More Than an ER: How Hospitals Can Play a Vital Role in Engagement and Enrollment

© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org


More Than an ER:

How hospitals can play a vital role in engagement and enrollment



Merry Hutton, MPA | 06.11.15 Providence Health & Services

More Than an ER: How hospitals can play a vital role in engagement and enrollment


About Providence Health & Services

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© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 4

Our longstanding vision for access

What we believe Health care is a basic human right. Everyone should have access to

quality health care, regardless of ability to pay.

The Providence commitment Across the communities Providence serves, we offer free assistance to

enroll in coverage.

Providence enrollment outcomes During the 2015 open enrollment on ACA exchanges, our financial

counselors helped more than 20,000 individuals to enroll in coverage.


Strong partners

•  Federally qualified health center

•  Missoula Indian Center

•  Tribal Health •  CAC/Navigator

funded groups •  Exchange insurer

representatives at fairs

Advance preparation

•  Providence facilities ACA-certified application sites

•  Our caregivers trained as certified application counselors

•  12 caregivers supported plan

Easy access

•  Community enrollment fairs

•  Health insurance literary education at the fairs

•  Walk-in enrollment at our hospitals

•  Individual appointments during the week

Key success factors

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Outcomes in Providence Western Montana

State of Montana

Missoula County

Lake County

2013 20.7% uninsured

21% uninsured 26% uninsured

2014 15.8% uninsured

14% uninsured 16% uninsured

Percent change 4.9% 7% 10%

ACA-certified site

Providence St. Patrick Hospital

Providence St. Joseph Hospital

2015: Across Montana 54,266 people are enrolled and 85% qualify for premium subsidies


Next steps

Develop caregivers as health activation and literacy coaches

Decrease the number of public enrollment fairs

Increase the number of individual appointment slots, including weekends

Creating healthier communities, together

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Audrey Hoener

Director of Outreach Services

Denver Health Outreach Services


Denver’s Safety Net, an Innova2ve Health Care System Denver Health Medical Center (Hospital), 8 Community

Health Centers, 16 School-‐Based Health Centers Denver Public Health

Who is Denver Health?


•  Twenty-‐five percent of all Denver residents, or approximately 150,000 individuals, receive their health care at Denver Health.

•  One in three children in Denver is cared for by Denver Health

Who is Denver Health?


Expansion State EBNE Connect for Health Colorado Peak Health Advocacy successes

•  12 month continuous eligibility •  Elimination 5 year bar •  Streamlined application

State of Colorado and Denver


•  Medical Assistance Site •  Hospital and Community Health Enrollment sites

•  State contract

Enrollment Department


Community Health Advisors/Outreach Staff •  School-Based Health Centers •  Community Health Centers •  Health Access Express Enrollment Van

Outreach Services


Community Events and Partners

•  Pridefest Parade •  Urban Peak •  9 News Fair •  Gathering Place •  Beauty Shops •  Mobile Clinic

Outreach Services


In reach/outreach Appointment lists Warm hand off SBHC uninsured DPS partnership Following up with expansion populaSon

How do you find who is eligible?


Benefits of Outreach and Enrollment

More patients with a payer source Increased revenue Increased capacity to provide

services to low-income persons


Cumulative Enrollments via DH Enrollment

1,231

2,443

3,899

5,425

6,571

7,925

8,806

9,588 10,340

11,051 11,691

12,388 13,011

13,540 14,134

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Oct-‐13 Nov-‐13 Dec-‐13 Jan-‐14 Feb-‐14 Mar-‐14 Apr-‐14 May-‐14 Jun-‐14 Jul-‐14 Aug-‐14 Sep-‐14 Oct-‐14 Nov-‐14 Dec-‐14


ED Visits Percentage Medicaid & Insurance

64.18%

67.05% 66.85%

79.36% 80.32%

81.90% 83.26%

84.38% 84.88% 85.17% 85.38% 85.56% 85.72% 86.05% 86.15%

60.00%

65.00%

70.00%

75.00%

80.00%

85.00%

90.00%



Percentage of Patient Visits @ ACS with Medicaid

51.14% 52.24%

53.34%

61.29% 61.47% 59.98%

63.83%

56.44%

60.90%

62.50% 63.40%

62.30% 61.20% 61.10%

62.60%

40.00%

45.00%

50.00%

55.00%

60.00%

65.00%

70.00%



Outpatient Visits at Denver Health – 2013 and 2014

0

50000

100000

150000

200000

250000

300000

350000

400000

Primary Care Specialty Care Behaviroal Health Care ED and AUC

2013 2014

↑7.9%

↑51.2%

↓1.3%

↑12.3%

© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 21 21

ACA Impact on Payer Sources at Denver Health


Percent of Denver Residents Enrolled in Health Care Coverage

11.3%

Sources: 2012 American Community Survey, Colorado Department of Health Care Policy and Finance (HCPF), Connect for Health Colorado, Kaiser Family Foundation

Be Healthy Denver Goal: 94% by

12/31/2018

Before 2014 ACA Expansion Estimated Expansion Estimated Uninsured

Estimated Current Coverage = 94.4%

83.1%

5.6%


Denver Residents Enrolled in Health Care Coverage By Type

Sources: HCPF – Increase in Medicaid Enrollment January 2014 – January 2015. Connect for Health Colorado – Enrollment data for First Open Enrollment Period through April 26, 2014 and Second Open Enrollment Period through February 15, 2015, adjusted to exclude

those estimated to have been previously insured and those who re-enrolled in the second period. Kaiser Family Foundation (2014), Survey of Non-Group Insurance Enrollees.

Medicaid expansion total = 62,828


Enrollment Update – Denver County, 4/30/2015

*Medicaid enrollment through 4/30/15 and Connect for Health Colorado enrollment in the first and second open enrollment periods through 2/15/15, adjusted to remove those thought to be insured prior to purchasing plans and those who re-enrolled in the second open enrollment period. **Includes adjustment for Denver's population increase 2012-2013. Sources: American Community Survey, 2012, Colorado Department of Health Care Policy and Financing, Connect for Health Colorado, Kaiser Family Foundation (2014), Survey of Non-Group Insurance Enrollees and (2015) Survey of Non-Group Health Insurance Enrollees, Wave 2.


Challenges for Outreach and Enrollment

•  NegaSve media coverage about the ACA •  ConSnued access to CICP, although it does not saSsfy

the individual mandate to have insurance •  Lack of knowledge about:

–  new forms of coverage – Medicaid and Connect for Health CO – and eligibility

–  availability of financial assistance to purchase insurance –  generous size of the subsidies (average $277/family, C4HCO

2013-‐2014) –  Insurance generally – what it is, how to use it, why have it?

•  PercepSon of unaffordability of insurance •  Unwillingness to pay for insurance, even with subsidies •  Many plans to choose from -‐ 176 plans at Connect for

Health Colorado in 2014-‐15


•  People do want insurance – 84% of those who did not enroll in 2013-2014 want it (Enroll America survey).

•  Accurate and widely available information about the benefits of health insurance and how the ACA helps people get covered.

•  Assistance to sign up for Medicaid and insurance plans.

•  CICP does NOT satisfy the individual mandate – holders will pay penalty. They can use CICP as secondary coverage to help with co-pays.

•  Tax penalty going up – from $95 to $325 per adult or 1% to 2% of family income in 2015.

•  Connect for Health CO is working – individual plans went up by only 0.71% on average statewide this year.

•  Medicaid is free, good coverage for those who qualify.

•  Many others are getting it - 42,351 new adults got Medicaid in Denver in 2014, up 79% from 2013. 1/5 people in CO have it now!

Overcoming the Barriers


•  Community Health Worker model

•  Health Insurance Literacy •  Patient Ambassadors

•  Sustainability?

Moving Forward


Audrey Hoener Director of Outreach Services

Denver Health [email protected]

(303) 602-8969



Daniel Waldmann, SVP, Public Relations

Path to Health Tenet’s Enrollment Campaign


Tenet Healthcare Today 80 hospitals

110,000 employees

219 outpatient facilities

36,000 affiliated physicians

20 million annual patient encounters

16 accountable care organizations

6 health plans

20 Conifer client service centers

Hospitals

Outpatient Facilities

Health Plans


Tenet in 10 of 13 Counties with Most Uninsured

LA County, CA 2.2M 22.0%

Harris County, TX 1.1M 25.8%

Cook County, IL 887k 16.9%

Miami-Dade County, FL 762k 29.4%

Dallas County, TX 675k 27.5%

Maricopa County, AZ 657k 16.8%

Orange County, CA 531k 15.1%

San Diego County, CA 521k 16.3%

Riverside County, CA 445k 19.6%

Clark County, NV 434k 20.7%

San Bernardino, CA 419k 20.1%

Broward County, FL 408k 22.6%

Queens County, NY 402k 17.7%

These 13 counties contain 20% of all of

the uninsured individuals in the US.

# of Uninsured % of County Uninsured

Source: U.S. Census Bureau March 2012


Seizing the Opportunity

Actions to increase enrollment in Exchange products / expanded Medicaid programs

Identification Outreach Enrollment

•  Info websites •  Community

outreach •  Conifer •  Enroll America

data

•  Traditional / digital marketing •  Community events •  Branded campaign with bilingual

website, social media, hardcopy educational materials and central call center

•  Partnerships with credible community organizations

•  Supplemental staffing in priority markets

• Partnerships with Navigator groups to staff enrollment events at hospitals and out in the community

• More than 355 medical eligibility personnel qualified as certified application counselors (CACs)

• Direct mail and telephone outreach targeting existing exchange-eligible self pay patients

Market-specific targeted outreach plans Websites, toolkits and other materials +


Collateral Material Building Blocks


Second Round Collateral Material


•  Recruited more than 400 trusted community-based partners.

•  Held 646 outreach events and 209 enrollment events, attended by more than 216,000 people.

•  Scheduled 1,648 appointments with Enroll America Connector.

•  Provided enrollment assistance and education to nearly 17,000 individuals.

•  Facilitated more than 10,439 exchange enrollments resulting in 15,000-16,500 enrolled individuals.

Open Enrollment 2 Achievements


•  Consumers more comfortable enrolling online

•  Presence of insurance brokers on exchange increased dramatically, giving consumers more in-person assistance options

•  Higher number of complex cases from individuals who were unable to enroll in OE1

•  Get Covered Connector streamlined enrollment assistance scheduling

•  Collaboration with School Districts has increased effectiveness of outreach efforts in CA & GA

•  Broaden appeal of enrollment events through incorporation of wide range of services

Lessons Learned



Sonja Smith, Project Manager for Enroll Alabama | 06.05.15

More Than an ER: How Hospitals Can Play a Vital Role in Engagement and Enrollment


More Than an ER

About Enroll Alabama •  8 satellite offices

•  Hosted over 900 outreach

events

•  Enrolled 15,000 consumers

•  Assisted over 20,000

Alabamians

•  Project of AIDS Alabama


More Than an ER

2014 Open Enrollment •  Huntsville Hospital System

Partnership

•  Month-long Enrollment Blitz

•  Over 100 Consumers

Enrolled


What Didn’t Work •  Too Short

•  Limited Planning

•  Not Enough Locations

More Than an ER: 2014 Hospital Enrollment

What Worked •  Fixed Location & Time

•  Use of Volunteers

•  Location

•  Cross-marketing


More Than an ER: 2015 in North Alabama


More Than an ER: 2015 in Central Alabama


More Than an ER: Marketing

Hospitals Provided…

•  Customized Mail outs

•  Newspaper Ads

•  Social Media Integration

•  Building Signs

•  Distribution of Enroll Alabama

Materials

•  Door-to-Door Flyer Distribution

•  $20K Radio Campaign


2015 Hospital Affiliated Sites

More Than an ER: 2014 vs. 2015 Sites

2014 Hospital Affiliated Sites

Huntsville, AL 100 enrolled

Athens, AL

Birmingham, AL

Decatur, AL

Dothan, AL

Cullman, AL

Florence, AL

Huntsville, AL

Jasper, AL

Mobile, AL

Muscle Shoals, AL

Sylacauga, AL

Talladega, AL

400+ enrolled


•  Engage Hospitals

•  Ask for help

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Section 1: Enrolling your family

•  Market, Market, Market!

Follow Us: Facebook: Facebook.com/EnrollAlabama Twitter: Twitter.com/EnrollAlabama YouTube: YouTube.com/EnrollAlabama Instagram: @EnrollAlabama For more information about Enroll Alabama, including upcoming events, frequently asked questions, and more, visit EnrollAla.com

More Than an ER: Takeaways



Sonja Smith [email protected]

More Than an ER: How Hospitals Can Play a Vital Role in Engagement and Enrollment

Healthcare

Transcript of More Than an ER: How Hospitals Can Play a Vital Role in Engagement and Enrollment