In places like rural El Paso, Texas, community health workers (CHWs) help thousands of underserved individuals obtain the food, housing and medical services they need to survive.
They speak the same language and often come from similar backgrounds as the community members they serve. During the pandemic, CHWs were an essential resource for vaccine administration and education, meal-delivery service and chronic disease management services.
Yet, while CHWs represent the epitome of value-based care—a model that emphasizes collaboration, efficiency, proactivity and accountability—these front-line workers are among the most underutilized and underfunded professionals in the U.S.
In spite of 2014 federal guidelines that allow Medicaid reimbursement for services provided by CHWs, organizations continue to experience financial barriers when it comes to implementing the CHW model and securing funding to appropriately staff CHWs for optimal impact, according to one 2021 study. Moreover, many CHWs across the nation feel they don’t have the appropriate support tools, like fundamental technology solutions, to further improve their work and community health outcomes.
Unless these things change, value-based care (VBC) will fail to live up to its potential. In other words, you can’t have VBC without CHWs.
Connecting the dots
To fully understand the importance of CHWs to VBC models such as accountable care organizations (ACOs), it’s helpful to consider the origins of VBC.
As authors Kip Sullivan, Ana Malinow and Kay Tillow noted in a 2022 essay, the concept of value-based payment became widespread among U.S. health policymakers and analysts during the 2000s. The idea is that healthcare providers and hospitals would receive financial incentives for interventions that would improve cost and quality “without generating the hostility provoked by managed care insurance companies during the HMO backlash of the late 1990s.”
Yet, two decades in, neither one of these goals has been completely realized. Instead, healthcare providers are burned out, patients are underserved, and resources are running thin all around. As a report published in 2021 in The New England Journal of Medicine notes, a retrospective review of VBC models shows that most did not save money and improve quality.
That’s why CHWs are the knights in shining armor we need.
They’re best positioned to protect VBC as physicians continue to leave medicine in droves while social inequities rise. In places like El Paso or San Antonio with large Hispanic populations—and issues of trust in U.S. physicians—CHWs are the critical driver of behavioral and socioeconomic changes needed to improve outcomes and reduce healthcare cost burdens.
When a CHW takes on a new case and visits the home of a community member, that person’s walls tend to come down relatively quickly. It’s not uncommon for an individual to warm to a member of their own community when asked about their needs for assistance in obtaining food and transportation, even if they’ve been hesitant to share the same information with a provider. This candor allows CHWs to understand the complete picture of someone’s life to better equip them with the tools and resources they need. For individuals in high-risk situations, who are facing multiple or complex barriers to accessing care, bridging these healthcare gaps is key to improving outcomes.
In one study, CHW intervention in a low-income population with multiple chronic conditions was linked with increased support for disease self-management (63% compared to 38% control group) and lowered hospitalization rates (23% compared to 32% after one year). A separate JAMA study showed that utilizing CHWs boosted preventive care for children from low-income families enrolled in Medicaid.
Into the trenches
But if CHWs are knights in shining armor, it’s time to give them the tools and resources they need to fight for underserved community members. Here are three ways to move forward:
- Advocate for funding. We’ve come a long way in recognizing and supporting front-line workers in the U.S. For example, the National Association of Community Health Workers was founded in April 2019 after several years of planning and organizing by CHWs and their allies. But many organizations employing CHWs could use a financial boost so they can afford to hire additional workers. Supporting bills like the one Sen. Bob Casey, D-Pennsylvania, recently introduced, the Community Health Worker Access Act—which aims to improve CHWs’ ability to bridge gaps in health outcomes by improving Medicare coverage for their services—is a good start.
- Push for better visibility. Many of the barriers currently blocking CHWs arise from the fact that they are not as well-recognized as their clinician counterparts by traditional medicine and government institutions. However, as VBC continues to gain momentum, these professionals hold the key to unlocking the health and social needs of communities that need the most support. Too few CHW initiatives are short-term pilot programs in lieu of long-term or permanent branches of a healthcare system. We’d never expect a doctor to work without the right tools or funding, or expect them to make widespread impact after only a few months of work. CHWs must be recognized as integral parts of the VBC ecosystem if any of these barriers are to be eliminated.
- Elevate the status of CHWs within the healthcare ecosystem. Traditional physicians have their own struggles with reimbursement and accessing the resources they need, but systems exist to support them. As governments and organizations often still struggle to understand where CHWs fit into long-term population health programs, it can be challenging these workers to receive the appropriate reimbursement for their services—and the tremendous value they bring to the public health system and community at large. This challenge may stem from CHWs’ lack of voice in reimbursement discussions, or even a lack of understanding as to why CHWs need the right technology to best serve patients—just as their provider counterparts have. As these workers do more for our communities, and the advancement of VBC, we must come to consider them as providers in their own right and equip them as such.
Even through these steps, infusing a valuable care partner into the fabric of VBC will be difficult. But by implementing better technology for our front-line workers, and increasing our advocacy efforts, we’ll only strengthen VBC models.
Marisela Zuniga Campos is a community health worker at MHP Salud. Jonathan Jackson is co-founder and CEO at Dimagi.