hospitals: tactics for getting uninsured patients covered in the marketplace
TRANSCRIPT
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Hospitals: Tactics for Getting Uninsured Patients Covered in the Marketplace
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© 2016 Enroll America | StateOfEnrollment.org
Getting Every Patient CoveredHenry GarciaManager, Managed Care ContractingUniversity Medical Center, El Paso, TX
Denver Health: Outreach, Retention, and RenewalAudrey HoenerDirector of Outreach ServicesDenver Health, Denver, CO
Running a Multi-Encounter Engagement ProgramLinda OlsenSite SupervisorCSRA, Inc., Atlanta, GA
Hospitals: Getting the Uninsured Covered
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Henry Garcia, Managed Care Contracting, University Medical Center | 05.12.16
Getting Every Patient Covered
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UMCUniversity Medical Center of El Paso
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UMC Mission and Values
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UMC Role in Region
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UMC at a Glance
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Payer Mix by Percentage
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Charity Care
The Medical Center providers care without charge or at amounts less than its established rates to patients meeting certain criteria under its charity care policy
• Health Care Options
• Care Plus
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ACA Enrollment Efforts
Strong supporter of The Enroll El Paso Coalition
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ACA Enrollment Efforts
Enrollment Events in the Hospital
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Earned Media
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Community of Assisters
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CAC Organization
University Medical Center is a Certified Application Counselor Organization with CMS
TXCACA51• 18 total associates are certified throughout main
campus and Neighborhood Health Care centers
Champion for Coverage Organization with CMSSelf-Serve Enrollment Center
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UMC Self Serve
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Enrollment Services Unit
18 Certified Application Counselors onsite• Monday through Friday 7:30 to 5:00• Provide 1:1 ACA Counseling• All Bilingual
Dedicated ACA enrollment line• Eligibility requirements• Go over what documents are required for
enrollment
CAC was added to as an additional job function• Certified yearly
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Certified Application Counselors
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UMC CACs
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UMC Enrollment Statistics
Enrollment Period
• 2014 = 630
• 2015 = 239
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UMC Required Forms
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Consumer Email and Login Info
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Managed Care ContractingThe Managed Care Contracting Department works with all Payers to contract in quality and affordable health plans for our patients
PPO’s, HMO , Exclusive “Narrow” Networks
• Hospital Contracting• Primary Care Group Contracting
We realize that not one plan works for all consumers
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Managed Care ContractingProvides a rotating marketing schedule for all health plans to market on site at the main campus and at our Neighborhood Health Care Centers
Benefits:
• Plan enrollment• Customer Service • Q&A
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Managed Care Contracting
PCP Pay-for-Performance
Quality Reporting
Improving the health outcomes of a traditional patient
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Audrey Hoener, Director of Outreach Services| 05.12.16
Denver Health Outreach Services
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Who is Denver Health?
Denver’s Safety Net, an Innovative Health Care System.Denver Health Medical Center (Hospital), 9 Community Health Centers, 17 School-Based Health Centers, and
Denver Public Health.
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Outreach Services
• Community Health Centers
• Enrollment Van
• School-Based Health Centers
• Community Events
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Community Health Centers
Colorado Expansion State & State MarketplaceStarted Outreach in CHCs in OE 1
Patient Tracking Sheet
Potential Eligibility for Medicaid or Connect for Health Colorado Insurance Plan
This patient may be eligible for Medicaid Expansion or a low-cost health insurance plan from Connect for Health Colorado. Denver Health Medical Plan (DHMP) is offering a variety of plans called ELEVATE for those that do not qualify for Medicaid. Please help all potentially eligible patients be screened by a Denver Health or a DHMP enrollment specialist. Check appropriate box below and thanks for your help!
“Enrollment Information Document” Given To Patient (to be marked by clerks)
Pharmacy Staff Talks to Patient
“I see that you MAY be eligible to get Medicaid or qualify to buy low-cost Health Insurance through Connect for Health Colorado under the new Affordable Health Care Law.”
“I encourage you to meet with our Community Health Advisor today, our HCP will escort you to her”
Pharmacy Staff Directs Patient to Community Health Advisor - TODAY
Community Health Advisor Consultation:
Patient has already completed a Medicaid application (approx. date: _________)
Patient is not eligible (i.e. Marketplace candidate, or is already on Medicare)
Patient is not interested Patient has been provided Enrollment Specialist contact information (i.e. patient is
self-employed and needs verification documents)
Patient completed a Medicaid application today
Patient Label
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School-Based Health Centers
What does SBHC Outreach Look Like? Insurance is Identified at Time of Visit Uninsured Reports Run Daily Warm Hand Off and Phone Call Outreach Weekly Enrollment Events
Why Schools Work? Safe Environment and Familiar Close Proximity to Home Collaboration with School District Outreach Staff
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Health Access Enrollment Van
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Community Outreach
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Data Collection
0
50
100
150
200
250
July August September October November December
Num
ber o
f Pati
ents
Months
Medicaid Applications Received via CICP Outreach in staff hand offs
# of Patients from CICP outreach list
# of Patients from CICP outreach with appsubmitt ed
# of Warm Hand offs (column F)
# of Warm Hand offs with app submitted (columnD)
0
10
20
30
40
50
60
70
80
90
100
July August September October
Num
ber o
f Pati
ents
Months
Medicaid Applications Received via CICP Outreach, staff hand offs, and walk ins
# of Patients from CICP outreach list
# of Patients from CICP outreach with appsubmitt ed
# of Warm Hand offs (column F)
# of Warm Hand offs with app submitted (columnD)
# of Walk ins
# of Walk ins with app submitted
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Linda Olsen, Site Supervisor, CSRA, Inc 05.12.16
Running a Multi-Encounter Engagement Program
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THE GRADY APPROACH
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The Plan
Get the List Uninsured, multi-encounter
patients May be ACA eligible
Resources The Connector Enrollment Experts Volunteers
Call and call again! Multiple calls an absolute
Timing Counts Optimum call time
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The Executioners!
Volunteers Are Key! Well Trained
Multitaskers
Tech Savy
Creative
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The Tools
Get Covered America Chase Phone Script Review Practice Personalize-----------------------------------------------------------------------------------------------------------
Hi. Is _________ available? Hi _________. My name is _____________ . I’m a volunteer with Get Covered America, a non-profit organization and I’m calling on behalf of _______Health Systems. We talked to you a while back about your new health insurance options under the Affordable Care Act, and I’m calling because the marketplace is open and I want to make sure you have the information and help you need to take action by January 31st to get covered! Do you currently have health insurance? YesNo ………
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The Connector – Step 1
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The Connector – Step 2
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The Connector - Step 3
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Total Attempts Canvassed Spanish Yes No Yes/Maybe No Scheduled
GA01E, GA01E56SP 83 16 0 7 6 6 6 4GA01E, GA01E57SP 82 15 1 12 3 2 11 2GA01E, GA01E62SP 89 18 0 12 3 3 13 1GA01E122, Spelman, A Cornish 101 19 0 15 4 6 13 1GA01E124, Spelman, S Clark 54 5 1 2 3 2 1 2GA01E126, Spelman, D Gilbert 75 8 0 6 2 2 6 2GA01E58 Spelman, A Little 201 29 3 20 9 8 2 3GA01E60 Spelman, A Robinson 180 34 3 23 11 7 14 3GA01E61 Spelman, S Sleweon 52 6 1 6 0 1 2 0GA01E64 Spelman, D Watkin 95 21 1 17 4 8 6 3GA01E65 Spelman, Mercedes 200 42 2 26 16 15 27 3GA01E69 Spelman, B Davis Haney 64 16 0 15 1 2 14 0GA01E70 Spelman, Q Holmes 51 4 0 3 1 1 0 0GA01E71 Spelman, T House 58 9 1 5 4 3 6 0GA01E73 Spelman, C McKay 56 4 0 3 1 0 4 0
ConSCanvasser
Canvass Results Insu StIn
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Total Universe Uninsured Marketplace eligible Multi ER visits
Total Passes 4+ 100% passes thru universe
Total Call Attempts More then 12,000
Total Conversations 67% of total universe
Connector Appointments 485
The Numbers
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Round Robin:
If you could point to one factor that has allowed you to be successful and effective, what would it be?
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Questions?
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Henry GarciaManager, Managed Care ContractingUniversity Medical Center, El Paso, [email protected]
Audrey HoenerDirector of Outreach ServicesDenver Health, Denver, CO
Linda OlsenSite SupervisorCSRA, Inc., Atlanta, GA
Be In Touch!
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Celebrating Success and Taking Advantage of Learning Opportunities