Arm2011 cousineau 6.14.11

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Arm2011 cousineau 6.14.11

  1. 1. Outreach and EnrollmentStrategies in California Michael R. Cousineau Academy Health Annual Meeting Seattle June 14, 2011
  2. 2. Problems and Challenges• through 2008, many children uninsured although many eligible• CA counties embarked on Outreach and Enrollment campaigns• Unique challenges,• Approach not organized or systematic• Not know what works, data systems not linked
  3. 3. Research Purpose• To describe a county’s approach outreach and enrollment (OE) strategies• Correlate enrollment with the deployment of specific OE strategies: – Medi-Cal (Medicaid) – Healthy Families (CHIP) – Healthy Kids
  4. 4. Outreach and Enrollment Strategies Non-Technology Based Technology Based Mass Media Campaigns Health-E-App Community Health Workers One-E-App Provider In-Reach Pre-populated Renewal Forms School Based Strategies County Developed Data System Waiting Lists Matching potential eligibility against existing program enrollments
  5. 5. Data Source/Methods• Study Sample: CHI Counties (n=25)• Study Period: January 2001 to June 2008• Unit of analysis, County-Quarter (CQ)• Study Procedures – Key Informant Group Interviews/Site Visits – Enrollment data for three programs for each CQ• For each quarter we had – Strategy (yes or no) – Enrollment for each program for each CQs
  6. 6. Non-technology Strategies by Quarters, 2001-2008 N=25 counties 20 18 16 14 12Counties 10 8 6 4 2 0 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 2001 2002 2003 2004 2005 2006 2007 2008 Quarters Mass Media Campaign Community Health Workers Provider In-reach School Based Matching Public Insurance
  7. 7. Use of Technology Tools. (2001-2008) N=25 counties* 18 16 14 12Counties 10 8 6 4 2 0 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 2001 2002 2003 2004 2005 2006 2007 2008 Quarters County Data System Health-E-App One-E-App
  8. 8. Rate Ratios of Being Newly Enrolled per 10,000 children, Ages 0-18 Years (2001-2007)Strategy Use (Yes vs. No) Rate Ratio p-valueHealth-e-App 1.11 0.02One-e-App 1.11 0.14School Based 1.12 0.01Community Health Worker 0.96 0.41Matching Public Programs 0.98 0.59Provider In-Reach 1.04 0.39Media Utilization 1.04 0.26County Developed System 1.10 0.09
  9. 9. Rate Ratios of Being Newly Enrolled per 10,000 children, Ages 0-18 Years (2001-2007)Number of Strategies per county- Rate Ratio p-valuequarter 0 Reference 1 to 2 1.04 0.54 3 to 4 1.11 0.16 5 to 6 1.24 <0.01 7 to 8 1.54 <0.001*Controlling for county effects, season (quarters), and percent estimates of poverty
  10. 10. Implications for Health Reform• Systematic evidence-based approach to outreach and enrollment• Using multiple strategies will be more effective than using one or two particularly if they are organized in reference to specific population groups and by taking into account the effects of time.• Increasing use of technology will simplify enrollment activities, could achieve higher volume of enrollment• Less technology focused interventions still be important for hard to reach groups

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