Community health workers have long been part of the public health field. Unfortunately, their versatility and role ambiguity have led them to be misunderstood (and sometimes also overlooked) compared to other frontline health care clinicians such as physicians and nurses.
Payers can look toward a growing body of evidence to incorporate community health workers into their provider network strategy to bolster both patient health outcomes and their bottom line.
What Role Do Community Health Care Workers Play in My Provider Network?
Community health worker is an umbrella term for a wide variety of job titles, such as outreach worker, patient navigator, health advocate, community health advisor, promotor(a) (in Spanish-speaking communities), and others. These frontline public health workers are often trusted members of the communities they serve, making them accessible and relatable to patients.
How Can Community Health Workers Strengthen My Provider Network?
Community health workers are uniquely positioned to bridge gaps in the continuum of care by meeting patients in the comfort of their homes or other neutral community settings.
They are poised to improve a range of patient outcomes. Most notably, these include better management of chronic diseases, more consistent participation in screening efforts, and improved adherence to recommendations from doctors and other clinicians. For example, community health workers have been known to help patients with diabetes better manage blood glucose levels, record their readings, schedule appointments, and take medications regularly.
As another example, a community health worker supporting a patient with asthma might visit their home to see what disease triggers can be eliminated or reduced. They would also ensure the patient is taking their medicine as directed by their doctor and provide the patient with disease management education.
What The Numbers Say
Research shows there is a distinct benefit to the services community health workers provide. One study conducted by the Kansas City Regional Community Health Worker Collaborative looked at the work these clinicians did across six health care organizations. Results showed they were responsible for significantly decreasing service utilization in their clients – by as much as 59% for emergency department visits and 70% for hospitalizations.
While these numbers are impactful on their own, the cost savings are tangible. Penn Medicine found that every dollar Medicaid invested in their community health worker program yielded $2.47, leading to a notable return on investment.
How Can Payers Best Utilize Community Health Workers?
Community health workers are also an important part of the interprofessional care team and ensure patients closely follow their doctors’ care plan. Payers can leverage community health care workers to reduce service utilization, address complex health concerns better and earlier, identify social determinants of health and other inequities (such as housing instability, lack of transportation, and job loss) that may limit access to care, and cut costs across the board.
Payers can strategically utilize community health workers to achieve significant improvements in patient outcomes and their bottom line. Here’s how:
1. Targeted Program Development:
- Identify High-Need Populations: Analyze claims data to pinpoint patient populations with high health care costs, frequent hospitalizations, and unmet needs (e.g., those with chronic conditions, mental health concerns, or substance use disorders).
- Design Tailored Interventions: Develop community health worker programs that address the specific needs of these populations. For example, a program for patients with diabetes might focus on medication adherence, healthy eating, and blood sugar monitoring, while a program for those with mental health needs might focus on connecting them to mental health services and providing social support.
2. Integration with Care Management:
- Collaborative Care Teams: Integrate community health workers into care teams alongside physicians, nurses, and other health care professionals. This allows for a holistic approach to care that addresses both clinical and social needs.
- Referral Pathways: Establish clear referral pathways between providers and community health workers to ensure seamless coordination of care. Providers can refer patients to community health workers for support with social needs, while community health workers can alert providers to any emerging health concerns.
3. Leveraging Technology:
- Data Collection and Tracking: Utilize technology platforms to track community health worker activities, collect data on patient outcomes, and monitor program effectiveness. This data can be used to refine programs and demonstrate value to stakeholders.
- Communication and Collaboration: Employ telehealth and other communication technologies to facilitate communication between community health workers, patients, and providers, improving care coordination and access to care.
4. Sustainable Financing:
- Value-Based Contracts: Explore value-based payment models that reward providers and payers for achieving specific outcomes, such as reduced hospital readmissions or improved chronic disease management. Community health worker interventions can contribute to these outcomes, making them a valuable investment.
- Medicaid and Medicare Reimbursement: Advocate for policies that allow for Medicaid and Medicare reimbursement for community health worker services, ensuring program sustainability.
5. Training and Support:
- Comprehensive Training: Provide community health workers with comprehensive training on topics such as health education, motivational interviewing, care coordination, and cultural competency.
- Ongoing Support and Supervision: Offer ongoing support and supervision to community health workers to ensure they have the resources and guidance they need to succeed.
6. Evaluation and Quality Improvement:
- Data-Driven Evaluation: Regularly evaluate community health worker programs to assess their impact on patient outcomes, health care costs, and quality of care.
- Continuous Improvement: Use evaluation data to refine programs and ensure they are meeting the needs of the community.
7. Community Engagement:
- Community Partnerships: Build strong partnerships with community organizations to ensure that community health worker programs are culturally relevant and responsive to the needs of the community.
- Community Input: Seek input from community members to inform program design and implementation.
By implementing these strategies, payers can effectively utilize community health workers to improve patient outcomes, reduce health care costs, and advance health equity.