September 23, 2015

Presented by:

Pete Paniagua

LCHD WAIVER 1115 PROGRAM

INQUISITION OR INTERVIEW

brought to you by the Lynn County Hosp i ta l D is t r ic t o f Tahoka

Wait time

Expense

Lack of Insurance

Access to Care

Additional Resources

Lack of Mental Health

Services

Inability to get an

appointment

The need to use ER for initial

contact

High Incidence of Obesity

Diabetes Mellitus

Heart Disease

Need for Cancer Screening

with mammograms, pap

smears, colonoscopy,

sigmoidoscopy, rectal exam

COMMUNITY NEEDS ADDRESSED

Strictly private and confidential. For LCHD internal business use only.

PATIENT NAVIGATOR’S OFFICE

The Patient Navigator’s office is located at the Specialty Clinic,1705 Lockwood, Tahoka, TX. It is centrally located for easy access to all patients. The Specialty Clinic is within walking

distance to the Family Wellness Clinic and Rehab Center/Gym.

LCHD Waiver

1115

Program

Administrator

s

Donna RaindlComptrol ler

Pete PaniaguaPatient Navigator

Project Description

The Patient Navigator uses an ED (emergency department) report daily to fi nd the non-emergent users and to verify whether these patients have a PCP or any type of insurance. The Patient Navigator also works with referrals from the Family Wellness Clinic, Specialty Clinic, Rehab and Fitness Center, and O’Donnell Family Wellness Clinic .

Assist Clients with Additional Resources Cardon Outreach Jeanne Morales for Disability Determination for

assistance with Disability Medicaid Issues. South Plains Community Action for other needs.

PROJECT DETAILS

Strictly private and confidential. For LCHD internal business use only.

Wait timeExpenseLack of InsuranceAccess to CareAdditional ResourcesLack of Mental Health

Services Inability to get an

appointmentThe need to use ER for

initial contact

High Incidence of Obesity

Diabetes Mellitus

Heart Disease

Need for Cancer Screening with mammograms, pap smears, colonoscopy, sigmoidoscopy, rectal exam

COMMUNITY NEEDS ADDRESSED

Strictly private and confidential. For LCHD internal business use only.

PROJECT ACCOMPLISHMENTS

Strictly private and confidential. For LCHD internal business use only.

This translates Into A

333% Increase

Since Implementing Waiver 1115

Program!The majority of the clients we process are uninsured and low income. Many attempt to get Medicaid and are denied. Others with higher income still are unable to afford traditional insurance on a continual basis and their out of pocket expense is too high.

From an initial baseline enrollment of 69 individuals from when the waiver 1115 program began we have now as of August 30, 2015 serviced 230

patients through the program.

CHALLENGES & LESSONS LEARNED

Challenges Acquiring supporting

information in a timely manner

Obtaining proof of income and proof of non-income

Assistance from outside sources i.e., family members & friends

Providing long range solution to address needs

Strictly private and confidential. For LCHD internal business use only.

Lessons Learned Our Project is impacting

more people than anticipated

Increase the # of staff in the Waiver 1115 Program

Continue reaching out to patients immediately after their init ial ER visit .

Develop a rapport with the patients during the interview process exercising basic kindness and compassion vs. Inquisit ion & Interrogation tactics.

Problem: Many individuals are overlooked in the system. One such ind iv idual was a menta l ly chal lenged woman surv iv ing on a $250 per month widow’s pens ion. She lacked the sk i l ls and knowledge to seek ass is tance. Consequent ly she used the ER as her pr imary source of medica l care. The Pat ient Nav igator a f ter one such ER v is i t , contacted th is ind iv idual by phone, and scheduled a personal in terv iew her. I t was d iscovered that a fami ly member had t r ied to he lp her and had appl ied for Disabi l i t y and Medica id for the pat ient but was unsuccessfu l . The c la im was denied and the pat ient made no other e f for ts a t seek ing ass is tance.

Solut ion: The woman was placed on the Indigent Program for immediate medical care. By assigning the pat ient a PCP, she no longer used the ER as her primary provider. The woman was then referred to Jeanne Morales , At torney, who provided the ini t ial consul tat ion at the Special ty Cl inic . The case was appealed and the pat ient now receives SSI and Medicaid. She is no longer on the Waiver 1115 Program.

This ind iv idual would have cont inued to fa l l through the system and would have cont inued ut i l iz ing the emergency room for pr imary care. Ins tead the Pat ient Nav igator was ab le to immediate ly o f fer the proper ass is tance and long term so lut ions to the pat ients needs.

SUCCESS! PATIENT STORY

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