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In Massachusetts, nearly one in ten residents lives in poverty, according to the US Census Bureau. That number jumps to 18% when looking at Boston alone (though the exact percentage varies, based on immigration status and reporting measures). Though Medicaid expansion and the Affordable Care Act have improved the ability of community health centers to provide affordable care to low-income patients, insurance is just one facet of navigating health care near the poverty line.
The good news? Massachusetts has a long history of helping remove barriers to health care. The state launched one of the nation’s first health centers in 1965 to help provide primary and preventative health care for low-income patients. Today, the state’s community health centers continue to play a vital role in treating low-income patients as a whole, integrating themselves into the spaces where the city’s most vulnerable live, work, and congregate.
Health care barriers for low-income families
For many low-income individuals, health inequity isn’t just about insurance, but also the socioeconomic factors that have a direct impact on health outcomes. According to the Office for the Assistant Secretary for Planning and Evaluation (ASPE), this includes housing, food and nutrition, transportation, social and economic mobility, education, and environmental conditions. When needs in these areas are not met, long-standing health inequities are further exacerbated.
Language barriers are another obstacle at community health centers. Providers such as the Roxbury-based Dimock Center recognized this challenge in their patient population and sought a seamless solution. Marisol Rosario, director of health center operations at The Dimock Center cites their interpretation service — which includes four on-site interpreters and an on-demand phone interpretation service — as a service that allows all patients to access a high level of care without language barriers. Other obstacles Rosario regularly sees include lack of transportation to and from appointments and access to reliable childcare.
“We know it takes a collective intellect and combined unique resources to unravel some issues [around] equity,” acknowledges Hollis Graham, RN, BSN, the director of strategy, innovation, and transformation at the East Boston Neighborhood Health Center (EBNHC). “Many of our community members are new to the country and need to be plugged into both emergent and preventative health care services and support, [and] our most vulnerable families are simultaneously facing other insecurities such as food, childcare, and housing. It is difficult to navigate all of these simultaneously with health care and insurance navigation issues.”
Equitable health care, with or without insurance
Community health centers are a pillar in the community for quality health care for all. EBNHC, for example, does not deny care to anyone, stressed Graham, calling it a vital part of their mission. “We provide care to anyone, regardless of their insurance status, their immigration status, their age, race, or socioeconomic status,” she notes.
Researchers acknowledge that it will take more than the Affordable Care Act to reform health care; other resources must be considered in low-income populations. Because a person’s financial situation can quickly change, community health centers make it a priority to offer continuity of care, whether you are on Medicaid or later qualify for commercial insurance.
Health insurers must also step up in order for everyone to receive the care they deserve. “[Our plans provide quality] support for our members, regardless of whether they are seniors, on commercial insurance [or] Medicaid,” says Melissa Stier, M.Ed., LICSW, and director of population health and integrated care management for Tufts Health Plan, a Point32Health company, noting directors across departments at Tufts Health Plan work together to manage an individual’s care.
Building communities through partnerships
Besides working directly with patients who come through their doors, community health centers are utilizing partnerships to integrate themselves into the community and provide the most benefit to the low-income population. That’s because families often seek support from trusted partners in their neighborhoods (whether that be a community-based or faith-based organization), according to Chrismaldi Vasquez-Casado, MBA, manager of community relations for Tufts Health Plan.
“[Families] have places they turn to for support because [navigating health care and insurance] is really hard,” Vasquez-Casado notes. “Part of what we are doing is ensuring that those institutions are armed with culturally relevant resources and in-language information, so that they can help spread the word.”
In the case of Point32Health, the information they are getting to low-income families includes details about open enrollment for insurance or important health care notices. Point32Health also supports local organizations that help with health information and insurance navigation, an important community resource.
Meeting patients where they are at
In order to support a large number of members who may need help with insurance and health care navigation, Point32Health ensures they have a strong presence at community events, with a team specifically focused on meeting the community where they are. “We go to community events and food pantries and our [trained] team is available to answer any of the questions for a wide variety of [insurance] plans,” Vasquez-Casado shares.
In addition to providing information at community events, Point32Health has community health workers that Stier refers to as “boots on the ground,” who take patients to doctor’s appointments, support them on what questions to ask, and even deliver diapers to families in need.
A physical presence in the community is what makes community health centers stand out from traditional hospitals. Graham notes that the EBNHC doesn’t wait for community members to come to them for help. Instead, they are partnering with community organizations — such as La Collaborativa in Chelsea — to have a presence at their food distributions to help low-income families navigate the insurance process. “What we have done is re-imagine the model for how we engage our vulnerable families,” she adds.
Because access to health care is just one facet of ensuring a person’s overall health and well-being, community health centers aim to be more than just a place you go to visit with a doctor or access health programs. They reach beyond the walls of traditional care and help low-income families navigate common obstacles to high-quality health care, ensuring patients receive care with the respect, dignity, and attention they deserve.
Point32Health is a nonprofit health and wellbeing organization, guiding and empowering healthier lives for all. Bringing together over 90 years of combined expertise and the collective strengths of Harvard Pilgrim Health Care, Tufts Health Plan and our family of companies, we help our members and communities navigate the health care ecosystem through a broad range of health plan offerings and tools.
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