September 2007

Grant Results

SUMMARY

The Healthcare Leadership Council, along with Jason Lee, Ph.D., from Health Policy Consulting, studied the impact of educating small business owners in Virginia and Pennsylvania about health insurance. Lee conducted the first part of the study in Virginia. Project staff from the Healthcare Leadership Council conducted the second part of the study in Pennsylvania.

Key Results

  • The grantee produced three guides to health insurance options for small businesses with location-specific information or inserts.
  • Briefings were held for members of Congress from Virginia and for others on Capitol Hill in Washington.

Key Findings

  • Small business owners who attended an educational seminar and received a guide to health insurance options knew more about and were more aware of health insurance than were those who did not attend the seminar or did not receive the guide.
  • The type of education matters. The educational seminars with the guides were more effective than the guides alone.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $362,252 to support this unsolicited project from January 2003 to December 2005.

 See Grant Detail & Contact Information
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THE PROBLEM

In 2001, the majority of the 41.2 million uninsured people in America were members of working families, according to the U.S. Census Bureau. RWJF's Synthesis Project reported that during the same period, more than half of people who worked and were uninsured were employed in small businesses (defined as businesses with fewer than 199 employees).

Although cost has been widely cited as a significant barrier to coverage, many studies show that the lack of knowledge about health insurance among small business owners is a significant obstacle to decreasing the number of uninsured. For example, a 2002 survey conducted by the Healthcare Leadership Council found that small business counselors, although frequently asked about health insurance, believed that they did not have sufficient knowledge to counsel clients effectively about health insurance. The Healthcare Leadership Council, located in Washington, is a coalition of health care chief executives that develops policies, plans and programs to improve the affordability, innovation and quality of American health care.

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RWJF STRATEGY

Since 1972, one of RWJF's major goals has been to assure that all Americans have access to quality health care at reasonable cost. To further that goal over the years, RWJF has pursued various strategies to expand insurance coverage. Research on and work with small employers have been key features of RWJF's efforts to decrease the number of uninsured Americans.

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THE PROJECT

Staff members from the Healthcare Leadership Council worked under a subcontract with Jason Lee, Ph.D., of Health Policy Consulting in Bethesda, Md. They studied the effects of educating small business owners in Northern Virginia and Central and Southeastern Pennsylvania about health insurance. The study focused on changes in employers' knowledge and awareness of health insurance facts and local insurance options.

The first part of the study, which Lee conducted, focused on Virginia. Project staff members from the Healthcare Leadership Council handled the second part of the study, in Pennsylvania, after realizing that they needed more control over the project and had the expertise in-house to conduct the study.

Project staff also partnered with local Small Business Development Center programs (public/private partnerships providing management assistance to small business owners) and chambers of commerce (business federations representing businesses of all sizes, sectors and regions), which provided access to their members. Staff members began working with chambers of commerce after they could not recruit enough participants through Small Business Development Centers.

Methodology

Project staff used a quasi-experimental design to study whether and to what extent educating small business owners was effective in improving their knowledge of health insurance through:

  • A 15-minute educational seminar about health insurance with a guide to health insurance options for small business owners (experimental group) compared to no educational seminar or guide (control group):
    • Study participants were sole proprietors and small business owners with one to 50 employees (most had fewer than 10 employees) who did not offer health insurance through their businesses.
    • Each group had 160 participants from Virginia and Pennsylvania.
    • Staff delivered the seminars at Small Business Development Center or chamber of commerce events or small business fairs.
  • A guide to health insurance options for small business owners mailed to approximately 1,400 small business owners in Virginia (through the Loudoun County Chamber of Commerce); 36 participated in the study.

Project staff developed the educational seminar and three health insurance guides. The seminar covered:

  • Basic health insurance facts.
  • The business case for offering insurance to small firms.
  • Tax benefits of offering coverage.
  • Advantages of group purchasing and alternatives to traditional insurance.

MT Donahoe, a group health insurance administrator/wholesaler, provided local information for the three guides under a subcontract.

Project Survey. To measure the effectiveness of the educational program, project staff developed a survey composed of:

  • General questions (demographics, coverage status and firm size).
  • A 14-item "Knowledge and Awareness of Health Insurance Scale," which assessed:
    • General knowledge about how health insurance works.
    • Knowledge of tax treatment.
    • Knowledge of the regulatory environment.
    • Knowledge of health insurance options.

All participants in the experimental group completed the survey in person before the seminar, as well as by phone four weeks later. Project staff mailed the survey to participants in the experimental group one year after the seminar but received responses from only three of the 160 participants. Staff attributed the low response rate to the long interval between the four-week and one-year surveys and to the use of mail rather than telephone. Staff did not follow up with nonresponders.

The participants in the control group completed the survey in person. After that, project staff gave them the guide. Two weeks later, project staff resurveyed the members of the control group by phone.

Project staff asked the 1,400 small business owners who received the guide and survey in the mail to complete the survey and mail it back. Thirty-six small business owners completed the survey. Staff did not follow up with nonresponders.

RWJF's Cover the Uninsured Week

At RWJF's request, project staff created a national Guide to Health Insurance Options for Small Businesses (updated in 2007) for use in RWJF's 2004 Cover the Uninsured Week. Cover the Uninsured Week brought together business owners, union members, educators, students, patients, physicians, nurses, faith leaders and their congregants and organizations nationwide to demand that our nation's leaders find solutions for Americans without health insurance.

Communications

Project staff distributed more than 2,600 guides to small business owners, members of Congress and their staff, chamber of commerce members, Small Business Development Center members and foundations. The guides are posted on the Healthcare Leadership Council's Web site. Project staff also:

  • Made presentations at the Second Annual Virginia's Governor's Conference on Covering the Uninsured (2004) and the Virginia Lt. Governor's Commission on Small Business Insurance Costs (2004).
  • Drafted an article about the project.

See the Bibliography for details.

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RESULTS

Project staff reported the following results in a report to RWJF:

  • Three guides to health insurance options for small businesses, with location-specific information or inserts: The guides cover:
    • Important facts about health insurance.
    • Key concepts needed to make an informed decision about health insurance, including:
      • How much health insurance coverage costs.
      • What types of insurance plans are available.
    • The inserts cover local information about health insurance, including charts of:
      • Health plan comparisons.
      • Employee cost sharing (under various health plans).
      • Other health benefit options (e.g., eligibility and tax advantage).
  • A briefing of members of Congress from Virginia, along with staff from RWJF and the Small Businesses Development Centers.
  • A briefing on Capitol Hill.

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FINDINGS

Project staff reported the following findings to RWJF:

  • Participants who attended the educational seminar and received the guide to health insurance options (experimental group) knew more about and were more aware of health insurance than were those who did not attend the seminar or receive the guide (control group). The experimental group scored higher on the Knowledge and Awareness of Health Insurance Scale than did the control group:
    • In Virginia:
      • The experimental group answered an average of 11.7 out of 14 questions correctly (84 percent) approximately four weeks after the seminar.
      • The control group averaged 10.1 correct answers (72 percent) on the survey completed at the small business event.
    • In Pennsylvania:
      • The experimental group answered an average of 12.8 out of 14 questions correctly (92 percent) approximately four weeks after the seminar.
      • The control group averaged 10.08 correct answers (72 percent) on the survey completed at the small business event.
  • Participants who attended the educational seminar and received the guide to health insurance options (experimental group) knew more about and were more aware of health insurance after attending the seminar and receiving the guide than they were before this exposure:
    • The experimental group scored an average of 9.58 on the Knowledge and Awareness of Health Insurance Scale before the seminar and an average of 12.14 four weeks later.
  • The type of education matters. The educational seminars with the guides were more effective than the guides alone:
    • The small business owners who received the guide in the mail had average scores on the Knowledge and Awareness of Health Insurance Scale of 9.7. This was the same as the score of experimental group participants before the seminar (9.7) and not significantly different from the score of the control group (10.1).

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LESSONS LEARNED

  1. Know the strengths of project staff. The project director originally thought that using a subcontractor was the most efficient way to manage the project. However, she later realized that the subcontractor was excellent at some tasks (research and writing) while staff within the Healthcare Leadership Council was better at other tasks (leading the educational seminars) and could, in fact, complete the project. She shifted the seminars and the study in Pennsylvania to in-house staff. (Project Director/Witchey)
  2. Find the right local partners to gain access to the target market. Project staff used local partners with existing networks to find small business owners to participate in the study. Staff originally planned to solicit study participants solely through the Small Business Development Centers in Northern Virginia. When the network turned out to be not as extensive as originally thought, staff established a relationship with the chambers of commerce. (Project Director/Witchey)
  3. Create an effective partnership by ensuring that all partners receive a benefit from participating. The Healthcare Leadership Council conducted a study and obtained data to advance its work on covering the uninsured, and the Small Business Development Centers and chambers of commerce received practical guides for use with their small business membership. (Project Director/Witchey)

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AFTER THE GRANT

Healthcare Leadership Council staff, under contract from the Virginia Governor's Office Task Force on the Uninsured, created four more regional inserts to accompany the Guide to Health Insurance Options for Small Businesses in Virginia. The new inserts covered:

  • Central Virginia
  • Eastern Virginia
  • Northwestern Virginia
  • Southwestern Virginia

In 2006, the Healthcare Leadership Council relaunched its Health Access America initiative, which educates people, including small business owners, about coverage options in communities across America.

The Healthcare Leadership Council has partnered with RWJF's Cover the Uninsured Week since its inception in 2003. In 2007, the Healthcare Leadership Council was a co-sponsor of the event.

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GRANT DETAILS & CONTACT INFORMATION

Project

Conducting a Demonstration and Evaluation of Educational Interventions to Increase Awareness of Health Insurance and Purchasing Rules

Grantee

Healthcare Leadership Council (Washington,  DC)

  • Amount: $ 362,252
    Dates: January 2003 to December 2005
    ID#:  047227

Contact

Debbie Witchey
(202) 452-8700
dwitchey@hlc.org

Web Site

http://www.hlc.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.)

Articles

Lee J, Grealy MR and Fronstin P. "The Effect of Education on Small Employers' Knowledge and Awareness of Health Insurance." Unpublished.

Reports

A Guide to Health Insurance Options for Small Businesses in Northern Virginia. Washington: Healthcare Leadership Council, 2003.

A Guide to Health Insurance Options for Small Businesses in Virginia. Washington: Healthcare Leadership Council, 2004. Also available online. With regional inserts:

  • An Overview of Health Insurance Options for Small Businesses in Region I: Northwestern Virginia, 2006. Also available online.
  • An Overview of Health Insurance Options for Small Businesses in Region II: Northern Virginia, 2004. Also available online.
  • An Overview of Health Insurance Options for Small Businesses in Region III: Southwestern Virginia, 2006. Also available online.
  • An Overview of Health Insurance Options for Small Businesses in Region IV: Central Virginia, 2006. Also available online.
  • For Small Businesses in Region V: Eastern Virginia, 2006. Also available online.

A Guide to Health Insurance Options for Small Business. Washington: Healthcare Leadership Council, 2003. Also available online. With regional inserts:

  • An Overview of Health Insurance Options for Small Businesses in Central Pennsylvania, 2003. Also available online.
  • An Overview of Health Insurance Options for Small Businesses in Southeastern Pennsylvania, 2003. Also available online.

Survey Instruments

"Attitudes and Experiences of Virginia Small Business Owners," Healthcare Leadership Council and Virginia Small Business Development Centers, fielded October 9, 2003–December 4, 2003.

"Attitudes and Experiences of Virginia Small Business Owners," Healthcare Leadership Council and Virginia Small Business Development Centers, fielded November 13, 2003–January 21, 2004.

"Attitudes and Experiences of Virginia Small Business Owners," Healthcare Leadership Council and Virginia Small Business Development Centers, revised, fielded December 9, 2003–December 17, 2003.

"Attitudes and Experiences of Pennsylvania Small Business Owners," Healthcare Leadership Council and Pennsylvania Small Business Development Centers, fielded October 11, 2004–December 9, 2004.

World Wide Web Sites

www.hlc.org/html/main_street_initiative.html, Healthcare Leadership Council. This portion of the council's Web site has all of the guides and inserts.

Presentations and Testimony

Dede Spitznagel, "HLC's Main Street Initiative: Educating Small Businesses about Health Insurance," at the Congressional Briefing on Small Businesses and Health Insurance: Community Efforts to Expand Coverage for the Working Uninsured, Healthcare Leadership Council, December 8, 2003, Washington.

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Report prepared by: Barbara Matacera Barr
Reviewed by: Lori De Milto
Reviewed by: Marian Bass
Program Officer: Karen Davenport
Program Officer: David J. Morse

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