEHP Responsible 98,201 273 73 1 98,548 IEHP Direct 268,017 449 172 14 268,652 Per Diem Hospital Contract 10,938 12 3-10,953 Vision 19,413 36 11-19,460 Pay For Performance (P4P) 5,716 - - - 5,716 Mental Health 22,160 48 48-22,256 Member Reimbursement - - - - - Redirected 69,130 204 68-69,402 Decaps 7 2 - - 9 No Category - - - - - Professional Subtotal 493,582 1,024 375 15 494,996 % of Total 99.71% 0.21% 0.08% 0.00% Institutional IEHP Responsible 19,142 187 61 1 19,391 IEHP Direct 15,273 57 21-15,351 Per Diem Hospital Contract 94,988 639 333 16 95,976 Vision - - - - - Pay For Performance (P4P) - - - - - Mental Health 243 3 1-247 Member Reimbursement - - - - - Redirected 14,373 151 56 8 14,588 Decaps 10 - - - 10 No Category - - - - - Institutional Subtotal 144,029 1,037 472 25 145,563 % of Total 98.95% 0.71% 0.32% 0.02% Grand Total 637,611 2,061 847 40 640,559 % of Total 99.54% 0.32% 0.13% 0.01% Month Reporting:03/16 Submitted:04/16
A. ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 3) PCP Member Allocation Report (May 2016) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 30% 47% 46% 47% 44% 45% 44% 47% 57% 52% 51% 67% 70% 53% 54% 53% 56% 55% 56% 53% 43% 48% 49% 33% Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 2015-2016 Member Choice Member Assignment
A. ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 4) Member Services Telephone Activity Report (March 2016) Response Month Actual Time in Call Length Outbound Inbound Calls Abandonment % of Inbound Calls Membership Seconds in Minutes Rate Calls Total Calls Actual Forecast Variance Member Provider Provider Eligibility General April '15 1,069,862 121,551 148,910-27,359 0:15 8:00 1.51% 99.1% 0.5% 0.4% 29,914 151,465 May '15 1,087,833 112,400 128,079-15,679 0:35 8:21 2.84% 99.2% 0.5% 0.3% 29,549 141,949 June '15 1,084,186 121,585 124,727-3,142 0:44 8:45 3.98% 99.2% 0.5% 0.3% 32,422 154,007 July '15 1,091,662 120,658 120,999-341 0:09 8:47 1.14% 99.2% 0.5% 0.3% 39,180 159,838 August '15 1,105,348 121,860 127,276-5,416 0:14 8:44 1.11% 99.3% 0.4% 0.3% 45,102 166,962 September '15 1,121,183 116,846 119,356-2,510 0:34 8:56 2.50% 99.3% 0.4% 0.3% 39,642 156,488 October '15 1,116,567 * 114,285 118,241-3,956 0:23 8:49 1.64% 99.3% 0.4% 0.3% 37,861 152,146 November '15 1,115,005 * 100,867 101,038-171 1:10 9:04 5.38% 99.3% 0.4% 0.3% 34,890 135,757 December '15 1,119,715 * 98,446 104,750-6,304 0:51 8:57 3.95% 99.3% 0.4% 0.3% 38,416 136,862 January '16 1,125,820 * 110,734 114,607-3,873 0:45 8:59 3.16% 99.3% 0.5% 0.2% 36,554 147,288 February '16 1,131,917 111,526 111,808-282 1:06 8:56 4.70% 99.3% 0.4% 0.3% 36,897 148,423 March '16 1,138,467 121,945 123,034-1,089 1:18 8:49 5.36% 99.3% 0.4% 0.3% 42,612 164,557 * 03/15/16: Revised Membership numbers
A. ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 5) Provider Automated Eligibility Contact Report (March 2016) Total Actual IVR WEB Page Spot Check Automated Month Membership Contacts Contacts Contacts Contacts April '15 1,069,862 21,175 1,349,323 167,659 1,538,157 May '15 1,087,833 25,953 1,245,553 251,432 1,522,938 June '15 1,084,186 58,666 1,353,451 961,266 2,373,383 July '15 1,091,662 32,336 1,367,475 429,674 1,829,485 August '15 1,105,348 29,678 1,345,062 260,498 1,635,238 September '15 1,121,183 18,413 1,362,890 304,759 1,686,062 October '15 1,116,567 * 19,655 1,409,574 261,696 1,690,925 November '15 1,115,005 * 28,097 1,322,324 211,151 1,561,572 December '15 1,119,715 * 24,799 1,361,854 208,008 1,594,661 January '16 1,125,820 * 26,665 1,430,855 185,390 1,642,910 February '16 1,131,917 19,627 1,491,924 208,329 1,719,880 March '16 1,138,467 20,111 1,616,310 375,989 2,012,410 * 03/15/16: Revised Membership numbers
A. ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 6) Member Eligibility Verification Report (March 2016 Total: 2,012,410) Inland Empire Health Plan Spot Check 375,989 IVR 20,111 Web Page 1,616,310 IVR Web Page Spot Check
A. ADMINISTRATION (Brad Gilbert, M.D.) 1. Review Of the Standard IEHP Monthly Reports c. Provider Reports 1) IPA Consolidated Membership Report (April 2016) Inland Empire Health Plan Number of Service PCPs Enrollment IPA NAME Areas 04/01/16 * 04/01/16ŧ Inland Empire Health Plan Direct All Areas 525 391,100 Vantage Medical Group All Areas 191 233,380 Inland Faculty Medical Group R1/R4/S1/S2/S3 80 103,461 Kaiser Foundation Health Plan, Inc. R1/S1 N/A 94,804 Alpha Care Medical Group, Inc. R1/R3/R6/S1/S2 134 67,528 LaSalle Medical Associates R1/R2/R4/S1/S2/S3 52 67,474 Inland Valleys IPA All Areas 115 56,777 Physicians Health Network S1 34 31,425 Horizon Valley Medical Group E7/S3 15 15,008 Dignity Health Medical Group - Inland S1 9 11,725 Empire Allied Pacific IPA S2 22 4,394 Regal Medical Group R1/R2/R3/R4/R5/S1/S2/S3 109 897 Desert Oasis E2/R6 53 889 Beaver Medical Group S1 53 802 San Bernardino Medical Group S1 15 563 PrimeCare Medical of Chino Valley S2 35 504 Riverside Medical Clinic R1/R4 28 493 PrimeCare of San Bernardino S1/S2 17 482 PrimeCare of Riverside R1/R4 17 476 Pinnacle Medical Group S1 14 449 PrimeCare of Inland Valley S2 41 426 PrimeCare of Moreno Valley R1/R2 11 426 CPN-Horizon Valley Medical Group E7/S3 13 366 Heritage Victor Valley E7/S3 17 320 PrimeCare of Temecula R5 17 298 PrimeCare of Corona R1/R4 19 286 PrimeCare of Hemet Valley R3 10 280 Dignity Health Physician Network - IE 5 256
A. ADMINISTRATION (Brad Gilbert, M.D.) 1. Review Of the Standard IEHP Monthly Reports c. Provider Reports 1) IPA Consolidated Membership Report (April 2016) (continued.) Inland Empire Health Plan Pomona Valley Medical Group S2 72 239 PrimeCare of Citrus Valley R4 11 190 PrimeCare of Sun City R5 10 175 Redlands Yucaipa Medical group S1 11 131 Alliance Desert Physicians S3 6 106 PrimeCare of Redlands S1 5 92 Valley Physicians Network R5 8 77 Tri Valley Medical Group R5 6 60 Chaffey Medical Group S2 9 22 Totals: 1,789 1,086,381 Due to timing issues, these figures may not exactly reflect figures used for capitation * = Total number of non-terminated unique PCPs per IPA ŧ = Excludes Medi-Medi and Open Access Enrollment.
IPA GEOGRAPHIC SERVICE AREAS R1 R2 R3 R4 R5 R6 S1 S2 S3 Riverside Proper Mira Loma, Riverside, Nuevo, Perris, Moreno Valley The Pass Banning, Beaumont, Cabazon, Calimesa Hemet Region Idyllwild, Hemet, Homeland, Mountain Center, San Jacinto, Winchester Corona Region Corona, Norco Temecula Region Aguaga, Anza, Canyon Lake, Lake Elsinore, Menifee, Murrieta, Sun City, Temecula, Wildomar Low Desert Cathedral City, Coachella, Desert Hot Springs, Indian Wells, Indio, La Quinta, Mecca, North Palm Springs, Palm Desert, Palm Springs, Rancho Mirage, Thermal, Thousand Palms, Whitewater San Bernardino Proper Bloomington, Colton, Fontana, Grand Terrace, Highland, Patton, Rialto, San Bernardino, Bryn Mawr, Crafton, Loma Linda, Mentone, Redlands, Yucaipa West End San Bernardino Alta Loma, Chino, Chino Hills, Etiwanda, Guasti, Montclair, Ontario, Pomona, Rancho Cucamonga, Upland High Desert Adelanto, Apple Valley, Hesperia, Lucerne Valley, Oro Grande, Phelan, Pinon Hills, Victorville
IPA GEOGRAPHIC SERVICE AREAS (Excluded Areas) Inland Empire Health Plan E1 Blythe Blythe, Ripley, Desert Center, Mesa Verde, Ehrenberg, Eagle Mountain E2* Yucca\Morongo Valley Amboy, Cadiz, Landers, Joshua Tree, Moronga Valley, Marine Corp Base, Pioneer Town, Twenty-nine Palms, Yucca Valley, Wonder Valley, Rimrock E3* Mountains Angelus Oak, Big Bear City, Big Bear Lake, Blue Jay, Cedar Glen, Cedarpines Park, Crestline, Crest Park, Phelan, Fawnskin, Forest Falls, Green Valley Lake, Lake Arrowhead, Rimforest, Running Springs, Sky Forest, Sugar Loaf, Twin Peaks E4 Needles\Laughlin Cima, Essex, Kelso, Needles, Nipton, Mountain Pass E5 Ridgecrest Johannesberg, Randsburg, Ridgecrest, Red Mountain, Trona E6 Colorado River Big River, Parker Dam E7* Barstow Baker, Barstow, Daggett, Fort Irwin, Hinkley, Ludlow, Yermo, Newberry Springs, Desert Center, Lenwood, Helendale * Active Membership in these areas
A. ADMINISTRATION (Brad Gilbert, M.D.) c. Provider Reports 2) Hospital Consolidated Membership Report (April 2016) Number of PCPs Enrollment HOSPITAL NAME 04/01/16 04/01/16 ŧ Dignity Health Community Hospital of San Bernardino 122 St. Bernardine Medical Center 84 79,122 62,899 Subtotal: 206 142,021 Physicians For Healthy Hospitals Hemet Valley Medical Center 55 46,801 Subtotal: 55 46,801 Prime Healthcare Services Montclair Hospital Medical Center 62 Chino Valley Medical Center 2 24,869 98 Subtotal: 64 24,967 Tenet HealthCare Corporation John F. Kennedy Memorial Hospital 61 Desert Regional Medical Center 53 55,476 35,279 Subtotal: 114 90,755 Universal Health Systems, Inc Rancho Springs Medical Center 52 53,934 Corona Regional Medical Center 63 40,226 Inland Valley Regional Medical Center 24 14,828 Subtotal: 139 108,988 Victor Valley Global Medical Center 101 101,158 Kaiser Fontana/Riverside N/A 94,804 Pomona Valley Hospital Medical Center 285 90,022 Arrowhead Regional Medical Center 73 78,015 Riverside County Regional Medical Center 72 69,302
5 A. ADMINISTRATION (Brad Gilbert, M.D.) c. Provider Reports 2) Hospital Consolidated Membership Report (April 2016) (continued..) Number of PCPs Enrollment HOSPITAL NAME 04/01/16 04/01/16 ŧ Riverside Community Hospital 91 66,014 Parkview Community Hospital Medical Center 101 58,394 Eisenhower Medical Center 36 23,850 Redlands Community Hospital 21 16,126 Loma Linda Children Hospital 19 15,819 San Gorgonio Memorial Hospital 17 15,363 St. Mary Medical Center 11 13,729 Barstow Community Hospital 7 5,709 Mountains Community Hospital 8 1,308 Subtotal: 842 649,613 Total: 1,420 1,063,145 Due to timing issues, these figures may not exactly reflect figures used for capitation PCP totals deviate from IPA report totals due to multiple hospital affiliations ŧ = Excludes Medi-Medi, Medicare and Open Access Members
I Inland Empire Health Plan A. ADMINISTRATION (Brad Gilbert, M.D.) c. Provider Reports 3) New Enrollment Trend Report By Consolidated IPA (April 2016) Average Defaulted Member Analysis Healthy Kids New Members New Member Family Auto Family New Medicare Per IPA Name Members Choice Link Assign Assign Members Members PCP Horizon Valley Medical Group 429 97 137 157 38 0 0 36 Inland Faculty Medical Group 2,572 805 699 824 241 3 0 33 Dignity Health Medical Group - 284 129 81 57 17 0 0 32 Inland Empire Vantage Medical Group 4,930 1,935 1,237 1,278 477 3 0 27 LaSalle Medical Associates 1,264 493 355 311 105 0 0 25 Alpha Care Medical Group 2,423 734 786 791 112 0 0 20 Physicians Health Network 678 280 159 199 40 0 0 20 Inland Valleys IPA 1,897 576 626 537 101 0 57 17 Inland Empire Health Plan Direct 8,708 3,340 916 3,381 666 0 405 13 Allied Pacific IPA 210 62 71 70 7 0 0 11 CPN-Horizon Valley Medical Group 25 5 0 3 0 0 17 2 PrimeCare of Hemet Valley 15 5 0 1 0 0 9 2 PrimeCare of Moreno Valley 17 4 0 2 0 0 11 2 PrimeCare of San Bernardino 24 6 0 1 0 0 17 2 Alliance Desert Physicians 5 1 0 1 0 0 3 1 Desert Oasis 28 6 0 3 0 0 19 1 Pinnacle Medical Group 15 5 0 0 0 0 10 1 PrimeCare of Riverside 15 4 0 0 0 0 11 1 New
A. ADMINISTRATION (Brad Gilbert, M.D.) c. Provider Reports 3) New Enrollment Trend Report By Consolidated IPA (April 2016) (continued..) Average Defaulted Member I Inland Empire Health Plan Analysis Healthy Kids New Members New Member Family Auto Family New Medicare Per IPA Name Members Choice Link Assign Assign Members Members PCP Redlands Yucaipa Medical group 8 2 0 1 0 0 5 1 Riverside Medical Clinic 17 1 0 0 0 0 16 1 San Bernardino Medical Group 16 5 0 0 0 0 11 1 Valley Physicians Network 7 1 0 1 0 0 5 1 Beaver Medical Group 13 3 0 1 0 0 9 0 Chaffey Medical Group 0 0 0 0 0 0 0 0 Dignity Health Physician Network - IE 0 0 0 0 0 0 0 0 Heritage Victor Valley 7 1 0 0 0 0 6 0 Pomona Valley Medical Group 7 2 0 0 0 0 5 0 PrimeCare Medical of Chino Valley 16 3 0 1 0 0 12 0 PrimeCare of Citrus Valley 4 1 0 0 0 0 3 0 PrimeCare of Corona 6 1 0 0 0 0 5 0 PrimeCare of Inland Valley 15 6 0 0 0 0 9 0 PrimeCare of Redlands 0 0 0 0 0 0 0 0 PrimeCare of Sun City 5 2 0 0 0 0 3 0 PrimeCare of Temecula 0 0 0 0 0 0 0 0 Regal Medical Group 41 13 0 1 0 0 27 0 Tri Valley Medical Group 2 1 0 0 0 0 1 0 Total: 23,703 8,529 5,067 7,621 1,804 6 676 13 New
A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 1) All Medi-Cal Aid Codes Enrollment Report (April 2016) Month IEHP* Percent of IEHP Molina* Percent of Molina Total Enrolled Recipients** Jul 2015 1,068,957 68.1% 167,521 10.7% 1,570,000 Aug 2015 1,082,517 69.0% 168,646 10.7% 1,570,000 Sep 2015 1,098,536 70.0% 169,924 10.8% 1,570,000 Oct 2015 1,093,795 69.7% 168,022 10.7% 1,570,000 Nov 2015 1,091,933 69.5% 166,826 10.6% 1,570,000 Dec 2015 1,096,927 69.9% 166,502 10.6% 1,570,000 Jan 2016 1,102,803 70.2% 166,051 10.6% 1,570,000 Feb 2016 1,109,240 70.7% 166,496 10.6% 1,570,000 Mar 2016 1,116,004 71.1% 165,884 10.6% 1,570,000 Apr 2016 1,121,492 71.4% 164,811 10.5% 1,570,000 Sources: * http://www.dhcs.ca.gov - HCO Monthly Plan Enrollment Status Reports (COPS-25) ** http://www.dhcs.ca.gov - Medi-Cal Beneficiary Counts Pivot Table, County, May 2015
A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 2) Medi-Cal Mandatory - Families Aid Codes Enrollment Report (April 2016) Inland Empire Health Plan Month IEHP* % of IEHP Molina** % of Molina Mandatory in FFS & Excluded Zips % of Mandatory in FFS & Excluded Zips Total Families Mandatory Recipients*** Aug 2015 709,883 60.9% 154,612 13.3% 301,505 25.9% 1,166,000 Sep 2015 722,037 61.9% 155,929 13.4% 288,034 24.7% 1,166,000 Oct 2015 713,021 61.2% 154,161 13.2% 298,818 25.6% 1,166,000 Nov 2015 710,525 60.9% 153,077 13.1% 302,398 25.9% 1,166,000 Dec 2015 709,255 60.8% 152,838 13.1% 303,907 26.1% 1,166,000 Jan 2016 711,387 61.0% 152,476 13.1% 302,137 25.9% 1,166,000 Feb 2016 715,700 61.4% 152,981 13.1% 297,319 25.5% 1,166,000 Mar 2016 718,277 61.6% 152,461 13.1% 295,262 25.3% 1,166,000 Apr 2016 719,053 61.7% 151,492 13.0% 295,455 25.3% 1,166,000 Sources: * IEHP's Marketing Management Report #1 - Data as of 15th of the month ** http://www.dhcs.ca.gov - HCO Monthly Plan Enrollment Status Reports (COPS-25) / Total enrollment less 3% estimated non-mandatory population and less estimated Mandatory SPD. *** http://www.dhcs.ca.gov - Projections based on Medi-Cal Beneficiary Counts Pivot Table, county-level and state-level data, May 2015.
A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 3) Medi-Cal Mandatory Seniors & Persons with Disabilities (SPD)Aid Codes Enrollment Report (April 2016) Month IEHP* %IEHP Molina** %Molina Mandatory in FFS & Excluded Zips % of Mandatory in FFS & Excluded Zips Total SPD Mandatory Recipients*** Jul 2015 62,241 57.6% 9,053 8.4% 36,706 34.0% 108,000 Aug 2015 60,881 56.4% 8,975 8.3% 38,144 35.3% 108,000 Sep 2015 63,863 59.1% 8,897 8.2% 35,240 32.6% 108,000 Oct 2015 60,988 56.5% 8,820 8.2% 38,192 35.4% 108,000 Nov 2015 60,945 56.4% 8,744 8.1% 38,311 35.5% 108,000 Dec 2015 60,939 56.4% 8,669 8.0% 38,392 35.5% 108,000 Jan 2016 60,928 56.4% 8,594 8.0% 38,478 35.6% 108,000 Feb 2016 61,039 56.5% 8,520 7.9% 38,441 35.6% 108,000 Mar 2016 61,057 56.5% 8,447 7.8% 38,496 35.6% 108,000 Apr 2016 61,020 56.5% 8,374 7.8% 38,606 35.7% 108,000 Sources: * IEHP's Marketing Management Report #1 - Data as of 15th of the month ** 2% annual growth rate for enrollment starting July 2013 - June 2014. *** http://www.dhcs.ca.gov - Projections based on Medi-Cal Beneficiary Counts Pivot Table, county-level and state-level data, May 2015.
A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 4) IEHP s Medi-Cal Non-Mandatory Aid Codes Enrollment Report (April 2016) Inland Empire Health Plan Month Medi-Medi's* Foster Children* Others* Total IEHP Non-Mandatory Total Non- Mandatory** Percent of IEHP Jul 2015 48,065 9,749 3,411 61,225 168,000 36.4% Aug 2015 47,981 9,761 3,125 60,867 168,000 36.2% Sep 2015 48,400 7,239 2,676 58,315 168,000 34.7% Oct 2015 48,007 9,944 2,702 60,653 168,000 36.1% Nov 2015 47,619 9,724 2,498 59,841 168,000 35.6% Dec 2015 47,527 9,953 2,405 59,885 168,000 35.6% Jan 2016 48,503 10,073 2,388 60,964 168,000 36.3% Feb 2016 48,462 10,128 2,859 61,449 168,000 36.6% Mar 2016 48,460 10,349 2,429 61,238 168,000 36.5% Apr 2016 48,434 9,684 2,867 60,985 168,000 36.3% Sources: * IEHP's Marketing Management Report #1 - Data as of 15th of the month ** http://www.dhcs.ca.gov - Projections based on Medi-Cal Beneficiary Counts Pivot Table, county-level and state-level data, May 2015. *** Excluded Medi-Medis who are enrolled in IEHP Medicare DualChoice.
A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 5) IEHP s Medi-Cal Expansion Aid Codes Enrollment Report (April 2016) Month LIHP Transition (L1) Medi-Cal Expansion Adults (M1 & 7U) Total IEHP Medi-Cal Expansion Jul 2015 28,306 225,966 254,272 Aug 2015 28,307 233,966 262,273 Sep 2015 18,127 250,039 268,166 Oct 2015 19,795 257,229 277,024 Nov 2015 17,368 264,423 281,791 Dec 2015 15,807 270,122 285,929 Jan 2016 14,645 275,755 290,400 Feb 2016 12,362 278,111 290,473 Mar 2016 12,363 282,026 294,389 Apr 2016 9,423 293,486 302,909 Source: IEHP's Marketing Management Report #1 - Data as of 15th of the month Note: Members with L1 aid code will be transitioned to M1 at their annual eligibility redetermination.
A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 6) IEHP s Healthy Kids Program Enrollment Report (April 2016) Month Enrollment in Riverside Enrollment in San Bernardino Total Enrollment Total Funded Eligibles Percent of Enrollment Jul 2015 711 28 739 1,230 60.1% Aug 2015 699 24 723 1,230 58.8% Sep 2015 756 29 785 1,230 63.8% Oct 2015 905 29 934 1,231 75.9% Nov 2015 993 28 1,021 1,232 82.9% Dec 2015 1,045 29 1,074 1,230 87.3% Jan 2016 1,086 28 1,114 1,231 90.5% Feb 2016 1,101 29 1,130 1,230 91.9% Mar 2016 1,094 31 1,125 1,230 91.5% Apr 2016 1,086 31 1,117 1,230 90.8% Source: IEHP's Marketing Management Report #1 - Data as of 15th of the month
A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 7) IEHP Medicare Enrollment Report (April 2016) Month D-SNP Medicare Members Cal MediConnect Medicare Members TOTAL MEDICARE MEMBERS Jul 2015 1,143 22,425 23,568 Aug 2015 1,135 22,490 23,625 Sep 2015 1,113 22,280 23,393 Oct 2015 1,099 22,350 23,449 Nov 2015 955 22,217 23,172 Dec 2015 912 22,062 22,974 Jan 2016 0 21,815 21,815 Feb 2016 0 21,811 21,811 Mar 2016 0 21,833 21,833 Apr 2016 0 21,688 21,688 Source: IEHP's Marketing Management Report #1 - Data as of 15th of the month