‘A close review of the reality show shows that urgent care and costs have gone down, while outpatient care has increased, among low-income Detroiters who have connected with healthcare workers. community (CHW). ‘
A new study finds that community health workers employed by Medicaid health plans help low-income people with barriers to care rely less on the emergency room and more on outpatient care.
br> And that could lead to better use of funding and potentially lower costs for the Medicaid system in the long run, the researchers say.
br> The new finding comes 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 Health Policy and Innovation in partnership with the University of Michigan. cooperation with local and state agencies and organizations. It is published in American Journal of Public Health.
br> But the study also points to challenges associated with making connections between CHWs and high-use Medicaid participants. The findings could help Medicaid CHW programs in Michigan and beyond improve the way they support and structure their efforts to close the gap between people and services.
br> “These results are truly encouraging, especially through the lens of the success of Medicaid plans in terms of reducing acute care use and increasing emergency care use among those without access to primary care,” said Michele Heisler, MD, MPA, project leader and professor of internal medicine at UM School of Medicine. “This is very encouraging because the CHW programs can be sustained over the long term, because of the potential to translate into cost savings. But our results also show the importance of flexibility and durability. when connecting with this group of patients.”
br> Heisler and her IHPI colleagues conducted the study with the help of three of Michigan’s Medicaid managed care plans, which since 2016 have mandated CHW.
br> They focused on Detroit’s predominantly Black and low-income neighborhood known as Cody Rouge, where high numbers of Medicaid enrollees did not receive primary care and instead went to emergency room, and a strong social and local community network. service organisations. They partnered with the Detroit Department of Health, the Joy-Southfield Community Development Corporation, and the Michigan Community Health Workers Coalition to design and conduct a CHW program review that has been implemented in three health plans .
The study randomly assigned nearly 2,500 Medicaid participants who had sought urgent care three or more times in the last year, or had been hospitalized for a condition that could be effectively treated. in an outpatient facility. Participants were 65% female, with an average age of about 30 and income below 133% of the poverty level. Just under 1,400 people assigned to the group can be contacted by CHW.
br> But the challenges CHW faces in actually reaching and interacting with these individuals means that only 284 of them have access to CHW access. About half of them actually engage with a CHS for their health and social needs assessment, planning and referral to local services.
br> The CHS health program encounters obstacles to effective access including outdated contact information for participants, working hours that do not match participant availability, and participants were worried about why CHS was trying to reach them.
br> But even with this low absorption, the study showed a significant difference. At the end of the first year after randomization, the group of 284 people exposed to a CHS had an average of 6.4 clinic visits per person per year and 2.8 emergency department visits per person per year. years, 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 group but had no exposure to CHW.
br> The annual per-person urgent care costs for the 284-active group were about $500 less than the controls, and the outpatient costs were about $450 more. The total cost is no different.
br> All CHWs in the study were Black and were from Cody Rouge or familiar with the surrounding area. They all underwent general training in autonomous supportive communication and other CHW best practices, and used similar health and social needs assessment guidelines for initial exposure. with the participants. This is consistent with the CHW model, which focuses on hiring and training people who share characteristics such as culture, ethnicity, language, and community with the people they serve.
br> Many other studies have shown that CHW programs can improve clinical outcomes and reduce hospitalization rates and costs. But these are not large randomized controlled trials that measure the effectiveness of a real-world CHW model with fully funded staff, but not a funded CHW. In addition, very few people have considered both urgent and urgent care, such as emergency visits and hospitalization.
br> Heisler noted that as a result of the study, related Medicaid health programs worked to contract with local community organizations for CHW employees, so they were more in touch with the community. specific area or neighborhood. The plans have allowed CHWs to work evenings and weekends, rather than just during normal business hours when many registrants are at work or school and are unavailable. The CHW model, which is part of Michigan’s Medicaid program, should be used by others nationwide, she said.
br> An accompanying editorial by Natalia Rodriguez, PhD, of Purdue University calls the new study a ‘rigorous methodological template’ for evaluating other CHW programs and concludes, “the Health plan-run CHWs such as the one described by Heisler et al can serve as an innovative model for other contexts.”
br> The full study design is described in this paper. The study was funded by the Blue Cross Blue Shield of Michigan Foundation, the Michigan Department of Health and Human Services, the Ralph C. Wilson Foundation, Poverty Solutions at the University of Michigan, and the National Institutes of Diabetes and Digestive and Kidney disease (DK092926). It has National Clinical Trial Number NCT03924713.
br> In addition to Heisler and first co-author Adrienne Lapidos, Ph.D. of UM’s Department of Psychiatry, the study’s authors include senior author and IHPI director John Z. Ayanian, MD, MPP, Edith Kieffer, PhD, of the UM School of Social Work, and Rebeca Guzman, of the Detroit Department of Health.
br> Citation: Impact on health care utilization and costs of the Medicaid community health worker program in Detroit, 2018-2020: A randomized program review, Am J Public Health. Published online before print March 24, 2022: e1-e10. DOI: 10.2105/AJPH.2021.306700