MCHB 2003 FederalState Partnership Meeting, " Building Bridges: From Research to Practice"

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• MCHB 2003 Federal/State Partnership Meeting, "
  Building Bridges From Research to Practice"

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Panel

• Lynda Honberg
• Maternal and Child Health Bureau
• Lise Youngblade, Ph.D.
• University of Florida
• Phyllis Sloyer, Ph.D.
• Florida Childrens Medical Services
• Jerry Williamson, M.D.
• Marion E. Fether Community Health Center,
  Immokalee, FL
• Conni Wells
• Florida Institute for Family Involvement

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Overview of Presentation

• Introductory Remarks
• Description of Project
• Connections with Floridas Title V Agency
• Connections with Community Health Centers
• Connections with Families

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Introductory Comments

• Lynda Honberg
• Project Director, Health Insurance and
  Financing Initiative
• Division of Services for Children with Special
  Health Care Needs
  Maternal and Child Health Bureau/HRSA

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Outreach to Uninsured Children with Special
Health Care Needs

• Telemedicine Links Between Title V and Community
  Health Centers

Lise M. Youngblade, Ph.D. Donna Hope Wegener,
M.A. Institute for Child Health Policy University
of Florida
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Purpose of the Project

• To link Floridas Title V program (CMS) and local
  community health centers
• To reach and identify uninsured children with
  special health care needs in Florida and enroll
  them in insurance
• To focus on underserved communities that
  traditionally have faced numerous barriers to
  care
• To use telemedicine to facilitate evaluation and
  enrollment in CMS

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Project Funders

• The Maternal and Child Health Bureau (MCHB)
• Match support for equipment, nurses, and
  consultant time is provided by
• The Florida Department of Health, Childrens
  Medical Services
• The Early Childhood Initiative Foundation
• Community Voices Miami

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Why Florida and Why Now?

• Florida has one of the highest uninsurance rates
  in the nation
• Florida has a high level of poverty
• Florida is geographically diverse
• Florida is ethnically and racially diverse
• Community Health Centers are an integral
  component of the safety net

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Assessment of Need

• Identification of demonstration sites in areas of
  great need
• South Miami (South Florida)
• Immokalee (Gulf Coast)
• Trenton (North Central)
• Gadsden County (Panhandle)

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Development of System of Partnerships

• To reach uninsured CSHCN who needs to come
  together?
• State Title V
• Community Health Centers
• Outreach experts
• Family advocates
• Public Insurance Medicaid and Title XXI
• Health care providers
• Evaluation team

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How to Identify and Reach Uninsured CSHCN

• In-reach to families already accessing services
  at Community Health Centers
• Out-reach to families in communities

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Outreach Components

• CHC-based in-reach
• Coordinator hired, trained, and located at the
  CHC
• Job is to screen children as they access care at
  the CHC
• If pass the screener, they are referred to CMS
• Immediate hook-up with CMS via telemedicine for
  intake and enrollment
• All families are helped with KidCare application
  even if the child doesnt qualify for CMS

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Outreach Components (continued)

• Community outreach
• Using Grandmothers to reach families in their
  neighborhoods
• Grandmothers provide liaison support to talk to
  families about health care, health insurance
• Grandmothers also identify families with
  uninsured CSHCN and provide encouragement to come
  to CHC for evaluation and care

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Process Partnerships

• Partnerships for training and education
• Outreach experts, local advocacy groups
• In-house efforts at insurance enrollment
• Family input to make things family friendly and
  culturally sensitive
• Partnerships for ongoing clinic activities
• Coordination of activities and use of facilities
• Partnerships with other community organizations
  serving same population
• Churches, Schools, Daycare Centers

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Process Partnerships (Cont.)

• Outreach to the community
• Connections to other organizations for hiring
  grandmothers
• Partnerships with other CHCs in project

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Incentives for Sustainability

• Partnerships
• Reimbursements
• Infrastructure that can support multiple
  activities related to childrens health and
  special needs
• Telemedicine clinics
• Education
• Physician consultations with specialists

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A great model. But does it work?

• Need research and evaluation components too
• Collect data on
• Number of families contacted
• Number of families assisted with insurance and
  number enrolled in insurance
• Number of children screened for SHCN
• Number of children referred to CMS and number
  enrolled in Title V services
• Do the data vary by inreach or outreach
  strategy?

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Model Evaluation

• Satisfaction with telehealth enrollment
  strategies
• After six months,
• Are children accessing the services they need?
• Are children still enrolled?
• What about out-of-pocket expenses and unmet need?
• What about the perspectives of the partners? Is
  the model working?
• Analysis of cost effectiveness balanced by
  increased access to care and quality of life
  improvements

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Connections with Title V

• Phyllis Sloyer, Ph.D.
• Deputy Director, Childrens Medical Services
• Florida Department of Health

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Title V (Cont.)

• CMS is Floridas CSHCN Program
• CMS has adopted the 6 national performance
  measures for CSHCN
• Early Identification and Access measures are
  impacted by this venue

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Title V (cont.)

• CMS has experienced significant access problems
  to specialty services over the past few years
• Some areas have wait times in excess of 9 months
  for specialists
• Some areas lack specialists in general
• CMS estimates that it is reaching less than 5
  percent of Floridas CSHCN

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Title V (Cont.)

• Telemedicine is a good mechanism to identify
  children and to provide access
• CMS covers care coordination, equipment costs,
  and line charges

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Connections with Community Health Centers

• Jerry Williamson, M.D.
• Marion E. Fether Center
• Immokalee, FL

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TELEMEDICINE IN IMMOKALEE, FLORIDA
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DEMOGRAPHICS

• Rural Community
• Population 20,000
• Hispanic 82
• Haitian/Indian 7
• African American 6
• White 5

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BARRIERS TO HEALTH CARE

• Poverty
• Transportation
• Multiple languages
• Education
• Specialty Care

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BARRIERS TO TELEMEDICINE

• Geographic limitations
• Reimbursement
• JCAHO

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OPPORTUNITIES

• Clinical
• Educational
• Multiple partners

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Connections with Families

• Conni Wells
• Executive Director,
• Florida Institute for Family Involvement

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Why Use a Family Organization?

• Reality check
• Access to population leadership
• Access to families
• Increased credibility and exposure

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Why FIFI?

• Family to Family Health Information and Education
  Center grantee (MCHB)
• Family Networking grantee (SAMHSA)
• Family involvement contract with CMS/DOH
• Network of established and trained family leaders
  (Family Health Partners)

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Barriers to Insuring CYSHCN

• Geographic area
• Diversity
• Trust
• Community variables

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What We Know About the Families We Are Trying to
Reach

• Families do not always recognize Medicaid and
  Title V as an insurance
• Families are influenced by other family members
  and their neighbors
• Brandeis-Family Voices Study
• 2/3 of families of CYSHCN report a significant
  impact on their ability to work
• Families on Medicaid report a lower impact on
  their finances

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Building a Support Model

• Outreach worker
• Authority figure
• From within the community
• Face to Face intakes
• Confidence and comfort
• Evaluations via telemedicine
• Expanding the comfort zone

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What We Know About Telehealth(Family
Voices-Telehealth project)

• Supports the concept of community based care
• Families see it as a faster way to receive
  services
• Families like not having to travel
• Families feel that the technology increases their
  trust

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What We Will Learn

• How families will respond to neighborhood
  outreach
• Community reaction and support
• How to do real grassroots outreach
• The impact telehealth has or can have on diverse
  cultures

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Maintaining the Momentum

• Families as advisors
• Team building
• Diversity adjustments
• Flexibility