Community Health Workers and Medicaid Managed Care in New Mexico

We describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448 enrollees who were assigned to field-based CHWs in 11 of New Mexico’s 33 counties. The CHWs provided patients education, advocacy and social support for a period up to 6 months. Data was collected on services provided, and community resources accessed. Utilization and payments in the emergency department, inpatient service, non-narcotic and narcotic prescriptions as well as outpatient primary care and specialty care were collected on each patient for a 6 month period before, for 6 months during and for 6 months after the intervention. For comparison, data was collected on another group of 448 enrollees who were also high consumers of health resources but who did not receive CHW intervention. For all measures, there was a significant reduction in both numbers of claims and payments after the community health worker intervention. Costs also declined in the non-CHW group on all measures, but to a more modest degree, with a greater reduction than in the CHW group in use of ambulatory services. The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization and cost

Advancing the Transition to a High Performance Rural Health System

There are growing concerns about the current and future state of rural health. Despite decades of policy efforts to stabilize rural health systems through a range of policies and loan and grant programs, accelerating rural hospital closures combined with rapid changes in private and public payment strategies have created widespread concern that these solutions are inadequate for addressing current rural health challenges. The rural health system of today is the product of legacy policies and programs that often do not “fit” current local needs. Misaligned incentives undermine high-value and efficient care delivery. While there are limitations related to scalability in rural health system development, rural communities do have enormous potential to achieve the objectives of a high performance rural health system. This brief (and a companion paper at http://www.rupri.org/areas-of-work/health-policy/) discusses strategies and options for creating a pathway to a transformed, high performing rural health system

Community Health Workers and Medicaid Managed Care in New Mexico

Abstract We describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448 enrollees who were assigned to field-based CHWs in 11 of New Mexico's 33 counties. The CHWs provided patients education, advocacy and social support for a period up to 6 months. Data was collected on services provided, and community resources accessed. Utilization and payments in the emergency department, inpatient service, non-narcotic and narcotic prescriptions as well as outpatient primary care and specialty care were collected on each patient for a 6 month period before, for 6 months during and for 6 months after the intervention. For comparison, data was collected on another group of 448 enrollees who were also high consumers of health resources but who did not receive CHW intervention. For all measures, there was a significant reduction in both numbers of claims and payments after the community health worker intervention. Costs also declined in the non-CHW group on all measures, but to a more modest degree, with a greater reduction than in the CHW group in use of ambulatory services. The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization and cost

Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease

The Agricultural Cooperative Extension Service model offers academic health centers methodologies for community engagement that can address the social determinants of disease. The University of New Mexico Health Sciences Center developed Health Extension Rural Offices (HEROs) as a vehicle for its model of health extension. Health extension agents are located in rural communities across the state and are supported by regional coordinators and the Office of the Vice President for Community Health at the Health Sciences Center. The role of agents is to work with different sectors of the community in identifying high-priority health needs and linking those needs with university resources in education, clinical service and research. Community needs, interventions, and outcomes are monitored by county health report cards. The Health Sciences Center is a large and varied resource, the breadth and accessibility of which are mostly unknown to communities. Community health needs vary, and agents are able to tap into an array of existing health center resources to address those needs. Agents serve a broader purpose beyond immediate, strictly medical needs by addressing underlying social determinants of disease, such as school retention, food insecurity, and local economic development. Developing local capacity to address local needs has become an overriding concern. Community-based health extension agents can effectively bridge those needs with academic health center resources and extend those resources to address the underlying social determinants of disease

Assessing the Unintended Consequences of Health Policy on Rural Populations and Places

The purpose of this paper is to illuminate the unintended consequences of health policy so that past is not prologue to future. The Panel explores a series of health policies that have affected, or had the potential to affect, rural people, places, and/or providers in ways counteractive to policy intent. Two realities drive the need for this analysis: 1) Rural health care systems are living with the legacy of policies having unintended consequences because the full impact of such policies on rural stakeholders was neither predicted nor understood; and (2) Policymakers have recognized the need to apply a rural lens to new and ongoing programs and policies to inform the pathways by which equitable rural health status and health care can be achieved, as articulated by the Centers for Medicare & Medicaid Services (CMS) Rural Health Council in its first explicit Rural Health Strategy. The Panel concludes with a framework for health policy evaluation that considers potential and unintended rural impacts. [Author Abstract