A Health Plan That Cares
Interviewed by Melissa Moniz
Wednesday - September 02, 2009
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Dr. James Tan
Senior medical director of ‘Ohana Health Plan
Interviewed By Melissa Moniz
Where did you receive your schooling and training?
I received my undergraduate and medical degrees from Loma Linda University in California. While doing my residency in family medicine in Orlando, Fla., I earned my master’s in public health. Subsequently, during my years of practice, I obtained my master’s of business administration from the University of Redlands. I am a board-certified physician in family medicine.
Why did you decide to make the transition from a physician to a medical director of a health plan?
I realized that in a medical practice I could impact about 3,000 people, at best, but in population care I could have more influence. I could actually impact thousands of people. So I started taking leadership roles in the medical group setting and practice, and was elected to chief of staff-type positions at different hospitals where I worked. In my current position as a medical director of a health plan, I can oversee the care of more than 22,000 members.
So prior to this position were you in medical practice?
Yes, and though I’ve been in medical administration for about 15 years now, I’ve always remained involved with direct patient care.
What is ‘Ohana Health Plan?
‘Ohana Health Plan is one of two health plans selected by the state Department of Human Services to provide managed care services through the QUEST Expanded Access program. It’s a new Medicaid program for seniors 65 and older and people of ages with disabilities. Our main focus is making sure that our members - who are aged, blind or disabled - get the right care and services. These members have historically received their care from whomever they could go to. But under the ‘Ohana Health Plan model of care, we actually have professionals who reach out to our members. They assess them in their own environment and make sure their health needs are met.
What sets ‘Ohana Health Plan apart from other health insurance companies?
One of the big things we’ve done is to bring on board a spectacular group of professionals. Many of them are RNs, LPNs, licensed social workers, and some have special interests in caring for this population. For instance, some have family members who they care for, so they are very sensitive to the needs of this population. What sets us apart is having a team that’s very knowledgeable, sensitive and understands the needs of our members. Our team also goes into the home of each member to do a health assessment. The beauty of going into someone’s home - to see what their living environment is like and see who their caregivers are - is that it gives us a clearer understanding of how they are living and what they are coping with.
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So it is one assessment visit or is it an ongoing thing?
The assessments are ongoing. The initial assessment is the hardest because the member is brand new, so the visit is a bit longer; then after that, depending on the member’s needs, the assessments are done either by phone or face-to-face. Minimally, assessments are done annually. But higher-need members receive more frequent visits and assessments.
How many do you have on staff?
In Hawaii we have more than 120 staff. Specifically in health services, we have approximately 70.
How do you become a member of ‘Ohana Health Plan?
Once the state determines you are eligible, you are provided with a choice of two health plans, one being ‘Ohana Health Plan.
What is HealthConnections?
HealthConnections is our 24-hour nurse help line. All of our members can dial this toll-free number and talk with a health professional who will help them with their questions.
How is it determined which physicians are available for ‘Ohana Health Plan members?
As a health plan, ‘Ohana contracts with a network of physicians. They have to meet a certain criteria before we contract with them. After contracting, we put them through a credentialing process, and basically all the physicians who are contracted become available to ‘Ohana members. Also, the state tells us what specialty physicians we have to have in our network.
Are there any new programs or changes that have occurred since ‘Ohana Health Plan started?
At this time, no. The program is still relatively young, but we are very comfortable with what we have done in the first six months.
Is there a reason Waipahu was chosen for its location?
The main reason we chose our Waipahu office location was because we wanted to be a part of the community we serve. A large number of care homes and community foster homes are in the area, and our population tends to live in such homes, so we moved here to be closer to our members. We have additional office locations throughout the state, including on Maui and the Big Island.
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