Using “mystery shoppers” looking for access to health care, Public Health – Seattle & King County has found troubling indications that access to primary-care providers may not be as advertised.

About half the time, primary-care providers listed as accepting new patients on Medicaid managed-care organization websites in fact told the “shoppers” they were not accepting new Medicaid patients.

The initial survey was conducted over a 10-day period in early December. A random sample of adult primary-care providers was selected for each of the four regions of King County, and callers used the online provider directories of the five Medicaid Managed Care Organizations that serve King County.

The “shoppers” were staff of a survey consulting firm, but told the doctors’ offices they were uninsured patients in the process of deciding what kind of health insurance to get.

They then asked if the provider was accepting new patients for Medicaid (Apple Health) managed-care plans.

King County added about 80,000 new adult Medicaid clients over the past six months, surpassing the state’s 2018 enrollment target.

Two University of Washington Master in Public Health students working under the supervision of Public Health epidemiologist Eli Kern conducted a follow-up, which is just concluding.

The information, to be presented to the King County Board of Health on Thursday, is one part of an assessment of the success and the impact of the county’s effort to enroll the uninsured in health insurance, both private and public, made available through the Affordable Care Act.

Overall, more than 165,000 county residents were enrolled in health insurance during the campaign, which was fueled in part by knowledge of the county’s noteworthy income disparity.

According to Public Health, King County, among the 15 largest U.S. metropolitan areas, has the widest income disparity between those who do and don’t have health insurance.

“We did our homework before the enrollment season started — and we knew that in some communities in King County more than a quarter of adults were uninsured,” said Dr. David Fleming, director and health officer for Public Health – Seattle & King County, in a statement. “So we made certain community groups active in those areas got involved in helping people sign up.”

Board of Health members will also hear a report by Jasmine Hutchinson, a master’s degree candidate from the University of North Carolina at Chapel Hill, who studied the strategies used by King County, which was picked by the Washington Health Benefit Exchange to lead county enrollment efforts.

Among states that expanded Medicaid and created a state-based exchange, Hutchinson calculated that Washington’s enrollment, as a percentage of those potentially eligible, was bested only by Massachusetts, Rhode Island and Vermont.

Among Hutchinson’s conclusions: King County showed that six practices can have a major impact on such an effort and may provide a model for others.

• Solicit active support from local leaders, and create opportunities for them to lead.

• Invite non-health related organizations to participate.

• Build on existing partnership networks and bring them — particularly the smaller ones — to the table.

• Let grassroots organizations make the detailed decisions.

• Talk about enrollment in terms that resonate with communities.

• Convene a regular forum for those assisting with enrollment to address technical issues and solutions.