Impact Report: Access To Health Care

In September 2017, the Utah Women and Leadership Project along with the YWCA of Utah brought a group of healthcare experts together to identify current resources/strengths, challenges, and potential interventions to help Utah women have access to health care. What follows are their recommendations organized by category.  See the comprehensive list here. Clearly, there is much we can do.

Financial Incentives and Support

• Medicaid can de-bundle services, which means  billing and reimbursement issues are less complicated or more flexible.
• Utah need to more Community Health Worker certifications in order to get reimbursed, that way services can be sustainable.
• Medicaid and private insurance reimbursement is critical for these services to be more widely available in Utah.
• Utah need to provide better ongoing coverage system for low- income mothers, especially after a child is born.
• Full expansion of traditional Medicaid is needed, which would help lower income households.
• Contraceptive care should be covered for low-income women. Medicaid expansion through family planning waiver or State Plan Amendment is needed to do this.
• Overall, there is a need to increase coverage options and decrease cost for all Utahans.

Technology Infrastructure

• We need to continue to support and grow telemedicine/telehealth services generally to increase Utah women’s access to healthcare in rural areas.
• Implement evidence-based programs through these telemedicine/telehealth services; online access to these programs is critical moving forward.
• We can increase education for providers to adopt telehealth technologies.
• Let’s bring healthcare systems to the table to discuss possible approaches for connecting medical records in a way that does not threaten patient confidentiality. Although this is a complex issue, there is a possibility for progress here.

Creation of Economic Opportunity

• We can focus on wellness for the whole family helps create economic opportunity.

Capacity and Capability Building

• California has  “health for everyone” (CA Senate Bill 562) and includes the undocumented population. This is a great start and model Utah should use as a model.   In addition, California and 8 other states cover all children regardless of documentation status. Utah has the highest rate of uninsured Latino children in the nation. We should use other states as examples when increasing Utah women’s access to health care.
• The SUPeRAD Prenatal Specialty Clinic in South Jordan provides specialty prenatal care for pregnant women who use substances. Recreating their model elsewhere can improve pregnancy and birth outcomes. Offers Naloxone training for community with free kits.
• Providers need to offer best practice services. For providers to understand best practices, more continued education is necessary
• Community Health Workers can be a critical piece of preventative healthcare and support, but they need to be eligible for reimbursement to be sustainable.
• Improve understanding of roles between Community Health Workers and Health Educators within healthcare systems so these aren’t seen as competitive roles.
• Create a comprehensive referral system so that Community Health Workers can make sure people get care when needed. These workers provide information, resources, peer support, and referrals for actual healthcare – referrals are key and we need a better system
• Need co-location of services; a mother needs to be able to get services when she brings her children to get care. Convenience is key for mothers, whether they work outside of the home or not. Need moms to be screened when kids see the pediatrician. Providers must be equipped to do this, have capacity for it, and have good referral systems.
• Increasing and building integration of mental and physical healthcare is critical.
• Women need to be presented with all the information; women and providers need to see the bigger picture of how all their health issues are interconnected. People see a lot of different providers for different things, and it needs to be more coordinated.

Advocacy and Shaping Attitudes

• Need to now implement Family Planning Elevated (expansion of HER Salt Lake Contraceptive Initiative). The hope is that this starts to normalize preventative healthcare that impacts women down the road (not just during reproductive years) and with health issues unrelated to reproductive healthcare.
• Increase public education to reduce shame and stigma around postpartum depression and related issues, and the same with mental health and substance use issues.
• Related campaign needed around taking care of mom = taking care of baby/children/family. Not selfish for women to take care of themselves.
• Need to shape messaging so we aren’t silo-ing issues. Need “poster children” for these issues in order to make it real for people, funders, and policymakers. Focus on how these issues integrate/overlap in one person or family’s life and paint that picture more effectively.
• Also need to frame issues as “family issues.”
• One possibility is to collaborate so that a number of issues are combined in the way they all focus on the early years, under the umbrella of toxic stress/adverse childhood experiences/trauma. There are various approaches to the health of mom, children, and the whole family that can be connected to these issues.
• Perhaps the Intergenerational Poverty (IGP) framework is another approach (problem, however, is that the state’s IGP definition excludes immigrants and refugees).
• Get more men involved with women’s and children’s healthcare; dads need to know who the pediatrician is. Women often overseeing men’s healthcare too – they carry a lot of the burden for whole family’s care. Social media campaign around this.
• Basic awareness and education is still needed to help people understand the healthcare system, and to understand the link between mental and physical health. 
• Perhaps Department of Health can expand their public awareness and education efforts to include some of these other things – its focus is on women being as healthy as they can before getting pregnant or between pregnancies.
• We need to include domestic and sexual violence information in all of these efforts. These issues are all interconnected and people don’t always recognize that – need providers to ask questions and raise awareness.
• Apps can help educate people.
• Focus on wellness and holistic approach for the whole family.

Laws, Policies, Regulations

• Pass a full Medicaid expansion bill in Utah.
• Pass Representative Ward’s family planning bill during the 2018 Regular Session.
• Need people working on different issues to work together to present a comprehensive case/picture to legislators rather than competing on individual line items. Coordinated Health related editorials before and during the legislative session to enhance constituent knowledge of the issues. Consider a mandate for providers to provide data to CHIE.
• Coordinated Health related editorials before and during the legislative session to enhance constituent knowledge of the issues.
• Consider a mandate for providers to provide data to CHIE.
• Re-engage efforts to adopt national network adequacy standards in Utah.

Research and Data

• Single payer system allows other countries to look at data across providers and across the patient’s life span.
• Funding to increase the size of various surveys helps with sample sizes and data analysis capabilities.
• Link UPDB to UDS (if possible) because we’re missing some of the most vulnerable and underserved populations in the UPDB data.
• More generally, UDS data could be a source for future research.

As a result, there are potential actions any citizen can take regardless of professional position, education level or socio-economic status. To learn more about what you can do to effect unpaid care work in Utah read the entire impact report, or our health related research snapshots.