Bringing Community Health Workers into the Mainstream of U.S. Health Care

Abstract

We have an innovation that is showing tremendous gains in improving health, especially among vulnerable populations. It has produced a return on investment of 4:1 when applied to children with asthma and a return on investment of 3:1 for Medicaid enrollees with unmet longterm care needs (Felix et al., 2011). Among participating patients with HIV, 60 percent achieve undetectable viral loads (Behforouz, 2014). In fact, examples keep emerging from around the country about its effectiveness in improving health outcomes and reducing emergency room visits and hospitalizations (CHWA, 2013; CDC, 2011; ICER, 2013). If these were the results of a clinical trial for a drug, we would likely see pressure for fast tracking through the FDA; if it was a medical device or a new technology, there would be intense jockeying from a range of start-ups to bring it to market. Instead, despite the promise this innovation has shown for years-and recognition from the Institute of Medicine (IOM, 2010), the Affordable Care Act, and the Department of Laborit still has not been widely replicated or brought into the mainstream of U.S. health care delivery. It is still not supported by most health care financing mechanisms, which causes some organizations that successfully deploy the innovation-and show better health outcomes-to actually lose money (Paquette, 2014). The innovation is the use of community health workers (CHWs), and, more specifically, their integration into team-based primary care. Scaling up the use of CHWs presents a unique set of obstacles, but it is also possible to chart a roadmap forward. The potential to improve care for vulnerable populations, help achieve the Triple Aim of better care, better health and lower costs, and advance population health is too promising to be deterred.

Social and Structural Determinants of Cervical Health among Women Engaged in HIV Care

“…Study findings suggest that additional efforts should focus on WLH who have adequate access to care to ensure that the innovation of the Pap is not merely realized by some, but all WLH. Utilizing community health workers to promote cervical cancer screening and continued health services utilization for WLH should prove most effective [47]. …”

Features and impact of trust-based relationships between community health workers and low-income pregnant women with chronic health conditions: A focus group study

“…Reports from the Institute of Medicine (2015) and the Agency for Healthcare Research and Quality (2009) have recommended expanded use of CHWs as a vital strategy to improve health behaviors and more effectively link vulnerable people to healthcare [31,32]. In addition, previous studies have demonstrated that authentic healing relationships improve outcomes among patients with comorbid chronic conditions [9].…”

Community Health Worker Employer Survey: Perspectives on CHW Workforce Development in the Midwest

“…One of the challenges of growing a CHW workforce relates to sustainable funding mechanisms where CHW positions are primarily supported through grants, which are time-limited and often not sustained [19]. Our sample of employer respondents reported a combination of funding sources, with a notable three-quarters of CHW employers utilizing agency operating budgets, presumably with some combination of either government funds, private funds, feefor-service or other funding mechanisms.…”

“…Though these examples offer guidance to the other states that do not have a comprehensive CHW program, including Nebraska, the challenge is determining how exactly these policy recommendations should be implemented, and this is where specific context and nuance need to be considered and studied, such as place of employment, geographic location (i.e., rural, suburban,urban), and amount of organizational and community resources. For example, the California Health Workforce Alliance conducted a statewide assessment that identified several obstacles to bringing CHWs into the mainstream of U.S. healthcare, including limited professional recognition; lack of data to make the business case; sustainability; and lack of knowledge of best practices [19]. Adding to this complexity is the number of national trends in public health such as implementation of the Patient Protection and Affordable Care Act (ACA), Health in All Policies, evidence-based public health practice, and primary care and public health integration.…”