Component Eight: Funding and Sustainability

Funding for community health worker (CHW) programs can be a challenge. Most organizations are left cobbling together funds from grants and individual gifts to administer their program. While this will continue to be the case for many organizations, changes in the healthcare sector may provide opportunities for new, more sustainable sources of revenue. This component outlines the changes in healthcare financing (which are also touched on in component three), potential sources for CHW funding, and provide examples of sustainable healthcare-funded models.

Healthcare Financing

Healthcare financing is increasingly being tied to service value/outcomes as opposed to the old reimbursement approach in which payments were provided in exchange for services rendered. In the Old Reimbursement Model, the incentive was to provide more health services (fee for service). In the New Reimbursement Model, the incentive is to divert or avoid healthcare services, especially for hospitals. With this shift in healthcare financing, there are increased opportunities to partner and support high-quality, preventative care and CHW programs have proven effective in lowering avoidable costs and increasing patient satisfaction.
While somewhat outdated, the National Academy for State Health Policy provides an overview of state CHW programs and remains a valuable resource to understanding key elements of local CHW programs, including financing. An increasing number of state Medicaid agencies reimburse for CHW services. While states in which CHW services are reimbursable may have a leg up, healthcare organizations throughout the country are recognizing the value of CHW's and may have alternate funding sources.
It may be advisable to first seek partnerships from local FQHC's or charity clinics given their community connections. Hospitals, especially those that are non-profit, also provide an opportunity given their focus on lowering avoidable costs (e.g., unnecessary hospitalizations) and the requirements for nonprofit hospitals to provide community benefits.
Managed Care Organizations (health insurers) are traditionally the most difficult to establish direct partnerships with. It may be strategic to first form partnerships and experience with FQHCs, hospitals, and other local providers.

Community Health Worker Funding Sources

One Community Health Worker (CHW) Learning Lab participant shared that some of their funders helped with providing their organization technical assistance to scale their place-based work to a statewide practice. Their funder also helped them disseminate the results and learnings of their CHW program, which helped them to raise additional resources.

Below is a list of several potential sources of funding for CHW programs.
Individual gifts: The increased public focus on racial and health equity represents a potential opportunity to raise funds in support of CHW programs. CHWs provide an incredible service and, if the story is told the right way and supported with outcomes data, it can make a compelling case to potential donors.

Foundation grants: Private philanthropy can be a useful source of funding to establish or expand CHW programs because CHW programs often address multiple foundation priorities — workforce development, community health improvement, health equity and community stabilization.

Federal, state, and local contracts: COVID ushered a huge surge of state and local public health funding to help with community engagement for contact tracing, community safety, promoting vaccinations, and maintaining social connections for vulnerable people. Government agencies rarely have the capacity to respond to a public health emergency and need help when there is a spike in community needs. This provides a great opportunity for NeighborWorks network organizations to be the partner of choice.

Managed Care Organizations: Many state and federal authorities are prioritizing CHW programs as an evidence-based approach to increase the value of Medicaid and Medicare services. As a result, Medicaid, Medicare, and Special Needs managed care plans are expanding their CHW workforces and partnerships to better engage racial and ethnic minority communities and to advance health equity.

Hospital Systems and Accountable Care Organizations: Hospital systems often have contracts with the federal government that require value-based healthcare services. There are penalties if a patient is readmitted to the hospital within 30 days of their discharge and there are incentives to meet quality measures. The reasons for readmissions to a hospital can include a multitude of reasons, including a person's home situation or what is happening in their community. One of the needs of hospitals is to have a partner to help identify risk factors, such as living alone or in an unsafe environment, a person may experience that would hinder their recovery. Some NeighborWorks network organizations have developed partnerships and secured funding from hospital systems to implement CHW models to help identify and mitigate risks to recovery.

Infrastructure Requirements for Healthcare Funding

For organizations interested in pursuing healthcare partnerships to support their work, they should be aware that these types of partnerships often require investments in infrastructure, such as

Data entry and documentation software platform
Confidentiality and compliance policies and procedures
Eligibility and referrals processes
Billing and claims process

Sustainable Healthcare-Funded Models

Securing and sustaining healthcare partnerships requires a sharp focus on program processes, quality, and outcomes. It requires continuous assessment of results and improvement. This is not just about data. NeighborWorks organizations are well-positioned to balance their data and analytics with qualitative feedback gathered from community members, staff, and partners. They can evaluate processes through community member "journey maps" and stories that describe people's experiences accessing health services and other resources needed for health and wellness.
Health partnerships may start out small by focusing on a specific need like COVID vaccinations, but over time can grow to address more needs as the organization and health partner realize all the other ways they can bring value to each other.

Sustainable Models

Penn Center for CHWs, Philadelphia, PA The organization uses community and general funds from large health systems and health plans to fund 24 CHWs under the IMPaCT model. Other staff are funded partially or entirely through grants.
Northwest Ohio Pathways Hub One entity serves as the central clearinghouse for a variety of payers to contract and pay for regional community care coordination services related to birth outcomes and chronic disease provided by CHW employers.
Hennepin County Medical Center, Minneapolis, MN The program combines grants and Minnesota Health Care Programs reimbursement.
St. Paul — Ramsey County Public Health, St. Paul, MN The organization primarily relies on Minnesota Health Care Programs reimbursement.
Mayo Clinic/ IMAA, Rochester, MN The organization uses Accountable Care Organization payments along with grants and MNSure Navigator funding to cover CHW costs.
Molina Healthcare's, NM Molina, a Medicaid managed care organization, contracts with a community-based organization and the state university to use CHWs to identify individuals with complex medical and social needs in the community and connect them to needed resources. The program saved an estimated $2 million in healthcare costs in one year across 448 patients, suggesting close to a 4:1 ROI