• Do community health workers work?

    The following is largely based on the content of emails I received from staff of the New England Comparative Effectiveness Public Advisory Council (CEPAC), of which I am a member. CEPAC is an independent body comprised of physicians, public representatives, and scientific experts who meet in public to review the evidence on the effectiveness and value of medical interventions. 

    At its forthcoming meeting (June 28th) CEPAC will examine the use of community health workers (CHWs) in the health care system. Why?

    The health care reform act provided a new impetus toward population-based care through the formation of accountable care organizations and patient-centered medical homes. These new organizational structures, along with existing integrated provider groups, are charged with providing better care to entire populations of individuals while holding down costs, and one of the important tools being considered to achieve this goal is the introduction of CHWs into the care process.

    CHWs are not trained as doctors or nurses or social workers. They are recruited directly from the community they serve, and their goal is to connect with individuals to help them navigate the health care system, manage chronic illnesses more effectively, and access the preventive care they need. But do CHWs really work? Can they help control costs?

    With state Medicaid programs, private payers, and health care provider organizations all poised to consider the introduction of CHWs, now is a critical time for objective review of the evidence and for guidance on whether and how to maximize the potential for CHWs to improve health care outcomes and value. On Friday, CEPAC will convene to conduct the public portion of that review, which will result in a report that will offer that guidance.

    Some examples of recent policy initiatives relating to CHWs:

    • Oregon recently received a $45 million CMS Innovation grant and Medicaid waiver to test the effects of their coordinated care organization framework that includes CHWs as part of their integrated care teams. 
    • A similar model has kicked off in Vermont, where commercial insurers, Medicaid, and Medicare are reimbursing “community health teams” as part of the Vermont Blueprint for Health’s Advanced Primary Care Practice initiative. Some sites are choosing to integrate CHWs into these care teams to help patients better navigate social services, secure health appointments, and connect to community resources.

    Additional details about community health workers and the CEPAC meeting are found here.


    • What I am interested in seeing and have thought about (timely post), after the JAMA release yesterday (Joynt, Gawande et al) relates to avoidable and unavoidable utilization.

      Note the classification of DRGs in their paper: some like CVA not considered avoidable, whereas CHF yes.

      MIght we reclassify if one considers CHWs or their ilk and we learn we can derive improvements because, not in spite of them. Authors point out many of these conditions develop over decades and thus, may not respond to short term changes in care. However, reversing suboptimal compliance with rx and other interventions could alter equation.

      The substrate for stroke develops over years; adhering to best practice might stave off or attenuate the effects however.


    • As an advanced practice community health nurse with 24 years of practice in the community the evidence I have gathered is that CHWs work and save money when they are educated through skill identification and development to work with health care providers to the community. This takes a great deal of time, patience and partnership with community agencies and academic centers where a portion of the CHW’s education is offered. The CHW, both men and women, have a strong desire to make change within their community. Let’s join them to develop the necessary tools.