20030624_m



COUNTY OF SAN MATEO Inter-Departmental Correspondence
Health Services Agency

DATE:					June 6, 2003
BOARD MEETING DATE:					June 24, 2003

TO:		Honorable Board of Supervisors
FROM:		Margaret Taylor, Director of Health Services

SUBJECT:		Urban Institute Contract to Evaluate the Children’s Health Initiative

Recommendation
Adopt a resolution authorizing the President of the Board to execute an agreement with the Urban Institute for the evaluation of the Children’s Health Initiative.

Background
In 2002 your Board established and funded the San Mateo County Children’s Health Initiative (CHI) to address community-wide concern for the 17,000 county children who lacked access to comprehensive health insurance coverage. With your actions, a broad-based, local coalition collaborated to develop and implement an initiative that offers all children residing in low-income and middle-income households with comprehensive medical, dental and vision health insurance coverage. In January, the Coalition moved the County closer to the Board’s vision of 100 percent coverage for children by implementing the new Healthy Kids insurance program to cover all children ineligible for the existing Medi-Cal and Healthy Families programs and by expanding outreach and enrollment efforts, reaching out to the unions, childcare organizations, schools, and faith-based sites.

CHI has enrolled 3,000 previously uninsured children into the new Healthy Kids program in the past six months. This success rate far exceeded its six-month target of 1,200 children. In addition, the CHI has enrolled 1,500 into Healthy Families and 1,000 into Medi-Cal.

The Coalition has allocated approximately $1.25 million over 5 years to pay an independent contractor to evaluate CHI. The evaluation will ensure program effectiveness and build a case for long-term funding and community support. In December 2002 the Coalition released a request for proposals (RFP) to over 30 organizations. Applications were due at the beginning of March 2003.

Discussion
After extensively reviewing the three proposals that were submitted, the Coalition selected the Urban Institute and its subcontractors, UCSF and Mathematica, as the top candidate to evaluate the impacts of providing health insurance coverage to all low-income and middle-income children in San Mateo County. The Coalition had assigned an evaluation review team with experience working on other County health and social service surveys and evaluations to examine the proposals. This team believed that the Urban Institute proposal offered the most comprehensive and well-developed quantitative and qualitative evaluation. The Coalition found the Urban Institute and its subcontractors to be the most qualified due to their extensive experience and track record in evaluating other children’s health insurance expansions. These included the evaluation of the Santa Clara County CHI, the federally mandated State Children’s Health Insurance Program multi-year evaluation, and the Robert Wood Johnson Covering Kids national evaluation.

The Urban Institute and its subcontractors have developed a work plan that includes the following components: a client survey, process analysis, provider analysis, crowd-out and insurance analysis, health plan administrative data analysis and a cross-cutting impact analysis. It will provide reports on an annual basis to address and answer several important policy questions including:

1) Has CHI improved overall health outcomes for low-income children? 1) How does the cost of providing care to previously uninsured children through the new CHI compare to the cost of serving them prior to the implementation of the CHI? 2) Has CHI enhanced the delivery and stability of the community health care system? 3) Does CHI lead to 100 percent coverage for all San Mateo County low-income children? 4) Has the existence of CHI resulted in a reduction in employer-based health coverage? 6) Has CHI increased community-wide collaboration to address issues of the uninsured?

Vision Alignment
The evaluation contract keeps to the commitment of Ensuring Basic Health and Safety for All and goal number 5: Residents have access to health care and preventive care. It contributes to this commitment and goal by evaluating the most effective approaches to providing health care coverage to all children from low-income and middle-income families.

Fiscal Impact
The contract term is April 29, 2003 to April 28, 2008. The total amount is $1,250,000. $50,000 is included in the 2002-03 approved budget for the CHI. $250,000 is in the recommended budget for 2003-2004.

Outside funding of the CHI covers $1,125,000 of the evaluation contract. The remainder, $125,000, will be covered by the County’s contribution to the program provided from the Solid Waste Fund.

EXHIBIT A
1.	General Description of RFP		• The Request For Proposals for the San Mateo County Children’s Health Initiative 5-Year Evaluation included an overview of the CHI; a list of the policy questions that should be addressed; an overview of the proposed evaluation components that a potential evaluation could include; a detailed description of what should be included in the submitted proposal; and the selection criteria and timeline.
2.	List key evaluation criteria		• Proposal is innovative in concept, delivery and impact and feasible and approach and methodology; • The study’s design, methods, and procedures fit the study’s questions and reflect a clear understanding of the strengths and limits of various analytical techniques; • Proposal clearly demonstrates that project activities will be carried out in a timely and efficient manner; • Proposal clearly states how the project will be staffed and describes the experience the staff has with similar type of projects; • The evaluation team has a record of doing high-quality work that is relevant to the proposal; familiarity with key populations and/or technical issues; and a ability to work collaboratively with diverse group of stakeholders to achieve project goals; • The evaluation team has a proven track record in undertaking high profile evaluations and the ability to produce results in a timely manner; • The work plan is reasonable and the team is committed to meet deadlines; • The project represents a cost-effective use of the CHI’s resources;
3.	Where advertised		• It was not advertised since the Coalition worked with several foundations to gather the names of all potential consultants throughout the country that have evaluated similar projects and would be interested in evaluating a similar initiative.
4.	In addition to any advertisement, list others to whom RFP was sent		• State Health Policy Research, The MEDSTAT Group, Inc. • Harvard School of Public Health • Texas A&M, School of Rural Public Health • Institute for Health Policy Studies, UCSF • University of Minnesota, Division of Health Services • IOX Assessment Associates • Rand Corporation • Abt Asscoiates Inc. • Alan Pardini • Center of Health Management Studies, UC Berkeley Public Health • Mathematica Policy Research • School of Public Affairs, Baruch College, CUNY • Laurel Consulting • Deloitte Consulting • Westat • The Center for Health Policy, Stanford University Kaiser Permanente Research Triangle Institute • Field Research • ASDC • Department of Health Care Policy, Harvard Medical School • San Diego State University, Graduate School of Public Health • University of Michigan • USC School of Policy, Planning and Development • UCSD	• Philliber Research Associates • Michigan State University • The Conservation Company • Park Nicollet Institute for Research and Development • Harder+Company Community Research • American Institute for Research • SG Associates • Eric Marder Association • New England Medical Center • Freeman, Sullivan & Co. • UC Davis Division of General Medicine • Samuels & Associates • Academy for Educational Development • Vital Research • Quality Measurement Advisory Service • Diringer and Associatesz • The Teslow Group • First 5 Santa Clara County • Gibson & Associates • University of Southern California, Division of Community Health • The Urban Institute • Pacific Health Consulting • Center for Health And Public Policy Studies, University of California, Berkeley • Sphere Institute • Nancy Frank & Associates • Applied Survey Research
5.	Total number sent to prospective proposers		• 36
6.	Number of proposals received		• 3
7.	Who evaluated the proposals		• Anand Chabra, Health Services; Colette Fanning; First 5 San Mateo County; Heather Ledesma, Health Services; James Miller, Human Services Agency; JoAnna Caywood, Lucile Packard Foundation for Children’s Health; Sam Tobin, Health Plan of San Mateo; Srija Srinivasan, Peninsula Community Foundation; Liane Wong, Institute for Health Policy Solutions; and Toby Douglas, Health Services
8.	In alphabetical order, names of proposers (or finalists, if applicable) and location		• The Rand Institute, Santa Monica, CA • The SPHERE Institute, Burlingame, CA • The Urban Institute, Washington, DC

COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

Discussion

1) Has CHI improved overall health outcomes for low-income children?

1) How does the cost of providing care to previously uninsured children through the new CHI compare to the cost of serving them prior to the implementation of the CHI?

2) Has CHI enhanced the delivery and stability of the community health care system?

3) Does CHI lead to 100 percent coverage for all San Mateo County low-income children?

4) Has the existence of CHI resulted in a reduction in employer-based health coverage?

EXHIBIT A