5 ways community health worker programs can improve post-ACA

Community health worker (CHW) programs are more relevant than ever in the United States amid the current emphasis on outcomes and value, but these initiatives still must overcome several significant barriers in order to succeed, according to an opinion piece published in the New England Journal of Medicine.

After a storied history that began in 1800s Russia and continued with "barefoot doctors" in 1920s China, CHWs have gained increasing traction in the U.S. thanks in no small part to Affordable Care Act (ACA) provisions, according to the article. A 2014 report indicated that the country has about 38,000 CHWs, and some providers have indicated plans to expand their current programs.

Indeed, "the current policy and financing environment has created a historic opportunity to improve U.S. healthcare delivery through the effective use of CHWs," the article states. To accomplish this, however, programs must focus on overcoming five "key implementation barriers" that continue to hamper the success of CHWs. Here's what the article suggests:

Integrate with formal care teams. Though CHWs' community-based identity is important, they also must find a way to integrate themselves into formal care teams in order to truly improve patients' health, the article says. They can accomplish this by sharing a location with care teams, sharing patient registries, participating in multidisciplinary rounds and communicating via electronic medical records or telephone.

Avoid fragmented and disease-specific interventions. CHWs are most effective when they focus on holistic, upstream socioeconomic problems that can influence health, rather than focusing on clinical care or disease-targeted interventions that can lead to clashes with traditional providers and fragmented care, according to the article.

Develop clear work protocols. Though not all CHW programs are alike, each one needs to develop policies that explicitly regulate worker caseloads, supervision structures, workflow and necessary documentation, the article states, in order to avoid burnout and poor patient outcomes.

Hire better candidates. Effective training can only go so far to ensure worker competence--it's more important to simply hire the best candidates in the first place through formal interviews and a well-defined candidate selection process, the article states.

Support more comprehensive research. Past studies on CHWs' effectiveness have sometimes hurt their cause due to their questionable scientific merit, the article states, though it notes that the volume and quality of research have increased drastically since 2010. Future research, the article predicts, will focus on what features make CHW programs the most successful.

To learn more:
- read the opinion piece (subscription required)

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