Organizational Readiness for Community Health Worker Workforce Integration Among Medicaid Contracted Health Plans and Provider Networks: An Arizona Case Study

Abstract

Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona – which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.

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

“…The finding that CHWs make and receive referrals is consistent with nationally recognized CHW roles (6). Although a study in 2018 found limited CHW engagement in conducing assessments (27), the finding that CHWs are now conducting screenings for social needs is unsurprising, given the increasing interest in addressing social determinants of health and that some state Medicaid contracts specifically outline that role (24). As MCOs continue to engage CHWs in their service delivery models, it will be critical to ensure that CHWs' efforts to address social determinants of health are not limited to merely making referrals for social issues identified through screening.…”

“…In California, providers reported positive experiences when collaborating with CHWs through an MCO initiative that focused on ensuring that CHWs hired held credibility in their communities (26). A 2018 study found that hiring practices and qualifications for CHW employment varied widely among MCOs in Arizona (27) and coordination care organizations in Oregon have found that a lack of understanding of CHW roles among leadership has proved a barrier to CHW integration (28).…”

Participant engagement in a community health worker-delivered intervention and type 2 diabetes clinical outcomes: a quasiexperimental study in MexicanAmericans

“…22 37-41 Expanding diabetes care to include these types of interventions for high-risk patients has been considered by providers and payers. [42][43][44][45][46] For example, an integrative literature review conducted by Franklin et al concluded that interprofessional teamwork and collaboration with CHWs is associated with positive health outcomes and therefore recommended that 'patient care should no longer be delivered within the silos of individual health professions'. 47 This SyV study adds valuable new knowledge demonstrating that CHW-delivered programmes are associated with improved HbA1c outcomes over time and provides an example model of care.…”

“…More specifically, the SyV programme contributes to the growing body of evidence that participation in CHW interventions is associated with improved HbA1c outcomes 22 37–41. Expanding diabetes care to include these types of interventions for high-risk patients has been considered by providers and payers 42–46. For example, an integrative literature review conducted by Franklin et al concluded that interprofessional teamwork and collaboration with CHWs is associated with positive health outcomes and therefore recommended that ‘patient care should no longer be delivered within the silos of individual health professions’ 47.…”

Community Health Representative Workforce: Integration across systems and teams to address the social determinants of indigenous health and wellbeing

“…In Arizona, licensed healthcare providers, including those serving in Indian Health Service (IHS) and tribal health systems, consider CHRs to be valuable members of health teams ( 10 ). Moreover, Arizona Medicaid contracted health plans, 30% of whose members identify as Indigenous and AIAN, are highly motivated to integrate the broader Community Health Worker (CHW) workforce, inclusive of CHRs, within systems and teams ( 10 ).…”