ASPIN Health Navigator Program

The ASPIN Network is a 20 year old, not for profit, behavioral health network, comprised of seven independently managed rural safety net mental health and addiction providers that provide clinical care through a matrix of 47 offices. ASPIN serves 62,000 consumers annually, 19,000 uninsured. All network members sign a memorandum of understanding and utilize a part time navigator for assistance with healthcare insurance enrollment at their facility.

Resources Used

ASPIN was successful in obtaining funding from CMS in both year one and two to establish the ASPIN Health Navigator Program which employs 20 navigators. Data is collected per the cooperative agreement guidelines which include: navigators completing Federal and State certification, consumer enrollments by Marketplace or Medicaid plans, consumer appointments (first time, follow-up and telephone), Small Business Health Option Program (SHOP) appointments, outreach and enrollment events, and marketing activities and consumers reached.

Implementation

An ASPIN Health Navigator Program is comprised of a project director, three regional supervisors, a human resource coordinator and 15 community based part-time navigators. All the positions maintain Federal and State navigator certifications. Navigators are equipped with Mobile units that include an encrypted laptop, scanner, mobile Mi-fi, marketing banner and office supplies which allow them to respond to locally and attend enrollment events. Policies were developed to address: confidentiality and data security, HIPAA compliance, safety, conflict of interest, education loans, administrative duties, outreach activities, group enrollment events, consent forms, certification and certification renewal. Navigators are required to submit weekly work plans, outreach logs, and consent forms. Each supervisor maintains an ongoing relationship with approximately five navigators in their geographic region to pool resources at large enrollment events. Navigators are required to attend biweekly information update conference calls and two in-house trainings annually.

Lessons Learned

Barriers:

• Lack of receptivity and understanding of the ACA
• Indiana Medicaid Expansion did not take place until the middle of 2nd year which left 350,000 consumers in the healthcare coverage gap the 1st year
• Complex enrollments and consumers unfamiliar with health insurance
• Indiana required additional navigation certification on top of the required Federal navigator certification

Lessons Learned:

• Power of Peers: Hire a diverse workforce to interface accordingly with consumers.
• Collaborations are Golden: Utilize organization’s existing events to market your services. 
• Identify Champions: Partner with key individuals in communities that can connect and support your program. 
• Easy Access: Go to your consumer in their community setting. 
• Share your Successes: Word of mouth referrals are the best form of marketing.

Results

ASPIN Health Navigator Program Results (9/13 through 3/15):

• Access to healthcare insurance was improved in 90 of the 92 Indiana counties
• 2,620 consumers enrolled in qualified health plans
• 4,375 appointments conducted to assist consumers in enrollment or to clarify insurance coverage
• 1,172 enrollment and outreach events conducted or attended
• 1,006 marketing or promotional events conducted
• 1,855,672 individuals received information about healthcare insurance enrollment

Contact

Kathy Cook
ASPIN
Ph: 317-471-1890
Email

This article was written by Brendan L. Ashby, MBA, MPH, MCHES, FACHE, Dean of Health Sciences and Service Programs, Saint Paul College, for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

            Having been involved in the development and leadership of rural based healthcare networks in Minnesota and health workforce training in post-secondary academic institutions has shown me the importance of strategic planning.  As network leaders, our charge is to assess the viability of the current or emerging network, gauge if the network is tactically positioned to meet its goals and objectives, and identify which strategic concerns and challenges warrant immediate leadership attention (Ashby, 2014). However, as important as strategic planning is, I have found it useful to adopt a mindset of strategic process that involves strategic thinking, acting, and learning that are just as important if not more important than any approach to strategic planning (Ashby, 2014).  To help foster that mindset of strategic process, I want to share two of the tools that have helped my stakeholders and me-the Business Model Canvas and Strategy Change Cycle.   

Business Model Canvas

When I was preparing for strategic planning sessions with my network, I wanted a novel approach and a colleague of mine suggested I try to develop business model canvases that she had effectively incorporated into her strategy sessions.  The Business Model Canvas is a strategic tool developed by Alexander Osterwalder and Yves Pigneur as a way to visually capture and describe a network’s business model.  I have had great success when using the business model canvas, especially when engaging reticent stakeholders that might have limited experience in any type of strategy planning or experts who appreciate the pragmatic framework.  This unpretentious but powerful tool can demonstrate what is happening within a network and its value proposition in nine key areas:

• Key activities: What are the most important activities that your network does or is planning to do?
• Key resources: What resources are necessary for the network and its stakeholders to experience success?
• Key partners: Identify all of your network’s critical partners such as hospitals, clinics, vendors, community-based organizations, academic partners, insurance companies, and other stakeholder groups.
• Value proposition:  What makes your network the best value for your stakeholders?  Why would a patient, customer, or partner organization participate in your network’s services?
• Costs: How many resources and types of resources does your network need to be sustainable and successful?
• Customer relationships:  How does your network establish and maintain relationships with your customer segments?  On a one-to-one relationship, mass market, or niche?  What are the costs of those relationships?
• Customers:  Who are your customers?  Think beyond the healthcare partners, funders, or health consumers. 
• Revenue:  How do you bring money into your network?  Through grants, training, services, shared savings?   What else?
• Channels:  How do you communicate with your stakeholders?  Face to face meetings? Social media?  Web conferencing? Printed materials?  Think about all of the channels that your network currently uses or could use. 

Using the business model canvas helps network participants to discover areas of strength, minimize network weaknesses, and potentially discover opportunities for additional funding and increasing services (businessmodelgeneration.com).  For example, the business model canvas was an instrumental tool used in my former palliative care network to develop new relationships with other likeminded rural based healthcare systems across nine counties in northern Minnesota that resulted in increasing interdisciplinary training for health providers involved in palliative care, growing patient participation, and improving patient education.  The business model canvas is an effective, interesting, and enjoyable method for network participants to begin to review their efforts from diverse perspectives.      

Strategy Change Cycle                     

            The Strategy Change Cycle developed by John M. Bryson can assist network leaders to figure out what the challenges are and provides ten steps to work through the strategic planning process. The strategy cycle will help network leaders think about your stakeholders and who needs to be part of the discussion; what details does the network leadership need and if you are missing any information; how you are going to implement this strategy process; if this is realistic; and lastly how can we create the highest enduring value for the people that your network serves (Ashby 2014). 

The ten steps are as follows:

• First your network leaders have to agree on the strategic planning process
• Identify the network’s mandates
• Review and gain understanding on the network’s mission and vision
• Conduct a SWOT analysis
• Discover the strategic issues facing the network
• Frame tactics to address the challenges
• Review and approve the strategic plan
• Reaffirm alignment with the network’s vision
• Foster a successful implementation process
• Revaluate strategies and the strategic planning process

(Ashby, 2014).

     The final steps of using both the Business Model Canvas and Strategy Change Cycle will occur when your network reassess your identified strategies and remember to be agile, change when necessary, and make corrections as needed.  You need to constantly be thinking strategically.  Remember, this is a process and not a one-time project.  If you keep that in mind then you will be successful.

 

References

Ashby, B.L. (2014).  Topic Based Essay.  Creighton University, Omaha, NE.
Bryson, J. M. (2011). Strategic planning for public and nonprofit organizations. San Francisco, CA, USA: Jossey-Bass.
Osterwalder, A., & Pigneur, Y. (2010). Business model generation. Hoboken, NJ, USA: John Wiley & Sons.
Thompson, A. A., Peteraf, M. A., Gamble, J. E., & Strickland III, A. J. (2014). Crafting and executing strategy: Concepts and readings (Vol. 19th ed.). New York, NY, USA: McGraw-Hill Irwin.

Formation of Indiana Veterans Behavioral Health Network 

Through grant funding from the Health Resources and Services Administration, the Indiana Veterans Behavioral Health Network (IVBHN) was formed in 2010. It established a partnership with Affiliated Service Providers of Indiana, Inc. (ASPIN) and the Roudebush VA Medical Center in Indianapolis which facilitated the establishment of five rural telehealth connections with Roudebush; thus enabling rural veterans to receive behavioral health counseling services from their VA clinicians at locations within rural community mental health centers. Additional partners included the Indiana National Guard, the Indiana Rural Health Association, the Purdue Military Family Research Institute, the Indiana Department of Veterans Affairs, the Indiana Division of Mental Health and Addiction, the Veterans Integrated Service Network 11 (VISN11), and the Indiana Department of Labor. In addition, six ASPIN members served as host sites.

Resources Used

Equipment was initially purchased and installed at five different rural Indiana communities: Bloomfield (Hamilton Center), Crawfordsville (Wabash Valley), Logansport (Four County Counseling Center), Rushville (Centerstone) and Warsaw (Bowen Center). New policies and procedures were developed to ensure streamlined and safe access for the veterans served. As a result of the success of the IVBHN tele-behavioral health network, Roudebush was awarded an additional $900,000 pilot project to install tele-health units in three new locations: Columbus (Centerstone), Bedford (Centerstone), and Kokomo (Community Howard), and to support more therapists for the program. This pilot project stemmed from an Executive Order issued August 31, 2012, in which President Barak Obama directed the VA, the Department of Health and Human Services, and the Department of Defense work together to find ways to collaborate with community-based providers to assist veterans with easier access to behavioral health services.

Implementation

Developing a shared understanding of and commitment to program goals between the two principal organizations, ASPIN and Roudebush VA Medical Center proceeded the actual grant funding. Having relationships with decision-makers was essential.

Lessons Learned

The cultures of the VA and civilian organizations differ; therefore, communication between trusted representatives is very important. Finding the right people to prod systems was very helpful. Turnover and retraining are expected issues.

Results

As of the end of the grant period (April 30, 2014), the IVBHN tele-behavioral health network had 328 completed visits. Veterans using the tele-behavioral health sites saved 35,218 driving miles by attending appointments in their home communities compared to traveling by car to the Roudebush VA in Indianapolis. This represents over 704 hours of drive time. At Indiana’s current median wage of $15.26, the savings in drive time accounts for $10,749. Additionally at the federal mileage reimbursement rate ($0.555 for 2012, $0.565 for 2013 and $0.56 for 2014), the cost savings for miles driven is $19,834. With 328 completed, visits the IVBHN network has realized a cost saving for veterans and their families in drive time and mileage of $30,583.

In addition to the cost savings to veterans for drive time and mileage, IVBHN partners have been able to bill facility fees to the VA for the use of the tele-behavioral health services. During the second grant year, the total facility fees were $13,618. For the third grant year, the facility fees billed were $21,651. The total facility fees billed for the grant were $35,271. The ability to bill facility fees helps to sustain the IVBHN. The network continues to serve veterans Monday through Friday at eight locations. More information is available at www.ivbhn.org.

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ASPIN is a 501 (c) 3 not for profit network that operates five major services lines: third party contract administration, professional training, grants management, consumer education and workforce development, and technical assistance. The mission of ASPIN is to provide innovative educational programs, resource management, program development and network management in collaboration with all healthcare entities to address health disparities and whole health management.

Contact

Kathy Cook
Ph: 317-471-1890
Email

We received the following email from Bill Finerfrock at the National Association of Rural Health Clinics

March 31, 2014

To:          RHC Community and Friends

From:    Bill Finerfrock and Matt Reiter

Re:         SGR Patch/ICD-10 Delay

The United States Senate has joined the House of Representatives and passed legislation to prevent a 24% cut in physician fee schedule payments from occurring tomorrow (4/1) as previously scheduled.  Instead, Medicare physician fee schedule payments will continue to be paid as they have been for the past 3 months.   Although the legislation must be signed by the President in order to become effective, the President has indicated that he will sign this legislation once it reaches his desk. 

In addition to preventing the SGR related reduction, Congress approved language extending various other Medicare provisions slated to expire at Midnight tonight.  These include: 

• Extends Medicare work Geographic Practice Cost Index (GPCI) floor for 1 year
• Extends Medicare therapy cap exception process for 1 year
• Extends Medicare ambulance add-on payments for 1 year
• Extends Medicare adjustment for Low-Volume hospitals for 1 year
• Extends Medicare-dependent Hospital (MDH) program for 1 year

In addition to these “extenders” Congress also approved a one-year delay in the effective date of the ICD-10 transition.  As you know, ICD-10 has been scheduled to take effect on October 1, 2014.  Due to Congressional intervention, the new effective date will be October 1, 2015. 

Bill Finerfrock
202-544-1880
bf@capitolassociates.com