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June 2014 St@teside

Researchers, Policymakers, and Practitioners Gather to Share the Latest in State Health Policy Research

AcademyHeath’s State Health Research and Policy Interest Group held its annual meeting on Saturday, June 7 in conjunction with the Annual Research Meeting. This meeting provides a forum for researchers, policymakers, and practitioners to share state-level research that emphasizes the unique challenges of working within a state policy and political environment, and it fosters dialogue between health services researchers, policy analysts, and policymakers to help inform decision-making. This year’s meeting featured six panels presenting on a variety of state-level health policy and research topics, including delivery system and payment reform, Medicaid innovations, states’ role in health care safety and monitoring, and health insurance exchanges. Select presentations are now available on AcademyHealth’s website, and several presentations are highlighted below.

Enrolling University Students in Health Insurance: One California Experience

Walter Zelman, Wendy Lee, and Natasha Buranasombati of California State University, Los Angeles (CSU) presented the results of the CSU Health Insurance Education Project, which strives to educate CSU students, families, and staff about the new coverage options available to them under the ACA. After conducting an initial poll to inform their outreach and education strategy, the project staff found that the primary barrier to getting coverage on campus was affordability, not the perception of invincibility. In the second poll conducted after the end of the initial open enrollment period, they found that the number of uninsured students across 15 CSU campuses had been reduced by approximately 60%. While the CSU Health Insurance Education Project was not involved in directly enrolling students in health plans, they identified several key factors that contributed to the decline in uninsured rate, including the intensity of effort devoted to educating the student population; the support of university leadership, faculty, and student health centers; and the high concentration of uninsured, low-income young adults on CSU campuses, who served as a “locked-in” audience for outreach efforts.

Oregon's Alternative Payment Methodology - Early Practice Implications

Erika Cottrell of Oregon Health and Science University presented her findings from the evaluation of Oregon’s Alternative Payment Methodology (APM) pilot project, which is working to convert the current fee-for-service model of the participating community health centers to a per member per month rate in order to better align the payment systems with patient-centered care. By conducting site visits and interviews, Dr. Cottrell and her research team found that, in implementing the APM and moving towards value-based care, clinics have had to restructure their physical layout, reconfigure their workflow processes, and employ new tools (e.g., walk-in clinics expanded access, etc.). She also found that patient visits have been changing in terms of who is seeing the patients and the formats of the visit. For example, some clinics have been exploring home visits and group visits. Additionally, Dr. Cottrell’s team reported that the care teams have been incorporating new staff roles and are better enabling team members to work at the top of their licensure as they more to improve panel management and data quality. The Oregon Health and Science University team has also created a blog, Frontiers to Healthcare, to report on real-time findings as they continue to evaluate the APM project.

Patient Navigators and Certified Application Counselors: Best Practices for Enrolling the Uninsured in North Carolina

Rachel Holtzman of the University of North Carolina’s School of Global Public Health focused on her research assessing the best practices for enrolling the uninsured in North Carolina. Based on interviews with key informants at various consumer assistance entities throughout North Carolina, Ms. Holtzman identified several key strategies for facilitating enrollment, including:

  • The use of a scheduler to set-up a time to connect consumers to assisters;
  • Phone call reminders to remind consumers about appointments with assisters and the documents needed to complete the enrollment process; and
  • Enroll America’s assistance in outreach efforts.

The assisters interviewed also identified the following as the biggest barriers to enrolling individuals in coverage:

  • The Medicaid gap, in which an individual’s income is too low for him/her to qualify for subsidies through the Exchange, but too high for him/her to be eligible for Medicaid;
  • Glitches with the Exchange website;
  • The demanding workload;
  • Inadequate training, since the assisters, who were working in a state with a Federally-Facilitated Marketplace, only had access to federal training modules and did not have any training that included North Carolina-specific information; and
  • The lack of understanding of the Medicaid eligibility requirements.

Ms. Holtzman’s takeaways from her research highlighted the need for North Carolina to expand Medicaid and to develop a federal-state partnership in order to better support outreach and enrollment efforts and overcome the key enrollment barriers.