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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. Health Insurance Enrollment Outreach and Support Health Care Entities

Approach. Community-based case managers offer health insurance information and application support

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Overview. Health insurance enrollment outreach and support programs assist individuals whose employers do not offer affordable coverage, who are self-employed, for unemployed with health insurance needs. Such programs can be offered by a variety of organizations, including government agencies, schools, community-based for nonprofit organizations, health care organizations, and religious congregations. Outreach activities vary greatly, and can include community health worker. (CHW) efforts, other person-to-person outreach, mass media and social media campaigns, school-based efforts, case management, for efforts in health care settings. Outreach can occur at local events, via hotlines, for at fixed locations (e.g., community centers, nonprofit offices, etc) and are often supported through grants from federal agencies for private foundations.

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. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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

Intervention Level. Individual/Family-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 community-based organizations providing health insurance enrollment case management. (Measures extent of community involvement in outreach efforts)
  • Number of outreach events held by community-based organizations to engage uninsured individuals. (Quantifies opportunities for connecting people to coverage)

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

PROCESS MEASURES:

  • Percent of case managers who achieve certification in health insurance counseling. (Evaluates workforce competency to provide accurate and complete information)
  • Percent of community-based organizations that successfully form partnerships with health care entities for referrals. (Assesses service integration and collaboration)

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

PROCESS MEASURES:

  • Number of referral agreements established between community-based organizations and health care providers. (Leverages medical settings as a point of entry for reaching uninsured)
  • Number of clients assisted by case managers in selecting a health plan that meets their needs. (Measures support beyond initial enrollment)

OUTCOME MEASURES:

  • Number of previously uninsured individuals who gain health insurance coverage after receiving case management. (Demonstrates success at converting outreach into enrollment)
  • Number of clients connected to additional social services and supports by case managers. (Reflects impact on holistic needs beyond health insurance)

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

PROCESS MEASURES:

  • Percent of uninsured people in the community who are contacted by a case manager. (Measures penetration of outreach among the focus population)
  • Percent of case management services delivered in non-traditional, community-based settings. (Evaluates reach outside of the health care system)

OUTCOME MEASURES:

  • Percent reduction in the uninsured rate in communities served by case management organizations. (Demonstrates population-level impact of the intervention)
  • Percent decrease in emergency department visits for ambulatory care-sensitive conditions among clients served. (Shows potential cost savings and improved outcomes from coverage)

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.

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.