Speeding Up Reform Learning Curve, One Clinic at a Time

Although they’re part of daily life for industry professionals and policy wonks, the changes brought on by health care reform are slow to make their way into the consciousness of most Californians.

For those who have occasion to use the health care system frequently, some of the changes may be having an impact on their lives. For others, however, it isn’t until they make a trip to the clinic or physician office that they notice anything different. And for many others — perhaps the majority of Californians — the big changes won’t be felt until 2014 when major shifts in eligibility and coverage come into play.

To help speed up the learning curve in California, the California Primary Care Association, which represents more than 800 clinics and community health centers in the state, launched an educational campaign. The Ambassador program, which started partly as a political campaign to gain public support for the new law, is evolving into a navigational tool that could be used by the new state insurance exchange.

“This is first and foremost an educational effort, and it’s a wonderful thing that providers and patients see the benefits from it,” said Carmela Castellano-Garcia, president and CEO of CPCA. “But that being said, there’s no doubt that it’s also an important tool to build political support for the Affordable Care Act,” she added.

Castellano-Garcia said her organization plans to use the Ambassador program as a model for helping steer patients to the appropriate coverage in the California Health Benefit Exchange, which will become a pivotal point for millions of Californians beginning in 2014.

“We think the Ambassador program is in a perfect position to become a patient navigator. There’s going to have to be competency in outreach and enrollment. There needs to be language and cultural sensitivities and we think this program will be a good launching pad to accomplish all that,” Castellano-Garcia said.

Community-Specific Lessons

A big part of the Ambassador program’s goal is to develop and deliver culturally appropriate lessons in ways patients can best absorb them.

Ricky Choi, director of the pediatrics department at Asian Health Services Community Health Center in Oakland, said educational efforts are paying off.

“The general public in communities we work with is slowly starting to get wind of how health care reform might change things for them. It’s a very exciting thing to see when a greater portion of your community starts to understand the benefits,” Choi said.

Health care reform’s increased availability of subsidized and low-cost insurance is especially important to the Asian population of California, Choi said.

“Our clinic focuses largely on the immigrant Asian population, and a high percentage of this population is without insurance for one reason or another,” Choi said. “The expansion of coverage is going to mean a lot for our patients.”

Some experts estimate that up to 60% of California’s Asian population, uninsured or underinsured now, will get coverage under the Affordable Care Act.

“We estimate that around 5,000 of our patients will get coverage,” Choi said. “A lot of them through the Medicaid expansion but many also who are single, childless adults who previously couldn’t get coverage.”

Choi said language and cultural literacy will be big factors in insurance coverage expansion in California.

“People will be looking for a health center that speaks their language and understands their culture. We’re just one micro-example of how this is all going to unfold. If you expand that to 800 community health centers and a bunch of languages and cultures, you get an idea of the gravity and the potential for these changes to really change lives,” Choi said.

Choi, in his role as ambassador, recorded a radio spot about health care reform, and he’s starting a blog for the San Francisco Chronicle.

Model for Other State Clinic Associations

Now in its ninth month, the Ambassador program has trained more than 1,000 ambassadors — mostly health care providers and clinic employees — who in turn have educated thousands of patients.

Training educators with hands-on sessions, webinars and literature, the Ambassador program is geared to focus on system changes, and the webinars and training sessions were tailored to deal with federal reforms that took effect after six months and then after a year.

CPCA developed a toolkit of supportive materials for ambassadors to use in their education efforts. Toolkits include patient-specific fact sheets in several languages, a pocket guide with answers to frequently asked questions, PowerPoint presentations and a video public service announcement. Developed by the California Endowment, the video features two physicians speaking to the benefits of the Affordable Care Act.

CPCA presented its Ambassador program and materials to the federal Health Resources and Services Administration, part of HHS. The program is being adopted and adapted by primary care associations in other states. Like CPCA, whose clinics provide health care services to about four million Californians, primary care associations in other states represent not-for-profit community clinics and health centers often serving low-income, uninsured and underserved patients.

CPCA staffers are working with their counterparts in several states — including Kentucky, Colorado, Texas and Washington state — offering technical and practical assistance in setting up educational efforts based on the Ambassador program.