April 12, 2013

April 12, 2013
Patient Navigators

Welcome to another day in my life. Today is Saturday and I hope you had a beary safe and great week. It is another busy weekend for Dab the AIDS Bear and me.

Because of changes in our country, caring for people living with HIV and AIDS is going to change a lot in the next couple of years. But what can help with this transition?

The Affordable Care Act (ACA) will transform healthcare in America. Is your mix of services aligned with what will be funded? As we get closer to the start of enrollment and implementation of the ACA, the federal government has started to examine how their programs will compliment and not duplicate ACA services.

The HIV/AIDS Bureau at the Heatlh Resources and Services Administration (HRSA) recently posted guidance on their website that highlights which Ryan White HIV/AIDS Program services can be used to pay for outreach, benefits counseling and enrollment services. Study this page carefully. Do your services align with what they will be funding?

State health exchanges and/or the federal government will be issuing requests for proposals to support Patient Navigators (PN). PNs will operate similarly to case managers in many AIDS service organizations, except they will be focsuing on ensuring eligible individuals gain access to the health insurance they need. The Ryan White Program aleady pays for many navigation services provided often times by people living with HIV. The federal RFP will be out shortly; however, it is only for those states that have opted out of the ACA. Maryland, New York and Nevada have already issued their RFPs. You may want to review them to get an idea of what to expect.

A good resource on PNs was developed by Families USA.

According to Families USA:

Whenever possible, navigators should be chosen from groups that have established relationships with the populations that will be eligible to apply for exchange coverage.
Navigators will have a broader reach if they are located in organizations that provide a range of services.
Navigator programs should provide assistance when and where it is convenient for consumers.
Navigator selection and outreach efforts should be informed by demographic data.

Skills of Navigators:

Navigators will require specialized training.
Training should include competency testing and require continuing education.
Navigators will need to assist consumers with all the coverage options that are offered through exchanges.
Navigators must provide assistance with enrollment from start to finish.
Some navigators will need training in assisting small employers.

Finally, Families USA makes recommendations for successful programs:

Secure adequate and sustainable funding for navigator programs.
Create a formal process for engaging stakeholders.
Establish a central entity to provide technical support for navigators.
Provide formal mechanisms for communication and data sharing among navigators, the exchange, and state agencies.
Create structured opportunities for navigator entities to provide feedback to the exchange and state agencies.
Create a seamless referral system among the entities that are providing consumer assistance.
Ensure that the outreach and public education strategies that are used by the exchange and navigator programs are consistent and coordinated.
Provide contact information for the navigator program in all outreach and public education materials, and through a searchable directory on the exchange website.
Provide oversight of navigator entities.
Work with navigator entities to develop data collection requirements that enable the exchange to evaluate navigator performance.

If you have an existing case management infrastructure, you may be able to modify your programs to fit the criteria for PNs. This will allow you to move beyond the RWCA for funding and help your constituents enroll in these new programs. The value of enrolling our constituents into the health marketplace is directly related to our work to end the epidemic. Before you begin treatment, you need to ensure PLWHA have access to healthcare. This must remain our primary mission.

Hope you have a beary safe and great Saturday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab