Removing Barriers to Care | Medicaid and Affordable Care

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Removing Barriers to Care | Medicaid and Affordable Care

Providence has long been a champion of affordable health care, and our family of organizations remains deeply committed to providing quality, compassionate care to everyone, regardless of their ability to pay. It is clear that we must continue to invest in affordable health insurance, including Medicaid, the largest coverage program in the country.

In 2021, more people were covered by health insurance than ever before, across all available insurance coverage options, and the total number of unique patient visits covered by Medicaid reached record highs in the United States. In Providence, 2021 visits to our outpatient care centers by patients with Medicaid coverage increased by 16% over 2020 levels.

In 2021, Providence served 984,987 individual patients who rely on Medicaid coverage for access to care.

Providence continues to be a strong advocate at all levels of government to preserve access for the millions of individuals and families who depend on Medicaid for their care. This program and other important safety net programs need our continued support, and Providence is proud to have helped secure a 6.2% increase in federal funding for Medicaid in 2021.

Oregon: Being a voice for Medicaid during a public health emergency

Thanks to the federal government’s continued response to COVID-19, many states have seen an influx of improved Medicaid funding in 2021, but as COVID infection rates decline, these improved benefits will be reduced.

For example, in Oregon, Providence is a leading voice for preserving and expanding Medicaid in a post-pandemic fiscal environment. With the improvement Federal Medical Assistance Percentage, people who enrolled in Medicaid during a public health emergency can remain enrolled for the duration of the emergency. During COVID-19, Oregon saw record enrollment due to this expanded benefit.

When the additional funding expires, Providence predicts nearly 300,000 people in Oregon will lose their Medicaid coverage. To prepare for this change, the Providence team has systems in place throughout 2021 to help those affected bridge the gap by obtaining new insurance coverage, either through programs sponsored by the government or through the private insurance market. Providence is providing phone and clinic navigation assistance to Oregonians at risk of losing Medicaid coverage, while advocating for additional state and federal funding to maintain the enhanced program.

Puget Sound: Reduce ER visits for patients with complex needs

Swedish runs a program for people who regularly visit the emergency department, designed to help patients get the care and resources they need in the best possible setting. Many of these patients are dependent on Medicaid coverage and have chronic challenges in their lives that make managing their health more difficult. Swedish caregivers recognized that emergency visits would not help these patients stabilize and created the program to better meet their basic medical and social needs.

The Emergency Department Care Navigator helps connect patients to care and services in the best setting for their medical and social needs.

Social worker Lacey Haymon is the care coordinator for Sweden’s multiple patient visit program. It serves as a bridge between the hospital and community partners, connecting patients to available resources and helping them receive care and services in non-emergency settings. She coordinates stable housing, schedules appointments, arranges transportation to and from medical appointments, and procures equipment such as wheelchairs for patients with reduced mobility. In 2021, Haymon worked directly with 87 patients, 61 of whom were enrolled in Medicaid.

One patient in particular stands out in Haymon’s memory. “A patient on Medicaid needed hernia surgery at our Swedish First Hill site, but he consistently missed his preoperative appointments,” says Haymon. “I began attending his consultations with him, developed a recovery plan that included stable accommodation after surgery, and served as the main point of contact. After his successful operation, he is not returned to the emergency room,” says Haymon.

Northern California: Free enhanced care management for those who need it most

In Napa County, Providence’s CARE Network is a vital free resource for patients who need additional healthcare navigation and assistance to stabilize their healthcare needs. People served by the CARE network face complex health issues and socio-economic challenges, including unstable housing, inadequate insurance coverage and lack of transportation.

The goals of the community program are to empower the people it serves to become active partners in managing their own health. It helps reduce the number of avoidable emergency department visits by connecting people to care and services such as medication stabilization, behavioral health and addiction treatment, housing, primary care, and chronic disease management.

In 2021, CARE Network programs received community benefits that enabled caregivers to serve 3,416 unique individuals. The team knew the data would help them better understand the impact of the program and plan for future needs. So last year, she partnered with analysts from Providence’s population health team to develop a dashboard. Data showed that for the more than 200 people with the most complex needs, a significant reduction occurred in avoidable emergency department visits and hospitalizations after enrollment in the CARE Network program. The goal is to ensure that each patient receives care in the best setting for their individual needs.

Often people with complex illnesses who are under-resourced are overwhelmed and need someone they can trust to find the right resources and services in a complicated system.

Dana Codron – regional director of community health investment

When introducing the service to a new patient, a CARE Network nurse and social worker will often make an initial home visit to assess their needs. “You learn a lot when you visit someone in their own space or their home,” says Dana Codron, regional director of community health investments for Providence Northern California. “When I sat in their kitchen, I understood why they kept coming back to the emergency department or missing appointments. one they can trust to find the right resources and services within a complicated system.”

With this model of care, data also shows that clients are less likely to receive acute care and more frequently find care in other more appropriate settings. Plans are underway to expand the program to neighboring Humboldt and Sonoma counties and to form new partnerships, including with Medicaid in providing CalAIM programming.

Southern California: a new health center serving the community

Federally licensed health centers, known as FQHCs, are centers that provide medically necessary primary health services and qualified preventative services to low-income individuals and families. In December 2021, Providence St. Jude Medical Center, St. Jude Neighborhood Health Centers, and the City of Anaheim partnered to open a new FQHC site in Ponderosa Park, Anaheim. The health center is adjacent to a family resource center, school, and library, creating a full-service campus in a high-needs community.

The partnership has resulted in a new facility where individuals and families can go to receive medical, dental and mental health services at a sliding price scale. Providence St. Jude contributed $4 million to fund construction and equipment for the new health center and was instrumental in advocating with the city of Anaheim to provide the land for the health center.

Public funding for safety net programs, such as Medicaid, varies from state to state, but the need for these programs is constant. It is no longer a question of if these essential insurance programs need funding, but How? ‘Or’ What to finance them. Driven by our belief that health is a human right, Providence serves as both an advocate and caregiver for people who depend on affordable care options. Our government affairs team will continue to advocate for these essential services so that individuals and families can get the care they need to lead healthier lives.

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