UMass Medical School develops four sustainable community health worker intervention models for the state of Maine

April 05, 2017

UMass Medical School health policy experts have developed sustainable financing models for the state of Maine to support four community health worker (CHW) interventions that focus on patients with the greatest, and most costly, health care needs.

The models and their projected outcomes are detailed in a report, Sustainable Financing Models for Community Health Worker Services in Maine, co-authored by Katharine London, MS, Kelly Love, JD, and Roosa Tikkanen, MPH, MRes, of the Center for Health Law and Economics, a unit within UMass Medical School’s Commonwealth Medicine division. 

CHWs act as a bridge between providers and individuals to promote health, reduce disparities, and improve service delivery; and advocate for individual and community needs. CHWs serve a key role in health care because they can connect with patients on an individual level, as they often share similar language, backgrounds and socioeconomic status.  Even though CHWs do not provide clinical health care services, the connections they make and foster can lead to improved health outcomes, reduced health disparities and lower costs.

This report examines academic literature documenting results obtained by CHW interventions in other parts of the country, calculates the outcomes that could be achieved if the same interventions were implemented in Maine, and provides budget specifications needed to achieve those outcomes.

Using actual population and cost data from Maine, interviews with Maine CHWs and features of CHW interventions operating in other states, the team constructed four cost-effective models that target specific health concerns in different Maine counties. These models can be used by community-based organizations, health care providers, public and private payers, and others to develop sustainable CHW interventions throughout the state of Maine.

  • Improvements in diabetes control in Washington County would target 82 individuals with poorly controlled diabetes. The intervention is projected to cost $390,000 over three years and save more than $520,000 in medical costs over that same time period. The projected financial return on investment is $1.37 for every $1 invested in years one through three.
  • Improvements in asthma control among children in Kennebec County would target 112 children with poorly controlled asthma. Over a three-year period, the intervention is projected to cost $220,000, save more than $47,000 in medical costs, and have a positive impact by reducing sick days for the child and caregivers. An entity that is eligible to earn bonus payments for meeting quality targets could potentially earn a positive financial return on investment. 
  • Improving control of chronic conditions for individuals with high health care use in Aroostook County would target 150 individuals with chronic conditions and high medical spending.  The initiative would save a projected $1.3 million in direct medical costs over a three year period and require $550,000 to operate. The projected financial return on investment is $2.31 for every $1 invested in years one through three.
  • Connecting underserved individuals to services in the Lewiston area would target 260 individuals in the Somali community who have language and cultural barriers to accessing health care. The initiative is projected to cost $178,000 over three years and save $274,000 in direct medical costs. The projected financial return on investment is $1.54 for every $1 invested in years one through three.

In order for CHW initiatives to be successful in the long-term, they must be financed by sources that providers can count on year after year, not those with time and funding limitations such as grants, the report authors said. Building that type of financing model requires funding from private and public payers in the health care system. A number of strategies can be used to support CHW services, including fee-for-service, pay-for-performance, bundled payment, global payments, statewide assessments, and alternative payment models.

The report was prepared, under the direction of Barbara Ginley of the Maine Migrant Health Program and Elizabeth Foley of MCH Public Health, for the Maine Center for Disease Control and Prevention, which is overseeing the Community Health Worker Initiative portion of Maine’s State Innovation Model (SIM) grant from the federal Centers for Medicare and Medicaid Services.

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