September 23, 2015 Presented by: Pete Paniagua LCHD WAIVER 1115 PROGRAM INQUISITION OR INTERVIEW brought to you by the Lynn County Hospital District of Tahoka

 Wait time  Expense  Lack of Insurance  Access to Care  Additional Resources  Lack of Mental Health Services  Inability to get an appointment  The need to use ER for initial contact  High Incidence of Obesity  Diabetes Mellitus  Heart Disease  Need for Cancer Screening with mammograms, pap smears, colonoscopy, sigmoidoscopy, rectal exam COMMUNITY NEEDS ADDRESSED Strictly private and confidential. For LCHD internal business use only.

PATIENT NAVIGATOR’S OFFICE The Patient Navigator’s office is located at the Specialty Clinic, 1705 Lockwood, Tahoka, TX. It is centrally located for easy access to all patients. The Specialty Clinic is within walking distance to the Family Wellness Clinic and Rehab Center/Gym.

LCHD Waiver 1115 Program Administrators Donna Raindl Comptroller Pete Paniagua Patient Navigator

Project Description The Patient Navigator uses an ED (emergency department) report daily to find the non-emergent users and to verify whether these patients have a PCP or any type of insurance. The Patient Navigator also works with referrals from the Family Wellness Clinic, Specialty Clinic, Rehab and Fitness Center, and O’Donnell Family Wellness Clinic. Assist Clients with Additional Resources  Cardon Outreach  Jeanne Morales for Disability Determination for assistance with Disability Medicaid Issues.  South Plains Community Action for other needs. PROJECT DETAILS Strictly private and confidential. For LCHD internal business use only.

 Wait time  Expense  Lack of Insurance  Access to Care  Additional Resources  Lack of Mental Health Services  Inability to get an appointment  The need to use ER for initial contact  High Incidence of Obesity  Diabetes Mellitus  Heart Disease  Need for Cancer Screening with mammograms, pap smears, colonoscopy, sigmoidoscopy, rectal exam COMMUNITY NEEDS ADDRESSED Strictly private and confidential. For LCHD internal business use only.

PROJECT ACCOMPLISHMENTS Strictly private and confidential. For LCHD internal business use only. The majority of the clients we process are uninsured and low income. Many attempt to get Medicaid and are denied. Others with higher income still are unable to afford traditional insurance on a continual basis and their out of pocket expense is too high. From an initial baseline enrollment of 69 individuals from when the waiver 1115 program began we have now as of August 30, 2015 serviced 230 patients through the program.

CHALLENGES & LESSONS LEARNED Challenges  Acquiring supporting information in a timely manner  Obtaining proof of income and proof of non-income  Assistance from outside sources i.e., family members & friends  Providing long range solution to address needs Strictly private and confidential. For LCHD internal business use only. Lessons Learned  Our Project is impacting more people than anticipated  Increase the # of staff in the Waiver 1115 Program  Continue reaching out to patients immediately after their initial ER visit.  Develop a rapport with the patients during the interview process exercising basic kindness and compassion vs. Inquisition & Interrogation tactics.

Problem: Many individuals are overlooked in the system. One such individual was a mentally challenged woman surviving on a $250 per month widow’s pension. She lacked the skills and knowledge to seek assistance. Consequently she used the ER as her primary source of medical care. The Patient Navigator after one such ER visit, contacted this individual by phone, and scheduled a personal interview her. It was discovered that a family member had tried to help her and had applied for Disability and Medicaid for the patient but was unsuccessful. The claim was denied and the patient made no other efforts at seeking assistance. Solution: The woman was placed on the Indigent Program for immediate medical care. By assigning the patient a PCP, she no longer used the ER as her primary provider. The woman was then referred to Jeanne Morales, Attorney, who provided the initial consultation at the Specialty Clinic. The case was appealed and the patient now receives SSI and Medicaid. She is no longer on the Waiver 1115 Program. This individual would have continued to fall through the system and would have continued utilizing the emergency room for primary care. Instead the Patient Navigator was able to immediately offer the proper assistance and long term solutions to the patients needs. SUCCESS! PATIENT STORY

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