Technology helps community clinics take enrollment to the street

October 1, 2013

Centers reach out to low-income populations.

Under the Patient Protection and Affordable Care Act (PPACA), the nation’s community clinics are being fueled to better provide healthcare to uninsured and low-income populations with a much needed injection of $11 billion in funds. These health centers represent a critical population to target in the nation’s quest to expand healthcare coverage. As such, they will become an important source of members for the nation’s health plans.

But a critical problem remains: how to get eligible Americans to enroll in government-sponsored programs and connect with the system quickly and efficiently? And how can health centers overcome the many outreach obstacles presented when assisting this population?

Many health centers are just now beginning to explore enrollment barriers and the reality of the task ahead. Until recently, many politicians and some healthcare leaders erroneously believed that once the individual mandate kicks in, the enrollment dilemma for health plans will be solved. It could take years for enrollment efforts to catch up with the hodgepodge of outreach efforts, specifically those targeting Medicaid populations.

The good news is that enrollment programs are up and running. The bad news is that there is considerable information to communicate to millions of people in a short period of time.

According to the New York Times, while 30 million people will soon be eligible for coverage, as many as three-fourths are unaware of their options. Even in California, a state farther ahead than many others in its effort to educate uninsured populations, more than 78% of the population is unaware of their coverage options and what they need to do next. Newly-eligible individuals will continue to seek care within health centers and, more than ever, will need to be screened to identify which programs they qualify for, and to determine the most effective methods for enrolling.

It is expected, however, that millions of American may not in enroll in health plans, at least attributed in part to confusion and lack of direction and guidance.

These problems and possibilities leave health plans and health centers with a great responsibility to become active leaders in the effort to reach out and expand enrollment. First they must help patients that need quality healthcare and, for pragmatic reasons, help reduce the burden of bad debt. Also they can help health plans to build membership within targeted Medicaid and charity care populations.

However, enrollment itself will be challenging. There are many reasons why, including:

The information isn’t getting through to targeted populations. Many of the populations who are newly eligible for low-cost or subsidized health coverage programs are transient and difficult to reach through traditional advertising methods, such as radio, television and billboards.

It’s a highly diverse population. Americans who are eligible for Medicaid today range from young working adults, to working families, to the homeless. Clinics in some communities may also need to assist legal immigrants who are unsure if they qualify to enroll. Additionally, health plans must ensure they are communicating in the languages understood by this targeted, diverse population. In states like California and Texas, translation of materials needs to go well beyond Spanish and Vietnamese to other languages, such as Filipino, Punjabi, Cantonese and Arabic.

The message is complicated and misunderstood. How healthcare reform works is still very misunderstood by most Americans. Many consumers do not realize that their income levels will qualify them for free or low-cost healthcare, and many will be eligible for subsidies.

People are people. Many people aren’t going to enroll until they have to-waiting until they are sick. Buying food, clothing and other necessities often takes precedence over healthcare coverage premiums.

Screening a Critical Step

The real challenge for health clinics to tackle is that all patients must first be screened to ensure eligibility. Screening patients means identifying and helping them understand which coverage they may qualify to receive. For many community clinics it could be Medicaid, but it could also be a county program to help single pregnant women, a displaced worker or an immigrant awaiting legal status. The next step is to enroll these patients. Unfortunately, signing up for a plan or program is often complicated and time-consuming, as it may involve providing verification of income, proof of residency and proof of identity, such as a driver’s license or birth certificate.

To overcome current barriers, enrollment efforts will need to change. Simply reaching out and connecting with potential eligibles via traditional marketing methods is only part of the equation. Many people will need to be reached on a one-on-one basis-on the streets where they live.

For example, the Community Health Alliance of Pasadena (ChapCare) CEO, Margaret B. Martinez, MPH, challenged her staff to find solutions that would enable their team already going out into the community to provide ready access and to track their outreach efforts. ChapCare provides more than 55,000 medical, dental and behavioral health visits annually.

The staff identified two options for reaching potential patients: as they came into the clinic; and directly on the street where they live and work.

Technology helped address the challenges. In the clinic, office staff has access to cloud-based software featuring a quick questionnaire and database of every state, county and federal health coverage program in California. When an uninsured patient comes into the facility, clinic workers walk them through five screening steps that cover basic information, such as employment status, demographic information, income and health conditions.

To make it easier for patients, clinic workers also go out into the streets daily with laptops and tablets that can access the software and screen people before they come into the clinic. ChapCare’s leaders believe that the more screenings are done in the field, the more efficient it will be once those patients walks into the clinic-giving the staff more time for care. 

Clinic leaders also note that one value of a proactive approach to enrollment is that patients are much more willing to come to the clinic before a problem becomes acute when they know they have coverage. Having the ability to identify health coverage options quickly at the point-of-care, and enroll patients onsite, gives community health centers more time to focus on patients’ healthcare needs.

ChapCare is also using software to provide a back-end tracking system that will help them track and follow-up on enrollment. The clinic is now enrolling about 100 to 200 people per month.

Next Steps/Solutions

Industry leaders can ensure better communication with at-risk populations. Strategies that should be considered include:

  • Develop partnerships and collaborate closely with local community health clinics and providers. They are closest to the uninsured population and can help with education and outreach.

  • Expand community-based and highly localized enrollment events, health fairs, etc. Partner with community groups. Use available tools to communicate information, track and follow up.

  • Use technology to provide tools to people in the field. Speak and provide screening and enrollment materials in multiple languages.

  • Create efficient and simple screening programs to quickly identify appropriate programs.

  • Adapt on-site technology. Health plans may want to consider helping community clinics add self-service kiosks to assist with enrollment. 

  • Ensure patients are tracked to determine when they enroll and follow up if they don’t. Always keep in mind that outreach and enrollment are separate activities.

  • Track efforts and results so if patients don’t enroll, the clinic staff can go back out and provide further assistance. 

  • Utilize technology that can provide reports and record outreach efforts. This is helpful for tracking, but also necessary for clinics that need to report on activities as part of the effort to secure/retain grant monies.

It’s not just clinics and community health centers that need to get involved in enrollment. All providers, hospitals and health plans will need to find ways to integrate efforts into their programs.

The next several months present many challenges, and much will be learned as we all work together in a new system. Programs utilizing effective marketing, outreach and technology to provide information, foster education and create efficiencies will be an important part of the process.

If providers can have greater access to technology, they can ensure efficient enrollment.

Ankeny Minoux is COO of PointCare, developer of cloud-based, health coverage screening software. Steven Abramson is Marketing Manager for ChapCare, a community health center in Pasadena, Calif.