Online Program

Promoting Sustainability for Community Health Workers – Engaging Medicaid Payers in the Process

Wednesday, November 4, 2015 : 9:30 a.m. - 9:50 a.m.

Stacey Chacker, BA, Asthma Regional Council of New England, Health Resources in Action, Boston, MA
Heather Nelson, PhD, MPH, Research and Evaluation Department, Health Resources in Action, Inc., Boston, MA
Anne Rushman, MSPH, Policy and Practice Department, Health Resources in Action, Boston, MA
Healthcare reform is one of the most pressing issues currently facing the US, with the need to improve population health and contain healthcare expenditures. Community Health Workers (CHWs) have been demonstrated to provide cost-effective, culturally competent home visiting services for asthma. Yet, these services are rarely financed by payers. 

 In 2012, the Centers for Medicare and Medicaid Services granted a $4.2 million Health Care Innovation Award to Health Resources in Action/Asthma Regional Council of New England to establish the "New England Asthma Innovation Collaborative” (NEAIC). NEAIC is a multi-state partnership that includes health care providers, payers, and policy makers, organized by Health Resources in Action. NEAIC’s overarching goal is to improve asthma outcomes, quality of care, and health care costs of primarily Medicaid-enrolled children by advancing CHW-led home-based asthma interventions and sustainable payment systems. NEAIC is one of many innovative interventions that has the potential to drive significant policy, practice and payment reform.

HRiA will describe the process to engage Medicaid payers in NEAIC, as well as challenges and lessons learned along the way. Details include: getting payers to sign on as partners; securing claims and encounter data from six payers for the cost analysis, factors important to payers when considering covering CHW delivered asthma interventions, results from NEAIC’s March 2015 Payer/Provider meeting, and other steps towards sustainability.

Learning Areas:

Administration, management, leadership
Advocacy for health and health education
Chronic disease management and prevention

Learning Objectives:
Describe strategies used to engage Medicaid Payers in a multi-state collaborative to promote sustainable financing for CHW-led asthma home visiting. Explain the process and challenges to secure patient claims and encounter data from health payers for a cost analysis– including Data Use Agreements, consent forms, data transfers, etc. List challenges and potential solutions to promoting sustainable (and interim) financing for CHWs, be it from Medicaid payers or from Accountable Care Organizations based on experiences from the New England Asthma Innovations Collaborative

Keyword(s): Community Health Workers and Promoters, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Co-PI and Director of the New England Asthma Innovations Collaborative. I am principally responsible for working with payers for this project.
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.