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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.

Highlights: [•] We examine previously reported associations between TIV and GI illness. [•] We conducted a large case–control study among children ages 24–59 months. [•] We observed an association between medical visits without TIV and GI illness. [•] Co-occurring exposures in vaccine safety studies may cause confounding. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between autism and the level of immunologic stimulation received from vaccines administered during the first 2 years of life. Study design: We analyzed data from a case-control study conducted in 3 managed care organizations (MCOs) of 256 children with autism spectrum disorder (ASD) and 752 control children matched on birth year, sex, and MCO. In addition to the broader category of ASD, we also evaluated autistic disorder and ASD with regression. ASD diagnoses were validated through standardized in-person evaluations. Exposure to total antibody-stimulating proteins and polysaccharides from vaccines was determined by summing the antigen content of each vaccine received, as obtained from immunization registries and medical records. Potential confounding factors were ascertained from parent interviews and medical charts. Conditional logistic regression was used to assess associations between ASD outcomes and exposure to antigens in selected time periods. Results: The aOR (95% CI) of ASD associated with each 25-unit increase in total antigen exposure was 0.999 (0.994-1.003) for cumulative exposure to age 3 months, 0.999 (0.997-1.001) for cumulative exposure to age 7 months, and 0.999 (0.998-1.001) for cumulative exposure to age 2 years. Similarly, no increased risk was found for autistic disorder or ASD with regression. Conclusion: In this study of MCO members, increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines during the first 2 years of life was not related to the risk of developing an ASD. [Copyright &y& Elsevier]

This article reports the results of an exploratory study to determine how managed care is influencing mental health practice from an interdisciplinary perspective. Using two case vignettes, respondents were asked about how they would classify presenting problems and treatment strategies within the context of two scenarios: (1) managed care and its limitations, and (2) fee-for-service/private pay. Findings suggest that managed care has a significant influence on case assessment and treatment planning across the mental health disciplines. Although respondents did not favor adjusting treatment approaches to meet managed care expectations, they nevertheless did so. Findings also substantiate managed care's negative impact on earnings and job satisfaction. These preliminary results begin to address discipline-related cost effectiveness from the perspective of practitioner treatment choices and preferences and highlight the perceived incompatibility between preferred practice and the dictates of managed care. [ABSTRACT FROM AUTHOR]

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]

Managed care has been slow to come to underserved rural areas, where profits may not be as large as in metropolitan areas. In the last decade, increased threat of takeover by out-of-state managed care organizations (MCOs) has prompted rural community hospitals and providers to develop some new models of managed care that fit both their economic and health care needs. Stroke survivors in rural areas have the same need for coordinated, ongoing care during their lifetime, but it is more difficult to deliver it in rural areas. Rehabilitation providers are urged to be proactive in creating innovative managed care approaches that will improve both the health and recovery outcomes of rural stroke survivors.