Outreach programs have been long recognized as key to ensuring access to health care for underserved populations. Outreach staff may include community health workers, lay health workers, eligibility workers, case managers, community advocates and/or promotora/es, as defined by their roles and functions at their respective organizations. Outreach staff in programs nationwide has successfully initiated strategies that link communities to health centers; connect them to health care; and provide enabling services such as transportation, interpretation, and system navigation. They often provide an array of preventative services as well, such as health education, basic health screenings, and case management. Despite these successes, many outreach services are not reimbursable. Health centers consistently reported the non-reimbursable nature of outreach and enabling services to be a significant financial challenge in HOP’s past three needs assessments.[i] Health centers are often forced to absorb costs or make budget cuts to outreach programs. Lack of consistent funding affects organizations’ ability to expand outreach and enabling services, hire more staff, and effectively measure outreach impact i.
Outreach program sustainability is essential in order for health centers to continue to reach underserved populations. Need assessments, public health insurance outreach and enrollment assitance, and community partnerships are some strategies used by health centers to ensure the continuity and success of their outreach programs.
Demonstration of Need
A key strategy to tap into private or federal resources, especially in the current funding climate, is to demonstrate the needs of the population you serve or intend to serve.[ii]. As trusted members of the community, outreach staff can be very useful in helping their organizations capture the health needs and challenges facing the community. Involving outreach workers in the planning and execution of the needs assessment process can ensure that grant applications adequately demonstrate and respond to the true needs of the community. Staff can directly assist with developing questionnaires, conducting focus groups and community forums, and providing interpretation as needed. In addition, outreach workers may have established relationships with other agencies in the community and can ascertain what services are currently being offered to avoid duplication. Kansas Statewide Farmworker Health Program (KSFHP) in Topeka, Kansas used a needs assessment to identify the cultural and linguistic needs of an emerging farmworker population in their community, Low German-speaking Mennonites from Mexico. KSFHP then developed a successful application for an Expanded Medical Capacity grant from the Health Resources and Services Administration and hired new outreach staff to address the linguistic, cultural, and health needs of the Low German-speaking Mennonite farmworkers.
Needs assessments can also be an ongoing process for organizations to identify gaps in services, emerging health and social service needs, and areas of concern for their target population. Greene County Health Care, a FQHC located in North Carolina, conducts needs assessment three times a year to respond to the health needs of their farmworker community. The program assesses farmworker needs and evaluates its outreach services at the beginning, mid-point, and end of each harvest season. Data from the assessments is then used by the outreach workers to adapt their outreach and health education services to the changing needs of the farmworkers they serve.
Outreach and Patient Enrollment
Outreach staff can play an important role in identifying populations that are uninsured, determining their eligibility, and connecting them to coverage. These trusted individuals can work with newly enrolled individuals and families to overcome the common barriers of accessing health care, such as transportation and language needs. In the wake of the Affordable Care Act, outreach workers are even now more vital to reaching immigrants and other uninsured populations, as they can help health centers identify key barriers eligible members of immigrant families face to enrolling in coverage and accessing care, utilize successful outreach strategies to overcome these barriers, and enroll them into programs such as CHIP, Medicaid and Medicare[iii]. These new patients can bring in additional revenue for health centers, ultimately helping to increase the return on investment in the program. Columbia Basin Health Association (CBHA) in Othello, Washington established a Patient Benefits Program within their outreach department to assist farmworkers and other underserved populations in determining their eligibility, and help clients apply for public health insurance programs. Although some up-front costs were initially incurred in the form of staff wages, time, and office space, CBHA was able to save money by increasing reimbursable visits to the health center. The health center estimates that about $320,000 is grossed annually from the program.
Establishing community partnerships can help organizations develop and strengthen their outreach programs. Community partnerships can leverage existing resources, maximize funds and staff, and increase the impact of the outreach program in the community. Over the years, various health centers have created innovative partnerships with medical and nursing schools, housing authorities, job programs, and other social services agencies. Partnerships are strong when they mutually benefit both the health center and the partnering organization. For example, a dental school partnering with an outreach program can increase their visibility in the community and provide field experience for their students. The health center meanwhile gets to provide essential oral health services to its community and benefits from additional staff support from the dental students. The outreach program at Proteus Inc., in Des Moines, IA, partners with Des Moines University to use Des Moines University Mobile Unit and conduct clinical outreach throughout the state of Iowa.
Outreach programs play a key role in increasing access to health care for vulnerable populations. In addition to community education, outreach programs provide critical enabling services that may include health education, case management, eligibility assistance, interpretation, transportation and other services. Sustaining outreach program funding can be a challenge to health centers since many of the services they provide may not be reimbursable. However, outreach programs are increasingly well-positioned for funding through the utilization of needs assessment data for new grants, use of outreach staff in patient enrollment and eligibility in public health insurance, and development of community partnerships to maximize new and existing resources. Health Outreach Partners (HOP) has a number of free online tools and resources which are designed to provide training and technical assistance to outreach programs on needs assessment, community collaboration, as well as benefits enrollment. HOP also provides intensive training on public health insurance outreach and has developed a training of trainers curriculum for outreach staff. Please visit www.outreach-partners.org for more information and to contact us.
For more details on the outreach practices mentioned in the article, please visit Health Outreach Partners’ Innovative Outreach Practices Database available at: http://web.outreach-partners.org/resources/iopdb#articleText.
[i] Breaking Down the Barriers: Outreach Funding Fact Sheet. 2009. Health Outreach Partners http://www.outreach-partners.org/docs/FAN%20Funding%20Factsheet.pdf
[ii] Newly Funded TA Guide. Health Resources and Services Administration. http://bphc.hrsa.gov/technicalassistance/newguide/index.htmld.
[iii] Connecting Eligible Immigrant Families to Health Coverage and Care: Key Lessons from Outreach and Enrollment Workers. 2011. Kaiser Commission on Medicaid and the Uninsured. Kaiser Family Foundation www.kff.org/medicaid/upload/ConnectingEligible-Immigrant-Families-to-Health-Coverage-and-Care-Key-Lessons-from-Outreach-andEnrollment-Workers-full-report-pdf.pdf