Covered California Grant Application
Content
Alisa Rivera Writing Sample [email protected] This narrative was part of a $500,000 grant application submitted electronically on March 3, 2013, on behalf of a Los Angeles-area hospital for the Covered California Outreach and Education Grant Program. Section 4.0-Approach to Statement of Work Glendale Adventist Medical Center’s (GAMC’s) proposed approach to work for the Covered California Outreach and Education Program is an extension of the targeted outreach work GAMC has provided in local foreign-born communities for 25 years. More specifically, for the past nine years, GAMC has provided outreach and education to enroll eligible consumers in subsidized public and private health insurance programs through the Children’s Health Outreach Initiative (CHOI). The educational outreach provided through CHOI also increases awareness of health care and insurance options, influences individuals to change attitudes and adopt healthy behaviors, and motivates consumers to act. GAMC’s population health and education programs are culturally and linguistically competent to serve targeted populations. Because project staff is hired from the communities served, and thanks to GAMC’s years of outreach and programming for foreign-born populations, GAMC is a trusted partner of the communities we serve. The American Hospital Association (AHA) recognized GAMC’s ongoing efforts to meet the health care needs of our diverse community with the NOVA award, which recognizes health care institutions for “effective, collaborative programs focused on improving community health.” GAMC was also named a national finalist for AHA’s Foster G. McGaw Prize, which recognizes hospitals for broad and effective programming to improve the health and well-being of everyone in their communities. Target Population GAMC proposes to reach individual consumers eligible for health insurance coverage through Covered California (consumers who fall between 138% and 400% of the Federal Poverty Level, qualify for subsidized coverage and are eligible to enroll in Qualified Health Plans) throughout its service area, which includes Glendale, Montrose, Highland Park, Glassell Park, and Eagle Rock, with a strong focus on ethnic communities. GAMC’s service area includes Glendale, Montrose, Highland Park, Glassell Park, and Eagle Rock. This outreach is a natural extension of GAMC’s current educational outreach and complements GAMC’s enrollment efforts through CHOI.
The overall population in GAMC’s service area is 307,871 (source: www.healthycity.org). Local demographics include 42.9% White (a third of Glendale is Armenian), 37% Hispanic or Latino, 15.5% Asian, 1.6% Black or African American alone, and 3% bi-racial or American Indian/Alaska Native. The primary languages spoken in GAMC’s service area are Spanish, Armenian, Tagalog, and English. Many local households have limited English proficiency, described as “No one age 14 and over speaks English only or speaks English ‘very well’” (source: U.S. Census/American Community Survey). A sample of limited English households by zip code: 36.2% in Glendale zip code 91204 (43.8% Spanish-speaking and 57% speaking “other Indo-European languages”); 17.9% in Glassell Park/Cypress Park zip code 90065 (28.8% Spanish-speaking); 17.8% in Highland Park, zip code 90042 (26.2% Spanish-speaking); and, 11.3% of households in Eagle Rock zip code 90041 (18.4% Spanish-speaking) . The City of Glendale is home to the largest Armenian population outside of Armenia. In Glendale (zip codes 91201 to 91208), Armenians account for over 30% of the population, based on U.S. Census data and the 2011 Glendale Comprehensive Community Needs Assessment (CNA). Some 87% of households in GAMC’s service area have an annual household income of $99,999 or less. Of these households, 9.6% earn between $75,000 and $99,000, 17.4% earn between $50,000 and $74,999, 15.7% earn between $35,000 and $49,999, 12.6% earn between $25,000 and $34,999, 13.3% earn between $15,000 and $24,999 and 18.6% -- nearly a fifth of our local families -- earn less than $15,000. Some 16.9% of GAMC service area residents are uninsured. In zip code 90042 (Highland Park), 25.81% of the population is uninsured; zip code 90065 (Eagle Rock) counts 25.19% uninsured; zip code 90041 (Glassell Park) counts 22.60% uninsured; and Glendale zip code 91204 counts 16.58% uninsured. In its direct service experience with the targeted foreign-born populations, GAMC has identified a number of barriers that prevent access to health care and affordable coverage. Barriers experienced by hard-to-reach populations include low income, limited English proficiency, immigration status, and limited literacy. These populations sometimes rely on herbal remedies instead of consulting a doctor; and, in a problematic cultural norm following birth, in Armenian and Hispanic cultures, new mothers often do not go outside the home for upwards of three months, even for health care visits. This type of cultural norm is a barrier to preventive well-baby and new mother follow-up care, crucial during the early developmental stages of a newborn’s life. Over many years of
population health outreach and education, GAMC outreach staff has mapped these ethnic community behaviors and is experienced in creating outreach and education strategies to address the identified barriers. Both the Armenian and Hispanic cultures are traditionally patriarchal, with the oldest adult male designated as the final decision maker (Sources: “2009 National Survey of Latinos,” Pew Research Hispanic Center; “Hispanics and Health Care in the United States” Pew Research Hispanic Center, August 13, 2008; “Gender Assessment: USAID/Armenia,” U.S. Agency for International Development, August 2010). However, in both these cultures, women most often determine a family’s need for health care and important decisions often involve the whole family, including extended family. When possible, GAMC has learned that it is ideal to engage the entire family in major decisions regarding health care. Some 70% of Hispanic adults say they base health care decisions on information from their families, friends, churches and community groups (Source: “Hispanics and Health Care in the United States” Pew Research Hispanic Center, August 13, 2008). This suggests that community-based outreach efforts leveraging relationships with trusted groups and individuals in the community are highly likely to influence behavior change. GAMC’s direct experience working with the Armenian community has demonstrated that Armenians rely heavily on local institutions, such as churches, service groups, professional organizations, private schools, and community centers as trusted sources of information. These institutions are enormously influential and represent some of the most effective ways to reach the Armenian community. Local partners include the Western Diocese of the Armenian Church of North America, St. Mary's Armenian Apostolic Church in Glendale, Glendale City Church, Glendale Community College, Armenian Relief Society, Armenian Medical Society, Armenian American Nurses Association, Glendale Religious Leaders Association, Glendale Youth Alliance, and Homenetmen (a youth organization). GAMC staff, volunteers and health practitioners are also integrated into the fabric of the Hispanic community, building trust with health care consumers through partnerships with cultural organizations including Avenue 50 Studio (a Latino arts organization), The Wall–Las Memorias Project (which supports Latino populations impacted by HIV-AIDS), Holy Family Church, Latino Business Association, and Hathaway Family Resource Center. By leveraging these and other partnerships, the outreach team will reach and influence the households in the community that are newly eligible for coverage through Covered California.
GAMC has developed enduring relationships with the leaders of local ethnic communities and local cultural institutions through its local initiatives including the Los Angeles County Children’s Health Outreach Initiative (CHOI); GAMC’s CHOI outreach team educates over 5,000 households and enrolls more than 1,700 children into affordable or free healthcare programs per year. For the last three years, outreach has exceeded goals established by Los Angeles County. Other initiatives developing outreach capacity include grassroots tobacco policy campaign programs funded by Los Angeles County and the California Department of Public Health, the Armenian Hearts N’ Health program and Healthy Families cable TV program, the Parish Nurse program, Glendale Healthy Kids, and the Patient Centered Healthcare Transition project (PCHT). GAMC outreach team members take active leadership roles in the Glendale Healthier Community Coalition and the Northeast Los Angeles Community Coalition. Team members also leverage participation in the Consortium of Safety Net Providers (CSNP) to conduct outreach, enrollment, and retention activities. CSNP members include the Los Angeles County Department of Health Services and community clinics in Glendale and Northeast Los Angeles. GAMC will use these existing relationships to conduct outreach and education for the Covered California program. GAMC has also developed a key relationship with Glendale Community College (GCC). GAMC’s Program Director, Martha Rivera, has taught as an adjunct professor at GCC for the past 15 years and GAMC has partnered with GCC administration to bring outreach and education to students and faculty. This partnership grants GAMC access to GCC’s Community Services network, which refers Glendale residents to education and extracurricular activities for community wellness. In addition to the populations described above, GAMC delivers services to approximately 6,350 unique private pay and charity patients annually (inpatient and outpatient). As a Covered California contractor, GAMC will reach out to all private pay and charity patients treated at GAMC in the past three years. Outreach and Education Plan GAMC’s plan for outreach and education will build on the demonstrated efficacy of our current outreach program. Years of reaching out with culturally competent community health programs, through partnerships with cultural, faith-based, and service organizations, have built trust between GAMC and the community it serves, particularly among foreign-born populations. GAMC’s outreach and education activities to be expanded under the Covered California Outreach and Education Program include:
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Leveraging existing partnerships with community-based organizations and coalitions, including those named above, in order to reach and influence households in the community newly eligible for coverage through Covered California. Outreach through government programs includes neighborhood councils, recreation centers (Highland Park, Eagle Rock, and Ramona Hall Recreation Centers), L.A. City and County library events (which host story hours and literacy events for multi-ethnic, age group, and first language groups), and Community Development Department of Glendale, which oversees Affordable and Section 8 Housing. Glendale and the Housing Authority of the City of Los Angeles operate/manage 28 housing complexes in the SPA 2 and 4 population areas relevant to Covered California outreach and education. Conducting outreach and education at sites in the community where foreign-born residents work, live, shop, and play, including churches, farmacias (stores where traditional Latino medicines are sold), Glendale Community College-sponsored events, local malls (including Glendale’s two famous malls, the Glendale Galleria and the Americana at Brand), and other businesses frequented by the Hispanic and Armenian communities including ethnic food markets and health clinics serving medically indigent and uninsured populations. Conducting outreach and education at health/safety fairs, art festivals, holiday festivals and other community events such as the annual Highland Park Holiday Family Festival and the Lummis Day Festival. Making in-person and phone contact with potentially eligible individuals/families. Distributing Covered California brochures, mailers, fliers, fact sheets, and training materials. Working with the Los Angeles Unified School District and the Glendale Unified School District to create access to parents for outreach and education. Leveraging our relationships with community leaders (e.g., Armenian Apostolic Church and city and county representatives in Glendale and Northeast Los Angeles) in order to secure public endorsements of Covered California.
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Outreach and education activities will be conducted in the language of origin of the target populations, specifically Spanish and Armenian. Outreach and education will target both men and women. Men are targeted as family decision-makers, and women are targeted as the family caregivers who most often determine which family members need health care. GAMC’s history of executing successful programs includes allocating necessary resources, including a stellar team experienced in grassroots outreach and education, as well as complying with contractual agreements. The Covered California project team will include dedicated executive, accounting, compliance, programmatic (5 FTEs), and administrative staff. All employees recruited to GAMC’s Outreach team are bilingual and are experienced in conducting public awareness, outreach and education activities for limited English proficiency/foreign born and uninsured populations. Many current members of the outreach staff grew up as first generation Americans in uninsured households and have a personal understanding of the target populations and the barriers they face in accessing health care. New staff members will also be drawn from the identified communities and will speak the language and be part of the culture of the target populations GAMC proposes to serve. Outreach staff will disseminate clear, accurate, culturally competent and consistent messages to target audiences in order to overcome barriers, increase interest, and motivate consumers to enroll into coverage as required by federal law. Messages will be consistent with Covered California’s guiding principles and will be delivered at or near local partner institutions that have established, trusting relationships with targeted communities. Program messaging will also take into account the culture and language of the targeted audiences. Consumers will also be provided with resource information and tools they can use to enroll on their own. GAMC plans to hold 120 outreach events throughout the contract period, with an approximate 5-8 outreach and education events per month. We anticipate reaching the following number of households per phase as follows: Consumer Outreach and Education: May 1, 2013–June 30, 2013: 6,622 households Get Ready, Get Set: July 1, 2013–September 30, 2013: 9,933 households Enroll: October 1, 2013–March 31, 2014: 19,866 households Reinforcement and Special Enrollment: April 1, 2014–July 31, 2014: 1324 households
Get Ready, Get Set: July 1, 2014–September 30, 2014: 9933 households Enroll: October 1, 2014–December 31, 2014: 9933 households
GAMC’s high-performing outreach team has earned trust and demonstrated credibility in working with target populations. Because of this, GAMC is positioned to execute the Outreach, Education and Marketing Plan Phases of the Covered California Outreach and Education Program. All GAMC outreach team members are state Certified Application Assistants. Because of the outreach’s team’s expertise, GAMC will also apply to become an Assister Enrollment Entity under the Covered California Statewide Assisters Program. This will enable us to coordinate outreach and education activities with enrollment activities, making it more likely that consumers will enroll in insurance through Covered California. Approach to Monitoring, Quality Assurance and Reporting Since 1995, GAMC has successfully fulfilled and renewed contracts with the Los Angeles County Department of Public Health and the state Department of Health Services, Tobacco Control Section, including fulfilling all requirements with regard to monitoring, quality assurance and reporting. This includes the county’s Children’s Health Outreach Initiative (CHOI), which has been renewed annually for the past nine years thanks to the GAMC team consistently meeting, and in recent years exceeding, project goals. The GAMC outreach team meets each Friday to review weekly goals and to assess progress on measurable objectives regarding outreach, enrollment, and follow-up. In addition, the outreach team meets monthly to review troubleshooting, referrals, community meetings, and event participation tracking. The employee responsible for data entry/quality control and manager Martha Rivera review the outreach database for accuracy. The GAMC outreach team also relies on strategic partners, including hospital, administrative, and subject matter experts, and diverse community leaders, to address challenges and overcome obstacles in its program operations. In this way, GAMC ensures that accurate message points and information about Covered California are delivered, that high touch and personalized education and outreach activities are delivered, that Exchange provided tools are used, and that Exchange branding requirements for outreach activities are met.
The overall population in GAMC’s service area is 307,871 (source: www.healthycity.org). Local demographics include 42.9% White (a third of Glendale is Armenian), 37% Hispanic or Latino, 15.5% Asian, 1.6% Black or African American alone, and 3% bi-racial or American Indian/Alaska Native. The primary languages spoken in GAMC’s service area are Spanish, Armenian, Tagalog, and English. Many local households have limited English proficiency, described as “No one age 14 and over speaks English only or speaks English ‘very well’” (source: U.S. Census/American Community Survey). A sample of limited English households by zip code: 36.2% in Glendale zip code 91204 (43.8% Spanish-speaking and 57% speaking “other Indo-European languages”); 17.9% in Glassell Park/Cypress Park zip code 90065 (28.8% Spanish-speaking); 17.8% in Highland Park, zip code 90042 (26.2% Spanish-speaking); and, 11.3% of households in Eagle Rock zip code 90041 (18.4% Spanish-speaking) . The City of Glendale is home to the largest Armenian population outside of Armenia. In Glendale (zip codes 91201 to 91208), Armenians account for over 30% of the population, based on U.S. Census data and the 2011 Glendale Comprehensive Community Needs Assessment (CNA). Some 87% of households in GAMC’s service area have an annual household income of $99,999 or less. Of these households, 9.6% earn between $75,000 and $99,000, 17.4% earn between $50,000 and $74,999, 15.7% earn between $35,000 and $49,999, 12.6% earn between $25,000 and $34,999, 13.3% earn between $15,000 and $24,999 and 18.6% -- nearly a fifth of our local families -- earn less than $15,000. Some 16.9% of GAMC service area residents are uninsured. In zip code 90042 (Highland Park), 25.81% of the population is uninsured; zip code 90065 (Eagle Rock) counts 25.19% uninsured; zip code 90041 (Glassell Park) counts 22.60% uninsured; and Glendale zip code 91204 counts 16.58% uninsured. In its direct service experience with the targeted foreign-born populations, GAMC has identified a number of barriers that prevent access to health care and affordable coverage. Barriers experienced by hard-to-reach populations include low income, limited English proficiency, immigration status, and limited literacy. These populations sometimes rely on herbal remedies instead of consulting a doctor; and, in a problematic cultural norm following birth, in Armenian and Hispanic cultures, new mothers often do not go outside the home for upwards of three months, even for health care visits. This type of cultural norm is a barrier to preventive well-baby and new mother follow-up care, crucial during the early developmental stages of a newborn’s life. Over many years of
population health outreach and education, GAMC outreach staff has mapped these ethnic community behaviors and is experienced in creating outreach and education strategies to address the identified barriers. Both the Armenian and Hispanic cultures are traditionally patriarchal, with the oldest adult male designated as the final decision maker (Sources: “2009 National Survey of Latinos,” Pew Research Hispanic Center; “Hispanics and Health Care in the United States” Pew Research Hispanic Center, August 13, 2008; “Gender Assessment: USAID/Armenia,” U.S. Agency for International Development, August 2010). However, in both these cultures, women most often determine a family’s need for health care and important decisions often involve the whole family, including extended family. When possible, GAMC has learned that it is ideal to engage the entire family in major decisions regarding health care. Some 70% of Hispanic adults say they base health care decisions on information from their families, friends, churches and community groups (Source: “Hispanics and Health Care in the United States” Pew Research Hispanic Center, August 13, 2008). This suggests that community-based outreach efforts leveraging relationships with trusted groups and individuals in the community are highly likely to influence behavior change. GAMC’s direct experience working with the Armenian community has demonstrated that Armenians rely heavily on local institutions, such as churches, service groups, professional organizations, private schools, and community centers as trusted sources of information. These institutions are enormously influential and represent some of the most effective ways to reach the Armenian community. Local partners include the Western Diocese of the Armenian Church of North America, St. Mary's Armenian Apostolic Church in Glendale, Glendale City Church, Glendale Community College, Armenian Relief Society, Armenian Medical Society, Armenian American Nurses Association, Glendale Religious Leaders Association, Glendale Youth Alliance, and Homenetmen (a youth organization). GAMC staff, volunteers and health practitioners are also integrated into the fabric of the Hispanic community, building trust with health care consumers through partnerships with cultural organizations including Avenue 50 Studio (a Latino arts organization), The Wall–Las Memorias Project (which supports Latino populations impacted by HIV-AIDS), Holy Family Church, Latino Business Association, and Hathaway Family Resource Center. By leveraging these and other partnerships, the outreach team will reach and influence the households in the community that are newly eligible for coverage through Covered California.
GAMC has developed enduring relationships with the leaders of local ethnic communities and local cultural institutions through its local initiatives including the Los Angeles County Children’s Health Outreach Initiative (CHOI); GAMC’s CHOI outreach team educates over 5,000 households and enrolls more than 1,700 children into affordable or free healthcare programs per year. For the last three years, outreach has exceeded goals established by Los Angeles County. Other initiatives developing outreach capacity include grassroots tobacco policy campaign programs funded by Los Angeles County and the California Department of Public Health, the Armenian Hearts N’ Health program and Healthy Families cable TV program, the Parish Nurse program, Glendale Healthy Kids, and the Patient Centered Healthcare Transition project (PCHT). GAMC outreach team members take active leadership roles in the Glendale Healthier Community Coalition and the Northeast Los Angeles Community Coalition. Team members also leverage participation in the Consortium of Safety Net Providers (CSNP) to conduct outreach, enrollment, and retention activities. CSNP members include the Los Angeles County Department of Health Services and community clinics in Glendale and Northeast Los Angeles. GAMC will use these existing relationships to conduct outreach and education for the Covered California program. GAMC has also developed a key relationship with Glendale Community College (GCC). GAMC’s Program Director, Martha Rivera, has taught as an adjunct professor at GCC for the past 15 years and GAMC has partnered with GCC administration to bring outreach and education to students and faculty. This partnership grants GAMC access to GCC’s Community Services network, which refers Glendale residents to education and extracurricular activities for community wellness. In addition to the populations described above, GAMC delivers services to approximately 6,350 unique private pay and charity patients annually (inpatient and outpatient). As a Covered California contractor, GAMC will reach out to all private pay and charity patients treated at GAMC in the past three years. Outreach and Education Plan GAMC’s plan for outreach and education will build on the demonstrated efficacy of our current outreach program. Years of reaching out with culturally competent community health programs, through partnerships with cultural, faith-based, and service organizations, have built trust between GAMC and the community it serves, particularly among foreign-born populations. GAMC’s outreach and education activities to be expanded under the Covered California Outreach and Education Program include:
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Leveraging existing partnerships with community-based organizations and coalitions, including those named above, in order to reach and influence households in the community newly eligible for coverage through Covered California. Outreach through government programs includes neighborhood councils, recreation centers (Highland Park, Eagle Rock, and Ramona Hall Recreation Centers), L.A. City and County library events (which host story hours and literacy events for multi-ethnic, age group, and first language groups), and Community Development Department of Glendale, which oversees Affordable and Section 8 Housing. Glendale and the Housing Authority of the City of Los Angeles operate/manage 28 housing complexes in the SPA 2 and 4 population areas relevant to Covered California outreach and education. Conducting outreach and education at sites in the community where foreign-born residents work, live, shop, and play, including churches, farmacias (stores where traditional Latino medicines are sold), Glendale Community College-sponsored events, local malls (including Glendale’s two famous malls, the Glendale Galleria and the Americana at Brand), and other businesses frequented by the Hispanic and Armenian communities including ethnic food markets and health clinics serving medically indigent and uninsured populations. Conducting outreach and education at health/safety fairs, art festivals, holiday festivals and other community events such as the annual Highland Park Holiday Family Festival and the Lummis Day Festival. Making in-person and phone contact with potentially eligible individuals/families. Distributing Covered California brochures, mailers, fliers, fact sheets, and training materials. Working with the Los Angeles Unified School District and the Glendale Unified School District to create access to parents for outreach and education. Leveraging our relationships with community leaders (e.g., Armenian Apostolic Church and city and county representatives in Glendale and Northeast Los Angeles) in order to secure public endorsements of Covered California.
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●
●
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Outreach and education activities will be conducted in the language of origin of the target populations, specifically Spanish and Armenian. Outreach and education will target both men and women. Men are targeted as family decision-makers, and women are targeted as the family caregivers who most often determine which family members need health care. GAMC’s history of executing successful programs includes allocating necessary resources, including a stellar team experienced in grassroots outreach and education, as well as complying with contractual agreements. The Covered California project team will include dedicated executive, accounting, compliance, programmatic (5 FTEs), and administrative staff. All employees recruited to GAMC’s Outreach team are bilingual and are experienced in conducting public awareness, outreach and education activities for limited English proficiency/foreign born and uninsured populations. Many current members of the outreach staff grew up as first generation Americans in uninsured households and have a personal understanding of the target populations and the barriers they face in accessing health care. New staff members will also be drawn from the identified communities and will speak the language and be part of the culture of the target populations GAMC proposes to serve. Outreach staff will disseminate clear, accurate, culturally competent and consistent messages to target audiences in order to overcome barriers, increase interest, and motivate consumers to enroll into coverage as required by federal law. Messages will be consistent with Covered California’s guiding principles and will be delivered at or near local partner institutions that have established, trusting relationships with targeted communities. Program messaging will also take into account the culture and language of the targeted audiences. Consumers will also be provided with resource information and tools they can use to enroll on their own. GAMC plans to hold 120 outreach events throughout the contract period, with an approximate 5-8 outreach and education events per month. We anticipate reaching the following number of households per phase as follows: Consumer Outreach and Education: May 1, 2013–June 30, 2013: 6,622 households Get Ready, Get Set: July 1, 2013–September 30, 2013: 9,933 households Enroll: October 1, 2013–March 31, 2014: 19,866 households Reinforcement and Special Enrollment: April 1, 2014–July 31, 2014: 1324 households
Get Ready, Get Set: July 1, 2014–September 30, 2014: 9933 households Enroll: October 1, 2014–December 31, 2014: 9933 households
GAMC’s high-performing outreach team has earned trust and demonstrated credibility in working with target populations. Because of this, GAMC is positioned to execute the Outreach, Education and Marketing Plan Phases of the Covered California Outreach and Education Program. All GAMC outreach team members are state Certified Application Assistants. Because of the outreach’s team’s expertise, GAMC will also apply to become an Assister Enrollment Entity under the Covered California Statewide Assisters Program. This will enable us to coordinate outreach and education activities with enrollment activities, making it more likely that consumers will enroll in insurance through Covered California. Approach to Monitoring, Quality Assurance and Reporting Since 1995, GAMC has successfully fulfilled and renewed contracts with the Los Angeles County Department of Public Health and the state Department of Health Services, Tobacco Control Section, including fulfilling all requirements with regard to monitoring, quality assurance and reporting. This includes the county’s Children’s Health Outreach Initiative (CHOI), which has been renewed annually for the past nine years thanks to the GAMC team consistently meeting, and in recent years exceeding, project goals. The GAMC outreach team meets each Friday to review weekly goals and to assess progress on measurable objectives regarding outreach, enrollment, and follow-up. In addition, the outreach team meets monthly to review troubleshooting, referrals, community meetings, and event participation tracking. The employee responsible for data entry/quality control and manager Martha Rivera review the outreach database for accuracy. The GAMC outreach team also relies on strategic partners, including hospital, administrative, and subject matter experts, and diverse community leaders, to address challenges and overcome obstacles in its program operations. In this way, GAMC ensures that accurate message points and information about Covered California are delivered, that high touch and personalized education and outreach activities are delivered, that Exchange provided tools are used, and that Exchange branding requirements for outreach activities are met.
