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

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.