Designing Health Information Technology Tools to Prevent Gaps in Public Health Insurance

Jennifer D Hall, Rose L Harding, Jennifer E DeVoe, Rachel Gold, Heather Angier, Aleksandra Sumic, Christine A Nelson, Sonja Likumahuwa-Ackman, Deborah J Cohen

Abstract


Background: Changes in health insurance policies have increased coverage opportunities, but enrollees are required to annually reapply for benefits which, if not managed appropriately, can lead to insurance gaps. Electronic health records (EHRs) can automate processes for assisting patients with health insurance enrollment and re-enrollment.

Objective: We describe community health centers' (CHC) workflow, documentation, and tracking needs for assisting families with insurance application processes, and the health information technology (IT) tool components that were developed to meet those needs.

Method: We conducted a qualitative study using semi-structured interviews and observation of clinic operations and insurance application assistance processes. Data were analyzed using a grounded theory approach. We diagramed workflows and shared information with a team of developers who built the EHR-based tools.

Results: Four steps to the insurance assistance workflow were common among CHCs: 1) Identifying patients for public health insurance application assistance; 2) Completing and submitting the public health insurance application when clinic staff met with patients to collect requisite information and helped them apply for benefits; 3) Tracking public health insurance approval to monitor for decisions; and 4) assisting with annual health insurance reapplication. We developed EHR-based tools to support clinical staff with each of these steps.

Conclusion: CHCs are uniquely positioned to help patients and families with public health insurance applications. CHCs have invested in staff to assist patients with insurance applications and help prevent coverage gaps. To best assist patients and to foster efficiency, EHR based insurance tools need comprehensive, timely, and accurate health insurance information.


Keywords


Medicaid; Electronic Health Records; Community Health Centers; Insurance

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References


Schoen C, DesRoches C. Uninsured and unstably insured: The importance of continuous insurance coverage. Health Services Research. 2000; 5(1 Pt 2), 187-206.

Hoffman C, Schoen C, Rowland D, Davis K. Gaps in health coverage among working-age Americans and the consequences. J Health Care Poor Underserved. 2001; 12(3):272-89.

Cassedy A, Fairbrother G, Newacheck PW. The impact of insurance instability on children’s access, utilization, and satisfaction with health care. Ambulatory Pediatrics. 2008; 8(5), 321-328.

Cummings JR, Lavarreda SA, Rice T, Brown ER. The effects of varying periods of uninsurance on children’s access to health care. Pediatrics. 2009; 123(3), e411-418.

Abdus S. Part-year coverage and access to care for nonelderly adults. Med Care. 2014;52(8):709-14.

Olson LM, Tang SF, Newacheck PW. Children in the United States with discontinuous health insurance coverage. New England Journal of Medicine. 2005; 353(4), 382-391.

Hadley J. Insurance coverage, medical care use, and short-term health changes following an unintentional injury or the onset of a chronic condition. JAMA. 2007; 297(10):1073–1084.

DeVoe JE. Being uninsured is bad for your health: can medical homes play a role in treating the uninsurance ailment? Annals of Family Medicine. 2013; 11(5):473-6.

Hoffman C, Paradise J. Health insurance and access to health care in the United States. Annals of the New York Academy of Science. 2008; 1136(1), 149–160.

Peterson TH, Peterson T, Armon C, Todd J. Insurance-associated disparities in hospitalization outcomes of Michigan children. Journal of Pediatrics. 2011; 158(2), 313-318.

Oregon Health Insurance Marketplace. Renew your Oregon Health Plan or Healthy Kids. 2015. Available from http://www.oregonhealthcare.gov/renew-your-ohp.html

Bailey SR, Marino M, Hoopes MJ, Heintzman J, Gold R, Angier H, et al. Healthcare utilization after a children’s health insurance program expansion in Oregon. Maternal and Child Health Journal. 2016; 20(5), 946-954.

Lave JR, Keane CR, Lin CJ, Rice EM, Amerbach G, LaVallee CP. Impact of a children’s health insurance program on newly enrolled children. JAMA. 1998; 279(22), 1820–1825.

Heintzman J, Marino M, Hoopes MJ, Bailey SR, Gold R, Crawford C, et al. Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients. Preventive Medicine. 2014;67, 306-310.

Marino M, Bailey SR, Gold R, O’Malley JP, Huguet N, et al. Receipt of preventive services after Oregon’s randomized Medicaid experiment. American Journal of Preventive Medicine. 2016; 50(2), 161-170.

Gold R, DeVoe JE, McIntire PJ, Puro JE, Chauvie SL, Shah AR. Receipt of diabetes preventive care among safety net patients associated with differing levels of insurance coverage. J Am Board Fam Med. 2012; 25(1):42-9

DeVoe JE, Angier H, Burdick T, Gold R. Health information technology – an untapped resource to help keep patients insured. Annals of Family Medicine. 2014; 12(6), 568-572.

DeVoe JE, Angier H, Likumahuwa S, Hall JD, Nelson CA, Dickerson K, et al. Use of qualitative methods and user-centered design to develop customized health information technology tools within federally qualified health centers to keep children insured. Journal of Ambulatory Care Management. 2014; 37(2), 148-154.

Karsh BT. Clinical practice improvement and redesign: How change in workflow can be supported by clinical decision support. 2009; AHRQ Publication No. 09-0054-EF. Rockville, MD.

Devoe JE, Gold R, Spofford M, Chauvie S, Muench J, Turner A, et al. Developing a network of community health centers with a common electronic health record: description of the Safety Net West Practice-based Research Network (SNW-PBRN). Journal of the American Board of Family Medicine. 2011; 24(5), 597-604.

DeVoe JE, Likumahuwa S, Eiff MP, Nelson CA, Carrol JE, Hill CN, et al. Lessons learned and challenges ahead: Report from the OCHIN Safety Net West Practice-based Research Network (PBRN). Journal of the American Board of Family Medicine. 2012; 25(5), 560-564.

Crabtree BF, Miller WL, eds. Doing qualitative research. 2nd ed. Thousand Oaks, CA: Sage Publications. 1999. P.40-70.

Glaser, BG. Conceptualization: On theory and theorizing using grounded theory. International Journal of Qualitative Methods. 2002; 1(2), 23–38.

DeVoe JE, Ray M, Krois L, Carlson MJ. Uncertain health insurance coverage and unmet children’s health care needs. Family Medicine. 2010; 42(2), 121-132.

Kempe A, Beaty BL, Crane LA, Stokstad J, Barrow J, Belman S, et al. Changes in access, utilization, and quality of care after enrollment into a state child health insurance plan. Pediatrics. 2005; 115(2), 364-371.

Trenholm C, Harrington M, Dye C. Enrollment and disenrollment experiences of families covered by CHIP. Academic Pediatrics. 2015; 15(3 Suppl), S44-49.

Kenney GM, Haley JM, Anderson N, Lynch V. Children eligible for Medicaid or CHIP: Who remains uninsured, and why? Academic Pediatrics. 2015; 15(3 Suppl), S36-43.

Sommers BD. Why millions of children eligible for Medicaid and SCHIP are uninsured: Poor retention versus poor take-up. Health Affairs. 2007; 26(5), w560–w567.

Hearst AA, Ramirez JM, Gany FM. Barriers and facilitators to public health insurance enrollment in newly arrived immigrant adolescents and young adults in New York State. Journal of Immigrant and Minority Health. 2010; 12(4), 580-585.

Sommers BD. From Medicaid to uninsured: Drop-out among children in public insurance programs. Health Services Research. 2005; 40(1), 59-78.




DOI: http://dx.doi.org/10.14236/jhi.v24i2.900

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