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Publications by Dana Hughes for Health Policy Center

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Viewing 1-10 of 10. Most recent listed first.

Evaluation of the San Mateo County Adult Coverage and Systems Redesign Initiative (Research Report)
Embry M. Howell, Dana Hughes, Sarah Benatar, Genevieve M. Kenney, Ashley Palmer, Christine Coyer

In 2008 San Mateo County, California launched its Adult Coverage Expansion and Systems Redesign Initiative. The initiative expanded coverage for all uninsured adults below 200 percent of the poverty level and redesigned care in county safety net clinics. The program substantially improved access to care for uninsured adults, as well as improved continuity and quality of care for those served by county safety net clinics. However, access remains a problem for new enrollees, due to restrained provider supply and the economic recession. The report provides lessons for other counties as they expand coverage under national health reform.

Posted: November 23, 2011Availability: HTML | PDF

Swimming Upstream: Improving Access to Indigent Health Care in the Midst of Major Economic Challenges (Research Report)
Sarah Benatar, Dana Hughes, Embry M. Howell

An evaluation of San Mateo County's comprehensive health system redesign initiative finds notable improvements in access to high quality patient care for formerly uninsured adults. For example, the percent of such individuals having a usual source of care rose from 42.5 to 91.2 percent with the initiative. The initiative met with success despite mounting fiscal challenges associated with the economic recession and state budget crisis – threatening the county's ability to support these innovations. The county's efforts offer lessons for local and national policymakers, program administrators, and providers about how progress is possible despite severe financial obstacles.

Posted: December 13, 2010Availability: HTML | PDF

A Report on the Second Year of the San Mateo County Adult Coverage Initiative and Systems Redesign for Adult Medicine Clinic Care (Research Report)
Embry M. Howell, Dana Hughes, Sarah Benatar, Ariel Klein, Ashley Palmer, Genevieve M. Kenney

This report presents findings from the first 18 months of an evaluation of San Mateo County's Health System Redesign and Adult Coverage Initiative (ACE), an effort to improve access to high quality care for uninsured and underinsured adults and improve the financial sustainability of the San Mateo Medical Center (SMMC) and related delivery systems. The County has begun implementation of team-based care, disease management, Advanced Access scheduling, and electronic medical records. Enrollment in the ACE program continues to exceed expectations, and data collected for the evaluation show increased access to care and receipt of doctor visits.

Posted: June 07, 2010Availability: HTML | PDF

Final Report of the Evaluation of the San Mateo County Children's Health Initiative (Research Report)
Embry M. Howell, Dana Hughes, Louise Palmer, Genevieve M. Kenney, Ariel Klein

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. Healthy Kids covers uninsured children below 400 percent of poverty and primarily serves poor, undocumented Latino children. A survey of parents of Healthy Kids enrollees found that in the first year of enrollment, children experienced improvements in access to and use of medical and dental care; a reduction in missed school days due to health problems; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Moreover, use of preventive and dental services continued to improve during the children's second and third years of continuous enrollment.

Posted: May 30, 2008Availability: HTML | PDF

Three Independent Evaluations of Healthy Kids Programs Find Dramatic Gains in Well-Being of Children and Families (Policy Briefs/In Brief)
Christopher Trenholm, Embry M. Howell, Ian Hill, Dana Hughes

This brief presents highlights from rigorous, independent evaluations of the Healthy Kids programs in three California counties, Los Angeles, San Mateo, and Santa Clara. The three Healthy Kids programs provide children with comprehensive health insurance coverage. Children are eligible for Healthy Kids if they are ineligible for California's two major state insurance programs, Medi-Cal and Healthy Families, and live in families with incomes up to 300 percent of the federal poverty level (FPL) in Los Angeles and Santa Clara counties, and 400 percent of the FPL in San Mateo County. This brief describes some of the many positive impacts that Healthy Kids programs have had on children, including improvements in their access to and use of medical services and reductions in their unmet need for care.

Posted: November 19, 2007Availability: HTML | PDF

Access, Use, and Costs of Dental Services in the Healthy Kids Program (Policy Briefs/Health Policy Briefs)
Dana Hughes

This brief presents data on dental coverage benefits and enrollee's access and use of dental services through the Healthy Kids program in San Mateo County, California, which offers subsidized health and dental insurance for children living below 400 percent of federal poverty who are ineligible for Medi-Cal and Healthy Families (California's SCHIP program). Healthy Kids dental coverage has led to use of dental services among a sizable portion of enrollees. Children seeking dental services were more costly for the program than other enrollees, and dental care costs accounted for a large proportion of the overall cost of their healthcare. While there is adequate service capacity to meet children’s dental needs in the county, renewed efforts to link enrollees with dental care are needed.

Posted: August 01, 2007Availability: HTML | PDF

A Tale of Two Counties (Article)
Embry M. Howell, Dana Hughes

During difficult economic times, many California counties have expanded health insurance coverage for low-income children. These Children's Health Initiatives (CHIs) enroll children in public programs and provide new health insurance, Healthy Kids, for those ineligible for existing programs. This article describes the policy issues in implementing the Santa Clara and San Mateo County CHIs, as well as the children's enrollment levels and utilization of services. These CHIs are among the first of the thirty California counties planning or implementing such initiatives. Their success depends on leadership from county agencies that have not traditionally worked closely together, as well as the development of a diverse public and private funding base. This effort to provide universal coverage for all children is important to national policymakers desiring similar goals.

Posted: September 29, 2006Availability: HTML | PDF

Evaluation of the San Mateo County Children's Health Initiative (Research Report)
Embry M. Howell, Dana Hughes, Brigette Courtot, Louise Palmer

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. This third annual CHI evaluation report describes the demographic and health status characteristics of children enrolled in three public health insurance programs served by the CHI; how service use has changed over time; characteristics of high cost users of services and how they differ from other children; access to dental services and mental health services; the role of schools in outreach and enrollment; and the factors influencing employer decisions to offer insurance for dependents.

Posted: September 26, 2006Availability: HTML | PDF

Evaluation of the San Mateo County Children's Health Initiative (Research Report)
Embry M. Howell, Dana Hughes, Genevieve M. Kenney, Jennifer Sullivan, Jamie Rubenstein

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), a program to ensure that all children have access to comprehensive health insurance coverage. The report describes the governance structure for the CHI; its financing; enrollment growth (for all three public programs); access to services; use and cost of services for all three public programs; satisfaction on the part of both parents and providers; prior insurance and crowd-out; and the effect the initiative has had on hospital finances. Areas identified as needing attention include improving access to after-hours and dental care; increasing the use of preventive service; and developing new sources of financing for the CHI.

Posted: August 31, 2005Availability: HTML | PDF

Evaluation of the San Mateo County Children's Health Initiative (Research Report)
Embry M. Howell, Dana Hughes, Holly Stockdale, Martha Kovac

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), a program to ensure that 100 percent of children have access to comprehensive health insurance coverage. This first annual CHI evaluation report shows that, in its early months, the CHI achieved rapid enrollment growth in its new insurance product, "Healthy Kids." Utilization of services was low in the initial months. This successful outreach and enrollment is a product of intensive and sustained collaboration among the CHI partners. Future evaluation reports will document the impact of the program on access to care and cost.

Posted: April 30, 2004Availability: HTML | PDF

 

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