142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Quality Improvement Strategies: Bridging Geographical Needs of Diverse Medicaid Recipients Served by CHW Primary Care Practice

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 9:10 AM - 9:30 AM

Allie Gayheart, MHSA , South Carolina Department of Health and Human Services, South Carolina Department of Health and Human Services, Columbia, SC
Megan Old , South Carolina Department of Health and Human Services, SCDHHS, Columbia, SC
Ana Lopez Defede, Ph.D. , Department of Family and Preventive Medicine/SOM, Institute for Families in Society, Columbia, SC
In April 2013, the South Carolina Department of Health and Human Services (SCDHHS) initiated a Community Health Worker (CHW) demonstration project.  Through a selection process, fourteen primary care practices throughout SC were selected to participate in the yearlong CHW program. Practices were instructed to use CHWs to engage Medicaid beneficiaries with chronic conditions and challenges associated with accessing health care providers.    Requirements for practice participation included employment of a CHW, a Clinical Supervisor, adherence to reporting expectations and a commitment to working with SCDHHS in learning and improving the CHW program. CHWs were required to attend a six week training course consisting of a half day in the classroom followed by a half day conducting outreach in the community. Goals of program participation were to increase the partnership between the patient and medical home, decrease ER visits, improve beneficiaries’ chronic disease management skills, address socioeconomic factors, emphasize compliance with medication adherence, maintain appointments, and follow the physician-led care plan. Once the CHWs’ passed the SCDHHS certification course practices were authorized to submit CPT codes for reimbursement of approved CHW activities. Results of the demonstration include analysis of claims data, cost savings, HEDIS measures, beneficiary clinical risk group scores and feedback from participants.  Presenters will share the successes, lessons learned, evaluation framework, data results and future plans for continuing the CHW program in South Carolina.

Learning Areas:

Assessment of individual and community needs for health education
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health

Learning Objectives:
List 5 ways that CHWs can provide support to patients Assess the value of the CHW as part of the clinical care team Describe CHW activities that are acceptable for Medicaid reimbursement

Keyword(s): Medicaid, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an employee with the South Carolina Department of Health and Human Services and leader in the CHW initiative. I work with external stakeholders, CHWs, and Medicaid leaders to implement the SCDHHS CHW program
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.