FirstPlan, a way to help the working uninsured
Billie and Carole Williams work hard. Together, they own and operate SouthMoore Heating and Cooling in Pinebluff. On average, they employ around 16 people, although that number can fluctuate during the busy season.
Although the Williamses value every person who works for them, they couldn’t afford to offer a major medical plan through their company.
Until four years ago.
“Most of our employees live paycheck to paycheck,” says Carole. “They were interested in health coverage, but they could not afford to share the cost of the premiums with the company, and we didn’t have the means to fund the entire expense.”
In 2005, the Williamses learned about FirstPlan, a new product available through FirstCarolinaCare Insurance Company, FirstHealth’s managed-care plan. FirstPlan is available to businesses with 50 or fewer employees. Through the program, enrollees receive not only medical coverage, but also access to worksite health screenings for blood pressure, cholesterol and diabetes as well as annual flu shots.
“Through the on-site services, we have been able to help our employees learn about potential health problems before they get sick,” Carole says. “Our absenteeism is down, and our employees are healthy. We have even been able to re-employ previous workers who needed access to insurance. It’s a win-win for everyone.”
Across the United States, the numbers of uninsured are growing. Many of those without insurance are employed. They may work for businesses that are unable to provide medical coverage, or they can’t afford the coverage that is available. In fact, when FirstPlan was developed, employees of nearly 40 percent of the small businesses in Moore and surrounding counties didn’t have health insurance.
Through FirstPlan, subsidies are available from FirstHealth and other outside sources to help low-wage employees pay their share of coverage. In addition, employers who meet certain criteria can receive credits of up to 20 percent on their premiums.
During 2007, FirstPlan served about 50 small businesses and committed $500,000 to subsidies.
“SouthMoore is a family business,” says Carole. “My daughter and her husband work here. Our employees are like family. Being able to offer their families FirstPlan is a wonderful asset. I don’t know why everyone who owns a small business isn’t on it.”
Imagine how it must feel to step into an American high school for the first time. You don’t speak the same language, wear the same clothes or even eat the same foods as the other students. At a time when “fitting in” is critical, you stand out from the crowd in every way imaginable.
“Many young people who move into our communities from other countries experience the life of a typical American teen during the school day—complete with cell phones, iPods, computers, hamburgers and french fries,” says Barbara Bennett, administrative director of FirstHealth Community Health Services.
“Every afternoon they return home to an entirely different culture. Discovering ways to balance the two lifestyles, develop lasting friendships and achieve academic success can seem difficult, if not overwhelming at times.”
Recognizing the challenges facing parents, teachers and students in such situations, FirstHealth implemented “Reaching Out” during the 2007 school year. Funded through a three-year $280,000 grant from the Kate B. Reynolds Charitable Trust, Reaching Out targets high school-aged refugee and immigrant children in Montgomery County.
Although it is a small, rural community with family ties that span generations, Montgomery County is also home to a growing number of immigrants and refugees from areas as diverse as Mexico and Laos.
Modeled after a successful Chicago program, Reaching Out is designed to boost self-esteem and self-efficacy, and to help young people successfully become part of their surroundings. The program uses a three-pronged approach to assist parents and schools as well as the students.
“Because this is a three-year grant, we targeted ninth- and 10th-graders so that we have the opportunity to work with them throughout their high school careers,” says Bennett.
Students meet in small groups each week to share personal experiences, participate in educational sessions, and address any positive or negative situations that may have arisen. When entering the program and annually thereafter, each participant completes an assessment to scale his or her self-esteem. Carefully analyzing the changes in the scale will help the Reaching Out staff determine the success of the project.
In addition, every young person is expected to complete a special community project that will help bridge the gap between cultures.
This might involve coordinating an evening of entertainment featuring music from various cultures or planning a tasting event that showcases the differences in cooking and eating habits from country to country. These projects also meet the N.C. graduation requirement that each high school senior must complete to graduate. Every student who successfully finishes the program (including the project) will be eligible for a special incentive.
Through Reaching Out, FirstHealth staff members explore student needs at home, at school and within the broader community, tailoring programs to address each issue.
For example, many students admit that their parents do not speak English and often rely on their children to interpret. Some parents lack the education necessary to find appropriate work in the United States, and others do not understand the differences in acceptable child-rearing. As a result, Reaching Out offers classes for the adults so they can improve their English, learn skills such as computer operation and develop parenting strategies appropriate for their new surroundings.
At the school level, Reaching Out has taken steps to facilitate communication among families, teachers and administrators, and to overcome language barriers.
Reaching Out employs trained patient navigators to help young people register with the program and to lay the foundation for building a trusting relationship with the youths and their families.
It operates year-round. During the summer, a special reading program is available to assist with English skills. Students have also traveled to Raleigh to learn about state government and have visited the World Market in Greensboro. By September 2008, 40 young people representing an array of cultures including Hmong, Laotian and Latino had taken advantage of the program.
Charting health care waters with patient navigators
Years ago, ship captains relied on the stars and a compass to plot their direction. Today, airline pilots depend on an array of complex tools to ensure that they stay on course and reach their expected destinations.
For some people, navigating the health system may seem a lot like mapping out a long journey. For those who come to our area from different countries, the challenges are even greater. Language barriers, cultural differences and gaps in education may actually keep patients from seeking care when they need it or from following important steps involving medication and treatment. Recent changes in immigration laws and governmental regulations have also sparked fear in many communities.
So how do you encourage people to take advantage of medical care, access community resources and seek out needed social services when trust is an issue? A pilot program partnering Montgomery Community College (MCC) in Troy and FirstHealth of the Carolinas Community Health Services may be the answer.
Every neighborhood, church or community has certain “goto” people. These individuals may be sought out for advice on everything from parenting to financial matters. They are trustworthy and influential. The Patient Navigator Program identifies these community leaders and encourages them to become even more involved.
Through a continuing education class at MCC, prospective patient navigators explore the many resources available in the community from health care and housing to legal and financial. They learn about the role of each agency, how to access services, who is eligible and why it is important to take advantage of local opportunities. In addition, the semester-long course provides lessons on basic health care such as how to take a temperature or how to understand a blood pressure reading. Participants also learn about health issues facing their communities and ways in which they can help.
“Our goal with the program is to find those community people who can build bridges between services and the community,” says MCC instructor Andres Hernandez. “When the people in the community understand how certain services work, they will be more likely to use them.”
Fourteen individuals completed the first Patient Navigator Course. The group included nine Latinos, four Asians (Hmong and Laotian) and one African-American. Since graduating, they have assisted with local health screenings that included recruiting patients and working with several grant projects in the community. Program coordinators have also worked to help Patient Navigators secure employment opportunities that allow them to use their skills to manage language barriers and build trust.
FirstHealth covered the expenses for each participant including tuition and supplies for an investment of approximately $160 per student. In addition, FirstHealth worked in tandem with MCC instructors to develop an original curriculum that included identifying resources for the course.
“During the course, the students actually taught the instructors,” says Gary Saunders, MCC’s dean of Continuing Education. “They shared information about traditional medicines and customs that will help all of us learn to work together more effectively. It was a win-win relationship for students, instructors and the community.”
Community resource coordinator
Can you remember your first day of school? The building was a maze of hallways, doors and large rooms filled with foreign materials. The people were all smiling, but they seemed like strangers from a whole new world. Even with your grown-up book bag and new lunchbox, you felt very small.
Chances are mom, dad or another special adult in your life was nearby, holding your hand, showing you the way—giving you just enough help to make the day a success.
For many people in Moore County, navigating the resource systems in the community can feel a lot like that first day of school. Thankfully, they, too, have access to an outstretched hand that is ready to help.
In an effort to improve the health of the underserved in our community, FirstHealth employs a bilingual staff person who works on site at the Moore Free Care Clinic and Moore County Department of Social Services.
The community resource coordinator connects individuals and families with the services they need to keep themselves and their children safe and healthy. She may assist people with health care enrollment, interpretation or translation services, or ensure that they have access to needed resources by eliminating language or literacy barriers.
Originally created through a Federal Outreach Grant, the position has been in place since 2003 and is currently sustained through funds from the North Carolina Office of Rural Health and Resource Development. During 2007, the Community Resource Coordinator had 1,286 encounters. Ninety-four percent of those served were linked to needed assistance or community programs.
In addition to helping clients find assistance for health issues, social services, transportation and education, the community resource coordinator participates in home visits with social workers and may even attend scheduled court visits or medical appointments.
“Several years ago, I met a lady who had never had access to routine health care,” says Sheila McNeill, who has the job. “She had many health problems. She is a mother of eight children. She needed help, but she didn’t know where to turn.
“I have been able to help her family enroll in the Medicaid program and find other resources. I am still working with her today. She is having trouble with diabetes, but has resolved some other health
problems. She feels better and is better able to provide for her family.
If we had not been able to work on her behalf, I don’t know what would have happened.”
Although the names and circumstances differ from family to family, this story is one that is repeated throughout McNeill’s work week. In a world where the culture, language and rules can be hard to understand, she is ready to reach out with needed information and a helping hand.
Who uses FirstHealth’s community-driven outreach programs? Are the existing programs reaching the people who need them the most? Thanks to a project started in January 2008, FirstHealth will soon know the answers to these questions—and many more.
Although health problems are not usually difficult to find, creating the right plan to address them can be challenging. “It’s not enough to simply offer a service,” says Linda Cooke of FirstHealth Community Health Services. “We need to understand the details about who will be using each service in order to best meet their needs.”
There are many reasons why individuals from disparate populations do not take advantage of health care. Transportation may be a problem, or there may be language barriers. Patients and their families may not be able to read or write. Depending on work or home circumstances, traditional hours might not work with personal schedules.
Funded by a three-year, $500,000 grant through The Duke Endowment, FirstAccess is designed to identify such disparities in health services and to collect the information necessary to successfully eliminate them.
The benefits don’t end there.
Through detailed research, FirstAccess will develop a comprehensive database about the participants in this service and the community at large. “Having this information at our fingertips will open the doors to new opportunities,” says Cooke. “We will be able to prove to granting organizations the specific needs of disparate populations in our area. We will also be able to develop very targeted approaches to care for people. Our work will assist with identifying opportunities for improvement and barriers to services. Focus groups will help us define why those holes exist and help us fill them in.”
FirstAccess does not fund any screening programs or other direct services. Instead, through comprehensive evaluation, the project will ensure that services are delivered when, where and how they are most needed. Through careful data collection and targeted focus groups, FirstHealth will not only pinpoint service issues, but also tailor plans to bridge those gaps.
The project has already made a difference. The first step, a careful review of current data collection practices, quickly revealed inconsistencies. Based on these findings, FirstAccess organized a data revision plan and held a comprehensive training session to ensure that all participating community outreach programs collect the same demographic information using a best practice model.
In the months ahead, the project will work primarily with 15 existing community-driven programs to review demographics, identify gaps and recommend improvements.
A Health Net partnership
Martha and Ed live in Aberdeen. A former hotel housekeeper, Martha can no longer work due to the painful neuropathy in her hands, feet and legs, the result of uncontrolled diabetes. Ed has high blood pressure, high cholesterol, sciatic nerve pain, and is borderline diabetic. He recently took a full-time job after a period of unemployment.
With a family income totaling about $1,000 a month and two boys to raise, they just don’t have enough money to cover medical expenses or insurance.
For the first time in her life, though, Martha understands the connection between her poor diet and lack of exercise and the complications of her diabetes. Thanks to the efforts of community case manager Alexandra “Andra” Lawson, R.N., through a new program called Health Net, Martha not only has access to routine medical maintenance, but also has assistance with medications, opportunities for health education and referrals to needed specialists.
“I was diagnosed with diabetes in my 20s,” she says. “I did not know anything about caring for myself. I ate the wrong things and didn’t exercise. Andra enrolled me in the ‘Healthy Living’ class (Stanford University Chronic Disease Self-Management Program), and it was great. I have goals, and I’ve dropped 20 points off my blood sugar. Now I walk, even if it is painful, just because I know it will help me. I really am very proud of myself.”
Health Net provides chronic disease case management services, resource assistance and medication assistance to uninsured patients in Moore County. The partnership includes Sandhills Community Care Network, FirstHealth Community Health Services, the Moore Free Care Clinic and FirstHealth Cares. The program is funded primarily through a $198,000 grant from the state. During its first nine months of operation, Health Net served about 104 people who might not otherwise have received adequate care.
Health Net provides services to uninsured individuals with incomes up to 200 percent of federal poverty guidelines ($42,400 for a family of four). Anyone who lives in Moore County and meets the criteria can participate regardless of where they receive medical services.
“Our goal is to ensure that patients get the care that they need in the appropriate setting,” says Leonard J. Newton, M.D., MMM, CPE, executive and medical director of the Sandhills Community Care Network. “The Emergency Department is appropriate for severe acute cases and true emergencies, but patients who have chronic diseases need continuity of care in a medical home. If they begin to better understand their health needs, and we connect them with resources, we can ultimately reduce hospitalizations and help control health costs.”
Through Health Net, Lawson works one on one with patients to help link them to needed resources and manage their medical care. She visits them at home to educate them about medical conditions and help them “deal with a lot of life issues” that are affecting their health.
“The world can be very ugly, and for some, it gets a lot worse before it gets any better,” Lawson says. “When you visit (patients) at their home versus the physician’s office, you see what their world is like so you are able to better assess their situation and real need.”
Lawson sees “the real need” too often in Moore County—a family without running water, electricity, or worse, without food. “That’s what makes this work so critical,” she says. “I see it as a challenge to fix it for them, and I don’t let go of the issue until I feel I’ve done all I can to resolve it.”
Mobile Health screenings save lives
People today are busier than ever before. After juggling the constant demands of work and family, they often have little time left to schedule health appointments and participate in medical screenings. That’s why, during the late 1990s, FirstHealth of the Carolinas introduced a special program.
FirstHealth Mobile Health Services takes care out of the traditional hospital or medical setting and into the heart of the community.
“We try to visit places that are centrally located for easy access,” says Marion Sangiuliano, coordinator, Community Health Services/ Mobile Health Services. “We reach out to people where they work, attend church or even buy their weekly groceries.”
Although taking care of ourselves should be a priority, we tend to move our health to the back burner when we feel well. Mobile Health Services helps shift those priorities back to the right order. “Does our service make a difference? Absolutely,” says Sangiuliano. “Our screenings save lives.”
Earlier this year, a man in his 40s participated in a Mobile Health vascular screening. He was healthy and had no family history of vascular problems, but the test revealed significant blockages. Within a day, he had surgery to correct the problem.
He was, in essence, a walking time bomb. Without intervention, he could have had a stroke at any moment.
Mobile Health Services provides medical screening tests to identify targeted health issues and encourage early treatment. Available services include:
- EKGs to assess heart function
- Vascular screenings to identify blood vessel blockages to prevent strokes and detect abdominal aneurysms
- Prostate-specific antigen (PSA) screenings to detect prostate cancer
- Bone density scans to find signs of osteoporosis
- Blood tests to determine cholesterol levels
- Diabetes screenings to review glucose (blood sugar) levels
- Blood pressure screenings
All Mobile Health screenings are provided at a reduced rate, and financial assistance is available based on income. In 2007, FirstHealth Mobile Health Services provided nearly 5,000 screenings at a value of nearly $200,000. Of these, 1,100 resulted in physician referrals for abnormal findings.
“When we identify a problem, we notify the patient and his or her physician,” says Sangiuliano. “We also follow up with a second phone call after a specific period of time to make sure that the patient has taken steps to manage the problem.”
In addition to medical screenings, FirstHealth Mobile Health Services reaches out with valuable education about health and wellness. Materials are available on a variety of health conditions as well as guidelines for staying active and well.