Defining Community Health Workers 2 According to the American - - PDF document

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Defining Community Health Workers 2 According to the American - - PDF document

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Background Material for Fourth Meeting A Federal-State Discourse on the Role of Community Health Workers in the Wake of Health Care Reform October 5, 2015 Supported by The Commonwealth Fund 1 Defining Community Health Workers 2 According to

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A Federal-State Discourse on the Role of Community Health Workers in the Wake of Health Care Reform Background Material for Fourth Meeting

October 5, 2015 Supported by The Commonwealth Fund

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Defining Community Health Workers

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According to the American Public Health Association, a community health worker is:

— a frontline public health worker who is a trusted

member of and/or has an unusually close understanding of the community served.

— a liaison/link/intermediary between health/social

services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.

https://www.apha.org/apha-communities/member-sections/community-health-workers

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Other Terms for CHWs Include

3 http://www.who.int/hrh/documents/community_health_workers.pdf

— Promotora — Community health advisor — Patient navigator — Health coach — Community health outreach worker — Community health representative

Depending on their roles, birth doulas, lactation consultants and others may also be considered CHWs.

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Community Health Workers and Health Equity

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  • Many states are using CHWs to advance health equity.
  • CHWs “connect community members, particularly difficult-to-

reach populations, to the health care system…” (Viswanathan, 2009)

  • As trusted members of the communities in which they serve,

CHWs are able to provide health education and support that is culturally and linguistically appropriate. This makes them well positioned to help patients overcome gaps in knowledge, literacy, trust, and health care access.

Source: http://www.researchgate.net/publication/ 259449610_A_Community_Health_Worker_Intervention_to_Address_the_Social_Determinants_of_Health_Through _Policy_Change

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Community Health Worker Roles

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Working within their communities, CHWs’ roles include:

— Health education — Health system navigation — Outreach, enrollment, and engagement — Community organizing (catalyze new activities, advocate for

policy changes)

— Case management and care coordination — Home visiting — Member of care team (working with providers) — Provide informal counseling/support services

Sources: Am J Public Health. 2012 Oct;102(10):1981-7; http://www.hrsa.gov/ruralhealth/pdf/chwtoolkit.pdf

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How CHWs Improve Health

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  • Specific examples of CHW activities to address social determinants of

health may include:

  • Assisting with transportation to appointments
  • Addressing basic needs such as food, shelter, etc.
  • Interventions with utility companies
  • Increasing community capacity to support healthy behaviors
  • Findings indicate CHWs can have a positive effect on health
  • utcomes in underserved populations through activities such as:
  • Improving access to care
  • Providing screening and prevention services
  • Improving patient adherence to treatment

Sources: https://www.raconline.org/communityhealth/chw/files/measuring_roi.pdf; http://www.apha.org/policies-and-advocacy/public- health-policy-statements/policy-database/2014/07/09/14/19/support-for-community-health-workers-to-increase-health-access-and-to- reduce-health-inequities

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CHW and Cost Savings

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  • While more research remains to be done on the cost-effectiveness
  • f CHW initiatives, some initial findings suggest that CHWs can

contribute to reduced health care costs among underserved populations in certain cities or regions.

  • A 2006 Denver study found a return of $2.28 for every $1 spent
  • n CHWs, primarily through reduced uncompensated care
  • A 2012 study of CHWs in 11 counties in New Mexico found

lower inpatient, ED, and prescription costs after the CHW intervention than before it.

  • HRSA suggests CHW savings come from reduced inappropriate

ED use.

Sources: https://www.raconline.org/communityhealth/chw/files/measuring_roi.pdf; http://www.apha.org/policies-and-advocacy/public- health-policy-statements/policy-database/2014/07/09/14/19/support-for-community-health-workers-to-increase-health-access-and-to- reduce-health-inequities; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343233/

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Medicaid SPAs 1115 waivers MCOs Private Grants

Some CHW Funding Sources

SIM ACOs Health Homes & PCMHs Community Health Teams

Some Initiatives and Programs Using CHWs

See: Community Health Workers and Medicaid Managed Care in New Mexico: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343233/; also https://www.statereforum.org/state-community-health-worker-models; https://www.statereforum.org/state-community-health- worker-models

Some CHW Funding Sources & Initiatives

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State Funding for CHWs

ACOs FQHC or Community Health Centers Health Homes SIM 1115 waivers

AK X AZ X AR X CA X CO X CT X FL X ID X KY X X ME X X MD X MA X MI X MN X X X NM X NY X OH OR X X TX X VT X VA X WA X

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Formerly Now

Preventive services provided by a physician or

  • ther licensed practitioner

Preventive services recommended by a physician

  • r other licensed practitioner

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Medicaid Reimbursement for Preventive Services Provided by CHWs

A CMS rule change allows Medicaid to reimburse for preventive services provided by unlicensed practitioners—such as CHWs--at state option. For reimbursement, state SPAs must include qualifications for non-licensed practitioners (per Nov. 27, 2013 CMCS Bulletin)

78 Federal Register 42306; July 15, 2013 http://www.gpo.gov/fdsys/pkg/FR-2013-07-15/pdf/2013-16271.pdf

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State CHW Certification Requirements

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Certification required for some reimbursement

AK IN OH OR SC

(pilot)

TX

Voluntary certification programs

AZ FL (2016) MO

(pilot)

NM RI MA (2015) https://www.statereforum.org/state-community-health-worker-models

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NASHP State Refor(u)m Resources on State Community Health Worker Models

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https://www.statereforum.org/state-community-health-worker-models

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Meeting Format

— An opening presentation will provide background

and help set the context for the meeting. The meeting will be divided into three sessions. Each session will begin with brief presentations.

¡ Session topics: 1.

Defining the Roles of Community Health Workers

2.

Training and Credentialing CHWs

3.

Leveraging Funding Opportunities for CHWs

— Conclude with “Next Steps” discussion: ways the

states, federal government can move forward

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Key Resources

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  • The American Public Health Association. “Community Health Workers.”

https://www.apha.org/apha-communities/member-sections/community- health-workers

  • State Refor(u)m. “State Community Health Worker Models.”

chart- https://www.statereforum.org/state-community-health-worker-models map- http://www.nashp.org/state-community-health-worker-models/

  • World Health Organization. “Community Health Workers: What do we know

about them?” http://www.who.int/hrh/documents/community_health_workers.pdf

  • HRSA Office of Rural Health Policy. “Community Health Workers Evidence-

Based Models Toolbox.” http://www.hrsa.gov/ruralhealth/pdf/chwtoolkit.pdf

  • HRSA Bureau of Health Professions. “Community Health Worker National

Workforce Study” http://bhpr.hrsa.gov/healthworkforce/reports/chwstudy2007.pdf

  • State Medicaid Director Letter on Preventive Services.

https://www.statereforum.org/system/files/smd-13-002.pdf