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Healthy Communities
August 2010
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Objectives
Educate community partners about the Healthy Communities model– Present background information– Describe role of the Family Health
Coordinators– Provide contact information
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Background Information
The Department has provided outreach for both Colorado public health insurance programs– Medicaid since 1965– Child Health Plan Plus (CHP+) since
1997
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Information Early and Periodic Screening,
Diagnosis and Treatment (EPSDT) Outreach and Administrative Case Management services for children enrolled in Medicaid– Over 50 EPSDT Outreach Coordinators
situated throughout the state have:• Worked with families, children and
pregnant women• Provided education on benefits, care
coordination, etc.
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Information2006-2009 contract with MAXIMUS, Inc. for CHP+ marketing and outreach efforts – Media advertizing and marketing
materials – Eleven Regional Outreach Coordinators
(ROCs) promoted CHP+ program statewide
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Healthy Communities
• Effective July 1, 2010, Healthy Communities combines best from:– EPSDT Outreach and Administrative Case
Management – CHP+ outreach program
• New outreach model addresses that: – Families do not always understand distinction
between Medicaid and CHP+
– Many families have one child enrolled in
Medicaid and another enrolled in CHP+
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Connecting You to Health Care
Family Health
Coordinators
CHP+ RegionalOutreachCoordinat
ors
EPSDTOutreach
and Administra
tiveCase
Managers
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Implementation
• Department has contracted with local: – Departments of public health – Nursing services – County human and social services – Regional hospitals (two)
• Contractors have dedicated staff to serve as Family Health Coordinators– Over 50 Family Health Coordinators
statewide– Encompass duties previously performed by
EPSDT Outreach workers and CHP+ ROCs
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Implementation
• Outreach is provided through partnerships with – Medicaid enrollment broker – CHP+ eligibility and enrollment
contractor – Health care providers and managed care
organizations – Community-based organizations– Coalitions and task forces– Foundations and employers
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Client
Outreach
Information and Referral
Application Assistance
Applicant
ClientRetention
Eligibility Determination
Medical Home
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Coordinators • Inform family about Medicaid and CHP+• Facilitate successful enrollment • Ensure applicants find accessible and culturally
sensitive assistance in their communities • Educate families on available program benefits
and the importance of preventative care• Promote access to Medical Home
– Empower families to take responsibility for theirhealth care
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Family Health Coordinators
• Collaborate with Medical Quest (www.medicalquest.com) to maintain lists of current providers accepting new clients, office hours and ages accepted to ensure proper referrals
• Offer billing assistance to providers• Assist providers with clients who have
missed appointments• Work with community partners to maintain
list of local community resources
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Evaluation of model
Success will be measured by:• Family Outcomes: Customer satisfaction
survey• Improved Child/Youth Outcomes: Increased
well-child visits • Improved System Outcomes: Decreased
duplicative services • Increased Enrollment and Re-enrollment:
Increase in average number of months that clients are eligible
• Increased Access to Care: Increase in the number of appointments kept after missed-appointment follow-up
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Contact Information
• Gina Robinson, Healthy Communities 303-866-6167 [email protected]
• Cindi Terra, Healthy Communities303-866-5459 [email protected]
• Family Health Coordinatorswww.colorado.gov/hcpf Click on Clients and Applicants, then Early and Periodic Screening, Diagnosis and Treatment (EPSDT), then Healthy Communities Outreach and Case Management Locations
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Questions?
