BJ Spitler: geriatric care management pioneer.

The late BJ Curry Spitler pioneered a new geriatric care management business model that combined care management with home health services and emphasized high levels of training and professionalism for all members of the caregiving team. After working with BJ to write a marketing plan emphasizing quality, I learned to appreciate what she did when my mother needed "assisted living at home" services from the firm. Thanks to BJ Curry Spitler and her vision of helping seniors age in place, more elders are able to remain independent in their own homes with dignity and safety, and peace of mind for their families.

Addressing the need for access to culturally and linguistically appropriate HIV/AIDS prevention for Latinos.

This article reports a comprehensive national needs assessment of Latinos' access to HIV/AIDS prevention and education services in 14 cities throughout the United States and Puerto Rico. Interviews and focus groups were conducted with Latinos who were HIV-positive and at risk for HIV infection. The study explored risk behaviors, access to health care services, and exposure to HIV prevention messages. Differences in predictors of risk behaviors were noted by sex. For women, increased age, being married, foreign-born, and a U.S. resident, and having tested for HIV previously, were associated with reduced HIV/AIDS risk. Thematic analysis of qualitative findings revealed limited awareness of risk factors, and a need for culturally and linguistically appropriate, family-centered HIV/AIDS education incorporating Latino values. Findings were incorporated into culturally relevant brochures featuring vignettes and quotes. Brochures were distributed and evaluated by 71 community-based organizations (CBOs) in the U.S. and Latin America. Evaluators responded positively to the brochures, and Latino-serving organizations in 48 states now use them for HIV/AIDS prevention outreach and education.

Long term care: an essential element of health administration education.

Long-term care represents a career opportunity of choice for many healthcare executives and an education essential for the comprehensive management responsibilities of many others. Yet formal educational programs for health administrators include little academic attention to long-term care. This paper reports on an examination of the curricula and courses of undergraduate health administration educational programs certified or recognized by the Association of University Programs in Health Administration (AUPHA) and graduate programs accredited by the Commission on Accreditation for Health Management Education (CAHME). The results show that long-term care plays a minor role in the curriculum for most university programs in health administration, that there are few students enrolled in long-term care concentration or certificate offerings, and that courses in long-term care vary widely in their content and focus. We suggest that university health administration programs include specific training about long-term care services in their established core health management educational requirements so that all students in health management programs receive at least a basic education about long-term care.

Determinants of children's participation in California's Medicaid and SCHIP programs.

OBJECTIVE: To develop a comprehensive predictive model of eligible children's enrollment in California's Medicaid (Medi-Cal [MC]) and State Children's Health Insurance Program (SCHIP; Healthy Families [HF]) programs. DATA SOURCES/STUDY SETTING: 2001 California Health Interview Survey data, data on outstationed eligibility workers (OEWs), and administrative data from state agencies and local health insurance expansion programs for fiscal year 2000-2001. STUDY DESIGN: The study examined the effects of multiple family-level factors and contextual county-level factors on children's enrollment in Medicaid and SCHIP. DATA COLLECTION/EXTRACTION METHODS: Simple logistical regression analyses were conducted with sampling weights. Hierarchical logistic regressions were run to control for clustering. PRINCIPAL FINDINGS: Participation in MC and HF programs is determined by a combination of family-level predisposing, perceived need, and enabling/disabling factors, and county-level enabling/disabling factors. The strongest predictors of MC enrollment were family-level immigration status, ethnicity, and income, and the presence of a county-level "expansion program"; and the county-level ratio of OEWs to eligible children. Important HF enrollment predictors included family-level ethnicity, age, number of hours a parent worked, and urban residence; and county-level population size and outreach and media expenditure. CONCLUSIONS: MC and HF outreach/enrollment efforts should target poorer and immigrant families (especially Latinos), older children, and children living in larger and urban counties. To reach uninsured eligible children, it is important to further simplify the application process and fund selected outreach efforts. Local health insurance expansion programs increase children's enrollment in MC.

Promoting organ donation to Hispanics: the role of the media and medicine.

This study assesses the impact of a paid media advertising campaign employing Spanish language, culturally sensitive television and radio spots airing on major Hispanic stations in southern California. An advertising tracking study with a baseline and three postintervention telephone surveys was conducted from 2001 through 2003 among 500 randomly selected self-identified, primarily Spanish language dominant adult Hispanics. Measures of organ donation attitudes and behaviors (decision and declared intent to donate organs) improved significantly (P < .05) in 2001 and 2002, then leveled off or declined in 2003. Among the reasons given for not making a decision to donate was fear that medical personnel might withhold care from identified organ donors, suggesting lack of knowledge and distrust of the health care system. Few respondents talked to health care professionals or contacted the organ procurement agency for information either before or after the campaign. Findings from this study indicate a need for ongoing public education in the Hispanic community about organ transplantation and donation. Health professionals need to become more engaged in encouraging Hispanic patients to learn about organ transplantation and donation, and to inform their families that they have made the personal decision to donate.

Can we trust population surveys to count Medicaid enrollees and the uninsured?

Health foundations, such as the Robert Wood Johnson Foundation (RWJF), make multimillion-dollar investments in programs to expand insurance coverage. These efforts are driven largely by estimates of the number of uninsured people derived from population surveys, which might overestimate the number of uninsured people if they under-count people enrolled in Medicaid. This paper reports the results of the RWJF-funded California Medicaid Undercount Experiment (CMUE) to estimate the extent of underreporting of Medicaid in the California Health Interview Survey (CHIS) and its effect on estimates of uninsurance. Although some over- and underreporting occurs, overall CHIS Medicaid estimates match administrative counts for adults.

Consumer-directed health plans: enrollee views, early employer experience.

PURPOSE: Consumer-directed health plans (CDHPs) are a new health insurance product that is of growing interest to employers who are struggling to cope with rising health insurance premium costs and to consumers who are desiring more choice and engagement in their health care. This paper presents the results of a study of California consumer awareness of, and attitudes toward, CDHPs in the context of several national surveys and the experiences of some early-adopting employers. DESIGN AND METHODOLOGY: California Health Decisions conducted a telephone survey of 800 insured adult California residents in November 2002. PRINCIPAL FINDINGS: Few respondents had heard of CDHPs. They appealed more to younger, single, less educated, and healthier respondents and those who did not understand them well. The most attractive CDHP features were greater provider choice and health savings accounts' portability and flexibility. Concerns centered on personal financial exposure. CONCLUSION: While CDHPs' commercial market penetration is increasing, their greatest potential future contributions might be to reduce the number of uninsured Americans by offering an affordable health insurance product and to fund additional health services for retirees. As CDHPs further evolve, more consumer involvement in their refinement, implementation, and evaluation is essential.

The Latino Healthcare Professionals Project: responding to the diverse needs of the 21st century.

The Latino Healthcare Professionals Project (LHPP) is a privately-funded initiative to provide healthcare management training to first-generation educated Latino bilingual and bicultural upper division university students planning careers in healthcare. This unique curriculum, scholarship, and mentorship program is based in the Health Care Administration (HCA) Program at California State University Long Beach (CSULB). Initially funded by The Sisters of St. Joseph Healthcare Foundation, LHPP has been sponsored by several organizations, including Kaiser Permanente and the Health Care Foundation for Orange County, with a shared commitment to increase the diversity of trained Latino managers in the healthcare field. Since its inception in 1995,168 students have participated in LHPP, with demonstrated success in improved student performance, retention, participation in the health professional work force, and continuing educational achievements. This article discusses the need for Latino healthcare professionals, current issues facing the Latino population with regard to higher education and family involvement, and barriers affecting Latino students' ability to complete a four-year baccalaureate degree. Information on the projectincludes a description of the LHPP mission and goals, curriculum and core components, as well as the project's structure, process, and outcomes.

Models and momentum for insuring low-income, undocumented immigrant children in California.

Undocumented immigrant children are an underserved, vulnerable population that has not benefited from the recent expansion of publicly funded children's health insurance programs. The California Endowment funded a two-year demonstration project to provide subsidized health insurance coverage to more than 7,500 children through five nonprofit organizations. Sustaining and promoting coverage for this population will require continuing subsidies through a mix of private and public funding. Locally based, comprehensive initiatives are in place or emerging in a growing list of California counties.

Hispanic perceptions of organ donation.

The low rate of organ donation among Hispanics is of increasing concern to the transplant community at a time when the Hispanic population is growing rapidly, especially in Southern California. OneLegacy, the nation's largest organ procurement organization, commissioned a series of in-depth individual interviews with Spanish-language-dominant Hispanics to identify barriers and motivators to organ and tissue donation. Participants included 5 families who had consented to the donation of a loved one's organs within the past year and 7 families from the general Hispanic public who were either opposed to or ambivalent about organ donation. Individuals from both groups indicated a common reticence to speak of or make plans for either their own or a family member's death and lacked knowledge of procedures surrounding donation (whether consenting or being a donor themselves). Some respondents from the opposing group did not understand that organ donation takes place after death, expressing fears that declaring themselves donors would put them at risk of being allowed to die so that their organs could be recovered. Other attitudinal barriers included the wish to die with all body parts intact and reluctance to have another person's organ in their bodies. Consenting respondents found comfort in having helped another person to live. They wished for a personal expression of thanks from the recipients and an opportunity to learn more about and meet them. Interview findings suggest a great need to further educate the Hispanic community about organ donation, especially concerning brain death, the process for organ donation, and the protections afforded to donors and their families in the United States. Overcoming the taboos surrounding discussion of death and planning for death is an essential first step.

Optimizing claims payment for successful risk management.

Disputed claims and delayed payments are among the principal sources of provider and vendor dissatisfaction with managed care payment systems. Timely and accurate claims-payment systems are essential to ensure provider and vendor satisfaction, fiscal stability, and regulatory compliance. A focused analysis of conditions contributing to late payment of claims can disclose problems in provider, vendor, or payer operational and billing procedures, contracting processes, information systems, or human resources management. Resolution of these conditions equips claims-processing staff with tools to resolve problem claims promptly, thereby lowering costs.