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Putting Out the Welcome Mat – TargetingOutreach Efforts under the Affordable Care ActEvaluation of the Minnesota Community...
MNCAA Program Overview• Pay-for-performance outreach initiative (2008)  – Offers $25 bonus payment to community    organiz...
MNCAA Evaluation• Conducted for the MN Department of Human  Services (DHS) in the first half of 2012  – Funding from a Hea...
Key Evaluation Questions• Which organizations (or organization types) are  responsible for growth in application volume?• ...
Distribution of Level 1 MNCAAs byOrganization Type                            Other                Mental                 ...
Number of Level 1 MNCAAs Has Grown, butNumber Submitting Applications Has Tapered     Number of MNCAA Partners            ...
While Application Volume Grew in EarlyYears, Application Growth Has Also Tapered     60,000     55,000     50,000     45,0...
Percent of MHCP Applications Submitted byTop 15 MNCAAs in Terms of Volume                                                2...
Small Group of Level 1 Partners Responsiblefor Vast Majority of Applications• Most of these high volume partners:  – Are h...
Key Findings About Applicants• Population groups known to face health care  disparities appear to be targeted by program• ...
Enrollment Statistics Positive Overall, butLong Waits Continue for Clients, MNCAAs              Average Number of Weeks fo...
Policy Implications• Significant expertise already exists in core group of  community partners, most of whom have health c...
For a copy of the full evaluation report, please contact:                   Kristin E. Dybdal          Senior Research Fel...
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  1. 1. Putting Out the Welcome Mat – TargetingOutreach Efforts under the Affordable Care ActEvaluation of the Minnesota Community ApplicationAgent (MNCAA) ProgramKristin E. Dybdal, MPAMN Health Services Research ConferenceMarch 5, 2013 Funded by a grant from the Robert Wood Johnson Foundation
  2. 2. MNCAA Program Overview• Pay-for-performance outreach initiative (2008) – Offers $25 bonus payment to community organizations for every individual successfully enrolled in Minnesota Health Care Programs – Multiple levels of organizational involvement allowed: Level 1, 2, and 3 partners – MNCAA Resource Center, a DHS work team, facilitates access to case information, technical assistance, and payments for community partners 2
  3. 3. MNCAA Evaluation• Conducted for the MN Department of Human Services (DHS) in the first half of 2012 – Funding from a Health Resources and Services Administration’s (HRSA) State Health Access Program (SHAP) grant• “Lessons learned” approach – Focus was on Level 1 MNCAAs – Quantitative analysis using DHS database supplemented with key informant interviews – Opportune timing with four years of data and as state develops health insurance exchange 3
  4. 4. Key Evaluation Questions• Which organizations (or organization types) are responsible for growth in application volume?• How does location of applicants align with major geographic areas of health disparity within state?• What percent of individuals assisted successfully enroll in MHCP? What percent are new to MHCP?• How long do MNCAA organizations wait to receive bonus payments?• Is $25 an adequate enrollment bonus for MNCAAs?• What is the value of the program to MNCAAs? 4
  5. 5. Distribution of Level 1 MNCAAs byOrganization Type Other Mental 9% Health Organization 2% Community Health Care Action Organization Program 48% 5% Human Service Organization 36% *As of June 2012, the total number of Level 1 MNCAAs = 140 5
  6. 6. Number of Level 1 MNCAAs Has Grown, butNumber Submitting Applications Has Tapered Number of MNCAA Partners Number of Level 1 MNCAAs by Participation Level Submitting Applications 140 Type Dec ’08 Jun ‘12 120 123 Level 1 66 140 100 80 86 Level 2 59 227 60 72 69 72 40 Level 3 5 577 35 20 Total 130 944 0 2008* 2009 2010 2011 2012* Total *Represents number of MNCAAs submitting applications for a partial year. 6
  7. 7. While Application Volume Grew in EarlyYears, Application Growth Has Also Tapered 60,000 55,000 50,000 45,000 Level 1 MNCAA Application and Applicant 40,000 Volume per Year 35,000 30,000 25,000 20,000 15,000 10,000 5,000 - 2008* 2009 2010 2011 2012* Total Applications 3,135 10,733 11,382 9,801 4,593 39,644 Applicants 4,766 16,001 15,972 14,115 6,693 57,547 *Represents volume through June 8, 2012. 7
  8. 8. Percent of MHCP Applications Submitted byTop 15 MNCAAs in Terms of Volume 2008 2009 2010 2011 2012 Total Portico Healthnet 39% 19% 10% 8% 10% 14% MedEligible 15% 12% 7% 9% 4% 9% HCMC Whittier Clinic 5% 11% 9% 3% 2% 7% Cardon Outreach 0% 0% 7% 15% 9% 7% Lake Superior Community Health Clinic 13% 6% 4% 5% 5% 6% Childrens Hospitals and Clinics – Mpls. 3% 7% 6% 4% 4% 5% St. Cloud Area Legal Services 10% 4% 3% 3% 1% 4% HCMC Richfield Clinic 1% 3% 4% 4% 3% 3% HCMC East Lake Clinic 2% 5% 4% 2% 0% 3% Childrens Hospitals and Clinics – St. Paul 1% 3% 3% 3% 3% 3% La Clinica –West Side Community Health Svcs. 0% 3% 3% 3% 3% 3% Cardon Outreach – Duluth 0% 0% 4% 4% 5% 3% Southside Medical Clinic 1% 4% 3% 1% 3% 3% Park Nicollet Methodist Hospital 0% 0% 7% 1% 0% 2% Indian Health Board 1% 3% 2% 2% 1% 2% Subtotal 96% 86% 77% 73% 70% 74% Total number of applications 3,135 10,733 11,382 9,801 4,593 39,644 8
  9. 9. Small Group of Level 1 Partners Responsiblefor Vast Majority of Applications• Most of these high volume partners: – Are health care providers or organizations – Place highest value on access to case status updates provided by MNCAA Resource Center – Have elected to operate under data share agreements with DHS and no longer receive $25 bonuses 9
  10. 10. Key Findings About Applicants• Population groups known to face health care disparities appear to be targeted by program• Underrepresentation of applicants/applications from Greater Minnesota• 13 percent of applicants new to MHCP• 65 percent of applicants successfully enrolled in MHCP – 79 percent of successful applicants enrolled in Medical Assistance 10
  11. 11. Enrollment Statistics Positive Overall, butLong Waits Continue for Clients, MNCAAs Average Number of Weeks for MNCAAs to Receive Bonus Payments Year Average Number of Weeks* 2008 17 2009 16 2010 21 2011 15 2008-2011 18 *Reflects average difference between the date bonuses were paid and date applications were received. 11
  12. 12. Policy Implications• Significant expertise already exists in core group of community partners, most of whom have health care missions – Timely access to client case information essential• More substantial financial investments and a “higher- touch” model required to engage a broader group of community organizations in direct assistance• Implementing ACA outreach, navigator, and assistance activities may be most challenging in Greater Minnesota, requires special focus 12
  13. 13. For a copy of the full evaluation report, please contact: Kristin E. Dybdal Senior Research Fellow, SHADAC dybda003@umn.edu Sign up to receive our newsletter and updates at www.shadac.org @shadac
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