cdn1.digitellinc.com€¦ · Web viewfront lines, doing the job. Know that you have the support, and we're going to keep pounding together and working on this. Tom Van Coverden (09:53):

This transcript was exported on Jul 13, 2020 - view latest version here .

Rachel Gonzales-Hanson (00:00):

Good morning or good afternoon, as the case may be. I am Rachel Gonzales-Hanson, senior vice president of Western operations for the National Association of Community Health centers. Thank you for joining us today. As we began today, we will first hear from NACHCs president and CEO, Tom Van Coverden. Tom, thanks for joining us today. We're looking forward for you to share your insights. Take it away, sir.

Tom Van Coverden (00:26):

Rachel, thank you very much. For those who don't know Rachel, she's a past national chairman of the board of directors for the National Organizations. Rachel, I first met you when you put together an incredible health center network in Western Texas, and what an incredible job you did in providing services and getting people there. So thank you, Madam Chair, I shall call you, for all your efforts there.

Rachel Gonzales-Hanson (00:54):Thank you, Tom.

Tom Van Coverden (00:54):Rachel, I want to talk about, if I can briefly with folks, again on money and what it is, consistent with the theme, how do we keep our centers strong and keep them going? What are the current efforts, and where do we stand? I will stay on time. Last night, HHS announced, said that was putting on a niche on 21 million to health centers, 17 for Look-Alikes, and four and a half million to HCCN's controlled networks to further strengthen and expand the COVID-19 testing and tracing activities.

Tom Van Coverden (01:33):So the money, again, we keep on the track there. Let me just say with regard before getting back to money to our upcoming community health institute, which we'll be doing virtually. Again, there's a lot of interest in it. We have some very exciting keynote speakers for the general session on 831 and then going on to the 91 general session. Again, letters have been sent to Secretary HRSA, HRSA administrator Engels, Jim Macrae from HRSA, as well as the Bureau of Health Professions and Seema Verma from CMS. So again, we look to have a strong show going forward, Gina. I know you and a number of our staff are working to put that together with frankly with all of the staff. So stay tuned guys, but it should be exciting.


Let me just say that for those... Again, we had a meeting with secretary or Assistant Secretary Hargan, if you recall, for those of you met him. He is a strong supporter. His mother, some number of years ago, 30 years ago was working at a community health center in Rural Illinois. I just mentioned it. So he says, "I do have a firsthand knowledge." But also, the top administration staff has visited a number of health centers better than five, just during the last quarter. So I mentioned that they do get out into the field and continue to be impressed with what health centers are doing. Secondarily then, the point was made again, the data, the reports that all of you are sending in on the number of people that you have tested and to break down, the five or six questions in concert, we're working with the primary care association and HRSA.


Reimagining Care Ensuring Access to Coverage Dur... (Completed 07/11/20)Transcript by Rev.com

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Please make sure you get that data in. It is reported directly to the white house and to the centers for disease control and all of the top people, including the president on the president's task force. So it lets them know what health centers do and why you've seen so many positive statements on health centers. With that having been said and done, our fight continues on the funding. We met with the deputy secretary then, Hargan for an additional request in funding of $7.5 billion to, A, continue to strengthen and shore up health centers that are losing or have lost revenue and/or staff, and secondarily, to provide funding to those which were excluded under the payment relief, the provider relief fund.

Tom Van Coverden (04:25):So $3 billion for those health centers, of which there are three falling into that category. It's those that have a 500 or more specific funding, better than a billion dollars to be done there. The second area for those in urban. The rural areas did get funding for the urban and suburban, health centers that did not qualify for that under provider relief. So funding is requested there. Then lastly, for all centers, especially those targeted for hotspots, so that's a significant amount of money that has been contested or put on the agenda there.


The second then is four and a half billion dollars for all FQHC. Again, that is for revenue losses July through November, 2020. So that's continuing while we continue to push hard on 340B protections and Medicaid reimbursement on telehealth. The important point to make, I think, is again, we had a very receptive part at the meeting, and there was again with dealing so many of billions of dollars that I don't think that HRSA or the upstairs in HHS had were familiar with. So again, that was the purpose for this letter copy, of which was sent to everybody here.

Tom Van Coverden (06:01):But just, again, reiterating the points that we made time and again, one in medically underserved, rural frontier and urban communities, FQHC provide vital health services and testing to all regardless of insurance status or ability to pay and relieve considerable pressure on limited resources of hospitals in many areas where, again, the hospital admissions are continuing to go up and up. Again, health centers play a vital role. Number two, reduce disparities among minority and low income patients. Those who want to stop neglected. Again, the numbers speak for themselves. FQHCs deliver currently more than 160,000 COVID-19 tests per week, including being in many of the hardest hit communities.

Tom Van Coverden (06:52):Again, FQHCs providing care and treatment in so many areas to essential workers dealing with food, agricultural workers, service industries, and other frontline jobs. Again, those most often that have to show up for work that aren't allowed to work for our home that are often touching the food and other places and materials where we practice. Again, a vital role for the nation is for trying to get a handle and control and ultimately immunized when the vaccine becomes available.

Tom Van Coverden (07:30):So again, I think just making these points, health centers serve one in three people at or below poverty level, which includes 20% of Medicaid patients in the nation and providing documented quality and reduced hospital costs of 24 billion annually. So again, all these factors show that the health centers have fallen. They've lost revenue. They need that revenue to strengthen themselves for the next seven


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months. That goes through November. Then coupled with the request for a lot of additional emphasis to get the funding cliff fixed at the end of the year. So that would be the mass majority of our funding.


Again, I think what I'm referring to currently better than 4 billion a year, in addition, on top of the 7 billion. Again, the $77 billion package, which is a five-year support to strengthen and build community health centers, bring additional doctors and nurses into the health centers, as well as involve more of our centers in training programs, and thirdly, $20 billion over the five-year period for strengthening and building the health center infrastructure, whether that's facilities, whether it's telehealth and virtual health capacity, whether it's forming additional networks, whether it's ensuring they have all the equipment and backup products that they need, predated vaccinations, the testing material or PPE.


Again, we have a warm reception in Congress. The black and Hispanic caucuses have all gone forward supporting those recommendations. We just have to keep the pressure up. There was a good reception to the meeting that I mentioned on the seven and a half billion dollars. We said the money's already sitting there. You have about a billion dollars left. This is a modest request for people doing so much of the job, and it's critical to your ability to do that going forward. So again, we're there on the advocacy front for you, ladies and gentlemen, and we're so grateful to all of you who are on the front lines, doing the job. Know that you have the support, and we're going to keep pounding together and working on this.

Tom Van Coverden (09:53):Ashley, I know you, Cassidy, and Tia are going to be talking on some of this going forward. But again, you have to have the resources to do the job, and Rachel, in demand, which I'll be happy to answer any questions if that went quickly. A lot on the table, guys. But I think a lot of people are proud of what you're doing. Again, they said, how important those numbers and what it is we're doing, who we're touching, how important it is to the department, to the Centers for Disease Control, to the secretary of HHS and others who are dealing with trying to handle this, dealing with the COVID crisis. So thank you for all of your support together. We will win.

Rachel Gonzales-Hanson (10:40):Thank you, Tom. Thank you so much for all the work that the staff is doing to help bring those resources to the health centers. We're excited about the CHI at home this year. In this new world, we'll have to be flexible, and we will move on, and I'm sure it'll be a great success. Let's take care of a few housekeeping items before we start our program today, folks. If you're having technical difficulties, you could click on the request support button at the bottom of the screen. For those joining via internet, today's speakers will have content slides, and a link to those slides can be found in the resource box on the bottom left of your screen. For those calling in, the recording, the transcript, and the slides will be posted on NACHC's website after the webinar.


If you have a question during the panelist presentations or during the formal Q&A time at the end, please enter that question in the Q&A with speakers area and include to whom you are directing your question. We will try to group the questions around topics or themes to make our Q&A time more efficient. Questions that we are not able to address on air will be added to the NACHC's website COVID-


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19 page as well as the responses. Feel free to chat with other participants and communicate with the NACHC staff during webinar on the chat box. Lastly, we would like to hear your ideas for potential future topics. So you can also enter those in the chat feature.

Rachel Gonzales-Hanson (12:02):Now, let's get to the program. As you will recall, NACHC's Re-Imagining Care webinars series is focused on supporting health centers as they continue appropriately responding to the COVID pandemic, all the while taking that flexibility and those brilliant innovations and transformations health centers use to battle COVID-19 to guide us in re-imagining healthcare delivery. This is how we will continue to shape the future of healthcare and absolutely continue to uphold America's health centers as leaders in primary healthcare.


This is the third of our five webinars in the series, and it is focused on how health centers can help increase access to healthcare coverage, especially during this time when so many have lost their coverage. What an irony, losing coverage during the height of a pandemic? Well, we're going to try to help that. We are pleased to have Ted Henson, who focuses on health center performance and innovation at NACHC to serve as today's moderator. Ted, we'll turn it over to you.

Ted Henson (13:09):

Great. Thanks so much, Rachel, and thank you, Tom, and a big welcome to everyone listening today. It is always my honor to have an opportunity to speak to and engage with the health centers and PCAs. Just a quick note, I came to NACHC six years ago actually to lead a Robert Wood Johnson Foundation grant on health centers outreach and enrollment. I currently serve on the CMS Advisory Panel on Outreach and Education along with Tia Whitaker is one of our presenters today. So this topic is really near and dear to my heart. Before I pass this mic onto our first speaker, though, I do want to take a moment to set the context. So next slide please. And next slide.

Ted Henson (13:48):

Great. Thanks. So health centers have conducted outreach since their inception in the 1960s. But their role providing these activities has really grown and evolved of all during the healthcare reform efforts. Thanks to UDS, we know that health centers provided nearly 4.75 million assists in 2018, 4.75 million assists. So that's amazing. While UDS captures the number of enrollment assisters employed by health centers, which was over 4,000 in 2018, we know that you have a wide range of official title. So I have some on the screen here, like certified application counselors, navigators, outreach workers, in-person assisters, and more.

Ted Henson (14:26):

Even before COVID hit, your duties include not just providing enrollment assistance, but a broad range of activities, such as explaining benefits, health insurance literacy, connecting people to care, health education, case management, and other enabling services. While today's webinar will not focus on federal or state policies governing outreach enrollment activities, we know that this is a very important aspect, of course, of what you do. So at the federal, CMS has rules and regulations for assisters and navigators working within the Federally Facilitated Marketplace, FFM states, there's healthcare.gov.

Ted Henson (14:59):


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I do want to take a moment to note, for any organization out there that is in a healthcare.gov state, please know that CMS is refreshing their process for becoming a certified application counselor designated organization, CDO. If you don't know what that means, feel free to reach out to me. My contact info at the end of this presentation. But this is something that all organizations have to have a CDO certification in order for you to officially provide CHC services.

Ted Henson (15:27):There's also a link to more information in the resources section, which Rachel highlighted. Feel free to reach out to me as well for more information. For states with your own marketplaces or have expanded Medicaid, you have your own rules and regulations dictating how and what services you can provide, patient eligibility criteria, and your own special enrollment period. Next slide, please.

Ted Henson (15:49):

Great. So the reason we are here today is because COVID has changed everything, and it's forced us to reimagine care. This is what our speakers will be addressing today. How you provide care virtually or in person looks dramatically different now than it did a year ago, and that goes for outreach enrollment activities. The amount of people now eligible for assistance has also changed, given the massive disruptions and employment and loss of employer sponsored health insurance. The types of services you provide has also changed. We're going to have this presenter today talk about health enrollment assisters providing contact tracing and other services.

Ted Henson (16:22):

As I mentioned before, the state and federal policies are on special enrollment periods, presumptive eligibility and more also continue to evolve. So that's what Ashley, Cassidy, and Tia are all going to address today. Next slide.

Ted Henson (16:37):

So I do, before I turn things over to Ashley, want to highlight a resource and an opportunity. First is a virtual outreach and enrollment workflow template that NACHC has created in partnership with Transform Health. Check the resources tab to find the link to this PDF and a PowerPoint presentation. The workflow provides a general overview of the main touchpoints and the overall enrollment process. The slides and the company one page workflow will serve as a summary of the core stages of virtual ONE, and it's going to vary based on your state marketplace and rules. So these materials are really preserved to serve as a catalyst for you to train and go over your own internal workflow with your staff, and you're going to see our presenters today, present their own versions of these workflows. Next slide.

Ted Henson (17:25):One opportunity I want to highlight for everyone is a outreach enrollment learning collaborative that NACHC is going to be launching soon as of this fall. I'll be the lead on that with a colleague. We're going to have a small close cohort of outreach enrollment assisters. So see the slide for more details. If you're interested in participating, you can sign up when you complete today's webinar evaluation. So please do the evaluation and sign up. Or again, you can email me directly. There's an opportunity to exchange information, best practices with your peers and hopefully hear some from federal experts and industry experts in DC and beyond. So next slide.

Ted Henson (18:04):


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With that, I'm really excited to turn things over and introduce our speakers today. So you can see Ashley Shoemaker, Cassidy, and Tia all have extensive experience working in either a health center or PCA doing outreach and enrollment work. Our first speaker is going to be Ashley Shoemaker. Ashley is the director of outreach and enrollment at Family Health Center in the great city of Louisville, Kentucky. She's going to provide an overview of how COVID has impacted their outreach enrollment work. Also, how it changes in state Medicaid and policy eligibility. Is it something they've had to respond to and how the centers conducting virtual assist at this time. So with that, I'm going to turn it over to Ashley, and you can take it away.

Ashley Shoemaker (18:47):

Thanks, Ted. I'm excited to share what Family Health Centers is doing in terms of outreach and enrollment telework as a result of COVID. Family Health Centers is a federally qualified health center with eight locations in the Louisville Area. We serve nearly 45,000 patients a year. I do want to call your attention to two of our locations are Phoenix Health Care For The Homeless location and our Americano location, which houses our refugee health program. These two locations serve some of our most vulnerable populations in terms of COVID due to patients living in group living situations or having multi-generational households.


There are also populations that have some of the highest barriers to gaining and maintaining healthcare coverage. So we've really been trying to focus our outreach and enrollment efforts at those two locations. Not including myself, our outreach and enrollment department has five full-time certified application counselors and one administrative assistant. Despite our small department size, our assisters have enrolled nearly 35,000 Kentuckians in healthcare coverage since 2013. Next slide, please.


I'm going to briefly set the stage and explain the state of Kentucky's healthcare coverage prior to COVID-19. Kentucky is an expansion state, a Medicaid expansion state. In our connect program was a model of success in the country when the affordable care act rolled out. However, we soon discovered that getting insurance is one thing, but it's considerably harder for people to maintain coverage. This graph shows the steady decline in Medicaid membership that we've seen over the past two years with a low point in December of 2019. However, we've seen a marked increase in enrollment numbers since then, and over 130,000 people have newly enrolled in Medicaid since March alone when COVID first became a big issue in Kentucky. Next slide.

Ashley Shoemaker (21:08):So how do we achieve such strong enrollment numbers so quickly? Well, the state has made several policy changes that made it easier for people to get and maintain their health insurance, including 90-day extensions on verifications and recertification, except in client's statement as verification of income and loss of employment and stopping benefits terminations. So right now, we're not seeing the turn of people falling off coverage, and we're able to focus our efforts on newly enrolling people in care. Next slide, please.


The other big change that the state made was, at the end of March, the state gave application assisters the ability to conduct presumptive eligibility applications and relaxed many of the existing PE guidelines,


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including guidelines on income, citizenship, the limit on one PE per calendar year and the limit prohibiting people from enrolling in PE if they have existing insurance. It also expanded the PE coverage from two months to up to 90 days. This temporary Medicaid is a simple two-page application, and it does not require any documentation from the client. It covers everything that traditional Medicaid would cover.

Ashley Shoemaker (22:42):The first wave of temporary Medicaid enrollment was that to expire at the end of June. But as of July 1st, the state extended the coverage for an additional 90 days. So people who were originally enrolled in April now have coverage through the end of September. Next slide.

Ashley Shoemaker (23:07):So all of these factors, the no longer requiring as much documentation and the ability to do the simplified temporary Medicaid application has made it possible for outreach and enrollment staff to do telework. Staff began working from home in March and April. They use cell phones and laptops, which they already had because of our outreach events that we would conduct in the community. Our IS department provided remote access to our electronic health record system. So our application assisters are able to complete enrollment over the phone.


Each day, we receive a list of uninsured patients from our front offices, and the assisters make warm calls within one to two days of the patient's medical visit. They also keep a spreadsheet of their temporary Medicaid enrollments for future followup, and they email me their spreadsheet each week, and I'll compile them into a master list. Next slide.

Ashley Shoemaker (24:14):Okay. So this is a visualization of the workflow process. Our administrative assistant receives referrals from the print offices, from community partners, and also just from people in the community who have heard that this is a service that we offer. She divides the referrals among the assisters and the assisters make those warm calls and complete enrollments over the phone on the spot. As soon as they get the patient on the phone, they're able to do the application and give them their Medicaid ID number. The assisters then update the EHR with the Medicaid ID number for the billing department and log the enrollment on their spreadsheet for the future followup. Next slide, please.

Ashley Shoemaker (25:07):So going forward, we will use that enrollment spreadsheet to reach out to temporary Medicaid enrollees and complete a full Medicaid application or a marketplace application as appropriate. Because temporary Medicaid meets minimum essential coverage, we will be able to use the loss of temporary Medicaid as a special enrollment period for clients that are not eligible for traditional Medicaid. At the same time, we are continuing to do new temporary Medicaid applications for people without health insurance. Next line.


I want to close by briefly discussing some best practices that have made outreach and enrollment telework a success at our health center. First, it's critical to maintain open lines of communication with


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the state and community partners. Those relationships allow us to stay up to date on policy changes, report any problems or technical issues that we're having and then convey that important information to our community partners. That relationship is reciprocal, and those community partners then send us referrals for people who need assistance.


The second is accountability and teamwork. Despite our staff working remotely, we are in constant communication via email. Assisters see each other's schedules and can triage referrals to the next available assister. They also send me a reconciliation of their schedules each day so I know which clients they were able to contact, and I spot-check the enrollments for completion, and that provides some accountability. Finally, organizational buy-in is essential. Outreach and enrollment telework would not be possible without coordination from the front office, billing, IS, and support from our executive staff. It takes everyone to make this a success, and I'm thankful for the efforts of my team and everyone in the organization who's worked so hard to make sure our patients and community members can achieve affordable healthcare coverage. Thank you.

Ted Henson (27:31):

Great. Thank you so much, Ashley. We really appreciate just some of those practical strategies and best practices based on your experience. We're going to keep that going. But we're going to travel up to Massachusetts and hear from Cassidy Hayes, who is the public health project manager at Caring Health Center, Inc., Springfield, Massachusetts. Her whole bio is on the slide here. But I want to commend Cassidy for the frank conversations we had about what this really looked like at her health centers, and she's going to share some of the really nuts and bolts workflows and processes, which Ashley, but that they've developed at Caring Health Center. So Cassidy, take it away.

Cassidy Hayes (28:18):

Thank you, Ted. Thanks for the introduction. Glad to be here. So I'm going to provide a brief overview of my agency, of our outreach and enrollment program and of some of the primary efforts that we implemented at the onset of COVID-19 to transition our team to remote programming. So just about Caring Health Center, we are a federally qualified health center located in three neighborhoods within Springfield, Massachusetts, and we provide the full range of primary care, pediatric, dentistry, behavioral health, reproductive health, nutrition, care coordination, and social support services to about 21,000 patients annually.


Our patient population is highly culturally, racially, and ethnically diverse and largely low income, under insured or under insured. A large subset of our population identifies as immigrant and refugee groups speaking over 35 different languages. We operate in what's considered a medically underserved area and a health professional shortage area. We also operate the largest refugee health assessment program in Massachusetts funded by the department of public health. Next slide, please.


So I oversee our outreach enrollment and health access initiatives at the health center, and today I'm talking about our Navigator Program. So we are a certified navigator organization through the Massachusetts Health Connector, which means that our staff are trained and certified by the Health Connector to assist the public with health coverage, enrollment, and navigation through health safety


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net, Medicaid, which is referred to as Mass Health in Massachusetts, subsidized market plans, which are referred to as Connector Care in Massachusetts and unsubsidized market plans.


So we have a team of five navigators who are largely bilingual and with personal familiarity with immigrant and refugee experiences. So they provide a lot of language support and culturally sensitive services. They also provide SNAPs, otherwise known as food stamps enrollment and navigation, and they focus their engagement to populations that are most at risk for falling out of coverage and care, particularly immigrant and refugee communities, those with limited English literacy or limited technological access and communities experiencing changes in life circumstances. Next slide.

Cassidy Hayes (30:38):So in addition to more traditional forms of enrollment support, our navigators also typically collaborate with our community health workers, interpreters, and other staff to deliver a variety of different enabling and educational services. They conduct translated health insurance, literacy workshops, health center tours, and they also conduct many public outreach engagements each year with a variety of different community partners. Next slide.

Cassidy Hayes (31:10):So moving into COVID-19, on March 13, our agency transitioned all nonmedical staff to remote status until further notice, and that is still ongoing for some of our staff. So during this time, our agency and program leadership engaged in intensive contingency planning, resulting in a rapid transition to remote status. I just want to note that this presentation highlights key operational workflows that enable the transition to remote service delivery for our outreach and enrollment staff, but it's not all inclusive, and it doesn't include the many other workflows and protocols that were developed to address other aspects of the crisis. So just talking about outreach and enrollment here. Next slide, please.

Cassidy Hayes (31:51):So we found that our navigator program experienced a fairly smooth transition to remote programming in many respects. I think that broadly we can attribute our success in this area to three main factors, one being close communication with state and advocacy organizations, two, being a strong interest in flexibility among staff and leadership to embrace nontraditional approaches to outreach and enrollment. So thinking about things like multi-lingual educational video outreach campaign, and three, being strong program and agency infrastructure.


So in the next few slides, I'm going to very briefly overview some examples of the evolving program directive that I mentioned in factor one. I'm not going to spend much time discussing the nontraditional approaches as that topic pretty much deserves a whole presentation of its own at a later time. But I am going to conclude with some examples of the program infrastructure and operational responses that we took. So next slide, please.


So like I said, we maintain close communication with state and advocacy organizations, such as the Massachusetts Health Connector, Mass Health, Mass League of Community Health Centers, Mass Law


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Reform Institute, and others around the evolving program directives, enrollment best practices, and emerging needs. Essentially, there were many provisions and flexibilities that were granted to members and assisters to support enrollment in health coverage and alleviate navigational barriers. I won't provide an exhausted list of these flexibilities and provisions, but for those who are interested in more detail on Massachusetts member and assister changes, I'm listing three links here that I think provide the most comprehensive summary so you can check those out if you're interested. And next slide.


So I won't go into detail here. But I wanted to note that there were a variety of beneficial changes implemented in Massachusetts to facilitate enrollment during COVID. I've listed the key ones here. Essentially, the results of these flexibilities were that far fewer members got terminated, members were able to enroll in plans for longer and without signing and faxing documents, and navigators were and are able to provide most assistance from home without face-to-face interaction. Next slide.


So I want to briefly overview the most critical infrastructural action steps that we took to make the transition to remote enrollment programming. So this includes existing infrastructure and resources and new operational responses that we developed to facilitate remote programming. So in terms of existing infrastructure and resources, we already had an existing information technology department with existing vendor contracts. Our navigators already had laptops and were already a well trained and well connected team, and we already were a fully grant-funded program, which provided a critical source of information funding for technology and offered an avenue to provide and receive feedback.


So our IT department was a critical partner in this transition to remote programming. Some of the essential actions that our IT department took were that they purchased and re-imaged over 150 laptops for our staff, as well as headsets and white noise makers to ensure privacy in family and home settings. They also establish a virtual protected network or VPN for security and to enable access to the agency server. So VPN was established with the help of a contracted vendor that we had an existing relationship with.

Cassidy Hayes (35:23):On each of the laptops that the IT department purchased, they installed a number of software programs, including Microsoft Office encryption software, Mitel Phone application. So then Mitel Phone application enables full telephone switchboard and voicemail capability through the agency network, which is very important as it enables staff to make secure calls through the agency phone lines via their laptops, as opposed to using personal phones. So that was very critical for us when working with confidential information.


Each laptop also was installed with a fax server, which enables staff to send and receive faxes from their laptops, so very useful for our navigators. Our IT department also extensively trained staff on the use of remote software and technology. Next slide.



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So the agency's leadership team, including myself and other program directors, collaboratively developed a multitude of new organizational workflows and policies related to privacy and HIPAA compliance, supervision, communications, and safety. So workflows to ensure HIPAA compliance and privacy were very important in this transition. One of the first policies that we created was a remote access checklist and user agreement. So this is a detailed policy containing a screener to assess staff commitment and confirmation of their ability to uphold HIPAA practice at home. All staff were required to read and sign this policy within our online HR system, and this policy is available as a PDF to view in the webinar materials today for anyone who's interested.


All staff were also required to complete HIPAA training in our online HR training database as well as to submit a photo of their HIPAA-compliant home workspace to be reviewed by our privacy officer. I've looked at a couple of communication action steps here, but I won't go into too much detail on these. But I think they're relatively self-explanatory. But essentially, we created a variety of workflows for the management and deployment of remote IT equipment among staff and outline the process of triaging and directing calls among staff working on and off site. Next slide.

Cassidy Hayes (37:48):So supervising remote staff was a new process for most of our managers. So we created a remote supervision workflow and a remote productivity reporting form as standardized ways for supervisors and staff to set and maintain accountability for time spent working remotely. In terms of safety, there were many new protocols put in place in response to COVID. But I've looked at a few that pertain to our outreach and enrollment staff here. For example, we create a workflow for the processing of incoming and outgoing mailing documents, including things like sterile handling and development of a HIPAA-compliant document Dropbox and curbside services for laptop and IT assistance. Next slide.

Cassidy Hayes (38:32):Actually, just skip the next slide please, for the sake of time. So I've compiled a list of recommendations based on our process of transitioning to remote status. Hopefully, these recommendations can be helpful for some other agencies looking to transition to remote enrollment programming. So I would recommend creating a technology kit for each navigator in advance. This will be useful not only for preparing for a pandemic, but also for general community outreach as well. The IT department will definitely be a key partner here. So in a technology kit, I'd recommend including things like purchasing a laptop in advance for each navigator, installing software to enable phone and switchboard capabilities, fax server, virtual protecting network and encryption software, and also making sure that staff are able to access the assister portal if you used one as we found there, maybe glitches at first that require you to delete cookies and make settings adjustments, et cetera.


I'd recommend getting safe laptop cases to store the laptop, mouse, charger, Wi-Fi hotspot, and headset in each one, and even throwing in a white noise machine for staff who work in family and home settings. In terms of privacy and assurance, I would recommend establishing an agency virtual protected network, creating a remote access user agreement and adapting it as standard policy agency-wide. Again, ours is available to you as a PDF. I'd also recommend training all staff on remote access guidelines and requirements and having staff predesignate and plan a HIPAA-compliant home workspace, as well


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as identifying online HIPAA trainings to assign staff once annually and initiation of remote programming. Next slide.


So I have listed just a few quick recommendations in terms of training and remote supervision here. Essentially, I recommend investing in training to increase computer literacy amongst us. So training staff so that they have an existing level of comfort with these systems will make things much easier and less traumatic for staff if you have to go remote suddenly. In terms of supervision, my main point here is the importance of establishing strong program leadership to ensure that remote enrollment teams have a supervisor who understands and advocates for their needs and documents and acts on community needs and trends that are arising as well as developing clear agency expectations for supervisors to lead, engage, and advocate for remote staff. Next page, please.

Ted Henson (41:14):Great. Well, thank you so much, Cassidy. What a just really concrete nuts and bolts presentation. Really appreciate that. Also, just wanted to reiterate that, thank you for sharing some of your workflow templates document that's in the resources pile that was shared today in the webinars. So folks can look there for additional resources. Also, I like the suggestion of the white noise machine. If someone with a dog and two kids, that would be great to have, for sure.

Ted Henson (41:43):Last but not least, I want to turn things over to a longtime colleague and friend who I've worked with, I think since 2014 when we were really sort of doing a lot of the outreach and enrollment work when it was becoming a really fresh. It's Tia Whitaker, who is the statewide director of outreach enrollment at the Pennsylvania Association of Community Health Centers, which is the primary care association in Pennsylvania. You can see a full bio on the screen.

Ted Henson (42:08):But I'd mentioned before, but Tia and I serve on the CMS Advisory Panel on Outreach and Education. So Tia is a great state advocate and voice in Pennsylvania, but I want to thank you for your contributions to the national conversation as well. Tia's going to I think go over statewide generalizations and considerations there in Pennsylvania and I think talk maybe also about how outreach enrollment staff have been doing other duties as assigned during COVID. So Tia take it away.

Tia Whitaker (42:40):Ted, thank you so much, and thank you to my colleagues, Ashley and Cassidy for your insights on the health centers and laying that foundation. So as Ted mentioned, PACHC, Pennsylvania Association of Community Health centers, we are our state's primary care association. My presentation today, I'll talk a little bit about our health center network, our current landscape in Pennsylvania, how we're ensuring access to coverage, our enrollment assister work and how we're responding to COVID-19. We of course represent our community of community health centers, our FQHC, our rurals, and our Look-Alikes across the state.

Tia Whitaker (43:21):


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We're serving about 888,000 patients across the state, with more than 300 sites with locations in 52 out of Pennsylvania's, 67 counties. We serve one in 14 Pennsylvanians, one in five individuals on Medicaid or who are uninsured, and we provide nearly 3 million visits annually. We contribute more than $500 million to economies of local communities and provide more than 5,000 FTE jobs in Pennsylvania. Next slide. Next slide.

Tia Whitaker (44:05):Foremost on our minds right now is COVID-19 and how we are responding. So our response is guided by statistics and data from our health centers, and our marketing manager produces an infographic weekly highlighting key elements that help us make informed decisions about the direction we need to go. We're able to capture this information on how many health centers have the capacity to test and what services they are providing. Next slide.

Tia Whitaker (44:34):Ensuring access to coverage during a pandemic is key and has been embedded in our health center and PCA mission from the beginning. PACHC and our community health centers have been providing health insurance marketplace navigator services since 2013 using the Federally Facilitated Marketplace, and PACHC was the only navigator grantee, the sole navigator grantee for 2018, but we've been providing and getting grant funding since day one in 2013, and we are excited and happy to be able to be providing that service.


We currently have more than 80 navigators and certified application counselors in our health center providing outreach, consumer education, and enrollment assistance. Pennsylvania has been working to ensure coverage and options for coverage during these most uncertain times. Under the ACA, Pennsylvania expanded Medicaid in 2015 ensuring coverage for more than 700,000 new consumers to the Medicaid program. Act 42 of 2019 established the Pennsylvania Health Insurance Exchange authority, which will govern our marketplace and Pennsylvania as a state-based marketplace using the federal platform for this current year, which is 2020 and moving us into a fully state-based marketplace for 2021, that enrollment period. It also established a reinsurance program to assist in covering high-dollar claims to pass the risk to the program, thus lowering insurance premiums for consumers. We also work closely with other state partners like our department of health, human services, insurance, and aging. Next slide.


This is a historical timeline of important milestones for Pennsylvania, as we continue to ensure access for over 12.8 million residents of the state. Next slide. Enrollment assistance has taken on new roles and responsibilities during COVID-19. Not only are we helping to add the security of health coverage to the safety net of our patients. We're also expanding the role of supporting or enabling services. Coverage to Care is a component of the healthcare delivery system often overlooked, but has risen to the significance with all of the important identifying treating, tracing, and followup of COVID-19 patients.

Tia Whitaker (47:15):Some outreach and enrollment staff have been redeployed from in-person enrollment assistance to support contact tracing and expanded outreach through community health worker programs. Contact tracing responsibilities and plans tend to be very state specific and state or local health department


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driven. Health center interest in participating in contact tracing and having the capacity to do so also varies greatly across our state. Many health centers are awaiting clear direction from HRSA on when health center performed contact tracing is in scope before making a decision or whether to integrate this as a health center function.


In Pennsylvania, although we have one health center that has been doing contact tracing for all of its COVID-19 positive patients since March, most health centers are awaiting both HRSA and health department direction. Health centers interested in conducting contact tracing are primary interested in doing so because they believe it's part of meeting the needs of their patients and because there's no one else doing it or able to do it effectively or efficiently because of mistrust in some of our populations. An article published in a July 3rd edition of the Washington Post entitled, community health workers are essential in the crisis. We need more of them, discusses the importance of embedded, trusted resources to support and improve health outcomes during this pandemic. So the country is recognizing the need for these expanded services.


Our social determinants of health and health and our data informs our decisions on programs and services needed to best serve our health center patients and surrounding communities. Community health workers have been deployed to cover a multitude of needed services and gathering information. Value add can be determined as being able to get what you need, when you need it, from who you need it. Transitioning or augmenting the enrollment assistance component in what the documented value add of community health work is foundational and is another step in becoming a one-stop-shop resource. It's important to note that direct enrollment assistance is still an expectation of health center HRSA funding. There has been a 46% increase in consumers qualifying for and shifting to marketplace and CHIP enrollment. Next slide.


Transitioning and redefining our role in response to COVID-19 has taken on an urgent and immediate response. Our individual virtual workflow supports our telehealth outreach and enrollment activities. Remote assistance is a component of our outreach program, and we have focused on that for the last several years. It has really thrust us to the forefront during this pandemic. The majority of our navigators and certified application counselors shifted to remote assistance immediately, while a small percentage continued to provide in-person assistance for enrollment.

Tia Whitaker (50:30):We honed our work to a few key points to ensure efficient assistance. Some tips and best practices for providing remote assistance include, be sure to have adequate equipment, phone connectivity, printers, scanners in compliance with health center guidelines. Pre-screening and preparing before the actual enrollment appointment may take a few extra minutes, but saves time and can alleviate unnecessary or followup appointments. Obtaining verbal consent and retaining that consent for audit purposes protects consumers and enrollment assistance from potential legal action.


Privacy and security checkpoints are more important now due to the increase in cyber thefts, hacking, and other threats. Locking up our files, wiping cookies and erasing data is an integral part as well. Being


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the subject matter expert alleviates the hassle of the transfer chain and reduces consumer confusion. I personally have been caught in a transfer game. How many of us can say that we've been transferred more times than necessary? So being the subject matter expert really does alleviate some additional headings for consumers. Knowing that network and available health plans and state department phone numbers also cuts down on time spent, ensuring the coverage chosen is adequate for the consumer. These are some valuable outreach and enrollment practices to ensuring access to the appropriate coverage for patients and for consumers. Thank you.

Ted Henson (52:17):Great. Well, thanks so much Tia and Cassidy and Ashley. Again, just such great content. Thank you for all the work that you do. There was a contact information slide. So I see some questions in the chat in the Q&A specific to some speakers. So if we don't get to it today, feel free to reach out directly to speakers and kind enough to leave their contact information, and you can reach out to me directly. I think now I'm going to turn things over just to Phillip to see if there's questions from the audience.

Phillip Stringfield (52:48):Awesome. Thank you, Ted, and thanks Ashley, Cassidy, and Tia for sharing that wealth of information. We did get a couple of questions that came in. The first one is going to be targeted to Ashley. So the question was looking to see if we will get more information or insight on how to spot-check enrollment to make sure they were completed.


Sure. So because the application assisters send me their schedule reconciliations each day and show me which patients they were able to reach and get enrolled, I'm then able to go into the EHR system and make sure that that Medicaid ID number was input into their file. Then I also go back and check in our Kentucky Medicaid system and see if it's showing up in the system. It usually updates within 20 or 30 minutes of the enrollment. So I'm able to spot-check those pretty quickly.

Phillip Stringfield (53:56):

Awesome. Thank you. Then so the next one is going to be for Cassidy. So the question was, how have you handled the network communications in terms of remote connection to staff and also reaching out to patients who may not have appropriate digital device?


Yeah, that's a good question. So our navigators and staff in general have done a combination of things to try to facilitate care and enrollment for patients who may not have a high level of technological skills or even access to a device in general. Most of what the navigators are able to do is done over the phone. So there have been a lot of flexibilities and work around that have been disseminated by the state in Massachusetts, at least, that have allowed navigators to assist people who can't actually provide a physical signature, for example.

Cassidy Hayes (54:58):So most information can be provided, and most applications can be submitted simply through a phone call. We did though notice that there were some patients who needed to submit a proof or documentation or something like that, and using the phone just wasn't working to do that. So that's why


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we created a secure Dropbox system. So we basically created a Dropbox at the health center to allow people who really have to do things physically to drop off paperwork, have a navigator process it in a safe and sanitized space and then return the paperwork in a safe way.

Phillip Stringfield (55:44):Awesome. Thank you. Then so if I have time for one more question, I'm going to open it up for everyone. So this question was around marketing. So it's says, "What do you recommend with marketing and outreach to patients who already have Medicare that may not already be established patients at a health center?" So either anyone.


So the-


Go ahead.


So the question is how to best market the availability of navigator services to patients that aren't patients of the health center?

Phillip Stringfield (56:23):Right, that already have Medicare, but may not be established patients at the health center.

Cassidy Hayes (56:29):Well, I can't speak for everybody, but our navigators assist anyone in the general community, regardless of whether or not they're a registered patient at our health center. So when our navigators conduct outreach and when we develop marketing campaigns, they are targeting the general community rather than just our specific patient population. Is that what the question is getting at?


Exactly. Thank you. Ted, I don't know if I have enough time for another, so I'll just stop here, and you can let me know.

Ted Henson (57:05):I think we have time for another. Rachel, feel free to cut me off, but still three minutes. Let's see a couple more in the chat.


Yeah. I'm going to go ahead and target this to Tia. So specifically, what is included with COVID-19 contact tracing work? Is it just phone calls? How does PACHC start assisting with this, and did the state reach out to the FQHC?



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Well, currently, like I reiterated in my presentation, we have one health center who has been doing this from the very beginning, and they have provided resources to us to let us know exactly what they were doing and how they were doing it. I'm sure they have been working with CDC guidance and also with our department of health as to exactly what they need to do and how they do it. That information, I would be more than happy to share that with Ted to provide that as a resource, and that can be added to NACHC's information with the health center permission.

Ted Henson (58:11):

Phillip, if I could just add to that. I do want to flag for folks that HRSA has updated their COVID-19 FAQ. It's a little while ago back in May to really address what health centers can do within their scope of project regarding contact tracing. So I think that link to that is on our resources page. I won't read through it now, but they have made sure that they clarified the guidance around health interactivities on contact tracing as it relates to their 4 and 5A scope of project.


Thank you, Ted. We're going to have to cut it off here. I know there's a lot more questions, quite a few. But we will have those addressed and posted on the next NACHC's website COVID-19 page, along with the recording and the transcription of this webinar, and the PowerPoints as well. Thank you all for joining us today. A very special thanks to our speakers and to the NACHC team who helped bring this program to fruition.


We want to remind you to save the date for the next webinar in series, July 23rd, for this webinar. NACHC's Re-Imagining Care series is proud to present CDC and their featured presentation, COVID-19 state of the science. In the midst of re-imagining health center operations, we must stay updated on the evolving science of the coronavirus and COVID-19, including infection projections, geographic trends, and mitigation strategies. Please join us for this important CDC updates. Also, be on the lookout for the next webinar topic. It's coming soon. Remember to stay safe. You are important. This ends our webinar. Thank you all and have a good day.


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cdn1.digitellinc.com€¦ · Web viewfront lines, doing the job. Know that you have the support, and we're going to keep pounding together and working on this. Tom Van Coverden (09:53):