Publications by Ashley Palmer for Health Policy Center

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San Mateo County is one of a small number of innovative local jurisdictions that is expanding coverage for uninsured adults and at the same time undertaking a reform of its safety net primary care system. We evaluated the impact of the systems redesign by comparing outcomes for a group of people served at the largest county safety net clinic prior to systems redesign (2006) to those served at the clinic after systems redesign (2009). Use of any preventive care services in a year climbed from 25.9 percent to 33.3 percent. Continuity of care also rose significantly, and emergency room use declined. The county's experience provides an example for other communities to follow as they improve the efficiency of health care services for the most vulnerable members of society.

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.

This report concludes a comprehensive evaluation of The Data & Democracy II project, a program funded by The California Endowment and implemented by UCLA. These organizations sought to increase the capacity of local community-based organizations (CBOs) to collect, analyze, and interpret data to identify and prioritize areas for action. The program was structured after the Train-the-Trainer model, in which a group from local CBOs is trained in these skills and required to disseminate the information by conducting workshops in their own communities. We examine the program's effectiveness, long-term impacts, and challenges through observations, surveys and case studies.

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.

This issue brief presents findings from the 2009 District of Columbia Health Insurance Survey conducted August to November 2009. It compares the characteristics of nonelderly DC residents with employer-sponsored insurance and to those with public insurance coverage. We consider type of insurance across gender, race, income, ward of residence, and health and disability status. For workers, we look at work status (full-time vs part-time) and type of firm.

This chartbook presents results from a survey of insurance status and options in the District of Columbia, conducted with 4,717 households in fall 2009. Only 6.2% of residents report being currently uninsured, among the lowest rates nationally. Somewhat more, 10.2%, report having been uninsured at some time during the year. Employer-sponsored insurance was the most common source of coverage for non-elderly adults. Among children, public coverage was nearly as important as employer-sponsored coverage. Only about 10% of publicly insured children have the option of employer-sponsored insurance. Among employed adults with public coverage, about half work in firms that offer coverage.

This issue brief presents findings from the 2009 District of Columbia Health Insurance Survey conducted August to November 2009. It presents a profile of nonelderly adult residents in DC who reported that they were uninsured looking at gender, race and ethnicity, income, length of residence in DC, ward of residence, and employment status. It also presents the reasons that residents gave for not having health coverage.

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