How CHW Strategies Advance Health Policy

anneWilleart1The federal government as well as many states are taking greater interest in the CHW role. At the federal level, exciting policy developments include the Dept of Health and Human Services Working Group on CHWs, HUD’s CHW Initiative, CMS Medicare Diabetes Disparities pilots and the CMS Center for Innovation’s Workforce Innovation Awards.

The Patient Protection and Affordable Care Act lists CHWs as a member of the health care workforce and as a health professional. It defines CHW as “an individual who promotes health or nutrition within the community in which the individual resides.”

According to the law, a CHW promotes health in the following ways:

  • – Serving as a liaison between communities and healthcare agencies;
  • – Providing guidance and social assistance to community residents;
  • – Enhancing community residents’ ability to effectively communicate with healthcare providers;
  • – Providing culturally and linguistically appropriate health or nutrition education;
  • – Advocating for individual and community health;
  • – Providing referral and follow-up services or otherwise coordinating care; and
  • – Proactively identifying and enrolling eligible individuals in Federal, State, local, private or nonprofit health and human services programs.

New CHW investigations are underway in Delaware, Missouri, North Dakota and Utah while Massachusetts pursues a year-long effort to establish a CHW certification process under the direction of a new board of certification and with input from CHWs from around the state.

New CHW developments in Arizona, Illinois, Missouri, New Mexico and South Carolina share some common characteristics including:  focused education and awareness, agreement on scope and qualifications/skill standards, move towards certification on the part of many, strategy for sustainable financing, resources for workforce development and mobilizing CHWs to participate (Carl Rush, Oct 2012).

    • Are you interested in ways to address health equity and also control costs?
      • CHW strategies tackle health disparities.  They can also help reduce costly, avoidable use of emergency departments and preventable hospital readmissions.
    • Are your constituents contacting your office with concerns about navigating complicated systems of coverage and care?
      • CHWs work with patients and caregivers experiencing barriers related to culture, language, literacy, income, mistrust, isolation, income and other related factors. They teach patients how to access affordable coverage and quality care. They help patients understand how to use their health benefits, prepare for physician visits and follow their care plans.

Spotlight:  Oregon Coordinated Care Organizations

CHWs are integral to Oregon’s Coordinated Care Organizations (CCOs) with global payments to 15 regions to achieve quality metrics for Medicaid enrollees. Benefits and services are integrated and coordinated with a focus on prevention, primary care, and chronic disease management. CCOs address regional, cultural, socioeconomic and racial disparities in health. Find out more in this Washington Post article.

In the Central Oregon pilot, CHWs made a difference by addressing behavioral health issues and better meeting patient needs. They reduced emergency department visits by 49% leading to a decrease in net costs by more than $600,000 in the first six months. Get a full description here.

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