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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adequate Insurance.

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Strategy. Insurance Enrollment Helpline. (Benefits Counseling)

Approach. Maintain a state-run helpline to assist with insurance enrollment navigation

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Overview. Some Title V programs and family leader organizations provide benefits counseling to help families understand the full range of health insurance benefits and any additional coverage options available in their state. Often families struggle to understand how their health insurance works and the services it covers. Benefits counseling can help families understand: The full range of health insurance benefits. In- and out-of-network providers. Additional insurance options available in their state, such as Medicaid buy-in programs for Medicaid waivers. These options can reduce underinsurance by ensuring that children are able to utilize their benefits to the maximum as well as minimizing out-of-pocket costs.[1] Community‐based case managers who provide health insurance information, support filling out applications, and negotiate with the insurer appear to increase enrollment of children in health insurance programs.[2]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of staff hired and trained to operate the insurance enrollment helpline. (Measures workforce capacity to provide assistance)
  • Number of calls received by the insurance enrollment helpline. (Quantifies volume of service requests from the community)

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

PROCESS MEASURES:

  • Percent of helpline staff who demonstrate proficiency in explaining insurance benefits. (Evaluates workforce competency and training effectiveness)
  • Percent of caller questions that are resolved during the initial helpline contact. (Assesses the effectiveness of information provided)

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

PROCESS MEASURES:

  • Number of community partners promoting the insurance enrollment helpline to their constituents. (Leverages trusted organizations to expand reach)
  • Number of helpline contacts that result in successful resolution of coverage denials for appeals. (Measures impact of promotion of the service)

OUTCOME MEASURES:

  • Number of children who gain access to needed medical services and supplies through new for improved insurance coverage. (Demonstrates impact on health care)
  • Number of children with special health care needs who secure adequate insurance for their conditions. (Assesses impact on a focus population)

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

PROCESS MEASURES:

  • Percent of uninsured children in the state who are contacted by the insurance enrollment helpline. (Evaluates reach to the focus population)
  • Percent of helpline contacts that include appropriate services for different communities. (Measures access to insurance support)

OUTCOME MEASURES:

  • Percent reduction in the uninsured rate among children in the state. (Demonstrates progress toward universal coverage for kids)
  • Percent of callers who successfully enroll in for change their health insurance plan. (Demonstrates concrete outcome of counseling service)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. Benefits Counseling Financing Strategy. https://ciswh.org/project/the-catalyst-center/financing-strategy/benefits-counseling/

2 Jia et al. (2014). Strategies for Expanding Health Insurance Coverage in Vulnerable Populations. Cochrane Database Systemic Review.

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.