Building the Bridge to Better Healthcare in Pima County, Arizona

While picturesque Pima County is one of Arizona’s most populous and culturally diverse areas, some residents struggle to obtain the healthcare services they need.

According to recent estimates, 13.5% of Pima County residents live in poverty. Also, because Pima County is largely rural, it’s more challenging to access healthcare services: 17 of 23 primary care areas are designated as Health Professional Shortage areas because they lack sufficient primary care, dental, and/or mental health providers.

Community health workers bridging the gaps

Pima County’s community health workers (CHWs) are a vital resource in addressing these barriers to care, and providing a range of essential services to county citizens, including:

• health education services, including education associated with vaccines, tobacco cessation and more;
• answers to general health questions during community events, including questions related to program-specific policies, procedures, and service availability;
• specialized services such as COVID-19 testing, treatment linkages, and linkages to health and social determinants of health (SDOH) related resources.

Yet community health workers throughout the United States face a multitude of barriers to delivering these critical services.

Shifting Medicaid policy in Arizona

Historically, community health workers have not been eligible to bill Medicaid and most insurance providers don’t reimburse for their services. Now, though, as more and more states recognize the value community health workers bring to their community’s health and well-being, Medicaid reimbursement policies are beginning to change. In 2023, Arizona’s state Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS) approved an amendment that would allow Medicaid coverage for certain community health worker services.

This amendment is a big step forward for the community health workers in Arizona. However, to properly track and bill services, these community health workers need a central, integrated technology system that connects with other state health solutions. To address this need, Pima County is using funds from a Centers for Disease Control and Prevention (CDC) grant to build technology solutions for their community health worker workforce, strengthening their capabilities and connecting them with the larger state technology ecosystem, including their billing system and new electronic health record (EHR).

Investing in technology for community health workers

These investments are going a long way toward advancing technology initiatives and upgrades to enable the community health workers’ work, including:

• analysis of the current health information technology in use by community health workers, as well as gaps and inefficiencies in the tech stack;
• the migration of an initial cohort of community health workers onto a single case management and data-collection platform, Dimagi’s CommCare, for community health worker provided health education and coaching;
• connecting CommCare into the county’s new electronic health record solution so community health workers can more efficiently collect and submit data directly from the field, calculate relevant Current Procedural Terminology (CPT) codes, and streamline documentation and billing operations.

Pima County will implement the first phase of these initiatives with Dimagi in 2024, with goals to scale up and adjust project key performance indicators as needed. Over time, the county may expand its work with CommCare to cover more community health workers and services, including maternal and child home health visits, and more.

In turn, Dimagi will work closely with Pima County stakeholders to ensure they are equipped with a sustainable path forward beyond the initial engagement. Ultimately, the partnership will bolster Pima County’s efforts toward investing in its workforce, digitizing healthcare communications, and addressing population health gaps.

A common challenge, a shared path forward

Pima County’s challenges are all too common in the United States today, and in most cases, shifting Medicaid and reimbursement policies are just the beginning for states that want to bolster these workers. Fortunately, by working collaboratively with Dimagi and investing in the digital infrastructure to support its community’s valued healthcare workers, Pima County will continue to improve patient outcomes, county data quality and decision-making, and the efficacy of the community health worker work in the county.