ALAMEDA HEALTH CONSORTIUM
Oakland, CA

April 2000

        §       Background

This effort builds on long-standing local infrastructure to address the needs of the uninsured.  There is a 25-year old primary care delivery system whereby the County Health Department contracts with nine non-profit community health centers to serve uninsured County residents.  Several years ago, the County sponsored the development of a non-profit HMO (the Alameda Alliance for Health) that serve Medicaid and CHIP enrollees.  Two years ago, the Alliance began planning the development of a new managed care insurance product (Family Care) targeted at low-income, uninsured individuals who were not eligible for Medicaid or CHIP.  The Board of Alliance includes all the major public non-profit, and private healthcare providers in the County.  the Board also includes consumer and labor representatives.  

The Steering Committee for Alameda County Communities in Charge (ACCC) includes representatives from our County Health Agency, County Hospital, the Alameda Alliance for Health, the Alameda Health Consortium, (the local associate of non-profit community health centers) and the Community Voices Project (funded by the Kellogg Foundation to focus specifically on improving health insurance coverage for immigrant communities).

Care is currently delivered to the uninsured through a network of primary care clinics and a multi-site County Hospital.  The network includes nine non-profit community health centers that operate 28 primary care delivery sites.  The County hospital system includes seven primary care clinic sites, two specialty clinic locations, an acute care hospital, a psychiatric facility, and a long term care facility.

AAH currently is developing Family Care, a managed care insurance product for low-income children, adults and working families in Alameda County.  Family Care will provide comprehensive medical and dental benefits on a subsidized basis for these low-income children and working families.  The Alliance will discount the premium for families under 300 percent of the Federal Poverty Guideline.

The goal of the AAH's pilot project is to serve 5,000 people over the next five years.  ACCC believes that within the model of Family Care are the seeds for a comprehensive coverage option for the uninsured in Alameda County.  Because it includes all the appropriate providers, ACCC intends to build upon the existing network of the Alameda Alliance for Health.  Changes will be made to the network based on data analysis of the target population.  The AAH models, coupled with ACCC Phase One research and planning, will serve as a baseline for the development of a new product or products and an integrated strategy for delivery that is more responsive to a broader market.

Alameda County Communities in Charge is a joint effort of six safety net provider organizations.  Our long-term goal is to provide managed care insurance coverage for up to 20,000 uninsured County residents with incomes below 300% of the federal poverty level.  This undertaking builds upon existing efforts to obtain or maintain Medicaid and CHIP coverage for an additional 50,000 residents.  Our first year objectives are to:

• Develop a comprehensive profile of Alameda County's uninsured population

• Determine cost and develop multiple strategies for financing coverage

• Create an affordable, acceptable managed care insurance product for the uninsured

• Design changes in the healthcare delivery system to meet the needs of the targeted population

Financing Strategy

The Alameda alliance for Health already has dedicated $4.1 million in their reserves to fund subsidized managed care insurance coverage for uninsured, low-income County residents.  The County Board of Supervisors has tentatively allocated $2.5 million per year of its share of the tobacco settlement funds for the same purpose.  The Alliance recently received a grant of $300,000 from the California Endowment that is specifically targeted at providing coverage for undocumented children who are not eligible for Medicaid or CHIP.  We have submitted a funding proposal to another California foundation to seek additional financial support for our program.  We are also tracking the President's new safety net initiative as a possible source of support for the infrastructure development required by our project.  As our planning continues, we will identify other sources of foundation, County, State and Federal support for our initiative.

Outreach Strategy

Our outreach strategy for Family Care will build in the infrastructure we already have created for Medicaid and CHIP.  However, based on our experience with CHIP, we understand the difficulty in getting families to take advantage of insurance programs for which they are eligible.  We have three major outreach and enrollment strategies:

Seamless eligibility process:  Because we are able to cover Medicaid, CHIP and Family Care eligibles through the same HMO and provider network, we will be able to enroll entire families through a single process, even though different family members may be eligible under different programs.  We will design our outreach and enrollment process as a single unified system.  Families (and providers) will be spared all the paperwork and confusion of the different eligibility programs.

Coverage for everyone in the family:  Based on our experience with CHIP eligibility, we believe that one of the major barriers in the current system is that they often can offer coverage only to children and not to meet their parents.  With Family Care, we will be able to offer coverage to everyone in the family.

Immigrant Issues:  We know that a major segment of our uninsured population consists of families in which some or all family members are immigrants.  These families face additional barriers in enrolling in insurance programs.  Our outreach and enrollment activities for Family Care will be designed to address these concerns.  For example, we will rely heavily on the community-based agencies that have established trusting relationships with these communities.

Delivery System

The Alameda Alliance for Health (AAH) will serve as the insurer and service delivery network for our insurance product.  AAH is a state-licensed managed care plan, and is well equipped to design, manage and deliver any products created by ACCC.  AAH's current market includes Medicaid and CHIP enrollees.  The AAH provider network consists of nearly 300 primary care physicians and over 1,000 specialists and includes all major hospitals in Alameda County.  All of the traditional and safety net providers are part of the Alliance delivery system.

The proposed managed care insurance will be administered by the Alameda Alliance for Health (AAH).  AAH has the existing infrastructure to carry out all functions related to the new product launch and the flexibility to make necessary systems modifications determined by the objectives in the work plan.  AAH provides claims payment, data collection and analysis, medical management, member services and outreach for its existing programs.  The Alliance has been in operation for three years and has more than 75,000 enrollees.

Sustainable Financing:  One of our major long term goals will be to develop on-going revenue streams to cover the cost of providing subsidized insurance coverage for our targeted low-income population.  by securing a portion of our County's tobacco settlement funds, we have identified our first sustainable revenue source.  For the past two years, the Board of Directors of the Alliance has allocated a portion of their retained earnings to subsidize Family Care.  We also will continue to look at other sources of public funding which can be sustained.

Profile of the Uninsured:  One of our immediate challenges is developing a much more detailed profile of the different segments of the uninsured population we are targeting for our program.  This includes looking specifically at subpopulations such as immigrants, adults without children, low-wage workers, chronically ill uninsured; etc.   Detailed information about each of these groups will allow us to develop specific managed care insurance products (in terms of benefits, premiums, provider networks, etc.) to meet their specific needs.  It is very difficult to obtain information about the uninsured on a county basis.  In order to address this challenge, we are working with the Healthy Policy Center at UCLA to collaborate on a household survey of the uninsured in the County.