Community health workers under Medicaid plans positively impact quality and access to care

Medicaid community health workers (CHW) lead to a more positive impact on health care and preventative care, according to a new study by the Institute for Healthcare Policy and Innovation (IHPI) at the University of Michigan (UM). 

The study also showed that these CHW programs may lead to better use of Medicaid funding and lower costs in the system over the long run. 

 

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“These results are really heartening, especially through the lens of success for Medicaid plans of decreasing acute care use and increasing use of ambulatory care among individuals who have not been accessing primary care,” said Michele Heisler, M.D., M.P.A., who led the project and is a professor of internal medicine at the UM Medical School. 

“This is very encouraging for being able to sustain CHW programs over the long term, because of the potential to translate to cost savings. But our results also show the importance of flexibility and persistence when it comes to connecting with this patient population.” 

CHWs act as health care navigators for Medicaid health plans to assist low-income individuals who typically face barriers to care find the care they need. CHWs aim to guide Medicaid-eligible people out of the emergency departments (ED) and into outpatient and primary care settings. 

This new study, with the help of three Michigan Medicaid managed care plans, randomly assigned 2,500 Medicaid participants who sought emergency care three or more times in the last year, or have been hospitalized for a preventable condition. The study focused on the predominantly Black and low-income neighborhood of Detroit called Cody Rouge, which has high numbers of Medicaid members not accessing primary care. 

The participants were 65% female with an average age of 30 and incomes below 133% of poverty level. Of the 1,400 assigned to a group to be contacted by a CHW, only 284 were actually reached. Of those reached, about half actively engaged with the CHW to assess their health and social needs. 

CHW met hurdles to contacting members including outdated contact information, worries among enrollees about why the CHW was trying to reach them, and availability challenges. 

However, the study still showed positive outcomes for those who they did manage to reach. The contacted group had an average of 6.4 medical office visits per year and 2.8 ED visits, compared to 5.3 and 3.1 from the control group. 

The study also found that emergency care costs per person per year were about $500 less for the active group working with the CHW than the control group, while outpatient costs were $450 more for the active group. 

According to IHPI, many other studies show that these programs can improve clinical outcomes and decrease hospital readmission rates and costs. Heisler noted that this model should be used nationwide to improve access to care for underserved people.