Planning a low-cost ambulatory managed care insurance product for uninsured Los Angeles residents

This project will assist a broad coalition of private and public sector organizations, under the umbrella of the National Health Foundation (NHF), in the development of a low-cost ambulatory product for the uninsured in Los Angeles. There have been significant contributions and commitments from insurers, payers, and providers to market and sell this product once successfully developed. The experience of San Diego and other projects around the country have caused the NHF members to try a somewhat different approach to the development of this product, especially in light of the tremendous expansion of managed care in California coupled with the large numbers of uninsured. Based on preliminary data collection and a review of products such as those offered by California Kids, the NHF recognizes: (1) A low-cost, managed care health insurance product will not by itself, solve the uninsured problem, but it could make a meaningful difference; (2) To achieve a low price and facilitate meaningful health care, the focus will be on primary care, preventive care, and prescription drugs. The product will include case management. (3) Effective marketing is the most serious challenge and the strategy to address this will include using schools, providers, and piggy backing on efforts that already reach the target population such as worker's compensation insurance for small employers. Co-marketing efforts with other products such as the state's small business insurance pool products will be sought. (4) The demonstration will pilot the use of interactive telephone technology as a point-of-entry demand management tool for access to primary care and preventive services. (5) Health plans will participate in the design of the product and will serve as sponsors of the demonstrations utilizing contracts with traditional community providers. (6) Control of adverse selection must be accomplished to gain the involvement of health plans. Technical assistance and consultation specific to this concern will be critical.

Grant Details

Amount Awarded $142,433.00

Awarded on: 7/29/1996

Time frame: 8/1/1996 - 1/31/1997

Grant Number: 29119


National Health Foundation

515 South Figueroa, #1300
Los Angeles, 90012-3322

Rita Moya
Project Director