Webinar 9: Outreach and Enrollment Strategies to Reach Rural Communities (7/31/18)

>>Jason Werden
Welcome to today’s webinar on behalf of the Centers for
Medicare and Medicaid Services and the Connecting Kids to
Coverage National Campaign. We invite you to join us today,
and we appreciate your time as we discuss Outreach and
Enrollment Strategies to Reach Rural Communities. Reaching children and families
who are eligible for Medicaid and for the Children’s Health
Insurance Program, better known as CHIP,
can be particularly challenging in rural areas
across the country. Americans living in rural
communities can face many obstacles, including living
in communities with disproportionately
higher poverty rates, more chronic conditions,
and being underinsured, as well as experiencing
a fragmented healthcare delivery system with an overworked
and shrinking health force and lacking access
to specialty services. What we’d like to do for you
today is provide an opportunity to hear from a panel of speakers
who are well versed in reaching rural communities. Now, we are happy to introduce
the following speakers who will be joining us today. We will first hear
from Dr. Cara James, Director of CMS’ Office of
Minority Health to give us a snapshot overview of what
healthcare access and healthcare coverage looks
like in rural America. We will then have
John Hammarlund, who is a Deputy Consortium
Administrator of the Consortium for Medicaid & Children’s Health
Operations and Regional Administrator,
Seattle office of CMS. He will provide an overview of
CMS’ recently announced in May of 2018 new rural
health strategy. We will then hear
from Renee Bouvion, who is the Acting Regional
Health Administrator with Region 10 for the Office of the
Assistant Secretary of Health. Then we will have the
opportunity to hear from Rachael Hamilton and Sonciray Bonnell,
both with the Native American Rehabilitation Association
of the Northwest (NARA). They will be able to give us
a snapshot or look into ensuring access to education,
physical and mental health services across
rural communities. Finally, we will hear
from Dr. Kay Miller Temple, who will be joining us
on behalf of RHIhub. She is a Web Writer for RHIhub
and is also with the University of North Dakota School of
Medicine and Health Sciences. We now would like to introduce
Dr. Cara James to join us today.>>Dr. Cara James
Thank you Jason, and welcome to all of you. I appreciate the opportunity
to talk to you today about some of the activities that we are
doing as we are working to achieve health equity and how,
in rural communities, and how our CMS strategy
helps to do that. Next slide please. We are one of a number of
Offices of Minority Health within HHS,
and I provide that information just because I wanted to let
you know that you have resources across the government
that can help with that. If you could back up
just one for a second please. So you can see that there
is an HHS office in each as well as one in HRSA. Each of these run a number of
programs that are working to address health disparities for
a variety of populations, including not just ethnic and
racial minorities but others as well as rural communities,
children, and other populations. In our office, we have our
framework and how we are approaching our work
towards health equity. As you can see on the next
slide, we are working to increase our understanding and
awareness of disparities. We also are working to develop
and disseminate solutions. And then through ourselves
and our partners, implementing sustainable actions
that will reduce disparities for racial and ethnic minorities,
sexual and gender minorities, people with disabilities,
as well as rural communities. I don’t have time
to go through all of the activities that we have,
but I wanted to highlight a couple that may be of interest
for those of you who are engaging with individuals,
to help them not only sign up for coverage but to be able
to understand that. On the next slide you’ll see
one of our initiatives called From Coverage to Care. We’ve actually had the pleasure
of presenting some of this work on previous Connecting Kids
to Coverage webinars, but these are a number of
resources that we’ve developed to help people not only
understand their coverage but to be able to use it to connect
particularly to primary care and preventive services. They are available in multiple
languages as well as available in hard copy for free. And if you visit our website
below, you can order those and we’ll send those to you. But as you can see,
we have a number of resources, some focused on preventive
services. There is a particular one
that focuses on child health preventive services. We have added our newest tool on
behavioral health as well as a resource to help individuals
manage their healthcare costs. On the next slide we have
another initiative that we have been doing with the Federal
Office of Rural Health Policy to help manage,
go back one please, chronic care conditions
among individuals who have multiple
chronic conditions. This has been focused
specifically in rural communities as well as focusing
on racial and ethnic minorities and the providers to help them
become aware of the resources that we have available for this
to manage those conditions. We also on the next slide do
a number of things to help individuals map data
and understand what is happening at a more local level. We have a tool that’s called
our Mapping Medicare Disparities Tool. As you can see,
it allows you to compare disparities across different
conditions and to look at healthcare outcomes, cost
utilization, and so forth. We continue to add data
to the tool. We also are working on adding
a hospital lens, and as our Medicaid data become
more available we hope to be able to add that
in the near future. On the next slide,
I wanted to take a minute and talk about rural. And one of the things that
I am going to cover today is some of the variation
in how we define rural. And on the next slide,
you’ll see there are a key couple of definitions of rural. There are three
main definitions, one developed by the Office
of Management and Budget, one developed by
the Census Bureau, and one developed by the
Department of Agriculture. And then I added
a fourth one here from the Department of Agriculture. They all have at their root our
census data, and then it just varies based on that level of data
that they are looking at. So as you can see,
the core base statistical areas. The first one developed by the
Office of Management and Budget uses county level data
and has three categories of metropolitan, micropolitan,
and what they call non-core-based
statistical areas. The definitions of what they
include in rural, basically is everything in
the two and three categories. So micropolitan and the
non-core-based statistical area. As you can see,
that yields about 46 million individuals,
or 15% of the US population based on the 2010 census data
that are considered rural. In the Census Bureau itself,
they have urban and rural areas. They drill down a little bit
lower from county to the census block group. They have categories
as kind of urbanized areas and urban clusters. So included in rural
are all populations, housing and territories
that are not included within those urban areas with the
exception of Puerto Rico. By their method,
we see about 19%, more than 59 million US residents
would be classified as living in a rural community. Then within the Department of
Agriculture, we have the rural urban commuting areas,
or RUCAs. And that gets down
to the census track level. So you can see that
there are ten categories, they do a primary
and secondary rating, I won’t necessarily
go into all the details. But the primary group between 4
and 10 are classified as rural. So that yields for them,
as you can see a number in between the core based
statistical areas and the urban rural areas at 51 million or 16.6%. And then the urban influence
code is another area that they have captured,
and that has a slightly smaller proportion. The Federal Office
of Rural Health Policy, which is housed within the
Health Resources and Services Administration,
uses a combination of the core based statistical areas and the
RUCAs that result in about 18% of the US population
being considered rural. So these are some of the main
ways in which rural is counted. There are also a number of
varieties within that, where some only use for example
the non-core based statistical areas,
that would leave a smaller percentage from these other. So how we define rural varies
quite significantly around the government as well as
in our country. But basically,
somewhere between 15% and 20% of the US population is considered
to live in a rural community. On the next slide,
one of the things that we note is that our rural communities
tend to be a little less diverse than our urban communities. So here, this is reflecting the
combination of the micropolitan and metropolitan and the
non-core based statistical areas in a report that the Census
Bureau did, looking at some of the change between
the 2000 and 2010 census data. As you can see,
for those in the non-core based statistical areas,
the racial and ethnic diversity is quite different
but is growing, particularly among the Hispanic
and Asian populations. So in the last couple
of minutes that I have, I just wanted to highlight some
of the health challenges that we’ve heard,
and Jason alluded to them at the beginning as we talked
about what we are seeing in rural communities. But on the next slide,
and probably the one after that, you can see that in our rural
communities we have across all of our communities we have excess
deaths that are happening. This is work that was done last
year at the CDC in their Morbidity and Mortality Weekly
Report that showed excess deaths are significantly higher for the
five leading causes of death in our rural communities. On the next slide,
as we think about what this means for our children,
we note that here you can see some of those support services
that rural children are more likely to have at least one
parent in fair or poor mental health, to have financial
difficulties, to live in neighborhoods with
limited amenities or poor conditions or little
social support. Rural children are also less
likely to receive preventive services as well as
oral health services. They are more likely to die
than their urban peers from unintentional injury. And interestingly
for today’s topic, they do have similar insurance
rates compared to their urban peers, but tend to have a
greater reliance on Medicaid for that coverage. So on the next slide,
you’ll see that within our rural communities we also see
differences and disparities across race and ethnicity. So here you can see fair or poor
health is one example where we have higher rates of fair or
poor health among Black, Hispanic, and American
Indians in rural areas. And on the next slide you’ll see
that we typically think of our rural communities
as older and sicker, but in our racial and ethnic
minorities within rural communities,
they tend to be younger, if you’ll look particularly at
that center bar of the Hispanic population and the Asian
Americans as well as Native Hawaiian and other
Pacific Islanders, where about two thirds
of the population are between 18 and 44. Very quickly, on the next slide
you’ll see income differences. As we talked about earlier,
for our rural children tend to have lower income and come from
lower income households, but again within those rural
communities you can see the disparities that we have where
even greater populations have less income. And finally,
where you live matters. And as you can see on
the next slide, our populations are
not evenly distributed across the United States. So as you’re thinking about
whether or not a state has maybe expanded Medicaid coverage or
access to other social services very much depends
where individuals are. So taking all of this
into account, CMS has worked very hard to
focus on what we can do to improve health outcomes
in our rural communities. That led to the establishment
of the CMS Rural Health Council on the next slide,
of which my colleague John Hammarlund is going talk
a bit more about the work we’ve been doing there. But as you can see,
it was set up to ensure access to high quality healthcare for
all Americans in rural settings to address the unique economics
of providing healthcare in rural America,
and finally to bring the rural healthcare focus to CMS’ healthcare
delivery and payment reform initiative. So I know I’ve gone very
quickly, but on the last slide you can learn more about some of
the work that we have underway as well as our efforts across
the agency on rural health. And with that I will turn it
over to John to talk a bit more about our rural health strategy. Thank you again for having me.>>John Hammarlund
Thanks very much Cara. I appreciate it. This is John Hammarlund. I’m delighted to be
part of this webinar today, and thanks very much
for having me. As Cara mentioned,
CMS has been working diligently, particularly over the past two
and a half years since the CMS Rural Health Council was formed,
to better address the needs of rural providers
and rural patients. We’ve held a Solutions Summit
with various rural stakeholders and several listening sessions
across the country to ensure that we understand the needs of
rural providers and patients and also to uncover what road blocks
hamper providers from their successful participation in CMS
Innovation Center projects and other transformative
efforts of our agency. Next slide please. Knowing what areas we need
to focus on, our rural health strategy includes
five specific objectives. First, we want to apply a rural
lens to the work of the agency. So we’re applying rural proofing
checklists to any relevant policies and procedures and
initiatives that have impacts on rural plans, providers,
or communities. And we’ll work to identify and
accelerate the diffusion of promising evidence-based
practices to improve access to services and providers
in rural communities. That includes new payment and
service delivery models, that the Innovation Center at
CMS might be contemplating. The Innovation Center has been
especially engaged in ensuring that there is a rural component
to the state innovation models to make sure that changes
in healthcare delivery or payment don’t adversely impact
rural providers, patients, or their families. Second, we want to attempt to
improve access to care through provider engagement and support. So we plan to work on our rules
regarding the scope of practice in an attempt to align with what
states allow in terms of having clinicians practicing at the
full scope of their license. And we want to better engage
rural providers by implementing meaningful quality measures,
which is a new approach to quality measurement that focuses
on value rather than volume, therefore reducing
the reporting burden. Something that is particularly
important to rural providers. Third, for the past several
years telehealth has been touted as a way
to improve access to care. And the rural health strategy
describes how we will explore options for modernizing and
expanding telehealth through programs such as the Frontier
Community Health Integration project demonstration and
the Bundled Payments for Care Initiative models. Now, with respect to
telemedicine, telehealth, we’re confined by the law in
several aspects of telehealth. But we are committed to being
as flexible as possible whenever possible within
the confines of the law. We’re also exploring the
expansion of virtual care, which is different from
telemedicine but allows for important advances in care and
in access to care such as remote patient monitoring. So an example of some of the
flexibility in virtual care can be found in our recently
released proposed rule called the Physician Fee Schedule,
that’s how CMS establishes the payments for rules for a lot of
the Medicare part B services, the services that patients often
receive in the doctor’s office. We’re planning to pay
for something called a virtual check-in. This might be a phone call from
a doctor to a patient recently discharged from the hospital to
make sure that they are taking their medications
and getting their rest. So finding a way to use
technology to improve access to care is an area that we’ve been
working on for some time, and it really has the potential
to truly transform care in several key areas such as
chronic care management, behavioral health,
and post-acute care. Next slide please. The last two objectives of the
rural health strategy, and the place where I hope that
you can see yourselves in the rural health strategy. The fourth strategy is
empowering patients in rural communities to make decisions
about their healthcare. It’s critical to empower
patients to make good decisions about their health
and their healthcare. And we want to collaborate with
rural communication networks to develop and disseminate easy to
understand materials to help rural consumers navigate
the healthcare system. As healthcare continues to
evolve and transform, it will be critical that we
foster the engagement of all consumers in their healthcare. Patients usually don’t know what
things like community health integration or chronic care
management services are, but we should all know how to
talk to consumers about the impacts of those kinds of
services in a way that’s meaningful and understandable
and digestible to them. So we need to address
questions like, how do services affect their
co-payments or deductibles? What is a patient’s
responsibility when agreeing to receive certain services
like integrated care services? And then finally,
our rural health strategy talks about partnerships. Next slide please. We’ve been and will continue to
work with partners to understand and evaluate the impacts of CMS
programs on rural communities and supporting states
in their work to transform care in rural areas. One way we do this is through our
Patients Over Paperwork initiative, where we hold
listening sessions with specific stakeholder groups like doctors,
nursing homes, hospitals, and patients to understand where
roadblocks exist to providing timely efficient care and to get
the ideas from the people we’re talking to about
what we could do better. Also, our CMS regional offices,
such as my Seattle office, go out on road trips through
rural areas of our state, meeting with healthcare
providers to hear about their challenges with Medicare,
Medicaid, and the health plans under our programs. Also, every six weeks or so,
CMS sponsors a rural health open door forum call where we talk
about particularly Medicare’s latest innovations and payment
rules and projects with partner organizations who sign up
for our listserv. I would encourage you
to sign up for the listserv, I’ll have a resource
for you shortly. We also share information with
our rural partners through publications like our MLM
Matters weekly electronic newsletters,
as well as webinars that we host on specific programs and
requests for information. Many of these engagements are
specific to healthcare providers, and those of you who
work for a healthcare provider may find some of them of value. Finally, we try to connect
stakeholders where appropriate to help them learn
from each other as well. So we’re actively encouraging
and facilitating the sharing of promising practices throughout
and across the healthcare spectrum. Final slide please. So we invite you to learn more
about the CMS Rural Health Strategy by going to our Rural
Health website, which you see on the slide. We also have a fact sheet about
the Rural Health Strategy so you can learn more. And you can learn more about
the open door forum calls I mentioned earlier and sign up
to be on our listserv to get the agenda and information
about those calls. I encourage you to do that. Well, thank you again
for having me on this webinar. I will now hand it back
to our facilitators. Thank you.>>Jason Werden
Thank you very much John, and thank you Dr. James as well. We very much appreciate
your collective input. We’d like to pause for
a brief moment and share two poll questions with you,
the audience. First, we’d like to share:
Is your organization currently engaged in rural health outreach
and enrollment activities? You are invited to select
a response and we will capture your responses here. If you are currently conducting
activities that’s great. We are certainly interested in
learning more from you, and we will share later in this
webinar exactly how you can do so. And if you’re not and you’re
here to learn a bit more about how you can get involved,
thank you for joining. This will be a great opportunity
for you to learn how you can take today’s learnings
and put them into practice at your local organization. Let’s show those results. Great. So a number of you are currently
conducting outreach and enrollment activities. That’s phenomenal. We appreciate the feedback. We now will share
a second poll question. That question is,
which group does your organization hope to partner
with for rural health outreach in the future? Whether it be schools,
health providers, faith organizations,
government agencies, or engaging with local media. If you’re working
with any of those, or if you are currently working
towards how you would like to do that with your organization,
please share your feedback today. Let’s see those results as well. Very much across the board,
a lot of individuals who are working with schools
and health providers. And a little bit even with local
media, government agencies, and faith organizations. That is great feedback to see. As mentioned,
we will share additional poll questions throughout
this webinar, and as both John and Dr. James
shared, if you are interested in learning more we invite you
to go to cms.gov/ruralhealth, cms.gov/omh,
and to visit the rural health open door forum as well,
they are a great resource for all here involved. Next we’d like to introduce
Renee Bouvion, the Acting Regional Health Administrator,
Region 10, in the Office of the Assistant Secretary for Health. Renee?>>Renee Bouvion
Thanks Jason. I’m happy to be here today to
share some information about our office’s experiences in working
with rural communities. I’m going to start by sharing
some information about our office and our regions,
and then I’ll talk about our efforts to work with partners
in rural areas. Next slide. The Office of the Assistant
Secretary for Health, for those of you who aren’t
familiar with it, works to optimize the nation’s
investment in health and science to advance health equity
and improve the health of all people. Our work is carried out by
twelve core public health offices,
ten regional offices, and a number of presidential and
secretarial advisory committees. The work of our office focuses
on public health issues that cut across the Department
of Health and Human Services. Currently, those include opioid
use disorder and health equity. Next slide. There are ten regional offices
around the country, and on this slide you can see
how those regions are divided up as well as the locations
of the regional offices. I do need to point out that the
Region 3 office is actually in Philadelphia and not D.C. Each office is led by a Regional
Health Administrator, and their photos
are included here. Regional teams use their
expertise and networks to catalyze public health action
and impact leading health indicators. We do this through coordination
and collaboration around HHS priorities and by establishing
partnerships to leverage assets and advance public health. Next slide. Our regional offices work
as conveners, connectors, and communicators. We are actively involved in
convening meetings with state and local public health
officials and other stakeholders to better understand their
priorities and challenges and find ways to support their work. We’re also connectors,
we have strong networks and we’re able to connect people
or organizations with similar interests or goals to work
together, share resources and lessons learned. As communicators,
we disseminate information about HHS and other initiatives
severally to our key partners and regional distribution lists. We want to ensure that
organizations in our region are able to take advantage of the
tools and resources that are available to address important
public health issues, including campaigns such as
Connecting Kids to Coverage. Next slide. Given the way that HHS divides
the country into regions, every region has rural areas. So what I’m going to be talking
about isn’t specific or unique to region 10, and any one of my
regional colleagues could be giving this presentation. I do want to just provide
a quick snapshot of what rural looks like in Region 10. The Region 10 states of Alaska,
Oregon, Idaho, and Washington make up almost one quarter
of the land area of the United States, but only has
4% of the population. Next slide. And here you can see how
the individual states of the region compare
to the U.S. as a whole, with Alaska and Idaho having
the highest percentages of rural populations in our region. Next slide. When we look at percentages of
uninsured children under the age of 18,
we can clearly understand why working in rural areas is
important for a campaign such as Connecting Kids to Coverage. Nationally and in every state of
Region 10, more children in non-metro counties lack health
insurance compared to those in metro counties. So now that I’ve given you a
little bit of background about our office and our region,
I’m going to talk about how we approach working
with rural communities. Next slide. And this is our challenge. Working to foster coordination
and collaboration on public health issues in the vast states
of Region 10 with a team based in our regional office
here in Seattle. Our solution? Partnerships. We have a small staff and an
equally small travel budget, so we can really only accomplish
what we do through partnerships and collaborations with
local organizations. Our partners include state and
local health departments, health systems, community based
organizations, and many others. Next slide. Partnerships take time
and effort to develop. It’s often tempting to think
that it’s easier to go alone, that you’ll be able to
accomplish things more quickly and with fewer potential
complications. But when you’re working alone,
you’re more likely to make missteps or not understand the
community, especially if it’s a new area or you are doing it,
like we are, from a geographical distance. So here is why it has benefited
us to take the time and effort to develop relationships and
partnerships with local organizations in rural areas. Partnerships act
as a force multiplier. Working with partners
dramatically increases the effectiveness of our office
and extends our reach. The organizations we work with
are the experts on their communities. Working with them allows us
to better understand the context in which we’re operating. Partners from the community
know what the issues are, how to best reach and engage
key stakeholders, and all of this helps tailor our
approach so the work is useful and meaningful. Finally, we see partnerships
as a two way street and want our partners to benefit from a
relationship as much as we do. In rural areas, it’s not unusual
for us to work with small grassroots community based
organizations, and this gives us opportunities to provide
technical assistance and build capacity where needed to benefit
the organization and the community after
the project is complete. Next slide. Here are some of the lessons that
we’ve learned in cultivating and establishing partnerships,
especially in rural communities. Cultivating partnerships
can be a lot of work, especially when you
are doing it from a distance. We’ve found that having
partnership development as a priority for our office
has been helpful. We identify areas where we need
new or additional partners and track our progress regularly. Your current partners
or existing networks are a great place to start. Once we’ve identified
areas where we need new or additional partners,
we ask around in our current networks who we should
consider approaching. It’s also helpful when a current
partner can make an introduction to other organizations. Those introductions really help
pave the way for initial conversations. Successful partnerships
are a benefit to all the organizations at the table. One of the first things we do in
talking with potential partners is learn about their
organization’s priorities and focus areas to identify places
where our work would be stronger together and everyone would be
fulfilling some part of their mission. Communication is another key
element to cultivating successful partnerships. We take the time to listen to
what our partners are saying in terms of what their interests
are as well as how we can work best together. It’s important that we clearly
communicate any possible limitations of the partnership
and be realistic about what we want to accomplish. Next slide. Now I’m going to share a real
life example of how partnerships have allowed our office to reach
rural communities. In 2011, we became interested
in doing some work to address health disparities among the
largest racial and ethnic minority group in our region, Latinos. We knew that some of our
existing partners would also be interested and brought them
together to discuss the right approach. In talking with our partners,
we decided to focus on women as they play such a critical
role in the health of their families and community. We wanted to provide information
and resources to public health and social service providers
who work with Latinas and their families. These providers,
including community health workers and case managers,
are important sources of health information in
the communities where they work. The first event was held
in Seattle, and about forty people participated. That’s not a huge event,
but it was quite successful, and it created a lot of interest
from some additional partners. The following year in 2012,
with several new partners on board, we were able to replicate
the event in Granger, which is in rural eastern
Washington and has a large Latino population. Expanding our event wouldn’t
have been possible without the partners that we had here in
Seattle who also have staff in eastern Washington and were able
to help by providing input on the agenda and helping us to
organize something that would meet the needs of that
specific community. Next slide. After five years of practice
with this model and working with partners to reach rural
communities in Washington state, we wondered if it would be
possible to expand to another state in our region. We had some key contacts in
Idaho and worked with them to identify some
potential partners. In 2015, we brought them
together by phone to discuss our Latina Health Symposium
model and gauge their interest in working with us. Luckily for us,
they were enthusiastic and planning began for an event
that was held in 2016. A second event was held in 2017,
and we’re now working with them to plan another event
that will take place in 2019. A similar thing happened in
Oregon, and our staff has been able to bring together
a planning group. They are planning an event that
will take place this coming September. They are already talking about
the possibility of holding events on the eastern side
of Oregon state in 2019. After the events are
held in September 2018, more than a thousand providers
who work with Latinas will have been reached since 2011. Next slide. So why has all this worked? Without our partners,
our office would not have had the success that we’ve had
in expanding our efforts to address health issues
within rural communities. Over years of holding the Latina
Health Symposium Event, we’ve worked with amazing
partners, both here in Seattle and in the rural communities
where the events were held. Our partners have provided
crucial input on the health issues in their communities that
allowed us to tailor each event to address the specific needs
of each location as well as highlight local
organizations and resources. They also help us promote the
event, and that has led to an increasing number of
participants each year. Their feedback has really helped
us to improve the events along the way so that more
providers can participate. In Granger in eastern
Washington, we got the message loud and
clear that we needed to have some interpreters so that
non-English speaking providers, especially community health
workers in the area, could attend the event. Leveraging an internal
partnership here with CMS and Seattle Regional Office,
we were able to provide interpreters for
the last two years. It’s really our partners
who have allowed these events to continue over
the course of seven years. And a part of this process
has been building the capacity of some of the smaller
organizations that we’ve been working with. They’ve been able to take on
increasingly larger roles in leading the planning process and
developing the agendas to the extent that we really act more
as advisors now. So I hope this example of our
Latina Health Symposium events has demonstrated how working
with partners can be a key component in any strategy to
reach rural communities. Next slide. I just highlighted here some
tools that might support you engaging with rural communities,
and my contact information is there as well. And I’ll turn it back to Jason.>>Jason Werden
Thank you so much Renee, that was great. We very much appreciate
your time today. We would like to share our
third poll question if we may. That question is,
what types of outreach has your organization found successful
when conducting rural health outreach? We have a few options here
for you to look into, whether it be school information
nights, mobile health clinics, sharing information with state
organizations, or adding information to school
registration forms, taking the opportunity to reach similar
audiences, as we mentioned, through these additional
avenues. If you have not conducted rural
health outreach to this point, again, we invite you to continue
to learn more while you’re here and to take this opportunity to
hear from these speakers today. Let’s take a look at those
results that are coming in. We see that a number of you are
using school information nights on campuses and in classrooms
to share information. We’ll remind you that the
Connecting Kids to Coverage Campaign does offer tailored
school based outreach tools, and a number of customizable
materials on the school outreach library at insurekidsnow.gov,
resources that we will share and discuss further
in today’s webinar. Next we’d like to introduce our
friends from the Native American Rehabilitation Association
of the Northwest, otherwise known as NARA,
Sonciray Bonnell and Rachael Hamilton. Sonciray is the Oregon
Health Plan Manger. Rachael is the lead of
the Connecting Kids Outreach Program. Sonciray and Rachael,
welcome.>>Sonciray Bonnell
Thank you so much. Next slide. So we have a few slides that,
we’re really not going to talk a lot about NARA,
but I wanted to have that in front of you so that at a future
date you can go back and look. NARA has been around since 1970. We have ten different sites
around the Portland metro area, and I’ve listed them here. Next slide. We did want to put a little
about who we are as a culture. We do focus on the American
Indian/Alaska Native population in the Portland metro area,
but we help everyone that comes to our clinic. Next slide. I’ve listed nine federally
recognized tribes in our state, and I want to talk a little bit
about how and why we were asked to present. NARA received a CMS grant,
Connecting Kids, which focuses on enrolling
American Indian and Alaska Native kids and their parents
into health coverage, specifically Medicaid. And that’s why we were asked
to do this, because the grant was written statewide. So the three person team
travels across the state. We’ve met with all of the nine
tribes, that was our initial introduction, to see if we could
help them with getting their community members
signed up for health coverage. Next slide. I’ve provided a map. I wanted to give folks
an idea of how far away some of these places are. Our closest reservation,
tribe, to Portland is Grande Ronde, and you’ll see it to the
left there towards the coast. The farthest away is Burns
Paiute, and we have Flo and Liz heading out there on Thursday
night, it’s a 5.5 hour drive. I’m convinced
that Burns is actually frontier rather than just rural. It’s way out there. Next slide. I’ve provided a glossary,
so you see what NARA stands for. Oregon’s Medicaid program is
called the Oregon Health Plan, we often just call it OHP. So we’ll be using that
throughout the webinar. And then Oregon Health Authority
is where OHP lives within that department. Our community partners,
I know across the United States they are called different
things, but these are certified application assisters. So folks who are trained and are
able to help consumers sign up for not only health coverage on
the federal marketplace but in the Medicaid program. So in Oregon, we use both
community partners and certified
application assisters. Next slide. So I’m going to hand
this over to Rachael, and she’s going to talk a little
bit about the rural sketch. And I did want to say that we
are going to go into details on some of these bullets
on the next few slides.>>Rachael Hamilton
Thank you so much for having me. So these are just a few
challenges that we have encountered when working
with rural communities. Like Sonciray said,
we actually go into more detail with a few of them. With these, when we work
with rural communities, we run into
geographic isolation. They’re way off the grid. And that can create problems
for us to be able to get to them with the long distance,
they’re far from resources, we encounter weather problems
here in Oregon. A lot of the passes when it’s
snowy get very dangerous, so it’s harder to get out to
those communities when we need to meet with them. This also brings fewer
application assisters, fewer resources to work with
clients that are in need of gaining access
to health coverage. There’s also a lack of cultural
compatibility along the way, and this can create a problem
with communication and understanding exactly
what OHP can offer. So when we speak with folks,
we just try to give as much information as we can. There is also a problem with the
facilities being neglected for lack of funding and not being
able to provide such resources. >>Sonciray Bonnell
I know, this is Sonciray again. I want to just be very clear. We are talking about rural
communities and we are talking about American Indian/Alaska
Native communities. Very similar issues,
but as you’ll see in future slides we kind of divvy them out
and say in general rural here are the challenges,
and then when we get specific to tribal communities
it is even more detailed.>>Rachael Hamilton
Yeah, definitely. And also, as we all know,
there is a higher rate of uninsured, and this creates problems
along the way for folks that are needing access
to health coverage. We’ll go to the next slide. So these are a few challenges
that we have come across when we work with our communities
and like Sonciray said, a lot of our focus is with
American Indian and Alaska Native families and communities. So they are very close
knit communities. They don’t like to talk
to outside members, they don’t like to talk
to strangers, just in general
across the board. And when we’re trying to talk
to them about health insurance, it can be scary for them. So some of the solutions that
we’ve come up with is just making sure that we are very
clear in what we are trying to talk to them about,
what we’re trying to offer them. We continue to use
established relationships with then that NARA already has. We’ve been working with tribal
communities for an incredibly long time,
and so we use this as an advantage to continue to make
sure that we can provide them the best service that we can.>>Sonciray Bonnell
And I would add to that. NARA does have a
really great reputation. We have our inpatient
residential treatment program has helped so many people from
across the United States. So when we show up they are
like, Oh NARA, and they want to come and tell about their
father or daughter who went through our treatment center and
is alive and well and healthy. So we do have that to rely on. And I want to point out that,
you know, we’re in Oregon, the Portland metro area,
and so why are we rural? Well, because we wrote the grant
that way, but also we want to work with our nine federally
recognized tribes. And we do have experience. I have probably 25-30 years
working with tribal organizations in Oregon,
and that includes working directly with the nine tribes. I’m an enrolled tribal
member at Pueblo Sandia. And Flo Bergland is Navajo. She lived and worked on
the Navajo reservation. So between us,
we do have not only work but living experience
with rural communities.>>Rachael Hamilton
Absolutely. Another thing that we do as well
is we make sure that we do research before we
go out to these events. We find out who we’re working
with, and just working with the tribes we become aware of how
things work there before we go. A lot of the tribes do have
application assisters. They might have
one or two or a handful. So we always make sure that
we engage with them as well, because we’re not, we don’t just
show up to take over. We want to offer our services to
help and make sure that we can connect these members with an
application assister that is going to be close to them. We also just listen,
and we ask how we can help. We offer our services
in any way that we can, and we make sure that
we are available always. Next slide. Another challenge that
we do have is distance. A lot of the tribes,
as you could see in the previous map,
it does show that they are far away from the
Portland metro area. So it can be quite a drive
to make sure that we get to those locations. Weather of course
plays a factor. And we are statewide for
the services that we provide. We try, some of the solutions. We make sure that we have
multiple things lined up when we go meet with these tribes. We try to set up,
if we’re going to an event and we’ll meet with an
education department, and just use our time,
make sure we can get to all the places we can get on time. We are grant funded,
so we are specifically to do outreach with just health,
so we definitely can make sure that we get across the state. Then I’m going to jump down
to remote help. This is one of the biggest
things we can do across the state. We can help remotely. We can have folks sign
the consent form, and we can help them actually
over the phone as long as we get it signed. I’m actually going to introduce
Florinda Bergland, and she’s going to share a story about how
we were able to help remotely. And here she is.>>Flo Bergland
Hello everyone. So I’d like to tell a story,
and this story happened a few months ago, in June. Liz and I, our colleague,
she was with me when we went on our travel trip
to Klamath Falls. We stopped at Head Start
in Roseburg, Oregon, and we introduced ourselves and
told them that we are Oregon Health Plan assisters reaching
out to see if there are any family members
that need any assistance. They were pretty surprised and
shocked and overwhelmed and pretty happy that
we were there in person. On our way to Klamath Falls,
they gave us a call and said hey, we would like for
your team to come back, we would love your assistance,
we have a health fair coming up. So after our meeting with
Klamath Falls, we drove back down
to Roseburg, Oregon. We set up our table. We had our contact forms. We communicated with the
community population. And we actually were
very resourceful. We did the consent forms,
the parents came in. We had one family enrolled
in Oregon Health Plan. We renewed three families. And it is really good knowing
the fact that when we come together,
we are strategizing and conquering a few of
our challenges as a team.>>Sonciray Bonnell
I wanted to add too, it is so essential to have
somebody that you know at the tribe to introduce you to the
rest of the department. That is essential,
and so far at all of the nine tribes we have managed
to find somebody, usually in the
health department. But that is key,
because if we were to go there on our own not knowing anybody,
for those of you who work in rural communities you know that
that’s a difficult egg to crack. Next slide. And so this one
is more specific. Remember I talked about rural
versus rural native populations. That’s what this challenge is. The general distrust that
we already talked about with outsiders, but the U.S.
government, we’re talking broken treaties or treaties where
healthcare was promised. U.S. history. So that’s a real issue,
not only out at the tribes but within the four walls
of NARA sites. And so our solution is then
to meet where they are most comfortable. So go out to the tribes,
or get local buy in from somebody that you might know
that lives and works out there. And we do have a lot of
experience working with tribes, so we do have that on our side. We also want to make sure that
when we are out at the tribes, or even for our NARA clients,
if this is outside of our OHP/Medicaid scope,
we are still going to help them. If they need some,
if elders need some help or somebody needs food stamps,
our team will just step in there and assist. Also, just understanding
generational trauma. What American Indians and Alaska
Natives have experienced. And I don’t have experience,
but my mom or grandparents or my great grandparents
experienced it, and it affects me today. So that goes a long way
when working with tribes. Next slide please. Also, so the Indian
Health Service, it’s not true insurance. So we get a lot of native folks
who do not want to sign up for the Oregon Health Plan or
purchase health insurance because they feel like they have
kind of prepaid that with the land that was ceded. So that is always
a conversation, both within NARA and definitely
out at the tribes, definitely out at the tribes
we get a lot more pushback of, why should we buy insurance
or sign up for OHP when we’re native and have IHS. We are constantly having
those conversations. We do try to explain the
difference between private health insurance and clinics,
IHS clinics. One of the ways we do that is
to say, if you were to get cancer or in a major car
accident, we can’t help you within
the four walls of a clinic. And neither can
any of the tribes, because they are not hospitals. So we tell the folks that in
that case you would need to go to the hospital,
and you would be billed directly for all those services provided. And sometimes that works
and sometimes it doesn’t. So we just keep having that
conversation with them. And the other solution is just
explaining what the Oregon Health Plan is and how many benefits
they get and how to use it. Next slide. So I think that is everything.>>Flo Bergland
I have one thing. This is Flo again. And I just wanted to stress
that when we communicate with the nine tribes,
we like to communicate with the health directors,
we like to communicate with all the assisters on the tribal
reservations and say, we are working with you and we
want to ensure and focus on our clients’ enrollment
in Oregon Health Plan.>>Sonciray Bonnell
Good. We want to thank the rest
of the panelists, that was very interesting,
and I want to thank NARA staff that is on the webinar,
we had a few of them that were pretty excited that
we were doing this. So thank you all, I hope you
have a great rest of the day.>>Jason Werden
Thank you all very much. That was a very detailed
overview from our friends at NARA and the NARA
northwest team. Thank you for your time today. Again, if you are interested
in learning more about NARA northwest, visit
www.naranorthwest.org. We will now share our
fourth poll question of today’s webinar. What kind of health provider
partnership has been most successful in your rural health
outreach? Are you coordinating with doctors and nurses on the
local health level? Are you working with dentists,
pharmacists, or with local community health centers? Or it may be an instance where
you have not yet partnered with any health providers but are
looking to learn about those opportunities by joining
today’s webinar. We’ll take a minute and allow
you to supply your feedback. Let’s take a look
at those results. Trying to look back across the
board mostly here are allying with local community
health centers, about 52% of the responses. Thank you for your feedback. As we usually do in
these instances, we will share feedback on all of
these poll questions and on the results following
today’s webinar, and all of this will be
accessible in the coming weeks. We’d like now to move on
to our last panelist of the day. Dr. Kay Miller Temple is a web
writer with the Rural Health Information Hub, RHIhub,
and is based in North Dakota at the University of North
Dakota’s Health and Sciences. She will be sharing today
information on increasing rural health and well being through
community engagement and targeted and timely resources. She has a number of real life
experiences and examples to share with us today as well. Dr. Miller Temple, hello.>>Dr. Kay Miller Temple
Hi, good afternoon. Again, my name is
Kay Miller Temple, and I’m a content writer at the
Rural Health Information Hub. Thanks for inviting
Rural Health Information Hub to participate today. Next slide. The Rural Health Information Hub
is a national clearinghouse for rural health information. We are funded by the Federal
Office of Rural Health Policy and located at the North Dakota
Center for Rural Health. We partner with the Walsh Center
for Rural Health Analysis and the Rural Policy Research
Institute. As a federally funded
organization, all our resources are free. Next slide. RHIhub’s annual site visits
have grown to one million, and we aim to be your first stop
for rural health information. Next slide. I’d like to mention some
of our many resources. Our online library contains
thousands of publications, maps, news articles,
and funding opportunities. But in our data visualization
section, you’ll find even more topic focused maps and charts
with national, state, and county level data. Along with in depth information
in our topic guides and our state guides,
we have an online magazine, the Rural Monitor,
that features in depth stories examining key rural
health issues. Another resource,
the MI Rural tool, is found in our Tools
for Success section. This tool will provide answers
for those exploring whether a location meets a given
definition of rural, those definitions that were
mentioned by Dr. James. Next slide. In a 2006 U.S. Census blog post,
Life Off of the Highway: Snapshot of Rural America,
the author is reminded that the rural population is not the same
everywhere except in its distinction of not being urban. Frequently categorized as older,
sicker, poorer, less likely, less able to have engaged in
higher education opportunities, rural America can also be
described by one word: diverse. Because rural health education
and rural healthcare delivery efforts must accommodate
that diversity, state efforts might look
different from one another. Even within the same state,
the health landscape may look different from region to region. At RHIhub, we have a bird’s eye
view of the diversity of our rural communities’ health care
activities and feature them in another important
free resource, the Models and
Innovation section. Here, successful programs and
innovations for rural health issues are searchable by
evidence level, state, topic, and funding source. Many of these models are backed
by rural research studies. Others are stand alone,
anecdotal accounts. Overall, model strategy is a
unique way to translate rural success among geography and
democracy, with one model strategy possibly being adapted
by a rural community thousands of miles away. These models have elements of
flexibility, innovation, creativity, the ingredients for
meeting rural health needs. And a number of these models are
especially helpful for efforts focused on insurance education
eligibility and enrollment. We would like to share some of
those programs and their specific strategies today. Next slide. First, let’s talk about programs
and strategies that depend on key individuals,
for example, community healthcare workers,
or CHWs. The American Public Health
Association defines a community health worker as a frontline
public health worker who is a trusted member of or has an
unusually close understanding of the community served. Many rural communities depend on
these respected professionals to answer multiple types of
outreach needs, including health care
coverage and enrollment. I share an Indiana model
in innovation here, the ASPIN network. It currently offers robust CHW
training for several needs, including enrollment navigators. Like many CHWs,
those in this program are dually culturally competent,
a phrase that describes the many CHWs who not only understand
their local rural culture, but often have membership in or
unique insight into health attitudes and practices of
specific groups such as Latinos, American Indians,
or Asian Americans. Another Indiana model is the
Noble County Outreach Project, which uses another specially
trained individual, the outreach enrollment
specialist. The OES works in community
location such as the WIC clinic, the schools, the local hospitals
to offer enrollment services for Indiana Medicaid Health Indiana
plan and the private health insurance marketplace. Wisconsin is the location of a
unique program that uses CACs, or certified application
counselors, to provide outreach to isolated
seniors, old order Amish, Medicaid dental patients,
and Latino groups. A notable accomplishment of this
program is that from April 2016 to April 2017 outreach and
enrollment services reached nearly 2,500 people,
and the program’s single CAC directly helped nearly 650
individuals complete enrollment. The next model, the Santa Cruz
County Adolescent Wellness Network, is unique in that
it engages rural youth, a group often overlooked
and underestimated. With proper training, they are
a proven, valuable resource for themselves, their peers,
their families, helping the senior members of not only
their own families but often for those of their friends. Due to their age,
they may not be able to perform actual enrollment activities,
but they can prove a valuable member of any outreach team. We encourage you
to review this model’s Youth Involvement Toolkit. Next slide. A number of organizations assist
with rural outreach education and enrollment efforts. We’ll start with perhaps
the most obvious, rural hospitals and clinics. It can be difficult for some
rural hospitals and clinics to invest resources
in these activities, and organizations in Louisiana
have success using certified application counselors. This program has roots in the
Affordable Care Act outreach efforts and is still
able to use that enrollment infrastructure for their state’s
Medicaid expansion. Rural community schools can
help with outreach, and once again diversity applies. Specifically, in frontier and
remote communities, school nurses are
often the go-to medical professionals
for disseminating health information, especially when
the nearest healthcare facility might be over one hundred
miles away. So their main focus is routine
nursing interventions. In Virginia, the Nelson County
School Nurse Program, school nurses also take time to
educate parents about the state’s health insurance program
available for their children. In many rural areas, schools are
functioning as a strategic healthcare delivery site,
especially for preventive care. Taking rural healthcare access
to another level for children and youth is the school based
health centers. According to the Health
Resources and Services Administration,
school based health centers are often operated as a partnership
between the school and a community health organization. Louisiana has a school based
health center staffed mainly by specially trained nurse
practitioners providing oral health prevention. These providers must also engage
in outreach when they identify oral health treatment needs. Building on the program’s
success and dissatisfied by no show rates for these treatment
appointments they worked hard to get, they have current grant
funding for dental case management, another opportunity
for healthcare coverage enrollment activities. You will often hear talk of
rural communities depending on their healthcare organizations,
their schools, and their faith based organizations, or FBOs. FBOs are often specifically
vested in the health profiles of their congregants. In North Carolina,
the Partners in Health and Wholeness is a network of 475
congregations with a mission of building partnerships between
congregations and existing state health programs, even serving
as health promotion centers. Obvious then is the possibility
for reaching women and children through a network like this. Next slide. Though not specifically tied
to enrollment efforts, the models I review next are
certain to provide seeds for innovation,
proving that often the greatest value of our models and
innovations lies in their potential for sparking
creativity to meet other needs. For example, connecting with
trusted community members may offer valuable insight for efforts
to meet a rural population where they are. A food bank’s summer meal
program in eastern Tennessee was grateful to school bus drivers
who not only knew where and when children in rural areas would
likely be gathered, but understood the challenging
road conditions that would be encountered to get food there
in the first place. Alabama’s Kid One Transport. Exploding from one individual’s
idea, this organization now has twenty-one vehicles parked in
driveways across the state in order for their local drivers to
take rural expectant mothers and children to medical appointments
in urban locations. They work with 700 healthcare
organizations, county health departments,
community service agencies, physicians, government
agencies, and nonprofits
throughout Alabama. Perhaps not uniquely rural,
but still valuable, is the Guest Speaker Appearance
at special rural events such as health fairs, county fairs,
and local service organization meetings. The Texas C-STEP Program’s
community health workers are speakers at community events
or senior centers, providing outreach and education
on the importance of cancer screening. Those workers even help the
audience make mammogram, pap smear, or colon cancer
screening appointments. Next slide. When it comes to health
education outreach and enrollment efforts,
local rural media and social media can’t be overlooked
as partners. In the second of our two-part
Rural Monitor story on rural health literacy issues,
Who Is Delivering Health Information, rural newspaper
experts shared that over 85% of rural Americans get a weekly
newspaper, allowing newspapers to function as a health
information disseminator. Librarians told of how
they meet their rural patrons’ health information needs. And in another Rural Monitor
story on social media, rural healthcare providers share
how they leverage social media to attract patients to
a healthcare message. Next slide. We need to specifically point
out to today’s listeners that RHIhub has sixteen evidence
based toolkits that are step by step guides for using evidence
based programs for addressing rural health challenges. Yes,
evidence based. Next slide. First, our Rural Community
Health Toolkit is a general toolkit with information,
resources, and materials to help develop any community health
program, including one focused on outreach and enrollment. Note, this toolkit’s modules
focus on creating programs with an evidence based implementation
plan that also includes a framework to evaluate a
program’s effectiveness. There are also plans
for sustainability, dissemination of results
to project partners, funders, and the broader
rural health community. Next slide. We’d also like to highlight the
Rural Community Health Workers Toolkit and the Rural Oral
Health Toolkit both provide information for specific outreach
and enrollment efforts. Last slide. In conclusion,
whether you are trying to reach rural residents in remote areas
or frontier areas in the northwest or in the southeast,
we hope that these highlights featuring the diversity and
successes of some of our nation’s rural programs provide
a framework for replication or serve as a spark for new ideas
that translate across geography, program focus, targeted age
group, and especially provide ideas for outreach and
enrollment efforts. If you have any questions or
would like further information on any of our resources shared
today, you can reach me at [email protected],
or feel free to call us at 1-800-270-1898 and our
information specialist will pick up the phone and provide you
with free customized assistance. And of course, follow us
on Facebook and Twitter. Thanks again for allowing us
to participate, and back to the facilitators.>>Jason Werden.
Thank you very much Kay. We appreciate your time today. I’d like to quickly
go through our last poll question for the day. As we discussed the many types
of ways to engage with your means of reaching out to
the rural community, we’re interested to hear
back from you. What type of local media
engagement would best serve your outreach and enrollment efforts
in reaching your rural community? Whether it be through radio,
TV, an op-ed letter to the editor, blog post or online
coverage, or even through the community newsletter or through
a school PTA newsletter. Let’s take a look
at those responses. Thank you very much
for your feedback today. Certainly again, noting that
school and community newsletters are a highlight of your
feedback, and that school based tools are of high interest. Do know that the Connecting Kids
to Coverage Campaign does offer a number of school based
outreach tools, and those can be found at
insurekidsnow.gov. And speaking of those resources,
we can go through the many resources that are available
to you and each of your organizations. Next slide please. First I want to take a look
at the Rural Health Outreach Tip Sheet. We’ve developed a tip sheet with
five ways to conduct outreach in rural communities. This, as you’ll see on the
screen here, is an opportunity to identify eligible means for
families to use these tips to incorporate into their outreach. There are a number of
strategies in play. These are five tips
to help you make outreach work. This is available for download
of course at insurekidsnow.gov. Next slide. We recently worked with the
Mountain Comprehensive Health Corporation to develop
this new video. It’s an opportunity to show you
in the field what organizations like yourselves are doing
to work with rural communities locally. Reaching children and families
that are eligible for Medicaid and CHIP, as we mentioned,
can be particularly challenging in rural areas across
the country. In Whitesburg, Kentucky,
MCHC, Mountain Comprehensive Health Corporation,
is working within rural communities to help families
enroll in and gain access to proper health care. Now, MCHC is one of the largest
rural health centers in the country, but there are many
organizations who are joining us here today who we do feel
will find a lot of value in this video. Following today’s webinar
and in follow up to all of you who have attended,
we will be sharing through the eNewsletter,
an opportunity to view this video as it is posted to our
Outreach Tool Library. A link to that will also be
included on insurekidsnow.gov. Next slide. We also want to provide an
opportunity in this outreach tool library to see where we have
additional campaign materials and resources available
to all of you. From customizable posters to
palm cards and videos, we mentioned tip sheets. Informational webinars
such as this one, we have a webinar archive that has all of
our previous webinars for your review. We of course have the Campaign
Notes eNewsletter, which we encourage you
to subscribe to if you have not already, to keep up to date
with all of the news across the campaign. Many ready-made articles and
radio scripts and digital media tools and radio and television
PSAs, all accessible and many of which are customizable for your
use on a regular basis and in your outreach efforts
moving forward. Next slide. Those digital media tools
can be used on social media. We have graphics, guides,
web buttons and banners. A number of sample posts even
that you are able to use. All of these are available
as a guide for developing your outreach strategy
in the rural community. These are as always available
at insurekidsnow.gov. Next slide. A few examples of materials that
we have outside of just strictly rural health. We have many topic areas and
initiatives that reach other audiences that we have also
covered on previous webinars and that we have examples
of on insurekidsnow.gov. Whether the topic be back
to school, oral health, your vision, engaging teens,
using sports and athletics in schools as a method of engaging
those teens, and year round enrollment at any time
of the year. Next slide. We mentioned those customizable
materials from posters, flyers, palm cards. All are at your disposal to
customize to fit your organization and your audience. These are available at
insurekidsnow.gov, and they provide an opportunity
for you to add your logo, your organization, and your
contact information so that you can properly reach
your audiences. Next slide. For more on these best practices
for outreach and enrollment, we do invite you to visit the
Outreach Video Library and Outreach Tool Library at
insurekidsnow.gov as well as this webinar archive that
I did mention. They have all of our webinars
dating back to the beginning of this campaign. Two that we reference here,
because they are of particular interest. The last one we did in June on
connecting students to coverage this back to school season,
is still viable and of topical note. And also, one of our previous
webinars on reaching rural communities and how we reach and
enroll families across that rural audience nationwide. Those are all available at,
you guessed it, insurekidsnow.gov. Next slide. Many of our speakers today have
mentioned similarly, we want you to keep in touch
with all of us at the campaign as well as across our network
of partner organizations. You can follow us
on Twitter @IKNGov. You can engage with the campaign
all across social media by sending us a tweet,
re-tweeting any of our information,
or send us a message with the hashtags #Enroll365,
#KidsEnroll, or #Medicaid or #CHIP. As I mentioned,
do sign up for our eNewsletters, there is a hyperlink on the
screen but in our follow up we will also share a direct link
to sign up and subscribe. If you have any questions at all
or wish to contact the campaign or have questions that you want
to take beyond today’s webinar, email us at any time.
[email protected] Next slide. We want to hear from
you as well. We mention all of this as
a means of providing an opportunity to hear back from
all of you across the network. If you have outreach
and enrollment stories, best practices,
challenges that you face that you want to share with the
campaign or are looking at additional input on, do contact
us, and we would love to hear your stories. That then takes us as well
to our Q&A portion today. We’ve left the Q&A platform open
throughout the webinar for you to provide your questions. We’ve gotten a few back here
that we are excited to pose and share with you today. Our first question is for
Dr. Cara James at OMH. Dr. James, the question
we received is, Are the Coverage to Care materials available at a
lower reading level, such as the fifth or sixth grade
level of reading?>>Dr. Cara James
Thank you for that question Jason. We have worked very hard to get
the materials to as low a level as possible. Unfortunately,
we are not at a fifth or sixth grade level,
but that’s part of the reason we have a variety of tools
that are available. So for those with maybe lower
health literacy, the Five Ways to Make the Most
of Your Coverage is something that might be easier for that
population to focus on. But the other,
the roadmap and the other materials are testing at about
an eighth grade level. We do continue to try and see if
we can lower the level and still include the important
information that people need.>>Jason Werden
Thank you for that feedback Dr. James. Our second question goes out
to our friends at NARA. Is there any telemedicine being
used in the communities that you referenced,
and are you able to share any details on that if so? We might have lost our friends
at NARA for this afternoon, but do know that all the
questions posed today will be sent out to all of our speakers
following today’s webinar. If we have you, Kay,
still on the line, we have one more question that
is being posed your way. Are the toolkits that you
mentioned from RHIhub, are they culturally specific
to different populations across your communities?>>Dr. Kay Miller Temple
I don’t believe, most of them are not.>>Jason Werden
Okay. Well, we will reference again
that a number of materials available through the campaign
are customizable and also address multiple audiences,
and we have an opportunity to share that information with you
through insurekidsnow.gov at any point that you
might be interested. I will say once more,
if we did not get to any question that you had today,
or if you happen to think of it after the fact,
do share it with us. We will include it in our after
action with all of our speakers today and get back to you
with a response via email in the coming days. We will also note that
everything that you saw here today on this presentation as
well as the recording of the presentation itself will be
available within two weeks of today’s date,
when we will post it to the insurekidsnow.gov page as well
as the webinar archive previously mentioned. You can reference these
resources and all of the campaign’s resources
at any time. Thank you all for joining
today’s webinar, and remember that all of
these resources are available for download, reference,
and use at insurekidsnow.gov.

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