The IEHP DualChoice population is composed of individuals who are dual eligible for both Medicare and Medi-Cal in Riverside and San Bernardino counties, including the most vulnerable population. This also includes members transitioning from IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan).

IEHP has identified the most vulnerable as the following:

Age 21-70

Identified as High and Rising Risk

Diagnosed with Cardiovascular Disease AND/OR Diabetes

RUB Score of 4 & 5. *RUB is Resource Utilization Band which is a predictor of using acute or costly services.

IEHP will identify the most vulnerable members assigned to IPAs

IEHP and its IPAs must design care management specific interventions to demonstrate how they support these member's health and wellness goals.

Examples of Specially Tailored Services for the Most Vulnerable Population

Remote Patient Monitoring

Medically Tailored Meals and Other Community Supports

Nutrition Education

Pharmacy Services (medication reconciliation and other programs)

Long-Term Services and Supports (LTSS)

Telehealth Behavioral Health Services

Transportation

More frequent care management contact

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:

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You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.