Roles and Responsibilities of Community Health Workers in Louisiana Medicaid Managed Care Organizations

We explored the roles of community health workers (CHWs) working in Medicaid Managed Care Organizations in Louisiana by conducting 10 interviews with CHWs, supervisors, and administrators. We identified 6 themes: CHWs' backgrounds and training; roles as they related to nationally recognized competencies; team integration; who CHWs serve and how members are identified; metrics for success; and the effects of COVID. CHWs are hired for their community connections. CHWs generally do not receive core competency training, and they focus primarily on improving individual-level health outcomes. Administrators and supervisors may need training and support on CHW competencies, supervision, and using common evaluation indicators.

Community health worker team integration in Medicaid managed care: Insights from a national study

Introduction

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.

Methods

In 2021, two CHW professional associations and a university partnered to conduct a national cross-sectional survey of CHWs working with MCOs.

Results

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.

Discussion

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.

What Are the Roles of Community Health Workers in Medicaid Managed Care? Results from a National Study

Managed care organizations (MCOs) are increasingly engaging community health workers (CHWs) to support service delivery for their members, particularly in the realm of social determinants of health. Some states now require MCOs to offer CHW services. Although the roles and activities of CHWs working in other contexts (eg, clinics, hospitals, community-based organizations) are well established, there is sparse knowledge about how MCOs are operationalizing CHW roles and whether CHW activities differ based on whether CHWs are employed directly by MCOs or contracted through other organizations. In 2021, 2 CHW professional associations and a university partnered to conduct a national cross-sectional survey of CHWs working with MCOs. Respondents (n = 146) represented 29 states. CHWs employed by MCOs reported receiving significantly more training and benefits from their employers than CHWs who were contracted through other organizations. MCO-based CHWs were more likely to support members with high-cost conditions and high service use, whereas contracted CHWs were more likely to engage in population-focused interventions, which may produce less immediately visible financial returns. Health plans would do well to ensure the CHWs they support, whether through contract or direct hiring, receive appropriate compensation and training, and have the freedom to engage in the full range of CHW roles, including community-level interventions.

'You have to be almost dead before they ever really work on you in prison': A qualitative study of formerly incarcerated women's health care experiences during incarceration in Louisiana, U.S

Globally, the rate of incarceration among women is rising, and in the U.S., women's incarceration has grown at twice the rate for men over the last four decades. Louisiana has the second highest rate of incarceration in the U.S. There is evidence that men in Louisiana prisons do not receive adequate healthcare, but little is known about their women counterparts. We aimed to document formerly incarcerated women's experiences with receiving healthcare during incarceration in Louisiana to inform policy and practice change. In partnership with two community-based organisations in New Orleans, Louisiana, between August 2016 and April 2018, we conducted semi-structured 1-hr interviews with 22 formerly incarcerated women who had been incarcerated in the state for at least one consecutive year. A convenience sample of participants was recruited through community-based organisations' re-entry and health programmes. Our interview guide included questions about experiences with accessing care, reproductive health needs, interactions with providers and preventive care during incarceration. We used applied thematic analysis techniques to interpret data. Over 90% of interviewees identified as Black. Their mean age was 50.7. The average length of incarceration was 8.4 years. Participants reported multiple barriers to accessing care including punishment for seeking care, long wait times, costs, lack of respect from providers and health concerns being dismissed. Participants reported limited mental health, preventive and dental services; an insufficient number of providers; and poor health outcomes as a result of delayed care. Overall, women did not have access to adequate, timely care during incarceration. Findings suggest a need for policy changes related to the provision of carceral healthcare services and external oversight of prison conditions and healthcare delivery. Further research into women's experiences of ageing during incarceration and tailored transitional health models is needed.

Insights on COVID-19 From Community Health Worker State Leaders

Community health workers (CHWs) leverage their trusting relationships with underresourced populations to promote health equity and social justice in their communities. Little is known about CHWs roles in addressing COVID-19 or how the pandemic may have affected CHWs' ability to interact with and support communities experiencing disparities. A focus group with CHW leaders from 7 states revealed 8 major themes: CHW identity, CHW resiliency, self-care, unintended positives outcomes of COVID-19, technology, resources, stressors, and consequences of COVID-19. Understanding the pandemic's impact on CHWs has implications for workforce development, training, and health policies.

Community Resilience Learning Collaborative and Research Network (C-LEARN): Study Protocol with Participatory Planning for a Randomized, Comparative Effectiveness Trial

This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.