Defining Community Health Workers 2 According to the American - PDF document

Background Material for Fourth Meeting A Federal-State Discourse on the Role of Community Health Workers in the Wake of Health Care Reform October 5, 2015 Supported by The Commonwealth Fund 1 Defining Community Health Workers 2 According to the American Public Health Association, a community health worker is: — a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. — a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. https://www.apha.org/apha-communities/member-sections/community-health-workers 2

Other Terms for CHWs Include 3 — Promotora — Community health advisor — Patient navigator — Health coach — Community health outreach worker — Community health representative Depending on their roles, birth doulas , lactation consultants and others may also be considered CHWs. http://www.who.int/hrh/documents/community_health_workers.pdf 3 Community Health Workers and Health Equity 4 • Many states are using CHWs to advance health equity. • CHWs “connect community members, particularly difficult-to- reach populations, to the health care system…” (Viswanathan, 2009) • As trusted members of the communities in which they serve, CHWs are able to provide health education and support that is culturally and linguistically appropriate . This makes them well positioned to help patients overcome gaps in knowledge, literacy, trust, and health care access. Source: http://www.researchgate.net/publication/ 4 259449610_A_Community_Health_Worker_Intervention_to_Address_the_Social_Determinants_of_Health_Through _Policy_Change

Community Health Worker Roles 5 Working within their communities, CHWs’ roles include: — Health education — Health system navigation — Outreach, enrollment, and engagement — Community organizing (catalyze new activities, advocate for policy changes) — Case management and care coordination — Home visiting — Member of care team (working with providers) — Provide informal counseling/support services 5 Sources: Am J Public Health. 2012 Oct;102(10):1981-7; http://www.hrsa.gov/ruralhealth/pdf/chwtoolkit.pdf How CHWs Improve Health 6 • Specific examples of CHW activities to address social determinants of health may include: • Assisting with transportation to appointments • Addressing basic needs such as food, shelter, etc. • Interventions with utility companies • Increasing community capacity to support healthy behaviors • Findings indicate CHWs can have a positive effect on health outcomes in underserved populations through activities such as: • Improving access to care • Providing screening and prevention services • Improving patient adherence to treatment Sources: https://www.raconline.org/communityhealth/chw/files/measuring_roi.pdf; http://www.apha.org/policies-and-advocacy/public- health-policy-statements/policy-database/2014/07/09/14/19/support-for-community-health-workers-to-increase-health-access-and-to- 6 reduce-health-inequities

CHW and Cost Savings 7 • While more research remains to be done on the cost-effectiveness of CHW initiatives, some initial findings suggest that CHWs can contribute to reduced health care costs among underserved populations in certain cities or regions. • A 2006 Denver study found a return of $2.28 for every $1 spent on CHWs, primarily through reduced uncompensated care • A 2012 study of CHWs in 11 counties in New Mexico found lower inpatient, ED, and prescription costs after the CHW intervention than before it. • HRSA suggests CHW savings come from reduced inappropriate ED use. Sources: https://www.raconline.org/communityhealth/chw/files/measuring_roi.pdf; http://www.apha.org/policies-and-advocacy/public- health-policy-statements/policy-database/2014/07/09/14/19/support-for-community-health-workers-to-increase-health-access-and-to- 7 reduce-health-inequities; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343233/ Some CHW Funding Sources & Initiatives 8 Some CHW Some Funding Initiatives and Sources Medicaid Programs SIM SPAs Using CHWs 1115 ACOs waivers Health MCOs Homes & PCMHs Community Private Health Grants Teams See: Community Health Workers and Medicaid Managed Care in New Mexico: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343233/; also https://www.statereforum.org/state-community-health-worker-models; https://www.statereforum.org/state-community-health- 8 worker-models

State Funding for CHWs FQHC or Community Health 1115 ACOs Health Homes SIM Centers waivers AK X AZ X AR X CA X CO X CT X FL X ID X KY X X ME X X MD X MA X MI X MN X X X NM X NY X OH OR X X TX X VT X VA X 9 ¡ WA X Medicaid Reimbursement for Preventive Services Provided by CHWs 10 A CMS rule change allows Medicaid to reimburse for preventive services provided by unlicensed practitioners —such as CHWs--at state option. Formerly Now Preventive services Preventive services provided by a physician or recommended by a physician other licensed practitioner or other licensed practitioner For reimbursement, state SPAs must include qualifications for non-licensed practitioners (per Nov. 27, 2013 CMCS Bulletin) 78 Federal Register 42306; July 15, 2013 10 http://www.gpo.gov/fdsys/pkg/FR-2013-07-15/pdf/2013-16271.pdf

State CHW Certification Requirements 11 AZ NM MO (pilot) IN Voluntary RI Certification certification required for programs some FL (2016) AK reimbursement MA (2015) TX OR OH SC (pilot) https://www.statereforum.org/state-community-health-worker-models 11 NASHP State Refor(u)m Resources on State Community Health Worker Models 12 12 https://www.statereforum.org/state-community-health-worker-models

Meeting Format — An opening presentation will provide background and help set the context for the meeting. The meeting will be divided into three sessions. Each session will begin with brief presentations. ¡ Session topics: Defining the Roles of Community Health Workers 1. Training and Credentialing CHWs 2. Leveraging Funding Opportunities for CHWs 3. — Conclude with “Next Steps” discussion: ways the states, federal government can move forward 13 Key Resources 14 • The American Public Health Association. “Community Health Workers.” https://www.apha.org/apha-communities/member-sections/community- health-workers • State Refor(u)m. “State Community Health Worker Models.” chart- https://www.statereforum.org/state-community-health-worker-models map- http://www.nashp.org/state-community-health-worker-models/ • World Health Organization. “Community Health Workers: What do we know about them?” http://www.who.int/hrh/documents/community_health_workers.pdf • HRSA Office of Rural Health Policy. “Community Health Workers Evidence- Based Models Toolbox.” http://www.hrsa.gov/ruralhealth/pdf/chwtoolkit.pdf • HRSA Bureau of Health Professions. “Community Health Worker National Workforce Study” http://bhpr.hrsa.gov/healthworkforce/reports/chwstudy2007.pdf • State Medicaid Director Letter on Preventive Services. https://www.statereforum.org/system/files/smd-13-002.pdf 14