Advancing the profession and sustainability of community health workers

Community Health Workers (CHWs) strive to bridge gaps between traditional healthcare providers and the communities they serve, but the community health worker profession faces several challenges to realizing its full potential. In the fall of 2017, the Center for Healthcare Research and Transformation (CHRT) published an issue brief that focused on the ways State Innovation Model (SIM) grants have helped regions across the nation integrate community health workers into their healthcare systems. In this issue brief, CHRT enumerates the challenges states and health systems will need to overcome as they seek to develop a sustainable revenue stream for this work, to advance the community health worker profession, and to amplify the impact.

Key Challenges

Numerous studies have demonstrated the significant value of community health workers,2 but several obstacles stand in the way of their widespread adoption and continued development. In this brief, we outline some of the most significant challenges and describe how leaders across the nation are working to overcome them:

1. Scope. Many healthcare professionals are unfamiliar with the skills community health workers bring to health care teams. While most recognize their value as translators between health care professionals and the communities they serve, community health workers bring many other abilities. Promoting the diverse scope of skills community health workers can offer is essential to realizing their full potential.
2. Training. Community health worker training and certification processes vary around the country. Formalizing this process would provide employers and payers with assurance that community health workers have achieved a standard set of core competencies related to their roles.
3. Integration. Community health workers can play many different roles in health systems, which presents challenges for payers and employers who are working to integrate them into existing teams. While community health workers have proven particularly effective at working with narrowly defined populations or addressing specific programmatic goals, they should be given time to work in the community and to help their patients navigate a broader range of health and social concerns.
4. Funding. The funding mechanisms most commonly used to support community health workers—largely grants from government and foundation sources that support short-term work with individual patients—provide unstable revenue streams that can disrupt demonstrated improvements in individual and community health outcomes, and community health worker careers. While some health systems and health plans have begun financing community health workers for short-term interventions with high-cost patients, sustainable financing is not yet available for CHW services where cost-savings take longer to achieve (health promotion, maternal and infant health, disease prevention, and self-management).

Methods

The authors conducted in-depth, qualitative interviews with key informants from 14 states. The 19 informants included state health department and Medicaid officials, leaders of state community health worker associations, leaders in health systems and other organizations employing community health workers, and community health workers themselves. The authors supplemented these interviews with a literature review including academic and non-academic publications, as well as a landscape analysis of state policies.