Community health workers (CHWs) are trusted community partners who utilize unique, nontraditional approaches to care for our members. And they are critical to improving care access and ensuring that our members receive the care they need, when they need it, to manage their conditions. But the health system still lacks an effective way to pay for the services CHWs provide, making federal and state Medicaid policy reforms a priority as we continue to depend on these workers to connect members to care.
The health system still lacks an effective way to pay for the services CHWs provide, making federal and state Medicaid policy reforms a priority as we continue to depend on CHWs to connect members to care.
Impact of community health workers
Research done to date has identified that CHWs can help improve health outcomes and lower health care costs for the Medicaid population. In one study of a program in New York that utilizes CHWs, emergency department visits and hospitalizations decreased and health care savings were achieved for members.1 The impact of CHWs is more directly experienced through individual stories that highlight the work they do every day to support our members.
Tiffany,* a CHW at UnitedHealthcare Community & State, worked with a member who did not want to obtain care for their behavioral health needs. Tiffany first started interactions by explaining the difference between a psychiatrist and a therapist to the member. With that understanding, the member was inclined to make an appointment, which was scheduled, and the member is now continuing to see a therapist on a regular schedule. In addition to their behavioral health needs, the member has experienced numerous falls. However, they did not like to use a walker or wheelchair. Tiffany was able to educate the member about the benefits of using a walker or a wheelchair to ensure their safety. As a result, the member is now willing to try using a walker and has spoken to their primary care provider about ordering one. The member also actively smoked, so Tiffany initiated conversations about the Smoking Cessation Program and a referral was completed. The member is now using a nicotine patch to try to quit smoking.
Reimbursement for community health worker services
While some state Medicaid agencies allow for reimbursement for select CHW services, there is potential for states to allow Medicaid to pay for additional services. Currently, many managed care organizations pay for services provided by CHWs within administrative budgets. But this significantly limits the services that can be covered, and we believe that financing additional services provided by CHWs is critical to strengthening care for our members.
While some state Medicaid agencies allow for reimbursement for select CHW services, there is potential for states to allow Medicaid to pay for additional services.
The hesitation to expand coverage for these services is often rooted in the unconventional (but effective) approach many CHWs take to serve members. Whereas Medicaid typically reimburses health plans using codes that indicate specific services performed, CHWs often approach each situation differently to best serve the individual in need of care. This holistic approach to care creates an opportunity to rethink the parameters around CHW services. While the health system requires consistency for reimbursements, it shouldn't be too constraining or require CHWs to adhere to a strictly medical approach, which is not always effective for our members.
Utilizing partnerships to improve care access
At UnitedHealthcare Community & State, we are committed to supporting CHWs and advocating for the critical services they provide. We have formed a formal partnership with the National Association of Community Health Workers, a recently launched organization made up of public health workers that support communities in achieving health, equity and social justice. We also partner with the National Association of Community Health Centers, which focuses on comprehensive care and expanded health care access for the medically underserved and uninsured. We are working with both organizations to support CHWs and advocate for funding the services they provide
By listening and learning from the experiences of these organizations and the CHWs working for UnitedHealthcare Community & State, we are working hard to develop more strategic and inclusive policies and programs to directly improve care for our members.
Thank you to all of the CHWs out there providing critical support — you have our respect and gratitude.
* Not her real name