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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. Outreach Using Enrollment Assistants

Approach. Use enrollment assistants in community health centers to help patients navigate the public health insurance process.

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Overview. Community health centers serving low-income populations are well-positioned to support patients navigating the complexities of the public health insurance application process and prevent lapses in coverage. Enrollment assistants based in community health centers can help determine insurance eligibility and guide patients through application processes, including completing forms, understanding requirements, and providing appropriate documentation.1

Evidence. Emerging. There is some evidence that enrollment assistants within community health centers are valuable resources and effective at helping patients with public health insurance, but further research is needed to confirm effects. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Professionals (e.g., managers, clinicians, clinical and non-clinical staff, enrollment assistants, etc.), children and families.

Outcome. Keep families insured by assisting with public health insurance application processes. 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. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Use enrollment assistants in community health centers to help patients navigate the public health insurance process,” 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 community health centers that use enrollment assistants.

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

  • Percent of community health centers that use enrollment assistants.

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

  • Number of families that were helped by enrollment assistants.
  • Number of families that were able to maintain health insurance after being helped by enrollment assistants.

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

  • Percent of families that were helped by enrollment assistants.
  • Percent of families that were able to maintain health insurance after being helped by enrollment assistants.

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 Harding RL, Hall JD, DeVoe J, Angier H, Gold R, Nelson C, Likumahuwa-Ackman S, Heintzman J, Sumic A, Cohen DJ. Maintaining public health insurance benefits: How primary care clinics help keep low-income patients insured. Patient Experience Journal. 2017;4(3):61-9.

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.