Written by: Center for Care Innovations

Idea: Build an online and phone app to help patients with insurance program eligibility and enrollment.

Target: Patients and their families accessing clinic services, especially new patients coming in as a result of ACA.

Project Highlights: Mobile application that would have a wider reach and attempt to navigate the eligibility options in Alameda County. However, it became clear that a simple, patient friendly piece of paper translated in Chinese would provide more value at a significantly lower cost. The team also wanted to increase the patient’s experience by not only providing a helpful paper sheet, but educating patients around the necessary documents they need to bring and also schedule an appointment so they can leave the visit with everything in place to obtain health insurance coverage.

The Pitch: “We’ve identified the critical difficulty for our staff in assisting patients obtain health insurance coverage. Patients do not understand and/or bring the proper materials (e.g. income, residency paperwork, identification) for our eligibility staff. Our innovation seeks to streamline the process of getting an eligibility appointment and the necessary forms so that a patient can obtain insurance in a single visit. We’ve identified all of the appropriate forms that a patient needs, translated in concordance to their language, and provide an appointment slot based on the patient’s preparation with the necessary forms. We provide a simple one page sheet (“AHS Documents to Bring”) that explains the documents that a patient should bring to obtain coverage. The “AHS Documents to Bring” sheet can be obtained at the lobby. Our lobby staff will also help patients understand what they need to bring to obtain coverage in Alameda County. We believe this will help patients understand the factors around eligibility and also maximize our eligibility staff efficiency in helping our patients with our language concordance.

“Originally our pilot plan was to construct a mobile application that would have a wider reach and attempt to navigate the eligibility options in Alameda County. However, it became clear that a simple, patient friendly piece of paper translated in Chinese would provide more value at a significantly lower cost. Furthermore, we wanted to increase the patient’s experience by not only providing a helpful paper sheet, but educating our patients around the necessary documents they need to bring, and also schedule an appointment so they can leave the visit with everything in place to obtain health insurance coverage.

“Although the sample size of the pilot was small, indications show that the patients who received the translated form on documents to bring, came to the eligibility appointments better prepared, and left with their applications processed. This processed saved our patients additional trips to AHS and achieved their desired result. Our sorely under-resourced eligibility workers were saved from repeated visits from same patients. We were also able to leverage our under-utilized lobby staff in facilitating the process. The lobby staff helped explain what forms they need to bring and also scheduled the eligibility appointment from the lobby so the patient did not have to go elsewhere to wait.”

Evidence of Cultural Change from the Innovation Process

  • Information systems teams are capturing user stories around how clinic teams want changes implemented to EHR
  • Several team members are implementing rapid, iterative prototyping to clinical quality improvement efforts
  • Spending less time in meetings and more in building applications or systems and have it deployed to the field
  • During team meetings actively brainstorming, modeling processes, searching for insights, and ideating collectively

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