Slide 1: My Ombudsman
4th Quarter 2019 – 1st Quarter 2020 Presentation 
for the One Care Implementation Council
June 9, 2020
Jennifer Lynne Morazes, PhD
Director-My Ombudsman
Slide 2: Mission
My Ombudsman is operated by an independent non-profit organization (the Disability Policy Consortium (DPC)) and empowers individuals, including their families and caregivers, to access their services provided by MassHealth and its managed care plans.
Slide 3: Inquiries and Complaints
October 1, 2019-March 30, 2020
Slide 4: One Care Health Plan Inquiries 
October 1, 2019-December 31, 2019
*Note: A table is shown with the following information:
Total Inquiries: 15*
Inquiry Topics
•	Transportation = 4
•	Enrollment/Disenrollment =2
•	General Information =2
•	Physician/Hospital =2
•	Appeals/Grievances =1
•	Behavioral Health =1
•	Benefits Access =1
•	LTSS =1
•	Pharmacy/Medication =1
•	Total =15
*This number represents the total number of inquiries received. One individual may have more than one inquiry. For this quarter, 14 individuals made a total of 15 inquiries.
Slide 5: One Care Health Plan Inquiries 
January 1, 2020-March 31, 2020
*Note: A table is shown with the following information:
Total Inquiries: 15*
•	Appeals/Grievances =5
•	Other =3
•	Enrollment/Disenrollment =2
•	Benefits Access =1
•	Care Coordinator =1
•	CLAS/Accessibility =1
•	Transportation =1
•	General Information =1
•	Total =15
*This number represents the total number of inquiries received. One individual may have more than one inquiry. For this quarter, 14 individuals made a total of 15 inquiries.
Slide 6: One Care Health Plan Complaints 
October 1, 2019-December 31, 2019
*Note: A table is shown with the following information:
Total Inquiries: 87*
•	Appeals/Grievances =18
•	Transportation =12
•	Care Coordinator =11
•	Benefits Access =9
•	Pharmacy/Medication =9
•	LTSS =9
•	Physician/Hospital =8
•	DME =5
•	Claims/Payment =3
•	Home Health Agency =3
•	Other (subjects with 2 or fewer complaints) =1
•	Total =87
*During this period, there were a total of 87 complaints made by 62 individuals.
Slide 7: One Care Health Plan Complaints 
January 1, 2020-March 31, 2020
*Note: A table is shown with the following information:
Total Inquiries: 107*
•	LTSS =16
•	Appeals/Grievances =13
•	Transportation =13
•	Benefits Access =12
•	Care Coordinator =10
•	Claims/Payments =10
•	DME =8
•	Physician/Hospital =6
•	Enrollment/Disenrollment =5
•	Other (subjects with 4 or fewer complaints) =8
•	Total =107
*During this period, there were a total of 107 complaints made by 76 individuals.  
In February 2020, My Ombudsman had a high of 96 cases opened across all plans since My Ombudsman began in July 2018.
Slide 8: Evaluating Ombudsman Services and Outreach
*Note: A table is present with the following information:
Title: Results from My Ombudsman Member* Satisfaction Follow-Up Surveys*:
•	Members who rated our ability to understand their problem well to very well = 97%
•	Members who indicated they felt respected by Ombudsman staff =94%
•	Overall member satisfaction: members who were satisfied to very satisfied =78%
Title: How Individuals** Heard About My Ombudsman:
•	CCA Plan Staff Member =11.1%
•	Care Team Member =7.4%
•	Health Care Provider =3.4%
•	Outreach Event =3.4%
*64 individuals were called. 53% (34 individuals) agreed to participate in the survey.
Slide 9: Member Feedback About My Ombudsman Services
•	“You guys are the only people that cared about me. You guys are the only people that helped me. I was having a problem with insurance and they wouldn’t approve my medication.”
•	"It was all the difference when your office spoke to the plan. They straightened out the problem. I was making calls and I was so confused, and when I called your office everyone was so helpful. Your concern and respect for me was beyond my expectations.
•	"You guys were very responsive and very helpful in following up. Our issue wouldn't have been resolved without your help."
Slide 10: COVID-19: Case Examples*
•	Some dental cases are on hold because providers are only available for emergencies.
•	Care Coordinator changes have not been allowed during the pandemic.
•	Early refill policy not followed for medications.
•	Members in need of more PCA hours due to the pandemic.
*My Ombudsman has had 20 COVID-related cases across all plans. This slide contains isolated examples and not trends or patterns.
Slide 11: How to Contact My Ombudsman
•	Hot Line (855) 781-9898
•	Videophone (339) 224-6831
•	Email us at info@myombudsman.org 
•	Website: https://myombudsman.org/
We speak Spanish and Cantonese. We use ASL.

Address: 11 Dartmouth Street, Suite #301, Malden, MA 02148 
Office Hours:  Monday – Friday, 9am-4pm
Walk in hours:  Mondays: 1pm-4pm; Thursdays: 9am-12pm