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Effective Outreach Strategies to Reach Rural Communities Tuesday, September 15, 2015
Megan O’Brien Health Outreach Partners (HOP)
Client Services and Marketing Manager
Who we are We support health outreach programs around the nation by providing training, consultation, and timely resources.
Mission To build strong, effective and sustainable grassroots health models by partnering with local community-based organizations across the country in order to improve the quality of life of low-income, vulnerable and underserved populations.
Who we serve • Community Health Centers • Primary Care Associations • Safety-net Health Organization
Health Outreach Partners www.outreach-partners.org
The Problem • Almost 50 million people (16%) live in
rural areas • Rural areas have different demographics,
health needs and insurance coverage profiles
• 2/3 of uninsured people in rural areas live in a state that is not currently implementing Medicaid expansion
• Profile: – Individuals in rural areas are less likely to
have access to coverage through a job – Uninsured individuals in rural areas are
likely to live in low-income working families, are primarily adults, and are generally unable to afford coverage on their own
"The Affordable Care Act and Insurance Coverage in Rural Areas." The Kaiser Family Foundation. May 29, 2014.
Objectives • Understand the barriers faced
rural populations. • Describe the role of outreach
in health insurance enrollment and facilitating access to care for rural populations.
• Identify at least two strategies you can use to outreach to and educate rural populations about health insurance options.
Icebreaker: Unique and Shared
• Find someone you don’t know.
• Find 2 things you share or have in common.
• Find 1 thing that is unique.
Barriers to Accessing Affordable Health Insurance
• Lack of job-based coverage: work in industries with low rates of employer-sponsored insurance and high rates of uninsured (agriculture, construction, and wholesale/retail/trade)
• Cost/Affordability: earn less money (median household income for rural adults is $40,060 vs. $47,200 for non-rural adults)
• Lack of information: 9 of 10 uninsured Americans did not know when the second open-enrollment period began (KFF)
• More likely to fall into the coverage gap: Folks make too much to qualify for Medicaid and too little to qualify for a premium tax credit (15% of rural residents vs. 9% urban); 65% vs. 50% live in a non-expansion state.
• Difficulty enrolling: Spotty Internet service and living a significant distance from in-person assistance
• Complicated Application Process
• Language and literacy • Culture • Immigration Status • Stigma • Misperceptions about the
Quality of Care Offered • Public Perception and
Potential Political Resistance
Health Demystified, a Healthcare.gov Blog. "Rural Americans Face Health Insurance Barriers." November 2014.
HOP’s Definition of Outreach The process of improving people’s quality of life by:
• Facilitating access to quality health care and social services
• Providing health education
• Bringing linguistically and culturally responsive care directly to the community
• Helping people to become equal partners in their care
• Increasing the community awareness of the presence of underserved populations
Process for Ensuring Health Access
Step 1
Step 2
Step 3
Step 4
Step 5
Key Points
• There are many reasons that cause individuals and families not to enroll in health insurance.
• Identifying and addressing the barriers is a crucial aspect of outreach and enrollment.
• Outreach can be an effective strategy to address barriers to accessing affordable health insurance.
• The five-step process to ensure health access begins with establishing a team and ends with ensuring coverage.
What is outreach?
OUTREACH
Outside The
Clinic Walls
IN-REACH
Inside The
Clinic Walls
Enabling
Services
Clinical
Services
Community
Education
In-reach
• Identifying existing patients who are eligible for coverage
How to do in-reach:
• Anyone in contact with patient
• Provider-directed
• Screening during scheduling
• Simple registration system
• All staff training
Key Principles for Outreach • One size does not fit all.
• Building trusting relationships is at the core of O/E.
• Collaboration - internal and external - enhances the scope of O/E.
• No single strategy alone will work to ensure health access.
• O/E requires flexibility and the ability to adapt to changes.
• Evaluation is key to ensuring success.
Be
creative
Use
multiple
strategies Evaluate
Be
flexible
Increased
health
access
Rural Outreach Strategies that Work
“Best Practices Guide in Rural Outreach and Enrollment” (Federal Office of Rural Health Policy)
• Use in-person assisters
• Offer one-on-one counseling
• Streamline and offer efficient appointments
• Place-based outreach: location, location, location
• Leverage community resources
• Outreach to and collaborate with rural hospitals
Rural Outreach Strategies that Work
“Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas” (Rural Health Research Program)
• Build coalitions at the state, regional, and local level
• Include no/low-cost marketing options • Include the entire organization in in-reach
activities • Involve other community agencies with
education and outreach • Promote “word-of-mouth”
recommendations from satisfied consumers
• Offer enrollment events in locations throughout the community that are convenient to rural populations
• Collaborate with agents and brokers
East Texas Community Health Services, Inc.
Nacogdoches, TX
Our Leased Off-Site Space
New Off-Site Building Announcement
Service Area Map
Ads in Rural Area Newspapers
2015 Open Enrollment Ad
Picture of ACA Coalition Committee
Sept. 15th 2015
Erica Johnson, LVN, CAC, CHW, Clinical Outreach & Coordination Manager
Richmond, TX-population:11,863 31 miles from Houston Stafford, TX-population:18,126 19 miles from Houston Missouri City, TX-population:70,185 18 miles from Houston Rosenberg, TX-population: 33,188 35 miles from Houston Brookshire, TX-population: 4,869 45 miles from Houston
Outreach: O&E staff regularly attend Outreach events in the community, including health fairs, Head Start registrations, college events, sporting events, libraries, CHW chapter meetings.
Media & Materials: Public Service Announcements and Flyers
In reach: O&E receives referrals from WIC, clinic staff, Eligibility staff, Care Coordination Team, and other staff members. In reach usually involves a “warm hand off” to O&E, and a fair amount of collaboration.
Referrals from partners, such as OBMC ED and FBC Community Paramedics Program, Gateway To Care, FB County Indigent Program , other local hospitals and more.
Offering weekend and evening hours
The Affordable Care Act Health Insurance Marketplace
The Affordable Care Act became effective in 2014. This year, open enrollment for the Health Insurance Marketplace will begin on
November 15th. The Marketplace is designed to help you find health insurance that meets your needs and fits your budget.
Certified Application Counselors are available locally at AccessHealth, with offices located in Richmond, Missouri City,
Stafford, and Brookshire. The counselors can explain the programs and help you complete the screening application at no cost to you.
Your signature below gives us permission to share your personal
contact information with AccessHealth for the express purpose of contacting you related to the Health Insurance Marketplace.
__________________________________ ____________________________ Patient or Guarantor Signature Date
__________________________________ ____________________________ Business Office Representative Date
Patient Label
National Outreach Guidelines Introduction • Partners provided a vision for
the guidelines
• Convened an 18 person Advisory Council from CHCs across 14 states to review and provide feedback
• Guidelines provide a framework for how to build a well-rounded, comprehensive outreach program that helps meet the needs of hard-to-reach, vulnerable populations and connect them with a Patient-Centered Medical Home
Partners in Development
National Outreach Guidelines for Underserved Populations
• Person-Focused
• Community-Focused
• Program-Focused
• Module 1: Getting Started
• Module 2: The Basics of Affordable Health Insurance
• Module 3: Understanding Health Insurance Outreach
• Module 4: Working Effectively with Priority Populations
• Module 5: Defining Messages & Messengers
• Module 6: Reaching Eligible & Uninsured Individuals and Families
• Module 7: Collaboration with Community Partners
• Module 8: Accessing Care and Maintaining Benefits
• Module 9: Putting It All Together
• Module 10: Closing
Curriculum
• Outreach Connection e-newsletter articles: – “The Health Benefits of Health Insurance” – “Making the Most of Public Health Insurance Benefits: Getting
Eligible Individuals and Families Enrolled and Connected to Care” – “Connecting Underserved Populations to Health Insurance”
• Innovative Outreach Practices: – “Got Coverage? HCFA’s Phone-a-thon to Increase Enrollment: – “Prescription for Coverage: Provider Referrals for Insurance
Coverage”
• Additional Resources: – Outreach and Enrollment Metrics: A Tip Sheet for CHCs – Connecting Eligible Immigrant Families to Health Coverage and
Care: Key Lessons from Outreach Workers – Focus on Outreach and Enrollment: Unique Strategies from Four
California Health Centers
HOP’s O/E Resources
Activity: Sharing Success Stories
①Find a partner.
②Think back on the last year of providing outreach and enrollment assistance or supervising O/E staff.
③What are you most proud of accomplishing regarding your work?
④Take 2-3 minutes to share with your neighbor.
Executive Office 405 14th Street, Ste. 909 Oakland, CA 94612 510.268.0091
Megan O’Brien [email protected]