Emanuela P. leaf
Imagine a worker, a member of the healthcare team, who visits patients in their homes and encourages healthy behaviors. In one home, the worker may remind an elderly man to take his blood pressure medicine, and in the next, she may work with a diabetic woman to improve her diet. Or he may remind pregnant teens of medical appointments, provide education about breastfeeding, encourage those with high-risk behaviors to get HIV testing and help people get access to health insurance.
These workers exist. They are called community health workers (CHW) and can be found in both rural and urban communities, and they share ethnicity, language, socioeconomic status and life experiences with community members.
Ten states have established a certification process to formalize CHW knowledge and skills and to increase recognition of the CHW workforce. The benefits of certification are that health care providers are more likely to hire certified CHWs and Medicaid programs and private health insurers are more likely to approve payments for services provided by certified CHWs.
The Connecticut Health Foundation (CT Health), the state’s largest independent health philanthropy organization dedicated to improving lives by changing health systems, released a policy brief describing how community health workers (CHW) can improve health outcomes, reduce health disparities and contain costs.
“CT Health hopes that this research and the advances in other states provide the evidence and blueprint needed to convince key decision makers in Connecticut that community health workers must be supported through training, certification, practice transformation, and payment if the state is to meet the changing needs of the health care system,” said Elizabeth Krause, vice president of policy and communications.
“CHW interventions help patients to understand and to adhere to physicians’ instructions following a doctor’s visit. This is important as our health care delivery model moves away from the traditional fee-for-service payment system to new value-based purchasing: paying for services in a way that rewards health care providers for delivering better care at lower cost,” Krause said.
The analysis, highlighted in the report, Tomorrow’s Health Care System Needs Community Health Workers: A Policy Agenda for Connecticut, was commissioned by CT Health and conducted by the University of Massachusetts (UMass) Medical School Center for Health Law and Economics.
The policy brief outlines steps that can guide Connecticut’s efforts to create a health care system that is proactive and responsive to the expectations of tomorrow’s health care system. Connecticut is uniquely positioned to forge ahead as a leader in the implementation of the Affordable Care Act. For example, Connecticut’s State Innovation Model grant is one step towards cultivating a robust CHW workforce.
“Physicians often feel frustrated that they can’t influence their patients’ actions once they leave the office. CHWs extend health care beyond the clinic walls. They help their clients manage their own health,” said Katharine London, principal in UMass Medical School’s Center for Health Law and Economics and lead author of the brief.
But health workers within the community are not a new concept.
According to the American Journal of Public Health, many other countries have found CHWs to be important members of their healthcare teams for decades. Brazil provides an excellent example of a country that began using CHWs in the 1980s. The improved health outcomes attributed to the CHWs were so substantial that in 1994, the government included them in the primary healthcare teams of the national Family Health Program.
Today, each team is comprised of one physician, one professional nurse, one technical nurse, other health professionals and six or more community health workers. Each team serves 3,450 to 4,500 people. After about three decades of organization and collective struggles, Brazilian CHWs all carry an associate’s degree and are well respected by the health professionals and the people of Brazil. The United States can look to Brazil as an excellent model of team care that includes community health workers in promoting the health and wellness of their population.
For more information on the work of The Connecticut Health Foundation, please visit their website at http://www.cthealth.org/.