MODELS FOR PRACTICE
FOCUS AREA: ACCESS (INSURANCE)
Program Name: CHOICE Regional Health Network Regional Access
Location:
Problem Addressed: Access to Insurance
Healthy People 2010 Objective: 1-4, 1-5
Web Address: http://www.choicenet.org
SNAPSHOT
The mission of the CHOICE Regional Health
Network, a nonprofit consortium of rural and urban providers, is to “improve
the health of our community.” That “community” represents five counties in
central western
The Regional Access Program (RAP) serves
the uninsured and underinsured at or below the 250 percent federal poverty
level in the five county service areas. RAP
improves access to primary care and other medical services by connecting
eligible residents to a medical home and providing guidance on available
sources of health insurance.
THE MODEL
Blueprint: CHOICE Regional Health
Network Regional Access Program was created in 1996 to provide intensive outreach
to low-income individuals and families. Access coordinators partner with
schools, providers, daycare providers, state agencies, hospitals, and other
community-based organizations to reach children and adults who are without
health insurance.
Access coordinators meet individually
with clients to explain the various programs for which they are eligible, help
them complete the necessary paperwork, and serve as advocates.
In 2002, CHOICE helped enroll more than 3,000 people in public insurance. Since
the program began, CHOICE has assisted more than 14,000 people in the region to access needed health care services.
The services provided by RAP include:
outreach to community-based organizations;
provide a toll-free phone number that connects to a person who prescreens and schedules appointments;
provide application assistance to complete necessary paperwork and provide follow-up; offer Spanish translation and interpretive services through a toll-free, dedicated Spanish phone line and through four bilingual staff;
perform enrollment case management when appropriate;
serve as a liaison between state agencies and clients to
facilitate enrollment or to resolve problems;
educate consumers by explaining benefits and helping clients
choose an affordable health plan and primary care physician;
connect residents to available social services and programs for
which they may be eligible;
produce and distribute marketing materials to reach the target population; and
provide information to consumers about being informed and
responsible health care users, with a focus on primary care.
Making a Difference: The program conducts
annual surveys of providers and patients to assess
the effectiveness of the program. The impacts of the program for 2001 include:
reduced the number of uninsured in the region by 3,331;
decreased the insurance disenrollment rate
of CHOICE clients from 30 percent to 10 percent;
saved the providers in the region $4.5 million in uncompensated
care; and
reduced hospital bad debt and charity care by 14 percent.
Beginnings: The CHOICE Regional
Health Network is a nonprofit consortium begun in 1996. Network membership
includes public and non-profit hospitals, local health departments, family
practice residency programs, practitioners, schools, and community
members.
The CHOICE Regional Health Network takes on new
and/or expands existing programs based on an assessment of factors that reflect
their mission and vision. The questions asked as criteria for program selection
for the Regional Access Program are:
Is the problem important and in the long-term interests of the community?
Does it address a coordination, quality, access, or health status objective?
Is it a step toward better distribution of health resources?
Is
it a prudent investment in a cost-conscious market?
Challenges and Solutions: To address social and
cultural issues, case management services were created to connect people to
other needed services (e.g., food). Bilingual staff were
hired to address language and cultural issues. Special materials were developed
to assist clients from other cultures to understand the concepts of insurance,
medical home, and managed care. Recently, CHOICE partnered with the Crisis
Clinic to manage an Internet-based Regional Resource Directory.
Ongoing funding for the network comes
from membership dues that are paid by the six public and non-profit hospitals
(member sponsors). This funding
is
supplemented with state contracts and grants. For example, the Statewide Health
Insurance Benefit Advisor (SHIBA) Program was folded into the RAP program.
Savings from reductions in uncompensated care are reinvested back into the
program. In 2001,
the program received a Community Access Program (CAP) grant from the Health
Resources and Services Administration. Expanded
funding over the last five years allows
the program to increase its
service population, adding children, the underinsured, and additional
counties (from one to five).
PROGRAM CONTACT INFORMATION
Kristen West
CHOICE Regional Health Network Regional
Access
Phone: (360) 493-4550