Evaluation of the San Mateo County Adult Coverage and Systems Redesign Initiative

EVALUATION OF THE SAN MATEO COUNTY ADULT COVERAGE AND SYSTEMS REDESIGN INITIATIVE FINAL REPORT Embry M. Howell, Urban Institute Dana Hughes, University of California/San Francisco Sarah Benatar, Urban Institute Genevieve Kenney, Urban Institute Ashley Palmer, Urban Institute Christine Coyer, Urban Institute Submitted to: Srija Srinivasan, San Mateo County Health Department November 2011 i TABLE OF CONTENTS EXECUTIVE SUMMARY ......................................................................................................................... iii INTRODUCTION ........................................................................................................................................ 1 Background ............................................................................................................................................... 2 The Coverage Initiative ............................................................................................................................. 3 The Systems Redesign ............................................................................................................................ 11 OUTCOMES FROM THE COVERAGE INITIATIVE AND SYSTEMS REDESIGN ........................... 15 Access to Care......................................................................................................................................... 16 Utilization of Services ............................................................................................................................. 24 Continuity of Care ................................................................................................................................... 35 Satisfaction with Care ............................................................................................................................. 36 Quality of Care for the Chronically Ill .................................................................................................... 38 Cost of Care ............................................................................................................................................ 39 CONCLUSIONS......................................................................................................................................... 43 BIBLIOGRAPHY ....................................................................................................................................... 48 APPENDIX A: EVALUATION QUESTIONS AND DATA SOURCES ................................................. 51 APPENDIX B: TECHINICAL DOCUMENTATION OF DATA SOURCES .......................................... 53 APPENDIX C: DEFINITION OF PREVENTIVE CARE ......................................................................... 61 APPENDIX D: QUESTIONS ASKED IN ONE-E-APP SURVEY ........................................................... 65 ii Acknowledgements The authors acknowledge the help of our Project Officer, Srija Srinivasan, of the San Mateo County Health System, and of many other staff of the health department and county health care providers (both public and private). They provided us with all of the information contained in this report, both qualitative and quantitative information, allowing us to understand and measure the performance of a very complex program over time. The names of all those who provided help and information are too numerous to mention but one stands out. Vicky Shih of the Health Plan of San Mateo, and her staff, analyzed the plan’s claims/encounter data and provided several years of tables with data on plan enrollees. Other special thanks go to Eva Hruba of the Urban Institute, who constructed the tables and figures and prepared the document. We are especially grateful to the two major funders of this evaluation – The California Endowment and the Blue Shield of California Foundation. Additionally, the California Health Care Foundation supported the development of a client survey conducted during enrollment. iii EXECUTIVE SUMMARY This report provides results from a three-year evaluation—by the Urban Institute and the University of California at San Francisco—of the San Mateo County Adult Coverage and Systems Redesign Initiative. The initiative began in 2008 and is designed to both improve health coverage for otherwise uninsured adults in the county, as well as to improve access to and quality of care in county safety net clinics. The evaluation uses mixed methods, including:  Qualitative components: o A case study of implementation and o Focus groups to assess client satisfaction.  Quantitative components: o Analyses of aggregate data from clinics and the Health Plan of San Mateo o Analyses of individual level data from a client survey and from the largest clinic in the county, the Innovative Care Clinic (ICC). This report provides a synthesis of findings across these diverse data sources. Ou