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 blueshieldcafoundation.org March 30, 2016 blueshieldcafoundation.org
today‘s speakers Alvaro Fuentes Suzie Shupe Brian Vaughn Julie Michaels Community Clinic Redwood Community Sonoma County Marin County Health and Consortium of Contra Health Coalition Department of Health Human Services Costa and Solano Services Counties blueshieldcafoundation.org page 2
Alvaro Fuentes, Community Clinic Consortium of Contra Costa and Solano Counties blueshieldcafoundation.org page 3
Contra Costa CARES History of issue: • 2009 BOS Policy Shift • Eliminated Access to Undocumented Adults Planning Process: Leverage existing collaborative • Identify champion • Build trust • Transparent • blueshieldcafoundation.org page 4
establishing effective collaborative County Leadership: Board of Community Supervisors, Health Centers Health Services, Health Plan Community Local Hospitals Advocates blueshieldcafoundation.org page 5
where are we now? • Implemented program in November 2015 • Over 2,500 enrolled • Formed oversight committee • Evaluation framework • Ongoing advocacy blueshieldcafoundation.org page 6
what’s next? Community Expand Scope Health Centers Sustainable Advocates County Leaders Track Data Impact Sharing Program Hospitals Network Capacity Long-term solution Build on momentum is needed blueshieldcafoundation.org page 7
Suzie Shupe, Redwood Community Health Coalition Brian Vaughn, Sonoma County Department of Health Services blueshieldcafoundation.org page 8
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 • blueshieldcafoundation.org page 9
Healthy Kids of Sonoma County • 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 blueshieldcafoundation.org page 10
Covered Sonoma • The most recent iteration of Sonoma County’s ongoing community health coverage collaborative • Comprised of over 30 unique and trusted organizations • Robust coverage initiatives and coordinated enrollment efforts blueshieldcafoundation.org page 11
Covered Sonoma (cont.) Four Priority Areas: Remaining Uninsured 1) Outreach and Enrollment 2) Access to Care 3) Medical Home Linkage and Health Insurance 4) Literacy blueshieldcafoundation.org page 12
one 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 blueshieldcafoundation.org page 13
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) blueshieldcafoundation.org page 14
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. blueshieldcafoundation.org page 15
healthcare access and utilization among undocumented immigrants compared to US citizens and permanent residents, 2005-2014 PRELIMINARY RESULTS blueshieldcafoundation.org page 16
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 blueshieldcafoundation.org page 17
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%) • blueshieldcafoundation.org page 18
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 • blueshieldcafoundation.org page 19
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 PRELIMINARY RESULTS blueshieldcafoundation.org page 20
Julie Michaels, Marin County Health and Human Services blueshieldcafoundation.org page 21
Marin Access to Care Collaborative (MACC) Marin HHS • HHS Director • HHS PHO • HHS Policy Analysts Hospitals • Kaiser Marin Community • Marin General Hospital Foundation • Novato Community Hospital CBOs • Canal Alliance Partnership • Novato Human Needs Healthplan of • Operation Access • RotaCare California • Marin Community Services FQHCs • Coastal Health Alliance • Marin City Health & Wellness Marin Organizing Clinic Committee • Marin Community Clinics • Ritter Center Health Clinic blueshieldcafoundation.org page 22
quantitative data analysis Funded by: the Marin Community Foundation Analysis conducted by Jared Sanchez of USC using 2009-2013 American Community Survey (ACS) data blueshieldcafoundation.org page 23
Marin’s remaining uninsured Undocumented adults < 139% FPL < • 4,000 residents • 96% < 45 Years Old • $16,188 Median Wage blueshieldcafoundation.org page 24
undocumented adults below 139% fpl (2010-2014) Race/Ethnicity Percent of Undocumented Population 100.% 92% 90.% 80.% Education 70.% Language 54% 60.% 44% 50.% 36% 40.% 33% 30.% 15% 20.% 9% 4% 5% 2% 3% 10.% 0.% blueshieldcafoundation.org page 25
Insurance status – undocumented adults below 139% fpl (2010-2014) 60.% Percent of Undocumented Population 50.% 40.% 56% 30.% 20.% 23% 21% 10.% 0.% No Health Public Health Private health Insurance Insurance Insurance blueshieldcafoundation.org page 26
qualitative data - focus groups 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 blueshieldcafoundation.org page 27
key focus group findings Experience Health Seeking Access Accessing Unmet Needs Improving Care Behaviors Priorities Care Lack of Want Those with healthcare insurance Currently chronic resources affects Pro bono that covers paying $100s diseases are the quality care is everything to $1000 for not obtaining effective diagnostics consistent Provider when able to Prefer fixed care retention- people access Must be an cost want to see the advocate to same doctor They are ensure Need health waiting until adequate Current fee- education Must advocate to issues are care for-service ensure adequate acute unfair care blueshieldcafoundation.org page 28
Q&A blueshieldcafoundation.org page 29
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