Professional Abstract

Objective

To examine whether a health plan’s offer of support from a trained community health worker (CHW) helped women newly enrolled in Medicaid to access primary care and preventive services

Study Design

Design Elements	Description
Design	Randomized controlled trial
Population	2,267 women ages 18–39 newly enrolled in the University Family Care (UFC) Medicaid health plan for people living in southern Arizona
Interventions/ Comparators	Health plan’s phone offer of education and navigation support from a CHW Standard information offered by the health plan
Outcomes	Primary: use of a primary care provider, defined as at least 1 visit to a primary care provider in the first 6 months after enrollment Secondary: receipt of recommended preventive services (defined as at least 1 visit for immunizations or any of 5 reproductive screenings recommended by the US Preventive Services Task Force), avoidable emergency department visits and hospitalizations (defined as the number of emergency department or hospital visits for conditions that a primary care physician could have appropriately managed)
Timeframe	6-month follow-up for primary outcome

This randomized controlled trial examined whether offering CHW education and navigation support to women who recently enrolled in a large Arizona Medicaid health plan helped these women access primary care.

The study included 2,267 women ages 18 to 39 living in southern Arizona and newly enrolled in the University Family Care (UFC) Medicaid health plan. All women in the study had access to standard health plan information. The health plan randomly selected 1,521 women to receive a telephone call offering them CHW services. UFC call center staff attempted to contact these women three times and left recorded messages when calls were not answered. For women who were reachable by phone, staff offered CHW services including a 30-minute in-person planning session to discuss preventive services and educational resources and two follow-up calls. The remaining 746 women did not receive an offer to use CHW services.

Among study participants, 39% were white, 15% identified as other race, 32% were Hispanic, and 14% did not indicate a race or ethnicity. The average age was 27.

Using six months of Medicaid data, the research team examined differences in healthcare utilization between the women selected to receive the telephone offer of CHW services and those not selected.

An advisory board of UFC administrators, providers, and patients and representatives from the REACH Pima County Cervical Cancer Prevention Partnership and the Arizona Community Health Workers Association provided input to the research team during the study.

Results

Of the 1,521 women randomized to receive a telephone call offering CHW services, 78% were not reached by phone. Of the 331 women successfully contacted by phone, 48% accepted the offer and received support from a CHW.

Primary care use, receipt of recommended preventive services or immunizations, and avoidable emergency department visits and hospitalizations did not differ between the women in the group selected to receive an offer of CHW services and those not selected.

Limitations

UFC staff were unable to contact most of the women randomized to receive a call offering CHW services. As a result, the actual number of women who accepted the offer of CHW support was small; this may explain the study results. The study did not examine healthcare utilization outcomes for women who received CHW support compared with other study participants.

Conclusions and Relevance

Relying on phone contact information from the UFC health plan to offer additional services to Medicaid enrollees was ineffective. Combining telephone contact with other outreach methods may be more effective.

Future Research Needs

Future studies could examine other ways for health plans to offer support to new enrollees, such as through direct interaction with patients in local clinics or hospitals, or multimodal attempts to reach patients, such as texting, emailing, and direct mail in addition to telephone contact.