Investing in Outreach

Then senior leaders at the Health Care Financing Administration set out to make the agency more efficient and user-friendly, they might want to consult with Joyce Jackson. A technical director at the Center for Medicaid and State Operations in HCFA's Baltimore office, Jackson has made outreach the watchword of her organization. And she has an investment track record any Wall Street banker would envy.

Through a partnership with an Indian Health Service hospital, Jackson found a way to turn a $40,000 investment into several million dollars in health care benefits for Oklahoma Indians. By funding a staff position for a full-time benefits coordinator at the W.W. Hastings Indian Hospital in Tahlequah, Okla., HCFA enabled the hospital to enroll hundreds of Indians in federally funded health care programs for the poor and disabled. In most cases, patients were not aware of their eligibility for the programs. For many Indians, the enrollment program has given them access to services and prescription drugs they otherwise couldn't afford. For the hospital, the program has generated millions of dollars in reimbursements-money that can be redirected into other, underfunded programs and services. For HCFA, it means the agency is reaching more of the people it is supposed to be serving.

For Janice Woodard Morgan, the program was a lifesaver-literally. Complications from diabetes and high blood pressure forced Morgan to retire early from a clerical job with the Cherokee Nation in Tahlequah. She avoided doctors for fear the costs would consume her retirement savings. Then she met Emmett Eads, a benefits coordinator at Hastings hospital. Eads determined she was eligible for both Medicare, which would cover the $20,000 monthly dialysis treatments, and Social Security benefits, which provide $574 a month. "You just can't imagine what this has meant to me and my family," says Morgan. "I pray to God every day, thanking him for this."

There were a lot of sound business reasons to pursue the program, says Jackson, "but mostly, it was just the right thing to do. Indian people have the worst mortality and morbidity statistics in the country. We hoped we could increase access to necessary medical care," she says.

Jackson's job is to coordinate with federal and state agencies to enhance access to health care for Americans who have the most difficulty getting care-typically American Indians, African-Americans, Hispanics and people with disabilities. The historical lack of access to care for these groups is the result of many factors, says Jackson. "If you live in a rural area, frequently it's very difficult to really know where to go. And let's face it, our programs are complicated."

"It's very easy to say we're going to print brochures and have mailings. But if you haven't had a good relationship with the federal government in the past, what are you going to do when you get a letter from the feds? However, if you have a one-on-one experience with someone who knows you, knows your culture, and is sincerely concerned and dedicated, it really breaks down those barriers," she says.

An 'Extraordinary' Success

By working with agencies that have direct contact with people most likely to benefit from HCFA-funded programs, including Medicare, Medicaid and the State Children's Health Insurance Program, HCFA has been able to enroll many more eligible people who need care, Jackson says.

Jackson and Hickory Starr, the director of W.W. Hastings Indian Hospital, had served together on an interagency task force to better serve elderly Indians, and his familiarity with Medicare and Medicaid programs made Hastings a logical place to test the program when funding became available, Jackson says.

The effect of the program on Hastings has been "extraordinary," says Starr. Before the HCFA-funded benefits coordinator was hired in 1997, the hospital collected about $3.8 million under the Medicaid program. Last year, the hospital collected $6.7 million in Medicaid reimbursement payments. The increased revenues mean the hospital can improve care and services for all patients, Starr says. As a result, the hospital is planning to expand emergency room facilities, upgrade diagnostic equipment and create a tele-radiology service with a hospital in Tulsa.

The hospital now has three full-time benefits coordinators: one to focus on adults, another for women, and a third for children. Because state and federal medical benefit programs are so complicated, it is not realistic to expect patients to be able to navigate the bureaucratic maze of health care eligibility, says Starr. "You have to actively pursue the patients."

Denise Exendine, the business office manager at Hastings, says the number of patients who are eligible for both Medicare and Medicaid has increased by 14 percent since 1997. Patients with dual eligibility have lower out-of-pocket costs, because deductibles for things such as prescription drugs and office visits are fully covered. "For some of these people, that can mean an extra $50 a month, and while that might not sound like a lot, for many people around here that can mean the difference between getting care and not getting care, or getting the drugs you need and not getting the drugs you need," she says.

Jackson hopes to replicate the success of the program in other places. "We won't necessarily be able to do this exactly the same way, but we can at least get people to think about our programs and how we can do things better, more economically, more efficiently and more humanely," she says.

HCFA recently has begun working with historically black colleges and universities in Mississippi and South Carolina to enroll elderly African-Americans in programs for which they qualify, says Jackson. "We're sending young people door to door in rural areas to meet with people. Again, we don't have a lot of money for the program, but if we spend it right, we can make a big difference."