North Coastal and North Inland Administration

Video Interviewing

Health Services Delivery Reform in Rural Communities: Building Better Health Through Innovative and Evidence-Based Health Technology Practices

Focus:

To increase access to critical health, social, and self-sufficiency programs for rural residents through the innovative use of Video Interviewing.

Goal:

• Assess the need and define measurable outcomes for a Video Interviewing Program in North Inland rural communities
• Develop a Video Interviewing Program (Securing partners, agreements, trainings, equipment, computer system security, etc.)
• Implement the Video Interviewing Process
• Conduct Return on Investment/Cost Benefit Analysis
• Evaluate expansion opportunities in other Regions and across programs

Outcomes:

In July 2010, the San Diego County Board of Supervisors approved “Live Well, San Diego!,” a comprehensive strategy for Building Better Health by improving systems delivery, increasing access to services, and promoting healthy choices through evidence based, data driven strategies.  These strategies include outreach to San Diego County’s approximately 450,000 rural residents who often face unique barriers to accessing services.  For example, rural residents may travel approximately 90 miles roundtrip to be evaluated for County Medical Services (CMS).  This project originated in the rural North Inland Region and utilizes existing technology with limited one-time start up costs and minimal ongoing expenses which are mitigated by the reduction in mileage costs, as well as increased operational efficiencies, and customer benefits. 

Several problems existed pertaining to accessing benefits:

1. County eligibility staff serving rural areas would travel up to 40 miles roundtrip taking up to 90 minutes in travel time, often experiencing lost productivity due to a client “no show” rate averaging 33.3%.   County staff would complete a manual process in the field and duplicate the process to enter information into the computer once back in the office;
2. Clients in rural areas had to travel up to 90 miles roundtrip to be evaluated for CMS where outstation services were not available; 
3. Improvements were needed for customers seeking timely CalFresh (SNAP) benefits in collaboration with a community partner;
4. Certain targeted hard to reach populations, such as customers residing in Battered Women’s Shelters and migrant farm workers, were hesitant to seek benefits in person.

Since program implementation, the County of San Diego has experienced cost savings through mileage reduction and staff productivity gains.  Overall estimated annual savings after initial start up costs are $15,046 in gained efficiencies and 2,378 saved client miles for rural CMS applicants*.  Savings have been calculated by increased productivity due to travel time, eliminated mileage costs for travel to outstation clinics, increased productivity during client no shows, and gained clerical efficiencies through eliminated mail process steps.  This savings calculation continues to increase as expansion of Video Interviewing continues.

Clients benefit as they can apply for services in familiar surroundings, do not have to travel long distances to receive services, and on average are being approved the same day as the interview- up to 82% of the time at some locations.  Taxpayers benefit as government is able to reduce costs to deliver services allowing more work time to serve other customers.

Following initial implementation at one location with one community partner for one public assistance program (Medi-Cal), we have successfully expanded to include four HHSA Regions with eight community partners for three public assistance programs (Medi-Cal, CalFresh, County Medical Services).  As the network of participants expands, the potential for savings and improved access to services in rural communities continues to grow.  This project’s success is a reflection of engaged County/Community collaborations and a commitment to delivering cost effective services.

For more information on how to replicate this program in your operation, please contact Deanna Zotalis-Ferreira at Deanna.Zotalis@sdcounty.ca.gov or by phone at (760) 740-8807.

*As of August 2011