Migrant & Seasonal Farmworkers in Oregon Pops/Migrant and Seasonal Farmworker Webi… · 1....

December 15, 2015

Special & Vulnerable Populations

2015 Webinar Series

Migrant & Seasonal

Farmworkers in Oregon

Before we start

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Special & Vulnerable Populations

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2016 Conferences in Portland

Today’s Learning Objectives

Understand who serves Migrant and Seasonal Farmworkers and how they track them.

Learn about the Agricultural Workers Access 2020 Campaign and how we can support it.

Discover what your Oregon colleagues are doing to engage and provide access and care to this population.

MSFW UDS Definition

A migratory agricultural worker is an individual whose principal employment is in agriculture on a seasonal basis (not year round) who establishes a temporary home for the purpose of such employment. Migratory agricultural workers are usually hired laborers who are paid piecework, hourly or daily wages.

. . . principle source of income within 24 months of last visit as well as their dependent family members who have also used the center. Dependent family members may or may not move with the worker.

MSFW UDS Definition & PRAPARE

Seasonal agricultural workers – does not establish a temporary home for purposes of employment. Includes their dependent family members.

For both categories of workers agriculture means farming in all its branches as defined by the OMB

PRAPARE Question – Social Determinants of Health Screen: At any point in the past 2 years, has seasonal or migrant work been you or your families main source of income?

CHCs with MSFW Funding

Benton & Linn Counties CHC

Clackamas County Public Health Division

Columbia River Community Health Services - Boardman

La Clinica – Medford Area

Lane County CHC

Mosaic Medical – Central Oregon (Bend, Madras, Prineville & Redmond)

Neighborhood Health Center – Beaverton, Hillsboro, Canby, & Portland

One Community Health – Hood River & The Dalles

Valley Family Health Care – Eastern Oregon (Idaho Border)

Virginia Garcia Memorial Health Center – Washington County

Yakima Valley Farm Workers Clinic – Portland, Woodburn & Hermiston

OPCA Special Populations Webpage

Improving Access to Quality Health Care for Migratory and Seasonal Agricultural Workers

National Center for Farmworker Health Presentation to the

Oregon Primary Care Association Presented by Bobbi Ryder, President & CEO, NCFH

12.15.15

© 2015,National Center for Farmworker

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© 2015, National Center for Farmworker

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Welcome!

Webinar Presenter Bobbi Ryder, President & CEO, NCFH

Consultants/Trainers

Sylvia Partida NCFH, COO

Alicia Gonzales Director of Professional Services

I. Background: National & State Trends A. Current Status of Funding and Users Served

II. Turning the Curve A. Identifying and Reporting All Current MSAW Users

B. Opening Doors and Increasing Access

III. Building Capacity for Growth A. Strategies to Sustain and Fund Growth

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Webinar Presentation Outline

National Trend 2010-2013

330 g Funding MSAW Patients

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43

Mill

ion

14

Th

ou

san

d

Migrant Health Funding (ACA Trust Fund 8.6% Proportion)

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Ag Workers Served by 330g Funded MHCs

CHCs served a yearly average of 74,000 Ag Workers

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12/16/2015 18 © 2015, National Center for Farmworker

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Total Estimated # of migratory and seasonal agricultural workers in the

USA: 4.5-4.6 M* Total number of MSAWs served by

C/MHCs 864,000**

**UDS 2014 *NCFH and NLDA respectively

2013 Penetration Rate

Ag Workers Served by 330g Funded MHCs

CHCs served a yearly average of 74,000 Ag Workers

© 2015, National Center for Farmworker

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© 2015, National Center for Farmworker

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II. Turning the Curve

A. Identifying and Reporting All Current MSAW Users Take credit where credit is due Implications of doing so: Population Accountability Future funding Meaningfulness of data in EMR and UDS Strengthen the whole C/MHC Program

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Things We Have Learned

Competing demands on Health Center Staff

EMR Adoption has created some ‘glitches’

Definitions are still confusing

Turnover at front desk demands ongoing training Established systems may need re-tooling

Examples • EMR Adoption has been a top priority, but

adds to the confusion

• No system of checks and balances between registration and health history forms in EMR

• EMR re-writes demographics each visit, no carryover of info

• EMR severs Adult children’s records from Ag Worker parent in EMR

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Examples • Political sensitivity in the “ask” – Migrant vs. Ag

Worker • HRSA’s 12.1.12 clarification of definition of

Agriculture • Aged and/or Disabled former Migratory Workers

and their families • But where do you put that info? • Casual misinterpretation of statute, i.e. “families”

vs. “dependents” • Old practices die hard: M/S/O • “Migrant” and “Seasonal” are not an insurance

category 12/16/2015 23 © 2015, National Center for Farmworker

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Solutions

• Strengthening of Health Center Systems to evaluate and modify policies and procedures

• Provision of on-going training

• Analysis of penetration rates by county

• Asking the right questions in the right way with sensitivity to literacy levels and culture

• Clarification of federal policies and guidance

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B. Opening doors and increasing access

Re-vitalizing the “Causa” to serve the Ag Worker population

Reaching out to unserved population pockets

Defining ‘outreach and enabling’ as different from ‘outreach and enrollment’

Institutionalizing ‘outreach and enabling’

Articulating the value proposition to peers

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II. Turning the Curve

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Oregon’s Great Track Record Oregon

Trend

Year 330g Non-330g OR CHC Program

2010 11,788 1,287 13,075

2011 11,498 1,454 12,952

2012 14,204 2,419 16,623

2013 15,829 2,693 18,522

2014 16,471 3,382 19,853

Call for Action…

Ag Worker Access 2020

Ag Worker Access 2020 Goal: To Reach 2 Million

2013

790,226

2 Million

2020

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A. Ongoing dialog with HRSA & Bureau

B. Recommended further changes to UDS to bring into alignment with Statute and Regs

C. Recommending funding that recognizes growth where it occurs

D. New funding mechanisms that are sensitive to needs of applicants for uninsured population

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III. Building Capacity

Resources Available

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1. NCFH Web Site – Tools and PPT Presentations for staff training

2. NACHC My-Learning Community-Campaign Updates

3. Complimentary Webinars, archived and live

4. Conference Workshops upcoming

5. Custom designed webinars and presentations

6. 1:1 on site consultations (FFS)

7. Licensure Program and Regional Trainings for Systems Change (FFS)

8. County by County Population Estimations (FFS)

9. Farmworker Health Network (FHN)

I. Ensure accurate ID and reporting

II. Increase access to quality care

III. Build capacity to sustain growth

Approaches I. Appointment of Campaign Task Force

II. Building a network of supporters

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Campaign Strategies & Approaches Strategies

1. Support for Strategies?

2. Additional Approaches?

3. Additional Activities?

4. Building a Network or Coalition?

5. Sharing Oregon’s Successes?

6. Other?

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Discussion and Suggestions

Contact Information

I. Bobbi Ryder – CEO at NCFH

Ryder@ncfh.org

2. Joseph Gallegos – NACHC

Jgallegos@nachc.org

3. My Learning Community - NACHC

http://mylearning.nachc.com

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Contact Information

NACHC’s My Learning Community: • Follow these easy steps: • 1.http://mylearning.nachc.com (no WWW) • 2.Enter your NACHC ID and password (same as what you use when

registering for NACHC events) • 3.If you do not have an NACHC id click on the “Sign Up” link • 4.Once successfully logged in go click on NACHC Communities • 5.Choose “Ag Worker Access 2020 Campaign” from the Explore

Communities drop down • • •If you have any questions or need assistance, please email Neha Desai,

Senior Knowledge Management Specialist at ndesai@nachc.com or by calling her at 301-347-0400

© 2015, National Center for Farmworker

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Thank You for Your Time!

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MSFW and Primary Care

Providing Care & Engaging Landowners • ¡Salud! & Virginia Garcia – Collaboration with Oregon

Winemakers, Tuality and VG to provide mobile primary care services to Oregon vineyard workers. These services are funded, through an annual auction with winemakers’ support. Contact Ignolia Duyck for iduyck@vgmhc.org, Leda Garside, leda.garside@tuality.org, or visit http://www.saludauction.org/ for more information.

Promotoras Columbia River Health Center - CRHC has a 1.0 FTE

Promotora who is present at the local agricultural farms all year round to bridge , between migrant farmworkers and the CHC.

Contact: Sarah Nunez, Snunez@crchs.net.

MSFW and Insurance Enrollment

Health Insurance Agents & OE Staff • One Community Health - O&E staff maintain a strong relationship

with the local bilingual Insurance Agent to assist MSFW find affordable coverage (public and private) for themselves and family. Contact Emma Quintana for more information equintana@onecommunityhealth.org.

Ventanilla de Salud • Wallace Medical Concern – WMC operated Ventanilla de Salud in

Mexican Consulate to provide health outreach, referrals and insurance enrollment.

• What do you do?

National Resources

Farmworker Justice

http://www.farmworkerjustice.org

Health Outreach Partners

http://www.outreach-partners.org

MHP Salud

http://www.mhpsalud.org

Migrant Clinicians Network

http://www.migrantclinician.org

National Association of Community Health Centers

http://www.nachc.com

National Center for Farmworker Health

http://www.ncfh.org

Local Resources

Oregon Office of Equity and Inclusion

Maria Elena Castro, Rural and Migrant Health Coordinator, Maria.Castro@state.or.us

Causa

http://causaoregon.org/

Legal Aid Services of Oregon’s Farmworker Program

http://lasoregon.org/services/

Oregon Community Health Workers Association

http://www.orchwa.org/

Thank you for listening

We appreciate the time you have taken out of your day to think about this population and the care that they need.

This webinar has been recorded and will be posted to the OPCA website.

Please share any comments or questions with us.