Abstract
We describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are
high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448
enrollees who were assigned to field-based CHWs in 11 of New Mexico’s 33 counties. The CHWs provided patients education, advocacy
and social support for a period up to 6 months. Data was collected on services provided, and community resources accessed.
Utilization and payments in the emergency department, inpatient service, non-narcotic and narcotic prescriptions as well as
outpatient primary care and specialty care were collected on each patient for a 6 month period before, for 6 months during
and for 6 months after the intervention. For comparison, data was collected on another group of 448 enrollees who were also
high consumers of health resources but who did not receive CHW intervention. For all measures, there was a significant reduction
in both numbers of claims and payments after the community health worker intervention. Costs also declined in the non-CHW
group on all measures, but to a more modest degree, with a greater reduction than in the CHW group in use of ambulatory services.
The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services
to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization
and cost.
high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448
enrollees who were assigned to field-based CHWs in 11 of New Mexico’s 33 counties. The CHWs provided patients education, advocacy
and social support for a period up to 6 months. Data was collected on services provided, and community resources accessed.
Utilization and payments in the emergency department, inpatient service, non-narcotic and narcotic prescriptions as well as
outpatient primary care and specialty care were collected on each patient for a 6 month period before, for 6 months during
and for 6 months after the intervention. For comparison, data was collected on another group of 448 enrollees who were also
high consumers of health resources but who did not receive CHW intervention. For all measures, there was a significant reduction
in both numbers of claims and payments after the community health worker intervention. Costs also declined in the non-CHW
group on all measures, but to a more modest degree, with a greater reduction than in the CHW group in use of ambulatory services.
The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services
to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization
and cost.
- Content Type Journal Article
- Category Original Paper
- Pages 1-9
- DOI 10.1007/s10900-011-9484-1
- Authors
- Diane Johnson, University of New Mexico, Room 137 MSC 09 5065, Albuquerque, NM 87131, USA
- Patricia Saavedra, University of New Mexico, Room 137 MSC 09 5065, Albuquerque, NM 87131, USA
- Eugene Sun, Molina Healthcare of New Mexico, Albuquerque, NM, USA
- Ann Stageman, Molina Healthcare of New Mexico, Albuquerque, NM, USA
- Dodie Grovet, Molina Healthcare of New Mexico, Albuquerque, NM, USA
- Charles Alfero, Hidalgo Medical Services, Hidalgo, NM, USA
- Carmen Maynes, Hidalgo Medical Services, Hidalgo, NM, USA
- Betty Skipper, University of New Mexico, Room 137 MSC 09 5065, Albuquerque, NM 87131, USA
- Wayne Powell, University of New Mexico, Room 137 MSC 09 5065, Albuquerque, NM 87131, USA
- Arthur Kaufman, University of New Mexico, Room 137 MSC 09 5065, Albuquerque, NM 87131, USA
- Journal Journal of Community Health
- Online ISSN 1573-3610
- Print ISSN 0094-5145