Transcript Colorado Health Plan Plus (CHP+)

Resources
Trusts
Communities
Healthyand
Healthy Communities
August 2010
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Trusts
Communities
Healthyand
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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Trusts
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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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Background 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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Background Information
2006-2009 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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Healthy Communities
Connecting You to Health Care
EPSDT
Outreach
and
Administrative
Case
Managers
Family
Health
Coordinators
CHP+
Regional
Outreach
Coordinators
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Implementation
• Department has contracted with local:
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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
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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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The Life Cycle of a Client
Application
Assistance
Outreach
Retention
Applicant
Eligibility
Determination
Client
Medical
Home
Information
and Referral
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Family Health 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 their
health 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 wellchild 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 Communities
303-866-5459 [email protected]
• Family Health Coordinators
www.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?
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