Special project funds California community groups to help neighbors receive needed health care

Funded by an $8.5 million grant from The California Endow-ment in Los Angeles, seven consumer groups are attempting to demonstrate that independent, community-based organizations can help people navigate an increasingly complex health care system to obtain the services they need.

The three-year grant went to six Health Consumer Alliance assistance centers in six California counties and the Sacramento-based Health Rights Hotline. Together they serve areas that include more than 60% of California’s poor.

Health Consumer Alliance project director Stan Dorn says the organization’s ombudsprogram has three elements:

1. help consumers to get the health care services they need;

2. provide education and information to consumers;

3. perform a systemic analysis of health access barriers and attempts to overcome them.

The alliance started work in 1998 with a two-year, $5 million grant from The California Endowment. Mr. Dorn says it has helped more than 25,000 people with health access problems. The consumer assistance programs are operated by community-based legal service organizations.

According to a report issued by the group, 9,000 cases were resolved by:

• counsel and advice to consumers (39%);

• referral to other agencies (22%);

• other brief services (17%);

• negotiation without formal proceedings (4%);

• administrative appeals decisions (0.4%);

• negotiated settlements of litigation, primarily collection actions against indigent consumers (0.2%);

• court decisions, primarily collection actions against indigent consumers (0.09%);

• other outcomes, including client withdrawal, client ineligible for service, and claims found to be without merit (18%).

Mr. Dorn tells State Health Watch that while the organization’s main goal is to help the more than 1,000 consumers who come to it each month, its work provides a "great opportunity to see what the systemic access problems are." It is also working on a database of uniform, comprehensive information about the problems consumers bring and their resolutions.

The alliance can analyze results by gender, income, age, race, ethnicity, language, immigration status, area of residence, source of health coverage, health plan, medical group, self-identified disability status, health care need, and other factors.

The Health Consumer Alliance says it is in a position to provide "not just compelling anecdotes, but also the objective data needed to discern the extent to which problems are truly systemic. We then work collaboratively with other stakeholders to seek effective solutions to the problems our consumers’ experience."

The endowment’s support for the project follows announcement of studies indicating that millions of uninsured California children and their parents qualify for public programs but are not enrolled. Recent studies show that Californians are far more likely to be uninsured than are other Americans.

Mr. Dorn says the alliance’s programs offer a "very innovative approach to address the growing complexity of the health care system." In addition to navigational assistance and direct advocacy, the alliance offers educational programs on topics such as where to obtain health care coverage, health care for immigrants, the Children’s Health Insurance Program, MediCal (California’s Medicaid program), and how to use an HMO properly.

In the first two months of this year, 10,000 low-income consumers and staffs of organizations serving low-income communities attended education and outreach events sponsored by a variety of groups including:

• 20 children’s organizations;

• 20 local government agencies

• 18 community health centers and other health care providers;

• 12 Asian community groups;

• 12 organizations focused on mental health and substance abuse issues;

• 10 health care or consumer coalitions;

• nine Latino community groups;

• nine faith-based organizations;

• nine social service agencies;

• nine disability rights groups or organizations serving people with disabilities;

• 30 other groups.

Consumer education materials in 11 languages are available on the alliance Web site.

In recent years, federal and state lawmakers have considered public funding for independent consumer assistance. To help the public and policy-makers assess the potential benefits and drawbacks of such assistance, the grant will also fund University of Southern California researchers to evaluate the alliance and its hotline.

Under California’s new Department of Managed Care, which opened July 1, consumer assistance programs are expected to work closely with the state agency as stipulated in an HMO reform package signed into law last year. Independent assistance programs will supplement the department’s work by providing local expertise in solving consumer problems and furnishing intensive assistance to individual consumers when necessary.

"These programs have the expertise to clarify and resolve problems at an early stage, before they endanger consumers’ health," says Gwen Walden, senior program officer, for The California Endowment. "Independent consumer assistance programs help make the voices of the most vulnerable Californian consumers heard in the health care debate."

At the end of the five years of alliance work, Mr. Dorn hopes the evaluation will find that there is a need for independent, community-based, local assistance to help consumers with the health care system and that the work of the alliance will be able to continue through government funding and then be replicated in other communities.

"If a community-based agency can develop a real track record," he asserts, "local trust in it can develop, and it’s that kind of trust that is missing in today’s health care system."

[Contact Mr. Dorn at (510) 302-0445.]