Health Care Research - California's Patient Advocate

Racial and Ethnic Groups

This policy brief examines the assertion that HMO enrollees should be less likely to rely on emergency room and ambulatory care sensitive hospitalizations given HMOs focus on centralized care through use of a primary care provider. However, in this policy brief, researchers found that African-American HMO enrollees in California are more likely to delay obtaining needed medications and use the emergency room than other racial/ethnic groups in comparable HMO plans. The authors recommend a reexamination of use patterns and access barriers among African-American HMO enrollees.

Health Care Literacy

The purpose of this Report was to investigate the intersection between health literacy and health plan efficiency. To accomplish this, Health Research for Action (UC Berkeley School of Public Health) conducted a literature review, analyzed health literacy data from the California Health Information Survey (CHIS), conducted 31 key informant interviews with health plan professionals and advocates, conducted 12 focus groups and 20 usability tests with health plan members, and convened and met with an advisory group.

As a result of the extensive research and feedback from the expert advisory group, HRA’s top recommendation is to create 4-6 health plan newsletter inserts, each covering one of the topics listed above, using flowcharts and checklists.

Health Care Engagement

This report on health care consumer engagement was created at the request OPA by the California Program on Access to Care (CPAC), a program of UC Berkeley’s School of Public Health. The resulting recommendations detail specific steps that can help health care consumers play a greater role in improving the quality of their health care, now and in the future.

The four major health care topics covered include:

• 1) navigating the health care system,
• 2) making choices among health plans and providers,
• 3) influencing and managing the care they receive, including self management of chronic disease, and
• 4) adopting healthy behaviors.

Quality of Care

The objectives of the QPM project are:

• To identify useful measures for reporting the quality of health care in California.
• To assess health care stakeholders’ use of current and future quality measures, their perceived gaps in health care measurement, and their perceived role of OPA in quality measurement and public reporting.
• To assist OPA in developing strategies that contribute to the development of a coordinated and comprehensive set of publicly reported quality performance metrics for California.

This report contains the results of an evaluation of the 2003-04 version of the Office of the Patient Advocate (OPA) Quality of Care Report Card conducted by the Center for Health Services Research in Primary Care, University of California, Davis in 2004. It examined consumer use, usability, and usefulness of the Report Card website and printed summary. The Report Card website, updated annually, provides consumers with comparative information on the performance of California’s largest HMOs and medical groups serving approximately 11 million enrollees. It also includes a listing of HMO services in other languages. The website www.healthcarequality.ca.gov provides this information plus detailed results for more than 50 specific quality measures. Both the web and print versions are available in English, Spanish, and Chinese.

This report, produced by the UCLA Center for Health Policy Research under contract to the California Office of the Patient Advocate, provides a pre-health care reform snapshot of health status and utilization characteristics of Californians who were either enrolled in commercial or public managed care plans or who were uninsured in 2007. Using the most recently available data from the 2007 California Health Interview Survey (CHIS), this report provides a detailed profile of demographic characteristics, disease conditions, health status, health care use, and barriers to care among California residents. Among the findings are a high need for certain types of health care, such as mental health services, as well as a growing reliance on high-deductible health plans, especially among the low-income and self-employed.

2006 Survey: What Consumers Want to Know About Their HMOs

OPA recently commissioned a random sample survey of 1,224 adult Californians enrolled in HMOs. Goals of the survey were to:

• Determine the kinds of information HMO enrollees would like to know about their health plan and how it works.
• Identify the sources of information that consumers trust and the sources of information they find most useful. Specifically, the survey sought to understand how consumer information needs vary by source of coverage (employer, Medicare, or Medi-Cal), demographics, and geography.
• Document the changes in consumer experiences since 1997, when a similar survey was conducted.

2001 Profile of California's HMO Enrollees

This report, produced by the UCLA Center for Health Policy Research under contract to the California Office of the Patient Advocate, provides a detailed demographic profile of California's HMO enrollee population using data from the 2001 California Health Interview Survey (CHIS 2001). CHIS 2001, a new source of health information for California, is the largest state health survey ever conducted in the United States.

Language

Policy Brief - Language Barriers Pose a Risk for California HMO Enrollees

Among California’s adult HMO enrollees ages 18 to 64, 3.4 million speak a language other than English at home and of those, almost 30% report not being able to speak English well or not at all. Over one million of these HMO members with limited English proficiency (LEP) are at risk of facing problems accessing health care services and receiving quality treatment.

HMO Services in Other Languages

California is a very diverse state, and the population enrolled in its health maintenance organizations (HMOs) reflects this diversity. HMOs are faced not only with the challenge of providing appropriate health care services to members, but also providing services to enable access to care for limited English proficient (LEP) members. This report presents findings from the Office of the Patient Advocate (OPA) Cultural and Linguistic Services Information for Health Plans Survey.

Policy Brief - Diversity in Language and Education Poses Challenges for Health Plans

California’s health maintenance organizations (HMOs) face serious challenges in meeting the needs of their members who have diverse language proficiency and educational attainment. This policy brief summarizes findings from a report that is the most comprehensive profile of the state’s entire HMO membership available to date, including commercial, Medicare, Medi-Cal, and Healthy Families members.

Obesity

Policy Brief - More Than Half of Californians in HMOs Are Overweight or Obese

More than five million Californians enrolled in HMOs-over half of all HMO enrollees ages 12 to 64-are overweight or obese, based on the most recent data from the California Health Interview Survey.