CHIP EDUCATION PROJECT

Karin Dunn HCHD/Gateway to Care

Origins

Mandated by the 1999 Texas Legislature to determine efficacy in reducing costs when using peer-to-peer educators Community Health Workers Promotores de Salud Lay Health Workers About 70 other titles

Project Started in January 2006 and projected to continue to December 2008, serving 8,103 families

Project Overview Educate Harris County CHIP families

on how to appropriately use benefits PCP as “medical home” Ancillary Benefits (Dental & Vision) Case Management Identify barriers to use (language/culture,

transportation, etc.) Provide options to overcome

Insure that parents have HMO’s member service line number and nurse triage lines

Family Identified

Family Understands benefits and Health Plan

Complete Family Health Plan and review important phone numbers

Family does not understand

benefits and/or plan

Discuss benefits

Provide education about health plan and Primary Care

Physician

Family has specific education need

Complete Family Health Plan and review important phone numbers

Provide basic education resources

Reinforce/educate need for continuity of

care and medical home

Complete Family Health Plan and review important phone numbers

Educate to communicate with PCP and provide

information on additional education

opportunities available through health plan

YES

Reconnect with family 6 months later to determine if re-enrolled

CHIPFamily

Reinforce/educate need for continuity of

care and medical home

Reinforce/educate need for continuity of

care and medical home

NOTE: Family Health Plan includes: 1) contact information for Navigator, 2) encouragment to call if problems or questions, 3) reminders about enrollment and other useful information & telephone numbers

Family needs social supports to

utilize benefits properly

Reinforce/educate need for continuity of care

and medical home

Determine social needs and identify resources

Complete Family Health Plan and review important phone numbers

Encourage family to contact Navigator with social needs

Determine if appropriate referral for

Health Plan Case Management and

make referral. Provide other referrals

as appropriate

Referral Mechanisms

Provided by Health Plans based on self-defined criteria Emergency Room Usage

(frequent/primary care related) Near end of term

Navigators identified from patients of clinics where they are co-located

Since June 2007, have received a sample of newly enrolled families on CHIP directly from HHSC

Served through Febuary 29, 2008

Educated 4,877 families

Another 1,213 were educated, but were off CHIP as time of service

Findings to Date

Parents are confused by Program due to multiple changes over past 5 years and multiple errors encountered

Parents do not understand how managed care fits into benefits package – do not understand that member service line is available for problems with providers or for other issues

Findings - continued

Parents do not understand that ancillary benefits available – dental & vision

Parents have no knowledge of plan-provided nurse triage line

Parents do not know who to notify of address change

Families with child(ren) moving from Medicaid are often moved to another health plan.

Additional Outcomes

Community Health Worker Training Institute 5 certification classes (160-hour each) Continuing Education classes to

maintain certification CHW Regional Symposium Navigator Associates Training