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INFORMANT INTERVIEWS AND DOCUMENT REVIEW RESULTS

4.3 Interview Themes

4.3.6 Outreach and Education Barriers

The biggest concern of almost every informant for this research was the lack of outreach and education about P4HB®. These informants cite the lack of appropriate and continual outreach about P4HB® as the main reason enrollment and utilization of services has been low. Informants felt that there has not been enough outreach to the public as well as providers about the program. Furthermore, they expressed concern that there is (still) a lack of available information about the scope of services included in the program, the amount of documentation required for enrollment, and the different components of the P4HB® program. The barriers identified in the interviews are grouped according to three categories: 1) RSM client outreach; 2) IPC outreach; 3) Provider outreach; 4) General outreach.

RSM Client Outreach: Four out of the five public health providers explained problems with outreach to RSM clients who may be eligible for P4HB®. One provider in the Atlanta area who works in a large county health department, has not seen one IPC

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enrolled member in the 18 months of the program. This provider thinks DCH “has not done a good job of telling pregnant women in RSM about the program.” She has also noticed that RSM clients who are auto enrolled in P4HB® are not aware of their status. In December 2011, DCH began auto-enrolling RSM and Peach Care clients into the

program. RSM clients were supposed to be notified in their 8th month of pregnancy and again after delivery that they are going to be enrolled in P4HB®. The provider wished DCH had done “intense marketing, you know really making sure that whoever and wherever the woman had the opportunity to seek services and get services.”

A CMO representative also worries that women enrolled in P4HB® from RSM are not aware of the program. She used a car analogy to describe this confusion: “Women in RSM who are used to the fully loaded option of DCH services are given the car “with no sunroof, a basic radio, and rolled up windows…these women are used to the full flush of benefits under their previous plan and now this plan is more limited.” In addition, women don’t know they are in the program or what services are covered.

IPC outreach: Several informants were worried that women are not being enrolled in the inter-pregnancy care component (IPC) of P4HB® due to the lack of patient and provider outreach. One state agency representative thinks that hospital Neonatal Intensive Care Units (NICUs) should have received more training about the program from DCH.

The representative feels that these are the locations where most women are located who deliver a VLBW baby. The representative further explained that DPH has contractual relationships with regional perinatal centers, where most of these births occur, these relationships should be explored more and outreach provided on a continual basis. One provider also voiced this concern and has been actively working to provide outreach and

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education to Atlanta-area NICUs. The provider has also approached DCH to develop a web-based training for perinatal centers and NICUs throughout the state.

Interestingly, the interview with the Resource Mother revealed a lack of understanding about the IPC component as well. This informant did not know that

P4HB® women she assists are in a special component of the program that provides access to primary care services. She described her role as providing support to women after they deliver a LBW baby and informing them that they are eligible for family planning. She acknowledged that she works with a case manager who may assist women with accessing medical care. The two social workers interviewed for this study also expressed confusion over the nature of IPC. One social worker who works in a NICU in an Atlanta-area hospital is responsible for contacting women in the hospital after delivery and informing them about P4HB®. She had never heard of the Resource Mother services and simply tells women P4HB® is a health care program for women who deliver a pre-term baby.

Once a woman applied, she hands off the follow-up responsibilities to a hospital case worker. Another social worker who works in an Atlanta-are NICU was only told about P4HB® in June 2012, 18 months after the program began. She has worked in the NICU for 4 years. Therefore, there is a lack of information about IPC mainly due to the lack of outreach to appropriate providers.

Provider outreach: Representatives of both the provider organizations as well as some of the providers interviewed for this study described a delay in learning about P4HB®. One informant who represents a provider organization in Georgia explains that despite meetings with DCH after the waiver was approved, there was still a lot of confusion about how providers were going to enroll eligible clients, what services were

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covered, and how billing of these clients is supposed to occur. The informant indicated that several attempts to get such answers from DCH were fruitless. As a result, the provider organization developed their own outreach materials, which included provider newsletters and a blast fax. This organization still fields questions from providers about the enrollment and billing issues. Another provider organization representative said “our doctors don’t know about this..their patients don’t know about this.” She has joined another provider organization to approach DCH about their concerns about the lack of outreach. This organization has also asked a provider who is knowledgeable about P4HB® to do presentations at their physician meetings.

Among the five public health providers interviewed for this study, a majority (3) were informed about the P4HB® program in early January 2011 at a women’s health coordinators meeting. At this meeting, they were told that women at their clinics may be eligible for P4HB® and were told to distribute flyers to eligible clients. At this time, they were expressly told NOT to assist with enrollment. This mandate later changed, as described below. Only two of the informants knew the program included the IPC component. All providers were aware (and concerned) that eligible women could

possibly choose a private physician, and therefore, P4HB® would have a negative impact on the Title X program by taking away clients.

General outreach: Comments were made throughout many of the interviews about the overall lack of marketing and outreach about the P4HB®. One advocate explained, “I don’t think it was ever effectively marketed. Now everyone’s pointing fingers, like well, you’re not doing your job, we don’t get the information you’re

supposed to be providing.” This provider thinks DCH should have done more marketing,

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and that other agencies, such as Women Infants Children (WIC), and the Department of Family and Children Services (DFACS) should have been responsible for more outreach.

Several informants explained that their concern about outreach was voiced early to DCH before the waiver application was completed. One state agency representative who was familiar with other state’s family planning waivers, recommended to DCH that outreach be a billable service. An advocate voiced this same request to DCH because she knew that “then you’re going to have more likelihood of outreach activities occurring to ensure enrollment utilization.” This informant was so passionate about the outreach that she felt it was her primary duty to:

to keep a focus on including outreach as a component of the waiver. One of the things I have learned from DCH consultants that I had spoken with is that it is actually one of the most important things to include in any waiver..and so almost every meeting ,actually every meeting I asked about that..and I was told that yes, you know…and the truth is it (the waiver application) didn’t include outreach, which I think is a big problem.

DCH and CMO representatives described many marketing and educational efforts undertaken to advertise P4HB® once the waiver was approved in October 2010. The DCH representative felt that the LBW workgroup was kept well informed during the time the DCH was waiting to receive approval from CMS about P4HB®. This DCH official asked these members to spread the word about the program, and specifically asked the CMOs to begin working on their outreach materials. Once the waiver was approved, DCH released a press release and ordered radio and TV ads to be placed throughout the state about P4HB®.

DCH also secured funding from the Department of Public Health to conduct marketing for P4HB®. DCH “reached out to public health early on and they had agreed to

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provide us with funding to market the program.” This funding was discussed prior to the waiver’s approval for the amount of $150,000. The marketing costs for the first six months totaled $50,000, with the remaining marketing costs spent before the end of 2011.

There were no more funds secured for the continuation of outreach for P4HB® beyond the first year. Several informants felt this should have occurred, and that additional and continuous marketing about P4HB® is needed. As one state agency representative put it,

“especially with a short-term program like this, I think marketing should be something that’d one continuously, ongoing, and then in a mass media format.”

Two of the three CMOs representatives interviewed for this study explained that outreach continue to be conducted for eligible members and providers. One CMO representative described the plan’s current outreach plan as a “no stone unturned”

approach. Even though the CMO now has 10,000 P4HB® clients due to the auto

enrollment process, only 25% of these are using services, so educational efforts are being made to inform these current members to increase utilization. A second CMO

representative explained that the plan is currently reviewing several strategies to increase enrollment. They have so few IPC enrolled members, that their particular focus is on how to educate more providers and patients about this component of P4HB®.