Women from medically underserved minority and poor communities who historically have limited access to preventive health services may not have the basic information needed to fully benefit from these offerings. Such women may lack the necessary tools to effectively identify personal health care needs, take advantage of health services, or participate equitably in health care decision-making. Our study tests the effectiveness of a Medicaid health plan that offers new members the services of community health workers (CHWs) who use a community-developed curriculum and function as navigation aides. The CHWs assist patients to make informed decisions about the utilization of covered preventive health services and engagement with their health care providers.
The following was the overarching question addressed by this study: Does access to a trained CHW improve newly enrolled Medicaid health plan members' engagement in the health care system?
The study participants consisted of women aged 18 to 39 years who had newly enrolled in a Medicaid health plan serving southern Arizona between March 15, 2015, and March 14, 2016. All eligible health plan members were randomized 2:1 to be offered support from a CHW in addition to the standard services of the health plan or to receive only standard health plan services. We used the health plan's call center to contact those randomized to the intervention. We based the primary and secondary outcomes on analysis of 6 months' health care utilization data captured for all eligible members, and our primary outcome was a visit with a primary care provider (PCP). We also assessed patients' informed choice via a baseline survey completed by all members who worked with a CHW and a 6-month survey fielded to all members.
The health plan enrolled 2267 eligible new members during the study; all eligible members were included in the study, and 1521 were randomized to the offer of CHW services. Of those enrolled, 78% were unreachable by the call center to complete the offer and another 5% became unreachable after expressing initial interest and before they could meet with a CHW. Of reached members, 82% said they were interested in working with a CHW and 62% worked with a CHW. Following intent to treat we found no significant difference in our primary outcome (at least 1 PCP visit) between those randomized to the offer (58.2%) and those randomized to control (57.1%). However, although not designed to directly test the effectiveness of CHW services themselves, our results suggest that support provided by the CHW might have a beneficial impact in terms of accessing primary care services. A significantly larger proportion of the group that received the CHW services had 1 or more primary care visits (71.7%) compared with those randomized to the offer who did not work with a CHW (56.6%) or the control group (57.1%).
The study findings do not support the effectiveness of a health plan's offer of CHW services to its members. The direct telephone-based offer of CHW services by a Medicaid health plan to new members is not effective largely due to problems with the reachability of this low-income, highly mobile Medicaid population. The lack of effect may be due not to CHW services, which may themselves have a positive impact, but instead to the way these services were offered.
The main limitation of this study was that the health plan call center was unable to consistently connect with its membership using available member contact information.
