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Copy - Medi-Cal Member Pipeline

Leidy Lopez

Created on November 5, 2024

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Transcript

Acquiringnew Members

Awareness

Acquiring new members to serve is the key to fulfilling your mission and vision through serving your community members, and to a more sustainable CHW program.

Necessary to establish systems
The CHW needs to create connections
Active

Leads into "Passive"

Two main methods

Network

Information

Simple, but is based on assumptions
LPs/Providers send members to you
Passive

Generic

Connections

CHW conducts outreach in their community

CHW shares about Medi-Cal benefits

Member connects to their/your LP

"Expected"

Active

Outreach

CBO shares about own Medi-Cal services

CBO builds relationship with LPs and other Providers

Share forms and Health Plan information

"Expected/Collab"

Advocacy

Acquiring new members

Member takes form to you, theirCHW/CBO

Physician recommends member for CHW services

Medi-Cal member sees physician for health care

CHW services

Passive

Expected

Medi-Cal member sees physician for health care

Physician recommends member for CHW services

Member takes form to anotherCHW/CBO

Their CHW refers to you

Collaboration

QI Campaigns

A unique opportunity

Some members fall off the grid and need extra support to get connected to their PCP - closing care gaps. At the same time can access CHW and all 14 CS services. HealthNet's QI team has a "chase list" of members needing support, sorted by area. Recommendation is already provided by QI's LP. Determine why care gaps were not closed.

  • 3 contact attemps - min. 2 telephonetically.
  • Secure File Transfer Protocol.
  • Document referrals and outcomes.
  • Connect member to PCP.