Academic journal article The Qualitative Report

Assessing a Coalition for Outreach and Enrollment in Minnesota's Health Insurance Exchange

Academic journal article The Qualitative Report

Assessing a Coalition for Outreach and Enrollment in Minnesota's Health Insurance Exchange

Article excerpt

Community coalitions have become a widespread and accepted means for addressing an array of health and social concerns. A community coalition can be defined as a group involving multiple sectors of the community coming together to solve local problems (Berkowitz & Wolff, 2000). The increasing complexity of social problems coupled with limited funding to address such issues are forcing social service agencies and community organizations to do more with less (Plastrik & Taylor, 2006). Such approaches are fitting given the multiple social, behavioral, economic, and environmental determinants of health and uninsurance.

In terms of the outcomes associated with coalitions, there have been demonstrated impacts on social norms, behaviors, programs and policies (Roussos & Fawcett, 2000) across a broad range of issues. However, systematic reviews of coalitions and other coordinated community health efforts have found limited evidence of their effect on population-level health outcomes (Kreuter, Lezin, & Young 2000; Roussos & Fawcett, 2000). Quantitative measurement of outcomes associated with coalitions has proven challenging because measures tend to be context-specific and lack information on reliability and validity (Granner & Sharpe, 2004). Furthermore, it is often challenging to attribute observed outcomes to coalition activities due to a lack of experimental research designs (Roussos & Fawcett, 2000; Zakocs & Edwards, 2006). At the same time, the complexity of issues addressed by coalitions and the complexities of the communities in which coalitions operate make systematic evaluations challenging (Wolff, 2001).

Qualitative approaches are well suited for describing coalition formation and assessing the processes that sustain coalition functioning, recognizing that coalitions cycle through stages of formation, implementation, maintenance, and institutionalization (Butterfoss et al., 2006). Context-rich discussions provide knowledge and ideas for action that are useful across settings. Further, they help advance the literature by providing realtime, real-place insight into these contextual factors that enhance coalition formation and function (Trickett et al., 2011). Qualitative approaches are relevant in the evaluation of the Insure Duluth Coalition given the novelty of state-based health insurance exchanges and community assistance as a platform and means to increase health insurance enrollment. At this stage we do not have a handle on what works or does not work, or even what aspects of location, organizations, or service delivery might be germane to this discussion.

The current study was undertaken to describe and assess the formation of the Insure Duluth Coalition, a community-developed coalition to increase access to health insurance in light of the Affordable Care Act's individual mandate. Coalition formation began with a lead agency bringing together key community partner organizations to focus on an issue of concern. Research indicates that coalition formation is supported by leadership from a lead agency, core members who have experience with the issue, staff who have the skills to carry out coalition tasks, and formal structures and processes for communication, decision-making, and conflict resolution (Butterfoss, Lachance, & Orians, 2006). These factors not only support coalition formation but also enhance coalition progression to the implementation stage (McLeroy et al., 1994). In addition, studies have shown improved health care utilization as a result of coalition work (Bencivenga et al., 2008; Collins, Johnson, & Becker, 2007; Fisher et al., 2004). A recent analysis of 7 community coalitions found policy and systems change as well as positive health outcomes associated with coalition work over five-years (Clark, et al., 2010). Such findings suggest that coalitions may work for increasing access to health insurance.

This study contributes to the literature by providing an in-depth view of coalition formation and the early implementation efforts of the Insure Duluth Coalition's efforts to increase access to health insurance. …

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