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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adolescent Well-Visit.

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Strategy. Expanded Insurance Coverage

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

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Overview. Despite decades of adolescent preventive well-visit and services promotion. (Guidelines for Adolescent Preventive Services and Bright Futures), attendance rates are below recommended levels. Expanded insurance coverage has shown to be effective in increasing use of adolescent preventive services, particularly among low-income groups.[1]

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.
  • 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. Policy Development and Enforcement (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 adolescent health programs that adopt and implement a protocol for referring all participants for health insurance enrollment. (Measures the uptake and spread of the referral protocol across relevant programs)
  • Number of program staff trained on health insurance eligibility, enrollment process, and resources to assist adolescents and families in navigating insurance options. (Measures the capacity building efforts to support effective protocol implementation))

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

PROCESS MEASURES:

  • Percent of adolescent health programs that have a formal, written protocol for health insurance enrollment referrals, with clear roles and process for staff to follow. (Measures the standardization and institutionalization of the referral protocol)
  • Percent of program staff demonstrating competency in explaining health insurance options, eligibility criteria, and enrollment process to adolescents and families. (Measures the effectiveness of staff training and knowledge)

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

PROCESS MEASURES:

  • Number of partnerships and collaborations established between adolescent health programs, insurance providers, enrollment navigators, and community-based organizations to streamline referral and enrollment process. (Measures the level of multi-sector collaboration and care coordination)
  • Number of innovative strategies and best practices identified and disseminated by adolescent health programs for engaging populations facing barriers to access in insurance enrollment (e.g., youth experiencing homelessness, involved youth). (Measures the generation and spread of promising approaches)

OUTCOME MEASURES:

  • Number of adolescents with newly identified and treated physical, behavioral, for developmental health conditions as a result of accessing preventive well-visits and screenings through their insurance coverage. (Measures the impact on early intervention and improved health outcomes)
  • Number of schools, community centers, and youth-serving organizations that partner with adolescent health programs to host insurance enrollment events and promote coverage to their populations. (Measures the reach and community engagement of insurance enrollment efforts)

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

PROCESS MEASURES:

  • Percent of program materials, enrollment forms, and resources that are translated into multiple languages and adapted for various literacy levels to ensure usability for all adolescent and family populations. (Measures the responsiveness of the referral protocol)
  • Percent of adolescents and families engaged in the design, implementation, and evaluation of insurance enrollment referral strategies to ensure relevance, acceptability, and continuous improvement. (Measures the level of youth and family partnership and leadership)

OUTCOME MEASURES:

  • Percent reduction in differences for health insurance coverage and preventive service utilization between adolescent populations reached by the referral protocol and those not reached, particularly for groups with historically low coverage rates. (Measures the impact on advancing health outcomes and closing gaps)
  • Percent of overall adolescent healthcare costs in the community that are shifted from uncompensated emergency and hospital care to reimbursable preventive and primary care as a result of increased insurance enrollment through the referral protocol. (Measures the long-term financial and system-level impact of the insurance enrollment initiative)

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 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.