Community health worker team integration in Medicaid managed care: Insights from a national study

Abstract

IntroductionCommunity health workers (CHWs) have historically worked in community-based settings. Medicaid managed care organizations (MCOs) are integrating CHWs into their teams, largely to support social determinants of health. Little is known about how teams are structured in these environments or how CHWs and their supervisors perceive CHW roles in MCOs.MethodsIn 2021, two CHW professional associations and a university partnered to conduct a national cross-sectional survey of CHWs working with MCOs.ResultsA total of 146 CHWs representing 29 states and 55 supervisors working in 34 states completed the survey. Although two-thirds of supervisors said only a high school diploma or equivalent was required for hiring, over half of CHWs reported having a bachelors or graduate degree. The majority of CHWs (72.6%) and employers (80%) said CHWs receive training in core competencies. Under half of CHWs reported working with a registered nurse (RN) (45.8%) or social worker (43.8%), and about a third work with a behavioral health (36.3%) or primary care provider (33.6%). Among supervisors, 70.9% identified social workers as CHWs' team members and over half indicated CHW work with RNs (56.4%), behavioral health (54.5%) and primary care providers (52.7%). Over half of CHWs (52.1%) and roughly two thirds (63.6%) of supervisors indicated that CHWs use electronic health records. Roughly 85% of CHWs make referrals and roughly three quarters conduct social screenings. Around half of CHWs said they assist with care planning (54.1%), conduct health screenings (52.1%) or participate in case reviews (49.3%). About three quarters of CHWs (75.3%) and over two thirds of supervisors (67.3%) believed that CHWs are utilized to their full potential. Under three quarters of CHWs (72.6%) and over half of supervisors (54.4%) believe CHWs are equitably compensated for their work.DiscussionOverall, CHWs roles in MCOs appear to focus on supporting clinical care and making referrals for social issues, rather than addressing community-level concerns. Health plans should ensure that CHWs have the professional freedom to develop community-based solutions to common social needs. MCOs should also ensure that CHWs receive equitable compensation and ensure that CHWs have opportunities for promotion.

Mutually Supportive and Inclusive Societies Driven by Community Social Workers in Japan: A Thematic Analysis of Japanese Comics

“…Furthermore, their nuanced approach to leveraging diverse social resources, as noted by other social work studies, amplifies the community's capacity to address issues and maximizes community assets for sustained impact [39]. Crucially, CSWs not only act as facilitators, but also as educators.…”

Roles and Responsibilities of Community Health Workers in Louisiana Medicaid Managed Care Organizations

“…In fulfilling these requirements, MCOs maintain leeway to develop their own service delivery and staffing models. With a few exceptions (George et al, 2020; Johnson, 1998; Sabo et al, 2021; Wennerstrom et al, 2023, 2022), there is limited information about whether MCOs employ best practices established by the CHW field such as hiring based on community connection (Jackson & Parks, 1997), measuring outcomes based on the CHW Common Indicators (CI) Project (Rodela et al, 2021), and training on and enacting the 10 core roles and 11 core skills outlined by the Community Health Worker Core Consensus (C3) Project (Rosenthal et al, 2021). Hiring and training strategies vary widely among MCOs in Arizona (Sabo et al, 2021).…”

“…Oregon MCO leaders lack familiarity with the CHW role, creating challenges to team integration (George et al, 2020). A 2021 survey suggests that CHWs employed by MCOs generally focus on individual members' health (Wennerstrom et al, 2023, 2022) rather than activities such as capacity building and community-level advocacy that promote health among entire populations (Pérez & Martinez, 2008; Rosenthal et al, 2021; Sabo et al, 2013). However, there is some evidence that community-based CHWs who receive contracts to provide services to MCO members focus more broadly on population health than MCO-based CHWs (Wennerstrom et al, 2022).…”