2014 Grants Challenge

Spreading ChapCares Retail Health Insurance Enrollment Shop Model

Idea by ChapCare

To open 2 new retail health insurance enrollment shops in El Monte/South El Monte, one of the most underserved areas in Los Angeles County.


Please describe yourself.

Solo actor (just us on this project!)

In one sentence, please describe your idea or project.

ChapCare provides primary health care services; medical and dental care and behavioral health counseling; to 15,000 patients annually.

Does your project impact Los Angeles County?

Yes (benefits a region of LA County)

Which area(s) of LA does your project benefit?

San Gabriel Valley

What is your idea/project in more detail?

On February 3, 2014, ChapCare opened its first retail health insurance enrollment shop at the Paseo Colorado, a major shopping center located in downtown Pasadena.

The enrollment shop provides a clean, neutral space for those eligible to enroll in health insurance. It is highly visible, being located in a high traffic area in Pasadena. It is open year-round, 7 days per week, with evening hours.

In just 10 weeks, ChapCare enrolled 1,212 people into health insurance (an average of over 120 per week) at this location during last year's Covered California (California's State Exchange) open enrollment period.

ChapCare proposes to expand this model to the El Monte/South El Monte area, which is located in the central San Gabriel Valley.

What will you do to implement this idea/project?

ChapCare’s Marketing Manager will manage the project. The Manager is a member of ChapCare's Senior Leadership Team.

Upon award, scouting of enrollment shop locations in the El Monte/South El Monte area will begin. Based on previous experience, we expect to locate the 2 shop spaces within 4 weeks, with an additional 2 weeks required to operationalize the sites.

To support marketing of the project in the community, ChapCare’s 11 member Outreach Department will launch an outreach and education campaign to generate leads that will be enrolled at the 2 shops.

Specifically, based on the Consumer Tracking Survey that Covered California conducted (May 6, 2014), we know that the vast majority of people are aware of the Affordable Care Act (ACA) and their health insurance options, but what many have not chosen to do is enroll. What this means is that continued education is paramount to decrease barriers to enrollment.

We will leverage local partners in El Monte/South El Monte to conduct the majority of outreach work (i.e. making flyers available at their locations). These include the El Monte/South El Monte Chamber of Commerce, Greater El Monte Community Hospital, local school districts, community based organizations, libraries, etc. Outreach conducted by ChapCare directly will focus on locations where the populations live, work, shop, and play; and local high volume locations and events.

Our main focus to get people to enroll in health insurance will be on planning an aggressive education campaign that will provide group presentations to capitalize on the awareness already created. Education presentations will provide general information about health insurance, and more targeted information that seeks to respond to consumer concerns.

Referral cards will be available at enrollment locations, whereby a consumer can write a note to a friend about their positive experience enrolling into health insurance, and to encourage them to enroll. These will be mailed at no cost to the client.

The proposed strategy is cost-effective and reasonable based on our previous experience and lessons learned.

During the first open enrollment period, 42% of individuals who enrolled at our enrollment shop in Pasadena did so after a friend or family member enrolled and told them about it. As seen during the first open enrollment period, we expect the initial Outreach & Education to launch a multiplying effect that will leverage limited dollars into a sustained wave of activity.

How will your idea/project help make LA the best place to LIVE today? In 2050?

In the short-term, ChapCare’s proposed project will support increased health care access by stripping down barriers to care (lack of health insurance).

By 2050, the proposed project will support improved healthcare outcomes, and healthcare as a key driver of economic viability. Studies have shown that many low-income individuals miss significant amounts of time at school and/or work because of poor health; in many instances, affecting their long-term financial viability. These affects can sometimes be so significant, as to be generational in impact.

In order to shift long-term health in communities, preventive health care is key. In order for people to pro-actively access health care, health insurance is essential.

ChapCare’s enrollment shop model is a significant game-changer is this area since it promotes a culture of coverage in communities by normalizing the health insurance process. In most instances, for those who choose to enroll, they have to stand on long lines in a County office to enroll in Medi-Cal or call a phone bank in Sacramento to enroll in Covered California. For those who choose not to enroll there are many issues that need to be overcome such as: a lack of trust, cultural and linguistic barriers, and/or an inability to navigate the complicated health insurance system on their own.

The enrollment shop is a clean, visible space integrated into the fabric of the community, supported by people the community knows and trusts, that makes enrolling in health insurance feel no different than going to the post office or grocery store.

Whom will your project benefit?

ChapCare will open 2 new retail health insurance enrollment shops in the El Monte/South El Monte area in the San Gabriel Valley.

There are over 120,000 people living in this area, with over 50,000 living at or below 200% of the Federal Poverty Level ($22,980 for a single person) who have not accessed health care services. As a result, the area has experienced some of the worst health indicators in Los Angeles County; specifically, the area’s obesity rate ranks 116 out of 117 cities in the County, with over 31% of adults being obese, which has led to high rates of hypertension and diabetes.

Many people in the El Monte/South El Monte area do not access primary health care services due to a lack of health insurance, which is one of the key barriers to people accessing needed medical services. In the proposed area, there are 39,438 low-income people (living at 400% or below of the Federal Poverty Level) that currently do not have health insurance; of which, 21,789 are eligible for Covered California, and 17,649 can access free insurance (Medi-Cal).

The proposed area is predominantly Latino (75%) followed by Asian (20%), with the Asian population being predominantly Chinese and Vietnamese, making services that are culturally and linguistically competent of critical importance.

ChapCare’s proposed project will benefit the low-income populations of the El Monte/South El Monte region by providing easily accessible health insurance enrollment services. The project will provide services in a culturally and linguistically competent manner that is responsive to the needs of the community.

Please identify any partners or collaborators who will work with you on this project.

Not applicable.

How will your project impact the LA2050 LIVE metrics?

Healthcare access

Please elaborate on how your project will impact the above metrics.

ChapCare’s proposed project will significantly expand access to health care services by first expanding access to health insurance. Many low-income individuals want to visit the doctor, but those without health insurance oftentimes do not because they are afraid of being saddled with a large bill.

Based on our previous experience during the first Covered California open enrollment period, we are confident that we can enroll thousands of individuals per year into health insurance in this area and facilitate access for those enrolled into primary health care services (please see specific metrics sections for details), and as a result, significantly alter the health care landscape in this underserved community.

Please explain how you will evaluate your project.

ChapCare will measure success utilizing 3 metrics:

1) Open 2 new health insurance enrollment shops in the El Monte/South El Monte area within 60 days of award;

2) During months 3 – 12 of the project period, ChapCare will enroll 3,000 people into health insurance via Covered Caliifornia of Medi-Cal who were not previously insured; and

3) ChapCare will facilitate access to health care services for a minimum of 70% of people enrolled into health insurance at a ChapCare health center (ChapCare operates 2 health centers in El Monte/South El Monte) or another provider of their choice.

What two lessons have informed your solution or project?

Covered California performed a Consumer Tracking Survey (May 6, 2014) to find out what lessons could be learned from the first open enrollment period.

A few lessons that support our model include:

1) Latino population - Want face to face assistance in navigating through the health insurance system to secure enrollment; and

2) Asian population - Tend to access insurance after hearing about it from another individual who is happy after enrolling into insurance themselves (i.e. word of mouth), and are most likely to not be native English speakers, and as a result are least likely to learn about or enroll in health insurance on-line.

Explain how implementing your project within the next twelve months is an achievable goal.

ChapCare opened its first health insurance enrollment shop in Pasadena on February 3, 2014. The shop is located at the Paseo Colorado, a major shopping center in the area. ChapCare was able to locate this site in 4 weeks, and operationalize the site in 2 weeks (from lease signing) to provide services.

ChapCare understands the infrastructure necessary to quickly and effectively open an enrollment shop. The most important aspect is: Operating under a Cloud-Based Infrastructure – Since ChapCare’s health centers operate under a cloud, we do not need to take out internet or phone contracts for our enrollment shops. Instead, we assign a dedicated number for each shop to our existing cloud, add additional phone lines, and link the internet needed at the shop to the cloud. If not operating under this structure it can take up to 120 days to have new internet and phone lines installed.

Please list at least two major barriers/challenges you anticipate. What is your strategy for ensuring a successful implementation?

Two major barriers to implementation are as follows:

1) Staff Recruitment – Due to the language needs of the community (i.e. Spanish and Mandarin/Cantonese or Vietnamese), staff recruitment can sometimes be a challenge.

Strategy to Ensure a Successful Implementation: New Staff will be hired within 30 days of award. The Project Manager will work with ChapCare’s Human Resources Supervisor in the recruitment of project staff.

ChapCare’s recruitment process includes screening candidates based on their ability to provide for the cultural/linguistic problems of the communities we serve. ChapCare uses a number of strategies to recruit staff. All open positions are posted on the Community Clinic Association of Los Angeles County website and are forwarded to the California Primary Care Association. The organization also posts positions on Internet-based career sites.

ChapCare is a competitive employer among local safety net providers. This has developed out of our track record for growth, operational stability, and reputation for innovation. Attractions to ChapCare that have helped facilitate employee recruitment include: 1) Compensation that is competitive based on industry standards, and 2) Comprehensive benefits such as medical, dental, vision, long-term disability, worker’s compensation, vacation, sick/personal time, and a 403 (b) retirement plan.

2) Securing Enrollment Shop Locations – Finding enrollment shop locations that meet our criteria (clean and inviting space, 1,000 – 1,200 square feet, and a visible location in a high-density area that is frequented by the community) can be difficult.

Strategy to Ensure a Successful Implementation: Upon award, ChapCare will reach out to the El Monte/South El Monte Chamber of Commerce, which will liaising with local brokers in the area to support our shop search.

ChapCare has an existing relationship with the Chamber, and its CEO and Marketing Manager are part of the Chamber’s Ambassador Committee.