Print pageIn addition to state and local policy environments, it is almost important to explore the community health worker (CHW) landscape in your community. Beyond Housing shared that in addition to operating a CHW program, a local health convener in their community brings together other organization's CHW programs to share learnings, resources and information. This helps with recognizing how valuable the CHW role is to helping residents' health. The health convener in their community also helps to lift up issue affecting CHWs including pay equity and coordinating around data and evaluation.
Local and State Landscape Scan
Do you have a local health department (city/county) that is working to advance the use of CHWs, establish community partnerships, and/or address the Social Determinants of Health (SDOH)? Many public health departments have committed/recommitted themselves to promoting health equity, and CHW programs may be a perfect fit.What is your local hospital(s) structure? Are they nonprofit or for-profit, locally owned, or a part of a regional/national system? For partnership purposes, the best-case scenario is a locally owned nonprofit hospital, which are often committed to the local community and less bureaucratic than larger systems. They are also required to provide community benefits and conduct regular Community Health Needs Assessments (CHNA) that are available on their website. CHNA's are a valuable source of information about the hospital's focus, including SDOH, which can provide leads for potential partnerships.
What are local funders supporting? Do you have health-focused foundations (private, corporate, or otherwise)? It can be helpful to review their recent award information to better understand what type of programs they are funding.
The best (and clearest) indication of a positive environment for a CHW program are the existing programs in your area. Research whether local hospitals, clinics, nonprofits, and others are already operating programs. Existing providers are a reliable source of information. Do not be afraid to reach out to try and learn more about their program and how it is funded.
Medicaid and Medicare Landscape Scan
Has your state adopted Medicaid expansion? Understanding the Medicaid expansion landscape in your state can help identify resources available for connecting individuals to services.Does your state provide Medicaid reimbursement for CHW services? While somewhat outdated, the National Academy for State Health Policy provides information on CHW financing by state, including whether services are reimbursed by Medicaid.
Does your state Medicaid agency incentivize the use of CHWs by managed care organizations? Most states operate under a managed care model whereby the state authority can incentivize (or require) activities to be conducted by their contracted Managed Care Organization. The National Academy for State Health Policy, referenced above, also contains some information on state incentives and requirements. States that are currently rebidding their Medicaid Managed Care contracts are also increasingly focused on the SDOH and community investment, given the impacts of COVID and the glaring health disparities that it displayed, which may represent another good sign/opportunity. Large MCOs such as Aetna, Centene, Humana, Molina Healthcare, UnitedHealth Group, and the Blue Cross Blue Shield affiliates, amongst others, have begun paying for CHW services in some geographies.
What about Medicare? Similar to Medicaid, Medicare-funded organizations are also being incentivized to address the SDOH and improve outcomes, all while reducing costs. Accountable Care Organizations (ACOs), which are groups of doctors, hospitals, and other providers that come together voluntarily to provide coordinated care to Medicare patients, are a common entity type that provides Medicare-funded services. These models focus on achieving quality outcomes and value, which would incentivize them to incorporate CHWs into their multi-disciplinary care teams. Medicare Advantage Plans — Medicare-specific managed care plans which are paid a capitated rate based on member risk scores — are also exploring CHW models to improve outcomes while reducing costs.
What do I do with this information? As described above, organizations funded by Medicaid and Medicare (as well as commercial insurance plans) are being increasingly incentivized to improve outcomes, while reducing the cost of care. CHWs are a perfect model to support these goals and may represent an avenue for potential partnership. Do a scan of local service providers to try and determine whether they have employed CHWs to support their work with Medicaid and/or Medicare recipients. As noted above, do not be afraid to reach out to try and learn more about their program and how it is funded. This will help you better understand whether there may be partnership opportunities with that specific provider or other similar organizations.
Community Health Worker Certification Programs
Many Community Health Worker (CHW) Learning Lab participants shared they identified different pathways to certify their CHW staff. After they figured out their state CHW certification requirements, their CHWs were certified through programs at state universities, conferences, and local CHW programs offering certified training.
Certification will outline certain requirements such as education/experience, core competencies, training, among other prerequisites. Certification and training requirements vary widely by state. The Association of State and Territorial Health Offices (ASTHO) is one source for up-to-date CHW certification information.
Regardless of whether a formal certification process exists within your state, there are opportunities to create such a program and potentially partner with healthcare organizations for payment.
