Pilot Program in Los Angeles County Develops Online Screening Tool to Help Find Insurance Options for Uninsured
From 2000 to 2001, the Los Angeles Care Health Plan developed Health Express, an online screening tool for those in Los Angeles County without public health insurance to help them find the coverage options that best fit their needs.
Los Angeles Care is the largest U.S. public health plan serving vulnerable populations.
- Having learned from its focus groups and executive interviews that many consumers were unaware of available health care options, staff at the plan designed and developed Health Express.
It is an online screening tool that compares an individual or family's information against a database of more than 125 public and private health care insurance programs in Los Angeles County and then displays the coverage options that best fit the client's needs.
- Los Angeles Care is testing Health Express in health provider offices, health clinics, community-based organizations and schools. The sites will also give community providers access to the most current health care coverage programs' information and eligibility requirements.
The Robert Wood Johnson Foundation (RWJF) provided $198,359 in support for the project between May 2000 and April 2001.
Some 32 percent of Los Angeles County residents have no health insurance. This is the highest rate in California. Two-thirds of this population consists of low- to moderate-income families that earn too much for eligibility in public programs such as Medicaid but that cannot afford private insurance or that choose not to purchase it.
RWJF funded this grant to Los Angeles Care for a planning project that would increase access to primary and preventive care for this vulnerable population through use of an electronic medical card. Los Angeles Care, a nonprofit managed care organization, is the largest U.S. public health plan serving vulnerable populations.
The program, called MAC (for Medical Access Card), would offer a discounted fee for service to the uninsured and provide outpatient services with the emphasis on preventive and chronic care. Those whose annual income exceeded 250 percent of the federal poverty level and who were ineligible for publicly funded health care programs could participate in MAC.
MAC was not an insurance product; participants would pay annual dues for membership and for services with fees on a sliding scale based on income. Los Angeles Care planned to contract with nonprofit providers in the target cities of East Los Angeles and El Monte to provide health services.
To determine the viability of a discount program and the best mechanisms for communicating with the target market, Los Angeles Care conducted an in-depth consumer research effort. Los Angeles Care contracted with Garcia Research Associates of Burbank, Calif., to hold six focus groups with parents of Healthy Families members in African-American and Hispanic populations (Healthy Families is California's child health insurance program) and conduct 14 interviews with executives representing health care providers, insurance brokers and employers.
In addition, project staff evaluated the technology and information system the MAC program would require and assessed Los Angeles Care's information technology and that of eight targeted providers. The project staff also produced a business plan entitled "Medical Access Program: Product Development Outline and Implementation Project Plan (draft)."
Shortly after the project began, however, amendments were made to two bills (SB 173 and SB 1181) before the California legislature that would prevent health plans from offering discount programs such as the MAC program. Consumer health advocates and community-based providers supported the amendments because of their concern that discount programs could be used in lieu of offering traditional health care coverage to vulnerable populations.
Although the MAC program was geared to support those who had no other options because their income was too high for public insurance programs and even though the bills did not become law, given the prevailing political climate, the grantee organization decided to refocus its efforts on expanding the usage and purpose of an electronic screening device. RWJF concurred in that decision.
Other funding for the project included a grant of $150,000 from the federal Centers for Medicare & Medicaid Services (CMS, formerly known as the Health Care Financing Administration) and Los Angeles Care's in-kind support, valued at approximately $250,000.
- After learning from its focus groups and interviews with executives that many consumers were unaware of health insurance options available to them, the grantee organization designed and developed Health Express. This is an online screening tool that helps identify individuals' potential eligibility for public and private health insurance programs.
Health Express compares an individual or family's information against a database of more than 125 public and privately funded health insurance programs available in Los Angeles County such as Medi-Cal (Medicaid for California), Healthy Families, Kaiser Permanente for Kids Child Health Plan (I and II), Access Infants and Mothers, and others and displays the options that best fit the client's needs.
Health Express is designed to function as a screening tool in health provider offices, health clinics, community-based organizations and schools. Health Express also provides the most up-to-date information and eligibility requirements for these health care coverage programs information that is useful for community providers who otherwise do not have the resources to stay current on changing health care plans.
In addition, the screening capability of Health Express includes eligibility for the National Student Lunch Program, allowing on-site screening at schools for both health care plans and the student lunch program.
The project produced one report. (See the Bibliography for details.)
AFTER THE GRANT
The grantee organization will test Health Express at health provider offices, schools, community-based organizations, faith-based organizations and selected employers with the goal of having established 75 sites by the end of 2002. Translation of the text will include Cantonese, Khmer, Korean, Mandarin, Russian, Spanish, Tagalog and Vietnamese. The centers awarded a $250,000 grant to Los Angeles Care to continue developing information technology at community provider offices.
GRANT DETAILS & CONTACT INFORMATION
Medical Access Card Pilot Program
Los Angeles Care Health Plan (Los Angeles, CA)
Dates: May 2000 to April 2001
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Medical Access Program: Product Development Outline and Implementation Project Plan (draft). Los Angeles, Calif.: Los Angeles Care Health Plan, 2001.
Report prepared by: Michael Wylie
Reviewed by: Janet Spencer King
Reviewed by: Marian Bass
Program Officer: Pamela Dickson