Medicaid community health workers have positive impact on care

Community health workers employed by Medicaid health plans can help low-income people who face barriers to health care rely less on the emergency room, and more on outpatient care, a new study finds. The CHWs in the study worked with Medicaid participants to make a plan for their health and connecting them with services in their local area.

And that may lead to better use of funding, and potentially lower costs, for the Medicaid system over the long run, the researchers say.

The new findings come from the most rigorous study of a real-world CHW program to date, a randomized controlled trial conducted by the University of Michigan Institute for Healthcare Policy and Innovation in partnership with local and state organizations and agencies.

But the study also shows the challenges involved in making the connection between CHW and high-use Medicaid participants. The findings could help Medicaid CHW programs in Michigan and beyond improve how they support and structure their efforts to bridge the gap between people and services.

"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 U-M 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."

Heisler and her IHPI colleagues conducted the study with the help of three of Michigan's Medicaid managed care insurance plans, which since 2016 have been required to have CHW programs. They focused on the predominantly Black and low-income neighborhood of Detroit called Cody Rouge. The evaluation design and implementation were done in partnership with the Detroit Health Department, the Joy-Southfield Community Development Corporation and the Michigan Community Health Worker Alliance.

Challenges the CHWs faced in reaching and engaging with plan members meant that just 284 of them were reached by CHW outreach. About half of that number actually engaged with a CHW to assess their health and social needs, make a plan and get referrals to local services.

But even with this low uptake, the study showed significant differences. By the end of the first year after the randomization, the group of 284 people who had some contact with a CHW had an average of 6.4 medical office visits per person-year, and 2.8 emergency department visits per person-year, compared with 5.3 and 3.1 for the control group and 4.8 and 3 for the group of 1,100 people who were randomized to the CHW arm but had no contact with a CHW. 

Many other studies have shown that CHW programs can improve clinical outcomes and decrease hospital readmission rates and costs. But these have not been large randomized controlled trials that set out to measure effectiveness of a real-world CHW model with fully funded staff, rather than CHWs funded by a grant.

Paper cited: "Impact on Health Care Utilization and Costs of a Medicaid Community Health Worker Program in Detroit, 2018–2020: A Randomized Program Evaluation," Am J Public Health. DOI: 10.2105/AJPH.2021.306700