Where Massachusetts Succeeds: Community-Based Workers Are Key To Health Care Reform" by Meg Kroeplin and Johanna Bates

We’ve heard often about the broad coalition of insurers, state legislators and providers that conceived Chapter 58. This coalition built on a history of success; Massachusetts has always been a leader among states in insurance rates, and now we are nearing 98 percent.

What we hear less often is about who got us here. Massachusetts has relied on the work of community-based outreach and enrollment workers for over 12 years. Outreach workers were fundamental in achieving the initial low un-insurance rate that made Massachusetts able to consider moving towards universal coverage. Now, the majority of the newly insured are covered by publicly funded programs; the way most people get into those programs is with the help of an outreach worker.

Outreach workers find, educate and enroll eligible people in local health centers, hospitals, schools, and organizations. Poor and middle-income families rarely have the time or the experience to effectively navigate the extremely complex coverage systems. Many have been told for years that they weren’t eligible for publicly funded health care.

Many have never before had an insurance card.

Outreach workers help people maintain their coverage, and use it to get care.
Seasonal work, unemployment, lack of transportation and childcare, cultural and linguistic barriers are only a few of the obstacles that people face when they need coverage and care. Community-based outreach workers have the local knowledge and coverage expertise to bridge these gaps and help people get to the doctor for preventative care and afford their medications.

When President Obama called for community discussions on health care reform at the end of 2008 (summarized in a report on HealthReform.gov), the American people named the complexity of the systems in place as a major barrier to coverage and care. The report recommends simplifying and streamlining application systems. In Massachusetts, outreach workers are what make the system simple enough for most residents to use.

A simple, one-page application that will gain every American immediate access to a doctor is a wonderful goal, but is unlikely given the public-private hybrid system most often discussed. And you cannot simplify human need. There will still be vulnerable people who don’t have access to the Internet, don’t have a phone, cannot speak English, have regularly changing income status, or don’t understand what documentation they need to apply for coverage.

The Obama administration has already acknowledged that funding outreach is crucial to the successful expansion of coverage—funding for outreach and enrollment is included in his recent SCHIP reauthorization to cover more children. A February 2009 report from RWJ and the National Academy for State Health Policy agrees that community-based outreach and smart use of technology tools are top strategies for SCHIP success. The Center for Studying Health System Change recently reported that some Medicare beneficiaries do not have drug coverage because the plans are too complicated. A recent study in NY state shows that one-third of people on public health benefits lose their coverage while still eligible. When asked what would help them stay enrolled, a “recertification facilitator” and email and text reminders were cited among the best ideas. Massachusetts has those facilitators already—they are outreach workers.

Preserving funding in Massachusetts for community-based outreach workers creates jobs, improves access to coverage and care, makes the system more efficient and effective, and help reduce costs for hospitals, health centers, consumers, and state and federal governments. Making community-based workers a part of a national health care reform plan would do the same thing. So that the new systems can be the best they can be, Community Partners aims to help Massachusetts and the Obama administration understand that outreach workers are essential to the success of health care reform.

Meg Kroeplin & Johanna Bates, Community Partners, Amherst, MA