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Tribal Readiness. Jennifer DuPuis, M.B.A. Associate Director of Human Services Fond du Lac Band of Lake Superior Chippewa Tribal Self-Governance Consultation Conference Arlington, VA May 7, 2014. Key Opportunities. Plan Approach to Target Activities Where are your biggest opportunities?.
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Tribal Readiness Jennifer DuPuis, M.B.A. Associate Director of Human Services Fond du Lac Band of Lake Superior Chippewa Tribal Self-Governance Consultation Conference Arlington, VA May 7, 2014
Key Opportunities Plan Approach to Target Activities Where are your biggest opportunities? Medicare Medicaid Basic Health Plan Qualified Health Plans
Tribal Sponsorship Tribes, tribal organizations, and urban Indian organizations are permitted to pay premiums on behalf of eligible individuals. Medicare Part B (Reimbursement) Medicare Part C Medicare Part D Qualified Health Plans Target your low hanging fruit. Where is the easiest place to start?
Tribal Sponsorship Medicare Part D Successful sponsorship program informed us how worth while sponsorship is. In 2013, every $1 Fond du Lac spent on Medicare Part D premiums, there was over a $6 return.
Implementation Policy & Procedures You must establish and operate under policies that have been approved by Tribal Council. Contract Health Policy & Procedures Registration Policy & Procedures Patient Advocate Policy & Procedures Tribal Sponsorship Policy & Procedures
Implementation Develop gates to access services that include enrollment activities. Educate staff and establish uniformity of application of the policy. Gather, assess, and troubleshoot specific real-life examples during team meetings.
Enrollment Process Patient Flow • Eligibility for Medicaid, MNCare (BHP), Medicare, and QHP’s is checked • Demographics are updated • Uninsured individuals referred to Patient Advocate All uninsured patients are referred to a Patient Advocate for insurance eligibility check.
Enrollment Process Contract Health Services Because CHS is a payer of last resort, clients must apply for other alternative resources available to them. Process to get through the “gate” for CHS coverage: All CHS eligible individuals who are uninsured must complete the MNsure application process to determine eligibility for Medicaid, MNCare, or Tribal Sponsorship. Eligible individuals must accept Tribal Sponsorship, which is of no cost to them or their family. Descendents must complete the MNsure application process during the open enrollment period.
Enrollment Process Contract Health Services Waiver “By declining premium sponsorship by FDLTC, which is of no cost to me or my family, I understand that I am denying an alternative resource and will be waiving my rights to CHS funds until I have secured another form of health care coverage.”
Evaluate & Redesign Monitor Progress Be prepared to adjust your focus. Target your enrollment processes and adjust rules for payer groups. Enforce flexibility with staff assignments.
Marketing Literature Make literature your own. Use your own photos and information.
Marketing Patient Advocates Educate clients and evaluate eligibility for Medicare, Medicaid, MinnesotaCare, MNsure and other employer/private insurance programs. • Staff Expertise: • Familiar with all rules. • Relationally Rich Environment: • One-on-one counseling. • Community member staff. • Plenty of time to talk. • Familiar with cultural sentiments • Explains community benefits.
Marketing Educating Clients Why should IHS eligible individuals have health insurance? Although IHS makes a substantial contribution to the overall health of American Indians and Alaska Natives, in most Indian communities, the level of funding does not meet the need. Tribes must generate other sources of income.
Marketing Patient Advocate Referrals
Building Business Office Capacity Third Party Billing • Experience • Competence • Measures of Competence Administration • Budgeting • Monitoring • Managing Contracts • Credentialing
Contract Health Savings Medicare Like Rates Third Party Administrator Comprehensive Care Services (CCStpa) Blue Cross Blue Shield Discounts of 20-40% CHS pays discounted amount plus 22% of savings. Example: $1,000 bill – 40% discount = $600 CHS pays CCStpa $600 + 22% of savings = $688
Contract Health Savings Medicare Like Rates Third Party Administrator Comprehensive Care Services (CCStpa) Medicare Like Rate Discounts of 30-40% CHS pays discounted amount plus per claim fee of $9.50. Example: $1,000 bill – 40% discount = $600 CHS pays CCStpa $600 + $9.50 fee = $609.50
Contract Health Savings Medicare Like Rates Savings 2012 BCBS Discounts $375,488 Billed to CHS $248,853 Paid by CHS Savings of $126,635 MLR Discounts $563,369 Billed to CHS $172,221 Paid by CHS Savings of $391,148 Total Savings of $517,783
