Health Home Enrollment and Primary Care Promotion

Health Home Enrollment and Primary Care Promotion

Health Home Enrollment and Primary Care Promotion:
Opportunities in a Courthouse Setting

A working group of several criminal justice, public health and healthcare stakeholders convenes monthly to discuss opportunities to increase co-location of health and healthcare engagement services in New York City’s arraignment courts. This note outlines the design and initial results of early prototype intervention testing and will continue to be updated moving forward. 

Statement of Purpose and List of Key Stakeholders:

Arraignment courts are an important site for public health intervention as they interact with populations at highest risk for developing chronic disease and experiencing the highest burden of health and public safety disparities.  Baseline surveys of select individuals passing through the Midtown and Bronx CCI sites in fall 2014 (n=233) highlighted the physical health needs of these court-involved populations and their interest in receiving care despite a relative lack of insurance coverage.  Results included:

o    Self-reported rates of Asthma (7%-24%); Diabetes (7%-9%); Hepatitis (5%-14%); Hypertension (2%-8%); and resulting hospitalizations (16%-22%) in the last year;

o    35%-50% reported visiting an emergency room in the past year;

o    20%-40% reported lack of medical insurance/Medicaid; and

o    39%-46% were interested in speaking to a health professional about a current issue.

Given the relative lack of health services in arraignment settings (compared to jail settings, e.g.) these arraignment courts present an untapped opportunity for engaging marginalized populations in the array of care services made available through the Affordable Care Act. 

Preliminary Intervention Design:

Most individuals flowing through CCI’s courts see their cases resolved at arraignment, though many still face some form of court-ordered sanction.  The opportune intercept point arises when clients meet with an intake counselor in CCI’s Alternative Sanctions department, which helps clients identify the community service options and/or group educational activities that fulfill their court mandate. 

Through a series of facilitated conversations, the group identified five core objectives that can be pursued with little interruption or cost to the court system.  To expedite replication, intervention prototypes were carefully designed with minimal additional costs to the court system, save for unavoidable administrative time commitment for planning, partnership development and oversight.  Staffing burdens on community-based partners are also minimized by focusing co-location during peak hours/days of court activity.  Key intervention components include:

1)Initial Health Screening – A few additional questions during Alternative Sanctions intake help to identify whether clients are eligible or interested in heightened services.

2)Health Home Engagement – Care coordination liaisons are on-site at peak times throughout the week and ready to enroll eligible and interested clients referred from CCI’s intake counselors.  Midtown experimented with incentives (subway metrocards) to encourage individuals to complete the enrollment process, with some success.   

3)Medicaid Enrollment/Reactivation – Community partners deliver on-site and on-call Medicaid enrollment services to eligible clients.  Many clients reporting a lack of coverage were actually found to be enrolled in Medicaid but considered “inactive” due to a variety of factors, including a failure to recertify.

4)Community-based Primary Care – Nearby FQHCs stand ready to provide direct care to individuals often unfamiliar with accessing primary care instead of Emergency Rooms.  Importantly, FQHCs are funded to provide care to individuals without active health care coverage, including undocumented individuals. 

5)Health Literacy – Recent conversations at both locations brought forth the opportunity to engage clients in health and wellness conversations, regardless of their eligibility for particular programs.  Members are now working to operationalize this fifth intervention.

Preliminary Results & Next Steps:

Front-line staff members responsible for implementing the above interventions consistently reported their greatest challenge was to convince individuals to remain in the courthouse for the extra 15 to 30 minutes needed to complete a health home or Medicaid application. Though there were several interruptions in staffing while the model was evolving, the Midtown team enrolled almost 80 individuals in health home services in its first year.  Building on this momentum, the Bronx team screened 325 individuals and enrolled 56 health home clients in the first six months, confirming the group’s assumption that moving to busier courts will lead to increased success.

This working group was launched through collaboration of key partners in the From Punishment to Public Health (P2PH) initiative, including:

NYC Department of Health and Mental Hygiene (DOHMH),
John Jay College of Criminal Justice,
Center for Court Innovation (CCI),
New York Academy of Medicine (NYAM),
Vera Institute of Justice, and
CUNY School of Public Health.
 In addition to the P2PH members listed above, community partners currently working to refine court-based intervention options include:
Brooklyn Health Home, Maimonides Medical Center, Empire Blue Cross Blue Shield,
Coordinated Behavioral Care Health Home,
NADAP (Health Home enrollment at Midtown),
Ryan Chelsea Clinton Health Center (a Federally Qualified Health Center (FQHC)),
EAC, Inc. (Health Home & Medicaid enrollment in the Bronx), and 
Bronx Lebanon Hospital.