Indicators of access to healthcare and preventative services give part of the picture of the overall health of Alaskans and shine a light on important health inequities. According to the 2019 Healthy Alaskans State Health Assessment, compared to the US, Alaska adults have less access to health care and preventative services than other areas of the country. Among all Alaskans, 12.6% are without health insurance coverage, compared to 8.8% in the US Thirty percent of Alaska adults do not have one person they consider their personal health care provider, and 14% report being unable to seek health care services in the past 12 months due to cost. The HA2020 plan contained 3 leading health indicators (LHIs) focused on healthcare access (LHIs 21, 22, 23), relating to prenatal care, preventable hospitalizations, and ability to afford to visit a doctor.
The HA2030 team decided to keep the HA2020 LHI on prenatal care in the first trimester since little progress was made on that indicator and it did not reach the target by 2020. This objective is considered a significant prevention measure where the access to early prenatal care can prevent life-long health complications and outcomes. The team noted the many Alaskan organizations actively working to improve the issues this objective addresses and decided to keep the objective so the work will remain in the strategic plans and actions of organizations engaged in this area.
The HA2030 team decided to keep the HA2020 LHI on preventable hospitalizations since the 2020 target was not met. It was noted that the measure for this objective has improved and the strategies under this objective can prevent avoidable hospitalizations from acute and chronic conditions. The measure can also show if care is being provided in a timely and efficient manner and therefore can illustrate how well our health care system is performing.
The HA2030 team also decided to keep the HA2020 objective focused on healthcare affordability for the HA2030 plan. Although there was significant progress on that HA2020 LHI and it met its 2020 target, the HA2030 teams were concerned that future policy work in this area would benefit from having this objective future and wanted to continue to monitor data to protect the significant efforts being made to improve healthcare affordability.
The HA2030 teams also decided to add 2 additional objectives for healthcare access: one concerning well-child checkups and the other focused on health insurance coverage. The HA2030 teams are focusing more on early childhood health to prevent the healthcare issues that present later in life, so a well-child checkup objective can act as a measure of the social determinants of health and prevention. The objective on reducing the percentage of people without health insurance also gives an overall picture on healthcare access issues in Alaska, allowing for progress in Medicaid and insurance reforms to be tracked and measured.
The Agency for Healthcare Research and Quality describes components of health care access as follows: Access to health care means having “the timely use of personal health services to achieve the best health outcomes” (source: Millman M, ed. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Washington, DC: National Academy Press; 1993).
Health care access is measured in several ways, including:
The Agency for Healthcare Research and Quality describes components of health care access as follows: Access to health care means having “the timely use of personal health services to achieve the best health outcomes” (source: Millman M, ed. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Washington, DC: National Academy Press; 1993). Health care access is measured in several ways, including:
Healthcare costs in Alaska are high, much like other elements of the “cost of living” in the last Frontier. There are many factors that contribute to the high cost of healthcare in Alaska and to the high cost of health insurance. There is no one solution to the complex problem of high healthcare and health insurance costs but there are some underlying issues that can be addressed one by one in order to make progress.
Access to health services means “the timely use of personal health services to achieve the best health outcomes.”
Chronic disease management (CDM) programs are proactive, organized sets of interventions focused on the needs of a defined population of patients. Program design varies, but CDM programs are usually multi-component efforts that include planned visits to teach patients about their disease, coach them on healthy behavior change including medication adherence, and skills for self-management of chronic conditions in partnership with a coordinated, multidisciplinary care team. Interventions may be based on the Chronic Care Model, which identifies links to community resources, health system support, health care system redesign, self-management and provider decision support, and the use of clinical information systems as essential elements for health care systems to support high quality chronic disease care. CDM programs can support patients with illnesses such as diabetes, hypertension, heart failure, and depression, and can be delivered in various health care settings (CCM). Reducing hospitalization rates is a key to controlling health-care costs. Populations with the highest rates of potentially preventable hospitalizations have the largest potential for lower rates and inpatient costs. Communities with high rates of potentially preventable hospitalizations might see the benefit of investing in primary care, care coordination, and community health worker strategies that can lower inpatient costs.
In a case management model, health professionals, often nurses, manage multiple aspects of patients’ care, including status assessment, monitoring, advocacy, care planning, and linkage to services, as well as transmission of information to and between care providers. Case managers often care for vulnerable individuals who live independently. Patients from vulnerable populations often have complex health needs that require care from multiple providers, and are at increased risk of adverse outcomes from conditions that could be prevented with early detection and treatment (Eklund 2009*).
This has been a proved strategy by Bright Futures, who has been providing education for nearly 25 years.
The “Learn the Signs. Act Early” campaign strives to improve parents and health care provider’s knowledge on early child development by research, training videos, free materials, apps, and more. (link below)
RAND research program studied nine early intervention education programs and found that:
The CDC has proven this to be an effective strategy in identifying behavior concerns.
Medicine Net efforts are to educate parents on what to expect and check for during early development and more.
The American Family Physician supports this strategy.
The American Academy of Pediatrics provides documents that supports this strategy. (link below)
The American Academy of Pediatrics has proven studies that continuous coverage makes a difference.
The County Health Ranking and Roadmaps are supporting health insurance enrollment.
The Center for American Progress has proved this to be an effective strategy.
Access to health services means “the timely use of personal health services to achieve the best health outcomes.”1 It requires 3 distinct steps:
Access to health care impacts one’s overall physical, social, and mental health status and quality of life. Barriers to health services include:
These barriers to accessing health services lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services, financial burdens and preventable hospitalizations
Health insurance enrollment outreach and support programs assist individuals whose employers do not offer affordable coverage, who are self-employed, or unemployed with health insurance needs. Such programs can be offered by a variety of organizations, including government agencies, schools, community-based or non-profit organizations, health care organizations, and religious congregations. Outreach activities vary greatly, and can include community health worker (CHW) efforts, other person-to-person outreach, mass media and social media campaigns, school-based efforts, case management, or efforts in health care settings. Outreach can occur at local events, via hotlines, or at fixed locations (e.g., community centers, non-profit offices, etc.) and are often supported through grants from federal agencies or private foundations.
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