Michigan Breast and Cervical Cancer Navigation Program (BCCCNP)

1. Michigan Breast and Cervical Cancer Navigation Program(BCCCNP) Introducing Patient Navigation to Provider Offices June 7, 2016

2. Program Goal Assure low-income women receive timely access to needed breast and/or cervical cancer services.

3. BCCCNP Service Components • Two Types of ServicesProvided • Caseload Services – BCCCNP acts as a “insurance company” and pays for breast and cervical cancer screening and/or diagnostic services with contracted providers for women who are uninsured or underinsured. • Navigation-Only Services – provides reimbursement for patient navigation to assist insured women to overcome barriers that may prevent them from receiving breast and cervical services.

4. Eligibility Criteria for Navigation- Only Services • Be between the ages of 40 and 64 • Income < 250% Federal Poverty Level* • Income criteria set by federal law- must document woman’s verbal statement of income; no written proof required • INSURED • Requires breast/cervical cancer-related services ONLY • Pap test, Mammogram, and/or follow-up services for abnormal test result

5. NMHSIand BCCCNP • Provide Navigation-Only Services: • Increase the use of patient navigation in provider offices: • providing financial incentives for providing navigation. • Improves the quality of care provided to UP residents. • Decreases health care costs by preventing cancer or detecting it early.

6. How can Navigation Help? Is fear the reason she is not being screened? Does she really understand how cancer screening can help her? Are there family care or transportation issues? Have you looked for appointment times that work with HER schedule? Ask… Understand… Educate…

7. Navigation in Provider Offices Improves provider screening rates and HEDIS rates Promotes earlier screening and successful diagnostic resolution Identifies barriers that impede access to obtaining services Provides individualized support and assistance to overcome barriers/problems Decreases no-shows which are costly to offices BCCCNP provides the funds to pay providers to reach out to their clients

8. Who Do We Navigate? To be eligible women must meet the following: • BCCCNP age, income, insurance eligibility criteria AND • Is in need of breast / cervical cancer screening or diagnostic assistance AND • Requires education/assistance/resources to obtain needed breast/cervical cancer services • Is willing to complete breast /cervical cancer screening

9. How do we find these women? • AIMED at women who have never been screened or who face barriers to completing their screening and/or diagnostics. • Who has not completed cancer screening? • Patient records/Gaps in care report • Who needs diagnostics? Did they complete? • Conversations with patients

10. Patient Navigation Team Navigation is a process, not an individual: Navigation services can be provided by one person or shared by several individuals. Patient Navigator does not need to be a health care professional to provide non-clinical services. Unmet needs are identified and then split based on the skills of each team member.

11. Navigation in the office Non-clinical office staff: • Identify who is in need of cancer screening and flag the chart • Provide small media materials to patients in need of cancer screening as they check for an appointment • Schedule mammograms or diagnostic procedures before the client ever leaves the office. • ASK about times that are best for the patient

12. Navigation in the office RN and MA staff: Have the conversation, ask questions, understand cancer screening or diagnostic follow-through from her perspective. Why hasn’t she completed screening? What stands in her way? How can you help her resolve those barriers?

13. Information Needed to Document Navigation Services Age/Income (Program mandate: 40-64, < 250% FPL) Breast/Cervical screening services needed Barriers/problems the woman may have to receiving services Assistance provided by navigator to overcome barriers/problems Types and dates of services received

14. Encounter Form Intake Assessment Navigation Forms

15. Form # 1 - Intake Assessment Used by Navigator to document 1st encounter: • Client Eligibility by income (< 250% FPL) • Breast and/or cervical screening and/or diagnostic services required by the client • Barriers that may interfere with obtaining these services

16. 2016 FPL Guidelines 2016 Federal Poverty Level (FPL) Guidelines

17. Intake Assessment: Client Information • Client Verbal Acknowledgement - Verifies that client has agreed for assistance in obtaining breast/cervical services • A separate informed consent is not required

18. Intake FormClient Assessment: Services Required

19. Intake Form: Barrier Assessment • At least ONE barrier must be checked. • For each barrier checked, record in comments how it will be addressed.

20. Form # 2- Navigation Encounter Form Used by Navigator to document: • Breast and/or cervical cancer screening and/or diagnostic services received by the client • Referrals/Resources provided to the client

21. Encounter Form: Navigation Services Completed Document the following: • Dates of screening/diagnostic services received • Referrals/Resources provided to client

22. Encounter Form: Navigation Status Navigation status (ongoing): • Do you need to contact the client again? – Yes, identify when you will contact the patient. • Provide brief comments on current encounter

23. Encounter Form: Navigation Status Navigation status (complete): • Do you need to contact the client again? – No, all breast/cervical screening/diagnostic services are complete. • Provide brief comments on current encounter. • Sign and date encounter form

24. Navigation-Only Key Components Client is eligible (age and income) At least ONE Barrier/Problem is identified A solution is put in place for each identified barrier/problem. Client receives needed breast or cervical screening and/or diagnostic services.

25. When is Navigation Complete? • Has at least 2 (TWO) encounters with designated office staff via phone, email, or in-person • Completes breast and/or cervical cancer screening and any required diagnostics.

26. Options for Uninsured and Underinsured Women

27. Funding for Providing Navigation Services • MDHHS will fund the agency with $18,000 in one lump sum payment. • $6,000 “Administrative fees” • Identifying clinic sites to participate • Training the clinic sites – with MDHHS assistance, if needed • Collecting all navigation forms from the clinics • Reviewing all forms for completeness • Sending all forms to MDHHS • $12,000 = $60 per woman navigated (200 women = target) • Payment to your sites/clinics will be internally among your agency and the clinics

28. BCCCNP Caseload Services • BCCCNP will pay for breast/cervical cancer screening and diagnostic services for those who are do not have insurance or who need diagnostics but face a high deductible • Defined as: “I cannot afford that amount” • Will count as navigation (you resolved an insurance/financial barrier) • IMPORTANT: You must refer these women to the _______BCCCNP agency for these services to be covered by BCCCNP • If cancer diagnosed, women may qualify for treatment through the BCCCNP Medicaid Treatment Act Program

29. MDHHS Assistance • Data Entry will be completed at MDHHS -- Clinics will fill out the forms and fax to one centralized location at the agency for verification of completeness. --Completed forms will be mailed to MDHHS for data entry • Assist with agency staff trainings • Develop agency specific reports

30. Frequently Asked Questions 1. Who do I contact with questions about completing the form or if a woman qualifies for BCCC navigation services? Tory Doney - doneyt@michigan.gov or 517-335-8854. 2. Who do I call to learn more about navigation in my practice? Debbie Webster – websterd1@michigan.gov or 517-335-8517.

31. Frequently Asked Questions 3. Does the program provide support for women diagnosed with breast or cervical cancer? • YES!! Income eligible women, (insured, uninsured, and underinsured) may be eligible to enroll in a special Medicaid program through the BCCCNP. • The woman MUST be newly diagnosed in order to qualify • EXCEPTION: Women currently enrolled in HMP can transfer into the BCCCNP Medicaid program at any time during the treatment phase where they will incur NO co-pays! Contact Ann Garvin – GarvinA@michigan.gov(517-335-9087) or E.J. Siegl siegle@michigan.gov (517-335-8814) if you have a client newly diagnosed with breast or cervical cancer who may qualify for this program!

32. Next Steps 1. Develop Work Plan (template) - Outline for implementation of project 2. Identify project start date 3. Identify trainings agency will require prior to project start date 4. Obtain baseline data for breast/cervical cancer screening by participating provider offices • USPSTF: mammogram women >age 50-70, every 2 years • Pap test every 3 years in women age 21-65 (or Pap/HPV in women >30 every 5 years)

33. MDHHS Contact Information Tory Doney (Department Analyst) DoneyT@michigan.gov 517-335-8854 Ann Garvin (Nurse Consultant) GarvinA@michigan.gov517-335-9087 Debbie Webster (Navigation Consultant) websterd1@michigan.gov 517-335-8517 E.J. Siegl (Pgm Director/Nurse consultant siegle@michigan.gov517-335-8814