An Example of how HECAC's CHANCE system can help a family in need of Wellness
For the consumer, the process of getting services from HECAC's CHANCE system will be as easy as it is useful.
Here is a scenario of a "composite" family with similar problems to the counties that we will be helping:
Hector Lopez is a construction worker currently laid off due to the current economy and slowdown in new construction. He is still working on a per-job basis for a few firms, but the work is not consistent and he has no benefits. His wife, Maria is a nurse at a public health clinic with an RN certification but does not have a Bachelors degree in nursing. She has been informed that her job may be eliminated, due to budget cuts, and that may leave her with a choice of taking a position with less pay and fewer benefits or trying to get a home nursing position, but her choices may be limited, due to her lack of a BN degree. They have three kids. Maria is concerned that the oldest, Mario, may be getting involved in gangs, due to peer pressure at school. Their middle child, Erlinda, is 16 and may becoming sexually active. The youngest, Marta, is medically fragile, with allergies and a heart murmur and does very well at school.
Like so many families, their days and nights are filled with an uneasy feeling of impending financial and lifestyle disaster. Maria, concerned with the welfare of her family finds out about the HECAC CHANCE system through a flyer at her church, and the recommendation of her pastor. She sits down at the home computer with Hector (although she could have accessed the system at the church or local library, as well) in an anonymous or confidential mode, she inputs general information about her family, such as demographics, ages, income and education levels, etc. Then she and Hector go through a checklist of questions with yes/no answers, as well as questions with "Likert Scales" of 5 possible answers, from "least likely" to "most likely". The system asks questions about insurance, family health history, current health situations, and questions regarding the status of family situations in the other dimensions of well-being, including education, spiritual, environment,economic and social problems or assets.
Once the data is entered and submitted, several things happen. First, for the Lopez family, a interactive profile has been created that gives them the resources they need for their family's well-being. If finances are a problem, resources are given to help them with short and long-term needs, possibly including ways for Maria to get her BN. If they are uninsured or underinsured, they will get the connections to help them find the low cost or no-cost insurance they need to achieve their health needs, with an emphasis on prevention, as well as taking care of acute needs.
One of the most frustrating things that families deals with is finding healthcare providers that accept the insurance they have. Too often, a family has to spend hours trying to find providers that accept their Medicaid or Medicare plans, or they deal with the embarrassment of being rejected at the Registration Desk by healthcare providers when patients disclose their insurance plan, especially when the self-pay option is not viable. The CHANCE system will match up the needs of the family with physicians or clinics that will meet their health needs and accept their payment system.
The providers that will be in the system will be a vast mixture of for-profit providers and not-for-profit organizations, so many different needs can be met. For example, if a 501(c)3 organization is available to work with Mario and move him away from gang-activities thru a diversion program that will empower him, that resource will belisted in their profile. Women's health care needs, including counseling for Erlinda will be posted. In an age where even great programs like Healthy Kids, or SCHIPS insurance programs are affordable but not accepted by many providers, the system will offer the names and contact information of physicians that accept the insurance the consumer has, and keep little Marta healthy and out of the Emergency room, where the average bill starts at $1000.
For each of the resources given in the profile, Maria can click on the name of the provider and connect with them. Based on the systems used by the providers, in some cases, she can make appointments to see the providers on-line, and the system can give the provider her information in advance, to speed up patient registration, if the Maria allows her information to be submitted online. The providers can contact her to verify and remind her of the oncoming appointments. The Lopez family can also have the option of contacting the provider by phone..Once contact has been made and the providers have met with the Lopez family,Maria or Hector can go back to the system at any time by signing in with their username and password from any computer, update their profile and evaluate the providers utilized, by answering questions with a click of a mouse or short answers about how the were treated and whether their needs were met.