4 million people still in the medicaid gap - developing a network of care beyond free/low-cost...
TRANSCRIPT
© 2016 Enroll America | StateOfEnrollment.org
Valencia Bostic, Director, Chronic Disease Prevention, Palmetto Health; Russell Robinson, Manager, Patient Financial Clearance, Palmetto Health & Christopher Irizarry, MPA, Vice President and Executive Director of Clinic Services, Health Care District of Palm Beach County | 05.13.16
4 Million People Still In Medicaid Gap – Developing a Network of Care
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• What you can expect and who are our panelists
• Number of people in the coverage gap, who & where they are
• A brief look at the services in FL
• Small group discussions
• Larger group discussion
• Debrief & speaker closing
• Next Steps
AGENDA
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• Understand outreach that is inclusive and culturally sensitive
• How financial components lead to access to services
• The importance of collaborative partnerships to facilitate flow of services
WHAT YOU CAN EXPECT
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INTRODUCING OUR PANELISTS
Christopher F. Irizarry, is an Officer with the Health Care District of Palm Beach County
Valencia Bostic, Director, Chronic Disease Prevention, Office of Community Health Palmetto Health
Russell D. Robinson, Manager, Financial Navigation, Palmetto Health
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• Nationally, nearly 4 million adults fall into the coverage gap
• Adults in the coverage gap are spread across the country in states with the largest uninsured populations
OVERVIEW
FL GA NC Other States that Have Not Expanded Medicaid TX
FL20%
NC8%
GA11%
Other States that Have
Not ExpandedMedicaid
35%
TX26%
Midwest Northeast South West
Midwest7%
South89%
Northeast1%
West3%
Source Kaiser Family Foundation
© 2016 Enroll America | StateOfEnrollment.org Fair or Poor Good Excellent of Very Good
Excellent or Very Good50%
Fair or Poor18%
Good32%
Hispanic White Black Other
Black 28%
Hispanic 23%
White 45%
Other 4%
55-64 35-54 19-24 25-34
19-24 years 24%
55-64 years17%
35-54 years35%25-34 years
24%
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• Racial/ethnic characteristics of those in the coverage gap vary by state
• Adults of all ages fall into the coverage gap
• Uninsured are less likely than those with insurance to receive preventive care
OVERVIEW (continued)
Source Kaiser Family Foundation
© 2016 Enroll America | StateOfEnrollment.org
Miami – Dade CountyJackson Memorial Hospital - Jackson Health System's financial assistance policy is designed to ensure that all residents of Miami-Dade County receive a single high standard of care regardless of their ability to pay. Anyone in need of critical or emergency health care may receive such care regardless of financial status or ability to pay.
Orlando (all counties)The Primary Care Access Network, also known as PCAN, is a dynamic collaborative among Orange County Government, primary health care centers, community agencies, hospitals and other social services. PCAN’s mission is to improve the access, quality and coordination of health care services to the underinsured and uninsured populations of Orange County.
Broward County – Memorial Healthcare System - Healthcare Plans for Uninsured Patients (HOPE)Financial Assistance or Charity Care – Provided at reduced prices or for free to low-income patients and families
A LOOK INTO PARTS OF FL
The C. L. Brumback Primary Care ClinicsOrganizational Introduction and OverviewMay 2016
Our Mission
To provide compassionate, comprehensive health
services to all Palm Beach County (Florida)
residents, through collaboration and partnerships, in
a culturally sensitive environment.
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Why are we here?In our patient’s own words:
“They have a wonderful staff. They
always meet my needs. When I’m
feeling bad they make me smile. They
not only treat me physically but they
also treat me mentally and I’m grateful
for that.”
– Anthony Smith, Patient
Anthony Smith, Patient at West Palm Beach Clinic
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Why are we here? (con’t)In our patient’s own words:
“I think the dental services are great! It’s
very convenient for people who can’t afford
to go to a regular dentist. I was kind of
nervous since it was my first visit to get my
teeth examined but they made me feel very
comfortable. I would recommend the C. L.
Brumback Primary Care Clinics’ dental
clinics to my friends and family members.”
– Chantelsha Frazer, Dental Patient
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Robert Rotella, DDS and Chantelsha Frazer, Dental Patient at
West Palm Beach Clinic
We are the Front Door of Palm Beach County’s Health Care Safety Net
• The C. L. Brumback Primary Care Clinics
• Pharmacy Program
• Health Coverage – Coordinated Care and Maternity Care Programs
• School Nurses staffing health rooms in nearly 170 public schools
• Skilled nursing at the Edward J. Healey Rehabilitation and Nursing Center
• Lakeside Medical Center in Belle Glade, the county’s only public hospital serving the rural, agricultural communities bordering Lake Okeechobee
• Oversight and funding of the county’s lifesaving Trauma System, including the Trauma Hawk Aeromedical Program
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Palm Beach County voters had the vision in 1988 to approve the creation of the Health Care District and fund this safety net system with ad valorem, or property taxes.
Nine Clinic Locations
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• Majority of sites along the more populated east coast, I-95 corridor
• Large unpopulated agricultural area in western part of the county
• Two sites near hospital in underserved, rural area of need known as the Glades
C. L. Brumback Primary Care Clinics’ Timeline
• In 2012, Florida Department of Health Palm Beach County migrated the oversight of the primary care clinics to the Health Care District
• The Health Care District was awarded a grant from the U. S. Department of Health and Human Services Health Resources and Services Administration (HRSA) beginning in January 2013
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Timeline (con’t)• In 2013, the Health Care District began operating four clinic sites:
West Palm Beach, Lantana, Delray Beach and Belle Glade
• In 2014 the Clinics:
– Expanded to include evening and Saturday hours
– Implemented a Certified Application Counselor Program
– Began integration of Behavioral Health Services
– Opened a school-based clinic at Palm Beach Lakes Community High School, called the Rams Clinic
– Received a $50,000 American Cancer Society grant for colorectal cancer screenings
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• Opened a Primary Care Clinic at Jerome Golden Center for Behavioral Health (March)
• Opened a Primary Care Clinic at the Lewis Homeless Resource Center (May)
• Opened Four Dental Clinics: Lantana, Delray Beach, West Palm Beach and Belle Glade (July)
• Received $50,000 American Cancer Society grant for breast cancer screenings (April)
• Awarded federal “New Access Point” grant of $650,000 annually and opened a new clinic in western Lake Worth (August)
• Received a Health Center Quality Improvement Grant of $171,160, the fourth highest award in Florida (August)
In 2015
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In 2016• Lake Worth Clinic expanded hours Thursday nights until 7 pm and
Saturdays from 9 am to 1 pm (January)
• Recognized by the American Cancer Society for the Brumback Clinics’ contributions toward the fight against cancer
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Clinic Governance and Operations• District Clinic Holdings, Inc., doing business as C. L. Brumback
Primary Care Clinics
• Board of Directors
– Ten members, majority are clinic users
– Many served on Board when grant was under the Health Department
• 165 full-time employees
• Providers and staff speak English, Spanish and Creole
• Four Clinic sites are co-located in Health Department centers which further strengthens partnership
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Adult and Pediatric Clinic Services• Medical evaluations
• Yearly physicals
• Well visits and sick visits
• Pharmacy services
• Laboratory services
• Diabetes/hypertension screenings
• Mammogram and specialty care referrals
• Immunizations
• Financial counseling
• General and preventive dentistry for adults and children
• Mental health counseling
• Treat Chronic Conditions
• Employment, school, Department of Transportation and sports physicals
• Health care for the homeless and agricultural workers
• Hearing and vision testing
• School forms DH 680 and DH 3040
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Pharmacy Services• The Health Care District operates
pharmacies at five clinic sites: West Palm Beach, Lantana, Delray Beach, Belle Glade, and Lake Worth
• A broad formulary of medications are available
• District pharmacies do not charge a co-pay
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Homeless and Migrant Support Services• Primary Care Services at the Lewis Homeless Resource Center
• Clinics provide medical outreach workers to provide primary care and other services to the homeless in the field
• Team includes
– Clinical Staff
– Eligibility Staff
– Behavioral Health Care Staff
– Pharmacy Services
• Outreach teams assist migrant populations
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Clinic Statistics – Calendar Year 2015• 28,680 unduplicated patients
– 18,615 Adults (18-64 years)
– 8,650 Children (18 years and younger)
– 1,415 Older Adults (age 65 and over)
• 24,452 unique medical patients
• 6,294 unique dental patients
• 73,418 total encounters
− 10,278 encounters for Migrants
− 17,277 encounters for Homeless
− More than 20,000 dental encounters
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Medical and Dental Plans Accepted
• HCD Option 1• HCD Option 2• Medicare• Medicaid• Medicaid Share of
Cost• Vita Health
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In 2013Now
Now: Medical
• CMS (So. Fla. Community Care Network)
• Cigna (HMO, PPO, Open Access Plus)
• Cigna GWH (HMO, PPO, Open Access Plus)
• Coventry Commercial Plans (PPO, HMO, POS)
• Florida Blue Cross Blue Shield Medicare Advantage PPO
• Florida BCBS Exchange (My Blue)
• Florida BCBS Health Options
• Florida BCBS Preferred Patient Care
• HCD Options 1 & 2• Humana (MMA)• Humana Exchange (HumX)• Magellan Complete Care
(MMA)
Medical (con’t)
• Medicaid• Medicare• Molina (MMA) • Molina Medicare• Molina Marketplace• Molina KidCare• Prestige Health
Choice (MMA)• Simply Healthcare
(MMA)• Sunshine Health
(MMA)• Sunshine Exchange -
Ambetter• Sunshine Medicare
Advantage• United Healthcare
Commercial Plans• Veterans Choice
(Healthnet)• Wellcare/Staywell -
Florida Healthy Kids
Dental
• Argus Dental & Vision• Assurant• Children’s Medical
Services (CMS)• Dentaquest - Florida
Medicaid• Dentaquest Florida
Medicare• Dental Health &
Wellness• DHA PPO-Aetna Life
Insurance Company• DHA PPO-United
Concordia• Florida Blue - Dental• Health Care District of
Palm Beach County (HCD)
• MCNA• Medicaid
ACA Impact on Enrollment• The Health Care District’s managed care plans serve
county residents who are not eligible for other health coverage programs.
• These plans do not duplicate state or federal health plans.
• When Florida decided not to expand Medicaid under the Affordable Care Act, the District’s Coordinated Care Program became an option for many of the uninsured county residents left without coverage.
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• Since 1993, this program has been providing health care benefits to qualifying low-income residents (100% FPL or below) who cannot obtain or cannot afford coverage anywhere else.
ACA Impact on Enrollment (con’t)• Over 14,000 members of the District’s Vita Health
shared-cost plan became eligible to purchase coverage through the federal health exchanges and were notified the plan would sunset in January 2016.
• Members were assisted in enrolling in the health insurance Marketplace, Medicaid, Florida KidCare or the Health Care District’s Coordinated Care Program.
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• The Brumback Clinics’ Certified Application Counselors (CAC’s) help patients apply for health coverage on-site and through community outreach.
• Our CAC’s partner with the Health Council of Southeast Florida and Enroll America county-wide.
What You Can Do• Partner with public health departments and FQHC’s
• Collaborate with community, state and national health organizations
• Participate in community outreach– Schools, religious institutions, local not-for-profit health
care organizations, agencies for women’s health, families and children, municipalities, libraries, county government, etc.
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• Establish relationships with migrant and homeless organizations
• Train and staff CAC’s to help consumers navigate through application and enrollment processes
Palmetto Health Columbia, South Carolina
Thursday, May 12, 2016
To be remembered by each patient as providing the care and compassion we want for our families and ourselves.
Our Vision
Who We Are
Largest most comprehensive integrated health care provider in the Midlands with 7 hospitals and 1,835 beds
Locally owned, nonprofit system
Foster G. McGaw National Prize Winner
Palmetto Health Our Strategy
Today’s Message
• Engaging Stakeholders and Leadership
• Assessing Resources
• Developing programs
Connect to Purposehttps://www.youtube.com/watch?v=qIxN2qkNrRI
Stakeholders and Leadership
Palmetto HealthCommunity
Health Board
Advisory/ Task Force
Consultants
CommunityAnnual Town
Hall Meetings
Community Health Needs Assessment
Community Boards/
Committees
Engaging Stakeholders and Leadership
Canvas
Community
Resource Analysis
Set Priorities
Assessment
Program Development
Target Population Outcomes/Measures Service Lines
Continuum of CareInfant
Teen
Young Adult
Senior
Healthy Start
Maternal & Child Health
Screenings
Chronic Disease Management
Diabetes Prevention
Richland Care
Palmetto Cares
TeleHealth
Women at Heart
Paramedic Program
More About Our Palmetto Health Strategy
ACA Implementation Focus Population
Focus shift to 3 major customer populations
o 0-100 % of Federal Poverty Guidelines (FPG)
o 101-200% of FPG
o 201% & above FPG
Medicaid Gap
Unfunded/ Uninsured Customers
Contracting
o Our Finance Staff made the decision to sign contracts with all of the ACA Health Plans in our region.
o This was an effective strategy as we could refer customers to a variety of plans, and they could make the best selection for their situation.
o By contracting with all of the plans, we were able to offer a medical home for more customers.
Palmetto Cares
o Although South Carolina did not expand the Medicaid program, the state did create the Health Outcomes Program(HOP).
o Our system created the Palmetto Cares program as a response to this.
o This program assisted customer s by gaining them access to a primary care physician .
o Several options, both within the hospital system & within the community, were utilized.
Insurance Premium Assistance Program
o A community partner, The Cooperative Ministry, received funds to assist customers with Insurance premium payments.
o Assistance is available for individuals with incomes between the 101-200% FPG level who have selected a Silver Plan.
o Our Financial Counselors work closely with the partner and refer potentially eligible individuals for assistance.
Insurance Premium Assistance Program
Annual Self Assessments
o Debriefing sessions at the end of each Enrollment Period
o Strategic Planning for Future Yearso Investigate Partnership Expansiono Review of our Communication Strategy
Communication Samples
Ongoing Challenges
o South Carolina still has not expanded Medicaid.o Some ACA covered Patients have ended their
coverage due to inability to maintain monthly coverage.
o Most ACA covered patients have high deductibles and are challenged paying these amounts.
o Customers continue to utilize the ER for primary health needs.
Thank You