Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Adequate Insurance.

MCHbest Logo

Strategy. On-Site Medical Practice Care Coordination Services

Approach. Support the development of a care coordination plan by clinics

Return to main MCHbest page >>

Overview. Care coordination that includes counseling support in accessing health insurance is a crucial tool that ensures appropriate healthcare utilization and quality treatment for children.[1]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

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

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

  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

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. Case Management (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-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 clinic staff trained in care coordination procedures and insurance counseling (measures workforce preparation)
  • Number of partnerships established with insurance providers to facilitate enrollment (assesses collaboration efforts)

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

PROCESS MEASURES:

  • Percent of clinic staff who demonstrate competency in insurance counseling after training (measures the effectiveness of workforce preparation)
  • Percent of eligible patients who receive care coordination services that address insurance needs (assesses the reach of service delivery)

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

PROCESS MEASURES:

  • Number of partnerships established between clinics, insurers, and community resources to support implementation of care coordination services (engages key stakeholders in ensuring successful service delivery)
  • Number of patient assistance resources developed to help individuals understand and access insurance benefits (supports effective utilization of insurance coverage)

OUTCOME MEASURES:

  • Number of patients who obtain new insurance coverage or maintain existing coverage as a result of care coordination services (demonstrates direct impact on insurance status)
  • Number of avoidable emergency department visits and hospitalizations prevented through timely access to covered services (captures impact on healthcare utilization)

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

PROCESS MEASURES:

  • Percent of clinic patients who receive care coordination services that address insurance needs (measures the reach and potential for population-level impact)
  • Percent of healthcare providers who report satisfaction with the implementation and effectiveness of care coordination services (evaluates partner perceptions of service quality)

OUTCOME MEASURES:

  • Percent reduction in uninsured or underinsured rates among clinic patients (captures the program's impact on reducing unmet insurance needs)
  • Percent improvement in preventive care utilization among patients who received insurance assistance (reflects the program's contribution to better health outcomes)

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

1Johnson, K. (2010). Managing the “T” in EPSDT Services. The National Academy for State Health Policy.

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.