Patient Activation for Uninsured, Under-insured and Low Utilizers of Health Care

Project 2.d.i. Implementation of Patient Activation Activities to Engage, Educate and Integrate the Uninsured and Low/Non-Utilizing Medicaid Populations into Community-Based Care. 

Alliance staff contact: Linda Austin | 518.701.2286

Objective: Increase patient activation related to health care paired with increased resources that can help the uninsured (UI), non-utilizing (NU) and low utilizing (LU) populations gain access to and utilize the benefits associated with DSRIP PPS projects, particularly primary and preventative services.

Project Description:This project is focused on persons not utilizing the health care system and works to engage and activate those individuals to utilize primary and preventive care services. The PPS will be required to formally train on PAM® (Patient Activation Measure), along with base lining and regularly updating assessments of communities and individual patients. This project encapsulates three primary concepts, which drive the requirements for this project:

  • Patient activation
  • Financially accessible health care resources
  • Partnerships with primary and preventive care services

Definition of Engaged Patients: The number of individuals who completed PAM® or other patient engagement techniques.

Project Requirements:

  • Contract or partner with community-based organizations (CBOs) to engage target populations using PAM® and other patient activation techniques. The PPS must provide oversight and ensure that engagement is sufficient and appropriate.
  • Establish a PPS-wide training team, comprised of members with training in PAM® and expertise in patient activation and engagement.
  • Identify UI, NU, and LU “hot spot” areas (e.g., emergency rooms). Contract or partner with CBOs to perform outreach within the identified “hot spot” areas.
  • Survey the targeted population about healthcare needs in the PPS’ region.
  • Train providers located within “hot spots” on patient activation techniques, such as shared decision-making, measurements of health literacy, and cultural competency.
  • Obtain list of PCPs assigned to NU and LU enrollees from MCOs. Along with the member’s MCO and assigned PCP, reconnect beneficiaries to his/her designated PCP (see outcome measurements in #10).
    • This patient activation project should not be used as a mechanism to inappropriately move members to different health plans and PCPs, but rather, shall focus on establishing connectivity to resources already available to the member.
    • Work with respective MCOs and PCPs to ensure proactive outreach to beneficiaries. Sufficient information must be provided regarding insurance coverage, language resources, and availability of primary and preventive care services. The state must review and approve any educational materials, which must comply with state marketing guidelines and federal regulations as outlined in 42 CFR §438.104.”
  • Baseline each beneficiary cohort (per method developed by state) to appropriately identify cohorts using PAM® during the first year of the project and again, at set intervals.
  • Baselines, as well as intervals towards improvement, must be set for each cohort at the beginning of each performance period.
  • Include beneficiaries in development team to promote preventive care.
  • Measure PAM® components, including:
    • Screen patient status (UI, NU and LU) and collect contact information when he/she visits the PPS designated facility or “hot spot” area for health service.
    • If the beneficiary is UI, does not have a registered PCP, or is attributed to a PCP in the PPS’ network, assess patient using PAM® survey and designate a PAM® score.
    • Individual member’s score must be averaged to calculate a baseline measure for that year’s cohort.
    • The cohort must be followed for the entirety of the DSRIP program.
    • On an annual basis, assess individual members’ and each cohort’s level of engagement, with the goal of moving beneficiaries to a higher level of activation.
    • If the beneficiary is deemed to be LU & NU but has a designated PCP who is not part of the PPS’ network, counsel the beneficiary on better utilizing their existing healthcare benefits, while also encouraging the beneficiary to reconnect with their designated PCP.
  • The PPS will NOT be responsible for assessing the patient via PAM® survey.
  • PPS will be responsible for providing the most current contact information to the beneficiary’s MCO for outreach purposes.
  • Provide member engagement lists to relevant insurance companies (for NU & LU populations) on a monthly basis, as well as to DOH on a quarterly basis.”
  • If the beneficiary is deemed to be LU & NU but has a designated PCP who is not part of the PPS’ network, counsel the beneficiary on better utilizing their existing healthcare benefits, while also encouraging the beneficiary to reconnect with their designated PCP.
  • The PPS will NOT be responsible for assessing the patient via PAM® survey.
  • PPS will be responsible for providing the most current contact information to the beneficiary’s MCO for outreach purposes.
  • Provide member engagement lists to relevant insurance companies (for NU & LU populations) on a monthly basis, as well as to DOH on a quarterly basis.
  • Ensure direct hand-offs to navigators who are prominently placed at “hot spots,” partnered CBOs, emergency departments, or community events, so as to facilitate education regarding health insurance coverage, age-appropriate primary and preventive healthcare services and resources.
  • Inform and educate navigators about insurance options and healthcare resources available to UI, NU, and LU populations.
  • Ensure appropriate and timely access for navigators when attempting to establish primary and preventive services for a community member.
  • Perform population health management by actively using electronic health records (EHRs) and other information technology platforms, including use of targeted patient registries, to track all patients engaged in the project.
  • If the beneficiary is deemed to be LU & NU but has a designated primary care provider who is not part of the PPS’ network, counsel the beneficiary on better utilizing his/her existing healthcare benefits, while also encouraging the beneficiary to reconnect with his/her designated PCP.
    • The PPS will NOT be responsible for assessing the patient via PAM® survey.
    • PPS will be responsible for providing the most current contact information to the beneficiary’s MCO for outreach purposes.
    • Provide member engagement lists to relevant insurance companies (for NU & LU populations) on a monthly basis, as well as to the NYS Department of Health on a quarterly basis