Slide 1: My Ombudsman MassHealth Health Plans
Presented By
Leslie Diaz, Director
September 14, 2021
Slide 2: Our Mission
My Ombudsman is operated by an independent non-profit program (the Disability Policy Consortium). At My Ombudsman, we empower individuals, including their families and caregivers, to exercise their rights and access the services provided by MassHealth and its managed care plans.

We ensure that individuals can exercise their rights and access the benefits they have as a MassHealth member. 
Slide 3: Overview
•	Review of Quarter 2 data for One Care plans
o	Inquiries, complaints, outreach
•	Member feedback
•	Questions and comments
Slide 4: One Care Health Plan Inquiries
Quarter 2: April 1, 2021 – June 30, 2021
Inquiry Subject	Number of Inquiries	
General Information	5	
LTSS	3	
Enrollment/Disenrollment	3	
DME	3	
Care Coordination/Care Manager	2	
Pharmacy/Medication	2	
Appeals/Grievance Process	2	
Benefits/Access	1	
Physician/Hospital	1	
CLAS/Accessibility	1	
TOTAL INQUIRIES	23	

Slide 5: One Care Health Plan Complaints
Quarter 2: April 1, 2021 – June 30, 2021
Complaint Subject	Number of Complaints	
LTSS	25	
Benefits/Access	14	
DME	12	
Care Coordination/Care Manager	7	
Claims/Payment	7	
Physician/Hospital	5	
Pharmacy/Medication	4	
Transportation	4	
Appeals/Grievance Process	3	
TOTAL COMPLAINTS	85*	

*Total includes complaint subjects with fewer than 3 records (not shown): CLAS/Accessibility, Plan Administration, Home Health Agency
Slide 6: One Care Individuals Assisted
Quarter 2: April 1, 2021 – June 30, 2021
•	20 individuals submitted a total of 23 inquiries
•	57 individuals submitted a total of 85 complaints
•	23 of the 57 individuals who submitted complaints were new to MYO services
Slide 7: Common Complaints
•	Regarding the top 3 complaints
o	LTSS issues varied across PCA, homemaker, and meal delivery services
o	Most Benefits/Access cases were related to dental care requests or denials
o	Most DME cases were related to damaged items that needed immediate repair
•	In about 20% of these cases, My Ombudsman took immediate action due to safety concerns or delays in plan/care team responsiveness. 
•	My Ombudsman recommends that plans consider implementing a line of communication for members to report urgent issues that aren’t considered behavioral health or medical emergencies (since that line of communication already exists.) 
Slide 8: Case Examples
•	A One Care member needed to replace a partially broken feeding tube urgently. They asked their care team for help but had not heard back in a few days (member's report). They reported this to My Ombudsman who contacted the original vendor and learned that they did not have the parts necessary to fix the feeding tube. My Ombudsman relayed this information to the member’s care team, and they quickly found another vendor that could provide the necessary parts.
•	Another member reported that after being hit by a car, their main wheelchair was damaged and unusable, but it could not be assessed for repair for several weeks. The member was using a backup wheelchair that was damaged and uncomfortable to use. My Ombudsman asked the member if they had contacted their care team. Since they had not, My Ombudsman recommended this as the first step. The member heard back from the care team the next day and it appeared that they were able to work with the vendor to move the assessment up two days. Shortly after the update, the member told My Ombudsman that their discomfort had turned into pain and a visible injury. They said they had not heard from their care team in two days since reporting this to them. My Ombudsman immediately asked the plan to intervene and notify the care team. Four days later, the member received a safe loaner wheelchair to use until the assessment could take place.
Slide 9: Case Examples
•	A One Care member reported that their chair lift was not working, and the vendor could not provide a timeframe by which it would be repaired. The member could only use the stairs by crawling. The member stated that they hadn't heard from their Care Coordinator in 4 months. The member said they called the plan more than 20 times for help but kept "going in circles" with different people. My Ombudsman worked with the plan to engage with the care team and the vendor to coordinate the chair lift repair as soon as possible.
•	A One Care member’s homemaker agency closed permanently, and they were left without meal preparation post-surgery. The member reported that their Care Coordinator was unwilling to help, though they had spoken several times. My Ombudsman immediately worked with the Care Coordinator, the plan and care team to set up a meal delivery service for the member until they could find a new homemaker.
•	Another One Care member reported that they were having ongoing issues with their meal delivery service and the care team had been unable to find a solution. My Ombudsman worked with the member’s care team and ultimately the member was provided with a companion for grocery shopping so that the member could choose the food they needed.
Slide 10: Outreach
How Members Heard About My Ombudsman*
Source	​Quarter 1 **	Quarter 2	
Plan Customer Service​	35.7%	20.4%	
MH Customer Service	8.3%	8.9%	
Care Team Member	10.7%	6.2%	
One Care Member	<5%	5.3%	
Other	17.9%	16.8%	
Unknown	6%	17.8%	

*Data shows only sources greater than 5%
**Quarter 1 data has been corrected; corrected data shown here.
Slide 11: Outreach
Recent activities
•	Deaf Services Director co-hosted a live virtual event with Health Care For All (June 2021)
o	 The event was geared towards the Deaf/HOH community. Both HCFA and My Ombudsman gave an overview of their services.
o	 Attendees had the opportunity to ask both organizations questions about their eligibility and benefits through MassHealth’s managed care plans. 
•	Multilingual ad campaign, print and online (June 2021)
o	A short blurb about My Ombudsman services was placed in In El Planeta, (Spanish), Sampan (Chinese/English), Brazilian Times (Portuguese) 
•	MassHealth sent an outreach mailing to One Care members that included an informational letter and magnet (July 2021) 
o	Likely as a result, the number of One Care complaints almost doubled from July 2021 to August 2021, from 40 to 78
•	New and updated website launch (August 2021) 
o	In response to the pandemic, My Ombudsman has been working to improve its virtual presence. Over the past year, we worked with a web design/branding consultant and a culturally-responsive partner organization to improve the cultural competency and accessibility of the website and informational materials. 
o	Site users with various disabilities tested the accessibility of the website and their feedback was incorporated by the designer. The site also includes an accessibility “widget” to allow for users to modify the site based on their needs.
Slide 12: Member Feedback
•	"…The Ombudsman really understood what was going on. I thought she was very conscientious…. I have no complaints."
•	"You did everything beyond what I expected."
•	"The Ombudsman understood what I was saying, and I understood him…. I’m grateful to have someone I can call when I have problems.”
Slide 13: Thank you!
Questions or comments?
Slide 14: Contact Us
My Ombudsman
MassHealth Health Plans

•	Phone: 855-781-9898
•	Videophone: 339-224-6831
•	Email: info@myombudsman.org
•	Web: www.myombudsman.org
•	Nosotros hablamos Español
•	Nós Falamos Português
•	We use ASL

We use an interpreter phone service for many other languages as needed