An Emerging Model for Community Health Worker–Based Chronic Care Management for Patients With High Health Care Costs in Rural Appalachia

Authors: Richard Crespo, Matthew Christiansen, Kim Tieman, and Richard Wittberg

This paper presents the results of a CHW-centered intervention to improve diabetes health outcomes and lower diabetes-related healthcare costs for patients in Appalachia. The authors studied the dissemination of a community health worker–based chronic care management (CHW-Based CCM) model in three central Appalachian states and the process for engaging health insurance payers to sustaining the model. Results suggest that the intervention improves health outcomes and lowers blood glucose for patients served by CHWs. Study investigators recommend the model be scaled as patients and physicians become comfortable this new approach.