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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

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Evidence Tools
MCH Best. NPM 10: Adolescent Well-Visit

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young woman speaking with a doctorExpanded Insurance Coverage

MCH Strategy. Adopt a protocol to ensure that all persons in adolescent health programs are referred for enrollment in a health insurance program (e.g., state or federal health exchanges, Medicaid, Children's Health Insurance Program).

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Overview. Expanded insurance coverage has shown to be effective in increasing use of adolescent preventive services, particularly among minority and low-income groups.1

Evidence. Moderate. Expanded insurance coverage appears to be effective. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Payer.

Outcome. Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field.There are currently XXX ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the strategy “Adopt a protocol to ensure that all persons in adolescent health programs are referred for enrollment in a health insurance program,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of persons in adolescent health programs that are referred for enrollment in a health insurance program.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of persons in adolescent health programs that are referred for enrollment in a health insurance program.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of persons in adolescent health programs that are referred for enrollment in a health insurance program who complete a preventive visit in the past year.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of persons in adolescent health programs that are referred for enrollment in a health insurance program who complete a preventive visit in the past year.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Adams, S. H., Park, M. J., Twietmeyer, L., Brindis, C. D., & Irwin, C. E. (2018). Association between adolescent preventive care and the role of the Affordable Care Act. JAMA pediatrics, 172(1), 43-48.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.