Community Approaches To Providing Care For The Uninsured

Taylor, Erin Fries; Cunningham, Peter; McKenzie, Kelly

doi:10.1377/hlthaff.25.w173

Cited by 22 publications

(21 citation statements)

References 3 publications

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“…The study population was identified through published reports of community-based programs that broker access to care for the uninsured (Taylor, Cunningham, and McKenzie 2006; Taylor et al 2006; Scotten and Absher 2006; Blewett, Ziegenfuss, and Davern 2008; Nakashian 2007) and identification of newly founded CAPs. Of the 50 CAPs identified and categorized into one of four organizational models defined by Blewett and colleagues, 32 were excluded that served primarily employed individuals or that were a nation-wide model of care (Blewett, Ziegenfuss, and Davern 2008).…”

Section: Methodsmentioning

confidence: 99%

Organizational values in the provision of access to care for the uninsured

Harrison

Taylor

2016

AJOB Empirical Bioethics

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Background For the last 20 years, health provider organizations have made efforts to align mission, values, and everyday practices to ensure high-quality, high-value, and ethical care. However, little attention has been paid to the organizational values and practices of community-based programs that organize and facilitate access to care for uninsured populations. This study aimed to identify and describe organizational values relevant to resource allocation and policy decisions that affect the services offered to members, using the case of community access programs: county-based programs that provide access to care for the uninsured working poor. Methods Comparative and qualitative case study methodology was used, including document review, observations, and key informant interviews, at two geographically diverse programs. Results Nine values were identified as relevant to decision making: stewardship, quality care, access to care, service to others, community well-being, member independence, organizational excellence, decency, and fairness. The way these values were deployed in resource allocation decisions that affected services offered to the uninsured are illustrated in one example per site. Conclusions This study addresses the previous dearth in the literature regarding an empirical description of organizational values employed in decision making of community organizations. To assess the transferability of the values identified, we compared our empirical results to prior empirical and conceptual work in the United States and internationally and found substantial alignment. Future studies can examine whether the identified organizational values are reflective of those at other health care organizations.

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Section: Methodsmentioning

confidence: 99%

Organizational values in the provision of access to care for the uninsured

Harrison

Taylor

2016

AJOB Empirical Bioethics

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“…However, we found consistently positive views of the CHPs engaged in care coordination. The value of care coordination services has been examined in a number of other communities around the country 20,21. Many report an improvement in access to services, although it is not at all clear that these strategies have the capacity to meet existing need.…”

Section: Discussionmentioning

confidence: 99%

“…Many report an improvement in access to services, although it is not at all clear that these strategies have the capacity to meet existing need. Still, much of Michigan’s current system depends largely on an informal, dynamic network of volunteers that is vulnerable to changes in funding and patient volume,20,22,23 heightening concerns about the ability of Michigan’s safety net to meet rising needs.…”

Section: Discussionmentioning

confidence: 99%

Community Responses to Diabetes and Mental Health Care for the Uninsured Population in Michigan

Dalton¹,

Jacobson²,

Konig³

et al. 2009

hpu

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Objective To examine how the safety net in Michigan is responding to the health care needs of their uninsured population with diabetes and/or mental illness. Methods We used a multiple-site case study design. Data were collected through interviews of key informants in five Michigan communities. Analytic patterns and themes were identified, and compared across communities and by organizational type. Results Informants reported they are managing to meet the needs of uninsured diabetics but are having great difficulty caring for the uninsured with mental illness. Specialty care for diabetes is obtainable, but is resource-intensive. Mental health services available for uninsured patients are severely limited. The presence of a county health plan (CHP) appears insufficient to improve access, especially to mental health services. Conclusions The safety net for Michigan’s uninsured population with diabetes and mental illness is weak. Processes including referrals and care coordination are of poor quality in some communities. The value of integrating mental health services into primary care should be examined.

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“…7,11,22,23 Beyond negotiated inpatient Medi-Cal rates and the prospective cost-based rates received by FQHCs, development of prospective reimbursement agreements within safety-net systems has been limited. 7,11,16,24 Evidence indicates that participation in an organized care delivery network can mitigate many of the challenges faced by safety-net health care providers. 8 Despite this evidence, instances of such coordinated networks in the United States are infrequent.…”

Section: Inherent Challenges In the Safety Netmentioning

confidence: 99%