Denver Health workers often show up where you would least expect them to.  Whether it is at school, at church, or at a community gathering, Denver Health workers are there, helping the uninsured enroll in publicly sponsored insurance programs, such as Medicaid and the Colorado Indigent Care Program.  This community outreach effort is designed to increase the enrollment of eligible individuals into health programs.  A culturally diverse steering committee provides input on the best ways to interact with targeted communities.  Two bilingual enrollment specialists communicate with Latino families in Spanish. 

Project Scope

Denver Health (DH) is the only major provider in the area with the primary mission to provide health care to Denver residents regardless of their ability to pay. It provides the area's largest volume of medical services to: low-income populations, Medicaid recipients, persons eligible for Medicaid but not enrolled, persons eligible for the Colorado Indigent Care Program, children eligible for the Child Health Plan, and self-paying patients without health insurance.

Denver Health serves 160,000 individuals, about one in four Denver residents.  In 1997, 20 percent had Medicaid, 33 percent were classified as self-pay, and 20 percent were eligible for the Colorado Indigent Care Program.  These estimates suggest that the target population is approximately 90,000, about 70 percent of whom are ethnic minorities, including African Americans, Asian Americans, Latinos, and Native Americans.

The specific goals of Denver Health Community Voices are:

• To improve the health of Denver's medically underserved through innovations in community outreach, enrollment in publicly-funded health insurance, clinical case management; and
• To change public policy at the state and federal level for health program funding streams, reimbursement for community outreach and case management, and to reduce barriers to enrollment in publicly-funded health insurance.

Project Activities

Community Outreach

The Community Outreach program is designed to demonstrate that culturally sensitive community outreach to underserved populations improves the enrollment of eligible individuals into health plans and empowers communities to assume greater responsibility for health. Community Health Advisors offer information about health plans and services as well as provide health education and resource referral.  Additionally, Community Health Advisors form partnerships in each community.  To date, over 200 businesses, schools, churches, and community leaders have joined Denver Health as community partners to improve the health of their communities.

Facilitated Enrollment

The purpose of the facilitated enrollment program is to increase enrollment of eligible individuals into publicly sponsored insurance programs such as Medicaid, the Child Health Plan Plus (CHP+), and the state funded Colorado Indigent Care Program.  Denver Health redesigned the enrollment process to include centralized application assistance and enrollment support.

One aspect included the creation of enrollment specialists who help patients and families enroll.  There are now 36 enrollment specialists, 27 of which are bilingual, with at least one available at almost every DH site. Six bilingual enrollment specialists reach out to families in underserved communities through schools, churches, community events, and other community organizations. 

To support the enrollment initiative, Denver Health also developed and implemented a comprehensive application tracking database, AppTrack, which allows DH to track the progress of applications, monitor volumes, and provide quality control.  Progress in the facilitated enrollment initiative is the result of collaborative relationships with state and county officials from Medicaid, Human Services, Health Care Policy and Financing, Child Health Advocates, and the Department of Insurance.

Additionally, the enrollment initiative is attempting to make insurance more affordable to small business employers and employees.  DH is conducting research to study the effect of premium subsidies on enrollment and retention in small employer and child health plans.

Case Management

The Adult Case Management Program is designed to demonstrate via a randomized, controlled study that case management of chronically ill adults across funding streams and clinical disciplines improves health outcomes and lowers costs. If uninsured adult patients are admitted to Denver Health for the third time in one year, they are visited by a registered nurse (RN) or a licensed clinical social worker (LCSW) case manager and invited to participate in the study. 

After an initial assessment and completion of a plan of care, consenting patients without primary care providers are referred to a Continuity of Care Clinic designed specifically for this population. When patients are first enrolled in the case management program, the case manager spends a great deal of time identifying issues, accessing resources, attending clinic visits, and developing a plan for the individual. Case managers work closely with patients to identify and remove barriers they face, such as a lack of understanding of the health care system, homelessness, inadequate resources, substance abuse, and behavioral health issues. Contact may be daily, weekly, in-person, by phone, or even by e-mail. 

Community Involvement

Denver Health, with the support of the Fannie Mae Foundation, recently implemented the Employee Assisted Housing Program.  Eligible employees can borrow from their 401(a) or 457 plans, buy a home, and then pay themselves back.  Through this community-building program, Denver Health acknowledges the important links between asset development, improvement of property status, and development of good health.

Denver Health has established partnerships to strengthen its capacity to serve Denver's vulnerable populations and is one of four equity partners in Colorado Access, Colorado's largest Medicaid HMO.  Other partnerships include various state and local government agencies, such as the Colorado Department of Policy and Financing, Colorado Child Health Plan, the city and county of Denver and Denver Public Schools, and joint ventures for managed care for substance abuse treatment and mental health services.

Denver Health also continues to expand its work with community-based organizations.  These organizations include Chambers of Commerce (Denver metro, Asian, Black, Hispanic, and Women's American Indian), Head Start, Weed and Seed programs, and Minority Enterprises, Inc.