1. Partnerships for Successful Outreach and Enrollment Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care

2. 2 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.

3. Developing a Successful Outreach & Enrollment Plan Kristen Stoimenoff Deputy Director Health Outreach Partners

4. 4 Health Outreach Partners Outreach & 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

5. 5 Plan & Prepare Find, Connect, EducateLink to Application Process Enrollment Assistance Renewal Assistance Ensuring Access to Health Coverage

6. 6 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

7. 7 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)

8. 8 Ensuring Access to Health Coverage Step 5: Provide Renewal Assistance Ensure continuous coverage Assist with managing changes (address, family size, income)

9. 9 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.

10. 10 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.

11. 11 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.

12. 12 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…

13. 13 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.

14. 14 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…)

15. 15 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.

16. 16 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.”

17. 17 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)

18. 18 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.

19. 19 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.

20. 20 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.

21. 21 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).

22. 22 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!

23. 23 Contact Information Kristen Stoimenoff Deputy Director, Health Outreach Partners 510-268-0091 kristen@outreach-partners.org www.outreach-partners.org

24. Using the UDS Mapper to Find Areas for Outreach Jennifer L. Rankin, PhD Geospatial Informatics Senior Analyst Robert Graham Center American Academy of Family Physicians

25. 25 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

26. 26 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

27. 27 www.udsmapper.org Login or Register

28. 28 www.udsmapper.org You can start using the UDS Mapper immediately after registering

29. 29 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

30. 30 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

31. 31 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

32. 32 www.udsmapper.org Click “Tools” above the Map Uncheck “Explore Service Area Tool” Uncheck “Main Maps” Check “Uninsurance Explorer”

33. 33 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

34. 34 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?

35. 35 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

36. 36 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

37. 37 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

38. 38 In by Geography mode, click on ZCTAs to select them. Selected ZCTAs will be listed in the Selected ZCTAs box and will be highlighted with small black dots on them. www.udsmapper.org

39. 39 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

40. 40 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

41. 41 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

42. 42 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

43. 43 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

44. 44 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

45. 45 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

46. 46 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

47. 47 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

48. 48 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.

49. 49 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

50. 50 www.udsmapper.org Here 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.

51. 51 Contact Information Jennifer Rankin Geospatial Informatics Senior Analyst 202-331-3360 jrankin@aafp.org www.udsmapper.org www.graham-center.org

52. 52 Questions

53. 53 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

54. 54 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

55. 55 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 page http://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/

56. Raising the Visibility of Health Centers Jodi Samuels, PhD Assistant Director of Development California Primary Care Association (CPCA)

57. 57 Partnership: CaliforniaHealth+ Market Research & Focus Groups Pilot Sites & Training The California Endowment: Asegúrate Campaign PSA (aired in Spanish on Univision during NHCW) Materials & Resources

58. 58 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)

59. 59 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

60. 60 Contact Information Jodi Samuels, PhD Assistant Director of Development (916) 440-8170 x1101 jsamuels@cpca.org www.cpca.org www.californiahealthplus.org 1-855-899-PLUS (7587)

61. Health Insurance Marketplace & Medicaid Expansion O/E in Health Centers

62. 62 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

63. 63 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

64. 64 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

65. 65 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

66. 66 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.orgwww.laclinica.org vlujan@laclinica.orgvlujan@laclinica.org

67. 67 Health Center Panel

68. 68 Questions

69. 69 Contact Information Stephanie Crist Public Health Analyst bphcta@hrsa.gov