MOVING BEYOND ENROLLMENT Working in Communities to Connect Newly-Insured People to Care The complexity of our health care system is a challenge to every user; it is a particular challenge to individuals and families who may be coming into the system for the first time. Moving Beyond Enrollment, a three-year program begun in 1999, works with residents of three rural regions of Massachusetts who are enrolled in publicly funded health insurance to make sure they get appropriate health care. The program builds upon a foundation of strong community-based outreach and enrollment programs, working in partnership with communities - residents, organizations and human service providers - to expand health care access for these medically underserved rural communities in Lower/Outer Cape Cod, the North Quabbin region and the Southern Berkshires.
Moving Beyond Enrollment Goals The primary goal of the program is to demonstrate how community-based outreach and enrollment workers can be instrumental in establishing an effective relationship between people enrolled in publicly funded health insurance programs and an appropriate primary care provider, so that once insured, people may receive the high-quality health care services they need without delay. Moving Beyond Enrollment Objectives The program has four major objectives, designed to engage each important segment of this transaction: · Individuals - to connect them, once insured, to appropriate medical providers and services · Providers - to facilitate their connection to new patients covered by publicly funded insurance · Community systems - to help identify barriers and work toward solutions so people can get to their providers and receive their covered services · State systems - to identify barriers and work toward solutions to promote both access to covered medical services and their appropriate use
Moving Beyond Enrollment Resources (links coming soon!) The Health Access Continuum - a graphic depiction of the progression from outreach to enrollment to post-enrollment when seeking health care coverage Getting There From Here - documents how to practically operationalize the Health Access Continuum in order to provide effective post-enrollment support via community-based organizations (due Feb. 2002) Focused Discussion Groups with Staff from Area Medical Providers - summarizes observations of office staff from physicians' offices regarding post-enrollment access to health care Post-enrollment chapter from Outreach Works Community organization perspectives on post-enrollment/member education
Moving Beyond Enrollment Activities Individuals In the two years since the program began, Moving Beyond Enrollment staff, all active and experienced outreach and enrollment workers, have taken more than 2500 new State Medicaid program members through the following continuum of pro-active steps to connect them to care and prevent problems before they arise: *Track the process of each eligibility determination, verifying the status of each family member *Meet with eligible clients to help them select an appropriate plan and provider *Inform them of their benefits (emphasizing the importance of preventive care) *Educate them in how to negotiate the managed care system and how to maintain their eligibility *Cement the relationship for future follow-up and support *Verify the initial appointment (assist in making it, if necessary) *Follow up to make sure the initial visit has taken place *Address individuals' barriers to care through connection to additional resources Providers Moving Beyond Enrollment staffers in all three sites are developing reciprocal relationships with local providers and their office staffs in a number of ways which smooth interactions among providers, their patients, and the systems which provide them with coverage, through: *Initial outreach visits to introduce their outreach, enrollment and post-enrollment services *Supporting referred patients with information, education, a working insurance card, skilled help in solving billing or coverage problems - often transportation or language interpretation challenges as well *Assistance in finding resources for self-pay patients *Sponsoring facilitated discussion groups with providers and their staff in each community, exploring the provider's perspective on what factors interfere with patients' appropriate and effective use of services Community Systems Each community has a unique set of needs and resources. Moving Beyond Enrollment staffers at each site actively participate in community coalitions and task forces focused on local health access problems. They have become an integral part of local referral networks, the "go-to" people for health care access issues. They seek to work with the complete range of local health care stakeholders. State Systems The Moving Beyond Enrollment program provides community feedback on emerging issues to state level systems and offer solutions, whenever possible, before problems arise. The Massachusetts Medicaid agency has seen the value of post-enrollment services pilots and now offers a targeted funding for "Moving Beyond Enrollment" activities as part of its community-based outreach and enrollment mini-grant program. Additionally, major funders of innovative health access programs in Massachusetts have begun designing or are considering supporting initiatives to address post-enrollment needs.
Program Participants Program Coordination, AHEC/Community Partners Lead Agency, Children's Health Program Lower/Outer Cape Cod region Outer Cape Health Services, Inc. North Quabbin region Franklin Community Action Corporation, Inc. Southern Berkshire region Berkshire Health Systems, Inc., Fairview Hospital Program Partners University of Massachusetts Medical Center, Office of Community Programs Lower/Outer Cape Community Coalition North Quabbin Community Coalition Massachusetts Division of Medical Assistance Berkshire AHEC Massachusetts Department of Public Health, Office of Rural Health Health Care for All LinkAges Research Group, Inc.   For information about the Moving Beyond Enrollment program or developing and implementing similar initiatives, contact: Anne Rosen Moving Beyond Enrollment Coordinator Michael DeChiara Director of Health Access Programs
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