Local Solutions for Serving the Remaining Uninsured: Program - - PowerPoint PPT Presentation

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March 30, 2016

Local Solutions for Serving the Remaining Uninsured: Program Development Strategy

Presenters: Alvaro Fuentes, Community Clinic Consortium Suzie Shupe, Redwood Community Health Coalition Brian Vaughn, Sonoma County Department of Health Services Julie Michaels, Marin County Health and Human Services

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today‘s speakers

Julie Michaels Marin County Health and Human Services Brian Vaughn Sonoma County Department of Health Services Suzie Shupe Redwood Community Health Coalition Alvaro Fuentes Community Clinic Consortium of Contra Costa and Solano Counties

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Alvaro Fuentes, Community Clinic Consortium of Contra Costa and Solano Counties

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Contra Costa CARES

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History of issue:

• 2009 BOS Policy Shift
• Eliminated Access to

Undocumented Adults Planning Process:

• Leverage existing collaborative
• Identify champion
• Build trust
• Transparent

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establishing effective collaborative

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County Leadership: Board of Supervisors, Health Services, Health Plan Community Health Centers Local Hospitals Community Advocates

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where are we now?

• Implemented program in

November 2015

• Over 2,500 enrolled
• Formed oversight

committee

• Evaluation framework
• Ongoing advocacy

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what’s next?

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Community Health Centers County Leaders Hospitals Advocates

Build on momentum

Sustainable Program

Expand Scope Data Sharing Network Capacity Track Impact

Long-term solution is needed

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Suzie Shupe, Redwood Community Health Coalition Brian Vaughn, Sonoma County Department of Health Services

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from Healthy Kids to Covered Sonoma

• 1999 - Sonoma County Children’s Health Initiative (CHI)

convenes

• 2004 - Healthy Kids of Sonoma is established to be the

CHI

• 2005 - Healthy Kids insurance launches
• 2010 - Sonoma County transitions program admin to

Redwood Community Health Coalition

• 2015 - Covered Sonoma is established

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Healthy Kids of Sonoma County

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• A community driven, ground-up, merger of two

larger coalitions

• Built upon state-sponsored programs
• Locally developed and funded
• Included a collaborative effort by County Public

Health, community health centers, hospitals, private practice providers, CBOs, foundations and others

• Community marketing and engagement

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Covered Sonoma

• The most recent iteration of Sonoma County’s
• ngoing community health coverage collaborative
• Comprised of over 30 unique and trusted
• rganizations
• Robust coverage initiatives and coordinated

enrollment efforts

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Covered Sonoma (cont.)

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Four Priority Areas:

1)

Remaining Uninsured

2)

Outreach and Enrollment

3)

Access to Care

4)

Medical Home Linkage and Health Insurance Literacy

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• ne step closer to Health4All
• Covered Sonoma actively pursuing solutions to

address adult remaining uninsured

• Covered Sonoma making a coordinated effort to

implement Health4All Kids (SB 75 – Full Scope Medi- Cal for All Children) in Sonoma County

• Enrollment of individuals with DACA in Medi-Cal

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data objectives

• Determine the demographics of the remaining

uninsured (ACS)

• Identify high-level disparities in healthcare access

and utilization (CHIS)

• Determine current healthcare utilization patterns

(clinic data)

• Determine access to healthcare, dental care, and

mental health services among undocumented immigrants and their children (survey)

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healthcare access and utilization disparities

• CHIS Special Use Research File, 2005-2014
• Adults 18 years and older
• Analysis modeled after Bustamante et al., 2010
• Assumed undocumented immigrant if non-citizen with no

green card

• Measures:
• Usual place to go when sick
• Delay in care and receiving prescription drugs
• Physician visits in the last year
• Emergency department (ED) visits in the last year

Vargas Bustamante, A., et al., Variations in healthcare access and utilization among Mexican immigrants: the role of documentation status. Journal Of Immigrant And Minority Health / Center For Minority Public Health, 2010. 14(1): p. 146-155.

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healthcare access and utilization among undocumented immigrants compared to US citizens and permanent residents, 2005-2014

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PRELIMINARY RESULTS

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current healthcare utilization at Federally Qualified Health Clinics (FQHCs), 2015

• Obtained de-identified patient-level data:
• Sonoma County residents
• Seen at least once between January 1 to December 31,

2015 at any of four clinics

• Unduplicated
• Electronic medical records
• eClinicalWorks
• BrigitIT used to report and extract data
• Methods consistent with definitions used for annual UDS Report

to Bureau of Primary Health Care

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current healthcare utilization at Federally Qualified Health Clinics (FQHCs), 2015 (cont.)

• No existing variable that allows direct measurement of

immigration status

• Created undocumented immigrant proxy
• Latino or Hispanic
• Spanish speaking
• Uninsured but ≤138% FPL
• Adult sample
• n = 53,343 total
• n = 3,664 proxy undocumented immigrants (6.9%)

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survey of undocumented Immigrants, 2015-2016

• Surveyed n=282 undocumented immigrants
• ≥18 years and living in Sonoma County
• Mexican or Central American
• Non-citizen without a green card
• Respondent-driven sampling and convenience sampling
• Measures related to access and utilization of health-related

care

• Finished data collection in February 2016

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preliminary implications of remaining uninsured study

• Non-citizens are largest sub-group of remaining uninsured in

Sonoma County

• Undocumented immigrants may experience disparities in

healthcare access and utilization

• Undocumented immigrants may be receiving fewer services

at FQHCs

• Disparities observed among farmworkers may be present

among undocumented immigrants

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PRELIMINARY RESULTS

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Julie Michaels, Marin County Health and Human Services

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Marin Access to Care Collaborative (MACC)

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Marin HHS

• HHS Director
• HHS PHO
• HHS Policy Analysts

Marin Community Foundation Partnership Healthplan of California Marin Organizing Committee FQHCs

• Coastal Health Alliance
• Marin City Health & Wellness

Clinic

• Marin Community Clinics
• Ritter Center Health Clinic

CBOs

• Canal Alliance
• Novato Human Needs
• Operation Access
• RotaCare
• Marin Community Services

Hospitals

• Kaiser
• Marin General Hospital
• Novato Community

Hospital

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quantitative data analysis

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Funded by: the Marin Community Foundation Analysis conducted by Jared Sanchez of USC using 2009-2013 American Community Survey (ACS) data

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Marin’s remaining uninsured

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<

• 4,000 residents
• 96% < 45 Years Old
• $16,188 Median Wage

Undocumented adults < 139% FPL

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undocumented adults below 139% fpl (2010-2014)

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0.% 10.% 20.% 30.% 40.% 50.% 60.% 70.% 80.% 90.% 100.% 2% 92% 4% 15% 5% 44% 36% 54% 33% 9% 3%

Percent of Undocumented Population

Language Education Race/Ethnicity

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Insurance status – undocumented adults below 139% fpl (2010-2014)

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0.% 10.% 20.% 30.% 40.% 50.% 60.% No Health Insurance Public Health Insurance Private health Insurance 56% 23% 21% Percent of Undocumented Population

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qualitative data - focus groups

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Funded by the Marin Community Foundation, analysis conducted by Selena Polston.

• 4 focus groups with a total of 50 Spanish-

speaking Marin County residents

• Groups contained 10-16 adults of various

ages and genders

• 60-75% were uninsured or had emergency

Medi-Cal

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key focus group findings

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Health Seeking Behaviors

Those with chronic diseases are not obtaining consistent care They are waiting until issues are acute

Experience Accessing Care

Lack of healthcare resources affects the quality Provider retention- people want to see the same doctor Must advocate to ensure adequate care

Unmet Needs

Currently paying $100s to $1000 for diagnostics Must be an advocate to ensure adequate care

Improving Care

Pro bono care is effective when able to access Need health education

Access Priorities

Want insurance that covers everything Prefer fixed cost Current fee- for-service unfair

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Q&A

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remaining uninsured learning series

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Upcoming webinars:

• Benefits & Financing, April 14, 1:30-2:45 pm
• Eligibility and Enrollment, May 17, 1:00-2:15

pm

• Measuring Quality for Program Improvement,

June 15, 2:30-3:45 pm

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today's webinar was recorded and will be available online in the coming weeks.

Thank you! For more information, visit: www.BlueShieldCAFoundation.org

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