1. Michigan Breast and Cervical Cancer Navigation Program (BCCCNP) Introducing Patient Navigation to Provider Offices 6/29/2016

2. 1991-2013: BCCCNP provided breast and cervical cancer screening and diagnostic services to > 510,000 low-income uninsured and underinsured MI women 2001-present: Women diagnosed with breast/cervical cancer may be eligible to apply for a special Medicaid program through BCCCNP 2013: Program served over 30,000 women 2014: ACA/HMP implementation dramatically # women eligible for program (8,500 women served); in insured women did not = screening rates 2015: Navigation program for insured women added to program BCCCNP History

3. 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/problems that may prevent them from receiving breast and cervical services. BCCCNP Expanded Services

4. Assure ALL low-income women (regardless of insurance status) receive timely access to needed breast and/or cervical cancer services. Program Goal

5. 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 Collaboration with Provider Practices

6. BCCCNP will provide payment to providers for navigating patients who are in need of but are not completing breast and/or cervical cancer screening. Navigation services AIMED at women who have never been screened or who need an additional intervention in order to complete cancer screening. NOT for women who simply call and schedule annual screening and complete it without additional assistance. BCCCNP Collaboration with Provider Practices

7. 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?

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. INSURED women meeting the following criteria: 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 Requires breast/cervical cancer-related services ONLY (i.e. Pap test, Mammogram, and/or follow-up services for abnormal test result) Who is Eligible for Navigation?

10. 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?

11. Patient Navigation A Team Approach! 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.

12. 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

13. 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

14. 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

15. Clinic Responsibility 1. Completion of the following forms --Intake Assessment – documents first client encounter --Encounter Summary – documents services received by client 2. Verification that forms are complete (not missing data) prior to sending to MDHHS 3. Mail completed forms to MDHHS at designated time interval MDHHS Responsibility 1. Data entry of completed forms 2. Consultation as needed on navigation/form questions 3. Assist agency with staff trainings of navigation/form completion 4. Develop agency specific reports Data Collection

16. Navigation Forms Intake Form Encounter Form

17. 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 Form

18. 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

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

20. Intake Form Client Assessment: Services Required

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

22. 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

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

24. 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

25. 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

26. 1.Client is age and income eligible 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 Summary

27. 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?

28. 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

29. Options for Un-insured & Under-insured Women

30. UNinsured women meeting age and income requirements are eligible to receiving breast/cervical screening services through BCCCNP (This includes migrant workers and undocumented citizens) Eligible women need to be referred to your local BCCCNP agency for program enrollment Questions regarding eligibility for uninsured women can be directed to your local BCCCNP agency or Tory Doney at MDHHS BCCCNP Services for UNinsured Women

31. UNDERinsured definition: 1) A high deductible (as defined by the woman; includes Medicaid “spend down” ) that must be paid before insurance will reimburse for services OR 2) Insurance classified as non-creditable insurance (i.e. insurance will not cover certain diagnostic procedures) IMPORTANT: You must refer these women to the local BCCCNP agency for these services to be covered by BCCCNP BCCCNP Services for UNDERinsured Women

32. Since 2001 BCCCNP has offered a special type of Medicaid that is available for age/income eligible women diagnosed with breast/cervical cancer. Client does NOT have to actively be enrolled in the program when diagnosed with cancer. Eligibility Criteria US Resident Uninsured or underinsured and newly diagnosed with breast/cervical cancer and requires treatment EXCEPTION FOR HMP ENROLLED WOMEN: 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! BCCCNP Medicaid Treatment Program

33. 1. Tory Doney, Department Analyst, DoneyT@michigan.gov or 517-335-8854DoneyT@michigan.gov Contact for questions about completing navigation forms or to determine if a woman qualifies for BCCCNP navigation services 2. Debbie Webster, Patient Navigation Consultant, WebsterD1@michigan.gov or 517-335-8517 WebsterD1@michigan.gov Contact for questions about provider training for navigation or to learn more about navigation MDHHS Contacts

34. 3.Ann Garvin, Nurse Consultant, GarvinA@michigan.gov or 517-335-9087GarvinA@michigan.gov E.J. Siegl, Program Director/Nurse Consultant, SieglE@michigan.gov or 517-335-8814 SieglE@michigan.gov Contact for questions if you have a client newly diagnosed with breast or cervical cancer who may qualify for the Medicaid Treatment Program MDHHS Contacts

35. 1. Develop Work Plan (see template) -Brief outline of project activities with time frame and staff responsible 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 1-2 years Pap test every 3 years in women age 21-65 (or Pap/HPV in women >30 every 5 years) Next Steps

36. Questions???