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THE UNINSURED CONNECTION CHALLENGE. Segments to be presented:. A Statewide Overview by Steve Cooper, ClaimAid Collaboration by Paul Pfaff, IU Health Effective Community Outreach By Kate Gentry & Mike Mannell, IU Health. A Statewide Overview Steve Cooper, ClaimAid.
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THE UNINSUREDCONNECTION CHALLENGE “Connection Challenge"
Segments to be presented: A Statewide Overview by Steve Cooper, ClaimAid Collaboration by Paul Pfaff, IU Health Effective Community Outreach By Kate Gentry & Mike Mannell, IU Health “Connection Challenge"
A Statewide OverviewSteve Cooper, ClaimAid “Connection Challenge"
Uninsured/Underinsured Challenges in Patient AccessInternal Inventory and Analysis • Connect • Communicate (Community) • Conversation (Patient / Family) • Comprehensive Review “Connection Challenge"
Make a ConnectionWho are the Uninsured? • There are 50 million uninsured persons in the US • 9 million uninsured children – approx. 6 million are eligible for coverage. • Indiana: approximately 900,000 uninsured • > 132,000 Children • 772,000 non-elderly adults • Both Medicaid and the Children’s Health Insurance Program (CHIP) offer health insurance coverage to children in low- and moderate-income families. • Indiana offers 27 categories of Medicaid “Connection Challenge"
Who are the Uninsured, cont… • Enrollment has been increasing, with 40 million children insured by Medicaid or CHIP in 2009 but barriers remain. • Recognize vulnerable patients’ needs • Remember there are cultural differences from one community to the next • Identify the set of struggles unique in your community • Strategize Outreach with community partners “Connection Challenge"
A New Face of the Uninsured • In 2010, an average of 310,000 Hoosiers were unemployed each month. This is more than double pre-recession levels. In 2007, unemployment was around 148,000 per month. • Nationally, and in Indiana - close to 30% of the unemployed remain unemployed long-term. This means approximately 100,000 Hoosiers in a given month may have been out of work for a year or more and have lost not only their health care coverage - but they are also exhausting their unemployment insurance benefits. • Considering the large % of unemployment in the manufacturing and construction industries, and the age and education level of this segment of the unemployed population (average level HS education or less) - substantial barriers to re-employment and access to health coverage exist. “Connection Challenge"
Perceptions of and Barriers to Enrollment • Most eligible uninsured children are concentrated in low income families • 1/3 of uninsured children have uninsured YET eligible parents • In recent studies >90% of low income parents are willing to enroll their children • 45% did not think they were eligible • 55% did not know how to apply • 50% felt the enrollment process was difficult • 51% did not know where to go for more information “Connection Challenge"
Communicate Common GoalLack of Awareness of Available Resources • Obtain Buy-In from all stakeholders • Coordinate pre-registration w/pre-screening of eligibility for coverage • Screen at point of service in Emergency Department for all programs • Coordinate screening cooperation with Financial Assistance eligibility • Educate all community partners of availability of resources to screen and assist patients "Individual commitment to a group effort - that is what makes a team work, a company work, a society work, a civilization work. " ~ Vince Lombardi “Connection Challenge"
Patient Access Points “Connection Challenge"
Conversation • Tools to screen are helpful but do not provide the complete picture for the assistance group. • Thorough face to face interview prior to or at Point of Service reaps best results. • Tone of voice, being non-judgmental, and keeping a sincere attitude is essential to gain confidence. (Patient’s Voice Skill Clinics) • Assist with filing of appropriate application(s) and collection of necessary documentation. • Education of deadlines and responsibilities/ consequences is necessary element. • Good understanding & awareness of current FSSA application process in your region of the state. “Connection Challenge"
Hybrid Roll-out Timeline by DFR Regions Region 1 = Lake (TBD) Region 2 = Saint Joseph (TBD) Region 3 = Allen (2/14/11) Region 4 = Grant (2/14/11) Region 5 = Marion (TBD) Region 6 = Vigo (6/22/11) Region 7 = Vanderburgh (1/26/10) Region 8 = Clark (9/19/11) “Connection Challenge"
Comprehensive Review • Follow up with processing entity ( DFR or Regional Call Center) by utilizing state’s available tools i.e. Authorized Representative forms, Agency Portal, participating in FSSA DFR Regional Advisory Group. • Make periodic identification of strengths and weaknesses in your system and processes to ensure that best allocation of resources are used. • Add screening access points as identified. • Implement performance indicators at key revenue cycle points to measure trends to quickly remedy problems. • Encourage patients to appeal inappropriate denials. • Be an advocate. “Connection Challenge"
A Referral System with Connections Why relationships are so important in maximizing Healthy Indiana Plan Enrollment Paul Pfaff, IU Health “Connection Challenge"
Vision and Purpose • Converting self pay and no pay patients into patients with health insurance • Increases revenue IU Health would receive for these patients • Reduces billing and collection efforts • Provides much needed community outreach • Offers a valuable service to those that utilize services within the system “Connection Challenge"
What we do • In 2009, the Clarian HIP Enrollment Center (now the IU Health Enrollment Center) was formed to: • Work with IU Health Marketing to develop marketing and educational communications for employees, patients, and the public • Develop referral network to identify and enroll HIP eligible individuals within the system and the community • Partner with HealthNet to identify and enroll HIP eligible individuals through • New patient intake • Existing patient referrals • Outreach • Participate in Outreach with IU Health Community Outreach and Engagement as well as identify outreach opportunities independently • Conduct annual survey of 2,000 – 3,000 IU Health affiliated supplemental employees for HIP eligibility “Connection Challenge"
Why Operate on Referral • 5 large hospitals in the Indianapolis Metro-plex • Numerous PCP and specialty offices • Affiliated FQHC with 8 separate locations • Large urban area includes: • One of the largest school districts in the state • Several homeless shelters and assistance organizations • Churches, neighborhood associations, small businesses • In short: ”A bunch of them…few of us!” “Connection Challenge"
Partial List of Referral Locations • Facilities • Emergency Department • Inpatient • Outpatient • Pre-Services • Clinical Social Work Staff • Organ Transplant • Pastoral Care • Occupational Health • Patient Financial Services “Connection Challenge"
Partial List of Referral Locations • Providers • FQHCs • Affiliated and friendly Primary Care • Affiliated and friendly Specialists • Clinics • Homeless Shelters • Churches • Small Employers “Connection Challenge"
Referral Solution • Needed to identify a solution that: • Integrates into organization’s work flows causing minimal additional effort on staff • Maximizes the number of individuals or patients that are screened for eligibility • Educates individual or patient on the benefits of the Healthy Indiana Plan • Results in working referrals to the IU Health Enrollment Center for successful application processing • Maximizes HIP enrollment for resources expended “Connection Challenge"
Referral Survey Tool • Can be tailored to the organization or department (aids in tracking) • Survey questions can vary based on application • Can be developed to serve additional uses • Can be completed by staff based on interview with patient or available in waiting rooms for patient or family members to fill out on their own “Connection Challenge"
HIP Survey - Examples • Emergency Department • FQHC Clinic Office
Specialty Surveys • To identify Package B Moms who would be eligible for HIP after pregnancy Medicaid benefits run out
“You have to kiss a lot of Frogs” • To date, the IU Health Enrollment Center : • Operates with a staff of 7 employees and draws from the undergrad and graduate Health Administration programs at IU and IUPUI • Has received more than 2,200 Healthy Indiana Plan referrals • Investigated 2,000 of them with 630 being converted to applications (31.5%) • Currently investigating 200 referrals • Is actively assisting MDWise with the redetermination of HIP members in the Methodist network (approximately 100 per month) • Is actively contacting approximately 11,000 HealthNet patients who have not been screened for HIP who may be eligible • Has originated 1,675 applications from referral, redetermination and outreach: • 877 submitted and processed by the state with 597 approved (68.1%) • 121 pending with the state • 257 pending information from the applicant • 420 closed for failure to cooperate • Have made 405 POWER Account subsidy payments totaling more than $65,000 through the Methodist Health Foundation “Connection Challenge"
What’s Next? • In early 2010, IU Health renewed its Enrollment Center Agreement with FSSA • Listed all 15 affiliated hospitals as enrollment centers • Included the IU Health Enrollment Center as an enrollment center • Effectively expanded application responsibility of IU Health Enrollment Center to include HIP, Hoosier HealthWise, Medicaid, and Medicaid-related and waiver programs “Connection Challenge"
Community Outreach & Marketing IU Health Mike Mannell & Kate Gentry “Connection Challenge"
Regional Focus • IU Health South Central • Represents Bloomington, Bedford, and Paoli hospitals • Servicing 10-county area “Connection challenge"
Roles in the Community • Facilitate enrollment processes for Healthy Indiana Plan (HIP) • Authorized Representative serving as liaison between applicant and FSSA or insurance carriers • Collaborate with community agencies and public service organizations “Connection challenge"
Outreach Goals • Decrease uninsured/self pay population • Increase HIP enrollment by county • Market & educate communities on affordable insurance options • Encourage preventative care by promoting access to insurance “Connection challenge"
Outreach & Marketing Strategies • Internal • Effectively educate and maintain relationships with associated hospital departments • External • Grassroots efforts, network with local resource agencies, and actively build relationships with public service organizations “Connection Challenge"
Internal Support • Keeping employees and departments up-to-date on HIP-related information • Build a network of referrals available within the hospital • Awareness of HIP is the single most important strategy for internal networking • Partnering with key departments sponsoring and hosting community events “Connection Challenge"
Support of Internal Departments • Community Health • Community events, WIC, Family Wellness Programs • OB/GYN Department • Prenatal education and Postpartum awareness • Human Resources • Employee Wellness program & eligible part-time/temp employees “Connection Challenge"
Key Internal Referrals • Patient Financial Services • Caseworkers, Financial Counselors, Social Workers all coordinate referrals to HIP eligible patients • Direct Mail -Key demographic information used to identify potential eligible individuals located in 10 county service area • IU Health Urgent Care Facility • Behavioral Health • Emergency Department • Patient Accounts “Connection Challenge"
External Outreach • Identifying our presence and role in the community • Build relationships with community health care providers • Networking with community resource agencies and public service organizations • Real grassroots efforts in rural areas “Connection Challenge"
External Support • Referrals from networking with community agencies and public organizations • Invitations to participate in local public events • Health fairs & Children’s wellness events • Community gatherings • Volunteers in Medicine • Provides healthcare to uninsured, low-income population of Monroe and Owen County • HIP advertising • Radio shows • Newspaper advertisement • Word-of-mouth referrals • Very important, especially in small, rural towns “Connection Challenge"
Grassroots Efforts • Willingness to become involved in smaller populations and events is key to gaining access and acceptance within communities • Identify areas of interest within demographic regions • Advertise at local “Hot Spots” (restaurants, gas stations, parks & lakes, churches, etc.) • Brand your role by “Representing the Program” “Connection Challenge"
Valuable Resources • Networking Drop-off Database • Created to help organize distribution of HIP material • Ensures efficiency by identifying specific county locations and scheduled follow-ups • Intern/Volunteer Opportunities • Adds new ideas and processes to the team • Experience in public health field and inter-department hospital relationships “Connection Challenge"
Financial Assistance for HIP Power Account Payments • Individuals are assigned monthly premiums based on 2-5% of their income • Funding available through the Bloomington Hospital Foundation • In 2009, $125,000 was allocated towards financial assistance • By the end of 2010, over $100,000 was applied toward HIP subsidy’s and assisted over 400 members • Each patient is eligible to receive up to $600 annually “Connection Challenge"
ConclusionKey Elements to Reduce Uninsured in Indiana • Encourage Indiana FSSA to continue to adopt improved enrollment and renewal procedures to reduce burdens on families. • Expansion of programs does not = more individuals enrolled. Connecting people to the expanded programs = more individuals enrolled. • Promotion of coverage options at: • Each Access Point/ Registration • Community Outreach • Ongoing education of all partners: • Internally • Externally • Be open and invite new ideas to continue to connect people tomedical coverage options. “Connection Challenge"
QUESTIONS???THANK YOU!!! “Connection Challenge"
Presenter Contact Information Steve Cooper, ClaimAid 800.842.4052 x116 scooper@claimaid.com Paul Pfaff, IU Health 317.963.9774 healthyindianaplan@iuhealth.org Mike Mannell 812.353.2023 mmannell1@iuhealth.org Kate Gentry 812.353.2022 kgentry2@iuthealth.org “Connection Challenge"