Rural Affordable Care Act outreach and enrollment: what we learned during the first marketplace open enrollment period.

As part of the Patient Protection and Affordable Care Act (Affordable Care Act) of 2010, 2 new opportunities for health care coverage were established for many uninsured individuals beginning on January 1, 2014. The first opportunity was through Medicaid expansion where states had the opportunity to expand Medicaid coverage to individuals with household incomes up to 133% of the federal poverty level. The second opportunity was through the establishment of Health Insurance Marketplaces where individuals could purchase private health plans and potentially qualify for financial assistance in paying for their plans. The Office of Rural Health Policy (ORHP) provided supplemental grant awards to help stimulate Affordable Care Act outreach and education efforts in rural communities that were being served by the Rural Health Care Services Outreach (Outreach) Grant Program. As a result, Outreach grantees enrolled 9,300 rural Americans during the initial Open Enrollment period. Valuable outreach and enrollment lessons were learned from rural communities based on discussions with the Outreach grantees who received the supplemental funding. These lessons will help rural communities prepare for the next Open Enrollment period.

Redesigning the system from the bottom up: lessons learned from a decade of federal quality improvement collaboratives.

The Health Resources and Services Administration (HRSA) is a federal agency that provides support and resources for America's safety-net providers. For more than 10 years, HRSA has engaged in Quality Improvement Breakthrough Collaboratives that have brought together multiple stakeholders to improve quality of care and enhance patient outcomes for the most vulnerable populations. Many of these collaboratives followed the Institute for Healthcare Improvement's Breakthrough Series Collaborative model and methodology to implement small tests of change that helped generate process improvements and clinical outcomes. This commentary summarizes HRSA's experience with these Quality Improvement Breakthrough Collaboratives, focusing on key lessons learned, in order to help inform and enhance future quality improvement efforts in both the public and the private sectors.