What Your Outreach & Enrollment Staff Bring to the Table Cheryl Sproles, Director Community Outreach, Su Clinica October 6, 2014

 Prior to the Affordable Care Act, more than 6.3 million Texans – including 1.2 million children – lacked health insurance.*  In June 2014, there were 378,000 more Texans who had health insurance than in September 2013, but Texas continues to have the highest rate of uninsured in the country. **  In the Rio Grande Valley, the average rate of the uninsured is 37.1% compared to 24.6% statewide.*** * Texas Medical Association ** Rice University, Baker Institute and the Episcopal Health Foundation *** Center for American Progress Fund and 2010 US Census Bureau respectively Uninsured

 Su Clinica’s leadership recognized the importance of O&E services, and all of the activities we have done over the past 12 years have laid the groundwork and prepared us for the HRSA O&E grant funds awarded in July  Received state CBO outreach grants through HHSC which helped to build a strong outreach department by adding 6 O&E employees in addition to the Community Outreach Workers (2007)  Partnered with TACHC under the CHIPRA Cycle II outreach and enrollment grant ( )  Became a Community Partner and served as a pilot site for the initial launch of HHSC’s online state benefits application  HRSA O&E grant funds allowed Su Clinica to maintain our 6 O&E staff, as well as hire 1 additional full-time employee.  Su Clinica provides application assistance for Medicaid, CHIP, Marketplace, SNAP, TANF, MEPD and the Texas Women’s Health Program History of Outreach & Enrollment – Su Clinica

 Texas health centers reported over 365,063 assists from July 1, 2013 through June 30, 2014  Su Clinica reported almost 14,000 assists with over 3,400 enrolled for the same time period.  As a trusted community provider, health centers are in a position to assist their patients and other uninsured individuals with education about affordable health insurance options and application assistance. First Open Enrollment Period

What Do O&E Staff Do?

 Su Clinica promotes O&E services at all outreach events hosted by the health center or hosted by a community partner  Attend community partner meetings to provide awareness of O&E services through presentations  Schools (Parent Involvement meetings) – monthly  Head Start – monthly  Migrant Council meetings – monthly  Public Housing – monthly  Faith based organizations  WIC programs  Day Care Centers  Speak with local media such as radio stations and newspapers  Work evenings and weekends to reach everyone in the community  Make additional outreach efforts to target special and vulnerable populations  Members of local coalitions  Promote Voter Registration  Host Community Education Sessions Outreach Activities

 Lobby presentations – O&E staff provide presentations to patients in the lobby while waiting for their appointment  Work closely with registration and billing clerks to provide assistance to patients eligible for coverage but unenrolled.  As part of the Patient Center Medical Home, we work with everyone from the physicians, appointment clerks to the patients.  Display promotional materials within the clinic to create awareness of O&E services and affordable programs (My Texas My Health materials, Community Partner materials, Marketplace materials, etc.)  Educational sessions with newly insured patients to help them understand and use their insurance.  Using patient panels to contact patients and make them aware of Marketplace assistance available through our O&E staff. In-Reach Activities

 Su Clinica formed mutual partnerships with the following types of organizations:  Community agencies  Non-profits  Faith-based organizations  School Districts  Head-Start programs  Any other organization that works with individuals and families that need assistance  These relationships take time and effort  Get to know the different entities and services they offer – can be another resource for our patients.  Take advantage of space and speaking opportunities offered by our partners to reach more people in the community Forming Partnerships

 O&E staff also need to be knowledgeable about other services to help eliminate barriers to care for our patients such as:  Transportation  Language  Public charge  Homeless  Help develop marketing or advertising messages and develop outreach materials  Report on activities (required by HRSA O&E grant) More Than Just Outreach

 Retain your O&E staff!!  Ensures consistency for your patients – they know and trust your O&E staff  Wealth of knowledge and experience gained with time is difficult to replace easily  Avoid the extra time and effort to train new staff – material is highly complex and overwhelming  More cost effective for your center to retain and continue investing in your O&E employees  Training and support necessary and/or recommended for O&E staff:  CAC certifications with CMS (required for all HRSA O&E funded positions)  YTB Navigator certifications with HHSC  HRSA O&E Assistance Calls/Webinars  CMS Weekly Assistor Calls/Webinars/Newsletter  TACHC O&E conferences, quarterly webcast and weekly updates  Trainings and support by other organizations: NACHC, Center for Budget Policy Priorities, National Cooperative Agreement organizations, etc. Retention of Qualified O&E Staff

 The Marketplace enrollment period is done but the work is not! O&E staff have plenty they must do:  Medicaid/CHIP application assistance for children year-round  Special Enrollment Period – Assist consumers that may qualify  Exemption Applications – Assist consumers in the coverage gap with a tax filing requirement. Deadline is December 31 st.  Helping consumers understand their insurance and how to use it  Continue outreach and in-reach – Educate community about importance of having health care and affordable health insurance options year-round  Updates to Marketplace Accounts – Assisting consumers that need to terminate coverage, change QHPs, add dependents, or report income changes, etc.  Voter Registration – Part of the application process  More Training! – Ongoing training and support necessary to keep up with policies and processes of the Marketplace, Medicaid and CHIP.  Any other O&E activities that the health center identifies as necessary What Is Expected When Open Enrollment Is Over?

 Community Involvement = Priceless $$$$  Patient Satisfaction – Happy customers tend to stay  Continuity of Care – Patients eligible and enrolled in coverage will return for renewals, avoid gaps in coverage, and are less likely to miss appointments out of fear they can’t pay. This helps improve health outcomes.  Opportunity for growth by offering O&E services to the community – potential new patients  Health center sustainability – O&E services directly impact financial revenue What O&E Staff Bring to the Table

In 2013 the Outreach Department brought in 198 new pediatric patients and 154 new Women’s Health patients. We tracked those referrals through their first scheduled appointment. 198 X 5 (avg annual visits) =990 (encounters) 990 encounters X our average rate = $178,200 (approximately) 154 X4 (avg annual visits) =616 (encounters) 616 encounters X our average rate = $169,400 (approximately) Health Center Sustainability

By adding the estimated revenue from both Pediatrics and WH we generated approximately $347,600 in revenue. The annual cost of 7 O&E employees is $179,000. Bottom line – O&E is a good investment for your health center. Bottom Line

 HRSA O&E grant funds allows Su Clinica with minimal costs upfront to provide a valuable service to our patients, their families, and the community in our service delivery area  Increase education and awareness of patients and community  Increase number of insured among existing patients  Increase number of insured new patients  Increase appointments kept and/or follow up treatment (patients with insurance no longer afraid they cannot pay)  Increase potential for better health outcomes for patients as a result of being insured  Increase renewal rates – patients more likely to remain insured when O&E services continuously available  Increase health center revenue ReCap: O&E Services Provide a Win-Win for Patients & Health Centers!

Thank you Cheryl Sproles, Director Community Outreach/Community Relations (956)