If we were to tell you there is a proven way to reduce health disparities and improve health outcomes while reducing costs you might say, “Where do I sign?” One such way exists, and it is to invest in and support the integration of community health workers (CHW) into our health care delivery system.
Community health workers are public health workers who are trusted members of their communities and typically share ethnicity, culture, language, socioeconomic status, and life experiences with community members. They bridge doctors’ offices with the community settings in which people with costly chronic conditions like asthma, serious mental illness, and diabetes manage their health on a daily basis. CHWs are particularly well suited to help those covered by HUSKY, Connecticut’s Medicaid program.
However, without infrastructure in place to support the contributions of CHWs, Connecticut will experience challenges in its move toward coordinated, community-integrated health care.
For far too long in Connecticut, CHWs have provided valuable services under a cloud of instability and uncertainty with a reliance on short-term funding. For example, many CHWs served as in-person assisters who helped enroll the state’s uninsured residents in health insurance during past open enrollment periods. Some report to us that they continue to help their community members without compensation since modest assister grants ended long ago.
The Connecticut Health Foundation has made several CHW grants over the years and we have witnessed this sustainability problem first hand. When our grant ended, the CHW was out of a job.
Ten other states from Texas to Oregon to South Carolina have established a certification process to formalize CHW training, knowledge, and skill requirements to increase recognition of the CHW workforce. The benefits of certification are that health care providers are more likely to hire certified CHWs, and Medicaid programs and private health insurers are more likely to approve payments for services provided by certified CHWs.
A 2013 federal rule changes gives state Medicaid programs the opportunity to reimburse for cost-effective preventive CHW services recommended by a physician or clinician. Medicaid administrative funds are another potential financing option. Medicaid programs in Minnesota and Pennsylvania support CHW services directly, while those in a number of other states make monthly payments to clinical practices to cover CHWs.
So, what can Connecticut do to ensure the long-term viability of community health workers? To maximize opportunities available under health reform, the foundation believes Connecticut has the opportunity to make real progress by:
* Establishing a process for certifying CHWs, along with training and experience requirements, to document CHWs’ skills for potential employers and insurers.
* Implementing Connecticut’s State Innovation Model (“SIM”) initiative, which includes a role for CHWs to help integrate communities and clinical services.
* Building on interest and momentum to add cost-effective CHW services to Medicaid-covered services and initiatives.
* Providing training to health care providers on how to effectively include CHWs as part of care teams.
Advancing community health worker infrastructure is a good investment for Connecticut. CHWs are part of the solution as we move toward paying for health care services in a way that rewards providers for delivering better care at lower cost.
Patricia Baker is the chief executive officer of the Connecticut Health Foundation.