Working With Your City or Public Health Departments to Get People Covered

© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org


Working with Your Public Health Departments to Get People Covered

Jennifer Roniger, MPH, Enroll America Malcolm Williams, Ph.D., RAND

Daphne Pie, Seattle & King County Public Health Department Maria De La Cruz, Houston Department of Health and Human Services



Daphne Pie, Manager-Public Health-Seattle & King County-Access & Outreach | 06.05.15

Enroll King County! What Did We Do & How Did We Do It?


Who Are We? King County, Washington State

State-based exchange—Wahealthplanfind.org Expanded Medicaid—Apple Health

1.8 million people; 39 cities Public Health-Seattle & King County:

10th largest health department Lead In-Person Assister Organization for King County region

14% Uninsured Rate before the Affordable Care act


2%

26%

0% 5% 10% 15% 20% 25% 30%

Mercer Isle/Pt Cities

Bear Creek/Carnation/Duvall

Vashon Island

Sammamish

Issaquah

Newcastle/Four Creeks

Snoqualmie/North Bend/Skykomish

Shoreline

Kirkland

Redmond

Covington/Maple Valley

Kenmore/LFP

Bellevue

Seattle

Bothell/Woodinville

Renton/Fairwood

Black Diamond/Enumclaw/SE County

East Federal Way

Kent

Burien

Auburn

Federal Way

North Highline

SeaTac/Tukwila

Des Moines/Normandy Park

Lack of health insurance by Health Reporting Area, age 18 to 64, King County, 2007-2011 average Source: BRFSS, produced by PHSKC, APDE, 9/2012

13X difference

Lack of Health Insurance Common


Snap Shot of the Uninsured in King County

Deeper Dive of the Uninsured

26% American

Indian/Alaskan Native

44% Hispanic

Uninsured Adults by Race/Ethnicity

15% Asian

19%

Pacific Islanders

King County, Washington

State

25% Black

16% White


Overview of Enrollment Efforts


How Did We Roll Out Our Strategies?

Slide and Content Source: Hutchinson, “Three Innovative Strategies: King County’s Quest to Cover the Uninsured”

Solicit active support from

local leaders and create

opportunities for them to lead

“Top down approach”

Defer detailed decision-making

to grassroots organizations

“Allow your community

experts to drive the work—cover

the gaps”

Frame enrollment in terms that will resonate with the

community

“We don’t use terms that are foreign to our communities”

Invite participation

from organizations

outside of health-care

“In our network we had various

types of agencies”

Utilize existing partnership

networks and bring all

organizations to the table—especially

smaller ones “DSHS, Health Care Authority, City of Seattle,

various networks”

Convene a regular forum to

address technical issues and share

solution

“First Friday Forum”


Helping Our Community Partners

GOAL: Always achieve system-wide changes that improve access to health care among the most vulnerable people by encouraging community

stakeholders to participate in this effort.

We asked our partners to help us with following for HCR implementation: 1.  Analysis (Outreach, enrollment process, training issues) 2.  Identify (Problems, gaps, barriers) 3.  Educate (Help us educated the community—King wide blitz) 4.  Advocate (For change with DSHS, Exchange & Health Care Authority)

How Did We Help Our Community Partners Through System Building?


Assure Access to King County Residents

We collaborate with our community partners to design outreach strategies! Ø  Reviewed data of the uninsured in 39

cities. Determined current outreach partners & looked at the gap areas to determine if we could get non-traditional help

Ø  Focused on race/ethnicity/special populations and provided outreach assistance at 34 of the 39 cities.

Ø  Manages the In-Person Assister network which has 310 certified navigators and over 40 partners.

Ø  Developed outreach strategies specific to community colleges, technical colleges, universities and the Promotora programs.

Ø  Designed a separate outreach model for large housing complexes.


Outreach

1.  Allow community partners to determine how and where they do their outreach.

2.  Provide outreach in “gap” areas with little or limited outreach.

3.  50+ outreach locations in rural and underserved communities.

4.  When outreach isn’t possible in an area, determine how to assure access:

a) develop Promotora programs b) outreach at libraries c) community fairs including Apple Health insurance providers d) Community blogs & working with local government

Provide services to the most vulnerable 5.  Translate materials into various

languages (Somali, Arabic, French, Burmese, Samoan, Purepecha)

6.  Maintain an outreach calendar and coordinated outreach in King County.


Four enhanced users, allows us to clear our

network partners system errors

Work with the Exchange on unresolved tickets and provide more support and

training

Outreach at the United Way Tax Preparation sites to educate clients about

the tax penalty and enroll

Fewer outreach events Enhanced outreach in the rural area’s of King County

Update our events/enrollment calendar

Distribute materials in 8 additional languages: Purepecha, Japanese,

Arabic, Punjabi, French, Tigrigna, Burmese &

Swahili

Reviewing the data to determine whose left for

enrollment

Open Enrollment 2 Objective: What Did We Do?


Did King County Achieve Their Goals?

47,706 44,431 43,594

52,754

10/31/2014 11/30/2014 1/31/2015 3/6/2015 10/31/2014 11/30/2014 1/31/2015 3/10/2015

Everyone else New adults

125,

373

130,

625

123,

714

139,

398

304,561 307,403

During Open Enrollment 1 & 2 the In-Person Assister Network enrolled 134,028 people into health insurance. Overall it’s estimated that King County reduced the uninsured rate to about 9%.

Qualified Health Plans Apple Health

Apple Health


Enrollment-Based Estimates of Uninsurance by Age

4.3%

16%

14% 12%

3.6%

9% 8%

7%

Age 0-17 Age 18-64 Age 18+ All ages

2013 March 31, 2014 Notes: 1.  2013 uninsurance estimates from US Census Bureau, American Community Survey, 2013. 2.  March 2014 uninsurance estimates based on number of uninsured individuals who enrolled in insurance between October 1, 2013 and March 31,

2014 and population estimates from American Community Survey, 2012. 3.  For age 0-17 enrollments, proportion of enrollees assumed to be previously uninsured set equal to the ratio of the 2012 King County child

uninsurance rate to the non-elderly adult insurance rate, which is 30% (ACS, 2012). 4.  Uninsurance rates for ages 18+ and all ages incorporate number of Medicare enrollments and number of uninsured adults age 65+ in 2012, and

assume no change between 2012 and March 31, 2014.


What’s Happening for the 3rd Open Enrolment Period?

Formulate strategies with our partners with a target on Qualified Health Plan Enrollments

Target outreach to zip codes that appear to have high numbers of uninsured

July = Roll out new outreach for small minority owned businesses

Planning another large summer enrollment event in one of the highest uninsured areas in King County.

Incorporating the new Orca LIFT transportation program

*Still waiting for race/ethnicity data

Although we did a good job in network, we have much work to do!


Data Source: Enrollments – Health Care Authority; Adults age 18-64 with income less than 138% of Federal Poverty Level – American Community Survey 2008-2012

ZIP Code Number not enrolled

98002 2,313 98003 2,636 98004 1,164 98007 1,308 98011 1,251 98023 1,782 98030 2,396 98032 1,838 98052 1,658 98102 1,176 98115 1,568 98118 2,137 98119 1,901 98121 2,123 98122 2,594 98125 1,841 98133 1,581 98146 1,333 98168 1,301 98198 2,331 TOTAL 36,232

Top 20 ZIPs with the largest estimated number of income-eligible adults not enrolled in Apple

Health


ZIP Code Number not enrolled

98002 8,593 98003 11,222 98023 10,004 98030 8,013 98031 9,668 98032 8,296 98034 7,298 98042 7,451 98052 7,303 98056 7,972 98058 8,215 98092 8,090 98103 10,858 98115 7,327 98118 8,533 98122 7,570 98125 8,165 98133 10,884 98168 9,515 98198 8,625 TOTAL 173,602

Top 20 ZIPs with the largest estimated

number of QHP tax credit-eligible adults not enrolled in Qualified Health Plans

Data Source: Enrollments – Health Benefit Exchange; Adults age 18-64 with income between 138 and 399% of Federal Poverty Level – American Community Survey 2009-2013


QUESTIONS?


Daphne Pie Manager [email protected] 206-263-8369

www.kingcounty.gov/health/access 1-800-756-5437

Callista Kennedy (206) 263-‐8368 Callista.kennedy@kingcounty Outreach Specialist

Carmen Olvera (206) 296-‐3948 [email protected] Outreach Specialist-‐Spanish

BreF Downey (206) 263-‐8373 [email protected] Outreach Specialist-‐Spanish

Luis Salazar (206) 263-‐8261 [email protected] Outreach Specialist-‐Spanish

Penny Lara (206) 263-‐8372 [email protected] Project Manager/Health Care Reform

Miguel Urquiza (206) 296-‐9875 [email protected] EducaXon Consultant I

Cindy Mai (206) 296-‐3949 [email protected] Outreach Specialist-‐Vietnamese

Javier Amaya (206) 263-‐8311 [email protected] EducaXon Consultant Ii

Willie Allen (253) 874-‐642 [email protected] Educator Consultant II/Program Supervisor

Bishaw Gezie (206) 296-‐3943 [email protected] Outreach Specialist-‐Amharic

How to Connect


How to Connect

Enrollgulfcoast.com

Maria De La Cruz [email protected]

Rosy Mota

[email protected]

Working With Your City or Public Health Departments to Get People Covered

Healthcare

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