Final Blue Shield Proposal
• Purpose of Funds

Funds from the implementation grant will be distributed to two organizations,
Working Partnerships USA and the Santa Clara Family Health Plan,to jointly
develop a pilot health plan for low-income employees ofsmall businesses by
providing staffsupport to complete the design ofthe program,initial marketing
and community outreach to small employers, and start-up costs associated with
initiation of plan operation.
• Project Description r2.ooo characters):

o Provide a full narrative description of the proposed project,
including the following information:(i)the need for this project as
identified through relevant facts from the community, referencing
statistics, research or evidence based models,(2)specific activities
that will address each key objective and,(3)the individuals
responsible for those activities

The three-share health coverage project seeks to address two major problems
affecting the health care system in Santa Clara County:the growing number of
uninsured adults, and the growing strain on the capacity ofthe public health care
safety net to provide care for the uninsured. Between 2000 and 2004, health
coverage among adults in California with incomes below 300% of FPL dropped
from 38% to 35%,and the proportion ofthis population who were uninsured
exceeded 38%.At the same time, public hospitals experienced a significant
reduction in state revenues. Between 2002 and 2006,state funding for Santa
Clara County services fell by more than 16%, with a disproportionate impact on
health care.

To address the problems of the increased number of uninsured adults and
resulting strain on the public health and hospital system, we have designed a
three-share health coverage product which will offer health care at an affordable
cost to uninsured low-income working adults in small businesses. This plan
meets our critical objective; providing an affordable health coverage option for
small businesses will have the effect of decreasing the number of uninsured
adults in the county. The public safety net would serve as the provider network,
allowing the county to receive revenue in the form of monthly premium
contributions from individuals who are currently uncompensated care patients.
Three organizations will be responsible for the implementation of this project:
the Santa Clara Valley Health and Hospital System(SCVHHS), which will provide
services to the enrolled population and administer the program; the Santa Clara
Family Health Plan(SCFHP), which will oversee marketing and enrollment; and
Working Partnerships USA(WPUSA), which will oversee community outreach.
All three organizations will be responsible for completing program design and
initiating enrollment. Grant funding for implementation will be directed to
WPUSA and SCFHP.

• Objective #i(2,000 characters)

o Please state the first key objective for the proposed project. We
define objectives as specific, measurable,time bound,operational
statements of the desired accomplishments of the program that are
necessary to achieve its goal.

Objective #1: To implement a small business health coverage program for lowwage workers with initial enrollment goal of 5,000 and long-term potential of
20,000 members.

Based on extensive research over the last eight months, WPUSA,the SCFHP and
the SCVHHS have developed a voluntary three-share health coverage model
targeted at the low-income working adult population employed in small
businesses. To be eligible for this program:
• An employer must have 50 or fewer workers.
• A worker must be between ages 19-64, work and live in Santa Clara
County, have an income below 300% FPL, and be currently uninsured.
Financing for the plan will require premium contributions from workers,
employers and the county health and hospital system. The county’s contributicr.
will be in the form of a discounted health plan.
Pending approval from the County Board of Supervisors in fall 2006, we will
launch a pilot project in early 2007 with a target enrollment of 5,000. In
preparation for initial enrollment, the following tasks must be completed:

• Completion ofprogram design details: determining eligibility criteria,
benefits and premium contributions.
• Establishing policies and procedurefor: enrollment and eligibility,
premium collection, communication/interface between health plan and
network.

• Execution ofpreliminary community outreach/marketing plan:
coordinating with local media to publicize program implementation,
working with community and employer groups to generate significant
interest and initial enrollments, and producing informational materials for
employees/enrollees, employers, and the community.
• Development of marketing planfor thefirst year: creating a long-term
marketing plan to reach the enrollment target of 5,000 adults in Santa
Clara County.
Although 41,000 uninsured adults would be eligible for this program, a realistic
expectation is that only 50% of employers will enroll. Therefore, at full
implementation, this program would likely serve 20,000 adults.

•

Project outcomes(2.000 characters):

o Briefly state the desired project outcomes. We define an outcome as
a benefit or change resulting from actions taken. Outcomes can

impact individuals,families, communities or larger populations
both during and after program participation.

During this initial start up phase, our primary outcome will be to provide lowincome small business employees with access to affordable health coverage
through the development and launch of the three share program. To build a plan
that is up, running, and enrolling participants by June 2007, our activities will
include;

• Preparing materials: Create enrollment forms and eligibility criteria.
• Establishing benefit structure: Determine benefit package and descriptive
materials for all adults enrolled.

• Executing initial community outreach plan: Develop employer and
community outreach events and enrollment kickoff event. Kckoff will

include recognizing the Blue Shield of CA Foundation for its role in
funding the development of this program.
• Performing employer research: Coordinate ongoing employer stakeholder
meetings and conduct research to ensure high small business take-up.
Investigate working with brokers to market and sell the product.
• Constructing administrative structure: Develop systems, policies, and
procedures, and identify and train staff.
• Launching program: Complete program details and initiate enrollment.

Our second,longer-term outcome is to build a sustainable program that will
improve the fiscal health of the public safety net and decrease the number of

uninsured. Monthly premiums and co-pays must produce sufficient funding to
cover the county’s cost of service delivery, while remaining affordable to workers
and employers. We will also explore opportunities to secure resources from the
City of San Jose, the state, or other sources. Once sustainability has been
achieved, we will expand enrollment, with the ultimate outcome of providing
health coverage to 20,000 uninsured residents.
Lastly, this program aims to demonstrate that a voluntary small business plan
can attract large-scale participation by employers and workers in Santa Clara
County. Successful implementation would provide a model that other California
counties can replicate.
•

Progress measured (2,000 characters'):

o Briefly describe how you will measure progress toward the stated
outcomes.

The initial success of the three share program will be measured by our ability to
launch the health plan, secure small business participants, and begin enrolling
uninsured workers by June 2007. Prior to launching, we will need to complete

the program design, develop an administrative structure, and create an outreach
plan to enroll eligible businesses and their workers.

Development of a sustainable program will be measured,first, by our progress
towards our goal of 5,000 enrollees, which will indicate that both workers and

employers find the plan affordable and valuable. Second, the fiscal impact on the
SCVHHS should be positive and significant by the time this enrollment milestone
is reached.

Finally, our progress towards creating a replicable model will be measured in a
longer time frame. Once the 5,000-enrollee goal is reached, we plan to expand
the program’s scale with the eventual target of 20,000 enrollees. At this time we
hope to begin disseminating information and providing technical assistance to
other regions that are interested in the three share model.
•

Dissemination of Outcomes(2.000 characters):

o

Briefly describe how project outcomes/impact will be shared with
others.

Implementation of the three share health coverage program will be widely shared
with local elected officials, the media and the broader community. In preparation
for initial enrollment, all final program details regarding financing, benefits and
administration must be approved by the County Board of Supervisors, at which
point all data presented will be available to the public. In addition, WPUSA and
the SCFHP will produce an initial community outreach and marketing plan that
will include meeting with the San Jose Mercury News Editorial Board and
developing employer and community outreach events to inform the general
public about the program.

Once the program is launched, WPUSA,the SCVHHS and the SCFHP will
monitor enrollment and produce a financial analysis to be presented to both the
Board of Supervisors and to a program oversight committee. WPUSA will also
collect additional information from employers and uninsured workers to produce
a policy brief to assist other regions interested in a three share model. The brief
will be published within the end of the first year of enrollment and distributed to
stakeholders, other counties, officials, and funders.

• Project Key Objectives/ Grantmaking Priorities(2,000 characters)
o Please describe how the key objectives for this project address our
primary grantmaking priorities

The three share health coverage model seeks to execute tw^o grant making
priorities: creating a path toward universal health coverage and strengthening the
public health safety net. This model creates an affordable and sustainable health
coverage product targeted at a segment of the population with one of the highest
uninsurance rates: low-income working adults. By building on the existing

employer-based system, it offers an affordable comprehensive program that
workers and small businesses can join. If full enrollment is achieved this plan
could enroll 20,000 uninsured low-income workers in Santa Clara County.
The three share health coverage program has also been developed with the goal of
strengthening the public safety net. The county health and hospital system will
serve as the provider network and will receive all premiums from workers and
small businesses. In addition, the plan aims to reduce the number of uninsured
patients currently enrolled in the county’s ability to pay program. The ability to
pay program is a discount fee-for-service program for low-income residents,from
which the county receives little if any financial return for delivering services.
Reducing the number of adults in the ability to pay program will improve the
fiscal health of the public safety net.
Once the program is implemented, our goal is to ensure sustainability and offer
our model to other regions interested in expanding coverage to adults. The
coverage plan aims to generate a product that can maintain affordable premiums
for all parties involved and gradually be expanded to cover all eligible workers.
Once there is substantial enrollment in the program, it can serve as an example
for other regions on how a local collaboration between small businesses, the
public safety net and community groups can work together to provide coverage to
uninsured working adults as the next step towards universal health care.
• Funding request: f2.ooo characters)
o Please provide a narrative description of the project budget
including an explanation of those line-items for which you are
requesting support from the Blue Shield of California Foundation.

Funding for the pilot project will be distributed between Working Partnerships
USA and the Santa Clara Family Health Plan, and will be directed into three core
areas: completing program design, execution of a preliminary marketing plan,
and additional start-up costs related to initial enrollment.
Funding for plan design will include staff support to generate the structure of the
pilot program, including determining benefits, eligibility requirements and
enrollment materials, premiums for workers and employers, and staff support to
obtain necessary licenses.

Roughly two-thirds of the requested funding for this project will be dedicated
toward initial community outreach and marketing, which will be critical to
launching the program. Outreach activities v^dll include; production of sales and
marketing materials, public relations and enrollment activities, outreach to small
businesses and employer associations, and development of community relations
and education materials. The Santa Clara Family Health Plan and Working

Partnerships USA will together develop the community outreach and marketing
materials and will also generate the marketing components of the full
implementation plan to cover enrollment during the second half of 2007.

In addition to program design and marketing, funding will also be used for
startup costs related to administration. The Santa Clara Valley Health Hospital
System will be the designated administrator of the program and the Santa Clara
Family Health Plan oversee enrollment and eligibility. Resources will be directed
towards creating the enrollment and eligibility claims systems, developing
employer/employee agreements and performing legal analysis.
In the first quarter of 2007, both organizations will work with the Santa Clara
Valley Health and Hospital System, which will provide health sendees for plan
participants, to prepare for the initiation of plan operation in June 2007.