Elevance Health Inc, Indianapolis, IN, USA.
Trilliant Health, Brentwood, TN, USA.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231153602. doi: 10.1177/21501319231153602.
INTRODUCTION/OBJECTIVES: In 2018, a Medicaid managed care plan launched a new community health worker (CHW) initiative in several counties within a state, designed to improve the health and quality of life of members who could benefit from additional services. The CHW program involved telephonic and face-to-face visits from CHWs who provided support, empowerment, and education to members, while identifying and addressing health and social issues. The primary objective of this study was to evaluate the impact of a generalized (not disease-specific), health plan-led CHW program on overall healthcare use and spending.
This retrospective cohort study used data from adult members who received the CHW intervention (N = 538 participants) compared to those who were identified for participation but were unable to be reached (N = 435 nonparticipants). Outcomes measures included healthcare utilization, including scheduled and emergency inpatient admissions, emergency department (ED) visits, and outpatient visits; and healthcare spending. The follow-up period for all outcome measures was 6 months. Using generalized linear models, 6-month change scores were regressed on baseline characteristics to adjust for between-group differences (eg, age, sex, comorbidities) and an indicator for group.
Program participants experienced a greater increase in outpatient evaluation and management visits (0.09 per member per month [PMPM]) than the comparison group during the first 6 months of the program. This greater increase was observed across in-person (0.07 PMPM), telehealth (0.03 PMPM), and primary care (0.06 PMPM) visits. There was no observed difference in inpatient admissions, ED utilization or allowed medical spending and pharmacy spending.
A health plan-led CHW program successfully increased multiple forms of outpatient utilization in a historically disadvantaged population of patients. Health plans may be particularly well positioned to finance, sustain, and scale programs that address social drivers of health.
简介/目的：2018 年，一家医疗补助管理式医疗计划在一个州的几个县推出了一项新的社区卫生工作者（CHW）计划，旨在改善那些可以从额外服务中受益的成员的健康和生活质量。CHW 计划涉及 CHW 的电话和面对面访问，他们为成员提供支持、赋权和教育，同时识别和解决健康和社会问题。本研究的主要目的是评估一项普遍（非特定疾病）、以健康计划为主导的 CHW 计划对整体医疗保健使用和支出的影响。
这项回顾性队列研究使用了接受 CHW 干预（N=538 名参与者）的成年成员的数据，并与那些确定参与但无法联系到的成员（N=435 名非参与者）进行了比较。结果测量包括医疗保健利用，包括计划内和紧急住院、急诊就诊和门诊就诊；以及医疗保健支出。所有结果测量的随访期为 6 个月。使用广义线性模型，将 6 个月的变化得分回归到基线特征上，以调整组间差异（例如年龄、性别、合并症）和组的指标。
在计划的前 6 个月，与对照组相比，项目参与者的门诊评估和管理就诊次数增加了更多（每月每名成员 0.09 次[PMPM]）。这种增加在面对面（0.07 PMPM）、远程医疗（0.03 PMPM）和初级保健（0.06 PMPM）就诊中均有观察到。住院人数、急诊就诊利用率或允许的医疗支出和药房支出没有观察到差异。
一项以健康计划为主导的 CHW 计划成功增加了历史上处于不利地位的患者群体的多种形式的门诊利用。健康计划可能特别适合为解决健康的社会驱动因素的项目提供资金、维持和扩大规模。
