Enrollment Assister Role: Community Health Worker ... · CHW / O & E SERVICES Spring of 2016: GLBHC...
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Enrollment Assister Role: Community Health Worker/Enrollment Cross Training
Transcript of Enrollment Assister Role: Community Health Worker ... · CHW / O & E SERVICES Spring of 2016: GLBHC...
Definitions
• Educate consumers on health coverage options
• Provide health coverage enrollment assistance
• Experts in system navigation: the marketplace, Medicaid programs, and other state benefits
• Community based experts who are trusted by the communities in which they serve
Enrollment Assisters
• Frontline public health worker
• Trusted member of the community
• Serves a link between services and community
• Facilitates access to health and social services
• Improves quality and cultural competence of service delivery
CHWs
Integrating CHWs and Enrollment Roles
Community Health Workers
Outreach and
Enrollment Assisters
Experts in System Navigation, Education, and Advocacy
Enrollment Assister and CHW
Models
Great Lakes Bay Health Centers
Saginaw, MI
Mercy Health-St. Mary’s Community Health Centers
Grand Rapids, MI
MHP Salud
Ypsilanti, MI
ENROLLMENT ASSISTER ROLE:
COMMUNITY HEALTH WORKER --
ENROLLMENT ASSISTER
CROSS TRAINING
MPCA Annual Conference
July, 24, 2017
Great Lakes Bay Health Centers
GREAT LAKES BAY HEALTH CENTERS’
CHW HISTORY
February 2013 - CMS Innovation Grant called MI Pathways to
Better Health
Three MI communities involved – Saginaw, Muskegon, and Ingham Counties
Patient eligibility – Enrolled in Medicare, Medicaid or Health MI Plan
Patient with two or more chronic health conditions such as Diabetes, Hypertension, Coronary Artery Disease, Asthma
3+ years of funding that supported Community Health Worker deployment within the communities/agencies involved
Goal – Address the Triple AIM (Improve the patient experience of care, improve the health of populations, reduce cost of health care
GREAT LAKES BAY HEALTH CENTERS’
CHW HISTORY
Year 1 of MI Pathways to Better Health (Saginaw Pathways to
Better Health): Created 4 CHW positions that were distributed to
4 Primary Care sites in Saginaw and Bay Counties
Year 2 of Pathways: Added 3 additional CHW positions
Created CHW Supervisor position
CHW TRAINING FOR PATHWAYS
2 days of training related to Chronic Diseases: Diabetes, Hypertension, Coronary Artery Disease, COPD, Asthma
Disease definitions and how they affect the body
Nutrition aspects including Label Reading
3 days training including the following Topics:
Managing Medications
Interpersonal and Communication Skills
Professional Boundaries
Outreach and Engagement
Networking and Community Resources
Home Visitor Safety
Healthy Lifestyles
Behavioral Health/Substance Abuse
SUCCESS OF PATHWAYS PROGRAM
The MI Pathways to Better Health grant program was
very successful in achieving the Triple AIM goals
CHWs were successfully added to Great Lakes Bay
Health Centers as part of our Team of healthcare
providers
CHWs highly valued in addressing the social
determinants of health for our patients
HEALTH INSURANCE MARKETPLACE -
2014
Great Lakes Bay Health Centers received
HRSA grant funding through the Affordable
Care Act for Outreach and Enrollment
activities
3 Outreach and Enrollment Assisters were
hired
OUTREACH AND ENROLLMENT (O&E)
Assist community members with applying for health insurance
Marketplace insurance applications:
In-center on-line assistance
Phone call assistance
Expanded Medicaid applications
Participate in O & E events in the communities where GLBHC
sites were located
Outreach activities at Public Library locations, Health Fairs, DHHS, etc.
Answer O & E “hot line”
OUTREACH AND ENROLLMENT
Trained as Certified Application Counselors
Received MI Bridges Training
Discovered that Patients were not only in need of insurance
enrollment assistance
Patients also needed assistance with completing applications for
food assistance, utility assistance, and other social service needs
CHW / O & E SERVICES
Spring of 2016: GLBHC realized that CHWs and O & E Assisters
had overlapping job duties
New MDHHS bid/initiative – MI CARE TEAM - received with launch
effective July 1, 2016, two year program
CHW positions added to all GLBHC locations (had previously
been only at Saginaw and Bay County sites)
O & E staff accepted into CHW positions
O & E staff and CHW staff cross-trained to better serve patients
MI CARE TEAM
New initiative / alternative payment model from MDHHS
Team-based approach for arranging, coordinating and managing patient health care
Eligible patients = Diagnosis of Depression and/or Anxiety plus one or more of the following conditions: Diabetes, Heart Disease, Hypertension, COPD, Asthma
MI Care Team members:
PCP
Nurse Care Manager
Behavioral Health Consultant
Community Health Worker
Health Home Coordinator
MI CARE TEAM
Eligible Patients must consent for enrollment
Monthly patient contact by MI Care Team member
Prospective reimbursement for monthly contact = we receive
payment for non-PCP “visits” by Care Management Nurses,
Integrated Behavioral Health Specialists and CHW interactions
where healthcare goals are discussed
If no “visit” occurs during a month, payment is recouped by
MDHHS
A visit can be face-to-face or via the phone - only one non-PCP
visit per month is reimbursed
COMMUNITY HEALTH WORKERS
Current CHW staffing = 10
Located at every GLBHC Primary Care site
2 CHWs certified through the MPCA Linkages program (2014 –
2016)
8 are Certified Application Counselors
2 will become CAC’s this summer
All received the MI Bridges Training
ENABLING SERVICES
Have been provided through GLBHC for years – such as
language interpretation, transportation, and WIC
CHWs have increased Enabling Services provision to include
assistance with:
Housing
Food
Utility bills
Education (completion of high school, college, trade school)
Employment (resume updates, interviewing, job applications, etc.)
KEEPING CURRENT/STAYING
CONNECTED
Monthly CHW meetings
Presentations from local agencies with updates on their services
Case conferences/debriefing
Stress reduction and
Mental health maintenance
Enrollment Assisters and
Community Health Workers
María Álvarez deLópez, MA
Manager of Community Benefit Programs
7/23/2017
Trinity Health- 2nd largest Catholic Health System
93*- Hospitals in 22 states
131,000 colleagues
5,300 employed physicians
24,000 affiliated physicians
1.75% of all babies born in America are
delivered at Trinity Health facilities
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Who are we?
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Why do we do what we do?
Mission-We serve together in the spirit of the Gospel as a
compassionate and transforming healing presence within
our communities.
We are committed to being a trusted health partner for life,
transforming the communities we serve, by providing high-
quality care that is the most accessible, compassionate and
personalized in West Michigan.
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Community Outreach Programs-CHW History
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Situation
Many needs, limited
resources
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Assessment
After a couple of months we assess
•Too much work to do
•Duplication
•Did not have a system to document enabling services
•Did not have a system for quickly communicating with
each other – In the office
– Out in the field
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What did we do?
Community Health Worker
• Healthcare coverage assistance
Medicaid, Medicare, Marketplace
• Billing/Past due medical bills
• DHHS application
• Utilities
• Resources (food, transportation,
housing, clothing, systems
navigation, Birth certificates, Social
Security, etc.)
• Advance Care Planning
• Onsite/ home visiting
Outreach and Enrollment Assister
• Healthcare coverage assistance
Medicaid, Medicare, Marketplace
• Home visiting
Role
• Enrollment (applications/verifications)
– Medicaid and Marketplace
• How to use health care coverage
• Navigation
• Keeping health care coverage
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Enhancing the roles
Phase 1
•Standardized role
•CHW Certification
•Training – DHHS, Medicare, Marketplace, Mental Health First Aid, Community resources,
etc.
•Documentation
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Where are we at now
•Reviewed work being completed
•Standardized work
•Shared system
•Fully intergraded CHW within health center. Access
(CHW) to EHR, Jabber, Cerner, huddles, staff meetings
•CHW certification for all
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Interdisciplinary Team
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Patient
Provider
Social Worker
CHW’s
CSC
RN
BOC
Medical Assistants
WIC
Phase II
CHW integration
within Health Center
Health Center – Clinica Santa Maria
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Patient
CSC
CHW-
Linkages
CHW Linkages
CHW HRSA
What are we doing?
Client Service Coordinator
• Prescription assistance
– Internal and External programs
• Healthcare coverage assistance
– Medicaid, Medicare,
Marketplace, Financial
Assistance
• Billing/Past due medical bills
• DHHS application
• Utilities
• Resources (food, transportation,
housing, clothing, systems navigation,
Birth certificates, Social Security, etc.)
• Onsite
Community Health Worker
• Healthcare coverage assistance
Medicaid, Medicare, Marketplace
• Billing/Past due medical bills
• DHHS application
• Utilities
• Resources (food, transportation,
housing, clothing, systems navigation,
Birth certificates, Social Security, etc.)
• Onsite/ home visiting
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Clinica Santa Maria
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Patient
CSC
CSC CHW HRSA
Where are we now?
•Standardized work
•Shared system
•Fully intergraded CHW within health center. Access
(CHW) to EHR, Jabber, Cerner, huddles, staff meetings,
Wifi (tag in access, while off site)
•CHW certification for all (including CSCs)
•Seamless collaboration among CSC’s and CHWs
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Additional work?
Of course….
One system to assess and document.
•Assess- SDoH
•Document- Assist and outcomes
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How do we do it?
Innovation
Collaboration
Integration
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UTILIZING CHWS AS NAVIGATORS
Rebecca Epstein
Program Director
MHP Salud
A Bit About Us
■ MHP Salud is a non-profit organization
■ Implemented Community Health Worker (CHW) programs to improve the health of
Latino communities for over 30 years
■ CHW programs address a variety of health topics
■ 9 active programs, including the Navigator Program
“The cornerstone of [CHW] programs is the
recruitment of community members who
possess an intimate understanding of the
community’s social networks as well as its
strengths and its special health needs.” -National Community Health Advisor Study
MHP Salud’s Navigator Program
■ CMS Navigator grantee since 2013
■ Texas: Cameron, Hidalgo, Starr, and Willacy
Counties
– 91.4 % Hispanic or Latino
– Rural
– Underinsured and Medically Underserved
– High rates of poverty
■ Team of 5 bilingual CHWs Photo Credit: Center for Community Health Development. https://cchd.us/about-our-communities/
Navigator Roles & Responsibilities
■ Outreach
– In-person
– Community events
– Radio Ads
– Phone banks
– Videos
■ Community Education
■ Enrollment Assistance
■ Provide Referrals
■ Provide training to other CHWs
Navigator Program Outcomes
■ In 2015-2016 MHP Salud Navigators
exceeded enrollment goals:
– Provided direct assistance to 5,800
consumers
– Indirectly served 2,250 family
members
– Reached over 250,500 individuals
through outreach
– Participated in 90 events
Training Navigators
■ Receive training on CHW core competencies
– Scope of work
– Popular Education and facilitation
– Communication
– Cultural competency
– Service coordination
– Confidentiality and ethics
– Evaluation
– Technology
■ Complete required CMS training
■ Complete required training from Texas Department of Insurance
On-Going Support
■ Weekly team meetings
■ Give and receive cross-training
to/from peers during monthly
meetings
■ Webinars
Non-Navigator Application Assistance
■ All CHWs can provide application
assistance
■ All CHWs are trained to provide referrals
to Navigators for enrollment assistance
■ UID system allows consumers to be
tracked across organization
Resource
■ Training and Supporting Certified
Application Counselors Toolkit
■ Available for free in our online
Resource Portfolio at mhpsalud.org
Questions?
For more information, please contact:
Dawn Beard
Community Health Worker
Great Lakes Bay Health Centers
(GLB)
María Álvarez deLópez
Manager of Community
Benefit Programs
Mercy Health-St. Mary’s
Community Health Centers
616.685.3350
Rebecca Epstein
Program Director
MHP Salud
956-968-3600 ext. 1040
Additional GLB Contacts: Dora Harris, CHW Supervisor
Lisa Burnel, Vice President of Clinical
Services
