Brand New Day HMO: 2019

Prime Partner

Provider Brand New Day (H0838) – Consumer Keith Torkelson

Figure - Feature Image(s) – Image(s) Up Front

Dedicated to:

Rimal Bera MD – Bum Soo Lee MD – Chester D Mojica MD – Ravinder P Singh MD – Annie Nguyen MD – Ahnika S Kline MD, PhD

In Memory Of

Brand New Day Clients

Douglas Keith – Sam I Am – “Lee”

MIA Clayton Covey

Blogger Post Name

201911 - Brand New Day Complaint Escalated to CMS-Medicare by and for Keith Torkelson MS (Consumer)

Primary Source Document

Medicare_QA_14042303_CMS_BND_Complaint V2019

Partners

Abstract - Executive Summary

Objective Up Front - BND CMS Stars 2019

We here at Mentalation Solutions Group (MSG) with the help of our principal, Keith “Buster” Torkelson, are writing to address a few of Buster’s Medicare Advantage Plan (MAP) shortfalls. The plan is Buster’s HMO Special Needs Plan (SNP) Brand New Day (H0838). For 2019 Centers for Medicare & Medicaid Services (CMS) Medicare awarded Brand New Day (BND) 3.0 CMS Stars overall and 3.0 CMS Stars for Health Plan Services.

BND Rewards Program - Promises

In years past Buster and MSG have suggested to Brand New Day to offer non-monetary compensation for our members’ participation. New this year (2019) in BND’s Newsletter as well as via direct mail BND introduced to Keith “Buster” Torkelson (B. 3/29/1959) their new and improved Rewards schedule. After about one or two Reward Incentive Gift Cards the rewards promised stopped coming.

Contact Effectiveness 0/3

Over this matter we contacted three (3) different groups: Brand New Day (BND), HICAP, and CMS-Medicare. Our Contact Effectiveness Grade (CEG) across all three as of November 19, 2019 (TU) is Fail.

20191119-TU: Rewards Outstanding

As of November 19, 2019 (TU) we have two (2) and most likely three (3) outstanding Reward Incentive Gift Cards (RIGCs). Brand New Day promised the following Rewards: Colonoscopy = $25 Gift Card; Physical Exam = $50 Gift Card; and Annual Fitness Plan = $10 Gift Card. We followed through with the Brand New Day Complaint Process (BNDCP) to little avail. We request that CMS-Medicare help us get our Rewards as BND promised (attachment).

Medical Transportation Complaint (MTC)

We here at MSG had made some headway with our separate Medical Transportation Complaint (MTC). In a formal letter (attached) BND said let them have 30 days or so to finalize their position. Our closure letter never came thus our MTC is still outstanding.

CMS Qualifying Complaint - Quality Of Care Evaluation (QOC-16 Items)

For this study we adapted material in the literature (including CMS literature) while creating a 16 Item Complaint Qualifying Tool (CQT). For 2019 we awarded BND 3.1 Star Equivalents about our Quality Of Care. As we indicated earlier BND is facing some shortfalls on delivering what they promise.

Attachments – Approximately Five (5)

For sharing our in scope evidence (attachments) is one of the main reasons we prefer sending a hard copy by US Mail. For the issues outlined here we have selected and include approximately five (5) attachments. For the blog version we embed some of the attachments in the report body.

Reconciliation – 15 Entries

We here at Mentalation Solutions Group (MSG) have been working with our new and improve reconciliation product. Our plan complaint reconciliation includes fifteen entries. We have determined that the strength of this CMS-Medicare grievance is Above Average.

Number of CMS Addresses = 4

For various in house reasons we prefer mailing hard copy documentation directly to the target. CMS offers an online method yet it is limited in options, space and value. We can’t locate the address that we used successfully to correspond with CMS in the past. During the course of this investigation we have been provided four (4) different CMS-Medicare addresses. We have three (3) routes to deliver this report: Hardcopy mailed to the address that we think should work, a brief version for sending electronically online via CMS-Medicare’s website, and a version for the general public using one or more of MSG’s Blogs.

Complaint Analysis (8 Items) – Quality Of Care Revisited

We here at MSG derived an eight (8) item screening tool to capture features about the CMS criterion Quality Of Care (QOC). For the most part Brand New Day (BND) delivers their product at or near their 2019 CMS Stars Score. Again, for 2019 CMS awarded BND an Overall Stars Score (OSS) of 3.0 with 5.0 being most superior. We find that about the features of this complaint BND scores 40% for QOC. We award them 2.0 Star Equivalents.

Cast of Character Performance (10 Plus)

About the medical transportation and reward issues we enlisted including ourselves more than ten (10) persons. To capture our team’s performance we created a tally tool about the primary people. As a team we earned 44.4% about our Formative Complaint Resolution Score (FCRS). Now that we are asking CMS for help we expect the final team score to improve. Once again we include Buster on the team. His awesome performance cannot offset all the subpar players.

All time (2012-present) Complaint incidences = 17

Buster signed on with Brand New Day (BND) back in 2012. The Buster/BND partnership has been in effect for just over seven (7) years. Since 2012 Buster has had approximately 17 Complaint Incidences. BND corporate has sent Buster at least 2 letters in which BND indicates his input is meaningful.

Could be worse

This time around it could be worse. The rewards complaints are medium weight. The medical transportation complaint is medium to high weight. We find that medication management complaints carry with them substantial risk and thus we give them high weight. Thank goodness that we don’t have a medication management complaint at this time around. Overall we are grateful to have Brand New Day help us out. During the interval 2012-2019 we have called upon CMS to help us out twice. Both times CMS delivered what we needed. At least once CMS put us to work filling out and submitting their CMS Complaint Resolution Survey.

[INSERT REWARDS PAGE]

List – Tables – Matrices – Special Topics

Objective First – Provider CMS Star Scores 2019

Table - Contact Information

Table - Summary of Presenting Problems/Concerns/Complaints

Matrix – Summary – Subjective COC

List – Attachments

Table - Grievance (Concern) – Summary Material from Literature

Table - Resource Issues

Method - Table – CMS Complaint – STR

Special Topic - Intervention – Asking for Help

Table - You have a complaint about…

Table - Introducing - Cast Of Characters – Promise Cohort

List – Complaints – All Time

Table - Impact of Settling Complaint – Complaint Value Score (CVS)

Objective First – Provider CMS Star Scores 2019

Provider Brand New Day (H0838) – Consumer Keith Torkelson

[PDF] - 2019 Star Ratings Marketing Template - Brand New Day

https://bndhmo.com/getattachment/Members/Plan-Resources/2019_STAR-Ratings_EN.pdf.aspx?lang=en-US

“For 2019, Brand New Day received the following Overall Star Rating from Medicare. We received the following Summary Star Rating for Brand New Day's health/drug plan services”

You've visited this page 3 times. Last visit: 9/10/19

Table - Contact Information

-
Agency Name	Resource	Phone #	Result
-
Brand New Day	Health Plan Provider	866-255-4795	Ineffective
Medicare	Federal Government Program (Insurer)	800-633-4227	Ineffective
HICAP	Counseling & Advocacy	800-434-0222	Ineffective
-

Last Reviewed: 20191119-TU:

20191118-M: Call Medicare

On this day Buster explained to the Medicare Phone Support Technician (MPST) that we needed the correct Medicare Address to send our Complaint to. The phone tech engages her researcher(s). After one half (1/2) hour no viable address was provided. Our need was not settled with this transaction. Medicare phone support needs improvement. The tech doesn’t understand CMS’s position in the public health hierarchy. She tried to convince us that the complaint is to be directed at our provider. We stated that we had already exhausted the direct approach with our health plan provider. She also tried to convince us not to complain. We told her we would continue with the direction that we are going.

FYI - HICAP Health Insurance Counseling & Advocacy Program

Non-profit organization in Irvine, California

Address: 2 Executive Cir #175, Irvine, CA 92614

Hours: Open ⋅ Closes 4PM

Phone: (714) 560-0424

Program Manager Linda Cardoza

(714) 560-0424

lcardoza@coasc.org

Hours Monday – Friday, 8 to 4

Hard Copy Report Review

It is very likely we will make the effort and visit HICAP for us and them to review the final report before we mail it off. There is a chance that Buster can teach them some things as well as HICAP teach us.

Problems Second - Table - Summary of Presenting Problems/Concerns/Complaints

All Entries as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Provider Brand New Day (H0838)

-
Item	Note	Detail (RV)	What we want?
-
Medical Transportation	Response still pending		Closure letter as promised
Rewards in General	Keeping Promises		All promises kept
FOTB	Lack of situational awareness	Tried to schedule me 3 times in one year	OK Brand New Day to coordinate better with PCP
Colonoscopy	Complete June 4, 2019	RV $25 Reward Pending	$25 Incentive Gift Card
Physical AKA Annual Wellness Exam	PCP said it has been done for 2019	RV $50 Reward Pending	$50 Incentive Gift Card
Annual Exercise Plan AKA Physical Fitness Plan	No-one wants to take responsibility for setting us up	RV $10	$10 Incentive Gift Card
Fitness Benefit	2019 Satisfied		Nothing we are satisfied with this promise
Health Information Transfers/Exchanges	2018-2019 Manual Transfers	Example Colonoscopy	PCP might perfect his Electronic Health prowess
Unneeded Expense	Flu Vaccine	Better grouped with prior CBC appointment	If appointment items due in one month try to group them
Outstanding Complaint
-

Last Update: 20191102-SAT: RV = Reward (Incentive) Value

Subjective Third - Quality Of Care (COC) Complaints

Matrix – Summary – Subjective COC

All Scores as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Provider Brand New Day (H0838)

-
	CMS Qualifying Complaint	2012-2018 Ever	2019
-
	Part A	7.00/10	4.00/10
	Part B	3.00/6	2.00/6
-
	SUM CALC	10.00/16	6.00/16
	Quality Of Care Score (QOCS) = Low scores are favorable	62.5	37.5

	QOCS Reciprocal =	37.5	62.5
	Star Equivalents (SEs) =	1.9	3.1
	Program CMS Stars for 2019 = Brand New Day H0838 Overall Stars Rating =		3.0
-

Date Calculated: 20191101-F:

Improvement

Right of-the-cuff we here at MSG had the impression that Brand New Day and its’ subcontractors were improving. Yet after tabulating our data and findings we determine: That BND across several domains of performance earns at best 3.0 Star Equivalents for Quality Of Care (QOC).

Matrix – Subjective Quality Of Care COC – Part A

Primary Players – BND & Chester D Mojica MD (PCP)

Quality Of Care Complaints could include: [COMPLAINTS ABOUT]

All Scores as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Plan - Brand New Day (H0838)

-
##	CMS Qualifying Complaint	2012-2018 Ever	2012-2018	2019	2019
-
01	Drug errors	Yes	1.00	Yes	1.00
02	Unnecessary or inappropriate surgery	No	0.00	No
03	Unnecessary or inappropriate treatment	Multiple Invega	1.00	SoSo	0.50
04	Not getting treatment after your condition changed	SoSo	1.00	No	0.00
05	Getting discharged from the hospital too soon	Yes	1.00	No	0.00
06	Incomplete discharge instructions and/or arrangements	Forte	0.00	Not Confident	1.00
07	Your health plan	Yes	1.00	SoSo	0.50
08	Your drug plan	OK	0.00	OK	0.00
09	Customer service	Yes	1.00	Yes	1.00
10	Access to specialists	Yes	1.00	Forte	0.00
-
	Part A Carry		7.00/10		4.00/10
-

Last Reviewed: 20191119-TU:

Note – “Contact your Quality Improvement Organization (QIO) for complaints about the quality of care you got from a Medicare provider”.

Matrix – Subjective Quality Of Care COC – Part B

Primary Players – BND & Chester D Mojica MD (PCP)

Quality Of Care Complaints could include: [COMPLAINTS ABOUT]

All Scores as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Plan - Brand New Day (H0838)

-
##	CMS Qualifying Complaint	2012-2018 Ever	2012-2018	2019	2019
-
11	Improper care	Multiple	1.00	SoSo	0.50
12	Unsafe Conditions	Yes	1.00	SoSo	0.50
13	Hospital conditions	No	0.00	No	0.00
14	Your doctor	Yes	1.00	Yes	1.00
15	Home health agencies	No	0.00	No	0.00
16 (6)	Kidney care	No	0.00	No	0.00
-
	Part B Carry		3.00/6		2.00/6
-

Last Reviewed: 20191119-TU:

FYI - Note

“For questions about a specific service you got, look at your Medicare Summary Notice (MSN) or go to MyMedicare.gov. If you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan, you can file an appeal.”

MSN Related – Invoicing

Our Primary Care Provider, Chester D Mojica MD, never invoices us. He has been just one weak link in the Brand New Day Plan (BNDP) Rewards process. We have no way of really knowing for sure what services were rendered and billed. The only Summary Notice we receive is a monthly accounting of prescription drug costs.

List – Attachments – Support Materials

All Entries as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Provider Brand New Day (H0838)

Pertinent Documents

-
Date If Known	Attachment Description	Note
-
Dated December 10, 2018	Brand New Day (BND) Medical Transportation	Offering Letter Corporate
-
Received by mail May 22, 2019	Reward Plus Program Specifications/Requirements	Offering Letter Corporate
May 28, 2019	Colonoscopy Instruction Transportation Requirement
Received by mail August, 26, 2019	The Healthy Habit Summer Newsletter 2019	H0838_1179.BNDNewsLtr.190711_C
Received by hand June 4, 2019	Colonoscopy Report – 2 Pages (HIT)	Hand delivered to referring physician’s office (CDM)
Dated July 2, 2019	Medical Transportation Letter	Promise to close issue within 30 days of June 28, 2019
Online November 3, 2019	BND Stars Score 2019	Objective Performance Measure
-
	-

DIK – Date If Known

Fitness Plan Promise

“Brand New Day members can receive a once a year Physical Fitness Plan, to help set up a fitness routine that works for you. Plus, all members have a fitness benefit to gyms and fitness centers they can join in their neighborhood at no cost.” As of November 19, 2019 Buster has yet to receive his 2019 Physical Fitness Plan.

Associated Documents

Resources_BND_Rewards_Program_Context_19072705_CDM

Assess_Vitals_18092704_CDM_Physical V2019

Fecal & Colonoscopy

11_BND_9.5.1_Fecal_FOBT_17110101_Notes V2019

Health Plan Rewards Promise

Table - Grievance (Concern) – Summary Material from Literature

Provider Brand New Day (H0838) – Consumer Keith Torkelson

-
Aspect	Note	Detail
-
Operation	The fact or condition of functioning or being active	SoSo
Activities	A thing that a person or group does or has done	Issue
Behavior	The way in which one acts or conducts oneself, especially toward others	Issue PCP’s poor bedside manner persists
Remedial Action Requested	A remedial action is a change made to a nonconforming product or service to address the deficiency	Purpose Here
Resources	[SEE BELOW]	Material and Staff issue
Quality of Services	Average
Quality of Care	Average
Coordination of Care	Average	Records Management Issues
-

Last Reviewed: 20191120-W:

Table - Resource Issues

Provider Brand New Day (H0838) – Consumer Keith Torkelson

-
Resource	Direct Value	Indirect Value	Note
-
Money		X
Subsidy	X		Buster is on a fixed income subsidies are always welcome
Materials		X
Staff	X		Should help PCP & BND find a better way to deliver rewards
Other Assets	X		External Quality Review skills
Effective Operation	X		Again this complaint will very likely help both PCP & BND about their rewards protocol
Time to Action		X
Strategy	X		MSG’s three-for-one concern approach
Break Even		X	In terms of time spend versus subsidies recovered Buster will not break even He will recover only about $1.00 on the hour
-

Last Reviewed: 20191120-W:

Table – Problem Management – Intensity of Intervention


Level (Intensity)	Definition	Note

Concern	Worry (someone); make anxious	We worry less about BND’s shortfalls
Annoyance	A thing that irritates someone; a nuisance	Mostly our PCP
Complaint	A statement that a situation is unsatisfactory or unacceptable	Share via our online submission to CMS
Grievance	A real or imagined wrong or other cause for complaint or protest, especially unfair treatment An official statement of a complaint over something believed to be wrong or unfair	Share via this report – Real - Our hardcopy version of this mailed to CMS

Last Reviewed: 20191119-TU:

Records

For Publishing Embedded

For CMS Attached to End of Report

Provider Brand New Day (H0838) – Consumer Keith Torkelson

Medical Transportation

-
Rewards
-

Health Information Transfer/Exchange (HIT/HIE)

Quality Assurance – HIT - 20190625-TU: Handed to Team Mojica MD

It has been more than a year since a key player our Primary Care Physcian’s office began adopting their Electronic Health Record. The office has been repeatedly challenged about Health Information Transfers and Health Information Exchanges. Buster has on several occasions manually carried records from specialists back to our PCP. An example would be on June 25, 2019 (TU) when he carried the Colonscopy outcomes report from the specialist to our PCP. When Buster’s PCP asks him to do something more often than not Buster follows through. When Buster asks his PCP to do something the doctor throws a tantrum.

Method - Table – CMS Complaint – Reconciliation (MSG- STR)

All Entries as Centered about Keith “Buster” Torkelson The Consumer – 3/29/1959

Provider Brand New Day (H0838)

-
Time Stamp	Task/Event	People	Note
-
20190305-TU	Submit FOBT at CCCHC	Team CDM	Received Reward
20190321-TH	Phone Consult w Teladoc	Phone MD	Preferred service as compared w PCP PCP Failed to treat condition
20190522-W	Receive Rewards Plus Program promise letter	BND Member Services

20190604-TU	Day of Colonoscopy	Self and Sister	Medical Transportation Issue
20190625-TU	Drop colonoscopy records back to PCP Ofc	Jocelyn	Wait for BND reward
20190701-M	Filed formal complaint with BND		Colonoscopy Medical Transportation
20190705-F	Rec Transportation Letter dated 7/2/19		Promise to resolve by 30 days after 6/28/19
20190711-TH		(PCP) CDM
20190725-TH	Address all lab results	(PCP) CDM	Failed to catch elevated liver Did not support us for getting our colonoscopy & physical rewards
20190826-M	Receive Healthy Habit Newsletter	BND	Indicates a Physical Fitness Plan is in order
Exact Unknown	Call Brand New Day Member Services Dept @866-255-4795	Anon	States they do not have colonoscopy or physical records
20191015-TU:	Routine CBC	Clinical Staff	For the record
20191024-TH	Flu Shot	CDM	Could have been grouped with 10/15 routine CBC to contain costs
20191025-F	Invite by phone to attend FOBT day	Jeff Gibbs	We already had it done for 2019 FOTB Nurse = Shannon
20191031-TH	FOBT Day	Jeff Gibbs	Poor situational awareness Fails to address outstanding Rewards
-

Last Reviewed: 20191104-M:

Special Topic - Intervention – Asking for Help

Mailing Address Unclear Online

Need help filing a complaint?

Contact your State Health Insurance Assistance Program (SHIP) for free personalized help

https://www.shiptacenter.org/

Contact Your SHIP

California Health Insurance Counseling and Advocacy Program (HICAP)

Call 1-800-434-0222

Website https://www.aging.ca.gov/hicap/

Local Number: 714 560-0424

Want CMS Complaint Filing Address

Context of CMS: HOS and The Myers Group

20160622-W Update

Need help filing a complaint?

Contact your State Health Insurance Assistance Program (SHIP) for free personalized help

http://www.shiptacenter.org/

Filing Our Complaint

20191104-M: Call to get CMS-Medicare

Complaints Mailing Address

20191104-M: Call HICAP twice

HICAP returns our call. We ask if they had the CMS Medicare Complaint mailing address. After about five minute they could not find a viable address. We are going to have to use the address that CMS sent us a few years back. We are also going to try to submit our complaint via CMS Medicare’s online service.

HICAP Says Call Medicare

20191118-M: Call to CMS-Medicare @ 1-800-633-4227 resulted in no progress. Plan to Blog first, mail to address above second, and use the online route third.

20191118-1430-M: Called Medicare

End of call survey – This phone transaction was not very helpful because no valid address provided – Note Medicare has Los Altos address on file.

Address List

Provider Brand New Day (H0838) – Consumer Keith Torkelson (DOB 3/29/1959)

Method – Mailing Label for CMS Medicare

Found On Medicare Correspondence – CMS Complaint Resolution Survey

Department of Health & Human Services

Centers for Medicare & Medicaid Services

7500 Security Boulevard, Mail Stop MS C1-25-05

Baltimore, Maryland 21244-1850

ATTN: PRA Reports Clearance Officer

ATTN: Complaints

Medicare Contact Center Operations

PO Box 1270

Lawrence, KS 66044

Medicare Headquarters

7500 Security Blvd

Baltimore, MD 21244

US Department of Health and Human Services

200 Independence Ave, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019

NA – Not a Civil Rights Complaint

Forms at

http://www.hhs.gov/ocr/office/file/index.html

https://www.hhs.gov/ocr/complaints/index.html

CMS – Medicare Online Resources

20140615: Medicare Complaint Form - Medicare.gov

[USE THIS ONE]

https://www.medicare.gov/medicarecomplaintform/home.aspx

Submit feedback or complaints about your Medicare health plan or prescription drug plan directly to Medicare using this form.

“Please note that this tool is for non-critical complaints. If your issue needs to be addressed within 10 days, you should call 1-800-MEDICARE (1-800-633-4227). 1-800-MEDICARE is available 24 hours, 7 days a week, including some federal holidays. TTY/TTD users can call 1-877-486-2048.”

Alternate Route

Medicare Complaint Form

https://www.medicare.gov/MedicareComplaintForm/response.aspx

Table - You have a complaint about…Complaint Analysis

Same Needs Different Form

All Scores as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Provider Brand New Day (H0838)

-
#	Aspect	Rewards	Other	Note	20191104 (TU-RT)
-
1	A Doctor PCP	Issue	Unilateral Decision Making	Failed to treat condition As Measured By (AMB) Teladoc consult	1.00
2	A Doctor BHD	NA	Time Limits Experimenting with Prescriptions		0.50
3	Hospital (Usage)	NA	NA	Haven’t been in the Hosp since 2012	0.25
4	Provider	Issue		PCP not doing his part for rewards	0.50
5	Your Health Plan	Issue	Medical Transportation Rewards Reimbursements	Pending Outstanding	1.00
6	Drug Plan	NA	NA	Good	0.00
7	Quality Of Your Care	Issue	Issue	Receiving 3.0 Star Care	0.50
8	Smoking Cessation	NA	How much is it worth it to BND/PCP that we quit smoking	Not taking Buster’s needs to quit seriously	1.00
-
				CALC (High scores indicate problems)	4.75/8
				A Measure of Quality of Care (QOC) = [Inverted]	59% [40%]
				Inverted QOC Star Equivalents =	2.0
-

Last Reviewed: 20191102-SAT:

Quality Of Care (QOC)

For Brand New Day’s Quality Of Care score they earned 40% or 2.0 QOC Star Equivalents. This is 1.0 unit below BND’s CMS Stars Score of 3.0.

Table - Introducing - Cast Of Characters – Promise Cohort

All Scores as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Provider Brand New Day (H0838)

-
##	Character	Role	Satisfied	20191104 (M-RT)
-
01	BND – Jeff Gibbs	Unhelpful	No	0.00
02	Brand New Day	Problem sending awards as promised	No	0.00
03	Brand New Day Phone Support	Unhelpful	No	0.00
04	California Health Insurance Counseling and Advocacy Program (HICAP) – Phone Rep	Last Step	Before sent to CMS
05	CDM Clerical Staff	Records	SoSo	0.50
06	Chester D Mojica MD	Antagonist	SoSo	0.50
07	CMS Worker (Follow up)	Pending	Pending
08	Colonoscopy Clerical @ PCP Office	Hand delivered to staff	Yes	1.00
09	Colonoscopy Clerical Origin	Shin’s Office	Yes	1.00
10	Keith Torkelson MS	Protagonist	Yes	1.00
	Others
-
	SUM/# Scored CALC			4.00/9
	Formative Complaint Resolution Score (MSG-FCRS) =			44.4%
	Star Equivalents =			2.2
-

Last Reviewed: 20191104-M:

Formative Complaint Resolution Score

We here at Mentalation Solutions Group (MSG) are hoping this is a summative complaint. In other words we would like to have nothing about Brand New Day (BND) to complain about for the whole of 2020. For the issue at hand BND earned a Formative Complaint Resolution Score (MSG-FCRS) 44.4%. This converts to a Star Equivalent of 2.2. This is below BND’s usual and customary CMS Stars’ Score of 3.0.

List – Complaints – All Time Since 2012 Till 2016

EQRO Register – Formal Complaints Primarily to Brand New Day

All Entries as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Provider Brand New Day (H0838)

-
Date if Known	Complaint	Outcome	Detail
-
????	Urgent Care Materials Not sent to us	Sent by mail
201206	Provider Assignment	Contract Error Reassigned	Waknine MD to Lee MD
20130912	Plan Information Packet Not sent for 2013	Provider directory, EOC, Summary of Benefits, Formulary
20130913	Dental Fee Schedule	With CMS’s help	Material sent by mail
20130918	CMS 2013 Complaints Resolution Survey	Completed	Mail to CMS
20140702	Health Risk Reports Response	Received by mail
20160222	Medication Error Incorrect Dosages sent to pharmacy	20160620	Dosages corrected Doctor alarmed we complained about him
20160229	Delta Dental Schedule A	20160331 S. Fuentes	Received by mail

Last Reviewed: 20191118-M: Roughly 8 Incidences

Eight (8) Incidences

We signed on with Brand New Day (BND) back in 2012. From the period 2012 till 2016 we had eight (8) incidences to complain. For the most part Brand New Day Quality Assurance Department satisfied our needs. Before formalizing most of our complaints we gave BND phone support a shot. We find that BND’s phone support is lacking. The medication error report was the most bothersome.

List – Complaints – All Time Since 2017 Till 2019

EQRO Register – Formal Complaints Primarily to Brand New Day

All Entries as Centered about Keith “Buster” Torkelson The Consumer – DOB 3/29/1959

Provider Brand New Day (H0838)

-
Date if Known	Complaint	Outcome	Detail
-
20171110	Deny to pay for yearly physical	BND declares “Ignore”	System Error
20171110	Deny to pay required lab work (CBC)	BND declares “Ignore”	System Error
20180225	Med Impact Audit Results	Denied usual and customary	At odds with new BHD’s support
20180618	Medicare Web-complaint	Burdensome
20190628	Formal Transportation Plus	Passed due	See letter attached
20180827	Denial of Payment Glasses	Ignored
20190829	BND Rewards	Promises not kept	See attached document(s)
20180927	Physical Errors Primary Care Physician	Failure to send paper work to BND	Error interpreting a lab result
20180927	Emerging Issue with PCP Chester Mojica	Resistant to BND requirements
-

Table Last Reviewed: 20191118-M: Roughly 9 Incidences

Formal V By Phone V Online

Phone service about Health & Human Services can be horrendous. The online routes often limit the amount of strategic information exchanged. We prefer the written route. With Brand New Day we also use the written route. We have mailing addresses to corporate that usually get our materials to the right person. We count about nine (9) incidences within the interval 2017-2019.

Areas that do not apply - You have a complaint about:

Provider Brand New Day (H0838) – Consumer Keith Torkelson

-
Aspect	Rewards	Other	Note
-
Your Dialysis	NA	NA
Kidney Transplant Care	NA	NA
Durable Medical Equipment	NA	NA
-

Last Reviewed: 20191105-TU:

Could be worse!

For every category Brand New Day could has performed worse. Buster with the help of BND and their sub-contractors has stayed out of the Hospital. Buster began partnering with BND back in 2012.

Summary & Expectations

This post we will be update with Outcomes. We are going to deliver this report in whole and in parts via: Direct mail to CMS, using on Brand New Day (BND) blog, and via the CMS webpage. Using the CMS Qualifying Complaints Checklist we find our concerns qualify as a CMS complaint.

Things to Appreciate - Attitude of Gratitude – BND

We would like to close with a statement regarding how grateful Keith “Buster” Torkelson is for the help that Brand New Day has offered him over the course of the last seven (7) years. Both Buster’s Quality Of Life (QOL) and satisfaction with life have improved. We give BND a 25% share about Buster’s improvements. His family helpers also appreciate BND.

Table - Impact of Settling Complaint – Complaint Value Score (CVS)

Provider Brand New Day (H0838) – Consumer Keith Torkelson

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#	Domain	Impact	20191120 (W-RT) Quant
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01	Living Arrangements	Slight	0.00
	Family Involvement	Slight	0.00
	Social	Slight	0.00
	Communications & Literacy	Strong	1.00
05	Relationships	Strong	1.00
	Health	Moderate	0.50
	Sleep	Moderate	0.50
	Satisfaction with Life	Moderate	0.50
	Quality of Life	Moderate	0.50
10	Technology	Strong	1.00
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	CALC		5.00/10
	Complaint Value Score (CVS) =		50.0%
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