NAVIGATING THE AFFORDABLE CARE ACT IN IOWA

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1 NAVIGATING THE AFFORDABLE CARE ACT IN IOWA Kurt Berke, Planned Parenthood Chris Espersen, Primary Health Care Karen Sullivan, Visiting Nurse Services of Iowa Rick Kozin, Polk County Health Department

2 Objective 1. Understand the barriers that Iowans have faced in obtaining healthcare and how to effectively engage individuals 2. Learn what interventions are effective in addressing health disparities 3. Be empowered to effectively communicate to providers and policymakers the impact of effective engagement on the health of the underserved

3 Impact of ACA Primary Health Care

4 Questions to Run On 1) How has health care in the United States traditionally been rationed? 2) How will the ACA change this? 3) How does the ACA affect people we serve? 4) Am I equipped to be a steward of equitable access to health in Iowa?

5 ACA from National Perspective Intent of ACA: ensures hard-working, middle class families will get the security they deserve and protects every American from the worst insurance company abuses. This law was also specifically designed to give States the resources and flexibility they need to tailor their approach to their unique needs. How many of you have experienced the following, or known someone to have experiences the following: Denied coverage due to a pre-existing condition? Worried about a child transitioning to college or the work community not having insurance? Been charged more because you are a woman? Have had insurance coverage cancelled? Fell into the Medicare donut hole? Foregone preventive care because of cost? Reached the lifetime limit on insurance coverage?

6 Potential Impact of O&E Website:

7 What Really Happened

8 Public Health and the Affordable Care Act Polk County Health Department

9 What were our choices (of roles to play)? Educator Enroller Convener Spectator

10 What were our concerns? Insurance doesn t assure access Access to care contributes minimally to health Our patients wouldn t qualify

11 What did we decide (to do)? Develop and display educational materials 1:1 patient outreach/referrals Convene enrollment fairs

12 Navigator Role Planned Parenthood VNS

13 Navigator Services Grant Why Become a Navigator Services Entity? Nearly 12 million women and men of reproductive age will be eligible for coverage under the ACA. Three Grantees: Genesis Health, Planned Parenthood, and Visiting Nurse Services of Iowa. Better coverage for Planned Parenthood (PP) patients, reinforce PP s role as an integral part in the healthcare system. Visiting Nurse Services has a rich history of serving the uninsured. This grant allowed us to assist consumers in becoming insured and provided better access to healthcare for our consumers. What impact did you hope to make in the community? Educate the public about the ACA and health insurance Increase access to healthcare Increase numbers of individuals with health insurance

14

15 Navigator Training 20 hours of federal training on the ACA and the Health Insurance Marketplace 12 hours of Iowa Approved State Specific Training Exam with a score of 70% or higher Licensed by the Iowa Insurance Division Navigators fully licensed by the middle of November 2014

16 Navigators can assist consumers on the Marketplace Look for and compare private health plans Get answers to questions about your health coverage options Get a break on costs (Premium Tax Credits and Subsidies) Enroll in a health plan that meets your needs

17 Barriers Healthcare.gov technical issues for first 6 weeks Identity verification process is lengthy especially for immigrants and those without credit history Setting up an account Rural areas lack adequate transportation, lack of medical providers and high costs of medical care Overcoming the consumer s negative view of the ACA Understanding how to make changes in health care

18 Effective Interventions Low or free costs healthcare coverage Hardship exemptions Paper applications during the Healthcare.gov technical difficulties Identify family member with credit history Setting up the account Offering multiple session to complete the application

19 HHS/CMS Stakeholder Meetings Regional HHS Director, Stephanie Moore, and Regional Outreach Specialist, Kit Wagar, visited in December 2013 to discuss issues related to outreach and enrollment activities Came together again January 28 th to discuss enrollment numbers and explore plans to increase enrollment through the end of open enrollment Weekly phone conference calls to discuss enrollment successes and issues

20 Vulnerable Populations Collaboration Since July 2013, a key group of community stakeholders began meeting regularly in anticipation of the ACA and open enrollment (Planned Parenthood, VNS of Iowa, Primary Health Care, Polk County Health Department, AMOS, Broadlawns, Unity Point, Mercy, NAMI, Mid Iowa Health Foundation, Free Clinics of Iowa, Iowa Primary Care Association) This group brainstorms how to best serve vulnerable populations; identify gaps in service, and develop strategic solutions to deal with gaps.

21 Community Outreach and Enrollment Events January 11, 2014: Evelyn K. Davis Center January 27, 2014: First Unitarian Church (targeting young adults) February 15, 2014: Evelyn K. Davis Center March 10, 2014: KCCI Phone Bank March 22, 2015: Evelyn K. Davis Center

22 Communicating the Impact of the ACA Primary Health Care

23 Social Determinants of Health Impact on Personal Responsibility 100% 90% 80% 70% 60% 50% 40% 30% Diabetes Compliance and Financial Class Iowa Care Medicaid Medicare/Dual Elig. Private Insurance Self-Pay Slide Not Collected 70% 65% 60% 55% 50% 45% 40% 35% 30% Mar Apr May 2013 Hypertensive Patient Compliance and Top Zip Codes Jun Jul. 13 Aug Sept 2013 Oct 2013 Nov 2013 Dec 2013 Jan ($44,057) ($30,864) ($54,891) ($42,864) ($50,762) ($30,827) ($41,501) ($33,175) ($46,600)

24 Access beyond primary care

25 Organize, Educate, Agitate - SBA It s so much more than a card Healthcare providers need to open the doors Cultural competency is a requirement Appropriate resource allocation: thinking outside usual suspects Allowing the ACA to fail is not an option, regardless of what tax bracket you fall in

26 Planned Parenthood: The Mission of Planned Parenthood of the Heartland is to be a leader in providing accessible reproductive health care, education and advocacy; responsive to the needs and rights of families and individuals Polk County Health Department: Creating the conditions for all people to live healthy lives by engaging residents, reducing disparities and attending to the needs of our most vulnerable families Primary Health Care: Primary Health Care, Inc. is a team of caring professionals providing healthcare and supportive services for people in Central Iowa to improve their quality of life. Visiting Nurse Services: Promoting dignity, independence and quality life for all through education, compassion and effective communitybased care

27 Contact Information Kurt Berke, Planned Parenthood of the Heartland Chris Espersen, Primary Health Care Rick Kozin, Polk County Health Department Karen Sullivan, Visiting Nurse Services of Iowa

28 Thank you!

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