Health care administrative burdens: Centering patient experiences

Herd, Pamela; Moynihan, Donald P.

doi:10.1111/1475-6773.13858

Cited by 37 publications

(43 citation statements)

References 21 publications

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“…Offline EBT reloading systems were associated with significant relative decreases in WIC participation during the COVID-19 pandemic, driven both by increased WIC participation in online states and decreased WIC participation in offline states. These findings support growing concerns that even seemingly minor barriers to accessing public programs may substantially reduce participation …”

Section: Discussionsupporting

confidence: 74%

“…Given the risks of in-person contact, delays in mail processing, and increased socioeconomic stress during the pandemic, offline benefits reloading may have limited access to WIC when the benefits were needed most . Because offline benefits reloading may have disincentivized participation among eligible families, we assessed whether WIC participation differed before and during the pandemic in offline vs online states.…”

mentioning

confidence: 99%

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Association of Remote vs In-Person Benefit Delivery With WIC Participation During the COVID-19 Pandemic

Vasan

Kenyon

Roberto

et al. 2021

JAMA

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Between April and June 2020 at the start of the COVID-19 pandemic, 29.5% of children in the US, predominantly from lowincome families and racial and ethnic minority groups, experienced household food insecurity. 1 The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a key source of nutritional support for women and children living in poverty. WIC benefits are currently issued on electronic benefits transfer (EBT) debit cards, which can be used to purchase WIC-approved food and beverage products.

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Section: Discussionsupporting

confidence: 74%

mentioning

confidence: 99%

Association of Remote vs In-Person Benefit Delivery With WIC Participation During the COVID-19 Pandemic

Vasan

Kenyon

Roberto

et al. 2021

JAMA

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“…Such administrative burdens create potential coverage disruption even if the beneficiary remains eligible. 17 We found that decreased churning explained nearly one-third of higher-than-predicted retention during the study period. Findings of the present study also showed that targeted policies can reduce disruptions and promote coverage continuity.…”

Section: Jama Health Forum | Original Investigationmentioning

confidence: 61%

“…Before the COVID-19 pandemic, Medicaid beneficiaries faced ongoing documentation requirements to maintain coverage. Such administrative burdens create potential coverage disruption even if the beneficiary remains eligible . We found that decreased churning explained nearly one-third of higher-than-predicted retention during the study period.…”

Section: Discussionmentioning

confidence: 75%

Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin

et al. 2022

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IMPORTANCEAfter the federal public health emergency was declared in March 2020, states could qualify for increased federal Medicaid funding if they agreed to maintenance of eligibility (MOE) provisions, including a continuous coverage provision. The implications of MOE provisions for total Medicaid enrollment are unknown. OBJECTIVE To examine observed increases in Medicaid enrollment and identify the underlying roots of that growth during the first 7 months of the COVID-19 public health emergency in Wisconsin. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study compared changes in Wisconsin Medicaid enrollment from March through September 2020 with predicted changes based on previous enrollment patterns (January 2015-September 2019) and early pandemic employment shocks. The participants included enrollees in full-benefit Medicaid programs for nonelderly, nondisabled beneficiaries in Wisconsin from March through September 2020. Individuals were followed up monthly as they enrolled in, continued in, and disenrolled from Medicaid. Participants were considered to be newly enrolled if they enrolled in the program after being not enrolled for at least 1 month, and they were considered disenrolled if they left and were not reenrolled within the next month. EXPOSURES Continuous coverage provision beginning in March 2020; economic disruption from pandemic between first and second quarters of 2020. MAIN OUTCOMES AND MEASURES Actual vs predicted Medicaid enrollment, new enrollment, disenrollment, and reenrollment. Three models were created (Medicaid enrollment with no pandemic, Medicaid enrollment with pandemic economic circumstances, and longer Medicaid enrollment with a pandemic-induced recession), and a 95% prediction interval was used to express uncertainty in enrollment predictions. RESULTS The study estimated ongoing Medicaid enrollment in March 2020 for 792 777 enrollees (mean [SD] age, 20.6 [16.5] years; 431 054 [54.4%] women; 213 904 [27.0%] experiencing an employment shock) and compared that estimate with actual enrollment totals. Compared with a model of enrollment based on past data and incorporating the role of recent employment shocks,most ongoing excess enrollment was associated with MOE provisions rather than enrollment of newly eligible beneficiaries owing to employment shocks. After 7 months, overall enrollment had increased to 894 619, 11.1% higher than predicted (predicted enrollment 805 130; 95% prediction interval 767 991-843 086). Decomposing higher-than-predicted retention, most enrollment was among beneficiaries who, before the pandemic, likely would have disenrolled within 6 months, although a substantial fraction (30.4%) was from reduced short-term disenrollment.

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“…Specifically, none of the parents/guardians screened reported needing help for themselves or someone in their household on cutting down on smoking, drinking, or drug use, and only 1 participating parent/guardian (2.5%) reported feeling unsafe at home due to domestic violence. Even for those who endorsed SDOH needs, not all screened families accepted the offered referrals, services, or resources, perhaps because they had access to alternate sources of support or because of the administrative burdens associated with social welfare policies and programs that appear to be more focused on excluding ineligible individuals than on including eligible individuals [36].…”

Section: Discussionmentioning

confidence: 99%

A feasibility and acceptability study of screening the parents/guardians of pediatric dental patients for the social determinants of health

Kaur

Lieberman²,

Mason

et al. 2023

Pilot Feasibility Stud

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Background The social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. Lack of SDOH training of dental providers on SDOH may result in suboptimal care provided to pediatric dental patients and their families. The purpose of this pilot study is to report the feasibility and acceptability of SDOH screening and referral by pediatric dentistry residents and faculty in the dental clinics of Family Health Centers at NYU Langone (FHC), a Federally Qualified Health Center (FQHC) network in Brooklyn, NY, USA. Methods Guided by the Implementation Outcomes Framework, 15 pediatric dentists and 40 pediatric dental patient–parent/guardian dyads who visited FHC in 2020–2021 for recall or treatment appointments participated in this study. The a priori feasibility and acceptability criteria for these outcomes were that after completing the Parent Adversity Scale (a validated SDOH screening tool), ≥ 80% of the participating parents/guardians would feel comfortable completing SDOH screening and referral at the dental clinic (acceptable), and ≥ 80% of the participating parents/guardians who endorsed SDOH needs would be successfully referred to an assigned counselor at the Family Support Center (feasible). Results The most prevalent SDOH needs endorsed were worried within the past year that food would run out before had money to buy more (45.0%) and would like classes to learn English, read better, or obtain a high school degree (45.0%). Post-intervention, 83.9% of the participating parents/guardians who expressed an SDOH need were successfully referred to an assigned counselor at the Family Support Center for follow-up, and 95.0% of the participating parents/guardians felt comfortable completing the questionnaire at the dental clinic, surpassing the a priori feasibility and acceptability criteria, respectively. Furthermore, while most (80.0%) of the participating dental providers reported being trained in SDOH, only one-third (33.3%) usually or always assess SDOH for their pediatric dental patients, and most (53.8%) felt minimally comfortable discussing challenges faced by pediatric dental patient families and referring patients to resources in the community. Conclusions This study provides novel evidence of the feasibility and acceptability of SDOH screening and referral by dentists in the pediatric dental clinics of an FQHC network.

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Health care administrative burdens: Centering patient experiences

Cited by 37 publications

References 21 publications

Association of Remote vs In-Person Benefit Delivery With WIC Participation During the COVID-19 Pandemic

Association of Remote vs In-Person Benefit Delivery With WIC Participation During the COVID-19 Pandemic

Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin

A feasibility and acceptability study of screening the parents/guardians of pediatric dental patients for the social determinants of health

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