Hospitals: Tactics for Getting Uninsured Patients Covered in the Marketplace

Getting Every Patient CoveredHenry GarciaManager, Managed Care ContractingUniversity Medical Center, El Paso, TX

Denver Health: Outreach, Retention, and RenewalAudrey HoenerDirector of Outreach ServicesDenver Health, Denver, CO

Running a Multi-Encounter Engagement ProgramLinda OlsenSite SupervisorCSRA, Inc., Atlanta, GA

Hospitals: Getting the Uninsured Covered

Henry Garcia, Managed Care Contracting, University Medical Center | 05.12.16

Getting Every Patient Covered

UMCUniversity Medical Center of El Paso

UMC Mission and Values

UMC Role in Region

UMC at a Glance

Payer Mix by Percentage

Charity Care

The Medical Center providers care without charge or at amounts less than its established rates to patients meeting certain criteria under its charity care policy

• Health Care Options

• Care Plus

ACA Enrollment Efforts

Strong supporter of The Enroll El Paso Coalition

ACA Enrollment Efforts

Enrollment Events in the Hospital

Earned Media

Community of Assisters

CAC Organization

University Medical Center is a Certified Application Counselor Organization with CMS

TXCACA51• 18 total associates are certified throughout main

campus and Neighborhood Health Care centers

Champion for Coverage Organization with CMSSelf-Serve Enrollment Center

UMC Self Serve

Enrollment Services Unit

18 Certified Application Counselors onsite• Monday through Friday 7:30 to 5:00• Provide 1:1 ACA Counseling• All Bilingual

Dedicated ACA enrollment line• Eligibility requirements• Go over what documents are required for

enrollment

CAC was added to as an additional job function• Certified yearly

Certified Application Counselors

UMC CACs

UMC Enrollment Statistics

Enrollment Period

• 2014 = 630

• 2015 = 239

UMC Required Forms

Consumer Email and Login Info

Managed Care ContractingThe Managed Care Contracting Department works with all Payers to contract in quality and affordable health plans for our patients

PPO’s, HMO , Exclusive “Narrow” Networks

• Hospital Contracting• Primary Care Group Contracting

We realize that not one plan works for all consumers

Managed Care ContractingProvides a rotating marketing schedule for all health plans to market on site at the main campus and at our Neighborhood Health Care Centers

Benefits:

• Plan enrollment• Customer Service • Q&A

Managed Care Contracting

PCP Pay-for-Performance

Quality Reporting

Improving the health outcomes of a traditional patient

Audrey Hoener, Director of Outreach Services| 05.12.16

Denver Health Outreach Services

Who is Denver Health?

Denver’s Safety Net, an Innovative Health Care System.Denver Health Medical Center (Hospital), 9 Community Health Centers, 17 School-Based Health Centers, and

Denver Public Health.

Outreach Services

• Community Health Centers

• Enrollment Van

• School-Based Health Centers

• Community Events

Community Health Centers

Colorado Expansion State & State MarketplaceStarted Outreach in CHCs in OE 1

Patient Tracking Sheet

Potential Eligibility for Medicaid or Connect for Health Colorado Insurance Plan

This patient may be eligible for Medicaid Expansion or a low-cost health insurance plan from Connect for Health Colorado. Denver Health Medical Plan (DHMP) is offering a variety of plans called ELEVATE for those that do not qualify for Medicaid. Please help all potentially eligible patients be screened by a Denver Health or a DHMP enrollment specialist. Check appropriate box below and thanks for your help!

“Enrollment Information Document” Given To Patient (to be marked by clerks)

Pharmacy Staff Talks to Patient

“I see that you MAY be eligible to get Medicaid or qualify to buy low-cost Health Insurance through Connect for Health Colorado under the new Affordable Health Care Law.”

“I encourage you to meet with our Community Health Advisor today, our HCP will escort you to her”

Pharmacy Staff Directs Patient to Community Health Advisor - TODAY

Community Health Advisor Consultation:

Patient has already completed a Medicaid application (approx. date: _________)

Patient is not eligible (i.e. Marketplace candidate, or is already on Medicare)

Patient is not interested Patient has been provided Enrollment Specialist contact information (i.e. patient is

self-employed and needs verification documents)

Patient completed a Medicaid application today

Patient Label

School-Based Health Centers

What does SBHC Outreach Look Like? Insurance is Identified at Time of Visit Uninsured Reports Run Daily Warm Hand Off and Phone Call Outreach Weekly Enrollment Events

Why Schools Work? Safe Environment and Familiar Close Proximity to Home Collaboration with School District Outreach Staff

Health Access Enrollment Van

Community Outreach

Data Collection

July August September October November December

f Pati

Months

Medicaid Applications Received via CICP Outreach in staff hand offs

# of Patients from CICP outreach list

# of Patients from CICP outreach with appsubmitt ed

# of Warm Hand offs (column F)

# of Warm Hand offs with app submitted (columnD)

July August September October

f Pati

Months

Medicaid Applications Received via CICP Outreach, staff hand offs, and walk ins

# of Patients from CICP outreach list

# of Patients from CICP outreach with appsubmitt ed

# of Warm Hand offs (column F)

# of Warm Hand offs with app submitted (columnD)

# of Walk ins

# of Walk ins with app submitted

Linda Olsen, Site Supervisor, CSRA, Inc 05.12.16

Running a Multi-Encounter Engagement Program

THE GRADY APPROACH

The Plan

Get the List Uninsured, multi-encounter

patients May be ACA eligible

Resources The Connector Enrollment Experts Volunteers

Call and call again! Multiple calls an absolute

Timing Counts Optimum call time

The Executioners!

Volunteers Are Key! Well Trained

Multitaskers

Tech Savy

Creative

The Tools

Get Covered America Chase Phone Script Review Practice Personalize-----------------------------------------------------------------------------------------------------------

Hi. Is _________ available? Hi _________. My name is _____________ . I’m a volunteer with Get Covered America, a non-profit organization and I’m calling on behalf of _______Health Systems. We talked to you a while back about your new health insurance options under the Affordable Care Act, and I’m calling because the marketplace is open and I want to make sure you have the information and help you need to take action by January 31st to get covered! Do you currently have health insurance? YesNo ………

The Connector – Step 1

The Connector – Step 2

The Connector - Step 3

Total Attempts Canvassed Spanish Yes No Yes/Maybe No Scheduled

GA01E, GA01E56SP 83 16 0 7 6 6 6 4GA01E, GA01E57SP 82 15 1 12 3 2 11 2GA01E, GA01E62SP 89 18 0 12 3 3 13 1GA01E122, Spelman, A Cornish 101 19 0 15 4 6 13 1GA01E124, Spelman, S Clark 54 5 1 2 3 2 1 2GA01E126, Spelman, D Gilbert 75 8 0 6 2 2 6 2GA01E58 Spelman, A Little 201 29 3 20 9 8 2 3GA01E60 Spelman, A Robinson 180 34 3 23 11 7 14 3GA01E61 Spelman, S Sleweon 52 6 1 6 0 1 2 0GA01E64 Spelman, D Watkin 95 21 1 17 4 8 6 3GA01E65 Spelman, Mercedes 200 42 2 26 16 15 27 3GA01E69 Spelman, B Davis Haney 64 16 0 15 1 2 14 0GA01E70 Spelman, Q Holmes 51 4 0 3 1 1 0 0GA01E71 Spelman, T House 58 9 1 5 4 3 6 0GA01E73 Spelman, C McKay 56 4 0 3 1 0 4 0

ConSCanvasser

Canvass Results Insu StIn

Total Universe Uninsured Marketplace eligible Multi ER visits

Total Passes 4+ 100% passes thru universe

Total Call Attempts More then 12,000

Total Conversations 67% of total universe

Connector Appointments 485

The Numbers

Round Robin:

If you could point to one factor that has allowed you to be successful and effective, what would it be?

Questions?

Henry GarciaManager, Managed Care ContractingUniversity Medical Center, El Paso, TXHGarcia@umcelpaso.org

Audrey HoenerDirector of Outreach ServicesDenver Health, Denver, CO

Audrey.Hoener@dhha.org

Linda OlsenSite SupervisorCSRA, Inc., Atlanta, GA

Linda.Olsen@csra.com

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