Partnerships for Successful Outreach and

Enrollment

Department of Health and Human ServicesHealth Resources and Services

AdministrationBureau of Primary Health Care

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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.

Developing a Successful Outreach & Enrollment Plan

Kristen StoimenoffDeputy Director

Health Outreach Partners

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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

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Plan & Prepare

Find, Connect, Educate

Link to Application Process

Enrollment Assistance

Renewal Assistance

Ensuring Access to Health Coverage

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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

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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)

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Ensuring Access to Health Coverage

• Step 5: Provide Renewal Assistance• Ensure continuous coverage• Assist with managing changes (address, family size,

income)

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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.

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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.

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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.

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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…

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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.

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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…)

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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.

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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.”

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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)

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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.

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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.

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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.

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Using the Plan:Monitor, Evaluate, Revise

• Establish a process for regular check-ins with the team.

• Use the progress column 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).

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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!

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Contact Information

Kristen StoimenoffDeputy Director, Health Outreach Partners

510-268-0091kristen@outreach-partners.org

www.outreach-partners.org

Using the UDS Mapper to Find Areas for Outreach

Jennifer L . Rankin, PhDGeospatial Informatics Senior Analyst

Robert Graham CenterAmerican Academy of Family Physicians

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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

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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

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www.udsmapper.org

Login or Register

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www.udsmapper.org

You can start using the UDS Mapper immediately after registering

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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

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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

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Accessing the Uninsurance Explorer

• 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

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www.udsmapper.orgClick “Tools” above the Map• Uncheck

“Explore Service Area Tool”

• Uncheck “Main Maps”

• Check “Uninsurance Explorer”

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www.udsmapper.org• 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

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www.udsmapper.org

Non- Medicaid Expansion States

Population that best matches the intent behind the Health Center Program funding

Medicaid Expansion States

Why So Many Levels

of FPL?

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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

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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

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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

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In by Geography mode, click on ZCTAs to select them.

Selected ZCTAs will be listed in the Selected ZCTAs box and will behighlighted with small black dots on them.

www.udsmapper.org

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Once you have ZCTAs selected, switch to the Data table to see the information from the rollover for multiple ZCTAs at a time

www.udsmapper.org

You can print or export these data to use outside of the UDS Mapper

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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

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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

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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

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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

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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

www.udsmapper.org

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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

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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

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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

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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.

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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

www.udsmapper.org

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www.udsmapper.orgHere 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.

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Contact Information

Jennifer RankinGeospatial Informatics Senior Analyst

202-331-3360jrankin@aafp.org

www.udsmapper.orgwww.graham-center.org

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Questions

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Affordable Care Act and Health Centers

• Outreach and Enrollment: • Hire O/E assistance workers• Certify your organization per requirements for

your state• Train O/E assistance workers• Plan and conduct outreach and enrollment

activities—take advantage of PCA, HRSA, and CMS resources

• Report progress: # of staff trained; # assisted; # with eligibility determination; # enrolled

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• Provide training and related information to health centers

• Coordinate O/E efforts at the state level

• Provide technical assistance

• Share real-time information with HRSA

• Report state level successes and issues.

ACA Outreach and Enrollment:Primary Care Associations

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ACA Key PCA and Health Centers Resources

Outreach and Enrollment Inbox (for general O/E questions)bphc-oe@hrsa.gov

PCA Outreach and Enrollment Inbox (for PCA questions and issues)

bphc-pca-oe@hrsa.gov

BPHC O/E supplemental funding TA web pagehttp://bphc.hrsa.gov/outreachandenrollment/

Other important websites: https://www.healthcare.gov/

https://www.cuidadodesalud.gov/es/ http://marketplace.cms.gov/

http://www.hrsa.gov/affordablecareact/

Raising the Visibility of Health Centers

Jodi Samuels, PhDAssistant Director of Development

California Primary Care Association (CPCA)

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Partnership: CaliforniaHealth+• Market Research & Focus Groups• Pilot Sites & Training• The California Endowment: Asegúrate

Campaign• PSA (aired in Spanish on Univision during NHCW)

• Materials & Resources

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Training & Peer Networking• Covered California Webinars: Outreach &

Enrollment 101 for CCHCs; Certified Enrollment Entity Application (planned)

• Annual Conference 2013: Outreach & Enrollment Briefing and Educational Expo

• CPCA Cross-Departmental O&E Team (Government Affairs, Programs & Training, Development & Communications)

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TA & Strategic Communications• O&E Grantee Contacts List for Bi-Weekly

Email Updates• Outreach & Enrollment Web Page• Enrollment Toolkit & Calculator (in development)

• CPCA Weekly Update (email)

• Covered California Meetings, Calls, Updates• HRSA Emails & Calls

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Contact Information

Jodi Samuels, PhDAssistant Director of Development

(916) 440-8170 x1101jsamuels@cpca.org

www.cpca.org www.californiahealthplus.org

1-855-899-PLUS (7587)

Health Insurance Marketplace & Medicaid Expansion O/E in Health

Centers

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HIRE &TRAIN O/E ASSISTANCE WORKERS

• HIRE • Job announcement, interviews, and hire

• 3 new staff to be hired out of 7 O/E workers

• Union Setting• Communications:

• “Don’t wait to enroll until you get sick and need services. Enroll as soon as you can. You don’t have to delay accessing health care for fear of costs. Community health centers are here to help you navigate the paperwork; and we’ll help you retain your eligibility in the language of your choice. - Jane Garcia”

• Educate all staff to focus health care reform changes

• State Requirements• TRAIN

• Overview• Expanded Medicaid and other Public Health Programs • Covered California

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IN-REACH, OUTREACH AND ASSIST WITH ENROLLMENT

• IN-REACH• Custom patient reports • Telephone calls & mailings• School Based, Medical and Dental Clinic sites

• OUTREACH• <138% • >138-400% • Current venues

• Faith based, health fairs, CBOs, businesses, schools, etc.• New Venues

• Non-health care venues, such as housing projects, small businesses, WIC sites, laundromats, etc.

• ENROLLMENT ASSSISTANCE• Clinic Based • Community Based

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BARRIERS AND SUCCESSES

• BARRIERS • Marketplace: Health Exchange: Covered California Training Schedule

• SUCCESSES • Build upon trust in the community • Build on & leverage existing resources & networks• Educate all staff• CPCA Training • Partnerships with CPCA and Local Consortia• Tracking Tools• Agency Wide Priority

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REPORT METRICS & BARRIERS TO HRSA QUARTERLY

• METRICS:• Clear Goals• Agency County Staff• Google Docs• CQI O/E efforts

• BARRIERS • External O/E materials written using

dense and technical language

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Contact Information

Viola Lujan, Director of Business and Community Relations

La Clínica de La Raza, Inc. (510) 535-4000 or (510) 755-6035

www.laclinica.org vlujan@laclinica.org

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Health Center Panel

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Questions

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Contact Information

Stephanie CristPublic Health Analyst

bphcta@hrsa.gov