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Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes. | LitMetric

Opportunities for and Perceptions of Integrating Community Health Workers Via the Affordable Care Act: Medicaid Health Homes.

J Public Health Manag Pract

College of Public Health, University of South Florida, Tampa, Florida (Drs Lockhart, Martinez-Tyson, and Marhefka); Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut (Dr Turner); and Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona (Dr Baldwin).

Published: October 2021

AI Article Synopsis

  • The Affordable Care Act promoted innovative practices to improve health care access, including the use of Community Health Workers (CHWs) in Medicaid Health Homes (MHHs) to help coordinate care for chronic conditions.
  • A study focused on the views of MHH administrators in New York about the engagement of CHWs, revealing overall support for their inclusion but highlighting challenges like reimbursement issues and unclear roles.
  • While CHWs can enhance the effectiveness of MHHs, addressing the barriers they face can provide valuable insights for integrating CHWs into broader health care systems across the U.S.

Article Abstract

Context: The Affordable Care Act created opportunities for innovative, cost-saving measures to improve health care access. Community health workers (CHWs) are frontline public health workers who have a close understanding of the communities they serve. States that expanded Medicaid coverage could also create Medicaid Health Homes (MHHs)-virtual health care networks-to coordinate care for people with chronic conditions. New York was the second state to implement MHHs and gave the option to include CHWs as part of the health care team.

Objective: To understand the perceptions of MHH administrators regarding CHW engagement in MHHs, as well as the facilitators and barriers to adoption in MHHs that are unknown.

Design, Setting, And Participants: Semistructured qualitative interviews (n = 18) were conducted with MHH administrators throughout New York State guided by the Diffusion of Innovations (DOI) framework. Qualitative thematic analysis was used to explore the domains and themes.

Results: Most MHH administrators believed that CHWs fit within MHHs. The DOI constructs of compatibility and complexity and the Consolidated Framework for Implementation Research construct of external policies helped explain CHW integration. CHWs were compatible with MHHs by enrolling patients, helping coordinate patient care, and providing social support. The complexities of CHW integration into MHHs included barriers to CHW integration, no direct reimbursement for their services, lack of clarity for CHW roles and responsibilities, and no explicit external policy for their use in MHHs.

Conclusions: CHWs can, and have, been integrated into the relatively novel Health Home system. While some barriers have prevented their integration into all MHHs, lessons learned could provide guidance for CHW integration into other health care systems in the United States.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8690535PMC
http://dx.doi.org/10.1097/PHH.0000000000001118DOI Listing

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