High Health Care-utilizing Medicaid Beneficiaries
Conditions
Keywords
Community health worker, health care utilization
Brief summary
The investigators are comparing health care utilization claims data of Medicaid beneficiaries who participated in a CHW program led by three Medicaid health plans' salaried CHWs in the Cody Rouge neighborhood of Detroit, Michigan with eligible beneficiaries who were not invited to participate in the program but received usual health plan services.
Detailed description
This program evaluation examines the effectiveness, barriers and facilitators of implementing a geographically targeted program led by salaried CHWs from three Medicaid health plans in collaboration with the Detroit Health Department and Joy Southfield Community Development Corporation. Beneficiaries who reside in the Cody Rouge neighborhood and had more than 3 Emergency Department (ED) visits or at least 1 ambulatory care-sensitive hospitalization in the prior 12 months are randomized to the CHW program or to usual outreach from the health plans. CHWs reach out to eligible beneficiaries to provide a comprehensive assessment of health, behavioral, and social needs; link them to needed resources; and provide necessary follow-up. At 12- month follow up, health plan claims data on ED visits, ambulatory care-sensitive hospitalizations, primary care visits and all related costs will be compared between participants who participated in this program compared with other participants who would have been eligible but were not offered the program (with no effort to contact them). The investigators hypothesize that patients enrolled in the CHW intervention will experience a reduction in acute care usage resulting in cost savings compared to those receiving usual health plan CHW outreach. This study is among the first to evaluate the impact on health care utilization of augmented services delivered by health plan CHWs for high-utilizing health plan members. This study will provide important information on the sustainability of future health plan CHW programs and provide insights into effective implementation of such programs.
Interventions
BEHAVIORALSupportive services
Assessment of behavioral, medical, and social needs, development of individual goals and action plan, follow-up to assist and work to ensure identified needs/goals are met. CHWs use their professional judgement to assess how long follow-up is required.
Sponsors
Molina Health Care of Michigan
Meridian Health Plan of Michigan
Blue Cross Complete
Detroit Department of Health
Blue Cross Blue Shield of Michigan Foundation
Ralph Wilson Foundation
University of Michigan
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Either have had more than 3 ED visits in the prior 12 months, or at least 1 ambulatory care-sensitive hospitalization in the prior 12 months
Exclusion criteria
* None if they meet above criteria.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergency Department Visits | 12-month period after participant enrolls in the program | Number of Emergency Department visits in health plan claims data |
| Hospitalizations | 12-month period after participant enrolls in the program | Number and length of stay of hospitalizations in health plan claims data |
| Primary care visits | 12-month period after participant enrolls in the program | Number of primary care visits in health plan claims data |
Countries
United States
Outcome results
None listed