Promotoras Help Children Get the Most Out of Health Insurance

roviding health insurance for low-income children has been the focus of national attention for several years, but health experts are finding that enrollment alone does not guarantee quality health care. Community Health Improvement Partners (CHIP) in San Diego is testing a pilot project, called Connecting Children to Health Care, that is helping newly enrolled children access the health care system.

CHIP is working with three nonprofit health insurance organizations—Kaiser Permanente, Sharp Advantage and Community Health Group—that have contracts with the state to provide health insurance to members of the Medi-Cal and Healthy Families insurance programs.

"We were finding that once a child was enrolled, [the family] wasn’t utilizing or taking advantage of what an organized health care system had to offer, particularly well-child exams and preventive services, because they did not understand the value of insurance," said Diane Strum, director of government affairs at Kaiser Permanente and co-chair of the Connecting Children to Health Care project.

TCWF has provided a two-year, $100,000 grant that is being used in part to hire a project manager and four community workers, or promotoras, to provide case management services. The health insurance plans share data about newly enrolled children with the promotoras. The promotoras then visit the families in their homes to explain how health insurance works and, if needed, help parents make doctors’ appointments, provide transportation, accompany families on medical visits, follow up on referrals and provide information on other local health resources.

"[The Connecting Children to Health Care project] serves a high number of Latino families by virtue of the geographic area selected, which was chosen because of its high numbers of uninsured and newly enrolled children," Strum said. "The promotoras are bilingual and reside in the communities that are the target of the pilot program."

Created in 1995, CHIP is a collaboration of 27 health care systems, hospitals, community clinics, insurers, physicians, universities, community benefit organizations and the County of San Diego Health Department. The group was formed to conduct ongoing needs assessments, identify health priorities and coordinate programs to address those priorities in San Diego. Partners also include the three nonprofit health insurance groups participating in the Connecting Children to Health Care project.

Dr. C.H. Beck, chairman of CHIP and chief community health officer for Scripps Health, said the collaborative nature of CHIP contributes to its success.

"We have sitting around the table all of these different health care organizations. This has allowed us to get things done quickly," Beck said. "It works very well because of the trust that has been built up and the in-kind donations of time and talent."

The Connecting Children to Health Care project is having an impact not only on individual families, but also on the way health organizations operate.

"The insurers are showing each other data on enrollment, which is competitive information not normally disclosed," Beck said. "What they get in return is information about the difficulties patients are having with [health care] providers so that those problems can be remedied. We are improving care of the patients and improving the system."

Original funding for the project came from Alliance for Health Care, a project of the Centers for Disease Control and Prevention and Group Health Kaiser, which was looking for a model of collaboration between managed care organizations and public organizations that would improve health care. Project results will be disseminated to California’s nonprofit, private and public health care agencies.

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