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IntroductionCommunity health workers (CHWs) have historically worked in community-based settings. Medicaid managed care organizations (MCOs) are integrating CHWs into their teams, largely to support social determinants of health. Little is known about how teams are structured in these environments or how CHWs and their supervisors perceive CHW roles in MCOs.MethodsIn 2021, two CHW professional associations and a university partnered to conduct a national cross-sectional survey of CHWs working with MCOs.ResultsA total of 146 CHWs representing 29 states and 55 supervisors working in 34 states completed the survey. Although two-thirds of supervisors said only a high school diploma or equivalent was required for hiring, over half of CHWs reported having a bachelors or graduate degree. The majority of CHWs (72.6%) and employers (80%) said CHWs receive training in core competencies. Under half of CHWs reported working with a registered nurse (RN) (45.8%) or social worker (43.8%), and about a third work with a behavioral health (36.3%) or primary care provider (33.6%). Among supervisors, 70.9% identified social workers as CHWs' team members and over half indicated CHW work with RNs (56.4%), behavioral health (54.5%) and primary care providers (52.7%). Over half of CHWs (52.1%) and roughly two thirds (63.6%) of supervisors indicated that CHWs use electronic health records. Roughly 85% of CHWs make referrals and roughly three quarters conduct social screenings. Around half of CHWs said they assist with care planning (54.1%), conduct health screenings (52.1%) or participate in case reviews (49.3%). About three quarters of CHWs (75.3%) and over two thirds of supervisors (67.3%) believed that CHWs are utilized to their full potential. Under three quarters of CHWs (72.6%) and over half of supervisors (54.4%) believe CHWs are equitably compensated for their work.DiscussionOverall, CHWs roles in MCOs appear to focus on supporting clinical care and making referrals for social issues, rather than addressing community-level concerns. Health plans should ensure that CHWs have the professional freedom to develop community-based solutions to common social needs. MCOs should also ensure that CHWs receive equitable compensation and ensure that CHWs have opportunities for promotion.

The purpose of this article is to suggest systematic observation of provider- patient interactions as part of the evaluation of the quality of patient care provided in managed-care settings. There have been many calls for the inclusion of patient satisfaction measures in outcome evaluations. Patient satisfaction is very important since it relates to appropriate service utilization, yet the measurement of patient satisfaction is not enough. An example of systematic observation, the "Clinic Observation Record" (COR), was used by trained observers in an early evaluation of federally-funded family planning clinics, along with a measure of patient satisfaction (PATSAT). Including time spent in the clinic, which was important but played a relatively minor role, the COR (in a regression analysis) accounted for 36% of the variance in the PATSAT score for patients in 34 clinics. Personal inter- actions with the doctor and nurse were the most important elements contributing to patient satisfaction. Improvements in the ways patients were addressed, introduced to staff, and treated, as well as in the clinic environment, were needed in many of the clinics observed. [ABSTRACT FROM AUTHOR]