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Medicaid Community Health Workers Cut Emergency Department Utilization

Community health worker programs implemented by Medicaid reduced avoidable emergency department utilization among low-income Detroit residents and increased patient reliance on outpatient care.

Medicaid community health workers facilitated better care access for low-income patients by boosting reliance on outpatient care and decreasing avoidable emergency department utilization, according to a new study. This ultimately cut patient care costs, the researchers said.

Community health workers play a major role in addressing social determinants of health that plague underserved communities. They are trained frontline healthcare workers who have a unique understanding of the community they serve.

The University of Michigan Institute for Healthcare Policy and Innovation study conducted in partnership with several local state organizations analyzed the effect community health workers had on healthcare utilization and healthcare cost. 

Community health workers reached out to Medicaid beneficiaries from Cody Rouge, a predominantly Black and low-income neighborhood of Detroit, to assess their health and social needs.

However, only 284 plan members engaged with community health workers, highlighting the patient engagement challenges involved in forming proper connections. Even fewer members allowed a community health worker to refer them to services that address their health and social needs.

Despite the low uptake of these services, engagement with community health workers dramatically improved care access for vulnerable patients.

Beneficiaries who engaged with a community health worker had an average of 6.4 ambulatory care visits per person per year, compared to 5.3 ambulatory care visits per person per year for patients with no community health worker contact.

“These results are really heartening, especially through the lens of success for Medicaid plans of decreasing acute care use and increasing use of ambulatory care among individuals who have not been accessing primary care,” Michele Heisler, MD, MPA, who led the project and is a professor of internal medicine at the U-M Medical School said in a public statement.

Emergency department visits also decreased to an average of 2.8 per person per year after engagement with a community health worker, compared to 3.1 visits per person per year for patients without contact.

Greater emergency department utilization often indicates inadequate access to other low-acuity services, like primary care. If patients are turning to the emergency department for treatable conditions, it may also be due to a lack of care coordination or patient education.

Visiting the emergency department can also generate high out-of-pocket expenses for patients. Reducing the number of avoidable emergency department visits can improve patient outcomes overall.

“This is very encouraging for being able to sustain CHW programs over the long term because of the potential to translate to cost savings,” Heisler added. “But our results also show the importance of flexibility and persistence when it comes to connecting with this patient population.”

The role of community health workers is expanding in the medical practice. Nationwide, organizations are training community health workers as it is an effective outreach method to connect patients to social services.

In hopes of improving care access, Ohio University partnered with Jackson Country Health Department to train community healthcare workers in several cities across Ohio.

South Ohioan residents face challenges such as population age, resistance to seeking outside assistance, transportation, poverty, food, and housing issues, further complicating COVID-19 matters.

In addition, residents face health disparities such as higher rates of chronic illnesses, putting them at higher risk for worse COVID-19 outcomes. 

Community health workers can improve health outcomes for underserved populations through enhanced health literacy and resource access.

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