Center for Healthcare Value and Equity, School of Medicine, LSU Health, New Orleans, LA, United States.
Department of Behavioral and Community Health Sciences, School of Public Health, LSU Health, New Orleans, LA, United States.
Front Public Health. 2023 Jan 13;10:1042750. doi: 10.3389/fpubh.2022.1042750. eCollection 2022.
Community health workers (CHWs) have historically worked in community-based settings. Medicaid managed care organizations (MCOs) are integrating CHWs into their teams, largely to support social determinants of health. Little is known about how teams are structured in these environments or how CHWs and their supervisors perceive CHW roles in MCOs.
In 2021, two CHW professional associations and a university partnered to conduct a national cross-sectional survey of CHWs working with MCOs.
A total of 146 CHWs representing 29 states and 55 supervisors working in 34 states completed the survey. Although two-thirds of supervisors said only a high school diploma or equivalent was required for hiring, over half of CHWs reported having a bachelors or graduate degree. The majority of CHWs (72.6%) and employers (80%) said CHWs receive training in core competencies. Under half of CHWs reported working with a registered nurse (RN) (45.8%) or social worker (43.8%), and about a third work with a behavioral health (36.3%) or primary care provider (33.6%). Among supervisors, 70.9% identified social workers as CHWs' team members and over half indicated CHW work with RNs (56.4%), behavioral health (54.5%) and primary care providers (52.7%). Over half of CHWs (52.1%) and roughly two thirds (63.6%) of supervisors indicated that CHWs use electronic health records. Roughly 85% of CHWs make referrals and roughly three quarters conduct social screenings. Around half of CHWs said they assist with care planning (54.1%), conduct health screenings (52.1%) or participate in case reviews (49.3%). About three quarters of CHWs (75.3%) and over two thirds of supervisors (67.3%) believed that CHWs are utilized to their full potential. Under three quarters of CHWs (72.6%) and over half of supervisors (54.4%) believe CHWs are equitably compensated for their work.
Overall, CHWs roles in MCOs appear to focus on supporting clinical care and making referrals for social issues, rather than addressing community-level concerns. Health plans should ensure that CHWs have the professional freedom to develop community-based solutions to common social needs. MCOs should also ensure that CHWs receive equitable compensation and ensure that CHWs have opportunities for promotion.
社区卫生工作者（CHWs）历史上一直在社区环境中工作。医疗补助管理式医疗组织（MCOs）正在将 CHWs 纳入其团队，主要是为了支持健康的社会决定因素。关于这些环境中的团队结构以及 CHWs 和他们的主管如何看待 MCO 中的 CHW 角色，知之甚少。
2021 年，两个 CHW 专业协会和一所大学合作，对与 MCO 合作的 CHWs 进行了全国性的横断面调查。
共有来自 29 个州的 146 名 CHWs 代表和来自 34 个州的 55 名主管完成了调查。尽管 2/3 的主管表示，招聘只需要高中文凭或同等学历，但超过一半的 CHWs 报告拥有学士或研究生学位。大多数 CHWs（72.6%）和雇主（80%）表示 CHWs 接受核心能力培训。只有不到一半的 CHWs 报告与注册护士（RN）（45.8%）或社会工作者（43.8%）一起工作，约三分之一的 CHW 与行为健康（36.3%）或初级保健提供者（33.6%）一起工作。在主管中，70.9%将社会工作者视为 CHWs 的团队成员，超过一半的人表示 CHW 与 RN（56.4%）、行为健康（54.5%）和初级保健提供者（52.7%）一起工作。超过一半的 CHWs（52.1%）和大约三分之二的主管（63.6%）表示 CHWs 使用电子健康记录。大约 85%的 CHWs 进行转介，大约四分之三（67.3%）的主管表示 CHWs 进行社会筛查。大约一半的 CHWs 表示他们协助进行护理计划（54.1%）、进行健康筛查（52.1%）或参与病例审查（49.3%）。大约四分之三的 CHWs（75.3%）和超过三分之二的主管（67.3%）认为 CHWs 被充分利用。不到四分之三的 CHWs（72.6%）和超过一半的主管（54.4%）认为 CHWs 的工作得到了公平补偿。
总体而言，CHWs 在 MCO 中的角色似乎侧重于支持临床护理和转介社会问题，而不是解决社区层面的问题。健康计划应确保 CHWs 有专业自由，为常见的社会需求制定基于社区的解决方案。MCO 还应确保 CHWs 获得公平补偿，并确保 CHWs 有机会晋升。
