Policy changes in two states to expand and strengthen the workforce of community health workers provide a model for other states as they implement the Affordable Care Act, says a new case study, “Community Health Workers: Part of the Solution,” in the July Issue of Health Affairs (free abstract—subscription required). Coauthored by Community Catalyst’s Director of Health Equity Lisa Renee Holderby, who previously headed the Massachusetts Association of Community Health Workers, the paper looks at how Minnesota and Massachusetts turned to community health workers to address shortages in the health care workforce and improve enrollment and primary care.
The case studies found that policy changes that supported the use of community health workers (CHWs), who provide patients peer-to-peer assistance managing their health and navigating the health care system, helped increase enrollment and quality of care in their communities. The Institute of Medicine has recommended that CHWs be included in care teams to help improve the health of underserved communities.
“As members of the community,” the authors write, “these front-line workers are valued for their cultural competence and mediate between providers and other members of diverse communities. Evidence is accumulating that including community health workers in determining the appropriate use of services has a sizable positive return on investment.”
So what policy changes do the authors want to see in other states? First, sustainable funding for CHWs to participate in the system – including reimbursement by public programs like Medicaid, Medicare and CHIP. And they suggest states establish workforce education programs and occupational standards to train and credential CHWs like other health care workers. The authors also propose that states establish some uniform guidelines they can use to chart and evaluate CHWs and their participation in the health care workforce – something that is going to be happening in many corners of the health care system as part of the Affordable Care Act.
“Community health workers can be vital to efforts to restructure the delivery of primary health care. The patient-centered medical home has been described as providing ‘accessible, comprehensive, family-centered, coordinated, compassionate and culturally effective care.’ Although the workforce required for the medical home model has not been fully defined, close ties to the community and cultural competence are essential. Additionally, a successful medical home will require continuity of communication between provider and patient.
“Community health workers are uniquely qualified to meet these responsibilities and to complement other members of the health care delivery team. These workers’ valuable capacity to increase patient engagement will be important to consider in evaluations of quality improvement.”
“Community Health Workers: Part of the Solution” is part of a special issue of Health Affairs on the implementation on health care reform, and the whole thing’s worth a read (caveat: subscription required.)
–Kate Petersen, Health Policy Hub