May 2007

Grant Results

SUMMARY

From 2002 to 2005, staff at Families USA created and ran a support center—the Health Assistance Partnership—to provide technical assistance to consumer health assistance programs.

Consumer health assistance programs, also known as ombudsman programs, educate patients and consumers about their health care rights and responsibilities, including insurance coverage, and identify, investigate and resolve complaints about health care coverage and services. The programs consist of three main types:

  • State health insurance assistance programs that provide information, counseling and assistance on a wide range of Medicare, Medicaid and Medigap matters.
  • Medicaid ombudsman programs to educate current and potential Medicaid beneficiaries about managed care plans.
  • General health care ombudsman programs, created by states in response to the increasing complexities of both public and private health insurance.

Key Results

  • The project team established collaborative networks among the three main types of consumer health assistance programs, serving nearly 1,000 such programs nationwide.
  • Partnership staff provided technical assistance services to strengthen consumer health assistance programs in all three networks and to stimulate cross-network communication and information sharing.
  • The project team established the Health Assistance Partnership to help state health insurance assistance programs enhance their capacity to serve Medicare beneficiaries and their caregivers. Staff provided education and technical assistance through:
    • User-friendly materials about Medicare and related health coverage.
    • Annual conferences.
    • A weekly electronic newsletter on timely issues and important topics.
    • A Web site featuring numerous resources and tools.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this unsolicited project with a grant of $5,359,435 to the Families USA Foundation, the organization's charitable entity.

 See Grant Detail & Contact Information
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THE PROBLEM

Consumer health assistance programs, also known as ombudsman programs, exist in various forms throughout the country. The programs educate patients and consumers about their health care rights and responsibilities, including insurance coverage, and identify, investigate and resolve complaints about health care coverage and services.

The programs consist of three main types:

  • State health insurance assistance programs provide information, counseling and assistance on a wide range of Medicare, Medicaid and Medigap matters, including managed care-related issues. They exist in all 50 states and the District of Columbia and are funded by the federal Department of Health and Human Services.
  • Medicaid ombudsman programs educate Medicaid beneficiaries and potential beneficiaries about managed care plans and help them resolve issues on a myriad of matters, ranging from enrollment to access to care.
  • General health care ombudsman programs, created by states in response to the increasing complexities of health insurance in general, take various forms. Some serve only those with private health insurance, while others serve privately insured, publicly insured and even uninsured consumers.

In 2000, RWJF issued a grant to Families USA to produce a comprehensive, nationwide catalog of consumer health assistance programs. (See Grant Results on ID# 036433.) Families USA is a Washington-based nonprofit that works to promote affordable health care for all Americans.

In a survey conducted under the same grant, Families USA staff found that many consumer health assistance programs had a significant need for technical, educational and training support services. Staff subsequently used grant funds to develop a feasibility plan for a national technical assistance support center for these programs.

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RWJF STRATEGY

For more than 30 years, RWJF has worked to improve Americans' access to medical care by increasing the number and proportion of the American public with health insurance. The Foundation is also interested in helping patients with health insurance navigate the health care system and become more engaged in their care.

This project addresses one strategy for enabling patients to participate actively in their health and health care. Consumer assistance programs have the capacity to engage consumers in health care and to develop linkages with other consumer-oriented organizations. They also have the ability to provide feedback to policy-makers, providers, employers and government agencies about consumer and patient experiences with health care. This project aims to strengthen the quality of services provided to consumers by using ombudsman programs and by helping diverse stakeholders learn on a timely basis about new consumer concerns and problems with the health care system. This project was meant to help low-income beneficiaries navigate Medicaid managed care by linking with other RWJF programs, such as the Center for Health Care Strategies.

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THE PROJECT

The chief goal of this project was to establish a support center for consumer health assistance programs, known as the Health Assistance Partnership. The partnership planned to work with all three types of consumer health assistance programs to:

  • Assist in building a collaborative network of consumer health assistance programs across the nation.
  • Provide services and support to strengthen the programs and improve the quality of the services they provide to consumers.
  • Assist consumer health assistance programs in developing data-collection and reporting systems so that policy-makers and insurance providers would be able to learn about problems experienced by consumers.
  • Promote its work to state and national policy-makers and stakeholders (e.g., foundations, insurance companies, disease societies), as well as to consumers.

Changes in Project Focus

Shortly after the project's inception, changes in the health policy environment led the project staff to change the project's focus significantly, emphasizing the Medicare and Medicaid sectors and de-emphasizing the private-sector consumer health assistance programs.

The change in focus came as managed care companies modified some of their policies in an attempt to defuse a public backlash against them and their perceived negative impacts on consumers. That reduced the demand from consumer health assistance programs for technical assistance in dealing with managed care.

At the same time, large numbers of beneficiaries began reporting confusion and frustration as a result of the Medicare Modernization Act of 2003, which:

  • Changed rules related to Medicare Advantage plans (the Medicare managed care plans offered through private insurers).
  • Introduced Medicare prescription drug subsidies.

Other Funding

The Atlantic Philanthropies provided $3,922,641 in additional funding for the project; five other funders provided another $958,900. (See the Appendix for details.)

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RESULTS

  • The project team established the Health Assistance Partnership to help state health insurance assistance programs enhance their capacity to serve Medicare beneficiaries and their caregivers. The partnership's services include:
    • Volunteer training tools.
    • Annual conferences.
    • User-friendly materials about Medicare and related health coverage.
    • Monthly interactive conference calls on timely topics.
    • Tools to help educate and counsel Medicare beneficiaries and caregivers.
    • Technical assistance and regional trainings on topics related to program operation.
    • A weekly electronic newsletter on timely issues and important topics, which, by the end of 2005, staff was distributing to approximately 1,800 people.
    • Customized counseling and infrastructure-related assistance to selected ombudsman programs.
  • The project team created a Web site featuring numerous resources and tools. The number of links that other Web sites have made to the partnership's Web site grew from 75 in March 2004 to more than 16,000 by November 2005.
  • The project team established collaborative networks among the three types of consumer health assistance programs, involving nearly 1,000 such programs nationwide. Participating programs can avail themselves of many of the services offered by the Health Assistance Partnership, including conference calls, annual conferences and technical assistance provided via e-mail.
    • The largest of these networks, serving the state health insurance assistance programs for Medicare beneficiaries, included some 500 programs in 47 states, three territories and the District of Columbia.
    • Approximately 150 programs joined the Medicaid network.
    • More than 160 programs joined the private insurance network.
  • Partnership staff provided technical assistance services to strengthen consumer health assistance programs in all three networks and to stimulate cross-network communication and information sharing. Examples include:
    • Approximately 30 audio conference calls a year, with from 30 to 130 participants representing all 50 states, the District of Columbia and territories.
    • Publication of 15 reports, covering topics such as the Medicare-approved drug discount card and the Health Insurance Portability and Accountability Act (HIPAA). See the Bibliography for details.
    • Technical assistance to more than 300 individual programs a year. Most calls dealt with issues related to dislocated workers and retirees who were losing health coverage and with concerns about dealing with new privacy regulations established by HIPAA.
    • Three annual conferences aimed at increasing practical knowledge of issues relevant to the day-to-day work of the participants. The 2004 conference had the highest attendance, with 220 participants.
  • Project staff helped consumer health assistance programs develop data-collection and reporting systems. For example:
    • In Kentucky and Florida, staff worked with consumer health assistance programs in reviewing their data reporting procedures and suggested different software programs to improve reporting capacity.
    • Project staff published a tool, available online, entitled Collecting and Using Data: How Consumer Health Assistance Programs Report on Their Work. The tool provides information on key features of some of the best data-collection systems used by ombudsman programs.
  • Project staff worked to promote its networks to state and national policy-makers and stakeholders (e.g., foundations, insurance companies, disease societies), as well as to consumers. Specifically, this included:

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AFTER THE GRANT

One important result of this project was the development of a funding plan for the future, which enabled the grantee to secure additional funding to continue some of its work after RWJF support ended. In 2006, the Health Assistance Partnership received a grant of nearly $4 million from the Atlantic Philanthropies to continue to develop its role as a source of information and technical assistance on Medicare for state consumer health assistance programs.

Project staff transferred responsibility for providing technical assistance and support for Medicaid and private insurance ombudsman programs to its parent organization, Families USA.

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GRANT DETAILS & CONTACT INFORMATION

Project

Creating and Nurturing a Support Center for Health Care Ombudsman Programs

Grantee

Families USA Foundation (Washington,  DC)

  • Amount: $ 5,359,435
    Dates: January 2002 to December 2005
    ID#:  040697

Contact

Ronald F. Pollack
(202) 628-3030
rpollack@familiesusa.org

Web Site

http://www.hapnetwork.org/about

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Additional Funding

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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.)

Reports

Assistance for Health Care Consumers: Key Provisions of State Laws. Washington: Health Assistance Partnership, 2005.

Collecting and Using Data: How Consumer Health Assistance Programs Report on Their Work. Washington: Health Assistance Partnership, 2005. Available online.

Confused about the New Medicare-Approved Drug Discount Card? Contact Your SHIP! Washington: Health Assistance Partnership, 2004.

Consumer Health Assistance Programs: A Model Act for Legislators and Advocates. Washington: Health Assistance Partnership, 2005.

Consumer Health Assistance Programs: Bridging Gaps in the Health Care System-Findings from a National Survey. Washington: Health Assistance Partnership, 2005.

Counseling on the Medicare Part D Drug Benefit. Washington: Health Assistance Partnership, 2005.

An Explanation of the Davila/Calad Supreme Court Decision. Washington: Health Assistance Partnership, 2004.

HAP Guide to Free Online Medical Resources and the HAP Guide to Free Online Legal & Policy Research. Washington: Health Assistance Partnership, 2003.

Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulation: Questions and Answers for Consumer Health Assistance Programs. Washington: Health Assistance Partnership, 2003.

The Health Insurance Tax Credit in the Trade Assistance Reform Act. Washington: Health Assistance Partnership, 2003.

The Medicare-Approved Drug Discount Card: Q&A. Washington: Health Assistance Partnership, 2004.

Medicare Prescription Drug Plans Are Coming Soon: Here's How You Can Help Low-Income Medicare Beneficiaries Get Coverage. Washington: Health Assistance Partnership, 2005.

Rights to Access Medical Records Under the HIPAA Privacy Regulation. Washington: Health Assistance Partnership, 2003.

Risk Management and Part D Counseling: Protecting Counselors from Liability. Washington: Health Assistance Partnership, 2005. Available online.

Screening for Medicaid and State Children's Health Insurance (SCHIP) Eligibility. Washington: Health Assistance Partnership, 2003.

Audio-Visuals and Computer Software

The Second Annual Health Assistance Partnership National Conference, a CD-ROM toolkit provided to conference participants. Washington: Health Assistance Partnership, 2004.

What You Need to Know about Medicare Part D, a PowerPoint® presentation. Washington: Health Assistance Partnership, 2006. Available online.

World Wide Web Sites

www.healthassistancepartnership.org. The Web site of the Health Assistance Partnership features tools and resources for consumer health assistance programs and a State Health Insurance Assistance Program Locator for consumers. Washington: Health Assistance Partnership, 2002.

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Report prepared by: Robert Crum
Reviewed by: Richard Camer
Reviewed by: Marian Bass
Program Officer: Robin E. Mockenhaupt
Program Officer: Anne F. Weiss