Pro-bono Christmas Report Card Centered about Imperial Insurance of California by Keith Buster Torkelson MS

 

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Title = “Human Autotroph”

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Detective that is the Right Question (I-Robot)

Pro-bono Christmas Report Card Centered about Imperial Insurance of California by Keith Buster Torkelson MS

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2023 Pro-Bono Christmas Card Report

 

Minnesota Turkey Growers (2023)

20231214-TH: Wrapping up the Marvel – SNG – Personal Psychosis Crisis

 

Why do it Pro-Bono?

It would appear that SSDI will cover the cost of this our annual Christmas Report Card.  CMS gets an honorable mention. 

 

Proposed Distribution

Like we said in the past we would share in part or as a whole with many of the persons addressed in our Annual Christmas Report Card.  For this upcoming term we will release this report in a whole form first via one of MSGs’ Blogs and share once per month for the next twelve (12) months in 2024 around the full moon as Peter Gabriel did with his I / O compilation.

 

Catharsis & Epiphone

 

20231222-F-Devin Velázquez Steve for Chess (MIA)

Velázquez, also Velazquez, Velásquez or Velasquez (/vəˈlæskɛz/, /-ˈlæz-/), is a surname from Spain. It is a patronymic name, meaning "son of Velasco".

Warmline

OC Links

Dedicated Housing Help Line

Homeless Migration LA > OC

 

Blog

BND HMO

Performance Earned Value

The Save is up to Veronica Kelley, Annette, Flor, Michelle, and

Executive Summary

We are pleased to announce that this year’s Christmas Report Card focusing on the Doctors.  The focal insurance partner is Imperial Health Plan of California.  As of 2023 Imperial replaces Universal Care Brand New Day as our Principle, Keith Torkelsons, health insurer.  In 2022 when Brand New Days Plan H0838 was removed from the market they had earned approximately 3.5 CMS Stars for their Overall score. Wheras, Imperial Health Plan of California for 2023 earned 2.5.  During Buster’s shopping around for a plan to replace Univeral Care Brand New Day he found it difficult to keep his current and relatively long-term doctor Rimal B Bera MD.  He would have chosen SCAN over Imperial if they contracted with doctor RBB.  CMS reported that Imperial was one of the most challenged plans that they oversee in the United States.  We have just been trying to help Imperial not lose our Health Plan as did Brand New Day did at the end of 2022.

Time Spent about Intelligence

Our records indicate that in 2016 we began to formally develop Keith Torkelson’s Health Related Engagement Concept (HRE).  Basically, our HRE addresses time spent in and around getting Buster the Healthcare Services necessary to improve his health.  Below is a table with some HRE related Measures (Metrics).

 

Version for Imperial Driven Christmas Report Card

Health Related Engagements (HRE)

For Prosumer Keith “Buster” Torkelson MS (2022 & 2023)

“MHSA: The Good Fight”

Individuals and Groups

Combined in private healthcare and public healthcare Torkelson transacts with more than twenty-five (25) annually in the community.  Here at Mentalation Solution’s Group (MSG} our external Quality Review systems have grown huge.  So now on the cusp of 2023 / 2024 we sample our reports for priority reports.

 

Nations

For 2023 Imperial contracted with a benefits bundle called OTC Nations.  The full package includes: Rewards monies, and Over-the-counter allowance, and grocery. During 2022 BND had added a grocery allowance.  A Torkelson lives with applied for Cal Fresh and is awarded over $100 per month.  Keith applied through the Social Services Agency (SSA) process.  He was hoping for $50 per month.  His SSA worker delivered $21 per month.  Keith is now relatively Buster.  Buster is very grateful for his $21 per month.  On and off he uses to buy a steak and dozen eggs.  With this money Buster ate a bit healthier. 

 

Cast of Characters – Persons of Interest (Including Feature Images)

Unfortunately this year we cannot feature images of all in Buster’s Health Care Networks (HCNs).  Buster basically has three (3) HCNs: Imperial-centered, Orange County Health Care Agency (OCHCA), and his Natural Supports including family and those providing for his living arrangements.

 

Brand New Day Lingerers - Critical

Before 2012 Buster was aware of BND because some of the people his lived with a Rent a Shared Room environment had BND as their “Program”.  During 2012 Buster ended up with BND.  His first: Worker, Helper, Care Coordinator, Life Coach, etc. Was Oswaldo Escalante.  Oswaldo went the distance for Buster and in doing so set a Worker Standard..  The issue is when BND folded Buster’s insurance and the associated program is Buster thought he would not have to see the under-performing Helpers anymore.  Imperial retains contract with Central City Community Health Center (CCCHC).  And CCCHC decided to give the under-performing Helpers a job.  So basically they hired the people who contributed to BND’s failure.

 

Central City Community Health Center (CCCHC)

Here we focus on clinic (CCCHC) centered clerical and clinical.  Buster has been with CCCHC since 2012 and about many incarnations.  For 2023 we offer people he deals with 5.0 Stars.  This includes those that participate in The client Clozapine Registry monthly Complete Blood Count (CBC) process.  The client wasn’t really happy when CCCHC decided to swap out Quest Diagnostics for Labcorp.  It took considerable effort on our part to get Labcorp to bill correctly.

Dental – In Network

Dental is a global problem so the issue with have with Imperial is not just centered around them.  Our standard for superior dental is Universal Care Dental.  After BND disengaged Universal Dental they went with Liberty and Delta Dental. Currently, Imperial contracts with Liberty for its’ dental plan.  Liberty is not a plan synergistic with the dental needs of older adults.  They cover things that a child or adolescent would need such as cleaning and fillings.  Older adults need services such as: Extractions, implants, dentures and the like.  So basically, older adults have to suffer pain because they cannot afford services not covered or those that have extensive co-pays.  Basically we score The client dental a needing substantial improvement.  If we could we would get a picture of Patrick’s mess of a mouth.

 

Dentist out of Network [STAYED]

Psychiatry Evaluation

Since The client was first prescribed a psychotropic back 1989 he has retained just over 17 psychiatrists.  His best were Dr. David Dobos and some of the low performers are: Dr. David Chandler, Daniels [?], De Silva, Himasiri K. and Vu, Alan.  Currently The client is served by Dr. Rimal B Bera.  After more than a year into their partnership we here at MSG give RBB a PASS.  One merit for RBB is that he has stepped up his triage using medical students.

Bindra

Imperial_Vitals_Stars_23090203_Notes

A key player in The client’s new health insurance, Imperial Health Plan of California, is Dr. Bindra.  The client receives many documents in the mail signed by Dr. Bindra.  So when we received the first of 3 Medicare Experience Surveys: First was paper version, second was internet version and the third was another paper version.  With Brand New Day Buster is the client. Was assigned a Single Point Contact (SPC).  He would share BND mandated assessment result with her.  She demonstrated that she valued Buster as a concerned individual.  In 2023 Buster gave Dr. Bindra a chance to touch bases as he did back in 2014 with “Sincerely, Constance J. Snyder”.  There was no reply while he stills receives mail from Dr. Bindra indicating he cares about his accounts

 

Constance J. Snyder – Compliance Officer

Letter Dated: July 2, 2014

[INSERT IMAGE OF DR. BINDRA]

 

Figure – Taken from Linkedin (2023)

Claims

In General with Brand New Day Buster did not have claims sent to him that indicated he owed anything.  It was assumed that any copay was billed up front before his approved appointment.  Most everything, claim wise for 2023 went rather well with the exception of Labcorp.  They could not get in their system the correct billing route.  He has one outstanding claim that they say sit on until we sort it out.  He also has a Dermatology claim we were working as an Imperial issue that turns out to be from 2022 and 2021 on BND’s watch.

 

Rewards

What can you say any Reward is a good thing?  BND had a Reward program.  And due to Buster’s effort they added a $10 annual reward for Health Risk Assessment (HRAs) that are filled out by the consumer.  Imperial has a substantial Reward for the consumer executing fully an Annual Wellness Visit.  Dr. Gandhi (PCP) mediated Buster’s AWV.  As Buster’s and Dr. Gandhi’s parting were coming to a close Dr. Gandhi comes into the exam room all excited because Buster was due reward Money.  Buster was un-affected: Saying to himself: I have to see it first. It took some odd half dozen phone calls and over five (5) months before the AWV monies were deposited in Buster’s Nations Debit Card Account.

 

Gifts & Benefits

Unfortunately after working with Nations for the better part of 2023, Imperial has decided to break the OTC contract.  So many of his efforts to entrain Nations will be lost starting 2024.  This is a good time to push for Imperial to add the grocery benefit.  With a better grocery benefit Buster could eat healthier like Quesadillas for the house..

 

Focus on Strengths

Buster discovered strengths based assessment back in college.  Exam and the like by default evaluated for the students strength.  In general they are objective measures of competencies.  Then he ran into assessment and measures about deficits such as his Anxiety Disorder.  Then around 2009 he runs into strengths assessment centered about Behavioral Health.  Now he routinely evaluates both his strengths and deficits.  Yet, one thing has become clear measurement, assessment, and evaluation are likely.  People need to step up their self-reporting including determining Performance Earned Values (PEVs), portable Assessment Values, Net Profile Efficiency, and Wellness Profile.

 

Newsletter – Digital Presence

Buster used to publish MSG’s routine Accountability MHSA Innovations Newsletter (AMIN).  He know quite a bit about good and great Newsletters.  One thing he has developed is using real people in Newsletters.  The OCHCA publishes online a monthly newsletter: What’s Up!.  What’s Up! Always features real people.

Newsletter Quality / Value

SE = Star Equivalent

Last Reviewed: 20231129-W-Close year for CRC

 

UATR=Unable Able to Rate

Fear of being dropped

Buster being treated for a full spectrum of Anxiety often feels being dropped for sharing his truth.  Yet overall in the last ten (10) or so years it would be hard to find evidence that his “Yellow Journalism” has harmed him and his.

 

Lab & Pharmacy

We group lab and pharmacy together because both are instrumental in keeping his primary medication, Clozapine, steaming.  Buster’s 28-day Clozapine cycle begins with the doctor prescribing both a CBC (labwork) and the prescription itself, the clinics communicates with the pharmacy of Buster’s choosing: Gilbert Drugs.  Gilbert reviews the CBC results for any signs of Agranulocytopenia (actually neutropenia).  If the lab is in the proper timeframe (28-day cycle) and there is no sign of neutropenia (can be life threatening) then Buster’s pharmacy delivers his monthly supply to Buster’s door.  Since 2012 when Buster began retaining Gilbert Drug’s their service has been stellar.  Buster and his 5.0 Star Pharm Guy, “Nick”, have been able to keep delivering on Buster’s Clozapine with a single gap :0)

 

Select Records

Referrals & Approvals

Basically the whole process of referral and approval has been driven by Buster.  The retained BND Helpers were of no help.  When Buster asks for help there is a potential crisis emerging.  When he asked the CCCHC retained BND helpers for help they did not deliver.  He knew he needed his Ophthalmologist, Dermatologist and Dentist. And in early 2023 he finds himself back to square one updating the PCP on situational awareness. After the necessary referrals he had to push forward the approvals.  As of November and dozens of phone calls he is ready to entertain that his services and supports for 2024 are in place. Remember though he still has a claim with Labcorp outstanding and he is facing the change in Imperial Rewards / OTC contractor.  In sum as has been he is more his care coordinator than his Imperial

 

Care Coordination

Going back the Health Related Engagement Concept (HRE-C) the majority of coordination was performed by Buster and his Team MSG.  For this term Team MSG was: Avey C Asus, Magnus EMe, Lled Buzzard (Developmental Disabled – A Bit Slow), KGT-A, LIV Vivo, Lys AAG and Sarah.

ADLs

 

Considers some Innovative Thinking

(STS LXE 20-Item)

 

ADL – Mainstream Assessment

GSM = Granular Scoring Methods

Buster Scores Buster – Self-Assessment

How is it Lived Experience?

Daily Activities that Promote Health

Part 1 of 2 – Heavy Hitting Items

Buster scores Buster

ADLs Derived Based on Lived Experience

Daily Activities that Promote

Part 2 of 2 – Mainstream Items

Buster Scores Buster

DORMIR – Sleep Science – The Big Sleep

 

People of Interest – Christmas Report Card

Remembering Those That Killed Themselves (KIA)

KIAs with no Mention of MIAs

Mortality Entertaining a Degree of Urgency

Death Report

Certification of Vital Record (Pending)

 

Things for Older Adults

Buster’s Retirement Date = December 22, 2023 (F)

 

Theme – Satisfaction as an Older Adult

Apply CEGU Probation to OAs

Concentration - DOMs = Dying Old Men

Sampling of Methods

Resistance to Dying Old Man Syndrome (DOM-S)

Prior studies and shares with Brand New Day

 

Web Related – Online Accounts

Back in 2009 Buster signed on with the OCHCA as a Technology Advisor.  To get up to speed he investigated was the Los Angeles Department of Mental Health (LADMH).  He even talked on the telephone with the Director at the time  He gained insight into but not limited to: Electronic Health Record (Hardware and Software), the RFP process, Personal Health Records, Patient Portals, Personal computing for consumers and family members, budgeting, etc (Kathleen Murray).  We want to focus on on-line accounts and patient portals.  Every time providers such as Imperial make changes on web-based content as a new lab we have to go through the process of creating a new account.  Now that we have a new Rewards intermediary we have to get another portal.  We have somewhere around a dozen health portal accounts.

CMS Perspective

Since 2012 we have been working on and off with CMS Medicare.  CMS is the entity that Medicare the Star Score System (SSS).  It is very complicated and can actually exhaust a contractor.  Oodles of people work delivering their concise Stars Report to their charges the Medicare approved Health Plan Insurers of America (HPIA).  Now is a good time to address disability even though Buster will turn 65 in 2023. He kept trying to get up and work full-time or as a small business owner.  And then bam a bout of Anxiety would fall and into the hospital we go.  In one “Episode” they semi-committed to a 2 year stay in semi-lockdown while his life on the outside including his most significant other ever (MSOE) was decaying. But is he not giving up on himself he has a project in the works to remedy Housing issues with the OCHCA and another to pitch to Yakult.  Yakult saying: We are “the world’s leading probiotic beverage created in Japan in 1935”… By chance they have a local in Orange County.  And that’s all she wrote (Avey, 2023)

 

CalMHSA [STAYED – LAW1]

Further Studies Centered about Imperial Health Plan

Approach = Prevention and Early Intervention

 

Stigma & Discrimination Reduction

Student Mental Health

Suicide Prevention

Cast of Characters

Orange County Ophthalmology (Dr. Taban)

While sitting in the exam chair Buster observed a list next to the telephone that included most all of Taban’s Ophthalmology staff.  We feel that other than having functional value it is an indicator of transparency and being Proud of Their People.  The Orange County Health Care Agency also highlights their people in their monthly What’s Up Newsletter.  With disclosures on pare with OCO and OCHCA like this we here at MSG know who and how to complement and praise our Health Care Workers (HCWs).  We find that active and passive anonymity “suck”.

 

Example of Transparency at Ophthalmology Office Circa

CRC = Christmas Report Card

 

“Get on with who you are (PBG-2023)”

Let it fly > Animal Magic

 

Elemental & Resource Breakdown

A Resource Leveling Approach

Back in 2014 Buster became aware of the Professional Quality of Life or PROQOL.  In no time he began to apply it to him and his.  With the PROQOL results on his Primary Care Physician, Chester D Mojica, he predicted that Dr. Mojica was in Professional Burnout Mode (PBM).  He also asked one of his Primary Natural Supports (PNSs) if she was Burned Out.  She replied “No”.  And now some ten years later it would appear that she was right.  Yet, still Buster determines he needs to level his resources and not become too dependent on a single person, group, thing, etc.

Dependency Status

Buster Rates Buster

Yields a Dependency Indicative Score

High score could be problematic

Last Reviewed: 20231219-TU

 

Honorable Mention

DSM Method Failed – Still too many Behavioral Health Consumers underserved and inappropriately served (Steinberg Programming Language – MHSA).

 

Salvo BB45 > Mark Refowitz Converge Principle

INN_AMIN_0002_Convergence-Prinicple_14100905

Cast Of Characters

 

Sharing (Excerpts and Briefs)

Comparing

Professionals, Administrators, and Leaders

May have extra Credential

In and Out of Network

Last Reviewed: 20231222-F

Q*M = Quick Star Method

Helpers

Non-MD helpers go by many names: Nurse, Therapist, Care Coordinator, Brokers, Landlords, Committee Members, Treatment Planner, Life Coach…

Focus about defunct local program and insurer Brand New Day

In non-profits the Best Help move up or onward

For Gary Zager (Cypress College & Janet Randall (CSUF)

SCR_BND_14091007_List-Log ALI V2023

 

(?) – Not available online

Specialists – Primarily In Network

MD and Medical Doctor Related Resources

Share with Dr. Richard Hoang – D.D.S., UCLA :0)

Q*M = Quick Stars Method score December 14, 2023 RT and Retro

Cast of Characters Lister Lista

(*) Out of Network - Control Psychiatrist

(**) Out of Network - Solution for crumby coverage with Liberty Dental under Liberty

 

20231221-W-Sikh & Ravinder P Glitch

For Spiritual Support

Plan to return for a cup of coffee

Rate Your Series

Cast by Modality or Procedure

Date of Encounter: 20181010-W @ 130 per Jocelyn

 

A Resource Leveling Approach

Last Reviewed: 20231222-F

 

Lesson Learned

Be patient while things develop with Michelle Smith, JMB, JET, ASK, QLK, Steph, Etc.  We have maintained a high degree of level one Binary Scoring.  In general, higher scores are favorable.

Images @ the End - None

Ethical

In Memory