Kaiser CHW Medicaid Outreach

A partnership to connect Kaiser Medicaid beneficiaries with health services, improve health outcomes, and reduce costs.


The Institute for Public Health Innovation (IPHI) has partnered with Kaiser Permanente (KP) to design a new Medicaid Outreach Pilot Program that integrates community health workers (CHWs) into their care teams to connect with and engage Medicaid beneficiaries in Prince George’s County, Maryland. The aim is to engage Medicaid beneficiaries in a productive relationship with their assigned KP care team so preventive health services can be used in a timely and appropriate manner to improve health outcomes and reduce costs.

This initial pilot is designed to engage KP Medicaid beneficiaries who have not connected with their health plan or have been high utilizers of emergency department services. CHWs use their unique position as trained community members to build trust, deliver information and education about KP services, help KP beneficiaries address barriers to care, provide beneficiaries with guidance on entering and navigating the often-complex healthcare system, and support beneficiaries until they feel confident in their ability to manage the logistics of caring for oneself amidst complex social conditions.

Three IPHI CHWs will support the existing KP team to achieve the following primary outcomes: 1) Improve health and wellness indicators for beneficiaries; 2) Increase beneficiaries’ utilization of services within Kaiser’s delivery system; and 3) Reduce beneficiaries’ utilization of emergency department and other unplanned services outside of KP’s delivery system.

For more information about this partnership or IPHI’s work with health systems to develop CHW models, contact us at 202.747.4120 or via e-mail at [email protected].