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									Care Solutions
      &
Medical Home

 November 2010
Mission:
   To increase access to comprehensive primary and
     preventive health care and to improve the health
        status of our community, especially for the
               underserved and vulnerable.


Article 28 Federally Qualified Health Center
NCQA certified, JCAHO accredited, Planetree Health Care Organization
Community Health
   Sites (16)

                                               Pine Plains
          New Paltz
           Walden                                Amenia
                                   SULLIVAN
                                              Poughkeepsie (2)
         Monticello                            Dover Plains
                                                 Beacon
           Goshen

                                                Peekskill
 Health Center        Haverstraw
                                              Yonkers
 Migrant Health
 Migrant Voucher program                                         Greenport
 Public Housing
                                                                 Riverhead
Organizational Overview
 Network of 16 sites (Migrant, Homeless, Public housing,
    Ryan White, Community Health Center)
   Secured NCQA Level 3 Medical Home Designation for
    network of sites, adding additional revenue ($6/MA
    patient/month)
   Full electronic health record implementation across 16
    sites by April 2009
   Maintained provider productivity at 3600 visits/physician
   Improved Medicaid and Medicaid Managed Care from
    29% of visits to 39% of visits
   Increased federal grants by over $3.5 Million in 5 years
Daily Challenges 2008
  Static           The Growing
 Funding           Uninsured


Medical
Home          “Free Clinic” Image
“Pardon me, but could you tell us where the public trough is?”
2001-2009 UDS
Revenues by Payer Source                                                                         *




                                                                            Patient Self-Pay
   Other 1%                                                                      53%




                           Patient Revenue
                                60.5%
Grants                                              Medicaid
38.5%                                                19%



                                                                                               Private Insurance
                                                                                                     19%
                                                       Medicare
                                                         8%           Other Public
                                                                          1%




         *Health Centers meeting federal grant requirements and receiving Section 330 funding
         ** Includes state, local, foundation, and private grants and contracts
         Source: Bureau of Primary Health Care, HRSA, DHHS, 2002 UDS
Patients by Poverty Level

   34.0%                                                            100% and Below
              Unknown                                 42.0%
                                                                    101-150%

                                                                    151-200%

                                                                    Over 200%
                                                                    Unknown
          9.0%
                   5.0%           10.0%
                                                                We don’t know where
                                                                to put them on the
  Note: Other Public includes Early Intervention                sliding fee scale
  Source: Bureau of Primary Health Care, HRSA, DHHS, 2008 UDS
Medical Home Elements Addressed
  Access & Communication
     Scheduling each patient with a personal clinician for
      continuity of care
     Identifying health insurance resources for
      patients/families without insurance
     Making language services available for patients with
      limited English proficiency
  Patient Tracking & Registry Functions
     Use of an electronic system that includes demographic
      data (name/DOB/gender/Marital
      status/race/ethnicity/telephone)
Care Solutions

Reframing of the cost of health
care & how we communicate it
Care Solutions
The Care Solutions Benefit is presented in a face-to-face
 meeting with an Access Coordinator and provide
 orientation to program:
   Create your medical home and selection of primary care
    giver
   Assess all demographic information to verify it is
    correct
   Render a Care Solutions ID card with picture
   Examine ways to make your care affordable ***
Care Solutions - Philosophy
 Quality health care with a solution for making it affordable, for
  anyone who walks in the door
 Redesign of our intake process – introduction to the Health
  Center
 Culture shift in the way we approach collecting payment –
  difference between ability to pay, and willingness to pay
 As an FQHC we are able to provide care to all who seek it.
    For those who are insured, we proudly take most insurance
    For those who are uninsured, we screen for eligibility for PB
    For those who are not eligible for PB, we offer a sliding fee scale
 In order to maximize care to all those who need it, we must
  collect the discounted amounts set by our consumer Board of
  Directors.
Approach
 Refocus on Board role
 Engage front end staff in focus groups
 Training, training & more training
 Develop scripts
 Develop patient education materials
 Review special population specific issues
 Assess & Review implementation
 Retrain
 Assess, etc.
“Uninsured? That needn’t be a problem. We can refer you
            to a very fine doctor in Ottawa.”
Board of Directors
 The Hudson River HealthCare, Inc. (HRHCare) Board of
  Directors is responsible for ensuring that we have policies
  (including financial policies) that follow federal and state laws
  and ensure that we are able to provide access to care for all the
  patients in our communities that are in need.
 In order to maximize care to all those who need it, we must
  collect the discounted amounts owed.
 Our policies require that we collect the amount that the patient
  is responsible for. The amount that you are required to pay is
  based on a highly discounted schedule determined by the
  Board of Directors based on the information that you provide
  regarding your family size and income.
We can improve data collection!
 Ask where someone falls on the sliding fee
 scale
  “Hudson River HealthCare, Inc. (HRHCare) is pleased to
    now offer all Health Center patients the Care Solutions
    Benefit. If you are ineligible for insurance, you will
    charged according to a highly discounted sliding fee
    scale determined by HRHCare’s Board of Directors
    based on the information that you provide regarding
    your family size and income.”
We can improve on collecting
copays and fees!
 “This is the minimum amount that is
 required at the time of service. It is the
 highly discounted amount set by our
 Board of Directors. In order to maximize
 care to all who need it, we must collect
 the discounted amounts owed by each
 patient”
We can improve on linking
patients to public benefits they
may be eligible for!
“Hudson River HealthCare, Inc. (HRHCare) is pleased to
 now offer all Health Center patients the Care Solutions
 Benefit. If you are uninsured, the Access Coordinator
 will screen and link you with any public benefits that
 you may be eligible for. Let’s take a quick look at the
 income and family requirements to see if you may be
 eligible.”
Care Solutions
Hudson River HealthCare, Inc. (HRHCare) is pleased to now offer
 all Health Center patients the Care Solutions Benefit. As an
 introduction into Care Solutions, all patients will have a face-to-
 face meeting with an Access Coordinator, who will graciously
 introduce you to the Health Center’s unique model of care and:
    Create your medical home and selection of primary care giver
    Assess all demographic information to verify it is correct
    Render a Care Solutions ID card with picture
    Examine ways to make your care affordable ***
“Unfortunately , you have what
    we call ‘no insurance’.”
CREATE MEDICAL HOME AND SELECTION OF PRIMARY CARE GIVER
Primary Care Physician – PCP (____________________________)
Orientation to Open Access
How to Make an Appointment
How to Call Provider in Off Hours
ASSESS ALL DEMOGRAPHIC INFORMATION
Name
Address
Date of Birth
Emergency Contact
Special Population Category
RECEIVE ID CARD (IF EVIDENCE OF INCOME OR INSURANCE IS PROVIDED)
EXAMINE WAYS TO MAKE YOUR CARE AFFORDABLE
                                               INSURED
Verified that HRHCare accepts insurance?
Has HRHCare been made the PCP?
Make a copy of insurance card and scan into ECW
                                            IF UNINSURED
                  Fill out sliding fee scale application and screen for public benefits
Have they been screened for public benefits?
If child, have they been screened for Presumptive Eligibility?
Have they been linked with a facilitated enroller?
                           IF NOT ELIGIBLE FOR PUBLIC BENEFITS
Explained the Sliding fee discount – applies to HRHCare services only
Given copy of fee schedule
Patient provided acceptable evidence of income
                                                      Type of evidence(________________________)
Care Solutions, cont.
 ***If you are insured, the Access Coordinator will make sure that
  HRHCare accepts your insurance and that the Health Center is
  your designated Primary Care Provider.
     If you are uninsured, the Access Coordinator will screen and
  link you with any public benefits that you may be eligible for.
     If you are ineligible for insurance, you will charged according
  to a highly discounted sliding fee scale determined by HRHCare’s
  Board of Directors based on the information that you provide
  regarding your family size and income. HRHCare’s Board of
  Directors is responsible for ensuring that we have financial
  policies that follow federal and state laws, while providing access
  to care for all the patients in our communities that are in need.
  In order to maximize care to all those who need it, we must
  collect the discounted amounts owed.
Care Solutions Packet
Migrant Specific Implementation
 Patient education materials
 Face to face interview to provide information
 Scripts and coaching for documentation assistance
 Dental fees
 Emphasis on 100% poverty guidelines
 Linkages with public benefits partners
Implementation Challenges
 Training & Retraining
 Culture of patient centeredness
 Workflow
 “Go Live” Burnout
 Assessing & Reassessing
 Supporting the front lines
Questions?

								
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