Recently, a woman came to the Hispanic Health Council (HCC) seeking help with housing. It was only during the visit that Maria, a Community Health Worker (CHW) who works with pregnant and postpartum women at HHC, learned that the woman was pregnant. The woman was about to be evicted because her work hours had been reduced and she couldn’t pay rent. Maria made a commitment to the client’s landlord that she would help the client to get the financial support needed to get up to date with her rent. Maria was able to secure funds from an outside charitable organization, combine them with charity funds that HHC had, and get the client up to date on her rent. Maria also followed the client’s job search to be sure that she was able to secure a job that would make her financially independent. After this, the client was able to focus on her prenatal care, her own health, and eventually the baby’s health and development. Maria provided her with referrals to prenatal care, WIC and other services, and directly provided health education, some basic needs and other supports.
What is a Community Health Worker?
A Community Health Worker is a front line public health worker, like Maria, who is a trusted member of, and/or has an understanding of the experience, language, culture, and socioeconomic needs of the community they serve. A CHW serves as a liaison between individuals, communities and health and social services systems. CHWs’ unique lived experience, qualities, and skills also position them to address factors that are outside the medical system but affect people’s health and quality of life – as Maria did with her pregnant client. These factors are known as social determinants of health (SDOH), and include income, education level, life stress and environmental quality, among others. The role that CHWs play in addressing SDOH makes them an essential component of health care systems.
How can we ensure Community Health Workers programs are sustainable?
At this time, a patchwork of federal, state, city, and private foundation grants supports CHW services. However, budget uncertainties often lead to reductions or even complete elimination of this grant funding over time, which leaves CHW services vulnerable and under-resourced. Nevertheless, there is potential for developing a sustainable financing system for CHW services. Research shows the positive impacts and health care savings of CHW services, establishing a clear case for sustained funding. Thanks to the ACA, the federal government changed its regulation on payment for preventive health care services, which would allow for funding of people that aren’t clinically licensed, like CHWs. Finally, state-level health care innovation initiatives across the country are working to advance how we pay for health care. In order to utilize and enjoy the full benefits of CHWs, we must shift our health systems to promote value rather than volume of services.
The use of Value-Based Payments (VBP) is a strategy for promoting high quality care, and instead of paying based on volume of services provided, paying based on results for patients. VBP programs also allow providers to be more flexible in what kinds of services they offer. They can cover more primary/preventive services, and services that are not usually covered by fee-for-service systems, including CHW services.
A move towards VBP is essential to securing sustainable funding for CHWs. Health care payment methods should reward improved outcomes, rather than volume, and address the underlying health risk of the population, including SDOH. Public and private payers should cover the time CHWs spend identifying and removing barriers and addressing SDOH. Ensuring patients are safe and have their basic needs such as housing and food are essential to their health, and CHWs are uniquely positioned to effectively address these needs. Now, state and federal policymakers and our health system must find a way to support them.
To learn more about policies and practices that facilitate effective and appropriate use of CHWs, access the policy brief, Addressing Social Determinants of Health through Community Health Workers: A Call to Action, prepared by the Hispanic Health Council and a national panel of CHW policy experts.
Grace Damio is the director of research and training at the Hispanic Health Council in Hartford, Connecticut