TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Inspection
Name of the organization
PREFERREDONE COMMUNITY HEALTH PLAN
Employer identification number
41-1796007
41-1796007
| Return Reference | Explanation |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE MISSION OF PREFERREDONE COMMUNITY HEALTH PLAN (PCHP) IS TO MAKE AVAILABLE TO THE RESIDENTS OF THE STATE OF MINNESOTA COMPREHENSIVE HEALTH MAINTENANCE SERVICES THAT ARE ACCESSIBLE, ACCEPTABLE, AND DELIVERED IN A MANNER CONGRUENT WITH THE ECONOMIC AND SOCIAL NEEDS OF THE COMMUNITY. THE HEALTH PLAN WILL ADVOCATE FOR IMPROVEMENTS IN THE DELIVERY, QUALITY AND COVERAGE OF HEALTH CARE SERVICES AND PURSUE HEALTH CARE PROGRAMS TO MEET COMMUNITY NEEDS. |
| FORM 990, PAGE 2, PART III, LINE 4A | PREFERREDONE COMMUNITY HEALTH PLAN MISSION THE MISSION OF THE QUALITY MANAGEMENT (QM) PROGRAM IS TO IDENTIFY AND ACT ON OPPORTUNITIES THAT IMPROVE THE QUALITY, SAFETY, VALUE OF CARE, AND SERVICE PROVIDED TO ALL PREFERREDONE MEMBERS, WORKING BOTH INDEPENDENTLY AND COLLABORATIVELY WITH CONTRACTED PRACTITIONERS AND COMMUNITY EFFORTS. AS PART OF THE ORGANIZATION'S MISSION, PREFERREDONE ADVOCATES FOR IMPROVEMENTS IN THE DELIVERY, QUALITY, AND COVERAGE OF HEALTH CARE SERVICES, AND PURSUES HEALTH CARE PROGRAMS TO MEET COMMUNITY NEEDS. IN 2019, PREFERREDONE COMMUNITY HEALTH PLAN RECEIVED AN ACCREDITATION STATUS OF ACCREDITED FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA), A PRIVATE, NONPROFIT ORGANIZATION THAT EVALUATES AND REPORTS ON HEALTH CARE QUALITY. NCQA ACCREDITATION RECOGNIZES THE COMMITMENT OF OUR ORGANIZATION TO PROVIDE QUALITY HEALTH CARE TO OUR MEMBERS AND DEMONSTRATES THAT WE HAVE INCORPORATED QUALITY IMPROVEMENT INTO THE FABRIC OF OUR BUSINESS. OUR ACCREDITATION STATUS WAS AWARDED AFTER RIGOROUS EVALUATION BY NCQA OF ALL ASPECTS OF OUR PLAN, INCLUDING PREVENTIVE HEALTH SERVICES, MEMBER SATISFACTION, PHYSICIAN CREDENTIALING AND QUALITY IMPROVEMENT. PARTICIPATION IN COLLABORATIVE AND COMMUNITY PROJECTS IN AN EFFORT TO POOL RESOURCES, CREATE CONSISTENCY AMONG PROVIDER NETWORKS IN OUR COMMUNITY AND IMPROVE THE DELIVERY OF HEALTH CARE TO OUR MEMBERS PREFERREDONE PARTICIPATES IN SEVERAL COLLABORATIVE ACTIVITIES. MINNESOTA COMMUNITY MEASUREMENT (MNCM) IS A COLLABORATION AMONG HEALTH PLANS AND PROVIDER GROUPS WHOSE MISSION IS TO ACCELERATE THE IMPROVEMENT OF HEALTH BY PUBLICLY REPORTING HEALTH CARE INFORMATION. THE VISION OF MN COMMUNITY MEASUREMENT IS: -BE THE PRIMARY TRUSTED SOURCE FOR HEALTH DATA SHARING AND MEASUREMENT -DRIVE CHANGE THAT IMPROVES HEALTH, PATIENT EXPERIENCE, COST AND EQUITY OF CARE FOR EVERYONE IN OUR COMMUNITY -BE A RESOURCE USED BY PROVIDERS AND PATIENTS TO IMPROVE CARE -PARTNER WITH OTHERS TO USE OUR INFORMATION TO CATALYZE SIGNIFICANT IMPROVEMENTS IN HEALTH PREFERREDONE IS ONE OF SEVEN HEALTH PLAN FOUNDING MEMBERS OF MNCM. THE STATE MEDICAL ASSOCIATION, STATE HOSPITAL ASSOCIATION, PARTICIPATING MEDICAL GROUPS, CONSUMERS, BUSINESSES, HEALTH PLANS, AND STATE HEALTH AGENCIES ARE ALL REPRESENTED ON THE ORGANIZATION'S BOARD OF DIRECTORS IN EITHER A VOTING OR NON-VOTING CAPACITY. DATA IS SUPPLIED BY PARTICIPATING HEALTH PLANS ON AN ANNUAL BASIS FOR USE IN DEVELOPING THEIR ANNUAL HEALTH CARE QUALITY REPORT. MINNESOTA COUNCIL OF HEALTH PLANS (MCHP) IS A NON-PROFIT TRADE ASSOCIATION REPRESENTING MINNESOTA'S NON-PROFIT HEALTH PLAN ORGANIZATIONS. THE COUNCIL PROMOTES ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH CARE. HEALTH PLAN MEMBERS ARE ACTIVE IN THE AREAS OF HEALTH CARE REFORM, RESEARCH-BASED GUIDELINE DEVELOPMENT, COMMUNITY HEALTH AND PREVENTION, MEDICAL TECHNOLOGY ASSESSMENT AND HEALTH CARE QUALITY DATA COLLECTION. PREFERREDONE EXECUTIVES AND STAFF MEMBERS SERVE ON VARIOUS COMMITTEES THROUGH THE MCHP INCLUDING THE BOARD OF DIRECTORS, COMMUNITY HEALTH, COMMUNICATIONS, HEALTH POLICY, QUALITY AND MEDICAL ISSUES. ORGANIZATIONAL SUPPORT FOR EMPLOYEE VOLUNTEER EVENTS PREFERREDONE SUPPORTS COMMUNITY INVOLVEMENT THROUGHOUT THE ORGANIZATION. EVENTS ARE EMPLOYEE-DRIVEN, WITH THE ORGANIZATION ENABLING OR PROVIDING EMPLOYEE TIME AND/OR FINANCIAL SUPPORT TO ENCOURAGE VOLUNTEERISM. EXAMPLES INCLUDE: -UNITED WAY -COMMUNITY HEALTH CHARITIES -FAIRVIEW FOUNDATION -ON-SITE BLOOD DRIVES -SECOND HARVEST HEARTLAND OTHER CONDITION-SPECIFIC EDUCATION AND SUPPORT PROGRAMS COMPLEX CASE MANAGEMENT COMPLEX CASE MANAGEMENT IS THE COORDINATION OF CARE AND SERVICES PROVIDED TO MEMBERS WHO HAVE EXPERIENCED A CRITICAL EVENT OR DIAGNOSIS THAT REQUIRES THE EXTENSIVE USE OF RESOURCES AND WHO NEED HELP NAVIGATING THE SYSTEM TO FACILITATE APPROPRIATE DELIVERY OF CARE AND SERVICES. THE GOAL OF COMPLEX CASE MANAGEMENT IS TO HELP MEMBERS REGAIN OPTIMUM HEALTH OR IMPROVED FUNCTIONAL CAPABILITY, IN THE RIGHT SETTING AND IN A COST-EFFECTIVE MANNER. IT INVOLVES COMPREHENSIVE ASSESSMENT OF THE MEMBER'S CONDITION; DETERMINATION OF AVAILABLE BENEFITS AND RESOURCES; AND DEVELOPMENT AND IMPLEMENTATION OF A CASE MANAGEMENT PLAN WITH PERFORMANCE GOALS, MONITORING AND FOLLOW UP. IN 2019 THE COMPLEX CASE MANAGEMENT PROGRAM IDENTIFIED 6,474 MEMBERS WHO COULD BENEFIT FROM CASE MANAGEMENT SERVICES. THE CONDITIONS THEY TRIGGERED FOR ARE AS FOLLOWS: POST ACUTE 51% GENERAL MEDICINE 34% ACUTE 13% CANCER 2% CARDIAC 1% CHRONIC ILLNESS MANAGEMENT PREFERREDONE'S CHRONIC ILLNESS MANAGEMENT PROGRAM IS AVAILABLE TO MEMBERS WHO ARE DIAGNOSED WITH ANY OF THE FOLLOWING CHRONIC CONDITIONS: DIABETES CORONARY HEART DISEASE CONGESTIVE HEART FAILURE CHRONIC OBSTRUCTIVE PULMONARY DISEASE ASTHMA (ADULT AND JUVENILE) RARE CONDITIONS (ULCERATIVE COLITIS, CROHN'S DISEASE, RHEUMATOID ARTHRITIS, MULTIPLE SCLEROSIS, SICKLE CELL, CYSTIC FIBROSIS, LUPUS, PARKINSONS, MYASTHENIA GRAVIS, HEMOPHILIA, SCLERODERMA, DERMATOMYOSITIS, MYOSITIS, POLYMYOSITIS, CIDP, ALS, AND GAUCHER DISEASE) THE GOALS OF THE CHRONIC ILLNESS MANAGEMENT PROGRAM ARE TO PROMOTE SELF- MANAGEMENT OF CHRONIC CONDITIONS, IMPROVE ADHERENCE TO TREATMENT PLANS WITH AN EMPHASIS ON MEDICATION THERAPY, REDUCE OR DELAY DISEASE PROGRESSION AND COMPLICATIONS, REDUCE HOSPITALIZATIONS AND EMERGENCY ROOM VISITS AND IMPROVE QUALITY OF LIFE. IN 2019 THE CHRONIC ILLNESS MANAGEMENT PROGRAM IDENTIFIED 5,913 MEMBERS WHO COULD BENEFIT FROM DISEASE MANAGEMENT SERVICES. THE CONDITIONS THEY TRIGGERED FOR ARE AS FOLLOWS: DIABETES 62% ASTHMA 19% CAD 8% COPD 6% CHF 5% QUIT FOR LIFE PREFERREDONE CONTRACTS WITH OPTUM FOR ITS QUIT FOR LIFE TOBACCO CESSATION PROGRAMMING (FORMERLY ALERE/FREE & CLEAR). THIS PROGRAM USES INBOUND AND OUTBOUND TELEPHONE SUPPORT TO SYSTEMATICALLY MOVE PARTICIPANTS TOWARD A SUCCESSFUL QUIT. THE CORE COMPONENTS OF THE QUIT FOR LIFE PROGRAM INCLUDE: -INDIVIDUALIZED TELEPHONIC COUNSELING WITH A QUIT COACH -PRINTED SELF-PACED MATERIALS (THE QUIT KIT) -TEXT AND EMAIL SUPPORT -ACCESS TO QUIT AIDS -24/7 ACCESS TO THE PROGRAM WEBSITE QUIT FOR LIFE IS A SYSTEMATIC AND SOLID SCIENTIFIC EVIDENCE-BASED BEHAVIOR CHANGE PROGRAM THAT HELPS TOBACCO USERS QUIT. CLINICAL TRIAL RESULTS INDICATE THAT TELEPHONE COUNSELING, ALONG WITH SELF-HELP MATERIALS, INCREASES QUIT RATES. IN 2019 PREFERREDONE ENROLLED 52 PAS MEMBERS, 3 PIC MEMBERS AND 5 PCHP MEMBERS INTO THE QUIT FOR LIFE PROGRAM. HEALTH RISK ASSESSMENT (HRA) PREFERREDONE OFFERS AN HRA THROUGH WELLSOURCE TO ALL PCHP, PIC, AND PAS MEMBERS AND THEIR DEPENDANTS. THE HRA IS ACCESSED ONLINE THROUGH THE PREFERREDONE MEMBER WEBSITE (WWW.PREFERREDONE.COM). THERE IS NO COST TO THE EMPLOYEE OR THEIR EMPLOYER FOR COMPLETING THE HRA UNLESS THE REPORTING AND HEALTH COACHING PACKAGE IS PURCHASED BY THE EMPLOYER GROUP. PREFERREDONE ENCOURAGES MEMBERS TO PRINT THEIR INDIVIDUAL RESULTS AND SHARE THEM WITH THEIR PHYSICIAN IF THEY DESIRE ADVICE OR DIRECTION TO IMPROVE THEIR LIFESTYLE. A TOTAL OF 1,708 PREFERREDONE MEMBERS COMPLETED THE HRA IN 2019. PATIENT SAFETY PREFERREDONE DEMONSTRATES A COMMITMENT TO PATIENT SAFETY BY INCORPORATING SAFETY INTO EXISTING QM ACTIVITIES AND TAKING PATIENT SAFETY INTO CONSIDERATION WHEN EXAMINING TRENDS AND DATA FOR POSSIBLE QUALITY IMPROVEMENT ACTIVITIES. PREFERREDONE ALWAYS IMPLEMENTS PROCESSES WITH OVERALL PATIENT CARE OUTCOMES AND SAFETY AS COMPONENTS OF QUALITY IMPROVEMENT ACTIVITIES. ELEMENTS OF PATIENT SAFETY ARE FOUND IN OUR EXISTING QUALITY IMPROVEMENT PROCESSES THAT INCLUDE, BUT ARE NOT LIMITED TO: -IDENTIFYING AND IMPLEMENTING PROCESSES FOR TRANSITIONS OF CARE FOR CONTINUITY AND SAFETY -IMPLEMENTING CARE MANAGEMENT PROGRAMS THAT INCLUDE FOLLOW-UP SYSTEMS TO ENSURE THAT CARE IS RECEIVED IN A RELIABLE AND TIMELY MANNER -IMPLEMENTING PHARMACEUTICAL MANAGEMENT PRACTICES AND POLICIES THAT INCLUDE SAFEGUARDS TO ENHANCE PATIENT SAFETY, INCLUDING AN EMERGING THERAPEUTIC ISSUES PROGRAM IN WHICH MEMBERS AND/OR PHYSICIANS ARE NOTIFIED OF SIGNIFICANT SAFETY ISSUES WITH PRODUCTS COVERED UNDER THE PHARMACY BENEFIT (INCLUDING PRESCRIPTION DRUGS AND CERTAIN MEDICAL DEVICES) -INCORPORATING ADVERSE EVENT REPORTING INTO THE CREDENTIALING PROCESS -TRACKING AND TRENDING ADVERSE EVENT REPORTING TO IDENTIFY SYSTEMS AND/OR NETWORK ISSUES THAT MAY COMPROMISE SAFETY -ANALYZING AND TAKING ACTION ON MEMBER AND PRACTITIONER COMPLAINTS AND SATISFACTION DATA THAT RELATE TO SAFETY -COLLECTING AND PROVIDING INFORMATION ON PROVIDER AND PRACTITIONER SAFETY AND QUALITY, INCLUDING ACTIVITIES ON PROVIDERS ACTIONS TO IMPROVE PATIENT SAFETY AND TO MAKE PERFORMANCE DATA PUBLICLY AVAILABLE FOR MEMBERS AND PRACTITIONERS. CONTINUITY AND COORDINATION OF CARE PREFERREDONE DEVELOPS A WORK PLAN TO SPECIFICALLY ADDRESS ISSUES RELATED TO CONTINUITY AND COORDINATION OF CARE WITHIN OUR NETWORK FOR OUR MEMBERS. DATA FROM VARIOUS SOURCES ARE USED TO IDENTIFY OPPORTUNITIES FOR IMPROVEMENT AND DEVELOP PROGRAMS TO ADDRESS THESE OPPORTUNITIES AS NECESSARY. POTENTIAL OPPORTUNITIES FOR IMPROVEMENT UNDER CONSIDERATION INCLUDE - |
| FORM 990, PAGE 6, PART VI, LINE 6 | MEMBERS CONSIST OF THE PARTICIPANTS OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS CONSISTS OF: A CONTRIBUTING MEMBER, COMPOSED OF EMPLOYEES OF PROVIDED OWNERS THAT HAVE CONTRIBUTED CAPITAL TO PREFERREDONE COMMUNITY HEALTH PLAN (PCHP) AND ENROLLEE DIRECTORS, WHICH ARE ENROLLED EMPLOYEES OF EMPLOYER GROUPS THAT HAVE PURCHASED HEALTH INSURANCE COVERAGE OR HEALTH ADMINISTRATIVE SERVICES THROUGH PCHP OR IT AFFILIATES. |
| FORM 990, PAGE 6, PART VI, LINE 7A | MEMBERS CONSIST OF THE PARTICIPANTS OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS CONSISTS OF: A CONTRIBUTING MEMBER, COMPOSED OF EMPLOYEES OF PROVIDED OWNERS THAT HAVE CONTRIBUTED CAPITAL TO PREFERREDONE COMMUNITY HEALTH PLAN (PCHP) AND ENROLLEE DIRECTORS, WHICH ARE ENROLLED EMPLOYEES OF EMPLOYER GROUPS THAT HAVE PURCHASED HEALTH INSURANCE COVERAGE OR HEALTH ADMINISTRATIVE SERVICES THROUGH PCHP OR IT AFFILIATES. THE CONTRIBUTING MEMBER APPOINTS (AND FILLS VACANCIES OF) UP TO 4 DIRECTORS RESPECTIVELY. THE VACANCIES THAT ARISE WITH RESPECT TO ENROLLEE DIRECTORS ARE FILLED BY MAJORITY VOTE OF OTHER ENROLLEE DIRECTORS FOR THE REMAINDER OF THE UNEXPIRED TERM. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE ASSOCIATE DIRECTOR OF ACCOUNTING COMPLETES THE WORKPAPERS FOR THE FORM 990. THE TAX DEPARTMENT THEN PREPARES AND CONDUCTS A DETAILED REVIEW OF THE COMPLETED RETURN. THE RETURN IS THEN REVIEWED BY THE ORGANIZATION'S DIRECTOR OF ACCOUNTING AND CFO. THE FORM 990 IS THEN PROVIDED TO THE MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING. UPON APPROVAL FROM THE BOARD OF DIRECTORS, THE FORM 990 IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ANNUALLY THE BOARD OF DIRECTORS UPDATE CONFLICT OF INTEREST STATEMENTS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | PREFERREDONE ADMINISTRATIVE SERVICES (PAS), THE COMMON PAYMASTER OF PCHP, HAS A COMPENSATION COMMITTEE CONSISTING OF THE CEO AND MEMBERS OF THE BOARD OR DIRECTORS OF PAS THAT MEET ANNUALLY TO REVIEW THE COMPENSATION OF THE PCHP OFFICERS. EVERY THREE YEARS THIS COMPENSATION REVIEW PROCESS INVOLVES AN OUTSIDE COMPENSATION CONSULTANT THAT CONDUCTS INDUSTRY COMPARISON ANALYSIS AND OTHER COMPENSATION COMPARISONS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | PREFERREDONE ADMINISTRATIVE SERVICES (PAS), THE COMMON PAYMASTER OF PCHP, HAS A COMPENSATION COMMITTEE CONSISTING OF THE CEO AND MEMBERS OF THE BOARD OR DIRECTORS OF PAS THAT MEET ANNUALLY TO REVIEW THE COMPENSATION OF THE PCHP OFFICERS. EVERY THREE YEARS THIS COMPENSATION REVIEW PROCESS INVOLVES AN OUTSIDE COMPENSATION CONSULTANT THAT CONDUCTS INDUSTRY COMPARISON ANALYSIS AND OTHER COMPENSATION COMPARISONS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). ANNUAL STATUTORY FILINGS ARE AVAILABLE ON THE STATE OF MN WEBSITE. TRI-ANNUAL AUDITS BY THE MN DEPARTMENT OF COMMERCE ARE ALSO AVAILABLE. |
| FORM 990, PART IX, LINE 11G | 961,979 8,625 0 |
| FORM 990, PART XI, LINE 9 | REINSURANCE PREMIUMS RECLASSED TO EXPENSE -122,209 REINSURANCE PREMIUMS RECLASSED TO REVENUE 122,209 |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019
Additional Data
| Software ID: | |
| Software Version: |