RAND Helps to Develop From Coverage to Care, a New CMS Initiative


Jul 29, 2014

A pregnant woman in an exam room with a gynecologist and nurse

Photo by Dangubic/Fotolia

“I have an insurance card—Now what?”

As a result of the Patient Protection and Affordable Care Act (ACA), more than 8 million Americans have obtained coverage through the individual marketplace, and more than 6 million others have obtained coverage through Medicaid and the Children's Health Insurance Program. These numbers continue to grow. Though a fundamental goal of the ACA is to reduce the number of uninsured, the overarching vision of the law goes beyond health insurance enrollment. Health coverage is a means to an end: the aim is to help more Americans use their coverage to access routine primary care and preventive services. Engaging with a regular source of care improves the chance that illnesses may be prevented or caught in earlier stages, that patients and physicians can discuss health-promoting lifestyle changes, and that non-emergency health care needs can be handled in locations other than the high-cost emergency department.

For many of the newly insured, however, the leap between obtaining insurance and establishing a regular source of care is substantial. Many have little or no experience with the primary care system and the experiences they have had suggest that there is room for improvement with respect to equitable, efficient and patient-centered care. Many of the newly insured have never had the luxury of selecting a provider that best meets their needs. Further, the majority have low health literacy, meaning they may have difficulty accessing, understanding and applying health information to make informed choices. This difficulty is compounded by the linguistic complexity of most health-related materials and the terminology used to describe health outcomes and health insurance. It is further compounded by the complexity of the processes individuals must follow, from selecting and applying for insurance to navigating a health care system to obtain needed care. These tasks can be frustrating and hard for the most highly educated.

Over the past year, RAND worked with the Centers for Medicare and Medicaid Services (CMS) Office of Minority Health and The MITRE Corporation to develop and pilot-test From Coverage to Care, an initiative designed to help people with new coverage understand their benefits and connect to primary care and preventive services that are right for them. The centerpiece of this initiative is an eight-step roadmap intended to guide the newly insured through the process of getting health care. Each step includes definitions, checklists, and recommendations for what to say or ask. In addition, the steps provide information for community organizations and providers looking to support the newly insured as they connect to care.

The steps include:

  • Step 1: Put your health first
  • Step 2: Understand your health coverage
  • Step 3: Know where to go for care
  • Step 4: Pick a provider
  • Step 5: Make an appointment
  • Step 6: Be prepared for your visit
  • Step 7: Decide if the provider is right for you
  • Step 8: Next steps after your appointment

The roadmap is available free of charge from CMS. In addition, videos explaining each step of the roadmap are available — in both English and Spanish. These resources are being shared with consumers through a variety of stakeholders, including state and local governments, hospitals and other health care providers, and numerous community organizations.

One of the lessons from RAND research is that the consumer perspective and experience have to be taken into account if a program or policy is to be successful. Our work in this area suggests that low health literacy is a major barrier to ACA outreach and enrollment efforts. But even for those who do enroll, providing access to a system that is hard to understand and navigate will not improve health unless the newly insured engage. We hope that over the longer term the roadmap and related resources, which were designed with the consumer in mind, will support the newly insured as they access care and will also foster longer-term engagement with the health care system, which in turn should translate into better health for millions of Americans.

Laurie T. Martin is a policy researcher and David M. Adamson is a communications analyst at the nonprofit, nonpartisan RAND Corporation.

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