Implementation of Health Insurance Support Tools in Community Health Centers

Abstract

Background: Health information technology (HIT) provides new opportunities for primary care clinics to support patients with health insurance enrollment and maintenance. We present strategies, early findings, and clinic reflections on the development and implementation of HIT tools designed to streamline and improve health insurance tracking at community health centers. Methods: We are conducting a hybrid implementation-effectiveness trial to assess novel health insurance enrollment and support tools in primary care clinics. Twenty-three clinics in seven health centers from the OCHIN practice-based research network are participating in the implementation component of the trial. Participating health centers were randomized to one of two levels of implementation support – Arm 1 (n=4 health centers, 11 clinic sites) received HIT tools and educational materials; Arm 2 (n=3 health centers, 12 clinic sites) received HIT tools, educational materials, and individualized implementation support with a practice coach. We used mixed-methods (qualitative and quantitative) to assess tool use rates and facilitators and barriers to implementation in the first six months. Results: Clinics report favorable attitudes toward the HIT tools, which replace less efficient and more cumbersome processes, and reflect on the importance of clinic engagement in tool development and refinement. Five of seven health centers are now regularly using the tools and are actively working to increase tool use. Six months after formal implementation, Arm 2 clinics demonstrated higher rates of tool use, compared to Arm 1. Discussion: These results highlight the value of early clinic input in tool development, the potential benefit of practice coaching during HIT tool development and implementation, and a novel method for coupling a hybrid implementation-effectiveness design with principles of improvement science in primary care research.

Effectiveness of an insurance enrollment support tool on insurance rates and cancer prevention in community health centers: a quasi-experimental study

“…Qualitative data collection included ethnographic observation and semi-structured interviews with key stakeholders at CHCs focused on barriers and facilitators to adoption of the enrollment tool were also conducted. Details about the implementation of the tool and differences in tool adoption between the two intervention arms appear elsewhere [ 40 – 42 ]. To summarize the findings of the implementation trial: we found that both arms used the tool though adoption was low (16%), but uptake was higher in Arm 2 (received practice coaching).…”

Implementation and adoption of a health insurance support tool in the electronic health record: a mixed methods analysis within a randomized trial

“…Qualitative data collection continued through July, 2018. The intervention included the enrollment tool, educational materials, 'beta testing,' and facilitation which are described below [12].…”

Implementation and adoption of a health insurance support tool in the electronic health record: A mixed methods analysis within a randomized trial

“…The intervention included the enrollment tool, educational materials, 'beta testing,' and facilitation which are described below. 12 The Enrollment Tool: As described in Table 1, the enrollment tool consisted of an electronic fillable 'form' which appeared alongside typical patient registration processes within the EHR. This form was intended for use by enrollment assisters or other staff who help patients or community members with registration or insurance enrollment.…”