Lack of insurance is only one factor that keeps people from seeking health care. Additional factors include inadequate insurance which may include high deductibles, high co-payments, and no money left after other expenses such as housing and food.

• Community health workers | County Health Rankings & Roadmaps Community health workers (CHWs), sometimes called lay health workers, promotores de salud, community health representatives, or community health advisors, serve a variety of functions including providing outreach, education, referral and follow-up, case management, advocacy, and home visiting services. 
  • NNPHD Community Health Workers Currently funding for Wayne.  May be an opportunity for expansion.

• Federally qualified health centers (FQHCs) | County Health Rankings & Roadmaps  Federally qualified health centers (FQHCs) are public and private non-profit health care organizations that receive federal funding under Section 330 of the Public Health Service Act. Governed by a community board, FQHCs deliver comprehensive care to uninsured, underinsured, and vulnerable patients regardless of ability to pay. FQHCs are located in high need communities in urban and rural areas¹. Often called Community Health Centers (CHCs), FQHCs can also include migrant health centers, health care for the homeless centers, public housing primary care centers, and outpatient health programs or facilities operated by a tribe or tribal organization².
  • Midtown Health Center (Norfolk)
     
• Health literacy interventions | County Health Rankings & Roadmaps  Health literacy is the degree to which people have the capacity to obtain, process, and understand basic health information and services required to make appropriate health decisions¹. Low levels of health literacy are associated with limited health-related knowledge, poor health outcomes, and behaviors such as limited use of preventive care^2, 3, as well as higher health care costs and expenditures⁴. Elderly individuals, those with low levels of income and education, and racial and ethnic minority groups are at higher risk of having low health literacy^4, 5. Approaches to addressing limited health literacy include improving patient-provider communication, simplifying health information in educational materials, eHealth interventions (i.e., PCs and tablets with videos & interactive self-help tools), and efforts to improve underlying health literacy skills, such as the ability to read. These approaches can be delivered by various health care providers, clinic staff, and public health professionals^2, 6, 7.
  • Various NNRHN partners are currently working on this.  It is a goal of Northeast Nebraska Rural Health Network to work on coordinating these efforts. 

County Health Rankings maintains online database of strategies that have been identified as "What Works for Health" for the Health Factors that they measure.  "What Works for Health provides communities with information to help select and implement evidence-informed policies, programs, and system changes that will improve the variety of factors we know affect health."  Strategies for this indicator can be found at Uninsured in Nebraska | County Health Rankings & Roadmaps. Opportuntities to explore in the NNPHD health district include: 

• Health insurance enrollment outreach & support | County Health Rankings & Roadmaps
• Text message-based health interventions | County Health Rankings & Roadmaps
• Mobile health for mental health | County Health Rankings & Roadmaps