THE UNINSURED CONNECTION CHALLENGE

1. THE UNINSUREDCONNECTION CHALLENGE “Connection Challenge"

2. Segments to be presented: A Statewide Overview by Steve Cooper, ClaimAid Collaboration by Paul Pfaff, IU Health Effective Community Outreach By Kate Gentry & Mike Mannell, IU Health “Connection Challenge"

3. A Statewide OverviewSteve Cooper, ClaimAid “Connection Challenge"

4. Uninsured/Underinsured Challenges in Patient AccessInternal Inventory and Analysis • Connect • Communicate (Community) • Conversation (Patient / Family) • Comprehensive Review “Connection Challenge"

5. Make a ConnectionWho are the Uninsured? • There are 50 million uninsured persons in the US • 9 million uninsured children – approx. 6 million are eligible for coverage. • Indiana: approximately 900,000 uninsured • > 132,000 Children • 772,000 non-elderly adults • Both Medicaid and the Children’s Health Insurance Program (CHIP) offer health insurance coverage to children in low- and moderate-income families. • Indiana offers 27 categories of Medicaid “Connection Challenge"

6. Who are the Uninsured, cont… • Enrollment has been increasing, with 40 million children insured by Medicaid or CHIP in 2009 but barriers remain. • Recognize vulnerable patients’ needs • Remember there are cultural differences from one community to the next • Identify the set of struggles unique in your community • Strategize Outreach with community partners “Connection Challenge"

7. A New Face of the Uninsured • In 2010, an average of 310,000 Hoosiers were unemployed each month.  This is more than double pre-recession levels.  In 2007, unemployment was around 148,000 per month. • Nationally, and in Indiana - close to 30% of the unemployed remain unemployed long-term.  This means approximately 100,000 Hoosiers in a given month may have been out of work for a year or more and have lost not only their health care coverage - but they are also exhausting their unemployment insurance benefits. • Considering the large % of unemployment in the manufacturing and construction industries, and the age and education level of this segment of the unemployed population (average level HS education or less) - substantial barriers to re-employment and access to health coverage exist. “Connection Challenge"

8. Perceptions of and Barriers to Enrollment • Most eligible uninsured children are concentrated in low income families • 1/3 of uninsured children have uninsured YET eligible parents • In recent studies >90% of low income parents are willing to enroll their children • 45% did not think they were eligible • 55% did not know how to apply • 50% felt the enrollment process was difficult • 51% did not know where to go for more information “Connection Challenge"

9. “Connection Challenge"

10. “Connection Challenge"

11. Communicate Common GoalLack of Awareness of Available Resources • Obtain Buy-In from all stakeholders • Coordinate pre-registration w/pre-screening of eligibility for coverage • Screen at point of service in Emergency Department for all programs • Coordinate screening cooperation with Financial Assistance eligibility • Educate all community partners of availability of resources to screen and assist patients "Individual commitment to a group effort - that is what makes a team work, a company work, a society work, a civilization work. " ~ Vince Lombardi “Connection Challenge"

12. Patient Access Points “Connection Challenge"

13. Conversation • Tools to screen are helpful but do not provide the complete picture for the assistance group. • Thorough face to face interview prior to or at Point of Service reaps best results. • Tone of voice, being non-judgmental, and keeping a sincere attitude is essential to gain confidence. (Patient’s Voice Skill Clinics) • Assist with filing of appropriate application(s) and collection of necessary documentation. • Education of deadlines and responsibilities/ consequences is necessary element. • Good understanding & awareness of current FSSA application process in your region of the state. “Connection Challenge"

14. Hybrid Roll-out Timeline by DFR Regions Region 1 = Lake (TBD) Region 2 = Saint Joseph (TBD) Region 3 = Allen (2/14/11) Region 4 = Grant (2/14/11) Region 5 = Marion (TBD) Region 6 = Vigo (6/22/11) Region 7 = Vanderburgh (1/26/10) Region 8 = Clark (9/19/11) “Connection Challenge"

15. Comprehensive Review • Follow up with processing entity ( DFR or Regional Call Center) by utilizing state’s available tools i.e. Authorized Representative forms, Agency Portal, participating in FSSA DFR Regional Advisory Group. • Make periodic identification of strengths and weaknesses in your system and processes to ensure that best allocation of resources are used. • Add screening access points as identified. • Implement performance indicators at key revenue cycle points to measure trends to quickly remedy problems. • Encourage patients to appeal inappropriate denials. • Be an advocate. “Connection Challenge"

16. A Referral System with Connections Why relationships are so important in maximizing Healthy Indiana Plan Enrollment Paul Pfaff, IU Health “Connection Challenge"

17. Vision and Purpose • Converting self pay and no pay patients into patients with health insurance • Increases revenue IU Health would receive for these patients • Reduces billing and collection efforts • Provides much needed community outreach • Offers a valuable service to those that utilize services within the system “Connection Challenge"

18. What we do • In 2009, the Clarian HIP Enrollment Center (now the IU Health Enrollment Center) was formed to: • Work with IU Health Marketing to develop marketing and educational communications for employees, patients, and the public • Develop referral network to identify and enroll HIP eligible individuals within the system and the community • Partner with HealthNet to identify and enroll HIP eligible individuals through • New patient intake • Existing patient referrals • Outreach • Participate in Outreach with IU Health Community Outreach and Engagement as well as identify outreach opportunities independently • Conduct annual survey of 2,000 – 3,000 IU Health affiliated supplemental employees for HIP eligibility “Connection Challenge"

19. Why Operate on Referral • 5 large hospitals in the Indianapolis Metro-plex • Numerous PCP and specialty offices • Affiliated FQHC with 8 separate locations • Large urban area includes: • One of the largest school districts in the state • Several homeless shelters and assistance organizations • Churches, neighborhood associations, small businesses • In short: ”A bunch of them…few of us!” “Connection Challenge"

20. Partial List of Referral Locations • Facilities • Emergency Department • Inpatient • Outpatient • Pre-Services • Clinical Social Work Staff • Organ Transplant • Pastoral Care • Occupational Health • Patient Financial Services “Connection Challenge"

21. Partial List of Referral Locations • Providers • FQHCs • Affiliated and friendly Primary Care • Affiliated and friendly Specialists • Clinics • Homeless Shelters • Churches • Small Employers “Connection Challenge"

22. Referral Solution • Needed to identify a solution that: • Integrates into organization’s work flows causing minimal additional effort on staff • Maximizes the number of individuals or patients that are screened for eligibility • Educates individual or patient on the benefits of the Healthy Indiana Plan • Results in working referrals to the IU Health Enrollment Center for successful application processing • Maximizes HIP enrollment for resources expended “Connection Challenge"

23. Referral Survey Tool • Can be tailored to the organization or department (aids in tracking) • Survey questions can vary based on application • Can be developed to serve additional uses • Can be completed by staff based on interview with patient or available in waiting rooms for patient or family members to fill out on their own “Connection Challenge"

24. HIP Survey - Examples • Emergency Department • FQHC Clinic Office

25. Specialty Surveys • To identify Package B Moms who would be eligible for HIP after pregnancy Medicaid benefits run out

26. “You have to kiss a lot of Frogs” • To date, the IU Health Enrollment Center : • Operates with a staff of 7 employees and draws from the undergrad and graduate Health Administration programs at IU and IUPUI • Has received more than 2,200 Healthy Indiana Plan referrals • Investigated 2,000 of them with 630 being converted to applications (31.5%) • Currently investigating 200 referrals • Is actively assisting MDWise with the redetermination of HIP members in the Methodist network (approximately 100 per month) • Is actively contacting approximately 11,000 HealthNet patients who have not been screened for HIP who may be eligible • Has originated 1,675 applications from referral, redetermination and outreach: • 877 submitted and processed by the state with 597 approved (68.1%) • 121 pending with the state • 257 pending information from the applicant • 420 closed for failure to cooperate • Have made 405 POWER Account subsidy payments totaling more than $65,000 through the Methodist Health Foundation “Connection Challenge"

27. What’s Next? • In early 2010, IU Health renewed its Enrollment Center Agreement with FSSA • Listed all 15 affiliated hospitals as enrollment centers • Included the IU Health Enrollment Center as an enrollment center • Effectively expanded application responsibility of IU Health Enrollment Center to include HIP, Hoosier HealthWise, Medicaid, and Medicaid-related and waiver programs “Connection Challenge"

28. Community Outreach & Marketing IU Health Mike Mannell & Kate Gentry “Connection Challenge"

29. Regional Focus • IU Health South Central • Represents Bloomington, Bedford, and Paoli hospitals • Servicing 10-county area “Connection challenge"

30. Roles in the Community • Facilitate enrollment processes for Healthy Indiana Plan (HIP) • Authorized Representative serving as liaison between applicant and FSSA or insurance carriers • Collaborate with community agencies and public service organizations “Connection challenge"

31. Outreach Goals • Decrease uninsured/self pay population • Increase HIP enrollment by county • Market & educate communities on affordable insurance options • Encourage preventative care by promoting access to insurance “Connection challenge"

32. Outreach & Marketing Strategies • Internal • Effectively educate and maintain relationships with associated hospital departments • External • Grassroots efforts, network with local resource agencies, and actively build relationships with public service organizations “Connection Challenge"

33. Internal Support • Keeping employees and departments up-to-date on HIP-related information • Build a network of referrals available within the hospital • Awareness of HIP is the single most important strategy for internal networking • Partnering with key departments sponsoring and hosting community events “Connection Challenge"

34. Support of Internal Departments • Community Health • Community events, WIC, Family Wellness Programs • OB/GYN Department • Prenatal education and Postpartum awareness • Human Resources • Employee Wellness program & eligible part-time/temp employees “Connection Challenge"

35. Key Internal Referrals • Patient Financial Services • Caseworkers, Financial Counselors, Social Workers all coordinate referrals to HIP eligible patients • Direct Mail -Key demographic information used to identify potential eligible individuals located in 10 county service area • IU Health Urgent Care Facility • Behavioral Health • Emergency Department • Patient Accounts “Connection Challenge"

36. External Outreach • Identifying our presence and role in the community • Build relationships with community health care providers • Networking with community resource agencies and public service organizations • Real grassroots efforts in rural areas “Connection Challenge"

37. External Support • Referrals from networking with community agencies and public organizations • Invitations to participate in local public events • Health fairs & Children’s wellness events • Community gatherings • Volunteers in Medicine • Provides healthcare to uninsured, low-income population of Monroe and Owen County • HIP advertising • Radio shows • Newspaper advertisement • Word-of-mouth referrals • Very important, especially in small, rural towns “Connection Challenge"

38. Grassroots Efforts • Willingness to become involved in smaller populations and events is key to gaining access and acceptance within communities • Identify areas of interest within demographic regions • Advertise at local “Hot Spots” (restaurants, gas stations, parks & lakes, churches, etc.) • Brand your role by “Representing the Program” “Connection Challenge"

39. Orange County 4-H Fair

40. Kids’ Health & Safety Fair

41. Working with Local Celebrities…

42. …And Having Fun Along the Way

43. Monroe County’s B 97 Radio Interview

44. Valuable Resources • Networking Drop-off Database • Created to help organize distribution of HIP material • Ensures efficiency by identifying specific county locations and scheduled follow-ups • Intern/Volunteer Opportunities • Adds new ideas and processes to the team • Experience in public health field and inter-department hospital relationships “Connection Challenge"

45. Financial Assistance for HIP Power Account Payments • Individuals are assigned monthly premiums based on 2-5% of their income • Funding available through the Bloomington Hospital Foundation • In 2009, $125,000 was allocated towards financial assistance • By the end of 2010, over $100,000 was applied toward HIP subsidy’s and assisted over 400 members • Each patient is eligible to receive up to $600 annually “Connection Challenge"

46. ConclusionKey Elements to Reduce Uninsured in Indiana • Encourage Indiana FSSA to continue to adopt improved enrollment and renewal procedures to reduce burdens on families. • Expansion of programs does not = more individuals enrolled. Connecting people to the expanded programs = more individuals enrolled. • Promotion of coverage options at: • Each Access Point/ Registration • Community Outreach • Ongoing education of all partners: • Internally • Externally • Be open and invite new ideas to continue to connect people tomedical coverage options. “Connection Challenge"

47. QUESTIONS???THANK YOU!!! “Connection Challenge"

48. Presenter Contact Information Steve Cooper, ClaimAid 800.842.4052 x116 scooper@claimaid.com Paul Pfaff, IU Health 317.963.9774 healthyindianaplan@iuhealth.org Mike Mannell 812.353.2023 mmannell1@iuhealth.org Kate Gentry 812.353.2022 kgentry2@iuthealth.org “Connection Challenge"