TakeAction Minnesota Education Fund
What has been most instrumental to your progress?
Door to door conversations. To foster in-depth questioning and listening, TakeAction sent trained volunteers and staff through neighborhoods statewide to hear about people’s experiences with health care generally, and MNsure specifically. These dialogues were important for two reasons. First, they were inclusive, providing direct access to the public at large, with a focus on low-income and racially diverse neighborhoods. Second, the feedback they provided was clear. Our conversations highlighted that regardless of program or market, people largely rated their coverage based on affordability and simplicity. Those who said they were happy with their healthcare were often enrolled in public programs or had generous employer coverage. The group in between, those buying insurance on the private market, often complained that premiums were expensive, deductibles high, costs unpredictable, and the plans hard to understand. Many individuals initially contacted on the doors agreed to follow up conversations to share more in depth about their health care experiences, and several joined regular meetings of a community team planning outreach, enrollment, and listening activities to engage.
Community storytelling event. In August, TakeAction hosted a “Story Harvest,” a format designed to tease out themes that emerge from personal narratives. Our harvest was organized around the question “Health equity and access – how can we create it together?” 50 people gathered, including a representative from MNsure, to hear eight people tell their own healthcare stories. Stories covered enrolling through MNsure, personal health stories, financial concerns and unique health insurance situations. Storytellers were invited in advance, and listeners were able to choose two stories to listen to during the day. Listeners volunteered to focus and take notes on common themes across the stories, and to share these back in the larger group. An artist sketched the themes that emerged in the final discussion, creating visual as well as written notes. The story harvest connected members of the community across divergent experiences, allowed for organic commonalities and insights to surface, and provided a window into how the successes and failures of the healthcare system (and recent changes) are affecting the lives of individuals.
Working collaboratively with navigators. TakeAction staff talked with over 200 navigators in settings that included two large trainings in Minneapolis and Duluth, frequent check-in calls with over a half-dozen navigator organizations, a conference for community health workers, and localized debriefs in Duluth and the Twin Cities after the first open enrollment period. These conversations about what was (and wasn’t) working in the new healthcare rollout made clear that navigators were quickly becoming a vital community resource, uniquely positioned to identify issues on the ground and look beyond individual situations to systemic solutions. TakeAction helped feed the navigators’ observations and suggestions back to MNsure staff, so they could improve the process as the roll-out proceeded. This partnership was important because navigators, like MNsure itself, were strapped for time and capacity to elevate the issues they identified on their own. Many stakeholders identified the need for improved communications between navigators and the various entities involved in eligibility and enrollment.
Other key elements of Community Innovation
First, our process was grounded in people’s immediate experiences. Problem solving in large public agencies is not always grounded in the lived experiences of real people. We created a channel of communication (by way of the navigators and our own direct contact with enrollees) to report problems people were facing on the ground, in real time, and suggest solutions. When one person would report an issue to us our staff and community leaders would reach out to navigators and other enrollees for advice for that individual, and also to establish a pattern and better understand the issue and if and how it needed to be reported. Through that work, we expanded people’s understanding of their roles. Many people employed as enrollment assisters for healthcare or other programs focus on helping individuals. Working together they were able these assisters were able to also inform the system so it worked better for themselves and those they served.
Understanding the problem
Through our process we developed clarity on the importance of infrastructure among navigators. Improvements in Minnesota’s enrollment infrastructure, and in communications with navigators, have allowed navigators to begin to identify some bigger picture problems and solutions. For example, navigators are developing ideas for a more robust online community that could help enrollment assisters and community organizations with continuing education, real-time problem solving, and communicating with health care agencies. We have hired a former navigator who is providing support and building relationships with a broader range of assister organizations state wide.
If you could do it all over again...
We have learned the value of engaging with Minnesota’s enrollment infrastructure more broadly. Minnesota’s health care coverage and enrollment infrastructure bridges many agencies, as well as people’s individual and private insurance. Many families have a mix of coverage statuses and experiences under one roof, or over time, and when asked about what is important to them in health care, their answers don’t fall neatly into things that one entity, policy, or agency can respond to. Luckily our process for engaging people was broad enough to allow this finding to surface quickly. Through this grant we have still focused on communicating issues related to Minnesota’s new and developing enrollment infrastructure, but we are aware that the priorities we are hearing on the ground also speak to other areas for community engagement – with employers, policy-makers, public health officials, and beyond.
One last thought
We are sharing images from our “story harvest,” an innovative visual method for extracting the big picture out of the individual narratives of many individuals.