Accelerate This: Making Healthcare More Accessible to Underserved Communities

In New Orleans, nearly 30,000 low-income residents qualified for free healthcare through the Greater New Orleans Community Health Connection, but few of these residents utilized the city’s network of free clinics. The city’s Office of Performance and Accountability, The Office of Neighborhood Engagement and the New Orleans Health department partnered with 504HealthNet to form the City Accelerator team. They sought to better understand why, despite the city’s high incidence of chronic disease, low-income residents rarely visited the clinics. The team came to understand the social and systemic barriers that discouraged residents from using available healthcare services, and tested civic engagement techniques that could be adopted by the city’s health department. Through the City Accelerator, New Orleans has:

• Encouraged more residents to use primary care services through Stand Up and Get Care, a multi-platform campaign including text messaging, mass media and health ambassador intervention techniques.
• Designed two community engagement curricula focused on training city hall and health department staff around human-centered design and engagement with the public.
• Received additional sustainability funding from the Louisiana Public Health Institute to sustain their work through April 2017.

Ideas to accelerate

1. Use behavioral science to drive change. The New Orleans team designed a text messaging pilot project to encourage qualified residents to make doctors’ appointments. Three versions of messages were sent to over 21,000 low-income adults, each one emphasizing a slightly different motivation to make an appointment. The results of this trial showed that people were most likely to reply to a message that emphasized ego (“you have been selected for a free doctor’s appointment”). This trial provided valuable insight: Simple, low-cost interventions -- when tested with the citizens they are designed to reach -- can be a promising method for reaching underserved people. The Philadelphia City Accelerator team employed a similar approach to encourage seniors to sign up for a tax benefit program.
2. Train community members to be ambassadors of public health initiatives. New Orleans co-designed a Health Ambassador program with 504HealthNet, the consortium of community-based health centers in New Orleans. The Health Ambassador program trains community members on the basics of primary care and health insurance, and supports local events that serve as safe spaces to have complicated conversations about and provide education on the importance of primary care and health insurance. The ideal health ambassador is someone who is already a trusted member of his or her respective community, and while this person may have a specific interest in health from a variety of personal and professional experiences, it is not a requirement. Health ambassadors serve as trusted sources of information for those who may not be reachable via traditional means like mailings or advertising.
3. Develop a toolkit to empower local residents. The City Accelerator team developed a Health Ambassador Toolkit, which served as a resource guide during Health Ambassador events and helped train health ambassadors. The toolkit is tailored to Louisiana health insurance program offerings and primary care resources in the greater New Orleans area. Using easy-to-understand language, the toolkit explains important concepts of health insurance benefits and eligibility requirements in a clear, engaging way.

Why this work matters

Low-income residents suffer disproportionately from poor health outcomes such as HIV/AIDS, syphilis and infant mortality, and the associated costs to government are substantial. Low-cost interventions like those piloted in New Orleans are a simple, but impactful way of reducing costs while improving service delivery for residents. After the devastation of Katrina, the availability and accessibility of healthcare for low-income residents in New Orleans was dangerously limited. New Orleans is a great example for all cities looking to engage residents in making healthier choices by employing behavioral science and community engagement strategies to encourage healthier choices.

The process

Stand Up and Get Care, a play on the song played when the New Orleans Saints make a touchdown, was designed to listen to and respond to New Orleans’ low-income residents. Emphasizing the element of inclusion, New Orleans (like other City Accelerator sites) staged a Design Day and sought to heavily involve low-income residents in the co-creation of key elements of the campaign, including the text messaging and Health Ambassador programs. The city’s health department has also utilized feedback from residents gathered during the project to improve its website and health education outreach materials.

Watch New Orleans’ pitch video here.