Community Health Worker Workforce:

Assessment of the Integration and Financing of Community Health Workers within Arizona Medicaid Health Plans 

A Final Report to the Arizona Department of Health Services 

Samantha Sabo DrPH, MPH  Associate Professor Center for Health Equity Research, College of Health and Human Services  Northern Arizona University  
Louisa O’Meara MPH Research Assistant  Center for Health Equity Research Northern Arizona University 
Katie Castro BS Center for Health Equity Research Northern Arizona University 

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2019 Assessment of the Integration and Financing of CHWs in Arizona Medicaid Health Plans 
EXECUTIVE SUMMARY 
The Community Health Worker (CHW) workforce, defined as a frontline public health worker who applies a unique understanding of the experience, language, and culture of the population served, has entered the spotlight as essential to health care systems. CHWs are valuable members of health teams and play a vital role in addressing medical and social determinants of health among underserved populations.  
In 2014, the Centers for Medicaid and Medicare (CMS) issued guidance to allow states to reimburse for preventive services offered by non-licensed professionals such as CHWs. Furthermore, reforms in health care in the United States have incentivized the shift toward a value-based reimbursement structure that rewards evidence of favorable medical and social outcomes.  

Such health policy trends present tremendous opportunity to scale the CHW workforce throughout public health and healthcare systems in Arizona. In response to shifts supportive of the integration of CHWs into public health and health care systems, the Northern Arizona University, Center for Health Equity Research interviewed leadership of all Arizona Health Care Cost Containment System (AHCCCS) contracted health plans to assess innovations in CHW workforce integration and financing.  
An estimated 4 AHCCCS Health Plans and 10 of 22 Federally Qualified Community Health Centers currently employ CHWs to link patients to community resources to promote self-management.  

Arizona health plan leaders recognize that by utilizing their unique position within their community, coupled with skills and training, CHWs can play a significant role in improving patient outcomes and reducing system costs for health care. Many health plan leaders actively support their contracted provider networks to better integrate and finance CHWs to meet Healthcare Effectiveness Data and Information Set (HEDIS) measures. 
 

KEY MESSAGES: HEALTH PLAN LEADERS :

    Value and capitalize on overwhelming body of scientific evidence demonstrating CHW impact on access to and appropriate use of healthcare, medication adherence, management of chronic disease and mental health, and use of emergency services.
    Utilize the full range of CHW roles, competencies and scope of practice
    Hire CHWs based on their ‘lived experience’ and intimate knowledge and connection to community
    Support CHW Voluntary Certification (HB2324)
    Desire standardized and accessible CHW core competency training
    Innovate through value-based payment models to integrate and sustain CHW services
    Require AHCCCS billable codes for CHW services to fully incentivize the scale the CHW workforce

To read the entire report click here.