mary windishar: good afternoon and welcometo today’s webinar, increasing health insurance marketplace open enrollment, sponsored bythe substance abuse and mental health services administration in collaboration with the officeof national drug control policy. i’m mary windishar, today’s host. here are a few announcements before i turnthe event over to today’s moderator, tom hill of samhsa. this webcast will be interactivebetween you and the presenters. the console on your screen can be completely customized.you can resize or move any of the windows that are open. at the bottom of your audienceconsole, there are several application widgets you can use. for example, if you have a questionfor our presenters during the webcast, just
click on the q&a widget at the bottom to submityour question. we’ll answer them during the last segment of the presentation. if werun out of time, left-over questions will be answered later via email. and we do captureevery question. a copy of today’s slide deck is availablein the resource list widget. that one looks like a green folder and that one is at thebottom of your screen. we also have a participant assessment today that we encourage you tocomplete. you can find a widget with the survey questions at the bottom of your console. youmay complete this participant assessment any time during the webinar or at the end of thewebinar. we welcome your feedback. you’ll be able to access a recording and transcriptof this webinar on samhsa’s website in the
near future. finally, if you’re experiencing any technicaldifficulty, please visit our webcast help guide by clicking on the help button belowthe presentation window. just hit the question mark icon for solutions to common technicalissues. now, here’s today’s moderator, tom hill,csat acting director at samhsa. welcome, tom. tom hill: thank you very much. welcome, everybody.this is tom hill. as was mentioned acting director of the center for substance abusetreatment at samhsa. and a thrill to moderate this great webinar entitled increasing healthinsurance marketplace open enrollment. as we stated earlier, this is a collaborativeevent between samhsa’s center for substance
abuse treatment and the office of nationaldrug control policy. and what we’re here to do today is to discusshealth insurance enrollment during the 2015-2016 open enrollment period for state health insurancemarketplaces. in this webinar, we’re going to explore how-to examples for enrollmentboth in expansion and non-expansion states targeting prevention, treatment, and recovery,and community-based organizations. specific attention will be given to strategies forenrolling individuals with substance use disorders. in this webinar, we’re drawing upon theexpertise of several national and community-based recovery organizations to discuss ways inwhich they are addressing the specific needs of individuals with substance use disordersand ways to enroll them in health care plans.
the goals are to help individuals understand,and enroll in health insurance coverage and to gain access to needed care. we’re very proud to be able to kick offthis webinar with two very important leaders. i’m going to introduce both of them verybriefly. but in all my introductions, know that more elaborate bios are available todownload online. i really take great pleasure in introducing kana enomoto who joined samhsain 1998. and during that time has held very many important leadership roles includingprincipal deputy administrator. and in august of this year, she was appointed into the positionof acting administrator of samhsa by health and human services secretary sylvia burwell.and now kana leads samhsa’s 600 employees
and manages a budget in excess of $3.6 billion. so with that, i’m going to turn it overto you, kana. kana enomoto: thank you, tom. and good afternoon,everyone. i also want to welcome mr. tom hill as the acting director of csat. he has graciouslystepped in since he just joined us last month. so thank you, tom, and welcome to you as well.i’m so pleased to be partnering between samhsa and ondcp and to be presenting todaywith director botticelli in this webinar. we’re so enthusiastic about open enrollment3 and this opportunity to engage our stakeholders and their efforts to get the uninsured folksin this country enrolled. we’re currently in week five of open enrollment3. it began on november 1 and runs through
january 31. and thanks to the affordable careact, there are millions of individuals and families now getting important preventiveand behavioral health services. we know that combined with mhpaea or the mental healthparity and addiction equity act and the aca, over 60 million americans have access to newor expanded behavioral health benefits. and early data are telling us, particularly forthose under 26 who are among the first to benefit from the expanded coverage of theaca, young people are seeing more or getting more behavioral health services through insurancethanks to their expanded coverage under the aca. so this is good news for us. the affordablecare act remains a priority not only for the president, the administration, the department,or secretary, but it’s very, very personal
for samhsa as well because our populationsare so greatly affected. on the fourth week of open enrollment, thisyear almost 395,000 people selected plans using healthcare.gov. and in total, we haveover 2 million plan selections since november 1. this is great progress. part of that, becausepicking a plan and signing up for coverage are easier this year. so healthcare.gov haslaunched new tools like out of pocket cost estimator and doctor look up and prescriptiondrug look up because they listened to consumers, and then figured out what was important toconsumers in selecting a plan and they gave them those tools. so consumers can know whichof their doctors and prescriptions may be covered by which plans. you can even applyusing your smartphone.
and as well, financial help is available.about eight out of ten people who enrolled in health coverage through healthcare.govqualified for financial health to make their monthly premiums more affordable. in fact,most people can find health insurance plans available for $75 or less per month. affordabilityis so crucial and we’ve heard this over and over again from the populations we serve. now, in just a few minutes, you’re goingto hear from our speakers about the successes that they’re seeing in states and how they’veovercome challenges to getting the uninsured enrolled. and you’ll also hear the storyof a person in recovery who has benefited from the affordable care act. very inspiring.
so as you listen today, to our speakers, ireally encourage you to get involved yourself, to make good use of the resources that areavailable. go to the centers for medicare and medicaid services website. look at thehealth insurance marketplace open enrollment snapshot from week four and see how your stateis doing. get your data on enrollment. use those to persuade others to get involved andto get enrolled. we need your involvement to reach more americans and to help them getthe healthcare that they need. so thank you very much. tom hill: thank you, acting administratorenomoto. kana, thank you so much. we have another leader i’d like to introduce andtake great pleasure in doing so. that’s
michael botticelli of the office of nationaldrug control policy, ondcp. he’s a director sworn in, in february 2015. and prior to that,he was the deputy director that came to ondcp in 2012. he leads the obama administration’sdrug policy efforts to attain a more balanced public health and public safety approach todrug policy reforms. with that, i’m going to turn it over to you, michael. michael botticelli: thank you, tom, for thatintroduction. and it’s really a pleasure to be with you and acting administrator enomotoon this call today to talk about increasing health insurance marketplace enrollment. it’sreally a pleasure to be with other speakers as well who would give us some really goodexamples on how we increase enrollment and
participation. i think we all are acutelyaware that one of the historic barriers to getting care is lack of insurance coverage.and with that, we all have an important role to play to ensure that people in need of bothmental health and substance use disorder services get help they need by enrolling in the healthinsurance marketplace. we’ve heard from tom and kana about therole that your organization can play in helping to get people enrolled. our goal is to makesure substance use disorder services are available to everyone who needs them. and we are workingto expand access to treatment and integrate treatment for substance use disorders intomainstream healthcare. because of the opioid epidemic, we are workingespecially hard to increase access to medication
assisted treatment for opioid use disorderswhich should be a covered benefit by most health providers. as kana discussed, the patientprotection and affordable care act allows us to expand access to substance use disorderservices. and together with parity, we’ll extend access to substance use treatment andmental health services for an estimated 62 million americans and help integrate theseservices into mainstream medical care. thus, full implementation of the aca gives manymore americans in need substance use treatment and opportunity to be treated. this is a particularlyimportant goal to ondcp and a prime goal of our national drug control strategy. in november, the obama administration launchedthe healthy communities challenge to engage
key communities with large numbers or highpercentage of uninsured in states across the country where strong federal, state, and communitycollaboration can help reach the uninsured. through this challenge, we are calling oncommunity leadership to build outreach effort to reach those remaining uninsured and helpthem gain coverage. at the end of this third enrollment period,the department of health and human services along with state based market place will publishtallies of new marketplace sign ups in participating communities. these tallies will be comparedto hhs estimates of the number of eligible uninsured people at the start of open enrollmentto see which communities made the most progress during the challenge. the victorious communitiesget first and foremost bragging rights, secondly,
a healthy community, and a third, a visitfrom president obama to celebrate their success in helping ensure every american has healthcoverage. the next slide shows the website in termsof where you can go to look up coverage. we’re just advancing that slide now. there you go.www.healthcare.gov gives you tremendous amount of information around plans and benefits.and for more information on ondcp and our work, here is our website. so with that, iwill turn it back to, tom. tom hill: thank you so much, michael, andthank you, kana, for those inspiring and knowledgeable words. and great introductions and welcometo the webinar. next, we’re going to be hearing from three different community-basedleaders and some of the work that’s been
happening on the ground, enrolling our folksin healthcare coverage. and i’m going to start with -- the firstspeaker is rylee curtis. she is a senior health policy analyst for the utah health policyproject. and she’s going to be sharing her experience in conducting outreach and enrollingparticipants in utah which is a non-medicaid expansion state. our second speaker is zac talbott. he is currentlyserving as the director of tennessee statewide and northwestern georgia chapter of nama recovery.and is a certified medication assisted treatment or we call that mat advocate. so the certifiedmedication assisted treatment advocate is called a cma. and as a cma, zac has visitedmany opioid narcotic treatment programs across
the country especially in the states of georgiaand tennessee. and he has advised opioid narcotic treatment programs on patient centered care,best practices, and regulatory compliance. important stuff. and our third speaker and final speaker iskate segel. she is a senior manager at health care for all in the state of massachusetts,the commonwealth of massachusetts where she leads a consumer health assistance programthroughout the state. she has been instrumental troubleshooter in the effort to broaden theaca reach to massachusetts residents. so with those three introductions, i’m goingto circle back to rylee and turn it over to you. take it away, rylee.
rylee curtis: thank you. thanks for havingme on this call today. they had originally reached out to usara and so i’m going toflip here to our logos. just so you know, utah health policy projects where i work for,we do two types of service. we have a policy and advocacy side of our organization whichis what i’m part of. and we also do direct enrollment. so we’re the lead navigatorgrantee for the state of utah. and we partner with united way 2-1-1 in our primary careassociation to do direct outreach and enrollment to populations that need access to healthinsurance. and then we also partner with usara, utah’srecovery community, and they couldn't be here today but i want to make sure you all knowwho this organization is in utah. and in case
you weren’t aware, usara was awarded the2015 america honors recovery joel hernandez award, so all of my slides have been in conjunctionwith them. so the topics that i want go over brieflytoday are challenges with being a non-expansion state and enrolling the specific population,how to engage the recovery community and health advocacy and challenges and successes of enrollingrecovery community in a non-expansion state. and then as you all are aware, there’s about30 states and dc that have expanded medicaid. and utah is one of 20 states that have notyet expanded the program under the affordable care act. so i show these not to give you a lesson inwho qualifies for medicaid and who doesn’t
in utah, but i want you to know that we dida lot of outreach in the beginning to help utahns in recovery advocate for their ownhealthcare coverage. so these new couple slides that i’m going to go through, this is whatwe showed utahns in recovery. we showed them these slides and gained their support in advocatingfor medicaid expansion in utah. so really we just went through who qualifiesfor medicaid, who doesn’t, how many utahns like them who are in the medicaid coveragegap. and we go through what they can do about it. so we really wanted to make it -- whenyou’re talking to folks in recovery, you’re really just a general public at large. talkingin federal poverty level percentages is really difficult for folks to understand. they don’tknow what the baseline is. and so we try to
make it as easy for them to understand aspossible. so you can see we have people like them. we always tailor our slides when wetalk to different groups. and so you can see these pictures are from our rally for recovery.and so it’s people like them, people they may actually know who have been actively involvedin these campaigns. and then we put dollar figures to what the poverty level and we tryto make it very visual and easy to understand. and then going forward, so just briefly, whatwe kind of do in terms of advocating for medicaid expansion in these realm of recovery. so thisis a one-pager that we used. we really hit hard on the criminal justice angle of this.and we can learn from other states who have expanded. so if you happen to be in a non-expansionstate, this angle works and resonates really
well with law makers. it’s very clear thatcriminal justice savings that can be seen through medicaid expansion and using yourrecovery communities and health advocacy orgs -- and people in recovery is a really greatway to deliver some of these messages. and again, we worked really closely with ourcounties. our counties are the ones who deliver behavioral and mental health services. andso we worked closely with county officials to deliver this message up to the legislature.this is an example of advocacy from utah and the leaders tying in recovery to health coverage,the need that’s necessary. and then just my favorite piece of this isat the bottom. it says -- many of these women will have not have access to health insurancewhen they’re released into the community.
and this is very true in non-expansion statesthat you have folks going out of the criminal justice system into halfway houses or supportservices. and then once they’re released, they’re falling into the coverage gap. theycan’t get access to care. so part of recovery is talking about healthcarefor yourself. so usara and uhpp, we did a lot of outreach. we went to where the peoplewere. we didn’t try to hold events where we tried to get people in recovery comingto them. we actually did a lot of outreach to people where they were. so usara beinga recovery committee, they had a lot of groups that met in their organization. we went tohouse of hope, odyssey house, first step house, the boa a lot of these names and organizationsthat i’m sure you all have similar organizations
like them in your state. so these all hadpeople concentrated in them. they were meeting, they were peer support services. and so wetook those previous slides that i’ve showed you, we went in there, we did advocacy, weshowed them people like them, we explained why they’re not able to get healthcare coverage. and then we tried to present this as an opportunityto why their stories mattered. so we showed them people like them who shared their storieson how they can get involved as well. and then i think it’s important to note thatwe use a lot of faces and voices guidelines in terms of how to share your story. so wefollowed those guidelines, usara did a lot of the help in that sense being a recoveryorganization, they know exactly how to talk
about recovery and what’s comfortable andnot comfortable. we just kind of assisted in terms of things that law makers might wantto know when they do advocacy work. so you can kind of see some guidelines here whendid you first apply for healthcare, when did you seek treatment when you needed it, whenyou did you find out you were in the coverage gap, and those types of things. so in this slide right here is my shamelessplug for how incredible utah’s recovery community is and how dedicated they are forenrollment in medicaid expansion. they hold the rally for recovery in late march. that’sthe last month of our legislative session here in utah. and they have thousands cometo the capital and rally for recovery. the
last three years, medicaid expansion has beena top priority for them. and you can see here’s a booth at our -- i think this is the artfestival or it might be the pride festival where they have us come and we do enrollmentsat their booth for their population. they have a sober safe zone at these events. theyhave us do outreach for medicaid expansion and story banking and services. and so that’sjust my shameless plug. and then moving along quickly, so again, youcan see how we use recovery stories. and it’s all about having them see people like themand understanding that their voices have power and their stories have power so enrollingthe recovery community in a non-expansion state.
so this has been difficult. take care utahis our navigator organization here in utah. across the state of utah, they employ 50 to100 navigators who sit down, do direct enrollment. and so these last couple of years, we havestarted to focus on how to enroll the recovery community in health insurance. so in 2014,we started at the orange street halfway house in salt lake city, utah. and we started itand we were very hopeful. but it didn’t work out because it turned out a lot of peoplethat we were trying to enroll fell into the medicaid coverage gap. so in 2015, we kind of learned from our mistakes,tried to really target organizations that had a high percentage or at least a higherpercentage of folks who might actually be
eligible for coverage under the affordablecare act. so what i want to go through is bonnevillecorrection center. we had a navigator set up a presentation to their staff. and he workedwith them to find a path forward. and it really was about talking through different solutionsand that garnered buy-in from the staff. that was one of the problems as well. we workedwith davis county, dora, the drug court up in davis county. and they didn’t have buy-inso they weren’t willing to work with us to find ways to get this community enrolled.so the problem that we found even still, is that there’s not a day of release or whenthey receive new people. so what they’re going to do now is have their navigators bepart of the orientation process which will
have a navigator on their facility on wednesdays. and then salt lake county criminal justiceservices, this is an interesting one because this actually started out of salt lake citybeing part of the healthy communities challenge. we wanted to work with salt lake county toincrease our enrollment because, of course, we would love to have a healthier community,have bragging rights, and have president obama come to our city. so this was one way thatwe could get involved. and we really singled out the criminal justice services as an opportunityto enroll folks who absolutely need the healthcare. so luis our navigator, he’s there on mondaysfrom 12:00 to 4:30. and i stole this slide from him. this is how he keeps track of whohe serves. and so you can see it’s fairly
new and we’re still learning how to targetpeople, what’s the best ways to reach them. but you can see that he's got about 14 peoplethat he’s reached out to, four applicants have selected a plan on healthcare.gov. fourhave applied for medicaid and chip in the state. he said that most of the individualshave been adults. because before what he was seeing was that the adults were followingin the coverage gap at orange street or the bonneville correctional center, but they wereable to get some of their children enrolled in chip in utah. but it turns out that withthis population that you’ve got a snapshot of, that most of them, their kids are alreadyenrolled in medicaid or chip already. so we want to streamline enrollment as bestpossible in our non-expansion states. we all
realized -- this slide is a little messedup, sorry for that. but we all realized the importance of getting these folks enrolledin healthcare coverage. but we also realized our limitations especially being in a non-expansionstate. so going forward, what we’re going to aim to do here in utah and any feedbackfrom other states too what they’ve done. i know this isn’t live for you guys to askquestions, but following up and things for these organization, samhsa, to work on is,how do states that are non-expansion states -- how do we do more outreach to halfway houses?how do we get these -- really focusing in on the folks who might qualify in non-expansionstates for aca insurance? one struggle is that, being in a halfway house,you’re not eligible for health insurance
until you’re actually released because thestate looks at that as being adjudicated or being incarcerated. so that’s an issue forus in non-expansive states. or i think in expansion states as well. but what we’regoing to focus on is more outreach after this open enrollment period. and that’s okaybecause i think it’s important for folks to remember that being released from incarceration,that qualifies as a special enrollment period. so you don’t have to be released in an openenrollment period in order to qualify. so anytime you leave a halfway house, anytimeyou leave jail, anytime you leave prison, you will be eligible so long as you’re abovethe 100% poverty level threshold to qualify for help on healthcare.gov or your state'sexchange.
so best practices that i would recommend,we would recommend for states, is working with case managers and therapists to get buy-in.it’s going to be up to them to make this part of the either orientation process orthe discharge process. so you need to make the case for them why it’s important tohave these navigators assisting them. and every time they see someone -- yes, i meanthese are the people who were asking folks, do you have health insurance? can you go seea doctor? and so if they know where to connect these individuals to, to get help, that that’swhat we need for this community. so if you have any questions, you want totalk offline about things that utah has done. here’s our contact information for bothour recovery community, usara, and for myself
at utah health policy project. and with that,i will turn it over to zac talbott. zac talbott: okay. thanks, rylee. again, myname is zac talbott. i appreciate being able to be a part of this webinar. in additionto my advocacy work with nama recovery when tom introduced me, he told you a bit aboutthat, nama recovery primarily is advocates for people who are in recovery from opiateor opioid addiction. and primarily advocates for patients of medication assisted treatment.so patients who are enrolled in a treatment that includes the use of one of the threefederally approved or fda approved medications for opioid addiction which is either methadoneor buprenorphine which mostly people know as suboxone, subutex, zubsolv, bunavail. orthe third medication now which has been approved
a while, but the formulation of naltrexoneis vivitrol which is a once monthly injection that’s a non-narcotic blocker only. so we primarily advocate for those patientsand those treatments. but in addition to the advocacy work i do, i’m also an individualwho is in long-term sustained recovery from opioid addiction who -- my recovery has beenpossible because of and is supported by a medication. and so i have some personal experiencedealing with insurance pre-aca and the parity act as well as post-aca and the parity act.and so i wanted to tell you, talk a little bit about that today, more as a person inrecovery. and then also some of the things in our advocacy work that we have seen aroundthe parity act.
the two states where i’m primarily locatedtypically, tennessee and georgia, those are non-expansion states. so i will just go aheadand say that out of the gate. i personally had a blue cross blue shield tennessee policy.i’ve had the same policy since 1999. i had my own, it’s as an individual policy, nota group policy or anything, that i bought through the tennessee farm bureau which isa group that sells insurance. and the health insurance that they offer is through bluecross blue shield of tennessee. though there was some behavioral health coverage on mypolicy, never covered a dime of my outpatient treatment at a comprehensive opioid treatmentprogram. for those of you who don’t know, an opioidtreatment program, when you hear that or an
otp, some people call them, they’re alsoknown as narcotic treatment programs or ntp, those are comprehensive centers where youget a variety of things. typically, the treatment modality will include one of the three medicationsi mentioned before for opioid use. but in addition to that, there is a full staffof substance abuse professionals including licensed and/or certified addiction counselors.so it’s really steep in individual counseling. and there’s group therapy. there’s alsoa full medical staff. so you having yearly physicals and other visits with the physician,regular drug screens. you see a nurse every day in the beginning. so it’s really a comprehensivetreatment center. but because there are so many services offered in an opioid treatmentprogram, medication, counseling, group therapy,
medical treatment, seeing the doctor, nurseassessments, lab work, drug screens, all those things they typically -- to make it accessibleto people, historically there has been a single weekly rate. sometimes they’ll do dailyrate for people who have jobs like maybe waitresses or somebody who’d be easier to pay daily. so they’ve done a bundled rate, and by bundledrate, i mean there’s one weekly rate or daily rate or monthly rate and that coversall of that. all of your treatment, your medication, your counseling, your group therapy, yourmedical, all that stuff is covered with that one fee. and so historically, the insurance companies,they’ve really known what to do with that.
and they’ve never really cared. my treatmentis just under $400 a month. and so for years, even though i’m in long-term recovery now,i still go back at least monthly and i still see my counselors because i know that i’mdealing with a chronic relapsing disease. and i want to stay plugged in even thoughi don’t need that intensive daily help anymore. and so for years, i’ve paid out of pocketalmost $400 a month. and, if you think of that, that’s in some parts of the country,that’s close to what some people pay for rent or mortgage, in other parts of the country,it might be half or a third. the point is, that’s a huge benefit. and for that to beongoing, not many people can do that. certainly not people that are living close enough tothe poverty line that they may qualify for
medicaid or other things. so since 1999, inever got any help whatsoever for my opioid treatment. back in 2013, of course, the aca had alreadybeen passed but it hasn’t been fully implemented, i started hearing a specifically methadoneand buprenorphine advocates because vivitrol has not had such a history of discriminationfrom insurance companies. partly because it’s so new and a lot of it, talk, and its usehave come in and kind of post aca. but it started here in advocates and the treatmentcommunity, national, regional conferences, start talking in 2013 about in january 2014,the affordable care act was going to go into full effect or it would have been fully implementedwhere they did it in stages.
and so advocates and people and treatmentprofessionals started saying -- well, maybe, it sounds like in january 2014, insurancecompanies and medicaid, medicare were going to no longer be able to discriminate againstsubstance abuse treatment or be able to discriminate against specific kinds because it’s notlike medication assisted treatment with methadone and buprenorphine, it’s not like that’san alternative treatment. we’re talking about what the national institutes of healthhas referred to as the gold standard treatment. they were talking specifically about methadonein that case. the center for disease control and prevention has referred to it as the mosteffective treatment. it’s the standard for care for pregnant opioid dependent women.so this is the most recommended and most proven
effective, most evidence based treatment,yet it was still being discriminated against. so january 2014 arrived, with that, the fullimplementation of the aca. and so the hope was that the provisions about behavioral healththat were within the law would prevent insurance companies whether we’re talking about publicpolicies, publicly funded policies like medicaid or medicare or private policies, from beingable to continue to discriminate because people that are patients of opioid treatment programs,are still having problems with medicare. so this is not just an issue of private policydiscriminating. in medicaid, it really depends on the state right now. and so we were hopingthat that would kind of force insurance companies to no longer be able to discriminate.
so in 2014, we saw some change. change wassporadic. of course, that was the first year it’s been fully implemented. but we didn’tsee a whole, whole lot of change. but then the mental health parity and addiction equityact which we know is the parity act, parity, that word means equality, that then finally,was fully implemented in january 2015. and so it’s kind of a combination, the aca cameinto full effect, and then the obama administration had finally implemented the parity act whichwas actually, originally signed into law, i believe, under george w. bush, but it wasthe obama administration that fully implemented parity. and so you had aca come into effect in 2014.right behind that parity act, both these federal
laws were finally in full effect. so in decemberof 2014, i got a letter -- i apologize, the slides since it was sent out by blue crossblue shield of tennessee. my letter actually came, i believe, from tennessee rural healthwho is the farm bureau. i have blue cross blue shield of tennessee, but farm bureauhealth plans is who administers it. but nonetheless, i got a letter in decemberof 2014 and it stated among many other policy changes that would go into effect januarythat year, that pharmaco therapies for substance use disorders such as methadone and buprenorphine,will no longer be included on the list of exclusions. and so a policy that i had hadsince 1999, a policy i had been paying for and i had for more than 15 years, finallywas going to strike my treatment from the
specific list of exclusions. so that letterwas a huge deal. and the letter cited due to changing federal law, well, we know whatthose changing federal laws are, combination of the affordable care act and the parityact. and so even though my state of residence whichis tennessee, is not an expansion state, and i feel that that’s unfortunate for manyreasons, but the medicaid expansion is one part of the aca, but the provisions of theaca and then on top of that, the provisions of the parity act, that’s federal law. sowhether or not you are a medicaid expansion state, the federal law and the provisionsof that law, are still going to stand whether or not your state has expanded medicaid ornot.
of course, then come january, opioid treatmentprograms, because of its history of discrimination, had never really dealt with third party inmany of them, and specially in the southeast had never really dealt with billing insurance.and so most of them were working very well with their patients. and to help the patientsget whatever paperwork or documentation they need, to then submit for reimbursement theirself. i mean this is a lot of change in a short amount of time. and so after the first quarter of this yearwhich would have been around the first part of april, the first quarter would have beeninto the march, i got printouts from my treatment center. and then there was a lot of confusionbecause a lot of folks when you just go to
the doctor and you’re handing your insurancecard, you don’t realize you got all these codes that the insurance company needs. yougot diagnosis codes, procedure codes, and such. and so there was some confusion amongstthe coding, and normally your doctor handles all that or the billing department of yourhospital or your doctor’s office. and so here, the treatment centers and thepatients and patient advocates are all trying to figure out the coding and there was someconfusion. then we got into the second quarter of 2015 and i still haven’t gotten the checksfrom first quarter but i submitted paperwork in for second quarter. finally, a couple weeksafter i submitted my second quarter paperwork, a check arrived. and i was reimbursed, thepercentage that my plan allows for outpatient
behavioral health treatment. so more than15 years of having a policy, finally, this year because of the aca, and because of theparity act, i am now finally being reimbursed under my health plan. now, of course in october this year, we changedcodes to the new icd-10 codes, so we’ll see what happens with fourth quarter. butnonetheless, change takes time. but there is now hope. it’s not happening overnight.i certainly, in my work, with advocacy work with nama, we still hear from patients. otherpatients had blue cross blue shield of tennessee like me that are having a horrible time tryingto get reimbursed. insurance companies, there’s hope. we’re moving in the right direction.
like i said, i’m someone who’s had a policyfor over a-decade-and-a-half that never paid a dime and i’ve gotten a check. i’ve depositeda check, there were two checks, rather, this year. and so hang in there. i would encourageyou, if you are someone who is recovery or are a family or friend of someone who’sin recovery, and they’re in a similar situation where their treatment center, whether it’san opioid treatment center or not, they are in a situation where that center does notyet bill insurance or they won’t bill insurance, if they’re trying to submit for reimbursementtheir self, keep calling the insurance companies. keep holding their feet to the fire. if youneed to talk to a lawyer, there are protections now under federal law and we’re moving inthe right direction.
opioid treatment program services at thatbundled rate i was talking about where it’s one fee for everything, patients ,they’restill having a hard time. we’re not getting medicare to reimburse at that bundled rateyet. but it’s coming. people are working on it so fight. and kind of like i mentioned earlier, evenin non-expansion states, the aca and the parity act are still the law of the land. even ifthey opted not to take the federal money to expand their medicaid programs, they still,insurance companies and policies, they still have to comply with the federal laws in thosestates. and so even in non-expansion states, specially for people who are dealing withmental health and substance use disorders,
the aca and the parity act, they really aremaking a difference. so hang in there, change takes time. specifically,if you know someone or you are someone who is in medication assisted recovery from opioiduse disorders, and/or a patient of an opioid treatment program, feel free to contact namarecovery. our website is methadone.org. the website was created back when methadone inthe 80s when that was the only medicine for opioid use. but methadone.org, an advocatewould be happy to help you. but hang in there. fight. keep trying. and know that these lawsare making a difference. and so with that, i will turn it over to kate. kate segel: thanks so much, zac. good morning,or actually afternoon everyone. my name is
kate segel and i work at a non-profit healthcareadvocacy organization called health care for all in boston, massachusetts. i worked athealth care for all now for over ten years, primarily working to help consumers navigatethe challenges of applying for and enrolling in health care coverage. for many years, i counseled consumers on healthcarecoverage options on our toll-free health insurance help line where we take about 30,000 callsper year from consumer seeking to enroll in medicaid and other low cost coverage optionsavailable through our state's health insurance marketplace. over the last couple of years,i’ve transitioned into my current role of overseeing our organization’s outreach andenrollment best practices work.
before i dive into the details of outreachbest practices that we’ve identified at health care for all, i thought it would behelpful to give you some background as to the massachusetts health reform experience.as many of you know, massachusetts passed a state health reform law in 2006 which greatlyexpanded access to health insurance coverage for our residents. then along came the acawhich even further expanded access to health insurance coverage, primarily through ourstates implementation of the medicaid expansion. so we are a medicaid expansion state. thischart shows our current insured rate that hovers around 96% to 97 %, among the bestin the nation. however, as you can see and as many of youknow very well, when you look at the rate
of insured status over the course of the entireyear, we dropped to about 90% insured throughout the entire 12 months. gaps in coverage continueto persist for many in the state, particularly low income people that should qualify forsubsidized health care coverage through medicaid or the marketplace. and so our outreach andenrollment work continues to be a critical piece of our work even almost ten years afterhealth reform was passed here in massachusetts. this next chart shows where massachusettsresidents get their health insurance today. i included it so that you could see that about17% or approximately 1.8 million people get coverage through our state medicaid programcalled mass health. the medicaid expansion in massachusetts addedabout 300,000 members to the program. our
marketplace coverage is included in the otherprivate section of this grant. currently, there are about 177,000 members that get subsidizedand a smaller number that get unsubsidized coverage through our marketplace, the healthconnector. now, i will move on to how we got to wherewe are today with a historic number of people that have health insurance in our state. allexperts agree that we couldn’t have gotten here without investing in intensive outreachand education campaigns over the past ten years. stakeholders came together when healthreform was passed in 2006 and agreed that there needed to be both a top down as wellas bottom up outreach in order to make sure that consumers knew that were new, more affordablehealth care coverage options available to
them. the success of those strategies hasbeen written about, published, and put to use all over our country. when it came to implementing the medicaidexpansion, massachusetts stakeholders again came together and implemented top down andbottom up outreach strategies to get people enrolled into coverage. our medicaid agencymade the decision to auto-enroll newly eligible medicaid expansion members directly into coverage.this slide shows a sample notice that was sent to newly auto-enrolled medicaid beneficiaries.the notice was sent to all members by the medicaid agency informing beneficiaries oftheir new coverage, effective date, covered services and other things that you can seehere in the notice.
here’s another example of a top down outreachstrategy that was performed by the medicaid agency in massachusetts when the medicaidexpansion was implemented. the agency published a fact sheet and distributed it to stakeholdersthroughout the state including providers, community-based organizations, enrollmentassisters, and others in order to ensure that the word got out about the new medicaid expansionprogram called careplus. as i mentioned earlier, top down outreach strategies are critical.but they must also be paired with an as intensive bottom up strategy in order to ensure success. my next several slides include descriptionsof the actual bottom up strategies that have been proven successful in massachusetts overthe last several years. i’ll start with
the most common strategies groups have used.enrollment assisters including navigators and certified application counselors haveplayed a critical role in providing successful enrollment outreach to consumers. there aremore than 1,500 navigators and other assisters that have been trained and certified by medicaidand our state marketplace. and they are required to provide ongoing outreach to consumers statewide. more than half of healthcare coverage enrollmentsin medicaid and the marketplace occur directly through the assistance of a navigator or otherassister in massachusetts. written materials have not been replaced by technology. andhave also been proven a successful tool for outreach to consumers in massachusetts. brochures,fact sheets, flyers, and other written materials
have played a key role in getting informationabout the medicaid expansion and marketplace out to consumers and leading them to the appropriateplaces to enroll in coverage. distribution of these written materials often has occurredand been successful at existing community events and health fairs where consumers alreadyare as was mentioned earlier on in the presentation from another presenter. we don’t want to reinvent the wheel or tryto hold events, where consumers are already. instead, we reach consumers in their communityamongst people that speak their language both literally and figuratively, partnering withschools, social service agencies, and houses of worship have ensured that we reach manymore people and get our messages out through
multiple channels and multiple times. this image is of a brochure that our organizationcreated through funding from our marketplace. we used tested words and phrases to reachout to people to let them know that new, free, and lower cost healthcare coverage optionswere available to them and their families. we used the picture of the injured young malesince message testing suggest that young males are more likely to be uninsured and associateneeded insurance for catastrophic emergency events like breaking a bone and car accidents. we included the new upper income limits forassistance so that families were encouraged to apply even if they thought their incomewas too high previously for help. last but
least, we encourage folks to apply and providedthem with the website and telephone number where they could take action. this brochurewas printed and translated into the three most commonly spoken languages in massachusettswho are also the most likely to remain uninsured in the state. i also want to include some less commonlyused strategies that have also proven very effective in reaching hard to reach populations.as many of you know, hispanics and latinos are much more likely to be uninsured evenafter coverage expansions. a recent study in massachusetts found that hispanics andlatinos in our state are three times more likely to be uninsured than their white counterparts.latinos are one of the largest groups of remaining
uninsureds in the state. white uninsured ratesare 3.9 % compared to 10.3 % for latinos. in addition, those with low english proficiencyhave even higher rates of uninsurance at 15.8 %. with this knowledge, health care for all andmany other groups in the state created ads in spanish and portuguese and blasted ourmessage out via spanish and portuguese media outlets in the state. this is the actual portuguesead that we used to conduct the outreach. other outreach strategies that proved successfulare listed here and include doing outreach via food pantries, via, and to small businesses,going door to door, outbound phone calls to existing and former clients as well as giveaways.everyone loves free stuff.
during the very first aca open enrollmentcycle, health care for all and several other organizations across the state went door todoor conducting outreach. this door hanger is what we left at doors where no one washome. again, we carefully chose our messaging on these door hangers and included a callto action. go to the marketplace and see if you qualify for new, free, and lower costhealthcare coverage options. i really love this next slide because as itshows how creative we have had to get with our outreach strategies here in massachusetts.the remaining uninsured are tough to reach. they’re still uninsured after nearly tenyears of outreach. as such, groups have developed these unique outreach strategies in orderto reach folks. my favorite on the list is
the method pictured here, posting an outreachflyer on the mirror in a beauty salon. the organization that did this reports that itwas highly successful in driving folks to their office for enrollment assistance. asyou can see, additional strategies employed here have been text messages and outgoingcalls even a mobile enrollment van, intercepting people at local public transportation offices,inserts in electric bills, newspapers, cocktail napkins at bars, outreach to accountants abouttax penalties, phone calls to clients, farmers markets, and libraries. that’s all for my formal presentation. ihope it’s been helpful for you all and will be helpful in the important and critical workthat you all do. thank you for samhsa, for
having me here today. and i look forward toyour feedback and questions. tom hill: thank you, kate. thank you, zac.thank you, rylee. and don’t go away, we’re going to do a little bit more program. butwe’re going to come back with questions and answers. and think of answers that youwould like the three of them to answer for you as well as general questions. next, we’re going to hear from a colleagueof mine and ours at csat, elicia mcintyre. she’s serving as csat special assistanton healthcare financing. she represents csat on cross center finance and integration teamat samhsa which supports one of our strategic initiatives, the one on healthcare and healthsystems integration. so with that, i’m going
to turn it over to elicia. and she’s goingto tell us about some aca-based resources. elicia mcintyre: thank you, tom. so i wantedto talk with everyone today about an initiative from the centers for medicare and medicaidservices, cms called coverage to care. and coverage to care seeks to do just that, tohelp consumers understand their new coverage and engage in the healthcare system as wellas equipping healthcare providers and staff with the information and resources neededto help them connect with the newly insured. and our colleagues over at cms, followinginput from a variety of sources including consumers, providers, community partners,payers, and policy makers developed this set of resources to help educate and empower thenewly insured.
and understanding that the newly insured aremore likely to listen to trusted resources, coverage to care builds on existing networksto disseminate the information and educate consumers. millions of americans have gainedcoverage through the marketplace and medicaid and chip during past open enrollments. andmany of the newly insured overcame barriers just to enroll in coverage such as cost, education,language, to name a few. and while the numerous support put in place to help them overcomethe challenges and enroll, there were significantly fewer supports that are in place to help themunderstand and appropriately utilize their coverage. and we know that if we don’t help the newlyinsured see the value of their coverage and
understand who to use it appropriately, toobtain primary care and preventive services, then we won’t really improve populationhealth nor reduce health care costs which are the two other goals of aca. and so this next slide would give a snapshotof the coverage to care roadmap. all of this information is available at the cms website,the marketplace website. and you can print or download directly from the website. youcan also order any of those publications to be shipped directly to you at no cost. i wantto add that these materials can also be ordered in bulk. so if you’re having enrollmentevents, enrollment fairs, you can order these materials in bulk to distribute at large events.
the signature piece is the roadmap to bettercare and a healthier you, which is pictured here. and the great thing about this is thatit’s available in english, spanish, arabic, russian, chinese, korean, vietnamese and haitiancreole. there’s also a tribal version and a fillable pdf where communities can personalizetheir roadmaps with their information. there are posters, consumer tools, discussion guides,and videos to offer more information on connecting people with primary care and keeping themengaged in health. so how can you use this information? the firstis really to start the conversation. use the roadmap to start a conversation with the newlyinsured and others needing help in navigating the healthcare system. you can use the roadmapin partnership with the discussion guide to
walk through each step. and pointing out somethings for the consumer to consider and think about. you may also want to customize theroadmap by adding information on local resources in your community. and you can also link consumersto videos and resources at each step of the roadmap along the way to improve their understandingof the material. and the coverage to care resources are reallyyour tools and then the stories, explanations, and conversations you have with new consumersare what will help them understand and remember the steps that they use their new insurance.so this is again, is just a little snapshot of the coverage to care roadmap. and as youcan see, it lays out a path for the newly insured to connect to care starting with stepone, put your health first. and ending with
step eight, next steps after your appointment. i want to direct your attention to step threewhich is about knowing where to go for care. and this is really for consumers to beginto understand the difference between when to go to the er versus when to go to the primarycare physician or urgent care. so that’s an important step. it also walks through tipson finding a provider. how to communicate with your provider. step six, being prepared for your visit. havinga list of questions to take with you to your doctor’s appointment, and then the all-importantfollow up, what follow up steps to take, what to do if you feel like you’re not connectingwith your provider, or you had questions unanswered
and really empowering consumers to rememberthat they do have a choice in providers and that you can change providers if the relationshipisn’t working with your current provider. lastly, i wanted to just point your attentionto just a snapshot of another piece of information that’s in the roadmap and that is just asample insurance card. we know that for many people getting enrolled under the aca, thisis either the first time in a long time since they’ve had coverage, or they may have neverhad coverage. so just understanding what the information is on the insurance card, a sampleexplanation of benefits. there’s also a resource list included in the roadmap. there’sa personal health tracking checklist and that helps consumers understand things like theirpersonal health numbers, contact information
for providers, and a general health informationpage for coverage and provider information. there’s a glossary of health coverage termsthat’s really important for people that are navigating insurance for the first time.it helps consumers what to expect, and also helps consumers keep track of their informationand contact information for providers. so again, this is the link and these linksare also available on the widgets at the bottom of your screen. they can link you directlyto the website to order the materials. if you have questions, you can also email coverageto care. and with that, i am going to turn things backover to tom. tom hill: thank you, elicia. so, this is myopportunity to tell you guys to get busy.
we have, roughly, seven more weeks of openenrollment and we want to see our folks get enrolled in healthcare insurance. they’reout there. we’re serving them and they need to have access to both insurance and to thehealthcare that they need and deserve. so, i’m going to move through with fivevery simple actions steps and these are taken from a publication, a very simple publicationthat’s very helpful, called, get american covered, and that’s at healthcare.gov, animportant resource. the first one is to email your list. and wheni think of that, i’m thinking like going to your electronic rolodex, who are the peopleyou serve? who are your members, your customers, your employees, your colleagues, people inthe community that you have access to, and
just deliver some simple email messages remindingthem or informing them of the enrollment period and including some links that make it easyfor them to get to the places they need to get to enroll, and being inspirational aboutthat, being creative and inspirational in your messages. and some of those messagesare included in that document i talked, about get american covered. the second is, include information on yourhard copy collateral. that’s exactly why it’s saying, printed materials. so anythingthat you have, like brochures, newsletters, annual reports, things like that that areobvious but also things like church bulletins, letters you have and appeal letters that you’reasking for contributions, this is the time
of the year when you can tag on to a lot ofother kinds of communication, materials that you’re sending out to folks. so, think aboutthat both electronically, and in terms of your printed material. the third is to host an enrollment event.and that could be a direct event about enrollment, but it could also be tagged on to other eventsthat are happening. so, there’s a lot of holiday parties and events that are happeningduring this season. after the holidays, you can support a health fair, anywhere that peoplein the community are getting together, you could host a table. you could host ways toshare that information, because people are gathering in a lot of places throughout thecommunity during this time.
so being able to leverage those activitiesthat are already happening where people are gathering is a good idea. sharing information on your space like youroffice, in your community center, where people come for services, where people congregatefor other supports, have posters, have cards to issue, palm cards, anything that just keepsthat information front and center where other people are gathering. you can find posters, brochures and otherproducts to download at marketplace.cms.gov. but you could also order them, but maybe downloadingand printing them with a short turn around time for enrollment period.
and then finally, join the conversation onlineand i would even say, to initiate the conversation online. share information about open enrollmentand all the facets and all the reasons why people need to take advantage of that, onyour facebook and twitter and other social media accounts that your folks are subscribingto, to check every day. and keep those messages as current throughout this important seven-weekperiod. so those are five easy ways you can take action.and i just want to remind you of some key dates in terms of open enrollment. basically,i’m going to start from the bottom. january 31 is the last day of open enrollment. however, if people want to start their insuranceon january 1, they need to enroll by december
15. so that’s a two-week process time. ifpeople miss that and they register or enroll by january 15, they’ll have health insuranceand coverage by february 1. so those are just some important milestonesto think about in the next seven weeks in terms of relaying that information so thatpeople can get, people who need insurance coverage earlier than later, will have thattimetable to work with. so, that’s it with the information portionof this webinar and would like to turn it over to questions either in general or specificallyto our presenters. acting administrator enomoto and director botticelli have left the room,left the building to do other important things but if you do have questions that are geareddirectly towards them, we’ll make sure that
they’d get to the proper places that you’llget your answer. in the meantime, we’ll take any questions,and we have a few of them already. we have one for kate and it’s a little bit long.so kate, basically the setup for it, is, as you said, massachusetts has been doing thisnew insurance plan since 2006, and so because of that, massachusetts is pretty far along.you can see that in your slides. can you give a couple of pointers or lessons learned topeople in other states that aren’t as far along as massachusetts? kate segel: sure. so, you’re right. massachusettshas had many years, almost ten years, to get folks enrolled, and we are a smaller stateand we have a fewer number of uninsured when
we began this challenge ten years ago. that being said, what we found and we’veadvised a lot of other states throughout the country is that the best practices that italked about today can be replicated and used in states that may not be as far along andmake an even greater impact because there’s a larger number of uninsured, so the messagesare the same. they’ve been tested to encourage enrollment and to grab people’s attention.so what i would encourage you to do is don’t reinvent the wheel. the lessons that i talkedabout today can be helpful in your state and have been helpful in other states that aren’tas far along. and if you wanted to brainstorm or troubleshoot with me, feel free to reachout to me directly via email.
tom hill: thank you, kate. we have anotherquestion regarding -- somebody from utah asked the question about utah’s third-party payersrefused to implement mental health parities, specifically for medication-assisted treatmentparticularly methadone and suboxone from coverage in otps. otps are excluded from all commercialnetworks. how can this be addressed? so i would address this question to both ryleeand to zac. and either of you can go first. rylee curtis: yeah. this is rylee from utah.so, i will just kind of briefly mention that this was a huge concern for us especiallyas we were negotiating the medicaid expansion through a private health insurance expansioninstead of putting folks on traditional medicaid because we are aware that some of our third-partypayers do discriminate based on whether it’s
like a court order procedure, alcohol-drugassessment, things like that. and so, mary jo might have been the betterperson to answer this question to know more specifics about utah in regards to that thirdpayer question, but i do know that we were working with salt lake county and usara, aswell as nami, to look at the insurance provisions of the expansion population and whether ornot the recovery community and mental health community would be able to get the servicesthey need if we expanded. but i recommended to the person who asked that question to followup with mary jo and myself directly and we can talk about this offline specially as we’resetting our priorities for 2016 general session. tom hill: thanks. thanks, rylee. and zac,can you talk about, just answer that in a
more global sense? did we lose zac? okay,so i have a follow up question for rylee while we’re waiting for zac. somebody said, idid not receive all the answers with regards to the best plan available to enroll in utahfor opioid-dependent individuals who need rylee, can you take that one? rylee curtis: yeah. so, i’m trying my besthere because i was the alternate to do this. so, i reached out. i sent an email to saltlake county because they are the ones who were compiling all the information in regardsto what services are covered and not covered as we were working on the medicaid expansion,so as soon as i get that information back, i do want to follow up and answer that question.and i also reached out to our navigator who’s
working with the halfway houses, so i’mtrying to get that answer. and i wonder, my question to you guys is ifi do get that answer and it’s after the end of this call, how do i get it to thisperson who asked that? tom hill: you can let us know and we’lltake it on this end. thanks, rylee. rylee: curtis: okay. tom hill: another question is to -- i’mtrying to decide for this. sorry. how can health insurance providers best use thesematerials? and i’m going to ask elicia to take thatone. elicia mcintyre: okay. so i think the questionis regarding the coverage to care materials.
we really encourage providers to go to thecms website to order those materials. there are posters that you can display, the coverageto care roadmap. these are designed to be displayed in clinics, in waiting areas, indoctors’ offices, provider offices, and the tools that i mentioned, there’s a discussionguide, there’s video vignettes. all of those are available from the cms clearing house. so, given that we are coming up on the firstdeadline, december 15, and some of those, you may not have time to order to receiveby mail, i would encourage you to go directly to the website and look at the discussionguides, download those video vignettes. and you can use those pieces of information withyour patients or clients.
tom hill: thanks, elicia. while you’re onthe line, i just want to ask you, this is a follow-up question. someone wants more informationabout becoming a navigator and where would they go to find that information? elicia mcintyre: that information is availableon healthcare.gov. and i believe one of our widgets that we have has a direct link forinformation for assisters and navigators. so, we can verify that, but i believe we dohave a direct link. tom hill: thank you, elicia. fielding someother questions here. i’m trying to decipher this one -- i’m working in safeco cignafor insurance, working for an insurance company, how can i help? and i’m also interestedin substance abuse issues. so how can somebody
who works for an insurance company help interms of being a part of this enrollment initiative? elicia mcintyre: that’s a good question.and i think we haven’t had, maybe, such a direct question from someone who is actuallyon staff. i think we might want to see if there’s a way that we can follow up moredirectly, if we can get contact information. tom hill: okay. thank you, elicia. we’llget back with you on that one. any other questions here? someone would like to have the aca behavioralhealth poster in spanish. is that available and how can they get that? elicia mcintyre: yes, there are resourcesin spanish. again, there are resources on the healthcare.gov site, english and spanishenrollment materials and also the coverage
to care materials are available not just inspanish but a number of languages. tom hill: different languages, great, great.zac, are you back on the line? we lost zac. just one more question for rylee. and it'sabout you talked about you shifted in your initial target population and if you couldtalk a little bit more about that. what precipitated the shift and how did you facilitate thatshift in terms of going to other target populations? still there, rylee? rylee curtis: yeah. yes, i'm still here. soi think the issue for us is that we were trying -- we didn't necessarily understand. we werekind of learning as we were going. we knew that this population needed access to healthinsurance and we were aware that they might
not qualify. so as we started actually doingthe outreach to the halfway houses or the recovery community organizations or treatmentfacilities, we learned which ones served folks who would likely qualify for aca insurance.and so under that sense, it was like who, which organizations are helping these folksfind jobs in the community so that when they leave, they have an income that's higher than100% of poverty or what likely would anyway. and so that was -- we wanted to focus ournavigator’s efforts and certified application counselor’s efforts places that they’vehad a higher success rate than where we initially started when we just partnered with the firstorganization that was willing. and so that was how the shift happened. and so when wego in and we do these presentations to these
halfway houses and the staff, and betweenthe facilities, we ask them what programs do you run here, are you helping these folksfind jobs, what are the likelihood of them actually being able to qualify, and we assesswhether or not we’re going to be able to help. because we want it to be beneficialfor both the consumer, the organization and our navigators and so that was how that shifthappened. and unfortunately, we even, were working withdavis county here in utah with their drug court in davis county and they weren’t boughtin to what we were doing and we tried, we set up meetings, we talked to them about screeningquestions, what’s your family household size, what’s your family income, and theyjust weren’t buying in to what we were selling
and so that unfortunately was a project thatfailed. but we found successes in other places. and i think that buy-in is key. tom hill: i believe that is it for the questionsand answers. and if we can move to the next slide. we have a slide that has about affordablecare act and social media, #getcovered. there it is. on facebook, on twitter, and on youtube,there’s all the links for that. so feel free to access that. and in closing, i want to thank everybodyfor being a part of this webinar, both the participants and audience, as well as ourspeakers and leaders. and a reminder on your way out the door, to please fill out yourevaluation and let us know how we did and
whether this was useful to you, and look forwardto seeing you all in the next webinar we’re doing.
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