Health Insurance and Consumer Navigation

Background and Importance

Access to care refers to the ease with which an individual can obtain needed services - the right care, for the right person, at the right time.  Access is influenced by a variety of factors including affordability of services and insurance coverage for services, provider capacity in relationship to population need and demand for services, and related concepts of availability, proximity and appropriateness of services.

While having health insurance is a crucial step toward accessing needed health care services and emergency treatment, health insurance by itself does not ensure access. It is also necessary to have comprehensive coverage, providers that accept the individual’s health insurance, and relatively close proximity of providers to patients in the community.

The complexity of the health care delivery system can also contribute to limitations in accessing the right care at the right time. When navigating the health care system is too confusing or burdensome, patients and their caregivers may respond by delaying or failing to get needed care or by seeking care in more easily accessible, but less appropriate settings such as emergency departments. In response, health care systems are increasingly recognizing the important roles of care coordinators, patient navigators and primary care medical homes.

Geographic Area

Percent of Individuals with Health Insurance Coverage[1]

Percent of adults who report having a personal doctor or health care provider [2]

Winnipesaukee Region

88.0%

86.1%

New Hampshire

89.5%

87.5%




[1] Data Source: US Census Bureau, American Community Survey. 2009-13

[2] Data Source: NHDHHS, Behavioral Risk Factor Surveillance System 2011-2012.


Regional Initiatives and Opportunities


The Access to Health Care Work Group, with leadership from LRGHealthcare and extensive collaboration of many local organizations, is working to improve access to health care services, health insurance and consumer navigation of the health care system. Key initiatives that are ongoing in this priority area include:

  • LRGHealthcare is continuing to subsidize primary and specialty care practices in geographically diverse service areas including subsidies to Health First to help assure that primary care needs of the community are met;
  • LRGHealthcare is offering expanded service hours to include weekends and evenings and continues to recruit additional primary care and specialty providers;
  • LRGHealthcare is supporting coordination of care by community based nurse care managers;
  • Genesis Behavioral Health is working to create an integrated behavioral health and primary care model care by embedding primary care providers in several practice locations;
  • Enrollment assistance and care coordination is available through Health First Family Care Center and LRGHealthcare;
  • Health First provides primary care using  a patient centered  medical home  model  for  all regardless  of insurance  status or ability to pay
  • ServiceLink Resource Center provides up-to-date information and assistance helping individuals and families make informed choices about health care and other services;
  • “My Health, My Care” educational resources have been developed for distribution through community organizations to help individuals and families to understand and navigate the health care delivery system.
  • Provision of clinical training sites for Physicians, Nurse Practitioners and Physician Assistants at LRGHealthcare, Genesis Behavioral Health and Health First Family Care Center and Social Workers at Horizons Counseling Center.

Goals, Objectives and Strategic Approach


Goal 1

Reduce financial barriers to health care access by increasing health insurance coverage

Objective 1

Increase the proportion of Winnipesaukee region residents who have health insurance to 92% by 2020 (baseline = 88%).

Goal 2

Increase the proportion of Winnipesaukee region residents who have appropriate, coordinated access to the health care system

Objective 1

Increase the proportion of Winnipesaukee region adults who have a personal health care provider to 90% by 2020 (baseline = 86%).

Objective 2

 

Recruit 30 local community organizations to distribute “My Health, My Care” educational resources to their clients



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