Evaluation of the San Mateo County Children's Health Initiative: Third Annual Report

Evaluation of the San Mateo County Children’s Health Initiative: Third Annual Report Embry Howell, Urban Institute Dana Hughes, University of California, San Francisco Brigette Courtot, Urban Institute Louise Palmer, Urban Institute September 2006 Submitted to: San Mateo County Children’s Health Initiative Coalition 225 37th Avenue San Mateo, CA 94403 ACKNOWLEDGMENTS We appreciate the help of all the individuals whom we interviewed, including members of the Children’s Health Initiative coalition, school personnel, providers, employers, and community members. We thank Vicky Shih and Min Zheng of the Health Plan of San Mateo, who prepared the data. We especially appreciate the help and support of ST Mayer, Marmi Bermudez, and Sosefina Pita of the San Mateo County Health Department. i EXECUTIVE SUMMARY This report, the third in a series of five annual reports from the Evaluation of the San Mateo County Children’s Health Initiative (CHI), provides an overview of the Initiative as well as a detailed look at particular aspects of the program and access to specific services. During 2005 the initiative took on several new challenges, such as an increased focus on improving retention in public programs, increasing use of preventive care, and improving access to dental and mental health care. This annual report provides some new data on several of these and other issues that are important to the continued development of the initiative. Using several data sources, the evaluation investigated issues that are of special interest to the CHI. These include: the demographic and health status characteristics of Healthy Kids served by the CHI; how demographic characteristics and service use have changed over time; characteristics of high cost users of services and how they differ from other children; access to dental services; access to mental health services; the role of schools in outreach and enrollment; and the factors influencing employer decisions to offer insurance for dependents. The data for the analysis come from the annual site visit conducted in October 2005; health plan administrative enrollment and utilization data; and interviews with employers. Key findings include • The growth in the Healthy Kids program continued at a slow pace in 2005, particularly for the youngest children (ages 0–5), despite special efforts to enroll more children in this age group. Growth in the 6–18 age group continued at a moderate pace, creating a challenge to the premium financing for these enrollees. • There was a moderate increase (of 4 percentage points) in the proportion of children who were in the higher income group (250–400 percent of the federal poverty level), and over 13 percent of children continuously enrolled in Healthy Kids from 2003–2004 were in this group. Penetration of coverage within this population was a specific priority for the CHI during the last year. • The use of preventive medical care, as well as dental and vision care, increased from the first to the second year of enrollment in Healthy Kids. In addition, overall use of ambulatory care increased from those who enrolled in 2003 to those who enrolled in 2004. • Ten percent of publicly insured children account for a sizable proportion of expensive medical (although not dental) care, particularly hospital and emergency room care. These children, defined as “high cost users,” account for a substantial portion of the total cost for all children enrolled in the Healthy Kids, Healthy Families, and Medi-Cal programs (39.9 percent, 48.4 percent, and 72.8 percent, ii respectively). High cost users are more often chronically ill and have frequent contact with the health care system. Since it is possible to identify them through the claims/encounter data, this group could be targeted for more intensive contact by Certified Application Assistors (CAAs) or health plan staff, to assure that they are receiving coordinated care and that they have good access to the specialty care that they need. This might have the additional benefit of reducing high cost emergency room and hospital care. • About 40 percent of Healthy Kids enrollees do not use dental services, indicating potential access problems and the need to educate parents about the importance of such care. Still, a relatively high percentage of the youngest children (ages 0–5) used services. In addition, Healthy Kids enrollees are more likely to visit a private dentist than to utilize public providers. This finding is in contrast to a widely held perception that access to private dental providers for publicly insured children is limited in the county. • Children with mental health diagnoses are much more expensive than their peers, and these higher costs pertain to both mental health and other health services. Not all children receiving mental health services under Healthy Kids or Healthy Families are having