Accessing care: Developing new programs

Click here to view a general explanation of Developing New Programs

Health care providers are often seeking new ways to meet unmet needs by expanding services or testing new approaches for reaching underserved populations. 

There are many untapped opportunities within a community to create connections among various health and human service organizations.  These connections can create more coordinated systems of care, decreasing barriers to access. 

In either case, donors can provide critical support as organizations and whole communities try new ways of delivering care to vulnerable populations. 

Meeting unmet needs.  In low-income communities, the most basic health care needs of many people go unmet.  Available services are often insufficient to meet demand; so, care ends up being rationed to the most urgent cases. 

Many face significant hurdles when attempting to access care:

• Cost, particularly when individuals lack insurance coverage
• Time, inability to take time off from work
• Lack of transportation
• Perception, real or imagined, that service providers will not be responsive or respectful

Local health care providers may choose to initiate new programs and services to address these barriers.  For example, a health center may decide to begin offering evening hours to better serve working poor populations.  Likewise, new translation services and cultural competency training for staff may be required to better serve the community.  These programs require both the will to establish and the resources to support added staff, overhead, training, etc. 

Changes in demography can yield dramatic changes in the health priorities of a community.   These changes can occur rapidly, leaving health providers unprepared. For example, when a community experiences a jump in its youth and young adult population, health providers may need to augment reproductive and family planning services.  Predicting these changes requires data, time and analysis, but can communities meet new health needs before they reach a crisis. 

Safety net providers are usually so preoccupied with meeting day-to-day challenges that they rarely have the opportunity to research, consider, and implement innovative new models for delivering care.  Yet, research on new models is constantly being disseminated by academia, government and foundations.  Donor support can give providers the space and time to review the latest and most relevant research in the field and test new approaches to delivering care. 

Connecting “hard-to-reach” populations to services.  Within low-income populations, certain groups tend not to be well-served by current networks of providers.  These groups include: youth/young adults, the homeless, gays/lesbians/transgenders, certain racial/ethnic groups, seniors, and men. 

Often, community providers might be aware of the need to reach out to particular groups but lack the resources or expertise to do so.  Community organizations may need to hire individuals with the appropriate background and expertise to effectively serve targeted groups. 

In other cases, support might be needed to assess the health needs of the community to determine which groups are underserved and why.  Support for community-based research and the dissemination of results can inform the development of new programs. 

An approach that providers may want to consider is expanding the use of technology to deliver and manage care. Tele-health is defined as the use of telecommunications and information technologies to share information, and to provide clinical care, education, public health, and administrative services at a distance. 

Telehealth can be especially vital for rural communities where residents may have to travel long distances to the nearest hospital or clinic.  Telehealth projects can not only improve access to care but can also improve organizational efficiency by offering alternative ways to see more patients. 

Creating coordinated systems of care.  Another way to address access-to-care barriers is by helping to foster cooperation among the various providers serving low-income populations.  Coordinating services among providers such as hospitals, community clinics, specialty providers, and other community-based organizations can create greater efficiencies in the system and fill gaps in services.  Creating a provider coalition, for example, can achieve increased sharing of resources, from translators to expertise on specific issues or populations.

Donors are unique in their ability to provide leadership through convening community stakeholders.  From a convening, stakeholders might agree to develop needs assessments that can advance health care services or develop crisis management plans.  A donor might convene both health care providers and other funders, to create a sense of shared resposnibility and action.

Expanding insurance coverage.  One way donors can expand insurance coverage among low-income populations is to support the statewide or regional coalitions dedicated to covering eligible groups.  Such coalitions can include providers, advocates, funders, local and state health departments, and other stakeholders in the issue.  Bringing such groups together is usually an effective way to address the coverage challenge because successful programs demand the skills and resources of multiple partners.

Baltimore Community Voices represents a broad-based partnership between the Baltimore City Health Department, the community, elected officials, and providers.  This coalition has the following goals:

• To ensure the best possible health services
• To reduce the incidence of risk factors among adolescents that lead to unhealthy outcomes
• To advocate for health, mental hygiene, environmental, and substance abuse services where they are needed

Based upon a health needs assessment that demonstrated serious health concerns among the young men of Baltimore, the Health Department opened a Men's Health Clinic, the first such facility in the nation. This free clinic serves uninsured men ages 19 to 64, providing primary and dental care, substance abuse counseling, and even links to jobs.

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Before you give...  New or expanded programs that help people access health care can fill a critical gap in services in a community, while leading to stronger communities overall. 

Whenever a group attempts to implement new programs, however, risk is involved. To mitigate this risk and ensure that the program lasts, it is important to explore a few issues.

Questions to consider before you give:

1. Are there gaps in current services which you think need to be filled?  What are they, and are there nonprofits which are ready to provide these services if they can raise sufficient funds? Or do you have an opportunity to urge a community group to try out a program you have seen work elsewhere?
2. Is there an opportunity for you to learn from testing this new way of addressing issues you care about? 
3. If successful, will the new program result in significant gains in employment? 
4. Does the group have the capacity (staffing, budget, time) to take on a new program? 
5. Does the group have a strategy to raise funds for the new program after its start-up phase? In other words, is there a plan for sustainability?
6. Will the program duplicate already existing services? 
7. Is the community group involving other community partners (for example, other nonprofits, potential beneficiaries of the program, business, government and philanthropic sectors)?
8. Having considered the other questions, what is the likelihood of success for new programs? Will failure harm the entire organization or the intended beneficiaries of the programs or might the leadership skills and experience gained allow the group to be successful next time? How much risk are you willing to accept?
9. In addition to grant money, are there other ways you can assist the group in meeting their goals?

You may find some questions irrelevant or have a few questions of your own, not listed here. This list is not meant to be exhaustive. 

Try using the questions as a springboard for lively and respectful conversation between you and a potential grantee. Or as a way of discussing a grant proposal with your fellow trustees, your family or other board members.

Related Reading

Other Ways to Take Action in Accessing care

• 2010 Health Care Reform: SmartLink Breaks It Down

  As a donor, you may be wondering how health care reform will affect individuals and families served by nonprofit health care providers, as well its impact on nonprofit organizations themselves. SmartLink has developed an overview of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act. Consider this summary a starting point. Over time, we will learn much more about how donors and communities can influence the health care for low-income communities.

• A FEW WORDS WITH Atum Azzahir

• Advocating for change

• Organizing for change

• Strengthening community groups

• Tackling immediate needs