My name is Jennifer Peterson, joined by Liz Morris, who is going to be moderaing our session.
Welcome, Liz.
>> Liz: Thank you so much.
My name is Liz.
Project coordinator for "Health Happens in Libraries."
This program is supported by the institute of museum and library services.
We have been working to magnify the role that public libraries play as key contributors to community health.
Over the past year, we worked closely with a number of partners, zero divide, to share resources and strategies for libraries it respond to patron requests regarding the Affordable Care Act.
We've also been fortunate to collaborate with representatives from the national network of libraries of medicine, as well as the Centers for Medicare & Medicaid Services to be sure that libraries and their community partners have access to the most up to date tools and we work closely with a number of state and public libraries to understand their experiences and highlight their strategies for health information services related to the Affordable Care Act as well as other health information areas.
I'm very happy to introduce some of you collaborators as panelists for our session.
Lynne Johnson, Deputy Group Director, partner relations group, Office of CommunicationsCommunications, Centers for Medicare & Medicaid Services.
Providing an update on the health insurance marketplace for the upcoming enrollment period.
Cara James, will be sharing resources from the coverage to care initiative which supports consumers in understanding how to utilize their health care coverage.
And we will also hear from Julie Kuchta, a Consumer Health Coordinator, Carnegie Library of Pittsburgh about how her library developed a plan and worked with community partners to support marketplace awareness in the last open enrollment period and how they're preparing for the next one.
Before we dive into our discussion, I would like to take a couple of minutes to acknowledge a couple of key themes that have emerged in our work on this topic over the past year.
First theme is that many states have developed resources, policies, and partnerships that compliment the national level marketplace resources we will be discussing today.
It is important to understand how the marketplace is being managed in your state to be sure that you connect with local resources that exist.
Identify the marketplace serving your state, HealthCare.gov, entering your state there and following the related information.
And we also have information on state marketplace resources on "Health Happens in Libraries" project page.
The other thing we know is that public libraries offer a level of community access that is highly valued by community partners and marketplace outreach and enrollment.
Libraries offer flexible hours, secure meeting spaces, strong public communications channels and computers and internet access and most importantly, libraries are trusted as neutral information providers and facilitatrs to community resources and this trust matters when dealing with a topic as important as health.
For those of you who may already be providing marketplace services or other health information services, some of what we cover today may be a bit of a review, but this is a great opportunity for you to share your experiences with other participants who may be coming to the topic for the first time.
For those of you who are new to the topic, we've got a lot to share and I'm looking forward to seeing your suggestions and questions in chat.
So, with that in mind, I'll turn it over to Lynne Johnson from the Centers for Medicare & Medicaid Services. 
Welcome, Lynne. 
>> Lynne: Thank you so much.
Thank you for the opportunity to provide these critical updates about marketplace to the library community.
I want to thank everyone for their efforts in providing outroach, enrollment information, consumers can access quality, affordable health care coverage.
Libraries have been critical for us as they are located in almost every community and are a trusted source of health information.
Libraries have opened their meeting rooms and computer centers to support enrollment efforts.
And we have reports that many libraries or librarians have become certified assisters in ensuring successful enrollments in their community.
I would like to note that the marketplace is working and that millions of previously uninsured are now covered.
A report released yesterday by the Department of Health and Human Services shows us that we have -- we will have more choices as consumers will have more choices as they shop for quality, affordable coverage on the health care insurance marketplace in 2015, because there will be a net 25% increase in the number of issuers offering marketplace coverage.
In total, 77 new issuers will offer marketplace coverage. 
The preliminary report for the 36 federal marketplace states and eight based marketplace states can be found in the new section on The HHF.gov web site.
I will finish presenting links I will talk about in addition to what you will see in the slides, I will make sure that I post them in the chat box. 
I have been asked to give a brief overview of the health insurance marketplace for those who may be new.
Health insurance marketplace is designated to help consumers find and buy health insurance that fits their budget.
Most of you already know, so this will just be a brief refresher.
Health insurance plans in the marketplace offer comprehensive coverage from doctors to medications, to hospital visits, and also will provide only dental benefits if desired.
Marketplace plans are called qualified health plans, consumers can compare insurance options based on price, benefit, quality, and other features that may be important to them.
And this is offered in plain language that also makes sense.
And some of you may know or have already heard that sometimes the term exchanges is used interchangeably with marketplace.
States across the country receive grants to establish a marketplace.
States have the option to create and operate their own marketplace, which is a state-based marketplace, or somewhat of a hybrid called a state partnership marketplace in which the state runs certain functions of its marketplace.
A partnership marketplace also allows states to make key decisions and tailor the marketplace to local needs and market conditions.
The federally-facilitated marketplace, which is run by the Federal Government, established in states who chose not to establish their own marketplace.
Consumers will know they're getting a quality health plan at a reasonable price because the coverage and benefit information and premium rates are readily available.
They may be able to pay less for health coverage every month if they qualify for a premium tax credit.
Savings depend on income and family size.
Consumers can view plans and prices available in their area by using the simple tool, which is located on HealthCare.gov.
They provide basic income and household information and will see how much they pay for each plan.
Prices shown account for any tax credit that they're eligible for.
Their final tax credit will be determined when they finish their marketplace application.
If a person's income falls below certain amounts, they may even qualify for coverage under their state's Medicaid program.
And this is true if they live in a state that decided to expand Medicaid coverage to cover more people.
But if your income falls below the amount shown on the chart, your state is not expanding Medicaid, and you don't qualify for Medicaid under your state's rules, then you won't be able to get premium tax credits that will reduce what you pay for your private insurance plan.
All of this in detail can be found on HealthCare.gov.
But I would like to note, too, that there is a marketplace for small employers where they can get coverage for their employees.
It's called a Small Business Health Options Program, and you may have heard that we refer to this as SHOP.
And SHOP information again can be found on HealthCare.gov by clicking on the small business tab.
I will show a screen shot of what the web site looks like in a few slides, but just wanted to give this review of marketplace and also talk a little bit about what happened in 2014 and then moving forward.
The first marketplace enrollment for 2014 ended March 31st, 2014.
And more than 8 million people signed up for health coverage in the federally-run marketplace.
After open enrollment ended, consumers generally couldn't enroll in a private health plan through the marketplace for the remainder of 2014.
Exception is that they had to have a special enrollment period that allowed them to enroll outside of open enrollmentenrollment.
Consumers could qualify for a special enrollment period two ways.
If they had a qualifying life event, like marriage or birth, adoption, or if they lost coverage, or if they had some type of complex situation related to applying in the health insurance marketplace.
A person could still and can still enroll in Medicaid or CHIP, the Children's Health Insurance Program.
They can do that any time throughout the year.
No limit of enrollment period for the programs.
They can apply any time, again, and if they qualify, they are enrolled immediately.
Small business owners can start offering coverage to their employees at any time.
Over the summer, we not only worked to continue to increase awareness of marketplace, we also promoted the coverage for care initiative that Cara James will cover.
We reached out at the grassroots level working with regional offices and partners, we pushed out messages to those who signed up for email updates on HealthCare.gov, and we are present on Facebook and Twitter and I will provide the links also in the chat box for those.
Now, on to 2015.
Enrollment begins November 15th through February 15th.
And coverage can start as soon as January 1, 2015.
To continue health coverage in 2015, a consumers can renew their current plan or choose a new health plan through the marketplace during the open enrollment period.
Consumers can keep their current coverage, if they wish, but should check their plan via HealthCare.gov to ensure it is still the best plan and option for them.
They should also update any necessary information on changes -- or changes to their information in their account on HealthCare.gov, and they should also check their qualification for their advanced premium tax credit.
Those not enrolled in the health plan, may have to pay a fee.
The fee in 2015 is higher than it was in 2014.
Could be 2% of their income, or $325 per adult, $162.50 per child, whichever is more. 
Again, consumers may buy marketplace insurance outside of open enrollment if they qualify for special enrollment period that I mentioned, or if there is, you know, well, this go-round, it would only be due to a qualifying event outside of marketplace.
There was a time period for those who could have a special enrollment period if they had some type of technical difficulty, but that time has since passed.
Any time, again, consumers can enroll in Medicaid or the CHIP program.
And also small businesses can coverage at any time.
Those are the stipulations around enrolling outside of the open enrollment program.
We continue, we will continue to work with national and local partners and stakeholders at the grassroots level on education and enrollment efforts.
We are building coalitions of partners in effort to focus on areas with high numbers of uninsured, as well as specific racial ethnic minority groups.
We are planning paid and media campaigns.
We will encourage consumers to sign up for email updates.
We will continue to post and update information on Facebook and Twitter.
We do translate our publications into Spanish, and also have Spanish version of HealthCare.gov. 
So, those are some brief updates for 2015. 
As far as enrollment assistance for consumers, I know I have been relying heavily on HealthCare.gov, which is a big way of going in to get information, an important way of going in to get information on -- and enrolling in marketplace, and this is the screen shot.
You can see where there is information for individuals and families and small businesses, and other topics, and many consumers going into this page for the first time will probably get a pop-up or a layover box to say, you know, have you signed up for email updates and mine doesn't work now because I think maybe a cookie or something prevents me from now seeing that pop-up, but I went in to the Spanish version today, which I had not signed up for, Spanish language updates, and I did get that pop-up to remind people to sign up for email updates information.
HealthCare.gov changes are integrated with the larger outreach and education strategy for open enrollment. 
Again, the pop-up is one of the new features.
In early October, we will launch a new design, and we are going to be focusing on start preparing messaging and highlight what users can do to get ready.
They can update their account.
They may want to change their passpassword.
They may have forgotten their password and have to get a new one.
We will start in early October with a lot of reminders on what people need to do to get ready for enrollment.
November 15th, the page will change to an act now action messaging for renew.
Renew your insurance and also focusing on providing local help.
We will have a shift to finding tools to help get the information that you need. 
So, we will have distinct messages and call to action for multiple target audiences, new to marketplace, current enrollees, renewals, and also related to SHOP.
New top navigation tabs will be created to make clearer pathways for different audiences, and we want to -- 
we're focusing on watching out for any complicated jargon.
We want to be sure that we use clear and simple calls to action to our audiences.
And we will also have an improved streamline application process.
And, again, I know that I promote it quite a bit the HealthCare.gov heavily in my slides, but in addition to the site, there are three other ways consumers can apply for and enroll in marketplace coverage.
Over the phone, they can use our 24/7 customer service center, which I have listed the number here.
There is local help, navigators, certified application counselors and assisters.
Working with a trained person in their local community, navigators serve as in-person resources for people who want aadditional assistance for shopping for and enrolling in health plans.
Consumers can submit a paper application through the call center, or downloading a copy at Marketplace.cms.gov.
Navigated grants were announced September 8th.
You can find the list on the link I provided here on the slide.
In addition, partners -- 
partners and consumers can also go to the find local health on the HealthCare.gov when looking to assist consumers. 
And we also focus web page on resources for assisters and outreach partners.
We have been working to enhance our page and also enhance our resources for our assisters and partners.
This is the landing page where you can get, you know, up to date information, where you have spotlight.
You can get information about the assister program, and also training. 
And this is just listing out on the web site, Marketplace.cms.gov, you can get training, all of the marketplace -- health insurance marketplace 101.
For training, if you choose to want to become an assister and need resources or just want to do a train the trainer type of event, we have the presenter slides and we also include speaker notes.
We also have training videos that you can download.
There is also a type of other resource materials and trainer materials.
In addition to the product ordering.
So, if you're looking to order some publications and applications for your library, go to our productordering.CMS.HHS.GOV link.
I would like to note as to what occurred last year, many times the materials in the web health were depleted.
We're looking to add more materials.
So, don't be discouraged about ordering things for your libraries.
You can also, if you have a print budget, you can download them from Marketplace.cms.gov, and print them out for your community. 
I also want to highlight again the Champion For Coverage program, initiative, where many organizations have become champions, just kind of pledging to help create healthy communities, push out information, many libraries, as I have said, navigators, assisters, and other partners to use their meeting rooms and computer centers to help enroll people.
We now have over 100 library champions representing public, state, and medical libraries, as well as several state library associations. 
And many of you do champion work but cannot enroll to become an official champion, which is fine.
We appreciate any of the support and information awareness that you have performed in the past. 
And because we have seen this happen, I just wanted to note that you, too, can become an assister.
Many champions are becoming assisters.
And I have included a publication assisting roles to help consumers, assistance roles to help consumers to apply and enroll health coverage through the marketplace.
It is a publication that can be ordered.
I also gave the number.
You can participate in required training to become an assister, which is located at marketplace.gov.
And also I had read on the "Health Happens in Libraries" initiative, Webjunction, Spokane county library district responsible in helping to ensure -- to enroll 500 members of its community.
We made sure that we shared that information all of the way up to the White House, which we are very appreciative.
I had mentioned in my beginning slide about the report that came out about the health insurance marketplace.
This is a screen shot and the web site, and the report includes a state-by-state facts about the marketplace, and specific states, and this preliminary report you will find enrollment data, how many enrolled in a specific state, percentages for male, female, age ranges, types of plans, and percentage receiving financial assistance.
Not only you, but we can take this information and look and do special targeting for areas where we see that enrollment may be low, and overlay that with what we know already with uninsured populations.
So, this is where we are today.
And I thank you for allowing me to present and as I said, I will share some additional links with you in the chat box. 
>> Liz: Excellent.
Thank you so much, Lynne.
It's great to know the amount of resources that are available out there, both for libraries and their community partners in terms of getting familiar with the marketplace as well as for consumers.
Lynne mentioned this, and I wants to reiterate, HealthCare.gov, in addition to being the portal for application or re-enrollment, excellent consumer assistance resources, question and answers, search feature, things like that.
It is a great place to get clear, simple answers to some questions that have popped up.
We have seen a number of questions in chat, which we've worked to address using our chat feature and sharing some links there.
One of the questions, Lynne, that I would like to pose to you is a question that asks who is considered a small business employer?
You mentioned the shop marketplace.
A lot of our work at health happens in libraries, primarily focused on the individual and family outreach marketplace but we know that SHOP is becoming increasingly utilize.
Where can people go to learn more about SHOP or what do we know about who is qualified as a small business employer?
>> Lynne: More information about SHOP on HealthCare.gov page, and it is -- it's at the top.
A tab that says small businesses.
All of the information you want about SHOP can be found there.
Small businesses under 50 employees. 
Very detailed information as well as publication.
>> Liz: Excellent, thank you very much, Lynne.
We look forward to seeing some of the resources from you in chat about the HealthCare.gov communications channels.
So, with that, we will move on to Cara James, who is going to share some information about the coverage to care initiative and how consumers can learn more about using their coverage once they have it.
Cara, welcome.
>> Cara: Thank you so much for having me.
Good afternoon to everyone.
I'm Cara James, and here to talk about from coverage to care.
And so as we know, we have had millions of individuals who got coverage during the first open enrollment period, and as we gear up for the next open enrollment, we are hoping that millions more will get covered.
For many of these individuals, this may be the first time or the first time in a long time that they've had coverage, and may not be familiar with how to use it and how to connect to care.
So, over a year ago, we started an effort to help individuals and educate consumers about their new coverage and to connect to care and primary care and preventive services so that they can live long and healthy lives.
The goal to think about some of the other goals of the Affordable Care Act beyond expanding coverage but also to improve population health and reduce health care costs.
We have developed a number of resources that I'm going to share some of them with you as we go through the presentation today.
And we have been sharing these resources through existing networks, such as yourselves, because we know our community partners are really the trusted sources for consumers, and one of the best ways in which to share the information and to help them understand it as they're journeying along in their process.
All of the resources on the marketplace web site, Marketplace.cms.gov/C2C.
Smaller digestible pieces, includng a poster, one page consumer tools, insurance card, a table comparing some of the differences between care received through a primary care provider and the emergency room and an explanation of benefits.
We have available each smaller booklet that you can order through our product ordering warehouse that Lynne mentioned during her presentation.
We have video vignettes and a discussion guide for video partners to share information and to help them talk about it with the consumers that they interact with.
We encourage you to use the roadmap to start conversations or to make it available to help consumers understand, you can use it as a companion with a discussion guide to have those conversations about coverage to help them understand the importance of it and getting the preventive services.
As you notice, when you go through the roadmap, you will see there is a lot of information in there.
We don't expect that consumers will be able to understand all of the information on the first go-round, but that they will hopefully use the roadmap as a resource as they go along their journey and refer back to it to ensure that they are working towards better health and well being.
We encourage you to personalize it.
You will notice in the roadmap that we have left space on the inside cover and other places, and to provide opportunities for you if you want to provide a label about local resources that are available in the community so that consumers can use those.
You will note that we sort of tested these resources and provided feedback from our participants and taken that into account.
A lot of what you are seeing is a result of that work.
We have in the roadmap eight steps.
And the first step is putting your health first.
And this really was something that during our pilot we found a lot of feedback with regards to the importance of helping consumers understand the value of using coverage to stay healthy.
I think it's perfectly clear for a number of people why it's important to have coverage when you're sick, but for many people who have not had coverage, understanding how to use it to stay healthy is a new way of thinking about insurance.
We then go to step two, which is understand your health coverage.
Followed by step three, know where to go for care.
And we really focus there on making sure that consumers are using primary care and preventive services rather than the emergency department for non-life-threatening situations.
In step 4, we talk about finding a provider and provide tips on how to do that, followed by making an appointment, with very specific tips on making the appointment and what information is needed.
And how to prepare for the visit, in accept 6- step 6.
In the long term, we want consumers to engage in a patient provider relationship, ongoing and long-term provider relationship so they can achieve their health goals.
We ask consumers to reflect on their visit and decide if this is the right provider for them.
This is something during the pilot a lot of consumers found empowering to know that they had a choice in their providers.
We encourage them to think back on it to try to problem solve if there were issues that didn't go to their desires to talk to providers and office staff to troubleshoot some of those and work on that as they move forward.
And if they find the issues can't be resolved, we encourage them to go back to step four and look again for the provider that is right for them.
Step 8, encourage them to follow-up after their appointment to make sure that they maintain coverage.
This is just an example of how you might use the discussion guide and the roadmap to talk to consumers.
As I mentioned earlier, step 2, understand your coverage and here you can see that we want the key points to make sure that the consumers understand what services are covered under their plan, be it Medicaid or CHIP or a plan through the marketplace.
We want them to be familiar with their costs, such as the premiums, copayments, deductibles, and coinsurance, and to know the difference between in network and out of network.
Throughout the roadmap, you'll note we have little boxes that we call cost tips.
Some of the feedback that we heard during the pilot was to help consumers understand the financial implications of the choices that they make.
To this step -- this step helps with that and we talk about those financial implications, encouraging consumers to find a provider in network so that they aren't at risk for higher costs.
In that example, in step 2, you will find an example of an insurance card.
And this card helps consumers become familiar with both some of the terms that they need, as well as the location of where that information can be found on their card.
If they're going to fill prescription or see a provider or call their plan to get information and clarification.
We also have in this step 2 a couple of sample cost tables where we show consumers how a deductible, copayment and coinsurance can come together in terms of their costs.
These are just examples, but as you can see on the left, an example of someone who may be having a baby.
On the right, an example of someone who is managing type two diabetes.
In step three, again, emphasizing know where to go for care.
Key points to point out for the consumer is really use the emergency room in life-threatening situations.
And primary care is the preferred care when it is not an emergency and, again, to help them know some of the differences between primary care and emergency care.
One of the tools that we pulled out is a one-pager, again, this table that shows some of those differences between primary care and emergency care.
And, again, being responsive to some of the feedback that we received during the pilot.
You will note the first line up there emphasizes some of the financial implications of going to the emergency department, if it is a non-life-threatening situation, talking about some of the differences between copayment.
We also talk about the wait time and how you can typically call and make an appointment and be seen around the time of your appointment, if you have a primary care provider, as opposed to waiting in the emergency room until you can be seen.
And, finally, we emphasize the importance that the primary care provider will likely check other areas and focus on all of your health as opposed to the emergency department but really will focus on the specific issue that brought you in for the day.
And just to show another example in accept 8 with those next steps after the visit -- 
step 8, we encourage consumers to write down providers instructions for healthy living, for follow-up, to schedule necessary follow-up visits and fill prescriptions, as well as review documents that they may receive and contact their Medicaid or CHIP program if they have questions.
In this step we tried to provide an example of an explanation of benefits to help consumers become familiar with some of the information.
We emphasize that this is not a bill, but it does not mean that they won't receive one.
We encourage consumers to maintain their continuity of coverage by paying their premiums as well as paying bills to providers, as that, too, can have implications for their ability to access care.
As we look in moving forward, other tools and resources in the roadmap.
We include a glossary of health coverage terms.
We provide a resource list that includes some of the other resources that have been developed by our colleagues across the federal family.
That include questions to ask the provider, as well as medication management.
At the end of the roadmap, you will see a personal health tracking checklist that provides consumers with an opportunity to include some information from basic screenings, as well as a page to write down information about their health plan and their provider contact information. 
So, again, the resources are available at coverage to care at Marketplace.cms.gov/C2C.
We see this as an on going initiative.
We have millions who signed up during the first open enrollment and many more who have come on board through the special enrollment periods that we've had.
We know that there are millions more who still need coverage and we want these resources as well to be available for them as they come into the system so that we can help them journey from coverage to care and ultimately to better health.
Again, you can order these resources through the clearinghouse.
You can also sign up for notifications for when other resources will be available.
And we should have the DVDs in the loop that can be played and ordered very shortly, as well as we are working on resources to be available in other languages.
This is the video example.
You can see the link there in which you can review the video.
As we know, people learn in different ways and want to provide as many opportunities for them to understand the information.
We encourage you to share the resources.
To think about customizing them to your community.
Consider incorporating them if you have any trainings that are happening and engage with providers -- we encourage you to let us know what works.
This is going to be an ongoing initiative and we are interested in feedback in terms of resources that are -- needed to help you as you're engaging with the community and helping them as they journey along. 
So, as we end, we kind of thing about the end of the first open enrollment and where we're going.
Journey of 1,000 miles begins with a single step, and together we can ensure that all Americans have access to quality, affordable health coverage and that we are working to eliminate health disparities.
Thank you. 
>> Liz: Thank you, Cara, for providing that overview of coverage to care.
We have learned a lot and talked a lot about the importance of health literacy in our work and how that supports patient advocacy, patron advocacy, and initiatives like coverage to care really do a lot to move that forward for individuals and families.
We appreciate you taking the time to join us today.
One of the questions that came to mind for me as I was listening to your presentation was the idea of working with community health partners to share these resources.
You know, a lot of large urban environments, there are many hospitals and many community health agencies and in small communities, there may not be as many community health resources.
Can you speak a little bit who how libraries might think about partnering with community organizations to share these resources and what types of organizations they might think about partnering with?
>> Cara: Absolutely.
That's a great question.
And thank you for that.
One of the things that we did during the pilot, very briefly, we shared the resources with a variety of organizations because we wanted to make sure that we were catching people wherever they were coming in through the door.
The resources, and we've seen in terms of ordering the roadmap, they have gone to faith-based organizations, to legal aid societies.
They've gone to community health centers as well as hospitals and even some of the counselors.
These are resources available for anyone regardless of the coverage that they are receiving.
You could partner, libraries could partner with the community health centers or the faith-based organizations that are there, and we hope that the discussion guide can be used to help some of those organizations who may not be as familiar, we're talking about some of the health terms, become a little more comfortable in doing so.
We also have available a more detailed kind of training video that we have developed that steps through each step of the roadmap to help individuals become more familiar with talking about it so that they could share.
I think there are a lot of opportunities for partnering with local health departments or other organizations like local social service organizations who are familiar with the community needs and can help share the information. 
>> Great.
Thank you.
We will be sure to post all of those resources to our webinar archive page and share them when we share the archive after this presentation.
And partnership we know has been a key part of the work that libraries have been doing related to the Affordable Care Act and beyond.
So, we are going to move on to our next presenter, as I mentioned, Julie Kuchta, Consumer Health Coordinator with the Carnegie Library of Pittsburgh and they have done an incredible amount of work to partner with their local community related to this topic.
>> Julie: Good afternoon.
I'm here to talk about our experiences at Library of Pittsburgh and share some of the experiences we learned with you today.
Carnegie Library of Pittsburgh, I would like to tell you a little about us.
We served the residents of the -- serve the residents of the greater Pittsburgh area, population of 306,000 and residents of Allegheny county.
We work in partner with community organizations, faith-based organizations, medical community -- Allegheny county has the second highest number of uninsured individuals in the state.
In addition to having the second largest population of individuals who are age 65 or older.
Second only to Tampa, Florida.
We are also becoming more culturely diverse, which I will talk about later.
In add did IGS -- addition to working in our neighborhood library, users and consumers of the library and its services. 
When we began our journey during the previous enrollment period, we hit a few glitches.
But it gave us an opportunity to identify and educate individuals about affordable care.
Thanks to the provider network that developed out of the desire to help and get the information to as many individuals as possible, and the commitment of my colleagues at the library, we came up with a strategy to accomplish our goals.
We knew that the library had a vital role to play.
Seen as a welcoming, neutral, safe place in the community where people come to learn and where they feel comfortable asking for information and assistance.
We also kept the Pennsylvania forward health literacy initiative in mind.
Quote, that libraries play an important role in helping citizens manage their own and their family's well being and empowering them to be effective partners with their health care providers so that they can live longer, more productive lives.
Next we made sure that our staff, clerks up through librarians, had the training necessary for them to be knowledgeable and comfortable using the information and online resources available at marketplace.gov and HealthCare.gov.
Affordable Care Act marketplace page was designed for the internet, which is our internal communication tool.
It provided a one-stop source for easily accessible, up-to-date information, including local assisters, news and history about the Affordable Care Act and the marketplace, informational and educational videos, email tip sheets and frequently asked questions.
We provided information for our users in paper and electronic format.
A slider on the home page directing individuals to marketplace.gov and HealthCare.gov and publicized educational programs offered at libraries and in the neighborhood.
We wanted to make it as easy as possible for everyone to find the information they needed.
We also found that transportation and accessibility were issues for many individuals.
And it was important to help eliminate those barriers for them so that they could get the assistance they needed.
Library provided free space for private meetings with individuals, as well as space for educational and enrollment events.
Certified application counselors were wonderful to work with.
They met with people in the community, rather than having them to come to them in their offices.
The next item may seem simple but it had a huge impact.
Giving individuals the access they needed to enroll in and find information about the Affordable Care Act and HealthCare.gov in the marketplace.
Many people were intimidated by the thought of having to sign up electronically.
Staff helped them with basic computer skills, helped individuals sign up for email accounts and offered one on one assistance navigating the marketplace.
I just learned that computers are less common in households in Allegheny county than any other Metropolitan area our size in the United States.
We rank last at 80%.
National average is 84%.
A strong support of collaborative network in place, certified application counselors in locations throughout the counties that we could refer people to when they were ready to enroll for health coverage.
In a nutshell, we provided users with hands-on training using the HealthCare.gov web site, frequently asked questions, resources and access to navigated and certified application counselors, as part of our health-related programming.
Partners.
We had great partners.
The non-profit community organized itself to make the most of this opportunity.
Local organizations and agencies that were willing to offer outreach and enrollment assistance met together.
Thanks to the Jewish health care foundation and Allegheny activates to develop a collective sense of what everyone was doing and to really identify and assess what we had in the community.
These groups included, of course, libraries, health centers, faith-based groups and grocery stores.
Community organizations in the Pittsburgh area knew they could play an important role in providing outreach and education to raise awareness about the Affordable Care Act and HealthCare.gov.
Many of the organizations did not have a working relationship with each other.
There was a vision and desire by organizations to educate as many individuals as possible and get them enrolled for health coverage and they recognized that libraries were seen as important community spaces. 
According to a recent pew research study, 91% of Americans say that libraries are important to their communities as a whole.
Think about that for just a minute.
Think about the power and influence that gives you. 
After several meetings, we formed closer relationships with the groups that we would work the most effectively with and the groups were then able to focus on their unique strengths and roles.
We worked with organizations like the consumer health coalition, CMS, who did presentations for staff, the united way, Allegheny -- and the health center.
As I mentioned earlier, we're becoming more culturally diverse.
A large population -- overcome the fear, mistrust, and language barriers, organizations, certified application counselors would go out in the communities and meet people where they lived and shopped to let them know about the Affordable Care Act and opportunities for enrollment. 
They went to local grocery stores, fliers in locations, and used traditional and social media.
Public libraries provided free meeting space and computer access as well as guidance and resources to individuals.
In addition, certified application counselors met with people at libraries to provide one-on-one enrollment assistance at no cost.
Tailored their outreach to reflect the unique characteristics of individual neighborhoods, including having interpreters to help with the enrollment process. 
25 and beyond.
By sharing resources and knowledge, the library has developed sustainable partnerships and will be able to jump right in during the second enrollment period.
We began planning during the summer.
We have had several meetings and I'm working on updating information for staff and offering refresher trainings on HealthCare.gov and the health insurance marketplace.
In addition to the services we provided during the last enrollment period, we're going to provide additional support by offering programs to primary care and talk about primary care and preventative services that are right for them and help people understand their benefits.
We're going to be doing that through organizations that will come in to talk to people about what they can use their health insurance for.
And how to prepare for their visits, just like the coverage that Cara was talking about.
During the last enrollment period we faced several challenges and learned several lessons.
Offer standardized outreach and educational materials, regularly scheduled meeting times and dates so that people know where they can go to get assistance and help.
And providing educational materials in different languages and at appropriate literacy levels to ensure consistent message in the community.
We are hoping to reach out into the community and more effectively get the information to them about library services to several groups, including immigrants, refugees, minorities and healthy adults ages 26-34.
We are aware that we may need to tailor a message to these audiences that goes beyond our traditional marketing.
Developing a definition defining when and how we should record an Affordable Care Act reference in our action.
That was something I didn't do during the last enrollment period and we didn't get good numbers on the interactions at all.
We are hoping to do better this time.
We're also working on designing a new evaluation tool.
The one we used last time gave us some really wonderful stories, but it didn't give us any hard data. 
I just wanted to share a few tips that I thought may be helpful to you.
And while these all contributed to our success -- the success of our program, there were a few that had more impact than others.
One that was very impactful was choosing partners.
This was essential.
We were able to partner, strategize and share our frustrations and best practices.
It was great having other organizations to bounce ideas off of.
And by identifying partners and coordinating our efforts, each of us was able to focus on our unique strengths and roles.
We were able to develop relationships, collaborate and support each other for a much greater impact.
We talked a little bit about training already.
And we also provided an internal communication tool on the internet, and I have a screen shot of it right here.
And this is what the staff could go to to get information.
As you can see, we have at the top, we have subject headings, information, publication, contact information.
When you click on that, it takes you to more detailed information, along with embedded links that you can click on to.
This was updated on a continual basis, as new information came out so that it was always up to date and current. 
Another thing that was really essential, really very, very important, everything was based on this was having clearly defined expectations of staff.
And providing the training and support that they needed.
This really was a -- it was -- 
it made our success.
This changed -- their needs changed through -- throughout the enrollment period, providing staff with support and training and a way to communicate their concerns and -- when helping individuals with the Affordable Care Act in the marketplace and HealthCare.gov.
Because of this, we were able to get staff support and buy-in.
Because of their dedication and support we were able to provide the services that we did.
Provided training to all levels of staff, from clerks to librarians so that no one felt like they didn't have the tools that they needed. 
Another one is just being aware of your community resources.
And thinking about them in a different way.
We found some of our strongest allies and partners were with organizations that we had not worked with before through programmingprogramming.
Consumer health coalition, Allegheny intermediate unit.
Don't forget about your government officials.
They were a huge help to us and thrilled to help us.
They provided printed material about the Affordable Care Act and marketplace and HealthCare.gov, and we -- that we requested so that we would be able to provide it to people that came to the library.
And also sponsored enrollment events in the neighborhoods.
One of the most difficult parts of this process for me was determining what services we could successfully provide.
In order to do this we took a look at staffing tables, computer use, number of centers in our location.
This influenced our decision to not train our staff as certified application counselors.
We decided that they could help individuals locate resources and forms needed for HealthCare.gov and enrollment and help people navigate through that, and sign up for email accounts, provide free training on that, provide free printing and extended time on computers if it was related to the marketplace or enrollment, and we made referrals to certified application counselors and navigators. 
>> Liz: Julie, this is Liz.
Hi, we are almost at the top of the hour, and I see that you have moved on to sharing the national and state and local resources.
So, if you can just very briefly let us know any other final thoughts you would like our group to hear, we will share those and then end the session. 
>> Julie: I just want to thank everyone.
If you have any questions or need more information or would like more information or clarification, feel free to get in touch with me and I would be glad to share any information that I have with you.
Thank you so much.
>> Liz: Thank you for joining us and thank you to all of our other panelists.
One of the key take-aways for me from the presentation, importance and value of meeting people where they're at when it comes to community health information, includes meeting your partners, meeting your staff and meeting your patrons where they're at in terms of their needs and working together to leverage the great community resources that exist.
So, thank you all for joining us.
We will post these details to the archives and all of the related resources and you can reach us at any time as well with any follow-up questions.
Enjoy the rest of your day.