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CommunityLinks, a program of the AIDS Foundation of Chicago (AFC), contracts with managed care health insurance plans to offer a variety of services to their members. One of the services CommunityLinks offers is Reach and Locate, which aims to find and engage members in their health care plans, ultimately offering them services intended to improve care and health outcomes.
Meghan Peterson, Terrence Clark and Andre Shaw spend their days scouring through Google search results, calling hospitals and correctional facilities, and knocking on the doors of houses and apartments across Chicago and the city's suburbs. No, Peterson, Clark and Shaw are not secret agents; instead, they are part of AFC's Mobile Engagement Team through which they seek to help the people they locate.
The Mobile Engagement Team is part of CommunityLinks, and Karen Kowal, the director of the program, believes it is "an innovative solution to the changes in the health care environment. CommunityLinks contracts with managed care organizations (MCOs), which are health insurance plans, to provide services to their members." AFC uses its decades of experience providing holistic care to clients through case management, housing and mental health services to save MCOs money and provide more effective services for their members.
CommunityLinks was created as a response to the changing landscape of health care after the Affordable Care Act was passed and health reform changes started. Kathye Gorosh, AFC's senior vice president of strategy and business development, knew things were going to change in terms of how services were delivered to people on Medicaid and for how they were paid. "AFC took a very progressive stance in trying to adapt sooner rather than later; we asked how we could take the work we do through our Care, Housing and Prevention programs and use this expertise to work with health insurance plans."
Moreover, explained Gorosh, “Illinois Medicaid is enrolling most recipients in managed care, including the over 600,000 who are newly covered thanks to health care reform. That means tens of thousands of people every month are assigned to new health plans, and the health plans have to find and engage their new members .” This engagement is especially critical when a health plan knows of a member who has been hospitalized and has multiple chronic diseases, but can’t get in touch with them because they don’t have a working phone.
That’s where CommunityLinks comes in. Currently, CommunityLinks has contracts with two MCOs and sub-contracts with two community-based organizations and provides different services based on each company's needs. Kowal explained, "We have eight different services that we can provide to clients, including services like reach, assessment, testing and HIV-Connect." She paused before continuing, "That's a lot of jargon-y lingo, though, isn't it?"
Kowal is right: the vocabulary of CommunityLinks can be confusing to someone who is unfamiliar with the language of the health insurance industry. The premise of the program, however, is simple: to help MCOs better serve their members by lending 30 years worth of expertise in providing holistic and coordinated care to highly vulnerable individuals.
"In reality," Kowal stated, "the services we provide are versions of AFC services offered in other capacities, such as testing and case management." It is this expertise that allows CommunityLinks to effectively serve members, "delivering services, helping them know who to call, getting them more engaged in their plan."
The goal of CommunityLinks is easy, but the process of achieving that goal is more complicated. Kowal noted, "We've had to find almost every single person in the program," and this task requires much time and patience. So how does this small team actually go about providing reach and locate services, engaging hard-to-reach clients in their plans? The group employs a go-get-'em attitude and a divide-and-conquer technique to achieve their goals.
For instance, Peterson works primarily from the office, and her days are filled with phone calls and internet searches to find accurate contact information for each member. Because phone numbers and addresses provided by plans are often unreliable, Peterson must be creative to fill in the gaps. Peterson follows every lead she finds, even if that lead comes in the form of a wedding registry or social media page, and her positive attitude propels her forward.
"The most important thing," Peterson said, "is that we use a wide variety of searches at different times in the month. For example, we might search for all of our monthly members in federal, state and county correctional systems at different points in the month and only find one member, but I’d still say all of those searches are worthwhile if we can find even the one person."
When Peterson's searches are successful, she has the opportunity to learn more about members through a Health Risk Questionnaire (HRQ). The HRQ serves to assess a health plan member’s overall health, as well as a way to allow the partner health insurance agency to learn more about their members. More importantly for CommunityLinks, though, making contact with a member means introducing them to additional services included in their plan. Peterson said, "Many of the members aren’t aware of the benefits that they receive from their insurance coverage, so it’s always rewarding to feel like we have a role in linking them to services that will help them better manage their health."
But what happens when internal searches don't lead to contact with a member? Four days a week, Terrence Clark and Andre Shaw travel to communities within and surrounding Chicago to knock on doors and attempt to make in-person contact. "Some days we won't find anyone, which is frustrating, and sometimes it can be kind of scary not knowing what you're walking into," Shaw noted, "but it's rewarding when you do find a member and reconnect them with their medical insurance."
When they do locate members, Clark and Shaw sometimes have the opportunity to offer immediate HIV and hepatitis C testing, but even then, it can be hard to get members plugged into care. One such instance sticks out in Shaw's mind: "There was a woman who tested positive for hepatitis C, but unfortunately we don't know what happened to her. We worked really hard to find her help. We went to a few places that used to treat people with hepatitis, and each place would transfer us to a different facility. When we finally got her to the right place, she disappeared. We still try to call her every now and then, but we always get disconnected numbers."
As frustrating as instances such as this can be for the team, they try to focus on celebrating the successes. "A lot of people are really grateful when we call. Our outreach creates a personal connection between the plan and the member that wasn't there before. Often, no one from their insurance plan has been able to contact them, so there is a general sense of gratitude when they're able to talk to us about their health," said Kowal.
“Our health plan customers are happy too,” Kowal continued. “We’re helping them find and engage some of their sickest and highest-cost members. If the plan can connect them with the right specialists and educate them to see a doctor instead of just going to the ER, they have a chance to cut unnecessary spending and improve their members’ health.”
Indeed, it is these personal connections to both members and health plans that has garnered CommunityLinks praise for its innovative approach to health care engagement, with the National Alliance of State and Territorial AIDS Directors (NASTAD) calling the program an "example of a promising model bridging public health and health care systems and payers."
Kowal and Gorosh agreed, and they consider the program's first year a success. "We really worked together as a team to figure out the best method for reaching members. We know there has been success in linking people back to their plan and empowering them to engage in their health care. Our work is really about those individual successes."
And ultimately, it’s those individual successes that emerge from programs like CommunityLinks that may make health care reform a success.