Partnerships for Successful Outreach and Enrollment

1. Partnerships for Successful Outreach and Enrollment Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care

2. Learning Objectives • Develop a plan to conduct in-reach to eligible health center patients and outreach to service area residents. • Access new data available in the UDS Mapper to target uninsured eligible populations. • Retain key partnerships between health centers and PCAs to support health center outreach and enrollment activities.

3. Developing a Successful Outreach & Enrollment Plan Kristen Stoimenoff Deputy Director Health Outreach Partners

4. Health Outreach PartnersOutreach & Enrollment T/TA • National Cooperative Agreement focused on strengthening outreach to special populations • Outreach & Enrollment TA • Aimed at building skills and developing community networks • TOT curriculum initially developed through a private grant • Collaboration with PCAs on CHIPRA projects • Regional trainings through conferences, PCAs • Site-specific trainings at health centers

5. Ensuring Access to Health Coverage

6. Ensuring Access to Health Coverage • Step 1: Plan and Prepare • Well-constructed workplan • Well-trained staff and partners • Clear and relevant messages, accepted messengers • Step 2: Find, Connect, and Educate • Identify eligible but uninsured individuals through “in-reach” to existing clients, outreach in the community, and through strong partnerships with other agencies serving your priority population

7. Ensuring Access to Health Coverage • Step 3: Link Eligible Persons to Application Process • Education about available programs and benefits • Education about application process • Providing support with tools and resources • Direct assistance or referral (“warm hand-off”) to CAC • Step 4: Facilitate Enrollment • Assistance completing and submitting application • Follow-up • Assistance with using coverage (getting care)

8. Ensuring Access to Health Coverage • Step 5: Provide Renewal Assistance • Ensure continuous coverage • Assist with managing changes (address, family size, income)

9. Key Planning Considerations • Find and Connect through Outreach and Inreach • In-reach – use a variety of ways to identify people who are already your patients and talk to them about the value of health insurance, the availability of affordable plans, and the assistance available to them. • Outreach – find people where they live, work, and spend time. Educate, answer questions, address barriers, acknowledge concerns, provide assistance and/or referrals. • Outreach can help identify and connect uninsured community members to coverage. It can also increase the number of patients coming into your health center.

10. Tools and Strategies to Guide Planning • Finding eligible but uninsured individuals is the first step in connecting with them. • For inreach use EHR (or patient charts) to record and verify insurance status. • Develop lists of uninsured patients and consider calling campaigns, mailings, etc., to reach out to patients without an upcoming appointment.

11. Tools and Strategies to Guide Inreach Planning • Capitalize on patient contact points throughout the visit to educate and connect uninsured patients to enrollment assistance. • Providers (importance, referrals); appointment scheduling; patient registration; billing; waiting room; health education... • Most inreach efforts will occur within the health center setting. Outreach should occur in places where people live, work, and spend time.

12. Tools and Strategies to Guide Outreach Planning • Health centers have limited staff time and resources. Identifying optimal times and locations for outreach is critical. • Start with some good-old-fashioned brainstorming to come up with a list of places where eligible but uninsured people might be found. • Outreach workers especially will have a good sense of where you priority populations can be found. Consider grocery stores, the laundromat, the library, work sites, food pantries/soup kitchens, public housing sites…

13. Tools and Strategies to Guide Outreach Planning • Create a map that visually represents where you need to be in the community to reach the uninsured. • Check your state Department of Transportation or county offices for low-cost wall maps • Use web-based maps (like Google Maps) • Use GIS, UDS Mapper, or other technology to further focus and customize outreach activities • Plot locations on the map (use physical or virtual “pins”) to highlight areas to conduct outreach.

14. Tools and Strategies to Guide Outreach Planning • Consider the best times to do outreach – both time of day, and time of year. • Create an annual calendar showing • Events the outreach team will participate in (community health fairs, parent meetings, church socials…) • Important community events (Head Start enrollment, Back-to-School events, holiday celebrations, annual festivals…) • Organizational activities that could impact O&E (staff meetings or trainings, planning events, vacations…)

15. Constructing the Plan • Develop a comprehensive workplan that addresses all outreach and enrollment components and incorporates the roles of everyone involved. • Executive team establishes priorities and broad parameters. • Involving individuals and programs enhances “buy-in,” participation, and accountability. • Can use templates for individual or team workplans.

16. Constructing the Plan • Start with a GOAL (or two…): a broad, brief, statement of intent that provides a vision for your O&E efforts. • “Ensure access to affordable health coverage and care across our 3-county service area.” • “Assist all eligible patients in obtaining and retaining affordable health coverage.”

17. Constructing the Plan • Create objectives that will help goals. • Create objectives for all key areas of your O&E work (ie, inreach, outreach, assistance, enrollment, retention) • “By February 2014, enroll 50 eligible families who are seeking food commodities from the local food bank into Medicaid.” (enrollment objective) • “By October 2013, provide a 1.5 hour training to 25 outreach staff at partner organizations regarding eligibility requirements and how they affect outreach and enrollment in this county.” (outreach objective)

18. Constructing the Plan • Outline the activities necessary to complete your objectives. • For the outreach objective above, you could include activities like: set training date; secure training location; develop invitation list; send invitations, develop presentation; confirm logistics; give presentation; evaluate training.

19. Constructing the Plan: Create Accountability • Who will be responsible for each activity? • Specify the department, title, or staff name. • When will each activity be completed? • Establish a specific date for each activity.

20. Constructing the Plan:Create Accountability • What are expected outcomes of each activity? • ie, 80 potential training participants identified; 75% of invitees RSVP that they will attend. • How will you know you have achieved your outcomes? • ie, signed location agreement; list of confirmed participants.

21. Using the Plan:Monitor, Evaluate, Revise • Establish a process for regular check-ins with the team. • Use the progresscolumn of the workplan to update and monitor successes, challenges, delays. • Revise activities as needed to help meet your objectives; revise objectives as needed to help you toward your goal(s).

22. Final Thoughts • Creating a comprehensive plan will allow all O&E team members to see where you want to go and how you plan to get there. • It’s not rocket science, but it requires time, shared commitment, and ongoing attention. • Make your plan work for you – don’t let it die on a shelf!

23. Contact Information Kristen Stoimenoff Deputy Director, Health Outreach Partners 510-268-0091 kristen@outreach-partners.org www.outreach-partners.org

24. Using the UDS Mapper to Find Areas for Outreach Jennifer L . Rankin, PhD Geospatial Informatics Senior Analyst Robert Graham Center American Academy of Family Physicians

25. What is the UDS Mapper? • An online mapping tool used to understand where health center patients live • Built to help safety net organizations plan for growth and outreach • New tools include the Uninsurance Explorer

26. Who Can Use the UDS Mapper? • Anyone! • Free to sign up • Must have an email address • Multiple people at a single organization can have their own accounts • Multiple people can use the same account at the same time

27. www.udsmapper.org Login or Register

28. www.udsmapper.org You can start using the UDS Mapper immediately after registering

29. What Data Can Be Found in the Uninsurance Explorer? • Estimates by ZIP Code Tabulation Area (ZCTA)* of the percent of the uninsured at different income levels based on the Federal Poverty Level (FPL): • Below 100% FPL • Below 138% FPL • Below 200% FPL • Between 100% and 400% FPL • Between 138% and 400% FPL * ZCTAs are created by the US Census Bureau to approximate ZIP Codes

30. What Data Can Be Found in the Uninsurance Explorer? • Official estimates from Centers for Medicare and Medicaid Services • Data are shown by Public Use Micro Area (PUMA) • Larger than ZCTA- may be whole county or multiple counties

31. Accessing the UninsuranceExplorer • In the UDS Mapper, • Login • Turn off the Explore Service Area tool • Turn off the Main Maps or current Main Map • Turn on the Uninsurance Explorer

32. Click “Tools” above the Map • Uncheck “Explore Service Area Tool” • Uncheck “Main Maps” • Check “Uninsurance Explorer” www.udsmapper.org

33. Click the check box to turn on/ off a layer • They will turn on above/ below other layers so turn off what you don’t need www.udsmapper.org

34. Non- Medicaid Expansion States Population that best matches the intent behind the Health Center Program funding www.udsmapper.org Why So Many Levels of FPL? Medicaid Expansion States

35. Scroll down in the Uninsurance Explorer to find tools to help you find areas for analysis and add health care facilities In this example, I searched for Aurora, CO, selected the correct choice from the drop down box and clicked “Go”; the map zoomed in and focused on Aurora www.udsmapper.org

36. When you roll over a ZCTA you will see this information: • Number of HCP patients, 2012 • Number of uninsured (not just patients) • % of uninsured by each FPL level • How many different HCP organizations the people who live here go to • Top five health centers that serve the people who live here www.udsmapper.org

37. Explore Service Area • There are three modes to use • By Geography – select ZCTAs by clicking on them or searching for them • By Patient Origin – select ZCTAs based on HCP organization 2012 service area • By Geography – select ZCTAs based on distance from an address/ point on map

38. In by Geography mode, click on ZCTAs to select them. Selected ZCTAs will be listed in the Selected ZCTAs box and will be highlighted with small black dots on them. www.udsmapper.org

39. www.udsmapper.org You can print or export these data to use outside of the UDS Mapper Once you have ZCTAs selected, switch to the Data table to see the information from the rollover for multiple ZCTAs at a time

40. In by Patient Origin mode, select a HCP grantee or look-alike and the ZCTAs where patients came from in 2012 will be covered by diagonal lines; ZCTAs with lines will be listed in the data table www.udsmapper.org

41. In by Distance mode, enter an address or click on the map to place a push pin. It will calculate a drive time or distance as large as you specify and select all ZCTAs that have any portion within that area. www.udsmapper.org

42. When to Use Each Mode… • By Geography • You know the area you want to focus on • You are selecting by colors on the map • By Patient Origin • You want to focus on the areas already served by your health center • By Distance • You want to see the area around a location where you are doing an O/E event

43. Add Your Own Data Using QuickGeocodes • Copy and paste your spreadsheet into the UDS Mapper to add points to the map • Make sure your dataset has: • Address • City • State • ZIP Code • Optional: Categories/ Location Types

44. www.udsmapper.org Quick Geocodes allows you to just paste your data into the UDS Mapper. It will match your fields to what it is looking for to geocode them. If it does not pick the right fields, use the drop downs to select the correct ones. Then click Geocode Now

45. Your points will show up on the map as blue dots. Use the Group/ Category option to color dots based on the categories in your dataset Change the shape on the map www.udsmapper.org

46. After you have categorized the data, they will appear as different colors (maximum of 10 categories/ colors)and appear in the legend. www.udsmapper.org

47. Validate What You See with Other Data • UDS data • Turn on Main Maps and/ or Explore Service Area tools • QuickThemes • Add data to the UDS Mapper that colors in ZCTAs, counties, census tracts etc. • Community Health View • Add other relevant health-related datasets

48. www.udsmapper.org With the UDS Mapper Main Maps tool on, I can see whether the people who live in these areas who I encounter during outreach already are likely to seek Health Center services.

49. www.udsmapper.org In Community Health View, enter a key word, in this case, I searched for ‘SNAP’, Supplemental Nutrition Assistance Program, to find areas where children are eligible for free or reduced price lunch

50. www.udsmapper.org Here I see by county the percent of students eligible for free lunch. I can use layer controls to increase the transparency of this layer to see my uninsurance layer in the back.