By Emma Opthof, Center for Health Care Strategies
Community health workers (CHWs), also referred to as promotores, peer navigators, and outreach workers, are trusted health professionals who share lived experiences with the individuals they serve. They foster connections between health care, social services, and the community, allowing them to provide culturally appropriate health education, resources, and support, which can be particularly valuable for people with complex health and social needs. CHWs have long held formal and informal positions in various settings, including health systems, community-based organizations, clinics, managed care plans, and government agencies.
Many health care stakeholders are interested in scaling up this workforce to maximize opportunities for CHWs to connect people to needed health and social services in their communities. To support this momentum, the Playbook has curated a diverse set of resources for health care organizations interested in understanding: (1) the evidence base for how CHW programs affect health outcomes, including implications for health equity; and (2) implementation tools and first-person perspectives from health care stakeholders on developing or expanding CHW programs.
Demonstrating the Evidence for CHW Programs
Numerous studies have shown positive outcomes from CHW interventions. A Centers for Disease Control and Prevention report summarizes evidence that CHW programs can improve health outcomes and address social needs. IMPaCT, a CHW model designed by the Penn Center for Community Health Workers in Philadelphia that has been widely implemented in many states, has been evaluated through multiple clinical trials with high-risk patients, with the following results:
- Improved patient health outcomes in diabetes, obesity, smoking, and mental health;
- Reduced total hospital days and hospitalizations across multiple settings, including hospitals, academic primary care clinics, Veterans Affairs, and federally qualified health center primary care practices;
- Return on investment of $2.47 for every dollar invested by a Medicaid payer for addressing patients’ social determinants of health; and
- Increased patient engagement through higher patient activation scores, primary care utilization, and high-quality quality discharge communication with providers.
An evaluation of Personalized Support for Progress, a CHW intervention, showed reduced costs for women with depression, high health care expenditures, and unmet social needs when compared to an enhanced screening and referral program for the same population. Similarly, CareMore’s complex care management program with a CHW on the care team reduced medical utilization and expenditures for high-need, high-cost Medicaid patients. A cost analysis of CHW programs that address medical and social needs found that a CHW with an annual caseload of 150 participants provided the break-even point for reducing emergency department visits to achieve cost neutrality.
CHWs are also well-positioned to address health inequities in underserved communities by advocating for patients who face many barriers to quality care. A Families USA summary of nine studies funded by the Patient Centered Outcomes Research Institute provides substantial evidence that programs using CHWs and peer providers can advance health equity in diverse communities with various health issues such as serious mental illness, chronic disease, and traumatic physical injury.
Considerations for Implementing CHW Programs
It can be difficult for health care systems to meaningfully integrate CHWs into already existing care models due to barriers like inconsistent funding, but there are successful examples of implementation around the country.
- In New Mexico, the use of CHWs spread statewide when a managed care organization approached the University of New Mexico Health Sciences Center for help with case management for their high-need, high-cost patients. Based on the success of CHWs in addressing health-related social needs in the community, New Mexico’s Medicaid program invested in the expansion of the CHW model to other health care systems within the state.
- Geisinger Health System‘s three-year CHW pilot program assisted 16,000 individuals and closed 24,000 care gaps, which inspired them to incorporate CHWs into their medical home model and expand their community health workforce.
- Finally, a recent Better Care Playbook webinar highlighted unique implementation examples from Visión y Compromiso, IMPaCT, and Mount Sinai Health System. For instance, Mount Sinai is creating a more sustainable financial strategy for CHWs by partnering with AIRnyc, a community-based CHW organization. Originally, the partnership revolved around asthma management, but COVID-19 led the partners to expand the scope of services to identify patients with food insecurity, lack of medication access, and behavioral health issues.
In addition, CHWs can contribute to quality improvement teams addressing health-related social needs, by applying their understanding of patient needs and experiences. This tool from Health Leads provides tips for successfully integrating CHWs into the quality improvement process by involving them in aim setting, process mapping, improvement design, measure defining, and data analysis.
The Future of CHWs in Complex Care
As health care organizations continue to develop strategies to address the unmet social needs of complex patients, CHWs can serve as a valuable resource in connecting with patients, coordinating care, and improving the health of communities. The COVID-19 pandemic has only highlighted the importance of keeping community members connected to health care and social services, which is creating new opportunities to support CHW programs. The Better Care Playbook team encourages readers to send promising practices or questions about CHWs to playbook@chcs.org.