Download Increasing Breast and Cervical Cancer Screening in Michigan

Michigan Breast and Cervical
Cancer Navigation Program
(BCCCNP)
Introducing Patient Navigation to
Provider Offices
June 7, 2016
Program Goal
Assure low-income women receive timely
access to needed breast and/or cervical
cancer services.
BCCCNP Service Components
• Two Types of Services Provided
• Caseload Services – BCCCNP acts as a “insurance
company” and pays for breast and cervical cancer
screening and/or diagnostic services with contracted
providers for women who are uninsured or underinsured.
• Navigation-Only Services – provides reimbursement for
patient navigation to assist insured women to overcome
barriers that may prevent them from receiving breast and
cervical services.
Eligibility Criteria for
Navigation- Only Services
•
•
Be between the ages of 40 and 64
Income < 250% Federal Poverty Level*
 Income criteria set by federal law- must document woman’s
verbal statement of income; no written proof required
 INSURED
 Requires breast/cervical cancer-related services ONLY
 Pap test, Mammogram, and/or follow-up services for
abnormal test result
NMHSI and BCCCNP
• Provide Navigation-Only Services:
• Increase the use of patient navigation in provider
offices:
oproviding financial incentives for providing navigation.
• Improves the quality of care provided to UP residents.
• Decreases health care costs by preventing cancer or
detecting it early.
How can Navigation Help?
• Is fear the reason she is not being screened?
• Does she really understand how cancer screening
can help her?
• Are there family care or transportation issues?
• Have you looked for appointment times that work
with HER schedule?
• Ask… Understand… Educate…
Navigation in Provider Offices
• Improves provider screening rates and HEDIS rates
• Promotes earlier screening and successful diagnostic
resolution
• Identifies barriers that impede access to obtaining
services
• Provides individualized support and assistance to
overcome barriers/problems
• Decreases no-shows which are costly to offices
• BCCCNP provides the funds to pay providers to reach
out to their clients
Who Do We Navigate?
To be eligible women must meet the following:
 BCCCNP age, income, insurance eligibility criteria AND
 Is in need of breast / cervical cancer screening or diagnostic
assistance AND
 Requires education/assistance/resources to obtain needed
breast/cervical cancer services
 Is willing to complete breast /cervical cancer screening
How do we find these women?
• AIMED at women who have never been screened
or who face barriers to completing their screening
and/or diagnostics.
• Who has not completed cancer screening?
• Patient records/Gaps in care report
• Who needs diagnostics? Did they complete?
• Conversations with patients
Patient Navigation Team
Navigation is a process, not an individual:
• Navigation services can be provided by one person or
shared by several individuals.
• Patient Navigator does not need to be a health care
professional to provide non-clinical services.
• Unmet needs are identified and then split
based on the skills of each team member.
Navigation in the office
Non-clinical office staff:
• Identify who is in need of cancer screening and flag the
chart
• Provide small media materials to patients in need of
cancer screening as they check for an appointment
• Schedule mammograms or diagnostic procedures before
the client ever leaves the office.
• ASK about times that are best for the patient
Navigation in the office
RN and MA staff:
• Have the conversation, ask questions, understand cancer
screening or diagnostic follow-through from her
perspective.
• Why hasn’t she completed screening?
• What stands in her way?
• How can you help her resolve those barriers?
Information Needed to Document
Navigation Services
1. Age/Income (Program mandate: 40-64, < 250% FPL)
2. Breast/Cervical screening services needed
3. Barriers/problems the woman may have to receiving services
4. Assistance provided by navigator to overcome
barriers/problems
5. Types and dates of services received
Intake
Assessment
Navigation Forms
Encounter
Form
Form # 1 - Intake Assessment
Used by Navigator to
document 1st encounter:
• Client Eligibility by income
(< 250% FPL)
• Breast and/or cervical
screening and/or
diagnostic services
required by the client
• Barriers that may interfere
with obtaining these
services
2016 Federal Poverty Level (FPL) Guidelines
Size of Family Unit
Poverty
Guideline
250% of
Poverty
138% of
Poverty
1
2
3
4
5
6
7
8
Each Additional Member
(Beyond 8)
$11,880.00
$16,020.00
$20,160.00
$24,300.00
$28,440.00
$32,580.00
$36,730.00
$40,890.00
$29,700.00
$40,050.00
$50,400.00
$60,750.00
$71,100.00
$81,450.00
$91,825.00
$102,225.00
$16,394.40
$22,107.60
$27,820.80
$33,534.00
$39,247.20
$44,960.40
$50,687.40
$56,428.20
$4,160.00
$10,400.00
$5,740.80
Intake Assessment: Client Information
• Client Verbal Acknowledgement - Verifies that client has agreed for
assistance in obtaining breast/cervical services
• A separate informed consent is not required
Intake Form
Client Assessment: Services Required
Intake Form: Barrier Assessment
• At least ONE barrier must be checked.
• For each barrier checked, record in comments how it will be
addressed.
Form # 2- Navigation Encounter Form
Used by Navigator to document:
• Breast and/or cervical cancer
screening and/or diagnostic
services received by the client
• Referrals/Resources provided
to the client
Encounter Form:
Navigation Services Completed
Document the following:
• Dates of screening/diagnostic services received
• Referrals/Resources provided to client
Encounter Form: Navigation Status
Navigation status (ongoing):
• Do you need to contact the client again? – Yes, identify when
you will contact the patient.
• Provide brief comments on current encounter
Encounter Form: Navigation Status
Navigation status (complete):
• Do you need to contact the client again? – No, all
breast/cervical screening/diagnostic services are complete.
• Provide brief comments on current encounter.
• Sign and date encounter form
Navigation-Only Key Components
1. Client is eligible (age and income)
2. At least ONE Barrier/Problem is identified
3. A solution is put in place for each identified
barrier/problem.
4. Client receives needed breast or cervical screening
and/or diagnostic services.
When is Navigation Complete?
• Has at least 2 (TWO) encounters with designated office staff via
phone, email, or in-person
• Completes breast and/or cervical cancer screening and any
required diagnostics.
Options for
Uninsured and Underinsured Women
Funding for Providing Navigation
Services
• MDHHS will fund the agency with $18,000 in one lump sum
payment.
• $6,000 “Administrative fees”
•
•
•
•
•
Identifying clinic sites to participate
Training the clinic sites – with MDHHS assistance, if needed
Collecting all navigation forms from the clinics
Reviewing all forms for completeness
Sending all forms to MDHHS
• $12,000 = $60 per woman navigated (200 women = target)
• Payment to your sites/clinics will be internally among your agency and the clinics
BCCCNP Caseload Services
• BCCCNP will pay for breast/cervical cancer screening and diagnostic
services for those who are do not have insurance or who need
diagnostics but face a high deductible
• Defined as: “I cannot afford that amount”
• Will count as navigation (you resolved an insurance/financial barrier)
• IMPORTANT: You must refer these women to the _______BCCCNP
agency for these services to be covered by BCCCNP
• If cancer diagnosed, women may qualify for treatment through the
BCCCNP Medicaid Treatment Act Program
MDHHS Assistance
• Data Entry will be completed at MDHHS
-- Clinics will fill out the forms and fax to one centralized location at
the agency for verification of completeness.
--Completed forms will be mailed to MDHHS for data entry
• Assist with agency staff trainings
• Develop agency specific reports
Frequently Asked Questions
1. Who do I contact with questions about completing the form or if a
woman qualifies for BCCC navigation services?
Tory Doney - [email protected] or 517-335-8854.
2. Who do I call to learn more about navigation in my practice?
Debbie Webster – [email protected] or 517-335-8517.
Frequently Asked Questions
3. Does the program provide support for women diagnosed with breast or
cervical cancer?
• YES!! Income eligible women, (insured, uninsured, and
underinsured) may be eligible to enroll in a special Medicaid program
through the BCCCNP.
• The woman MUST be newly diagnosed in order to qualify
• EXCEPTION: Women currently enrolled in HMP can transfer into the
BCCCNP Medicaid program at any time during the treatment phase
where they will incur NO co-pays!
Contact Ann Garvin – [email protected] (517-335-9087) or E.J. Siegl
[email protected] (517-335-8814) if you have a client newly diagnosed with
breast or cervical cancer who may qualify for this program!
Next Steps
1. Develop Work Plan (template)
- Outline for implementation of project
2. Identify project start date
3. Identify trainings agency will require prior to project start date
4. Obtain baseline data for breast/cervical cancer screening by
participating provider offices
• USPSTF: mammogram women >age 50-70, every 2 years
• Pap test every 3 years in women age 21-65 (or Pap/HPV in women >30
every 5 years)
MDHHS Contact Information
Tory Doney (Department Analyst) [email protected]
Ann Garvin (Nurse Consultant) [email protected]
517-335-8854
517-335-9087
Debbie Webster (Navigation Consultant) [email protected]
E.J. Siegl (Pgm Director/Nurse consultant [email protected]
517-335-8517
517-335-8814