Open AccessWhat Are the Roles of Community Health Workers in Medicaid Managed Care? Results from a National Study
Author(s) -
Ashley Wennerstrom,
Catherine Haywood,
Denise O Smith,
Dakshu Jindal,
Carl H. Rush,
Geoffrey Wilkinson
Publication year - 2022
Publication title -
population health management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 40
eISSN - 1942-7905
pISSN - 1942-7891
DOI - 10.1089/pop.2022.0191
Subject(s) - psychological intervention , managed care , medicaid , nursing , community health workers , service delivery framework , medicine , population , operationalization , health care , community health , family medicine , business , service (business) , public health , environmental health , health services , economic growth , marketing , philosophy , epistemology , economics
Managed care organizations (MCOs) are increasingly engaging community health workers (CHWs) to support service delivery for their members, particularly in the realm of social determinants of health. Some states now require MCOs to offer CHW services. Although the roles and activities of CHWs working in other contexts (eg, clinics, hospitals, community-based organizations) are well established, there is sparse knowledge about how MCOs are operationalizing CHW roles and whether CHW activities differ based on whether CHWs are employed directly by MCOs or contracted through other organizations. In 2021, 2 CHW professional associations and a university partnered to conduct a national cross-sectional survey of CHWs working with MCOs. Respondents ( n = 146) represented 29 states. CHWs employed by MCOs reported receiving significantly more training and benefits from their employers than CHWs who were contracted through other organizations. MCO-based CHWs were more likely to support members with high-cost conditions and high service use, whereas contracted CHWs were more likely to engage in population-focused interventions, which may produce less immediately visible financial returns. Health plans would do well to ensure the CHWs they support, whether through contract or direct hiring, receive appropriate compensation and training, and have the freedom to engage in the full range of CHW roles, including community-level interventions.