1. Michigan Breast and Cervical Cancer Navigation Program (BCCCNP) Introducing Patient Navigation to Provider Offices June 7, 2016

2. Assure low-income women receive timely access to needed breast and/or cervical cancer services. Program Goal

3. Two Types of Services Provided Caseload Services – BCCCNP acts as a “insurance company” and pays for breast and cervical cancer screening and/or diagnostic services with contracted providers for women who are uninsured or underinsured. Navigation-Only Services – provides reimbursement for patient navigation to assist insured women to overcome barriers that may prevent them from receiving breast and cervical services. BCCCNP Service Components

4. Be between the ages of 40 and 64 Income < 250% Federal Poverty Level*  Income criteria set by federal law- must document woman’s verbal statement of income; no written proof required  INSURED  Requires breast/cervical cancer-related services ONLY  Pap test, Mammogram, and/or follow-up services for abnormal test result Eligibility Criteria for Navigation- Only Services

5. Provide Navigation-Only Services: Increase the use of patient navigation in provider offices: o providing financial incentives for providing navigation. Improves the quality of care provided to UP residents. Decreases health care costs by preventing cancer or detecting it early. NMHSI and BCCCNP

6. Is fear the reason she is not being screened? Does she really understand how cancer screening can help her? Are there family care or transportation issues? Have you looked for appointment times that work with HER schedule? Ask… Understand… Educate… How can Navigation Help?

7. Improves provider screening rates and HEDIS rates Promotes earlier screening and successful diagnostic resolution Identifies barriers that impede access to obtaining services Provides individualized support and assistance to overcome barriers/problems Decreases no-shows which are costly to offices BCCCNP provides the funds to pay providers to reach out to their clients Navigation in Provider Offices

8. To be eligible women must meet the following:  BCCCNP age, income, insurance eligibility criteria AND  Is in need of breast / cervical cancer screening or diagnostic assistance AND  Requires education/assistance/resources to obtain needed breast/cervical cancer services  Is willing to complete breast /cervical cancer screening Who Do We Navigate?

9. AIMED at women who have never been screened or who face barriers to completing their screening and/or diagnostics. Who has not completed cancer screening? Patient records/Gaps in care report Who needs diagnostics? Did they complete? Conversations with patients How do we find these women?

10. Patient Navigation Team Navigation is a process, not an individual: Navigation services can be provided by one person or shared by several individuals. Patient Navigator does not need to be a health care professional to provide non-clinical services. Unmet needs are identified and then split based on the skills of each team member.

11. Non-clinical office staff: Identify who is in need of cancer screening and flag the chart Provide small media materials to patients in need of cancer screening as they check for an appointment Schedule mammograms or diagnostic procedures before the client ever leaves the office. ASK about times that are best for the patient Navigation in the office

12. RN and MA staff: Have the conversation, ask questions, understand cancer screening or diagnostic follow-through from her perspective. Why hasn’t she completed screening? What stands in her way? How can you help her resolve those barriers? Navigation in the office

13. 1.Age/Income (Program mandate: 40-64, < 250% FPL) 2.Breast/Cervical screening services needed 3.Barriers/problems the woman may have to receiving services 4.Assistance provided by navigator to overcome barriers/problems 5.Types and dates of services received Information Needed to Document Navigation Services

14. Navigation Forms Intake Assessment Encounter Form

15. Used by Navigator to document 1 st encounter: Client Eligibility by income (< 250% FPL) Breast and/or cervical screening and/or diagnostic services required by the client Barriers that may interfere with obtaining these services Form # 1 - Intake Assessment

16. Size of Family Unit Poverty Guideline 250% of Poverty 138% of Poverty 1 $11,880.00$29,700.00$16,394.40 2 $16,020.00$40,050.00$22,107.60 3 $20,160.00$50,400.00$27,820.80 4 $24,300.00$60,750.00$33,534.00 5 $28,440.00$71,100.00$39,247.20 6 $32,580.00$81,450.00$44,960.40 7 $36,730.00$91,825.00$50,687.40 8 $40,890.00$102,225.00$56,428.20 Each Additional Member (Beyond 8) $4,160.00$10,400.00$5,740.80 2016 Federal Poverty Level (FPL) Guidelines 2016 FPL Guidelines

17. Client Verbal Acknowledgement - Verifies that client has agreed for assistance in obtaining breast/cervical services A separate informed consent is not required Intake Assessment: Client Information

18. Intake Form Client Assessment: Services Required

19. At least ONE barrier must be checked. For each barrier checked, record in comments how it will be addressed. Intake Form: Barrier Assessment

20. Used by Navigator to document: Breast and/or cervical cancer screening and/or diagnostic services received by the client Referrals/Resources provided to the client Form # 2- Navigation Encounter Form

21. Document the following: Dates of screening/diagnostic services received Referrals/Resources provided to client Encounter Form: Navigation Services Completed

22. Navigation status (ongoing): Do you need to contact the client again? – Yes, identify when you will contact the patient. Provide brief comments on current encounter Encounter Form: Navigation Status

23. Navigation status (complete): Do you need to contact the client again? – No, all breast/cervical screening/diagnostic services are complete. Provide brief comments on current encounter. Sign and date encounter form Encounter Form: Navigation Status

24. 1.Client is eligible (age and income) 2.At least ONE Barrier/Problem is identified 3.A solution is put in place for each identified barrier/problem. 4.Client receives needed breast or cervical screening and/or diagnostic services. Navigation-Only Key Components

25. Has at least 2 (TWO) encounters with designated office staff via phone, email, or in-person Completes breast and/or cervical cancer screening and any required diagnostics. When is Navigation Complete?

26. Options for Uninsured and Underinsured Women

27. MDHHS will fund the agency with $18,000 in one lump sum payment. $6,000 “Administrative fees” Identifying clinic sites to participate Training the clinic sites – with MDHHS assistance, if needed Collecting all navigation forms from the clinics Reviewing all forms for completeness Sending all forms to MDHHS $12,000 = $60 per woman navigated (200 women = target) Payment to your sites/clinics will be internally among your agency and the clinics Funding for Providing Navigation Services

28. BCCCNP will pay for breast/cervical cancer screening and diagnostic services for those who are do not have insurance or who need diagnostics but face a high deductible Defined as: “I cannot afford that amount” Will count as navigation (you resolved an insurance/financial barrier) IMPORTANT: You must refer these women to the _______BCCCNP agency for these services to be covered by BCCCNP If cancer diagnosed, women may qualify for treatment through the BCCCNP Medicaid Treatment Act Program BCCCNP Caseload Services

29. Data Entry will be completed at MDHHS -- Clinics will fill out the forms and fax to one centralized location at the agency for verification of completeness. --Completed forms will be mailed to MDHHS for data entry Assist with agency staff trainings Develop agency specific reports MDHHS Assistance

30. 1. Who do I contact with questions about completing the form or if a woman qualifies for BCCC navigation services? Tory Doney - doneyt@michigan.gov or 517-335-8854.doneyt@michigan.gov 2. Who do I call to learn more about navigation in my practice? Debbie Webster – websterd1@michigan.gov or 517-335-8517.websterd1@michigan.gov Frequently Asked Questions

31. 3. Does the program provide support for women diagnosed with breast or cervical cancer? YES!! Income eligible women, (insured, uninsured, and underinsured) may be eligible to enroll in a special Medicaid program through the BCCCNP. The woman MUST be newly diagnosed in order to qualify EXCEPTION: Women currently enrolled in HMP can transfer into the BCCCNP Medicaid program at any time during the treatment phase where they will incur NO co-pays! Contact Ann Garvin – GarvinA@michigan.gov (517-335-9087) or E.J. Siegl siegle@michigan.gov (517-335-8814) if you have a client newly diagnosed with breast or cervical cancer who may qualify for this program!GarvinA@michigan.gov siegle@michigan.gov Frequently Asked Questions

32. 1. Develop Work Plan (template) - Outline for implementation of project 2. Identify project start date 3. Identify trainings agency will require prior to project start date 4. Obtain baseline data for breast/cervical cancer screening by participating provider offices USPSTF: mammogram women >age 50-70, every 2 years Pap test every 3 years in women age 21-65 (or Pap/HPV in women >30 every 5 years) Next Steps

33. Tory Doney (Department Analyst) DoneyT@michigan.gov 517-335-8854 DoneyT@michigan.gov Ann Garvin (Nurse Consultant) GarvinA@michigan.gov517-335-9087 GarvinA@michigan.gov Debbie Webster (Navigation Consultant) websterd1@michigan.gov 517-335-8517 websterd1@michigan.gov E.J. Siegl (Pgm Director/Nurse consultant siegle@michigan.gov 517-335-8814 siegle@michigan.gov MDHHS Contact Information