December 2001

Grant Results

SUMMARY

From 1997 to 2000, staff at the Community Service Society of New York to expand an education program for Medicaid beneficiaries enrolled in managed care. Researchers from New York University evaluated the program.

The program included:

  • A handbook about how to choose and use a health plan.
  • Workshops for Medicaid beneficiaries to prepare them to ask questions, research a health plan and advocate for themselves.
  • A training program to prepare community volunteers to conduct these workshops.
  • A training program for human service providers on managed care's impact on their clients.
  • A telephone assistance line to provide guidance to beneficiaries and social service providers.

Key Results

  • In New York City, project staff conducted nearly 500 workshops in English, Spanish and Chinese to reach more than 8,000 participants.
  • In Philadelphia, Community Service Society and its project partners conducted 75 workshops to reach more than 2,200 English- and Spanish-speaking beneficiaries and almost 200 workshops to reach nearly 750 people in the city's Asian communities.
  • In an evaluation conducted by New York University researchers, workshop participants indicated that they viewed the workshops as unbiased because the information came to them through trusted community organizations, not health care companies seeking customers.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $474,324.

 See Grant Detail & Contact Information
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THE PROBLEM

States are increasingly mandating that Medicaid beneficiaries enroll in managed care plans. Patients in managed care must learn to become discerning consumers and vocal advocates in their own care, a role that is unfamiliar and difficult for many. To participate in and benefit from managed care programs, Medicaid beneficiaries need education about how managed care works, how to navigate within a plan to receive covered services, the importance of primary and preventive care, and how to address problems that may arise.

In July 1995, CSS, a 150-year-old private, nonprofit social service organization whose projects address health care, affordable housing, and education for the urban poor, developed the Medicaid Managed Care Education Project, a pilot project designed to provide Medicaid recipients with information and skills that would allow them to navigate effectively within a managed care system. CSS trained community volunteers to lead interactive workshops on managed care in the South Bronx and Harlem communities of New York City. CSS developed an educational curriculum to teach basic concepts about managed care, such as the role of the primary care physician as a "gatekeeper" to other physicians or providers of additional care, the appropriate use of emergency rooms, and strategies to resolve difficulties encountered, such as having trouble scheduling an appointment. The pilot project included the following elements:

  • A handbook, written at the fourth-grade level and translated into English, Spanish, and Chinese, about how to choose and use a health plan.
  • Workshops for Medicaid beneficiaries to prepare them to ask questions, research a health plan, and advocate for themselves.
  • A training program to prepare community volunteers to conduct these workshops.
  • A training program for human service providers on managed care's impact on their clients.
  • A telephone assistance line to provide guidance to beneficiaries and social service providers.

Having developed and validated its educational program in two New York City neighborhoods, CSS was ready to replicate the materials and training programs at other sites.

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THE PROJECT

This grant from RWJF supported CSS' expansion of its Medicaid Managed Care Education Project in New York City and Philadelphia. (A separate grant from the Henry J. Kaiser Foundation supported replication of the project in Los Angeles; work done there is not covered in this report.)

In New York City, CSS managed the project and worked with more than 200 community-based organizations to hold workshops for consumers, volunteers, and social service providers. In Philadelphia, CSS partnered with two other groups to conduct its workshops and outreach activities — the Pennsylvania Health Law Project (PHLP), which works to help low-income people gain access to quality health care, and the Health Promotion Council of Southeastern Pennsylvania (HPC), which develops health education materials for people with low literacy.

The education curriculum employed the five components of the pilot project to teach basic concepts about managed care. Each partnering organization developed an implementation plan and modified the original curriculum to fit its own city's needs. At the time of the project, New York State had not yet initiated its mandatory Medicaid Managed Care program, so a key focus of the curriculum was on how to select a health plan. Since Pennsylvania had already initiated its program, the focus was on how to use a managed care plan.

Other Funding

Other sources of support for the project were JP Morgan ($80,000) and Pfizer ($75,000).

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RESULTS

  • In New York City, CSS conducted 498 consumer workshops reaching 8,472 participants. Of these, 302 workshops were conducted in English, 161 in Spanish, 10 in both English and Spanish, and 25 in Chinese. Setting up the workshops required the active involvement of 216 community-based organizations, which recruited Medicaid beneficiaries to attend. Workshops were conducted under the auspices of a variety of programs and institutions, for example, adult basic education programs, job training programs, and neighborhood health clinics.
    • To maintain an active base of 25 to 30 trainers per month, CSS trained 105 community volunteers through four trainer workshops. (CSS staff trained Spanish-speaking volunteers in separate sessions.) CSS recruited volunteers through a variety of sources, including press releases in local newspapers; through a CSS volunteer program for seniors and retirees; and AmeriCorps, a national program that places community service volunteers throughout the country. A Chinese outreach volunteer translated materials into Chinese and conducted workshops in Chinese communities. CSS conducted 37 trainer workshops in English and four in Chinese, reaching a total of 1,600 social workers, clinical providers, and other social services professionals. To supplement the training, CSS developed a manual in English, Guide to Medicaid Managed Care, and gave one to each participant.
    • CSS operated a Medicaid Managed Care help line that fielded calls from beneficiaries as well as social workers and other social service providers. During the grant period, 368 calls were received, with questions concerning how to receive health plan materials, how to obtain Medicaid benefits, and eligibility for exemptions from mandatory managed care
  • In Philadelphia, PHLP conducted 75 workshops for Medicaid beneficiaries reaching 2,237 people. While most of the workshops were conducted in English, four were conducted in Spanish, and seven were conducted in both English and Spanish. Although PHLP trained five volunteer workshop coordinators, the organization relied on two trained staff to conduct workshops after it emerged that volunteers had at times relayed irrelevant or incorrect information.
    • PHLP also conducted 25 workshops for 599 human service professionals at a variety of agencies throughout Pennsylvania. These included mental health agencies, foster care, maternal and child health agencies, and general social service agencies.
    • PHLP operated a help line that fielded calls from beneficiaries as well as social workers and other social service providers.
  • HPC operated an outreach program in Philadelphia's Asian communities, conducting 197 workshops and reaching 742 people. HPC used flyers and brochures translated into target languages to reach Cambodian, Chinese, Laotian, Vietnamese, Hmong, and Korean communities.
    • HPC also conducted three workshops for 14 volunteer trainers as well as seven workshops for human service providers with Asian social service agencies.
  • In an evaluation conducted by New York University (NYU) researchers with Commonwealth Fund support, workshop participants indicated that they viewed the workshops as unbiased because the information came to them through these community organizations, not health care companies seeking customers.

Communications

Project staff members published a report on the project in the American Journal of Public Health and have spoken at nearly two-dozen national conferences, including annual meetings of the American Public Health Association and the Association for Health Services Research. Articles on the project have appeared in several newspapers, including the New York Times.

In addition to workshop participants, several thousand copies of the project-produced Your Health Plan Handbook have been sold, including 1,000 copies purchased by the New York Public Library and 1,000 copies purchased by the New York/New Jersey Head Start Council. Continuum Health Partners, a New York City health plan, reprinted 20,000 copies of the handbook for its members. The federal Health Care Financing Administration (HCFA), which administers Medicare and Medicaid, cited the handbook as a model in its guide to writing and designing print materials for Medicaid beneficiaries

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LESSONS LEARNED

  1. In the competitive managed care marketplace, working with trusted community-based organizations was a critical component of the project's success. This lesson was an outgrowth of the NYU evaluation findings.
  2. Appropriate materials go far toward reaching minority and low-income consumers. Your Health Plan Handbook, the principal publication used in this project, was written on a fourth-grade reading level, employed large type, sample dialogues, and ample white space and illustrations. The handbook was published in a slick, bound format that consumers viewed as a high quality product they would want to retain.
  3. When selecting partnering organizations to work together for a project, it's possible to avoid many problems by choosing those that have previous collaborative experience. It also helps to use groups that have experience in the area of the project, because of their mission or previous work. Without such experience, organizations require time and education to get up to speed on the project.
  4. The model and materials written in English for low-income minority group can be translated into other languages to meet the needs of other groups. This project required creating materials for low-income minority groups. These are often difficult populations to reach, but the project did so successfully. Materials were written at a fourth-grade reading level, and had an easy-to-follow design that employed numerous illustrations and sample dialogues. The brochures were translated for many of the populations, including Spanish, Chinese, and other speakers of other Asian languages.

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AFTER THE GRANT

CSS received $4 million from New York City to develop and implement a multi-year Managed Care Consumer Assistance Project, a consumer education initiative similar to the Medicaid Managed Care Education Project. CSS staffers continue to make presentations at national conferences on educating Medicaid recipients about managed care. The group organized a conference for consumer advocates, Medicaid agencies, managed care organizations, and others on the importance of educating enrollees about managed care. The conference, entitled "Beyond Eligibility: Educating Managed Care Enrollees to Access Health Care Services," was held in Baltimore in March 2001 and was sponsored by HCFA, The Commonwealth Fund, and the Princeton, N.J.-based Center for Health Care Strategies.

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GRANT DETAILS & CONTACT INFORMATION

Project

Demonstration of a Community-Based Curriculum to Educate Medicaid Recipients to Use Managed Care

Grantee

Community Service Society of New York (New York,  NY)

  • Amount: $ 474,324
    Dates: October 1997 to June 2000
    ID#:  030142

Contact

Christine Molnar
(212) 254-8900
cmolnar@cssny.org

Web Site

http://www.cssny.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books and Reports

Molnar C, Your Health Plan Handbook (versions published for New York in English, Spanish, Chinese; Philadelphia in English, Spanish, Chinese; and Los Angeles in English, Spanish.) New York, N.Y.: Community Service Society of New York, 1997. 20,000 copies distributed to date.

Molnar C, Guide to Medicaid Managed Care. New York, N.Y.: Community Service Society of New York, 1998. 1,600 copies distributed.

Articles

Mason DJ, Nichols TE, Molnar C, and Bernstein A. "Using Public Media To Teach Medicaid Recipients About Managed Care." American Journal of Public Health, 90(1): 34–35, 2000.

Molnar C. "Policy and Practice Recommendations for reducing Race/Ethnic, Linguistic, and Class Disparities in the Health Care Delivery System." Commissioned paper for US Department of Health and Human Services, Office of Minority Health. July 2000.

Molnar C. "Addressing Challenges, Creating Opportunities: Fostering Consumer Participation in Medicaid and Children's Health Insurance Managed Care Programs." Journal of Ambulatory Care Management, 24(3): 61–67, 2001. Abstract available online.

Molnar C. "Reporting Health Care Quality to Minority Populations: Issues and Challenges." Commissioned paper for National Quality Forum Working group on Minority Healthcare Quality Measurement and Reporting. July 2001.

Presentations and Testimony

Christine Molnar, "Educating Medicaid Consumers about How to Choose and Use a Managed Care Organization: Results from a Pilot Project in Harlem and the South Bronx," at the American Public Health Association 125th Annual Meeting, Black Caucus section, November 10, 1997.

Christine Molnar, "Knowledge Gap: What Medicaid Beneficiaries Understand and What They Don't About Managed Care: Findings from a Survey in Harlem and the South Bronx," at the American Public Health Association, 125th Annual Meeting, Health Equity and Public Hospitals Caucus, November 10, 1997.

Christine Molnar, "Consumer Participation in Designing a Medicaid Managed Care Ombuds program for New York State," at the American Public Health Association, 125th Annual Meeting, Community Health Planning and Policy Section, November 10, 1997.

Christine Molnar, "The Impact of Medicaid Managed Care on Access to Care for Low-income New Yorkers," at the National Puerto Rican Coalition, 20th Anniversary Conference, panelist on the Health and Managed Care Forum, November 13, 1997.

Christine Molnar, Abby Bernstein, "CSS Model of Recruiting and Training Welfare Beneficiaries as Peer Trainers/Counselors who Conduct Medicaid Managed Care Workshops," at the Health and Human Services Region II Conference, sponsored by the Federal Interagency Welfare Reform Council, December 5, 1997.

Christine Molnar, Concurrent session, presentation on Evaluation of CSS' Medicaid Managed Care Education Project, at the Greater New York Hospital Foundation and the United Hospital Fund of New York Symposium on Health Services Research, December 10, 1997.

Christine Molnar, "Utilizing Community Organizations and Residents in the Effort to Educate Medicaid Recipients on Managed Care," at the Institute for International Research Conference on Marketing and Member Services for Medicaid Managed Care, March 24, 1998.

Christine Molnar, "Health Literacy: Interventions that Work," at the Pfizer, Inc., Roundtable Discussion, May 20, 1998.

Abby Bernstein, "Educational Interventions that Work," at the Blue Cross/Blue Shield Association National Meeting of BC/BS Medicaid Directors, Program Directors, and VPs of Government Programs, Medicaid Best Practices Forum, May 28, 1998.

Christine Molnar, "Access and Quality in Medicaid Managed Care: Impact on Minority Americans," at the Joint Center for Political and Economic Studies for Congressional staff, legislative aides, etc., June 2, 1998.

Christine Molnar, "Evaluation of an Educational Intervention to Improve Medicaid Beneficiaries' Navigation of Managed Care Plans," at the Association for Health Services Research 15th Annual Meeting Poster Session, June 22, 1998.

Christine Molnar, "Mandatory Medicaid Managed Care: From Concept to Reality," at the United Hospital Fund Panel on Implementation Issues, July 16, 1998.

Christine Molnar, Presentation on innovative outreach strategies to reach low-income, hard-to-reach populations at the National Academy for State Health Policy Preconference on State Child Health Insurance Program (SCHIP), August 9, 1998.

Christine Molnar, "Is Medicaid Managed Care Working? Experiences from New York, Los Angeles, and Philadelphia," and "Equity and Access: Measures and Methods for Making Health Care More Inclusive and Effective," at the Fifth Annual Managed Care to Managed Health Conference, October 22–24, 1998.

Christine Molnar, "Informing Consumers About Health Care Quality: Implementing the Research and Action Agenda for Consumers with Special Communication Needs" prepared as a background paper for the Quality Interagency Coordination Task Force (QuIC) Conference "Informing Consumers About Health Care Quality" December 11–12, 2001.

Christine Molnar, "An Evaluation of a Peer Education Program on How to Use and How to Choose A Medicaid Managed Care Plan," at the American Public Health Association 126th Annual Meeting, Public Health Education and Health Promotion Section, November 16, 1998.

Abby Bernstein, "A Community-Based Program to Prepare Medicaid Beneficiaries For Managed Care Using Lay Health Advocates," at the American Public Health Association 126th Annual Meeting, New Professionals Special Primary Interest Group (SPIG), November 16, 1998.

Christine Molnar, "A Model for Public Participation in the Implementation and Monitoring of Medicaid Managed Care Programs," at the American Public Health Association 126th Annual Meeting, Health Equity and Public Hospitals Caucus, November 17, 1998.

Abby Bernstein, "Partnerships for Success and Satisfaction: Consumers and their Advocates Working with States and Health Plans in Medicaid Managed Care," at the national conference sponsored by the Health Care Financing Administration, Division of Medicaid and State Operations, December 3–4, 1998.

Christine Molnar, "Making Quality Count: Helping Consumers Make Better Health Care Choices," at a national conference on consumer health information sponsored by the Health and the Health Care Financing Administration, June 8–10, 1999, Miami Beach, Fla.

Abby Bernstein, Case Study Presentation at the Seventh Annual Medicaid Managed Care Congress, Institute for International Research, June 23–25, 1999, Washington D.C.

Abby Bernstein, "Medicaid Managed Care Education Across the Country," panel presentation at the American Public Health Association, November 1999.

World Wide Web Sites

www.cssny.org/services details program services, plans, and accomplishments. New York, N.Y.: Community Service Society of New York. Estimated 5,000 visitors a month.

Print Coverage

"For Exiles from Medicaid, Lessons in Managed Care," in The New York Times, November 29, 1997.

"Understanding Managed Care," in Daily News, Carribeat Magazine, February 1998.

"Community Service Society at the Vanguard," in Daily News, Viva Magazine, April 1998.

"New York Bracing for Medicaid Managed Care," in The New York Times, October 7, 1998.

Radio Coverage

"Health Styles," Understanding Medicaid Managed Care, WBAI Radio, New York, N.Y., May 8, 1998.

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Report prepared by: Janet Spencer King
Reviewed by: Janet Heroux
Reviewed by: Richard Camer
Program Officer: David C. Colby