Medicaid enrollees in a community health worker program had fewer emergency department visits and more outpatient ambulatory care use than beneficiaries who received usual care.
Overuse of acute care and underuse of ambulatory or outpatient care for chronic conditions indicates individuals may have unmet social needs and barriers to accessing health care. Community health workers (CHWs) can help connect these individuals with health and social services, but few controlled trials have studied CHW program effects on acute and ambulatory care. This study evaluates the impacts of a Michigan CHW program under real-life conditions for Medicaid beneficiaries. The program was designed by three Medicaid health plans, the Detroit Health Department, a community-based organization, and a university and was staffed by salaried Medicaid health plan CHWs.
At 12-month follow-up, Medicaid enrollees randomized to the program had fewer emergency department visits and more outpatient ambulatory care use than beneficiaries who received usual care. There was not a decrease in total costs due to the greater ambulatory care use. In addition, only 16 percent of plan beneficiaries randomized to the program actually engaged with the program. The reasons for this are cited in a related study.
Increased use of ambulatory care and lessened reliance on emergency services may be a short-term marker of success of a CHW program for underserved communities due to lessened reliance on emergency services. State Medicaid programs and plans may apply this partnership approach to provide sustainable funding for CHW programs that address social, behavioral, and medical needs.