Thursday, 2 December 1999 Evaluation Present: Bill Wood, Marcia Hartsock, Lynn Fallin, Jean Kajikawa, Junedale Nishiyama, and Barbara Luksch Next meeting: Tuesday, 8 February 2000 at 8:00 AM in the HPCA Conference Room. 1. Evaluation 1: Number of Uninsured Children in Hawaii The subcontract between HPCA and UH School of Public Health is on hold at UH. Bill suggested a random sample on Maui where new DOE emergency cards are used. Some questions: Are the cards accurate? If many adults surveyed don't know if their child is insured do they use health services? Are the Department of Health counts from the emergency cards accurate? Is there a way for children to show health insurance information when registering so we could help families? Terrina Wong (Hawaii Association of Independent Schools and Hawaii Council of Private Schools) is collecting forms from their schools. She discussed the project with school heads and they will give us information for the census. This will include kids below kindergarten. It was noted schools should be concerned about accuracy of information on cards for emergency purposes (ex. evacuation due to accident or natural disaster). New cards should be completed by parents/guardians yearly. We will work with Good Beginnings Alliance play groups and other preschool groups to capture health insurance information and help kids get covered. 2. Outcomes and Indicators We discussed outcomes and indicators from the Process Simplification Task Force (see list in those minutes below) and gathering free, available data. there is no state registry for immunizations; could check with health insurance plans or school forms 14 emergency room data may be expensive to get; to have ER visits decrease, clients should be educated on appropriate use of ER what statistics do hospitals keep regarding uninsured children? Barbara is checking with Dee Helber at DOE re: student long-term absences 3. CyberCom Evaluation We reviewed the Med-QUEST application for our CyberCom project database: applications data (same as charts currently completed by pilots) FPL number of persons on application number of days between sent and received number of days between received and approved, denied, or discontinued age total number of children (ages 0-19) on application race gender zip code first four digits of telephone number total estimated household gross income gender marital status number of EPSDT yes and EPSDT no (question #7 on application) insurance companies (listed in #8 on application) date of submission location where application completed Med-QUEST office sent to 4. Newborns A group is planning to have 100% of the state's newborns enrolled in health insurance. Lynn Fallin is organizing the first meeting with the Hawaii Medical Association, American Academy of Pediatrics, Med-QUEST, and Hawaii Covering Kids. Monday, 6 December 1999 Training and Public Education Present: Alan Takahashi, Diane Tachera, Lealoni Puana, Barbara Luksch, Junedale Nishiyama, Tracy Carlson, and Pearl Tsuji Next meeting: 11 Tuesday, January 1999 at 9:00 AM in the Honolulu Med-QUEST Conference Room. Part A = general information for clients Part B = training for application assistants 1. We reviewed several videotapes and noted our likes for Part A: 1. Covering Kids (from the national program office) interviewed parents positively affected by having health insurance for their kids person, title, and activities with voice over music used well: intense when problems mentioned and relaxed when explaining it is easy to apply different aged children different ethnicities words printed = easy to follow and focus 2. New BESSD welcome short introduction questions and answers on application process explained what to bring and showed a list informs the audience uniformly visual: showed card and application 3. Old BESSD shows meeting with worker lists fades in as announced list had good contrasting colors shows medical setting when appropriate spell out programs and process Hawaiian music 2. We agreed Part A must be education-appropriate for our clients. Tracy and Junedale can assist in test marketing the script prior to production. 3. Information on rights and responsibilities and QUEST-NET (including premium share) should be included. 4. Barbara will check with BESSD and production companies regarding script writing. The scripts will be approved by Med-QUEST before production begins. Diane and Alan will work on Part A while Barbara, Junedale, and Gloria work on Part B. Wednesday, 8 December 1999 Process Simplification Present: Dorothy Colby, Lynn Fallin, Marcia Hartsock, Dee Helber, John Higuchi, Barbara Luksch, Junedale Nishiyama, and Mary Rydell Next meeting: Friday, 14 January 2000 at 2:00 PM in the HSPCA Conference Room. 1. Barbara, Lynn, and Marcia met to refine the outcomes and indicators list. It will also discussed at the Evaluation Task Force meeting (see list in those minutes above). Outcomes and Possible Indicators 1. Create a seamless health insurance enrollment process for children. * Number of Medicaid, QUEST, and CHIP applications increase * Number/percent of newborns enrolled increases * Number/percent of children ages 0-19 enrolled increases * Time from application to processing decreases * Average length of time required to complete the application decreases 2. Enroll more children in Medicaid, QUEST, CHIP and other health insurance programs. * Number of emergency room visits by children ages 0-19 decreases * Number of age-appropriate immunizations increases * School absences exceeding 10 days due to illness decreases Tertiary Indicators * Rate of child abuse and neglect decreases * Teen pregnancy rate decreases * Teen STD rate decreases * Number of low birth-weight babies decreases * Infant mortality rate decreases 2. John reviewed the CyberCom components-our final discussion leading to Barbara's sign-off on the prototype. Barbara will share the information with Dan Domizio, Dick Behenna, Gloria Samson, Big Island Hawa'i Covering Kids outreach workers, and Ann G Tam Sing for their feedback. 3. Copies of the "Federal Laws, State Laws, and Field Worker Requirements" matrix were distributed and Junedale explained the items listed. We are currently asking the Hawaii Covering Kids outreach workers to complete the last column. 4. Barbara reported on her Washington, D.C. trip to attend the School-Based CHIP Outreach Conference sponsored by the Department of Health and Human Services and Department of Education. Pearl Tsuji (Med-QUEST) and Judy Akamine (Big Island Public Health Nurse Supervisor) also went. A handout with her notes included: Matt Powers, Administrator of the Division of Medical Programs from Illinois highlighted his departments steps to simplify the process including a simple application (= more efficiency and saves money) and paying DISH/FQHC employees to help families complete forms (again complete applications = more efficiency = saves money). California representatives demonstrated their web portal for applications (they are several months ahead of us). Support speeches from Secretaries Donna Shalala, Janet Reno, Dick Riley, and Dan Glickman on enrolling children in health insurance. 5. We brainstormed barriers to children being covered by health insurance: a. original signature only b. verification: birth certificate, social security number, income c. Med-QUEST information telephone line busy d. getting accurate information e. public charge (fear) f. interview: times available, transportation, parking g. office hours during parent/guardian work hours h. crowd out (for CHIP) i. children not utilizing EPSDT services j. application: complicated questions, busy format, education level too high, font size too small, English-only, no simple instructions available k. job requirements for eligibility workers who do determinations (extensive raining) l. lack of dentists who accept Medicaid m. demeaning office atmosphere n. public doesn't know about programs o. education level of pamphlets too high p. scare tactics re: paternity We will review the list with strategies to overcome the barriers, including a simple application at our next meeting. Tuesday, 14 December 1999 Media and Public Information Present: Herita Yulo, Trudie China, and Barbara Luksch Next meeting: February 2000 (to be announced). Note: based on discussions started at the state coalition meetings, opio was added to our slogan to appeal to adolescents. 1. We discussed the importance of having a consistent message for the public and reviewed Med-QUEST's timeline. Barbara will discuss with Diane Tachera: what can we do to help Med-QUEST achieve their goals? how can we work together to have a consistent message to reach clients? what should we work on together and what will be parallel public information and outreach? how can we work together to have a consistent message reaching clients? 2. Dorothy Colby sends monthly PSAs to radio stations to promote AUW ASK-2000. Barbara will discuss them with her. 3. Trudie explained 2000 will be a difficult year to get television PSA airtime due to: Olympics, election year, and local stations are moving to clock time. One option is to buy pay time and get free time as a multiplier effect. 4. We discussed bus posters to advertise the hotline and feature our logo for recognition. There are 500 buses on Oahu (Neighbor Islands must be contacted separately) and the Department of Transportation will post them for one month on a space available basis. Barbara will solicit bids from printers (very few print on the required eighteen-point card stock). Trudie suggested writing "sponsored by" before the name Hawaii Covering Kids so readers do not think we are a separate health insurance program.