FAMILY HEALTH FOUNDATION
Peer Coaching/Mentoring Project
The "Community Resource Advisor" under
Medicaid/S-CHIP Managed Care
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Medicaid Managed Care presents an opportunity to improve the health of low-income families, but both providers and patients find that its rapid implementation has produced major negative side effects. The behavior changes demanded by managed care of low-income consumers are more profound than policy-makers understood. Communication with the patient population has proved difficult for both plans and providers.
Project Description
FHF has proposed a three-year project to demonstrate leading-edge methods in peer coaching/mentoring under Medicaid managed care. This project will show how family-centered coaching and support in the basics of accessing health services can significantly improve the performance of the Medicaid system, reducing net costs long-term. The services developed can be sustained long term as a Medicaid carve-out contract. The basic model can be extended to Medicare and commercial HMOs as well.
FHF has been selected as one of two CHW projects nationally to receive planning support through Seedco Inc. and the Annie E. Casey Foundation. We have also been asked by the Health Education and Training Centers Alliance of Texas (HETCAT), with federal funds from HRSA, to prepare a monograph on the application of CHW methods to improving preventive care under Medicaid managed care.
Method:
Locally-recruited, neighborhood-based peer outreach personnel (tentatively to be called "Community Resource Advisors") make periodic home visits to educate families on how to access services under managed care; schedule, reconfirm and follow up on appointments; help families learn to solve problems which create barriers to care; reinforce value of preventive care.Target populations:
Minimum demonstration would involve about 5-10,000 Medicaid eligibles and 15-25 outreach workers. Outreach network can also support both enrollment outreach for expanded children’s coverage plans and plan selection (enrollment brokering).Outcome objectives
| Improve access to primary care, use of "medical home" and appropriate use of services by Medicaid eligibles and uninsured family members |
| Increase use of preventive procedures under Medicaid, especially for young children |
| Increase Medicaid/CHIP enrollment among eligible children and overall stability of enrollment |
| Increase stability/predictability of Medicaid expenditures |
| Reduce acute care expenditures (long term) |
| Reduce rate of missed appointments; improve patient compliance (especially with medications) |
| Reduce inappropriate emergency room (ER) workload and costs of inappropriate service seeking behavior among both Medicaid and uninsured population |
| Higher Patient satisfaction and loyalty to providers and health plans, leading to decreased "doctor-shopping" and plan-switching behavior; lower malpractice liability risk |
Funding:
$100,000 in planning support already received. Demonstration project requires about $500,000 per year per site. Some portion may come from State Department of Health, HMOs, hospitals and physicians; all parties are supportive but waiting for commitment from the first investors. Successful implementation of this project can achieve substantial cost savings through reduction of emergency room use and preventable hospitalizations.Projections show that ongoing service costs will be covered by reducing such costs by only 25% in just three diagnosis categories: asthma, diabetes and complex labor/delivery.
Community support:
all significant local stakeholders in San Antonio have been involved in an Advisory Committee structure. Public support has been given at the State level from the Texas Medical Association, Children’s Hospital Association of Texas and Texas Organization of Rural and Community Hospitals. Similar coalitions can be created elsewhere.Background on the Family Health Foundation
FHF was created with the help of individuals from Santa Rosa Health Care (the largest Medicaid provider institution in Texas) and the University of Texas School of Public Health. For further background click here.
Contact:
Carl H. Rush, MRP, Chief Operating Officer, (210) 771-6539;P. O. Box 29777, San Antonio, TX 78229; fax (210) 270-9559; crush3@famhealth.org
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