Improving access to health care

Before making investments in this strategy, city and county leaders should ensure it 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 increasing access to health care. 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:

• Access to health, mental health and social supports: Ratio of number workers or students to number of health, mental health, and social services FTE staff (for example, school nurses, psychologists, and social workers).

• Mental and emotional well-being: Percentage of youth with mental or emotional health needs as identified by a universal screening tool.

• 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.

• Childhood experiences: Percentage of individuals with fewer than three adverse childhood experiences (ACEs).

• Health insurance coverage: Percentage of individuals with health insurance or percentage of eligible individuals (children or adults) enrolled in Medicaid or CHIP.

• Prioritizing community engagement: Building trust between communities and health care providers increases the likelihood that individuals will seek care. Engaging with residents and local organizations in the design and operation of programs can build familiarity and trust, ultimately leading to more effective services.

• Building partnerships outside the medical system: Strong partnerships across the healthcare system ensure that patients have access to comprehensive wraparound services. It is important to leverage the wide reach of primary care providers to disseminate health information; incorporate social workers (and/or case managers and patient navigators) into programs to meet patients’ non-medical needs, and create outreach programs to groups historically hesitant to engage with the healthcare system.

• Emphasize and incentivize preventive care: Preventive care practices such as check-ups, vaccinations, and screenings can help providers and patients identify health problems early and advise patients about lifestyle changes to improve health. Financial incentives can increase the uptake of preventive care, ultimately improving overall health and reducing costs associated with managing more serious illnesses in the future.

• Treating the whole person: Patient-centered care models and navigation systems should take a comprehensive approach, addressing an individual’s physical, mental, and social needs along with their medical issues. It is crucial to consider multiple aspects of a patient’s life that can influence care and outcomes, including cultural background and experiences, differing perspectives on certain types of medical treatment, as well as the patient’s family situation.

• Address fears and stigma: Many individuals, especially people of color, suffer disproportionately from a lack of access to health care and experience worse health outcomes in areas such as maternal and infant mortality, diabetes, and behavioral health. Healthcare systems and service providers must address a range of health fears, stigmas, societal pressures, and adverse childhood experiences and other traumas that may prevent patients from seeking care. Strategies to address this include using targeted messaging and community campaigns to inform residents about commonly-experienced medical issues and their health care options, and employing trauma-informed and culturally competent practices.

• Ensure health literacy: Health literacy enables patients to understand their care and treatment, communicate with providers, and encourages participation in community health initiatives. All health information materials, including print, video, and digital, should be culturally sensitive and appropriate, in multiple languages that reflect the community served, and easily understandable for different levels of literacy.

• Offer legal services: Medical-legal partnerships (MLPs) integrate legal services into health care settings, recognizing multiple factors that impact health and well-being, especially for underserved populations. MLPs assist patients with debt and bankruptcy issues, insurance claims, data protection, and more. They typically operate on-site within hospitals and clinics, often in collaboration with legal aid organizations, law schools, private law firms, and/or other legal service providers, and as part of mobile services. These programs can also help patients address legal issues concerning housing, public benefits, social services, and food assistance.

• Patients: Increasing access to health care and improving patient outcomes depends on in-depth knowledge of patient needs and circumstances, including insurance coverage and access preferences (such as in-person or virtual care). Using patient surveys, questionnaires, and feedback to adjust and upgrade accessibility and navigation systems helps meet patient needs and identify cultural practices that medical providers need to be aware of.

• Caregivers: Family members and other caregivers play a crucial role in a patient’s health outcomes and well-being, and should be integrated into patient navigation systems and other aspects of patient care. It is important to embrace the entire family to ensure that they are not only informed, educated, and aware of health issues but also able to communicate with patient navigators about health care decisions, family risks, and related costs.

• Medical professionals: Physicians, nurses, and other practitioners who provide services are the linchpin of health systems, managing patient care, diagnosing and treating illnesses, and advising on disease prevention. Medical professionals also contribute to the development of healthcare policies, procedures, and programs to increase access to services.

• Patient- and community-facing healthcare workers: Patient navigators, social workers, and community health workers provide support to patients and help them access resources, connect to a range of providers, and promote healthy lifestyles. They also advocate for their patients and communities, thereby promoting health equity. Given their proximity to patients, programs should create ongoing feedback loops with these workers to ensure that services are continuously improving.

• University healthcare systems: Large, university-affiliated healthcare systems have become integral to their communities, providing clinical care and serving as safety net hospitals for vulnerable populations or individuals with limited access to care. They also collaborate with community health centers and organizations, including FQHCs, to expand access to care and specialized services.

• Health system leaders: To implement or advance patient navigation systems, it is essential to secure buy-in from healthcare leaders, such as hospital or healthcare system CEOs and chief medical officers, state Medicaid directors, and directors of county and state health boards and agencies. These leaders are critical champions of such programs and can help secure funding, encourage broader adoption, and inform the community.

• Community organizations: Organizations with close ties to community members are in a unique position to build trust with residents to encourage participation in healthcare systems, especially for preventive care. They are often well-positioned to help patients access and understand treatment by providing transportation and translation services, and can advise on the social determinants of health, the non-medical factors that influence health outcomes in a community.

• Lawyers and legal aid organizations: Laws regarding health care, insurance, benefits, and patients’ rights are often in flux, requiring continuous consultation with lawyers, legal aid organizations, patients, and patients’ rights advocacy groups. Partnerships with legal aid clinics and medical debt relief organizations can ensure that services and information are available to patients.

• Prioritize hiring that represents communities being served: Programs intended to help patients navigate health systems are most effective when patient-facing staff reflect the diversity of the community they serve, receive comprehensive training in health education and communications skills, are compensated appropriately according to their skills and duties, and are closely supervised and supported through mentorship and professional development. In addition, it is important to integrate these workers into existing healthcare teams and workflows and establish community partnerships to expand outreach and awareness of available services.

• Emphasize outreach and communications: Effective messaging for community health programs raises resident awareness of healthcare services and health issues, increasing the likelihood of participation. Multi-channel communications, including phone calls, text messages, emails, social media, printed materials, public service announcements and campaigns, and local media, should be tailored to a community’s specific cultural and language needs. Door-to-door outreach and community health fairs, offering screenings and evaluations, are also important.

• Formulate standardized questions: Because interactions between patients, doctors, and nurses are often time-limited, receiving information and insights from patients in an easily accessible format is critical to assessing individual needs and suggesting further resources. Administrators responsible for patient care, outcomes, and referral services should create standardized templates of questions for primary care providers (PCPs), possibly as part of an AI-assisted system, to direct patients to services both within the healthcare system and outside it, such as housing, education, and more.

• Seek sustained funding for patient navigation systems: Health access and navigation programs require long-term, sustained funding mechanisms to have the greatest impact. To accomplish this, it is essential to secure multiyear grants and develop public and private funding partnerships that encourage cooperation and resource sharing between institutions (i.e. hospital systems, federally qualified health centers, and local government agencies).

• Expand training: Allocating time and funds to support existing and prospective healthcare staff to train on new models, services, and technologies helps them stay up to date with healthcare advancements and allows them to better assist patients with diverse needs. In addition, it is common to offer cross-training to navigators from different backgrounds to give them greater expertise and skills in a wider range of specific areas.

• Health outcomes: Data on changes in patient health status can provide insights into the effectiveness and impact of services and interventions. These could include measures like mortality rates, patient recovery, disease and health trends, and recovery rates.

• Hospitalization rates: Measuring admission and readmission rates to hospitals, clinics, and emergency rooms is used to assess the quality of care and efficiency of healthcare systems. Admission rates indicate the demand for services, while readmission rates suggest the effectiveness of treatment and post-hospital care, allowing administrators to adapt programming, staffing, and care protocols.

• Patient satisfaction: Assessing the overall level of patient satisfaction with services provided is critical to a well-functioning healthcare system. Satisfaction with health care services, personnel, ease of access to the system, and navigation of tech tools and communication channels also contribute to a better understanding of patient preferences, providing targeted services, and reducing barriers to care.

• Social needs: Meeting patients’ social needs is part of a more holistic approach to comprehensive health care. To determine whether needs are being met requires data on the content of social need screenings, how many screenings are being conducted, the rates of completion, and the time needed to address these patient needs through referrals to other agencies and/or service providers.

• Professional well-being: Because healthcare professionals face high levels of stress and burnout, data on job satisfaction and occupational wellness are critical to maintaining efficient operations and delivery of patient services. It can also help administrators attract and retain staff and create wellness and training programs focused on reducing stress and preventing burnout.

• Cultural sensitivity impact: Cultural sensitivity programs can help ease patient anxieties about seeking medical treatment and make them feel more comfortable in a health care setting. To ensure that these programs are working, it is important to determine whether patient concerns are being correctly targeted, that the needs of all patient groups are being addressed, and staff are fully trained and continually updated on program changes.