More Than an ER: How Hospitals Can Play a Vital Role in Engagement and Enrollment
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This document discusses how Providence Health & Services, a large non-profit health system, helped enroll over 20,000 individuals in health insurance plans during the 2015 open enrollment period. It highlights key strategies Providence used, such as establishing certified application sites in its facilities, training caregivers to serve as enrollment counselors, partnering with community organizations, and holding public enrollment fairs. The document also shows positive outcomes from these efforts, including reductions in the uninsured rates and increases in Medicaid enrollment in two counties where Providence hospitals served as leaders in the enrollment process.
More Than an ER: How Hospitals Can Play a Vital Role in Engagement and Enrollment
- 1. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org © 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
- 2. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Merry Hutton, MPA | 06.11.15 Providence Health & Services More Than an ER: How hospitals can play a vital role in engagement and enrollment
- 3. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org About Providence Health & Services 3
- 4. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org4 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.
- 5. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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 5
- 6. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org6 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
- 7. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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 7
- 8. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org AudreyHoener Director of Outreach Services Denver Health Outreach Services
- 9. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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?
- 10. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org • 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?
- 11. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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
- 12. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org • Medical Assistance Site • Hospital and Community Health Enrollment sites • State contract Enrollment Department
- 13. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Community Health Advisors/Outreach Staff • School-Based Health Centers • Community Health Centers • Health Access Express Enrollment Van Outreach Services
- 14. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Community Events and Partners • Pridefest Parade • Urban Peak • 9 News Fair • Gathering Place • Beauty Shops • Mobile Clinic Outreach Services
- 15. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org In reach/outreach Appointment lists Warm hand off SBHC uninsured DPS partnership Following up with expansion populaSon How do you find who is eligible?
- 16. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Benefits of Outreach and Enrollment More patients with a payer source Increased revenue Increased capacity to provide services to low-income persons
- 17. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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
- 18. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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% 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
- 19. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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% 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
- 20. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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%
- 21. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org2121 ACA Impact on Payer Sources at Denver Health
- 22. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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%
- 23. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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
- 24. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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.
- 25. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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
- 26. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org • 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
- 27. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org • Community Health Worker model • Health Insurance Literacy • Patient Ambassadors • Sustainability? Moving Forward
- 28. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Audrey Hoener Director of Outreach Services Denver Health Audrey.Hoener@dhha.org (303) 602-8969
- 29. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Daniel Waldmann, SVP, Public Relations Path to Health Tenet’s Enrollment Campaign
- 30. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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
- 31. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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
- 32. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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 +
- 33. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Collateral Material Building Blocks
- 34. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Second Round Collateral Material
- 35. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org • 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
- 36. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org • 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
- 37. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
- 38. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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
- 39. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 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
- 40. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org40 More Than an ER 2014 Open Enrollment • Huntsville Hospital System Partnership • Month-long Enrollment Blitz • Over 100 Consumers Enrolled
- 41. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org41 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
- 42. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org More Than an ER: 2015 in North Alabama
- 43. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org More Than an ER: 2015 in Central Alabama
- 44. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org44 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
- 45. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org45 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
- 46. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org • Engage Hospitals • Ask for help 46 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
- 47. © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org © 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Sonja Smith Sonja.Smith@AIDSAlabama.org