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From Coverage to Care: Gloria Baca CMS Regional External Affairs
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Why From Coverage to Care?
Millions of Americans gained coverage through the Marketplace and Medicaid and CHIP during open enrollment, and this year more than 500,000 uninsured 64-year olds will become eligible for Medicare. For many, this is the first time in a long time or they have ever had coverage. Unless we connect the newly insured to primary care and preventive services, we will not realize the other goals of the ACA – improving population health and reducing health care costs. As a result of the ACA, more than 8 million Americans have obtained coverage through the Marketplace, and more than 6 million have obtained coverage through Medicaid and CHIP. There are also a number of uninsured who will become old enough to qualify for coverage through Medicare. Many of the newly insured overcame barriers just to enroll in coverage – cost, education, language, to name a few, and while there were numerous supports put in place to help them overcome the challenges and enroll in coverage, there were significantly fewer supports in place to help them understand and appropriately utilize their coverage. If we don’t help the newly insured see the value of their coverage and understand how to use it appropriately to obtain primary care and the preventive services that are right for them, we will not improve population health nor reduce healthcare costs, which are two other goals of the ACA.
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What is From Coverage to Care?
C2C is an effort to help educate consumers about their new coverage and to connect them with primary care and preventive services that are right for them so they can live long, healthy lives. Resources online and in print include the Roadmap, Discussion Guide, videos, and more. C2C builds on existing networks of community partners to educate and empower newly covered individuals. From Coverage to Care seeks to do just that, to help consumers understand their new coverage and engage in the health care system, as well as equipping health care providers and staff with the information and resources needed to help them connect with the newly insured. Following input from a variety of sources, including consumers, providers, community partners, payers, and policymakers, the Centers for Medicare and Medicaid Services developed a set of resources to help educate and empower the newly insured. Understanding that the newly insured are more likely to listen to trust sources, Coverage to Care builds on existing networks to disseminate the information, and educate consumers. 3
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How to Use the Roadmap Start the Conversation. Use the Roadmap and Discussion Guide as a tool to help people understand their new coverage and understand the importance of getting the right preventive services. Help Consumers Understand. The Roadmap has a lot of information for consumers. You can help them use it as a resource to refer back to as they journey to better health and well-being. Personalize it. You know your community. Consider adding local resources and information. As trusted sources of information for the newly insured, I encourage to use the Roadmap to start a conversation with them. You can use the Roadmap in partnership with the Discussion Guide to walk through each step, pointing out things for the consumer to think about. Today, I’m going to walk you through each step of the Roadmap, use the Discussion Guide and resources within the Roadmap to explain each step, and generate discussion and answer questions. When you begin your conversation, you may want to ask the consumer which step seems the most appropriate place to start, so that you personalize the journey to meet their needs. You may also want to customize the Roadmap by adding information on local resources. You can also link consumers to videos and resources at each step of the Roadmap to improve their understanding of the material. The Coverage to Care resources are your tools and the stories, explanations, and conversations you have with new consumers are what will help them understand and remember the steps as they use their new insurance.
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Coverage to Care Roadmap
As you can see, the Roadmap lays out a path for the newly covered to connect to care, starting with Step 1, Put your health first, and ending with Step 8, Next steps after your appointment. Each step can be its own “lesson”. The Roadmap is structured so you can take it in pieces or as a whole, walking through one step at a time or taking the journey all at once. You can download the Roadmap and all Coverage to Care materials from marketplace.cms.gov/c2c. Online at marketplace.cms.gov/c2c
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Available C2C Resources
Visit Roadmap Poster Roadmap One-pagers: Insurance card, Primary care vs. emergency, and EOB Pull-out steps Discussion Guide Video vignettes Print copies available from All our resources are available at – marketplace.cms.gov/c2c. You can order many of the materials from the CMS Clearinghouse. Instructions for how to do so can be found on marketplace.cms.gov/c2c. Currently, Coverage to Care materials are available in English, and we will have the Spanish translations for the Roadmap booklet and other print materials available for order soon. We are working on additional translations, which will also be posted on the marketplace site and available for print.
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