Navigating health care systems and services
Strategy overview
- Improving access and navigation: As health care systems continue to grow in size and complexity, patients require increasingly more knowledge, skill, and support to navigate health care systems. Strategies that help patients navigate health care systems and services include offering patient-centered, coordinated care; helping patients understand and make decisions about health information; hiring staff to help patients navigate their care; and connecting patients to social and legal services.
- Coordinating care: The Patient-Centered Medical Home (PCMH) model provides patients with comprehensive, patient-centered, and coordinated care. In this model, primary care teams provide a wider range of services than in the traditional model, allowing patients to access pharmacists, nutritionists, and other professionals through their primary care team. When patients need specialized care, the primary care team takes responsibility for coordinating services with their counterparts across the health care system.
- Hiring dedicated staff: Health care systems can hire patient navigators to guide patients through medical, insurance, and social support systems. Typically, navigators work with patients undergoing time-sensitive and complicated treatments, like cancer care. However, they can also be integrated into general primary care teams. For patients with limited English proficiency, health care systems and public health agencies can hire or contract for professional medical interpretation services. Professional medical interpreters typically have forty or more hours of classroom and on-the-job training in health care interpretation and can provide interpretation services in-person or remotely.
- Increasing patients’ health literacy: Health literacy interventions aim to build patients’ capacity to find, process, and understand basic health information and services. Examples of such interventions include creating simple health education materials, improving patient-provider communication, and developing videos and online self-help tools.
- Providing access to legal services: Medical-legal partnerships (MLPs) integrate legal services into health care settings. MLPs typically operate on-site and can be run in partnership with legal aid organizations, law schools, private firms, or other legal services providers. These programs can help patients address legal issues in areas like housing, social services, and food and utility assistance.
Multiple common practices for assisting residents with navigating health care systems and services demonstrated significant, positive effects on health outcomes, access, and quality when rigorously evaluated.
A 2018 research synthesis found that medical homes are associated with significant improvements in health care quality and access, increased use of preventative services, and reductions in hospitalizations.
A 2017 research synthesis found that professionally trained medical interpreters are associated with improved patient satisfaction and patient-provider communication.
A 2016 research synthesis found that patient navigators are associated with an increase in cancer screenings.
A 2019 research synthesis found that health literacy interventions can improve health-related knowledge and patients’ adherence to treatment; further research is needed to confirm effects.
- A 2019 research synthesis found that medical-legal partnerships can improve access to legal services, improve health outcomes, and reduce stress; further research is needed to confirm effects.
Before making investments in this strategy, city and county leaders should ensure this strategy addresses local needs.
The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.
The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.
One indicator in the Upward Mobility Framework may be improved with investments in navigating health care systems and services. To measure this indicator and determine if investments in these interventions could help, examine the following:
Access to healthcare: Ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.
Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.
Several indicators in the E-W Framework may be improved with investments in this strategy. To measure these indicators and determine if investments in this strategy could help, examine the following:
Physical development and well-being: Percentage of students meeting benchmarks on self-rated surveys of physical health, such as the California Healthy Kids Survey Physical Health & Nutrition module.
Access to health, mental health, and social supports: Percentage of programs offering health, mental health, and social services, or staff or consultants providing infant and early childhood mental health consultation (IECMHC) services.
Mental and emotional well-being: Percentage of youth with mental or emotional health needs as identified by a universal screening tool.
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Health insurance coverage: Percentage of individuals with health insurance or percentage of eligible individuals (children or adults) enrolled in Medicaid or CHIP.
- Invest in training: Provide staff with dedicated time to receive training on new models or services. Training builds staff buy-in, reduces errors in program implementation, and prepares staff to integrate the new model or service into regular operations.
- Identify varying needs: Provide programs targeted to meet the needs of specific groups, like older adults, teenage parents, and non-English speaking patients. Targeted programs promote patient engagement and advance equity for disadvantaged groups.
- Develop partnerships: Developing partnerships across the health care systems allows staff to provide patients with comprehensive services. Examples of useful partnerships include leveraging the wide reach of primary care providers to disseminate health literacy interventions or incorporating social workers into medical-legal partnership programs to meet patients’ non-legal needs.
- Integrate services into standard operations: Making patient navigation, medical interpretation, and legal services easily accessible promotes ease-of-use for both health care providers and patients. With providers often citing time constraints as a barrier to providing additional services, integrating new programs into existing operations is vital for them to be used with fidelity.
Evidence-based examples
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Outcome Area |
This ranking reflects how these approaches are scored in one of the major government- or philanthropy-led clearinghouse resources. For more: https://catalog.results4americ... |
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Provides health outreach, education, referral and follow-up, case management, advocacy, and home visiting services
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Supportive neighborhoods Stable and healthy families |
Evidence varies across specific models |
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Tailored health care to patients’ norms, beliefs, values, language, and literacy skills
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Stable and healthy families |
Evidence varies across specific models |
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Assists uninsured individuals with health insurance needs
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Stable and healthy families Supportive neighborhoods |
Evidence varies across specific models |
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Interventions that enable individuals to obtain, process, and understand basic health information and services
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Stable and healthy families Supportive neighborhoods |
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Primary care providers and their teams coordinate care across the health care system, working with patients to address all of their health care needs
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Stable and healthy families Supportive neighborhoods |
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Integration of legal services into health care settings
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Stable and healthy families Supportive neighborhoods |
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Provide culturally sensitive assistance and care coordination in order to guide patients through available medical, insurance, and social support systems
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Stable and healthy families Kindergarten readiness |
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Professionally trained staff provide interpretation services for patients with limited English proficiency
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Stable and healthy families Supportive neighborhoods |
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Provides patients with text reminders, education, or self-management assistance
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Stable and healthy families |
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