Monitoring the health status of populations is a core function of all public health agencies but ... more Monitoring the health status of populations is a core function of all public health agencies but is particularly important at the municipal and community levels, where population health data increasingly are used to drive public health decision making and community health improvement efforts.1–3 Unfortunately, most local health jurisdictions lack important data for developing population health profiles, such as data on chronic disease prevalence, quality-of-life measures, functional status, and self-perceptions of health status. In addition, data on important determinants of health, including health behaviors and access to health care services, are rarely available locally.These data frequently are collected in national and state surveys (e.g., the National Health Interview Survey and the Behavioral Risk Factor Surveillance System) and provide critical information to assess progress toward achieving state and national health objectives.4 The surveys rarely serve local data needs, however, because of insufficient sample size and lack of flexibility to address local health issues. To address gaps in local health data, in 1997 the Los Angeles County Department of Health Services inaugurated the Los Angeles County Health Survey.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 4, 2013
ABSTRACT Background: As the country moves forward with implementing the health reform, there will... more ABSTRACT Background: As the country moves forward with implementing the health reform, there will be several opportunities for communities to implement programs that will assist in helping the newly eligible enroll into public health insurance. Enrollment events may serve as a venue to both enroll the community in public health insurance and educate them on the changes the health reform will bring. Study Strategy: Over 2,900 surveys were administered to attendees of six community planned public health insurance enrollment events. Surveys were used to identify whether participants had any change in understanding of the health care reform after participating in the event, and determine successful marketing strategies to maximize the attendance at the enrollment events. Results: Over half of attendees at the events had no knowledge about the health care reform prior to attending the event. On average, over 80% of attendees knew more regarding the health reform following the event, and over 80% believed the law would be beneficial to their families. Television and word-of-mouth were the most effective marketing tools, with health care enrollment the greatest factor for event participation. Lessons Learned: Public health enrollment events may serve as an effective opportunity to educate the public on changes to their health care as a result of the health reform. Further research will be conducted to determine how much attendees retain from the events. An effective marketing strategy for continued future success at the enrollment events should focus on using local organizations to start word-of-mouth campaigns and utilizing television advertisements.
A growing percentage of Medicaid patients are receiving medical care within a managed care system... more A growing percentage of Medicaid patients are receiving medical care within a managed care system. This policy change has raised concerns about whether safety-net providers can maintain their share of Medi-Cal (California Medicaid) patients. From 1995 to 1997 several of California's counties implemented mandatory Medi-Cal managed care. The majority of California's safety-net primary care clinics experienced a decline in the percentage of their patients insured by Medi-Cal. However, after the overall decline in the number of Medi-Cal beneficiaries was controlled for, the increased penetration of Medi-Cal managed care in a county was not independently associated with a decline in clinics' share of Medi-Cal patients. Despite this fact, it may become increasingly difficult for clinics to maintain their current level of services with declining Medi-Cal enrollment and other anticipated reforms in their funding.
California has expanded health insurance to children in low- and middle-income families. Currentl... more California has expanded health insurance to children in low- and middle-income families. Currently, Children's Health Initiatives (CHIs) have been developed in 26 counties to supplement Medi-Cal and Healthy Families (SCHIP). Yet, as coverage expands, we know little about the impact of these programs on child health outcomes. Child hospitalizations for ambulatory care sensitive conditions (ACSC) is a widely adopted measure of health outcomes. We compare rates of total ACSC hospitalizations among children ages 0-18 years in 9 operational CHI counties prior to CHI implementation to rates after the CHIs became operational. As a comparison group, we stratify the analyses by family income level and compare children in lower-income to higher-income families. Between 2000 and 2005, there were 281,000 total preventable hospital pediatric admissions. After adjusting for the effects of time and county, the rate of ACSC hospitalizations was 19% lower postimplementation of CHIs versus preimplementation for children of lower-income families (rate ratio of 0.81, P = 0.0001), but not for children of higher-income families (rate ratio of 0.99, P = 0.93).We estimate that 6324 ACSC hospitalizations may have already been prevented in existing CHI counties after implementation, saving about $6.7 million over the 6 years, assuming $7000 per child hospitalization. With health insurance coverage available for all children, and families financially able to connect with an ongoing source of primary care, some of the potential benefits of reduced ACSC hospitalizations may help to offset premium costs associated with assuring that all children have coverage.
State governments have used several types of mandates to assure that local governments fulfill st... more State governments have used several types of mandates to assure that local governments fulfill state-defined responsibilities, including public health care for the poor. This article reports the findings of a study of procedural public-participation mandates and financial sanctions imposed by California to hold counties to their obligations to provide indigent health care. An inventory of the laws' implementation in all California counties found noncompliance by some counties, although all counties complied after a state Health Services Department unit was established to monitor the counties and provide them with state aid. Case studies in eight counties identified factors that influenced the effectiveness of the laws in modifying or reversing county proposals to close county hospitals or reduce other health services. Policy guidelines are suggested for states that want to develop mandates to enforce indigent-care responsibilities of local governments.
The authors describe a family medicine center before and after a merger between the Keck School o... more The authors describe a family medicine center before and after a merger between the Keck School of Medicine of the University of Southern California, the California Hospital Medical Center, and the Eisner Pediatric and Family Medical Center in 2012. The merger provided new opportunities to stabilize the financial base of a clinical practice struggling financially and to enhance the training of residents and other health professionals in primary care, which motivated the partners to consider this new model. After 18 months of negotiations, they were able to convert the family medicine center and residency program into a new federally qualified health center. The benefits to this new model include an increase in both patient volume and the quality of education, supporting residency accreditation; a greater number of residents from U.S. medical schools; enhanced education and preparation of primary care physicians for practice in medically underserved communities; enhanced reimbursements and new opportunities for state, local, and federal grants; and quality improvement and new information technology. The partners overcame academic, administrative, legal, and regulatory obstacles, communication barriers, and differences in culture and expectations to achieve this merger. Keys to their success include the commitment of the leaders at the three institutions to the goals of the merger, a dedicated project manager and consultants, opportunities for new revenue sources and reimbursements, and support from a pioneering charitable foundation. The authors conclude by discussing the implications of using community health centers as the focal point for training primary care clinicians and addressing workforce shortages.
Monitoring the health status of populations is a core function of all public health agencies but ... more Monitoring the health status of populations is a core function of all public health agencies but is particularly important at the municipal and community levels, where population health data increasingly are used to drive public health decision making and community health improvement efforts.1–3 Unfortunately, most local health jurisdictions lack important data for developing population health profiles, such as data on chronic disease prevalence, quality-of-life measures, functional status, and self-perceptions of health status. In addition, data on important determinants of health, including health behaviors and access to health care services, are rarely available locally.These data frequently are collected in national and state surveys (e.g., the National Health Interview Survey and the Behavioral Risk Factor Surveillance System) and provide critical information to assess progress toward achieving state and national health objectives.4 The surveys rarely serve local data needs, however, because of insufficient sample size and lack of flexibility to address local health issues. To address gaps in local health data, in 1997 the Los Angeles County Department of Health Services inaugurated the Los Angeles County Health Survey.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 4, 2013
ABSTRACT Background: As the country moves forward with implementing the health reform, there will... more ABSTRACT Background: As the country moves forward with implementing the health reform, there will be several opportunities for communities to implement programs that will assist in helping the newly eligible enroll into public health insurance. Enrollment events may serve as a venue to both enroll the community in public health insurance and educate them on the changes the health reform will bring. Study Strategy: Over 2,900 surveys were administered to attendees of six community planned public health insurance enrollment events. Surveys were used to identify whether participants had any change in understanding of the health care reform after participating in the event, and determine successful marketing strategies to maximize the attendance at the enrollment events. Results: Over half of attendees at the events had no knowledge about the health care reform prior to attending the event. On average, over 80% of attendees knew more regarding the health reform following the event, and over 80% believed the law would be beneficial to their families. Television and word-of-mouth were the most effective marketing tools, with health care enrollment the greatest factor for event participation. Lessons Learned: Public health enrollment events may serve as an effective opportunity to educate the public on changes to their health care as a result of the health reform. Further research will be conducted to determine how much attendees retain from the events. An effective marketing strategy for continued future success at the enrollment events should focus on using local organizations to start word-of-mouth campaigns and utilizing television advertisements.
A growing percentage of Medicaid patients are receiving medical care within a managed care system... more A growing percentage of Medicaid patients are receiving medical care within a managed care system. This policy change has raised concerns about whether safety-net providers can maintain their share of Medi-Cal (California Medicaid) patients. From 1995 to 1997 several of California's counties implemented mandatory Medi-Cal managed care. The majority of California's safety-net primary care clinics experienced a decline in the percentage of their patients insured by Medi-Cal. However, after the overall decline in the number of Medi-Cal beneficiaries was controlled for, the increased penetration of Medi-Cal managed care in a county was not independently associated with a decline in clinics' share of Medi-Cal patients. Despite this fact, it may become increasingly difficult for clinics to maintain their current level of services with declining Medi-Cal enrollment and other anticipated reforms in their funding.
California has expanded health insurance to children in low- and middle-income families. Currentl... more California has expanded health insurance to children in low- and middle-income families. Currently, Children's Health Initiatives (CHIs) have been developed in 26 counties to supplement Medi-Cal and Healthy Families (SCHIP). Yet, as coverage expands, we know little about the impact of these programs on child health outcomes. Child hospitalizations for ambulatory care sensitive conditions (ACSC) is a widely adopted measure of health outcomes. We compare rates of total ACSC hospitalizations among children ages 0-18 years in 9 operational CHI counties prior to CHI implementation to rates after the CHIs became operational. As a comparison group, we stratify the analyses by family income level and compare children in lower-income to higher-income families. Between 2000 and 2005, there were 281,000 total preventable hospital pediatric admissions. After adjusting for the effects of time and county, the rate of ACSC hospitalizations was 19% lower postimplementation of CHIs versus preimplementation for children of lower-income families (rate ratio of 0.81, P = 0.0001), but not for children of higher-income families (rate ratio of 0.99, P = 0.93).We estimate that 6324 ACSC hospitalizations may have already been prevented in existing CHI counties after implementation, saving about $6.7 million over the 6 years, assuming $7000 per child hospitalization. With health insurance coverage available for all children, and families financially able to connect with an ongoing source of primary care, some of the potential benefits of reduced ACSC hospitalizations may help to offset premium costs associated with assuring that all children have coverage.
State governments have used several types of mandates to assure that local governments fulfill st... more State governments have used several types of mandates to assure that local governments fulfill state-defined responsibilities, including public health care for the poor. This article reports the findings of a study of procedural public-participation mandates and financial sanctions imposed by California to hold counties to their obligations to provide indigent health care. An inventory of the laws' implementation in all California counties found noncompliance by some counties, although all counties complied after a state Health Services Department unit was established to monitor the counties and provide them with state aid. Case studies in eight counties identified factors that influenced the effectiveness of the laws in modifying or reversing county proposals to close county hospitals or reduce other health services. Policy guidelines are suggested for states that want to develop mandates to enforce indigent-care responsibilities of local governments.
The authors describe a family medicine center before and after a merger between the Keck School o... more The authors describe a family medicine center before and after a merger between the Keck School of Medicine of the University of Southern California, the California Hospital Medical Center, and the Eisner Pediatric and Family Medical Center in 2012. The merger provided new opportunities to stabilize the financial base of a clinical practice struggling financially and to enhance the training of residents and other health professionals in primary care, which motivated the partners to consider this new model. After 18 months of negotiations, they were able to convert the family medicine center and residency program into a new federally qualified health center. The benefits to this new model include an increase in both patient volume and the quality of education, supporting residency accreditation; a greater number of residents from U.S. medical schools; enhanced education and preparation of primary care physicians for practice in medically underserved communities; enhanced reimbursements and new opportunities for state, local, and federal grants; and quality improvement and new information technology. The partners overcame academic, administrative, legal, and regulatory obstacles, communication barriers, and differences in culture and expectations to achieve this merger. Keys to their success include the commitment of the leaders at the three institutions to the goals of the merger, a dedicated project manager and consultants, opportunities for new revenue sources and reimbursements, and support from a pioneering charitable foundation. The authors conclude by discussing the implications of using community health centers as the focal point for training primary care clinicians and addressing workforce shortages.
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Papers by Michael Cousineau