Feature Image
Title = “Human Autotroph”
(For the United States Department
of Agriculture and Dr. Schwabe)
Detective that is the Right
Question (I-Robot)
Pro-bono Christmas Report Card Centered
about Imperial Insurance of California by Keith Buster Torkelson MS
Auto Link
https://brandnewdayhmo.blogspot.com/2023/12/pro-bono-christmas-report-card-centered.html
2023 Pro-Bono Christmas Card Report
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
[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
