Abstract
The Healthy Howard Health Plan (HHHP) is an innovative health access plan providing healthcare and health coaching to previously uninsured adults in Howard County, Maryland. HHHP members who enrolled in HHHP between January 2009 to June 2010 are followed over time using a variety of self-reported data collection tools including a health risk assessment (HRA), the SF-12, a measure of health status, and the PAM, patient activation measure. We describe their unmet health needs, demographics, health status and behaviors at baseline and we describe changes in health-related behaviors over time. Demographic and baseline HRA results for 700 individuals who enrolled over the first 18 months reveal HHHP members generally were racially diverse (white: 37 %; African American: 23 %, and Asian: 30 %), married (50 %) females (59 %). Most (62 %) have a family income between 121 and 200 % of the federal poverty level, and were without health insurance for more than 1 year (56 %). Self-reported health and behaviors for 163 plan members who completed initial and follow up HRAs revealed increases in physical activity, fruit and vegetable consumption, and health status. Statistically significant differences were found in patient activation from baseline to follow up (44 vs 58 %, p value 0.0005). Patient demographics, health status, and health behaviors of these newly insured Americans may help policy makers and care providers prepare to meet their needs. We noted improvements in certain self-reported health behaviors and health status, suggesting participation in the Plan is associated with positive health impacts for some Plan members.
Similar content being viewed by others
References
Holahan, J., & Chen, V. (2011). Changes in health insurance coverage in the Great Recession, 2007–2010. In The kaiser commission on medicaid and the uninsured, issue brief 8264. Retrieved August 25, 2012 from http://www.kff.org/uninsured/8264.cfm.
Franks, P., Clancy, C. M., & Gold, M. R. (1993). Health insurance and mortality: Evidence from a national cohort. Journal of the American Medical Association, 270, 737–741.
Wilper, A., Woolhandler, S., Lasser, K. E., et al. (2009). Health insurance and mortality in US adults. American Journal of Public Health, 99, 2289–2295.
Baker, D. W., Sudana, J. J., Albert, J. M., et al. (2001). Lack of health insurance and decline in overall health in late middle age. New England Journal of Medicine, 345(15), 1106–1112.
Institute of Medicine. (2002). Care without coverage, too little too late. Washington, DC: The National Academies Press.
Hadley, J., & Holahan, J. (2004). The cost of care for the uninsured: What do we spend, who pays, and what would full coverage add to medical spending?. Washington, DC: Kaiser Commission on Medicaid and the Uninsured, Issue update.
Newton, M. F., Keirns, C. C., Cunningham, R., et al. (2008). Uninsured adults presenting to US emergency departments: Assumptions vs data. Journal of the American Medical Association, 300(16), 1914–1924.
Schoenback, V. J., Wagner, E. H., & Beery, W. L. (1987). Health risk appraisal: Review of evidence for effectiveness. Health Services Research, 22(4), 553–570.
12th Annual National Business Group/Watson Wyatt Survey Report. (2007). Dashboard for success: How best performers do it. Retrieved August 25, 2012, from http://www.corpsyn.net/Special/images/SPC_090607_WatsonWyatt.pdf.
Scariati, P. D., & Williams, C. (2007). The utility of a health risk assessment in providing care for a rural free clinic population. Osteopathic Medicine Primary Care, 1, 8. doi:10.1186/1750-4732-1-8.
Collins, S. R., Robertson, R., Garber, T., et al. (2012). The income divide in health care: How the affordable care act will help restore fairness to the US health system. Retrieved August 25, 2012, from http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Feb/Income-Divide.aspx .
Blewett, L. A., Ziegenfuss, J., & Davern, M. E. (2008). Local access to care programs (LACPS): New developments in the access to care for the uninsured. The Milbank Quarterly, 86(3), 459–479.
Edsall Kromm, E., & Beilenson, P. (2011). Coaching for prevention: The healthy Howard model. In Health affairs blog. Retrieved August 25, 2012, from http://healthaffairs.org/blog/2011/09/21/coaching-for-prevention-the-healthy-howard-model.
Edsall Kromm, E., McDonald, E. M., Frattaroli, S., et al. (2010). Healthy Howard health plan: A summary of inaugural members’ demographics, health status and goals in 2009. Research Report #1. Baltimore, MD: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, March 2010.
Edsall Kromm, E., Holtgrave, D., McDonald, E. M., et al. (2009). Healthy Howard health plan: A summary of health care utilization in 2009. Research Report #2. Baltimore, MD: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health.
Wellsource. (1996). Personal wellness profile.™ Wellsource, Inc.
Hibbard, J. H., Stockard, J., Mahoney, E. R., et al. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4), 1005–1026.
Hibbard, J. H., Mahoney, E. R., Stockard, J., et al. (2005). Development and testing of a short form of the patient activation measure. Health Services Research, 40(6 Pt 1), 1918–1930.
Mosen, D. M., Schmittdiel, J., Hibbard, J., et al. (2007). Is patient activation associated with outcomes of care for adults with chronic conditions? Journal of Ambulatory Care Management, 30(1), 21–29.
Ware, J. E., Kosinkis, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.
QualityMetric. (n.d.). SF-36v2 health survey. Retrieved August 25, 2012, from http://www.qualitymetric.com/WhatWeDo/SFHealthSurveys/SF36v2HealthSurvey/tabid/185/Default.aspx.
Wilper, A. P., Woolhandler, S., Lasser, K. E., et al. (2009). Hypertension, diabetes and elevated cholesterol among insured and uninsured US adults. Health Affairs, 28(6), 1151–1159.
Ayanian, J. Z., Weissman, J. S., Schneider, E. C., et al. (2000). Unmet health needs of uninsured adults in the United States. Journal of the American Medical Association, 284(16), 2061–2069.
Sudano, J. J., Jr, & Baker, D. W. (2003). Intermittent lack of health insurance coverage and use of preventive services. American Journal of Public Health, 93(1), 130–137.
Milstein, B., Homer, J., Briss, P., et al. (2011). Why behavioral and environmental interventions are needed to improve health at lower cost. Health Affairs, 30(5), 823–832.
McWilliams, J. M., Zaslavsky, A. M., Meara, E., et al. (2003). Impact of medicare coverage on basic clinical services for previously uninsured adults. Journal of the American Medical Association, 290(6), 757–764.
Hibbard, J. H., Mahoney, E. R., Stock, R., et al. (2007). Do increases in patient activation result in improved self-management behaviors? Health Services Research, 42(4), 1443–1463.
Conflict of interest
The Horizon Foundation and the Aetna Foundation provided support to the Healthy Howard Inc to evaluate the program; Healthy Howard Inc, provided support to the Department of Health, Behavior and Society for this work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McDonald, E.M., Frattaroli, S., Edsall Kromm, E. et al. Improvements in Health Behaviors and Health Status Among Newly Insured Members of an Innovative Health Access Plan. J Community Health 38, 301–309 (2013). https://doi.org/10.1007/s10900-012-9615-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-012-9615-3