South Florida Hospital News
Saturday August 8, 2020

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December 2018 - Volume 15 - Issue 6


A Talk with Community Care Plan President and CEO

Putting Heart in Health Care Plans

If you think this is an article about claims submissions and denials, data entry instructions, provider contracts, fee schedules, patient codes, federal regulations or DME documentation from a Provider Service Network (PSN) … wipe that yawn off your face and read on.
True, Community Care Plan (CCP) has earned the highest accolades in quality of care indicators for the last two years, which means they meet or exceed all the regulations guiding the operational nuts and bolts of care and coverage; however according to Jessica Lerner, newly minted President and CEO, this is really a story about the health plan with a heart.
It’s a compilation of more than 180 employees who care for 100,000 members as if each individual was their only patient. The Plan offers an excellent choice of physicians who cover a wide range of health and medical services but additionally more than 50 community agencies partner with the health plan to identify and resolve related challenges of caring for a Medicaid and self-insured population across a large geographic footprint.
Lerner recognizes that social determinants can negatively impact how compliant patients are with preventive health guidelines.
“If you are homeless or wondering how you are going to feed your children tonight, your primary focus is not going to be on getting a mammography or visiting your primary care physician,” Lerner explained. “Accordingly, our case workers reach out to food pantries, and social service agencies to collaborate on assisting members with food, shelter, transportation or rent issues.”
Obviously, when a parent’s health deteriorates, it can set off a family domino effect that this community collaboration aims to head off.
Technology has enabled CCP to be agile and efficient in meeting health care needs before members end up in an emergency room in crisis mode. Within one business day of joining, each new CCP member is contacted by the Call Center Concierge to describe member benefits and how to navigate access to them. This initial phone conversation also establishes a health profile outlining their current and potential needs
“From the moment a member joins we start compiling their health profile in our proprietary enterprise data warehouse. This allows us real time access to target and monitor preventive and therapeutic health visits. Real time information also gives us leverage to connect with partners and clear obstacles or solve problems that may be barriers to health care access,” Lerner said.
According to Lerner, the immediacy of technology increases efficiency, controls costs in the long term, and contributes to healthy lifestyles. The physical location of call center, case workers and all employees under one roof, also gives a jump start on identifying barriers and providing solutions before a serious health crisis.
“We eliminate bureaucracy by having decision-makers on hand to keep us agile and supportive to our members,” Lerner said.
For example, our social work staff recently intervened to address a suicidal/homicidal concern during a routine follow-up call to a member to discuss resources recently provided to help the financial needs of her family. During the call, the member revealed that she was having suicidal/homicidal thoughts due to increased financial pressure and worry about her grandmother’s health issues. The social worker immediately dialed 911 to send assistance during that encounter to avert a tragedy, while another social worker kept the member engaged on the telephone until help arrived.
Because the organization grew out of Memorial Healthcare and Broward Health Systems, many employees were already rooted in the mission … to positively impact the health and welfare of the community.
Examples of going the extra mile abound. Another employee took extraordinary measures to ensure that a child with significant medical complexities could spend the Christmas holidays at home with family. That meant the case worker coordinated with home health aides, the skilled nursing facility, transportation specialists, and the parents to be certain that all health needs were considered. In fact, she even made a personal Christmas Eve visit to confirm that the holiday stay would be without any medical incidents.
“That’s truly the essence of our mission,” Lerner said.
Lerner has been associated with CCP since its inception in 2000 as the first safety-net, hospital-owned Provider Service Network (PSN). She played a major role in CCP operations and was promoted to Executive Vice President and Chief Operating Officer in 2016. Prior to joining CCP, Lerner served as Executive Director for Memorial Integrated Health for more than 19 years, where she spearheaded various health plan initiatives. Lerner received a bachelor’s degree in marketing and management from Florida International University’s College of Business, and a Master of Health Care Administration Degree from Florida Atlantic University. She also serves on the Board of Trustbridge Hospice Foundation and the Association of Community Affiliated Plans. Future plans are to share CCP’s unique experiential knowledge and culture with colleagues to expand the footprint of care to benefit members.
Community Care Plan, the health plan with a heart, serves members enrolled in Medicaid, Children’s Medical Services Network, and self-insured employee health plans. Headquartered in Sunrise, Florida, Community Care Plan is a partnership owned by Broward Health and Memorial Healthcare System. Plans offer an excellent choice of physicians who cover a wide range of health and medical services, and a variety of benefits that help enrollees get and stay healthy. The non-profit organization is fully accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) as a Health Plan.

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