Threading the Needle: Strategies to Elevate the Role of Community Health Workers in Emerging Models of Care for Dual Eligibles

Threading the Needle: Strategies to Elevate the Role of Community Health Workers in Emerging Models of Care for Dual Eligibles

Executive Summary

Individuals dually eligible for Medicare and Medicaid, known as “dual eligibles,” represent some of the most vulnerable populations under the purview of America’s public insurance programs. Characterized by advanced age and functional limitations, dual eligibles
present complex health care needs that have historically been mismanaged by the separate Medicare and Medicaid entities. Recent legislation at the federal and state levels introduced new policy opportunities for Medicare-Medicaid integration. California’s integration effort is known as Cal MediConnect.

In California, the dual eligible population is linguistically and culturally diverse, which presents both challenges and opportunities for the implementation of Cal MediConnect, including the need for culturally competent care. Community health workers, non-licensed members of the community that act as a bridge between the formal health care system and community members, may be able to meet this need. As members of the marginalized communities they serve and as a labor force that emerged in the shadow of the formal health care systems, community health workers themselves are also vulnerable. This paper proposes a partnership between the dual eligible population of Los Angeles County and the CHW labor force, mediated by the emerging care delivery and financing systems
for dual eligibles in Los Angeles County. Interviews with members of various stakeholder sectors revealed a lack of communication between CHWs and health plans, the potential use of CHWs as enrollment counselors or as a part of interdisciplinary care teams, and the difficulty and unlikelihood of CHW inclusion in formal health care systems under Cal MediConnect. Recommendations include CHW initiated communication with health plans, coalition building, and lobbying efforts on the part of CHWs.

Read More:  http://www.oxy.edu/sites/default/files/assets/UEP/Comps/2014/Lopez,Sarah_Thr eading%20the%20Needle.pdf