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Community Health Workers and Clinic Resources to Address Social Determinants of Health
Join our Sept. 25 webinar from 12:10 – 1 p.m. on Community Health Workers and Clinic Resources to Address Social Determinants of Health.
Kristen Godfrey Walters, the Community Health Worker Training Program Director in the Health Promotion and Chronic Disease Division at MDH, will provide a broad overview of Community Health Workers’ (CHWs) roles in addressing social determinants of health, Medicare and Medicaid CHW payment codes, CHW policies, and examples of tools and directories to address SDoH. The SagePlus Program will also showcase their work with clinics regarding heart health and share resources available to clinics for addressing barriers to health care. Lastly, clinics will have the opportunity to share how they are utilizing CHWs or other resources to address SDoH.
For additional background information: In 2024, Medicare introduced, and MN Medicaid adopted, new covered services to address health-related social needs including Community Health Integration, SDOH Risk Assessment, and Principal Illness Navigation Services. These are the first codes specifically designed to describe services involving community health workers, care navigators, and peer support specialists. By recognizing and addressing these social needs, Medicare, Medicaid, and other health care systems aim to improve health outcomes and promote equity in care delivery. You can learn more here: Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule | CMS The Sage Program does not cover these services due to limited funding resources. However, the SagePlus Heart Health Program can cover these services if your clinic is a SagePlus provider and women take part in a lifestyle change program (healthy behavior support service). Please reach out to us for more information.
This is the second webinar in a two-part Social Determinants of Health/Health Equity series. CEUs will be offered.
If you missed the March webinar on medical assistance for breast and cervical cancers (MA-BC) you can watch a recording on the Sage videos webpage.
Join us online for our quarterly office hours
Join our Oct. 23 ‘Office Hours’ from 12:10 to 1 p.m. for a brief Sage Program overview and Q&A time. Office Hours will be informal with a focus on the Sage Program basics and plenty of time for questions. The Sage Office Hours are intended for new clinic staff or clinic staff who need a refresher on the Sage Program.
Southwest Minnesota partners collaborate to increase breast cancer screenings
The Sage Program and the American Cancer Society are working with more than 12 partners as part of a pilot campaign to raise awareness about the availability of free breast cancer screening services in Southwest Minnesota.
Health care partners in the area came together with Sage to act after recognizing that women living in Southwest Minnesota who have been diagnosed with breast cancer are more likely to die from it than women living in other parts of the state.
The campaign includes paid advertising with local media outlets, social media ads, collaboration with SW Minnesota Sage clinics and mobile mammography units, and development of a Campaign Toolkit. SW Minnesota partners can use the Toolkit in their communities to increase breast cancer screening.
The campaign will run from August through October. We will share campaign results later this fall.
You can access the Campaign Toolkit here: Increasing Cancer Screening in Southwest Minnesota - MN Dept. of Health (state.mn.us)
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Help us update our contact list
Sage is in the process of updating clinic contact information. Our internal database includes five different roles. It’s important for us to have a contact person for each role at a site (the same person can fill more than one role; descriptions of the roles are in the survey.)
Please fill out the survey below so we can make sure we have the correct contacts in our system for timely communication with your clinic.
Please share this survey with other staff at your clinic who fulfill any of the Sage Program roles so they can enter their contact information using the form below.
Risk factor resources and Immunization Quality Improvement for Providers available
August was National Immunization Awareness Month. Here are some resources that provide more information about decreasing risk factors for cancer and ways MDH is working to increase HPV vaccination rates.
Cancers Grouped by Associated Risk Factors: https://www.health.state.mn.us/data/mcrs/data/dashrisk.html
MDH is partnering with the American Cancer Society (ACS) to provide an alternate Immunization Quality Improvement for Providers (IQIP) program to support and assist clinics in improving HPV immunization rates. The purpose of this alternate IQIP program is to improve on-time HPV vaccination coverage for both series initiation and completion. This IQIP program will offer technical assistance provided by MDH, including Minnesota Immunization Information Connection (MIIC) training and resource sharing.
For more information regarding the IQIP Program, including the webinar recording of Boosting HPV Vaccination Rates, visit their webpage:
https://www.health.state.mn.us/people/immunize/miic/iqip/hpv.html
Sage is modernizing to better partner with clinics in service delivery
The primary objective of the Sage Modernization Project is to modernize businesses practices and processes allowing for streamlined electronic data submission by clinic partners. We hear and understand that it is sometimes difficult to administer our program due to the manual processes, paper forms, and faxes. Please contact us if you have any questions or would like to learn more. Reach out to Ann Reid, ann.reid@state.mn.us, or Nicole Atkinson, Nicole.c.atkinson@state.mn.us.
The following is an update on our efforts to identify pilot clinics for Sage modernization work.
In June, the Clinic Outreach Team worked to streamline the process for engaging clinics they had identified to possibly take part in this pilot project. An email was sent out, in early July, to the identified clinics, briefly describing the project and asking some fundamental questions about the clinic’s availability and requesting the clinic reply if interested in learning more.
Discovery Meetings, with the clinics that replied, were scheduled to outline the scope and proposed schedule of this pilot project.
Also in July, the project team completed the SPEC Sheets (spreadsheets that list each field needed to be completed for all forms in scope (Sage and SagePlus). Several of the clinics use Electronic Health Record (EHR) Systems that are supported by external vendors. Initial meetings have been held with these vendors and we are waiting to hear back on availability and possible costs.
Several clinics have been actively engaged in conversations about this project including:
- Allina
- Bois Forte
- Neighborhood Health Source
- Red Lake
- Scenic Rivers Health System
- Southside Community Health Services
The technical team will roll out the four new data exchange options in the following order:
- Phase 1 - New Sage Portal/ Direct data entry into the following Sage Forms: Enrollment, Visit Summary, Breast Imaging Summary, Breast Abnormal, Breast Case Summary, Cervical PAP, Cervical Abnormal, Cervical Summary; and the SagePlus Form.
- Phase 2 - New Sage Portal/ PDF Form Submissions/ Clinic Dashboard that gives status of submitted forms (i.e. pending, approved)
- Phase 3 - For clinics that opt to update EHRs to include all required Sage fields, data can be sent via Minnesota’s certified Health Information Exchange – Koble or MDH DEX.
We look forward to keeping you updated on the project progress, again, please feel free to contact us with any questions.
– The Sage Modernization Project Team
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