What’s Next for the Community Health Worker Role?

The value of community health workers (CHWS) in connecting people to local resources and clinicians became increasingly evident to the health system and public health leaders during the pandemic.

«We saw how they were an antidote to misinformation and mistrust during our Covid-19 vaccination campaign in New York City,» said Dave A. Chokshi, MD, MSC. «It’s one of the investments I’m most proud of. mandate as the City Health Commissioner, when we launched a program known as the Public Health Corps to advance CHW.»

The number of CHWs has grown to approximately 80,000 in the United States today. But some advocates argue that a much broader, more systemic deployment of CHWs with more adequate funding could have a much greater impact.

Organization leaders addressing social determinants of health are trying to figure out what the next policymaking steps should be to solidify the CHW role and develop best practices for workforce development, reimbursement, and data exchange.

Shreya Kangovi, MD, CEO of Impact Care, which helps organizations build and manage their CHW workforces, believes we need to take a step back and look at how we spend $4.5 trillion on healthcare in the United States. Thirty percent of that goes to hospital care; Another 20% goes to doctors, and the other 50% goes to other clinical care, such as medications and devices, he estimated.

«We don’t really know how much goes into addressing the social determinants of health, but it’s often an unmeasured afterthought,» said Kangovi, who is also a professor at the University of Pennsylvania School of Medicine. “How we spend is inversely related to the value of our healthcare dollar. We know that clinical care is overshadowed by social, behavioral and economic factors, but we are out of sync with how we are spending our money and the workforce. “We cannot right the value ship in the next era of American healthcare without radically rethinking our workforce.”

Chokshi and Kangovi were speaking in December at a meeting of a group called the Common Health Coalition, which officially launched in March 2024 to turn lessons from the pandemic response into actionable strategies to strengthen the partnership between healthcare and health systems. public. Founding members include AHIP, The Alliance of Community Health Plans, American Hospital Association, American Medical Association and Kaiser Permanente, but the organization has since grown to nearly 100 members.

One of the coalition’s first efforts, launched in December 2024, is the Common Health Challenge for Community Health Workers, designed to advance meaningful CHW initiatives across the country through health-health partnerships. public. The Coalition seeks to offer guidance on how to better integrate community health workers into your organizational efforts.

Trust is the key

The key word when thinking about CHWS is trust, Chokshi emphasized. “CHWs are trusted professionals who build bridges between clinical, public health and community organizations to facilitate access to services and improve health. In my own clinical practice, I see each week how community health workers fill the gaps in our system, gaps in understanding, gaps in services, and gaps in trust. I think about how one of the CHWs I worked with called nearly a dozen pharmacies near one of our patients to find out which one would be best for him, given his limited mobility and complicated medication list, or how another of our ChWS organized delivering healthy meals to a patient’s homeless shelter, persisting even when the shelter was reluctant to make arrangements for their storage. CHWs who are truly embedded in neighborhoods have a deep understanding of the places they work because they are the same places they are from. That’s why public health responses from measles to mental health are supercharged by CHWs.»

Also speaking at the event was Bechara Choucair, MD, executive vice president and chief health officer at Kaiser Permanente. He served as White House vaccination coordinator amid the Covid-19 pandemic. «It was so clear that when people had questions about vaccines and wanted to talk to the people they trust to make that decision about whether to get vaccinated or not, they looked to community health workers,» she said. “I have no doubt that community health workers are a great community asset, helping to deliver better health outcomes across populations while strengthening community resilience.”

Choucair said five years ago Kaiser Permanente started an initiative with community health workers in the Pacific Northwest. «These CHWs worked with our members with high social needs who were at higher risk for increased utilization and poor outcomes, and help them address some of the root causes of our members’ health problems,» he explained. “This included helping them gain access to reliable transportation, stable housing, healthy food, among other needs. Our data has shown that members matched with a community health worker had more primary care visits, had fewer days in hospitals, and their total cost of care decreased.”

Kaiser Permanente has also learned how important it is to focus on recruitment and training and provide the proper infrastructure and support that community health workers need for that program. «Since that early effort that began years ago, our model now includes different patient populations and has seen benefits for socially and medically complex patients,» he said. «We are now planning to take these results and integrate more community health workers into our organization.»

Also speaking at the Common Health Coalition event was Simbo IGE, MD, MS, MPH, commissioner of the Chicago Department of Public Health.

«We’ve done a lot of surveys in Chicago, and overwhelmingly, people trust people who have shared lived experience, people who understand their daily realities,» he said, to describe a program that uses healing arts, with community health workers leading the way. meditation meditation. , sound therapy and yoga spaces to help create spaces for healing using the arts.

«»What we find is that communities feel more comfortable in those spaces when these human beings that draw them into the conversation are from the communities,» Ige explained.» They are using practices that the community feels connected to and through these practices, through this building of bridges, the communities, they feel more comfortable entering clinical spaces and now they are more eager to understand that we are doing these practices of healing for you, but we feel that you could benefit from a therapist, and we feel that you may need to consult with a psychiatrist. So this is an example of how trusted messengers can accelerate healing, accelerate access, and accelerate trust.”

CHWs can build connective tissue between many different social services and health and public health organizations, said Aurora Grantwingate, member engagement member and partner engagement manager at the National Association of Community Health Workers. “Many community health workers are doing this very naturally and informally, just as part of their everyday lives. «It’s a huge benefit to healthcare and public health organizations to help fill some of those gaps in social services, to help patients and healthcare providers focus on their daily jobs.»

Kangovi emphasized that there has been a lot of research to show the effectiveness of CHW implementation. «What if I told you that there was a treatment for loneliness, discrimination, and intergenerational poverty that had been tested in multiple randomized controlled trials, the same way we would test a new drug or medical device that had tens of thousands of trial participants In all different conditions, all walks of life, and we were able to show that this treatment improved mental health, improved blood pressure, improved A1C, reduced smoking rates Made people have access to primary care. , cancer screenings colon, mammograms, and reduced total hospital days by 34%, saving each taxpayer $2,500 per patient treated annually. Would we try to get people access to that medication? “I think we would,” he said. «It exists. It is empathy delivered in a structured way by community health workers.»

As Medicaid and Medicare begin to offer ways for managed care organizations to pay for community health workers and even more funding opportunities begin to appear, Kangovi said she is concerned about how that could affect this workforce within 10 years. “I think there is a big risk of the workforce being co-opted, both in terms of identity and in terms of the quality of the services they are providing. My concern is that once billing codes are part of our daily lives, people who don’t really represent the communities they serve, suburban nurses or EMTs or pharmacy technicians, can take a training course and call themselves themselves a community Health worker and bill that code to perform the checklist assessment and refer you. Do you have enough food to eat? Here’s a number for a food pantry. Trust doesn’t come without reliability, and that requires some guardrails for community health workers. How can we really guarantee the quality of the services they provide? Organizations must be held accountable for hiring the right people, paying them a living wage and having pay transparency, having career ladders, having true person-centered work practices that transfer power to the people they serve.»