Effective Strategies for the Patient-Centered Medical home (PCMH) in providing the uninsured information about the Affordable Care Act (ACA) and assistance in navigating the health insurance marketplace December 5, 2014 Sherry S. Hay, MPA UNC Department of Family Medicine Director of Community Health Initiatives Adjunct Assistant Professor Office Phone (919)

Disclosures It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/ invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and if identified, they are resolved prior to confirmation of participation. Only these participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

Objectives 1. To develop a framework for how a PCMH may support the uninsured in understanding the ACA & marketplace 2. To share patient resources on the ACA that a PCMH may want to adapt and use in their practice 3. To build a list of key questions for getting started in your practice

The Results…  Uninsured rate declined in NC: 20.4% % (2014 Gallup Survey)  357,584 North Carolinians enrolled ; 5 th highest of the states; 180% of CMS goal --91% received Tax Credit Advance Payment (Subsidy)  46% of our County* estimated eligible enrolled as compared to 33% statewide  2100 uninsured households at FM were touched and surveyed after open enrollment (summer 2014) --A Snapshot of the results follows…………….. * - HHS zip code data

Patient survey: Post Open Enrollment Have you used it for an appointment with a doctor? Do you think having health insurance is important? Do you have health insurance now ?

M ore than Health Coverage ……….

Setting North Carolina (Prior to first open enrollment in 2013/14) -1.5 million uninsured (19% of the nonelderly population). -87% of NC uninsured below 400% of FPL -77% of the uninsured hade been uninsured for more than one year -NC has not expanded Medicaid -NC uses the federally facilitated marketplace UNC Family Medicine Center –Over 16,500 patients and 54,000 outpatient visits per year. –Approximately 13% of patients Medicaid and 13% are uninsured. –40 faculty and 26 resident physicians. –PCMH (Level standards)

Outreach  Convened community partners: County and Regional --Discussed sharing of resources and key messages  Identified uninsured households – Billing data  Sent general awareness patient letters and/or s  Developed Poster for FMC-Patient Registration Area  Wrote articles for patient news & discussed with Patient Advisory Board  Developed and offered Community Presentations/Interviews

Education  Offered Patient Handouts  Sponsored Patient Educational Forums  Established one phone number for questions  Wrote articles in practice newsletter  Offered tips and key messages on practice website & Facebook  Branded efforts-”Get Covered Carolina”  Provided key updates at staff and faculty meetings

Enrollment UNCHCS became a certified application counselor organization Offered On-site enrollment assistance with certified staff and used community partners, e.g. we provided space at FM to a community partner who helped with enrollments Offered Enroll-a-thons - One day events where people can come to sign-up…

Enroll-a-thon “69% of patients said they needed help with enrolling from a counselor” 180 people came through event: ~100 met with a counselor; 69 staff & volunteers participate

Our Partnerships.. Legal Aid Enroll America League of Women Voters Health Departments United Way Department of Social Service Safety Net Providers Free Clinics Students (Medical, Public Health, Social Work) Library Media

In Summary……..  Offered on-site assistance with a certified application counselor  Developed and disseminated patient educational materials  Sponsored a dedicated phone line for questions and appointments  Sponsored three enroll-a-thons (250 people attended)(100 volunteers/staff)  Convened four regional leadership meetings (over 40 organizations/practices)  28+ Media and Community Events ( Radio, newspapers, website, phone bank, and patient forums )

PCMH: Keys to getting started….  Collect and review the data – numbers of uninsured population  Identify a practice champion to lead efforts  Identify and convene community partners  Develop a communication strategy for both the practice and patients  Test ideas, e.g. enroll-a-thon on a small scale before executing a large event  Decide on your process and outcome measures

ACA Resources Patient Protection and Affordable Care Act. Consolidated Bill Text Information about insurance coverage and health insurance marketplace: Information for consumers and enrollment site: Kaiser Family Foundation Enroll America “Ushering a New Era of Healthcare in NC” July/August 2013; NC Medical Journal. HHS county specific data.(Zip codes)

Questions and Discussion..

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