Care Solutions & Medical Home

1. Care Solutions & Medical Home November 2010

2. Article 28 Federally Qualified Health Center NCQA certified, JCAHO accredited, Planetree Health Care Organization Mission: To increase access to comprehensive primary and preventive health care and to improve the health status of our community, especially for the underserved and vulnerable.

3. Community Health Sites (16) Pine Plains New Paltz Amenia Walden SULLIVAN Poughkeepsie (2) Monticello Dover Plains Beacon Goshen Peekskill Haverstraw Health Center Yonkers Migrant Health Migrant Voucher program Greenport Public Housing Riverhead

4. Organizational Overview Network of 16 sites (Migrant, Homeless, Public housing, Ryan White, Community Health Center) Secured NCQA Level 3 Medical Home Designation for network of sites, adding additional revenue ($6/MA patient/month) Full electronic health record implementation across 16 sites by April 2009 Maintained provider productivity at 3600 visits/physician Improved Medicaid and Medicaid Managed Care from 29% of visits to 39% of visits Increased federal grants by over $3.5 Million in 5 years

5. Daily Challenges 2008 “Free Clinic” Image The Growing Uninsured Static Funding Medical Home

6. “Pardon me, but could you tell us where the public trough is?”

7. 2001-2009 UDS

8. Revenues by Payer Source* *Health Centers meeting federal grant requirements and receiving Section 330 funding ** Includes state, local, foundation, and private grants and contracts Source: Bureau of Primary Health Care, HRSA, DHHS, 2002 UDS

9. Patients by Poverty Level Unknown We don’t know where to put them on the sliding fee scale Note: Other Public includes Early Intervention Source: Bureau of Primary Health Care, HRSA, DHHS, 2008 UDS

10. Medical Home Elements Addressed • Access & Communication • Scheduling each patient with a personal clinician for continuity of care • Identifying health insurance resources for patients/families without insurance • Making language services available for patients with limited English proficiency • Patient Tracking & Registry Functions • Use of an electronic system that includes demographic data (name/DOB/gender/Marital status/race/ethnicity/telephone)

11. Care SolutionsReframing of the cost of health care & how we communicate it

12. Care Solutions The Care Solutions Benefit is presented in a face-to-face meeting with an Access Coordinator and provide orientation to program: • Create your medical home and selection of primary care giver • Assess all demographic information to verify it is correct • Render a Care Solutions ID card with picture • Examine ways to make your care affordable ***

13. Care Solutions - Philosophy • Quality health care with a solution for making it affordable, for anyone who walks in the door • Redesign of our intake process – introduction to the Health Center • Culture shift in the way we approach collecting payment – difference between ability to pay, and willingness to pay • As an FQHC we are able to provide care to all who seek it. • For those who are insured, we proudly take most insurance • For those who are uninsured, we screen for eligibility for PB • For those who are not eligible for PB, we offer a sliding fee scale • In order to maximize care to all those who need it, we must collect the discounted amounts set by our consumer Board of Directors.

14. Approach • Refocus on Board role • Engage front end staff in focus groups • Training, training & more training • Develop scripts • Develop patient education materials • Review special population specific issues • Assess & Review implementation • Retrain • Assess, etc.

15. “Uninsured? That needn’t be a problem. We can refer you to a very fine doctor in Ottawa.”

16. Board of Directors • The Hudson River HealthCare, Inc. (HRHCare) Board of Directors is responsible for ensuring that we have policies (including financial policies) that follow federal and state laws and ensure that we are able to provide access to care for all the patients in our communities that are in need. • In order to maximize care to all those who need it, we must collect the discounted amounts owed. • Our policies require that we collect the amount that the patient is responsible for. The amount that you are required to pay is based on a highly discounted schedule determined by the Board of Directors based on the information that you provide regarding your family size and income.

17. We can improve data collection! • Ask where someone falls on the sliding fee scale “Hudson River HealthCare, Inc. (HRHCare) is pleased to now offer all Health Center patients the Care Solutions Benefit. If you are ineligible for insurance, you will charged according to a highly discounted sliding fee scale determined by HRHCare’s Board of Directors based on the information that you provide regarding your family size and income.”

18. We can improve on collecting copays and fees! • “This is the minimum amount that is required at the time of service. It is the highly discounted amount set by our Board of Directors. In order to maximize care to all who need it, we must collect the discounted amounts owed by each patient”

19. We can improve on linking patients to public benefits they may be eligible for! “Hudson River HealthCare, Inc. (HRHCare) is pleased to now offer all Health Center patients the Care Solutions Benefit. If you are uninsured, the Access Coordinator will screen and link you with any public benefits that you may be eligible for. Let’s take a quick look at the income and family requirements to see if you may be eligible.”

21. Care Solutions Hudson River HealthCare, Inc. (HRHCare) is pleased to now offer all Health Center patients the Care Solutions Benefit. As an introduction into Care Solutions, all patients will have a face-to-face meeting with an Access Coordinator, who will graciously introduce you to the Health Center’s unique model of care and: Create your medical home and selection of primary care giver Assess all demographic information to verify it is correct Render a Care Solutions ID card with picture Examine ways to make your care affordable ***

22. “Unfortunately , you have what we call ‘no insurance’.”

24. Care Solutions, cont. • ***If you are insured, the Access Coordinator will make sure that HRHCare accepts your insurance and that the Health Center is your designated Primary Care Provider. • If you are uninsured, the Access Coordinator will screen and link you with any public benefits that you may be eligible for. • If you are ineligible for insurance, you will charged according to a highly discounted sliding fee scale determined by HRHCare’s Board of Directors based on the information that you provide regarding your family size and income. HRHCare’s Board of Directors is responsible for ensuring that we have financial policies that follow federal and state laws, while providing access to care for all the patients in our communities that are in need. In order to maximize care to all those who need it, we must collect the discounted amounts owed.

32. Care Solutions Packet

33. Migrant Specific Implementation • Patient education materials • Face to face interview to provide information • Scripts and coaching for documentation assistance • Dental fees • Emphasis on 100% poverty guidelines • Linkages with public benefits partners

34. Implementation Challenges • Training & Retraining • Culture of patient centeredness • Workflow • “Go Live” Burnout • Assessing & Reassessing • Supporting the front lines

35. Questions?