Advancing universal health coverage through hospital-based community health advocates: A sustainable model

A pioneer in health care reform, Massachusetts implemented universal health care coverage in 2006, expanding Medicaid coverage and offering state-sponsored affordable insurance exchange programs. Success has been realized on a global scale with approximately 97 percent of residents reporting having health insurance. However, gaps in coverage remain, particularly for those of minority racial and ethnic backgrounds. Through linguistically and culturally appropriate outreach by Community Health Advocates (CHAs), Steward Health Care is enrolling patients in available state health insurance programs utilizing a sustainable model. Steward Health Care employs bilingual CHAs at 5 of its community hospitals, all of which serve low-income communities throughout eastern Massachusetts. The CHAs reach out to patients who are uninsured and limited-English-proficiency following an emergency room visit. Each CHA is equipped with an electronic tablet to take on home visits, and assists patients in navigating the complex application process for available state health insurance programs. Following approval, the CHA connects the patient to a primary care provider. Through revenue generated by securing reimbursement for emergency room visits, the CHA program is able to address both the needs of the hospital and the community. In 2012 alone, the CHAs enrolled hundreds of patients in available insurance programs. Through alignment with hospital reimbursement process, Community Health Advocates can be sustainably employed to connect residents to health insurance coverage and a usual source of care.