Organization and Planning Grant Requirements

Phase One National Press Release

SAN MATEO COUNTY HEALTHWORKS
San Mateo, CA

April 2000

               Background

In 1987, the County developed one of the first county-organized care plans called the Health Plan of San Mateo (HPSM).  The Health Plan provided a managed care model for the County's Medi-Cal recipients.  The Health Plan is a community provider for the Healthy Families Program (CHIP).  Currently, all of the County's hospitals and 90% of its private physicians are part of its provider network.  An independent, locally controlled Health Commission oversees the HPSM.  In 1993, the Hispanic Coalition (a non-profit comprised of 20 Latino organizations) and the health Services Agency formed the Nuestro Canto de Salud Health Coalition to assess and address Year 2000 health objectives specific to the county's Latino population.  In 1997, the Health Services Agency began discussions with San Mateo County Central labor Council (AFL-CIO) to develop programs to expand access to low income union workers and their families to have affordable healthcare.  These four organizations began having discussions in early 1999 to find mutual and beneficial solutions to expanding access for low income uninsured residents.

The potential of funding through the RWJF Communities in Charge planning grant caused us to expand the Steering Committee.  The Steering Committee currently also includes three unions (Local 715, Local 340, and Local 1877), three Chamber of Commerce (including the Hispanic Chamber), other minority community-based organizations (Filipino Bayanihan Resource Center, Asian-American Recovery Services, and The Hospital Consortium), comprised of the Chief Executive Officers of local hospitals, and a representative from the Chair of the State Insurance Committee.  Healthcare on the uninsured in San Mateo County is currently provided by the San Mateo County Division of Hospital and Clinics.  The Davison provides acute, [primary and preventive care services through San Mateo County General Hospital and network of 13 clinics located throughout the County.  The clinics are projected to provide over 200,000 visits in the fiscal year 1999-2000.

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       Guiding Principles


In 1996, the Health Services Agency introduced the WELL (wellness, education, linkage, low cost) Program as a way to reduce costs and increase fees received for caring for indigent adults.  The WELL Program is the County's reduced fee program for medically indigent adults.  Eligible patients electing to joining WELL pay a flat annual fee and co-payments for actual visits.  In fiscal year 1998-1999, approximately $2.3 million was generated from annual payments and co-pays.  While this is only 11% of the total cost of care, it was a 100% increase over the previous sliding fee scale methodology.  There are over 9,000 WELL enrollees.  The proposed program entails expanding WELL into a larger system of care to meet the needs of our target population.

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       Initial Project Objectives

Program Expansion - Add a Nurse Specialist to assess and triage clients enrolling in WELL to assign appropriate primary care providers and provide health education.  Employ Patient Services Assistants to enroll and link families in Medi-Cal, Healthy Families and other benefit programs and community workers to work in the community to support and promote WELL.

Culturally-Based Disease Prevention - El Concilio's Nuestro Canto de Salud program uses "promoters" (Para professionals who provide bi-lingual health outreach/education), community workers and nurse educators to provide outreach, disease education and preventive care to reduce chronic conditions and case manage patients.  This model will be expanded and replicated in the African-American, Filipino, and Pacific Islander populations.

Labor Council to develop specialized assessments, education packages and health management plans tailored to prevent health problems associated with employment.

Provider Network Expansion - We intend to create a seamless network of care between WELL and The Health Plan of San Mateo Medi-Cal network that will effectively maximize and manage costs. 

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        Financing & Outreach Strategy

                                      

Financing Strategy

The WELL Program is currently subsidized through state reimbursement and County General Fund subsidy.  The Steering Committee, with technical assistance, will explore several opportunities to finance the expansion.  These include increasing the fee structure, integrating WELL with Medi-Cal coverage, marketing and selling WELL as a benefits package and pooled coverage.  One of the main outcomes of the planning grant's four objectives is to tailor the program that meets the unique needs of our community.

Outreach Strategy

As a prelude to targeted outreach, the program will contract with El Concilio and the labor Council to coordinate 5-9 community forums.  These forums, while promoting the WELL Program, will be used to develop health profiles of those attending and to identify barriers to the target population seeking health care and/or purchasing health insurance.  The Labor Council in collaboration with the Health Department will also develop worksite Health Promotions to outreach to underserved populations such as in-home support workers, hotel and restaurant workers and custodians.  El Concilio has been successful in the development of their "promoters" program.  They have trained community members in health promotion and risk reduction.  Stipends for working an average of 20 hours per week are given as an incentive for participation.  The "promoter" program will be expanded to other ethnic groups and will be one of the main strategies used to outreach the target population.

Delivery System

Much of the network to support the WELL Program's medical care is already in place through the development of Health Service's system of integrated care in the County's low-income areas.  There are currently 11 community clinics, two adolescent health clinics and a mobile Health Clinic.  In addition, the County is building a new hospital complex with three new facilities; acute medical and psychiatric unit, and inpatient long-term care unit and a diagnostic and treatment center.  It is expected that the delivery system will expand to include The Health Plan of San Mateo's provider network.  Health prevention services such as pre-natal care, health education, preventive screenings, immunizations, mental health promotion, nutrition and lifestyle education are provided at these clinic sites.  Cultural-based chronic disease programs are and will be integrated into their established sites.

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       Challenges

Healthcare providers, community based organizations, labor unions and local business' in San Mateo County have come together to establish a working coalition with the political and program clout to assess and select the most feasible options for expanding the number of uninsured served by the County's WELL Program.  Using four main objectives, strategies will be designed to overcome barriers to obtaining insurance and to organize networks to work with and through the WELL Program as a bridge to consistent care and comprehensive benefit options.

Coalition Building:  Our major challenge that the program has and will continue to face is the brining together of community leadership that may be in conflict.  Phased-in actions will be used to maintain leadership on the coalition.  A Steering Committee made up of leaders from key organizations will be the focal point for coalition efforts.  Interview's with stakeholders (e.g.., unions, small businesses, cities, and the non-profit sector) will describe the basic goals of WELL, their perceptions of problems faced by the uninsured, and interest in joining a coalition to promote health benefits for the uninsured.  Community Insurance Health Forums will be held to promote and cultivate interest.

Community Assessment:  In addition to affordability, there remain serious gaps in resources and services for the uninsured such as language, discrimination and cultural beliefs, continuous primary care gaps in improving the health of workers in service and part-time jobs.  A four-part community assessment process will identify and analyze gaps in services, reasons that families are uninsured relative to ethnicity, citizenship, occupation, the health consequences of being uninsured and an analysis of providers currently delivering care to the uninsured.  The four are:  multi-cultural community health assessment, a union worker profile, and employer benefits survey and a survey of healthcare providers.

Financing:  Because WELL is a "safety net" program that is designed to provide affordable and accessible primary and preventive healthcare to the indigent, it will never be self-supporting in its present structure.  The key will be to analyze the costs and risks associated with various service packages and feasible financial strategies to support these services with minimum risk.  Some of the strategies are mentioned above in financing.

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       Demographics

San Mateo County, located immediately south of San Francisco, is the service and geographic area for the project.  San Mateo County is located at the San Francisco Peninsula between Santa Clara and San Francisco Counties.  The County's 1997 population was estimated at 711,000.  Immigration continues to change the ethnic mix of this population.  In 1970, the County's population was 91% White.  In 1997 the racial make-up was 55% White 20.5% Latino; 19% Asian-Pacific Islander, 4.8% African American and 0.4% American Indian/Other.  San Mateo is a wealthy county; however, it has poor and vulnerable people who are the focus of the project's mission.

San Mateo County continues to have one of the lowest unemployment rates in the nation.  In 1999, that rate was 1.4%.  Despite this, nearly 1 in 5 residents lack health insurance.  A recent study by the Lewin Group estimated that 131,000 county residents were without health insurance.  The State of Health Insurance in California, "1997" published by UCLA Center for Health Policy Research estimated that 15,000 to 18,000 children ages 0-8 were among this group.  The Report also noted that 84% of the uninsured are members of working families.

The economic success of Silicon Valley, which includes southern San Mateo County and the biotech industry in South San Francisco, has increased housing prices in what had previously been lower income and working class neighborhoods.  In 1999, the median home price was $400,000.  Rising rents (the average 1998 rent for a 2-bedroom apartment was $1,300 a month) are forcing working class and low-income families to relocate to more affordable neighborhoods or leave San Mateo County altogether.

This trend, combined with immigration, has caused communities such as East Palo Alto and North Fair Oaks to become increasingly overcrowded and populated by families barely making the rent and doubling and tripling up with their families to survive.  This has caused families to make hard choices and forego health insurance because of the need to pay the rent.  This in turn deepened the poverty and risk factors contributing to individual and family health problems.  This points to a target population that is employed in low paying service jobs without benefits and who are more likely than not to be immigrants living in cramped and crowded housing.  The project is defining the target population as adults aged 18-64 under 200% of federal poverty without insurance.  Based on recent US Census estimates that 16% of the County's 1997 population is under 200% of poverty, 113,712 residents fall into this category.

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        Contact Us

Ronald Robinson
Chief Operating Officer
San Mateo Health Services Agency
Division of Hospitals & Clinics
222 - 39th Avenue
San Mateo, CA 94403
Phone: (650) 573-2406
Fax: (650) 573-2030
E-mail:  rrobinson@co.sanmateo.ca.us

Web Address:
http://www.smhealth.org

 

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