April 2011 Page 1 of 8 Grant Outcomes Report I. Executive Summary KEY INFORMATION: GRantEe Ibero-American Action League, Inc. grant title Dates The Ibero-American Action League, Inc. of Rochester, NY, created September 2007 August 2009 a ( Health Promoters ) program. Under this grant amount program, Ibero encourages better use and understanding of the $150,000 health care system among Latinos in the greater Rochester area. It reaches out to individuals in need of health care services and connects them to a medical home and to insurance resources. It also provides educational workshops and transportation, interpretation/ translation, and patient navigation services for area Latinos with targeted health conditions (allergy, asthma, diabetes, heart disease, lead poisoning, mental health, and obesity). Ibero demonstrated the extent of the need of Latinos living in and around Rochester for a regular medical home, assistive services, such as transportation and translation, and health insurance. II. The Problem There are significant differences in the causes of mortality and in access to health care between Latinos and the broader population of Rochester, New York, as detailed in a 2008 study of Latino health in the Genesee Finger Lakes region. 1 These differences reflect inadequate access to health care services for Latinos, as well as a failure among local Latinos to use existing community services. The same report noted that Latino patients who are treated and released at hospital emergency departments (EDs) for illnesses or complaints that could otherwise be treated in an outpatient setting is an indicator of the lack of a medical home, or a usual source of care, among Rochester-area Latinos. Patients who lack a medical home do not have easy access to timely, well organized health care. In 2006, 20% of Latinos in Monroe County between the ages of 18 and 64 lacked health insurance, compared to 7% of non-latinos. Additionally, 45% of Latinos were not continuously insured during the preceding two years, compared to 15% of non-latinos. Further, Latinos poor insurance coverage and lack of access to primary care may contribute to the high level of Latino hospitalizations in the 1 Nuestra Salud: 2008, A Report of the Health Status of the Finger Lakes Region s Latino Population, The Finger Lakes Health Systems Agency, September 2008. Available online at http://www.flhsa.org/complete%20nuestra%20salud%202008.pdf.
Page 2 of 8 Genesee Finger Lakes region for conditions that might otherwise have been prevented or treated in outpatient settings. 2 The scope of the twin problems of lack of a medical home and uninsurance among Latinos has been growing along with the size of the Latino population. The number of Latinos living in New York s Finger Lakes region more than doubled between 1980 and 2005, from 20,300 (2% of the region s population) to 53,700 (5% of the region s population), according to U.S. Census Bureau estimates. 3 Further, Latinos lack of medical homes and high uninsurance rate are directly related to a Latino unemployment rate that is more than twice the national average, according to the 2000 U.S. census. 4 EXPECTED OUTCOMES When Ibero launched in 2007, its chief aim was to identify uninsured Latinos in the Rochester area and assist them in obtaining health insurance, as well as a medical home and patient navigation services. Ibero expected to reach 600 uninsured individuals in year one and 1,400 in year two of the project. In consultation with staff at the New York State Health Foundation (NYSHealth), Ibero changed its goals partway into the grant period. The changes recognized the difficulties inherent in helping the uninsured to gain insurance coverage. Ibero shifted its primary focus to finding local Latinos a medical home. Ibero s new goals for the first 13 months of the Promotores program shifted to: Reaching out to a minimum of 258 documented uninsured individuals Enrolling a minimum of 206 individuals in a health plan (the responsibility of the Rochester Primary Care Network) Reaching out to a minimum of 258 low-income individuals who did not have a regular doctor Connecting at least 206 individuals with no regular doctor to a medical home (the Rochester Primary Care Network) Bringing at least 52 inactive patients back into active preventive care Assisting at least 82 patients with the targeted health conditions with keeping appointments, translation, and understanding the doctor s instructions and their illnesses Conducting a minimum of two wellness/health education workshop series that meet four or more times, each with an average of 10 participants Conducting a minimum of 11 wellness/health education workshops with an average of eight participants apiece Providing transportation or bus tokens so that a minimum of 155 individuals can keep their medical appointments Providing a minimum of 155 episodes of medical translation/interpretations Referring a minimum of 86 individuals to other needed services (e.g., substance abuse counseling, housing assistance, employment services) 2 Ibid. 3 Ibid. 4 Ibid.
Page 3 of 8 III. Grant Strategy In this project, Ibero adopted a method used successfully in California and other states Promotores de Salud to reach out to Latinos and connect them to needed health care services. These communitybased promoters of Latino health: identify individuals in need of health and mental health care; identify individuals in need of a medical home, typically people using the ED of local hospitals for non-emergency care; identify individuals in need of health insurance coverage; connect people to needed services and insurance; and create educational workshops for patients with one of the seven targeted health conditions, to enable them to better manage their own health. IV. Grant Activities Under this grant, Ibero worked with the Rochester Primary Care Network (RPCN), a Federally Qualified Health Center, to examine the needs of Rochester s Latino community, the existing system of health care providers and programs, service gaps and barriers, and best practices used elsewhere that might be used to improve access and care for the Latino population. Ibero sought to identify Latinos in need of health care, and to help them find the services they need. Ibero and RPCN determined that individuals not only needed to be linked to health insurance and quality health care, but to learn to manage their conditions, take better care of themselves, and develop the skills necessary to navigate the health care system. Ibero aimed to encourage local Latinos to use the existing health care system in a more appropriate way, to avoid emergency department overuse, and to ensure access to care for those in need. To achieve these ends, Ibero offered a, literally a Promoters of Health program, targeting low-income Latinos in the Rochester area. are community health workers who carry out a variety of health promotion, patient navigation, and non-medical supportive functions. They come from the communities in which FUNDING INITIATIVE This request for proposals (RFP) was part of the NYSHealth s Special Opportunities Grants fund. addressed all three broad mission areas cited in the RFP: expanding health insurance coverage for state residents who cannot afford to purchase their own coverage or whose coverage is inadequate; increasing access to high-quality health care services for underserved people; and improving public and community health by educating New Yorkers about health issues and empowering communities to address them.
Page 4 of 8 they work, and link individuals with needed health care by helping them understand, access, and navigate the increasingly complicated health care system. They offer education and information about health care and family wellness, and teach important problem-solving skills. focus on outreach to individuals in need of health insurance, a medical home, and patient navigation and/or educational workshops. Ibero found the Promotores model attractive because of its efficacy in other parts of the country, and its effectiveness in reducing costs to both providers and patients. 5 Ibero targeted seven health conditions: allergy; asthma; diabetes; heart disease; lead poisoning; mental health; and obesity Staff created educational workshops for patients with the targeted health conditions, and recognizing the specific needs of local, low-income Latinos, assisted those who required transportation and translation/interpretation services to keep medical appointments. Dr. America Bracho of Latino Health Access in Santa Ana, California the nation s foremost trainer in the Promotores model 6 conducted intensive training of Promotores, including patient education on the targeted health conditions. RPCN training staff worked with Ibero s management team and Dr. Bracho to design and implement additional monthly in-service trainings for the Promotores. 5 Keane, Dennis, Christine Nielsen and Catherine Dower, Community Health Workers and Promotores in California, University of California, San Francisco, Center for the Health Professions, September 2004. Available online at: http://futurehealth.ucsf.edu/content/29/2004-09_ Community_Health_Workers_and_Promotores_in_California.pdf. 6 Ibero-American Action League, Inc., Proposal to the New York State Health Foundation, 2007.
Page 5 of 8 Ibero engaged in outreach to identify low-income, uninsured individuals in need of a medical home, and worked to leverage additional funding from major payers (health plans), to allow them to continue the Promotores program after the end of the NYSHealth grant period. V. Challenges Ibero has described itself as initially naïve as to the extent of the problem and the volume of services [it] could provide with limited staff. 7 It found that health care facilities that serve the Latino community did not have a sufficient number of primary care providers to accept new patients. Ibero did not have enough bilingual/bicultural health insurance enrollers to enroll Latino individuals in health insurance, and found that there were Latinos who did not qualify for any government health insurance program. Even though uninsured people brought into the program may be employed, many could not afford to pay for commercial health insurance. Ibero found that some individuals were reluctant to disclose personal information necessary to apply for health insurance since many of them feared deportation. Some clients did not keep their appointments even though transportation services were provided. Negative experiences with other types of programs made some people hesitant to use the services offered. Latinos in the Rochester area are a transient population, moving often in and out of the area, thus making it difficult to recruit them and maintain them in medical services, training, and health insurance coverage. As a result of these unanticipated difficulties, Ibero in consultation with NYSHealth changed its primary focus of the grant from helping the uninsured gain health insurance to helping people find medical homes. Ibero scaled back its expectations, reducing the numbers of individuals it expected to help. The program s main focus, however, has always been both to connect the uninsured with health insurance and to connect them with a medical home. Ibero looked for efficiencies that would help it reach as many people as possible. It doubled the amount of outreach it had initially undertaken. However, concentration on this part of the program made it difficult to create the planned educational workshops on schedule. These began in May 2009, and have been well attended since then. Since funding was an ongoing challenge, Ibero worked to bring in long-term support from insurers and pubic agencies. VI. Key Findings Ibero recruited and filled the 4.5 full-time equivalent Promotores positions by April 2008. Dr. Bracho trained the staff in late April 2008. The training included specialized outreach techniques, with an emphasis on door-to-door outreach. began its work in the community in June 7 Ibero-American Action League, Inc., Final Narrative Report to the New York State Health Foundation, August 3, 2009.
Page 6 of 8 2008, at its offices at 777 N. Clinton Avenue, in the heart of Rochester s Latino community. The Promotores identified participants through door-to-door outreach, health fairs, festivals, program presentations, special events, walk-ins, agency referrals, presentations at local churches, and word of mouth. Preferred Care (now MVP Health Care, a managed care plan serving New York, New Hampshire, and Vermont) and Ibero agreed to make a male Outreach Worker available to the program two days a week. He is still assigned to be at the Program certain days during the week. During the time that this Latino male was a part of the program, he accompanied the female Promotoras on house-to-house outreach, at presentations to faith-based organizations, and during office hours at the Ibero s N. Clinton Avenue site. He was also helpful to program participants in the process of obtaining Medicaid health insurance. RPCN has funded at an annualized $150,000 level. The Monroe County Office of Mental Health funds 1.5 with an annual budget of $75,000. The Monroe Plan for Medical Care (a health management organization serving low-income individuals and the working poor) committed $50,000 per year, and Fidelis Care (the New York State Catholic health plan) asked Ibero to apply for $20,000 in funding. For the period of May 1, 2008 through June 30, 2009 (Year 1), the program s outreach brought in 602 documented contacts, or 2.3 times the goal of 258 individuals. Working with Ibero, RPCN helped 432 individuals enroll in a health care plan, or more than twice the goal of 206 individuals, and reached out to 397 individuals with no regular doctor, or 1.5 times the goal of 258 individuals. RPCN connected 310 individuals to a regular medical home, or 1.5 times the goal of 206 individuals. While Ibero hoped to work with 52 patients who no longer had a regular doctor or clinic, it was able to help only two because those 52 were to be identified from a list of patients whose phone numbers and addresses were no longer accurate. It assisted 123 individuals needing help navigating the health care system, 1.5 times the target of 82 individuals. Ibero conducted three wellness/health education training series with an average of four participants, rather than the target of two series with an average of eight participants. Similarly, it held one wellness/health education workshop with eight participants, falling shy of its anticipated 11 participants with an average of eight participants. According to the project coordinator, participants were unaccustomed to attending workshops;
Page 7 of 8 they were also not used to following through with recommended health care. As of April 2010, the Promotores program was again promoting workshops and working with participants to stay enrolled. However, Ibero provided 180 assists with transportation to medical appointments, almost 1.2 more than the targeted 155 assists. It provided 78 assists with medical interpretation/translation instead of the goal of 155 assists. Promotores who accompanied program participants to the hospital often found that the hospital provided interpreter/translation services. Ibero did not count such instances toward its goal; if it had, it would have exceeded the target of 155 assists with translation/interpretation. Last, Ibero gave 112 referrals to other needed services, or 1.3 more referrals than expected. Ibero demonstrated the extent of the need of Latinos living in and around Rochester for a regular medical home, assistive services, such as transportation and translation, as well as health insurance. VII. Lessons Learned Some clinics and other health care facilities saw the Promotores project as competition, making it hard for Ibero s clients to get needed medical appointments. Meeting with physicians and plan administrators early in the project would have helped to assuage this problem, and would have helped them to understand that the Promotores make the providers jobs easier. Another lesson, according to Maribel Torres, a coordinator at Ibero, is that it is important to have one individual responsible, respectively, for identifying the uninsured, providing transportation and translation services, and educating individuals about their health conditions. These clear roles make it easier for clients to understand how to get the most from the Promotores. Most important, health plans need to be involved from the beginning to make clear what they need if they are to enroll patients. Ibero worked with them collaboratively and from the earliest days of the project; the financial support several plans are providing for the project is evidence of the value of including them at the table, according to Torres. VIII. The Future Ibero s administrative staff continues to meet with prospective funders for the Program, with the goal of making it a long-term service available to Rochester s Latino community. According to Torres, RPCN, the Monroe County Office of Mental Health, and the Monroe Plan for Medical Care are committed to continuing financial support. Ibero plans to have more Promotores, and to help more community members to become Promotores.
Page 8 of 8 BACKGROUND INFORMATION: ABOUT THE GRANTEE The Ibero-American Action League, Inc. is upstate New York s largest Latino-serving, Latino-controlled advocacy organization. It has more than 40 years of experience, and serves more than 3,000 individuals annually. Ibero builds the capacity of Rochester s Latino community, providing services in education, employment, health, housing, business, disabilities, senior services, children and youth, and cultural development. GRANTEE CONTACT Jose Cruz Chief Operations Officer Ibero-American Action League, Inc. 911 E. Main Street Rochester, New York 14605 Phone: (585) 256-8900 Fax: (585) 256-0120 Web address: http://www.iaal.org/ NYSHealth contact Jacqueline Martinez GRANT ID # 1944194