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Putting Out the Welcome Mat – Targeting
Outreach Efforts under the Affordable Care Act
Evaluation of the Minnesota Community Application
Agent (MNCAA) Program

Kristin E. Dybdal, MPA
MN Health Services Research Conference
March 5, 2013




              Funded by a grant from the Robert Wood Johnson Foundation
MNCAA Program Overview
• Pay-for-performance outreach initiative (2008)
  – Offers $25 bonus payment to community
    organizations for every individual successfully
    enrolled in Minnesota Health Care Programs
  – Multiple levels of organizational involvement
    allowed: Level 1, 2, and 3 partners
  – MNCAA Resource Center, a DHS work team,
    facilitates access to case information, technical
    assistance, and payments for community partners


                                                        2
MNCAA Evaluation
• Conducted for the MN Department of Human
  Services (DHS) in the first half of 2012
  – Funding from a Health Resources and Services
    Administration’s (HRSA) State Health Access Program
    (SHAP) grant
• “Lessons learned” approach
  – Focus was on Level 1 MNCAAs
  – Quantitative analysis using DHS database supplemented
    with key informant interviews
  – Opportune timing with four years of data and as state
    develops health insurance exchange

                                                            3
Key Evaluation Questions
• Which organizations (or organization types) are
  responsible for growth in application volume?
• How does location of applicants align with major
  geographic areas of health disparity within state?
• What percent of individuals assisted successfully
  enroll in MHCP? What percent are new to MHCP?
• How long do MNCAA organizations wait to receive
  bonus payments?
• Is $25 an adequate enrollment bonus for MNCAAs?
• What is the value of the program to MNCAAs?

                                                       4
Distribution of Level 1 MNCAAs by
Organization Type
                            Other
                Mental
                             9%
                Health
             Organization
                 2%
       Community                              Health Care
         Action                               Organization
        Program                                  48%
          5%


             Human
             Service
           Organization
              36%
                                    *As of June 2012, the total number
                                    of Level 1 MNCAAs = 140




                                                                         5
Number of Level 1 MNCAAs Has Grown, but
Number Submitting Applications Has Tapered
     Number of MNCAA Partners                          Number of Level 1 MNCAAs
        by Participation Level                           Submitting Applications
                                                140
    Type         Dec ’08        Jun ‘12
                                                120
                                                                                        123
   Level 1          66           140            100
                                                 80                 86
   Level 2          59           227             60          72             69    72

                                                 40
   Level 3          5            577                   35
                                                 20

    Total          130           944              0
                                                      2008* 2009   2010     2011 2012* Total

 *Represents number of MNCAAs submitting applications for a partial year.



                                                                                               6
While Application Volume Grew in Early
Years, Application Growth Has Also Tapered
     60,000
     55,000
     50,000
     45,000              Level 1 MNCAA Application and Applicant
     40,000
                                    Volume per Year
     35,000
     30,000
     25,000
     20,000
     15,000
     10,000
      5,000
         -
                 2008*        2009        2010     2011      2012*    Total
  Applications   3,135       10,733      11,382    9,801     4,593   39,644
  Applicants     4,766       16,001      15,972   14,115     6,693   57,547

  *Represents volume through June 8, 2012.



                                                                              7
Percent of MHCP Applications Submitted by
Top 15 MNCAAs in Terms of Volume
                                                2008    2009     2010     2011    2012    Total
 Portico Healthnet                              39%     19%      10%       8%     10%      14%
 MedEligible                                    15%     12%       7%       9%      4%      9%
 HCMC Whittier Clinic                            5%     11%       9%       3%      2%      7%
 Cardon Outreach                                 0%      0%       7%      15%      9%      7%
 Lake Superior Community Health Clinic          13%      6%       4%       5%      5%      6%
 Children's Hospitals and Clinics – Mpls.        3%      7%       6%       4%      4%      5%
 St. Cloud Area Legal Services                  10%      4%       3%       3%      1%      4%
 HCMC Richfield Clinic                           1%      3%       4%       4%      3%      3%
 HCMC East Lake Clinic                           2%      5%       4%       2%      0%      3%
 Children's Hospitals and Clinics – St. Paul     1%      3%       3%       3%      3%      3%
 La Clinica –West Side Community Health Svcs.    0%      3%       3%       3%      3%      3%
 Cardon Outreach – Duluth                        0%      0%       4%       4%      5%      3%
 Southside Medical Clinic                        1%      4%       3%       1%      3%      3%
 Park Nicollet Methodist Hospital                0%      0%       7%       1%      0%      2%
 Indian Health Board                             1%      3%       2%       2%      1%      2%

 Subtotal                                        96%     86%      77%      73%     70%     74%
 Total number of applications                   3,135   10,733   11,382   9,801   4,593   39,644


                                                                                                   8
Small Group of Level 1 Partners Responsible
for Vast Majority of Applications
• Most of these high volume partners:
  – Are health care providers or organizations
  – Place highest value on access to case status updates
    provided by MNCAA Resource Center
  – Have elected to operate under data share
    agreements with DHS and no longer receive $25
    bonuses




                                                           9
Key Findings About Applicants
• Population groups known to face health care
  disparities appear to be targeted by program
• Underrepresentation of applicants/applications
  from Greater Minnesota
• 13 percent of applicants new to MHCP
• 65 percent of applicants successfully enrolled
  in MHCP
  – 79 percent of successful applicants enrolled in
    Medical Assistance

                                                      10
Enrollment Statistics Positive Overall, but
Long Waits Continue for Clients, MNCAAs
              Average Number of Weeks for MNCAAs
                    to Receive Bonus Payments

                  Year                  Average Number of Weeks*

                  2008                                 17

                  2009                                 16

                  2010                                 21

                  2011                                 15

               2008-2011                               18

     *Reflects average difference between the date bonuses were paid and
     date applications were received.




                                                                           11
Policy Implications
• Significant expertise already exists in core group of
  community partners, most of whom have health care
  missions
   – Timely access to client case information essential
• More substantial financial investments and a “higher-
  touch” model required to engage a broader group of
  community organizations in direct assistance
• Implementing ACA outreach, navigator, and
  assistance activities may be most challenging in
  Greater Minnesota, requires special focus

                                                          12
For a copy of the full evaluation report, please contact:
                   Kristin E. Dybdal
          Senior Research Fellow, SHADAC
                 dybda003@umn.edu




           Sign up to receive our newsletter and updates at
                          www.shadac.org
                                @shadac

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Pres hsr mar5_dybdal

  • 1. Putting Out the Welcome Mat – Targeting Outreach Efforts under the Affordable Care Act Evaluation of the Minnesota Community Application Agent (MNCAA) Program Kristin E. Dybdal, MPA MN Health Services Research Conference March 5, 2013 Funded by a grant from the Robert Wood Johnson Foundation
  • 2. MNCAA Program Overview • Pay-for-performance outreach initiative (2008) – Offers $25 bonus payment to community organizations for every individual successfully enrolled in Minnesota Health Care Programs – Multiple levels of organizational involvement allowed: Level 1, 2, and 3 partners – MNCAA Resource Center, a DHS work team, facilitates access to case information, technical assistance, and payments for community partners 2
  • 3. MNCAA Evaluation • Conducted for the MN Department of Human Services (DHS) in the first half of 2012 – Funding from a Health Resources and Services Administration’s (HRSA) State Health Access Program (SHAP) grant • “Lessons learned” approach – Focus was on Level 1 MNCAAs – Quantitative analysis using DHS database supplemented with key informant interviews – Opportune timing with four years of data and as state develops health insurance exchange 3
  • 4. Key Evaluation Questions • Which organizations (or organization types) are responsible for growth in application volume? • How does location of applicants align with major geographic areas of health disparity within state? • What percent of individuals assisted successfully enroll in MHCP? What percent are new to MHCP? • How long do MNCAA organizations wait to receive bonus payments? • Is $25 an adequate enrollment bonus for MNCAAs? • What is the value of the program to MNCAAs? 4
  • 5. Distribution of Level 1 MNCAAs by Organization Type Other Mental 9% Health Organization 2% Community Health Care Action Organization Program 48% 5% Human Service Organization 36% *As of June 2012, the total number of Level 1 MNCAAs = 140 5
  • 6. Number of Level 1 MNCAAs Has Grown, but Number Submitting Applications Has Tapered Number of MNCAA Partners Number of Level 1 MNCAAs by Participation Level Submitting Applications 140 Type Dec ’08 Jun ‘12 120 123 Level 1 66 140 100 80 86 Level 2 59 227 60 72 69 72 40 Level 3 5 577 35 20 Total 130 944 0 2008* 2009 2010 2011 2012* Total *Represents number of MNCAAs submitting applications for a partial year. 6
  • 7. While Application Volume Grew in Early Years, Application Growth Has Also Tapered 60,000 55,000 50,000 45,000 Level 1 MNCAA Application and Applicant 40,000 Volume per Year 35,000 30,000 25,000 20,000 15,000 10,000 5,000 - 2008* 2009 2010 2011 2012* Total Applications 3,135 10,733 11,382 9,801 4,593 39,644 Applicants 4,766 16,001 15,972 14,115 6,693 57,547 *Represents volume through June 8, 2012. 7
  • 8. Percent of MHCP Applications Submitted by Top 15 MNCAAs in Terms of Volume 2008 2009 2010 2011 2012 Total Portico Healthnet 39% 19% 10% 8% 10% 14% MedEligible 15% 12% 7% 9% 4% 9% HCMC Whittier Clinic 5% 11% 9% 3% 2% 7% Cardon Outreach 0% 0% 7% 15% 9% 7% Lake Superior Community Health Clinic 13% 6% 4% 5% 5% 6% Children's Hospitals and Clinics – Mpls. 3% 7% 6% 4% 4% 5% St. Cloud Area Legal Services 10% 4% 3% 3% 1% 4% HCMC Richfield Clinic 1% 3% 4% 4% 3% 3% HCMC East Lake Clinic 2% 5% 4% 2% 0% 3% Children's Hospitals and Clinics – St. Paul 1% 3% 3% 3% 3% 3% La Clinica –West Side Community Health Svcs. 0% 3% 3% 3% 3% 3% Cardon Outreach – Duluth 0% 0% 4% 4% 5% 3% Southside Medical Clinic 1% 4% 3% 1% 3% 3% Park Nicollet Methodist Hospital 0% 0% 7% 1% 0% 2% Indian Health Board 1% 3% 2% 2% 1% 2% Subtotal 96% 86% 77% 73% 70% 74% Total number of applications 3,135 10,733 11,382 9,801 4,593 39,644 8
  • 9. Small Group of Level 1 Partners Responsible for Vast Majority of Applications • Most of these high volume partners: – Are health care providers or organizations – Place highest value on access to case status updates provided by MNCAA Resource Center – Have elected to operate under data share agreements with DHS and no longer receive $25 bonuses 9
  • 10. Key Findings About Applicants • Population groups known to face health care disparities appear to be targeted by program • Underrepresentation of applicants/applications from Greater Minnesota • 13 percent of applicants new to MHCP • 65 percent of applicants successfully enrolled in MHCP – 79 percent of successful applicants enrolled in Medical Assistance 10
  • 11. Enrollment Statistics Positive Overall, but Long Waits Continue for Clients, MNCAAs Average Number of Weeks for MNCAAs to Receive Bonus Payments Year Average Number of Weeks* 2008 17 2009 16 2010 21 2011 15 2008-2011 18 *Reflects average difference between the date bonuses were paid and date applications were received. 11
  • 12. Policy Implications • Significant expertise already exists in core group of community partners, most of whom have health care missions – Timely access to client case information essential • More substantial financial investments and a “higher- touch” model required to engage a broader group of community organizations in direct assistance • Implementing ACA outreach, navigator, and assistance activities may be most challenging in Greater Minnesota, requires special focus 12
  • 13. For a copy of the full evaluation report, please contact: Kristin E. Dybdal Senior Research Fellow, SHADAC dybda003@umn.edu Sign up to receive our newsletter and updates at www.shadac.org @shadac