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					THE URBAN INSTITUTE


                           Coverage is Not Enough:
                      Lessons from the Covering Kids and
                           Families Access Initiative

                                       Ian Hill
                                    Louise Palmer
                                  The Urban Institute

                                     Brigette Courtot
                              National Women’s Law Center


                             AcademyHealth Annual Meeting
                                   Washington, DC
                                    10 June 2008
                 Outline of Presentation
   •   Background and context within CKF
   •   Methods and prior work
   •   Case study findings
   •   Lessons learned
   •   Conclusions



THE URBAN INSTITUTE
                      Project Background

   • CKF Access Initiative: 2 year/$4 million
     effort
   • Builds on larger CKF state/local grants
     aimed at increasing enrollment, to design
     and implement strategies to improve
     children and family access to care
   • 18 local CKF projects received CKF-AI
     grants


THE URBAN INSTITUTE
               Methods and Prior Work

   • Two rounds of telephone interviews with all 18
     grantees, explored initial implementation and
     ongoing sustainability (Needleman,
     2006/2007)
   • Building on these assessments, 5 grantees
     selected for closer study, based on diversity
     and innovation
   • 2-3 day site visits conducted in Fall 2007,
     multiple key informant interviews

THE URBAN INSTITUTE
       CKF-AI Grantees and Case Study States
                  WA

                                                                                                                                                   ME
                                       MT                  ND
                 OR                                                                                                                      VT
                            ID                                            MN
                                                                                                                                              NH        MA
                                                                                          WI
                                                           SD                                            MI                         NY
                                            WY
                                                                                                                                                        RI
                                                                                                                           PA                      CT
                                                                               IA
                       NV                                  NE                                                                             NJ
                                  UT                                                                IN         OH
                                                                                               IL                                           DE
                                                 CO                                                                                       MD
            CA                                                                                                       WV
                                                                                                                               VA        DC
                                                                KS                  MO                    KY
                                                                                                                               NC
                                                                                                     TN
                             AZ                                      OK
                                                                                     AR                               SC
                                            NM
                                                                                                     AL         GA
                                                                                               MS

                                                            TX                      LA


                                                                                                                          FL



                                 AK

                                                      HI
                                                                               CKF-Access Initiative Grantees
                                                                               Case Study grantees




THE URBAN INSTITUTE
           Findings: Connecticut

   • Grantee: Bridgeport Children’s Advocacy
     Coalition
   • Key partners: Connecticut Voices for
     Children
   • Identifying access barriers: focus groups,
     telephone interviews, survey
   • Barriers targeted: navigating Medicaid
     managed care; prescription drug benefit

THE URBAN INSTITUTE
           Findings: Connecticut

   • Interventions:
     - Fact sheets for consumers and pharmacists
     - Toolkit for providers
     - Encouraged MCOs to adopt “best practices” and
     incorporate into MC contracts
   • Effects:
     - Info dissemination on provision of temporary
     prescriptions
     - Reduced pharmacy-related problems
     - Improved collaboration b/w Medicaid, MC, advocates


THE URBAN INSTITUTE
               Findings: Minnesota

   • Grantee—Olmsted County Community
     Services
   • Key partners—Intercultural Mutual Assistance
     Association; MN Children’s Defense Fund
   • Identifying access barriers: Survey
     administered to 220 individuals; 80% w/
     children, 83% immigrants/refugees
   • Barriers targeted: Immigrants’ problems w/
     health plan and provider selection; and w/
     provider communications

THE URBAN INSTITUTE
               Findings: Minnesota
   • Interventions:
     - Community health worker program
     - State partner developed “paperwork matrix” identifying
     redundancy and reading level issues
   • Effects:
     - Over 500 clients served; over 1,000 home visits
     conducted; addressed paperwork, plan/provider selection
     - CHW training curriculum now established in area
     community colleges
     - Ongoing funding secured from United Way, Blue Cross,
     and federal grants
     - Legislation passed for Medicaid reimbursement of CHWs

THE URBAN INSTITUTE
Findings: North Carolina

  • Grantee: Buncombe County Dept. of Social Services
  • Key partners: Buncombe County Medical Society
  • Identifying access barriers: Interviews with 62
    parents; Group interviews with community
    stakeholders
  • Barriers targeted: factors interfering w/ appropriate
    use of health system, including language problems
    and lack of self-efficacy


THE URBAN INSTITUTE
  Findings: North Carolina

   • Interventions:
     - Interpreter network
     - Laminated childhood symptom checklist
     and thermometers
   • Effects:
     - Claims data show decrease in ER visits
     over the intervention period
     - Anecdotally a success
THE URBAN INSTITUTE
             Findings: Maryland
  • Grantee: Baltimore Health Care Access
  • Key partners: Public Justice Center and
    advisory committee
  • Identifying access barriers: two focus
    groups; 50 interviews with Hispanic women
    with newborns; discussions with hospital
    administrators
  • Barriers targeted: Language and cultural
    issues; system navigation

THE URBAN INSTITUTE
             Findings: Maryland
  • Interventions:
    - Informational brochure on system navigation for
    pregnant, Hispanic women
    - Cultural competency training to hospitals
    - DVD for waiting rooms regarding system
    navigation, naming issues
  • Effects:
    - BHCA has emerged as critical information
    source on cultural competency

THE URBAN INSTITUTE
         Findings: Washington

   • Grantee: CHOICE Regional Health Network
   • Partner: Local hospital and community-based
     PCPs, and Humanlinks Foundation
   • Identifying access barriers: focus groups, in-depth
     interviews, observations of provider visits
   • Barriers targeted: Inappropriate use of ER services




THE URBAN INSTITUTE
           Findings: Washington

   • Interventions:
     - Emergency Department Care Coordination Program

   • Effects:
     - 50 patients referred to EDCCP
     - Cost savings to Medicaid and ER
     - Improved patient health and satisfaction (self reported)
     - New partnerships b/w CBOs and ER providers




THE URBAN INSTITUTE
                      Lessons Learned:
                       Cross-Cutting
   • Long history/strong track record of community
     collaboration helped chances of success
   • Grantees gained valuable experience conducting needs
     assessment (were often surprised that leading access
     barriers were often not what was expected)
   • Grantees well-positioned to implement “home grown”
     strategies for addressing them
   • Targeting barriers and strategies narrowly improved
     chances of success



THE URBAN INSTITUTE
                      Lessons Learned:
                       Cross-Cutting
   • Structure and flexibility of grant applauded; technical
     assistance from Nat’l Program Office widely praised

   • A longer time-frame would have permitted more
     complete implementation, better data
     collection/evaluation, and more successful
     sustainability




THE URBAN INSTITUTE
                      Lessons Learned:
                       Sustainability
   • Sustainability is challenging, even for “successful”
     projects
   • Sustainability more likely if planned from the start
   • Grantees often sustained low-cost and low-
     resource activities, but updating materials still
     required time/resources
   • Projects w/ clear cost savings and tangible impacts
     more successful in obtaining ongoing funding


THE URBAN INSTITUTE
                      Policy Implications

   • Increasing health insurance coverage of
     children and families is critical first step
   • But addressing myriad barriers to access is
     equally critical
   • CKF-Access Initiative demonstrates
     complementary nature of outreach and
     enrollment efforts, coupled with access
     improvement strategies

THE URBAN INSTITUTE

				
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