1. Division of Community HealthDivision of Community Health University of Southern California Evaluating the Impact of Outreach and Enrollment Strategies in California Michael R. Cousineau, Dr.PH, Principle Investigator: Gregory Stevens, Ph.D, Co-Investigator: Albert J. Farias, MPH, Project Manager: SHARE Annual Grantee Meeting February 12 th, 2009

2. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Enrollment Medi-Cal and Healthy Families

3. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Healthy Kids programs and the California Children's Health Initiatives Number of California Counties with Active Children’s Health Initiatives (CHI’s), 2001-2008

4. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Enrollments in Healthy Kids Program, 2003 to 2008

5. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Problems and Challenges In spite of this outlay of resources, more than 60% of the uninsured in 2003 were eligible for Medi-Cal or Healthy Families and another 15% for Healthy Kids Unique challenges, –especially targeting the immigrant population –Enormously complex array of programs (confusing and anything but simple)

6. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Problem The shot gun approach to outreach and enrollment, and retention Little was known about –What strategies these counties were deploying and why. –Effectiveness

7. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Research Purpose Provide some descriptive data on the approach to outreach, enrollment and retention Try to correlate enrollment with different strategies

8. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Objective: Phase 1 How are counties in California organizing strategies for identifying and enrolling uninsured children into public health insurance programs?

9. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Objective:Phase 2 How do variations in the deployment of these strategies affect enrollment and retention in Medi-Cal, Healthy Families, and Healthy Kids? How has the introduction of technology-based systems affected enrollment and retention in public insurance programs?

10. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Data Source/Methods Study Sample: CHI Counties (n=25) Study Period: Quarterly from 2001 to Mid-2008 Study Procedures –Key Informant Group Interviews/Site Visits Study Instruments –Pre-Interview Worksheet –Interviews Guide –County-Quarter (CQ) measure of intensity

11. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Outreach and Enrollment Strategies Non-Technology Based Mass Media Campaigns Community Health Workers Provider In-Reach School Based Strategies Waiting Lists Matching Public Insurance Programs Technology Based Health-E-App One-E-App Pre-populated Renewal Forms County Developed Data System

12. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Preliminary Results: Phase 1 California County Use of Non-Technology Based Strategies, 2001-2008

13. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Preliminary Results: Phase 1 California County Use of Technology Based Strategies, 2001-2008

14. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Lessons Learned: Phase 1 Information Recall Interplay and overlap between strategies County concept of “strategies” Ideas and projects were initiated that were not well thought out: shot gun approach

15. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Conclusions/Next Steps Multi-variable Data Analysis Independent Measures: Intensity measure for use of Technology/Non-Technology based strategies per county per quarter. Dependent Measures: Enrollment Data for Medi-Cal, Healthy Families, Healthy Kids for children ages 0-18. Covariates: Number of Full-time equivalent (FTE) workers, County differences.

16. Division of Community HealthDivision of Community Health University of Southern CaliforniaUniversity of Southern California University of Southern California Questions/Comments