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Abstract
This report presents early findings of an evaluation of San Mateo County's Health System Redesign and Adult Coverage Initiative (ACE), an effort to improve effectiveness, efficiency, and care coordination among uninsured and underserved adults in the county. Enrollment in the ACE program has exceeded expectations, yet sustained financing for the program has yet to be identified. We have observed reforms in scheduling, team-based care, and the implementation of electronic medical records. However, we found significant barriers to access for primary care and specialty appointments. This analysis is the first of several ongoing evaluation reports by the Urban Institute and UCSF.
Introduction
In early 2008, San Mateo County embarked on a comprehensive "Health System Redesign and
Adult Coverage Initiative." This effort aims to address the financial sustainability of the San
Mateo Medical Center (SMMC) system through improved effectiveness, efficiency, and care
coordination of the uninsured and underserved. While the redesign has been officially underway
for only one year, leaders within the SMMC have been working (in a less coordinated manner) to
achieve many of these goals for many years.
This report summarizes the findings from the first six months of the Urban Institute's
three and a half year evaluation of San Mateo County's Health System Redesign and Adult
Coverage Initiative. This overall evaluation is designed to
- Evaluate the impact of the ACE (Access and Care for Everyone) coverage initiative, and
the WELL program
- Assess the activities related to the county's efforts to redesign the health system; and
- Measure the impact of these innovations.1
The preliminary findings presented here draw on the first site visit conducted in August
2008, which included in-depth interviews with 43 key stakeholders and clinic managers and
staff2 as well as waiting room observations at three clinics. Findings from the site visit offer
insight into clinic operations, efficiency innovations, and disease management efforts. We also
present data on demographic characteristics and health service use for the initial group of ACE
(the Adult Coverage Initiative) enrollees. And finally, we present baseline clinic-level data,
collected in 2007–2008 before many of the system design activities began, in order to illustrate
some of the challenges facing the SMMC system and Ravenswood Family Health Center and
highlight some of the county clinics' achievements.
The purpose of this report is to provide the context in which the system redesign and
ACE coverage initiative are taking place; to describe initial implementation of the program; to
update the Board of Supervisors on the current status of the evaluation; and to present a synopsis
of the next steps planned for the evaluation.
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