Community health workers can reduce health disparities

“Becoming a community health worker has been my dream job. I enjoy helping people to meet their goals to improve their lives, treating them with respect and empathy, and empowering them to do the things that are most difficult. Seeing my clients get ahead of a bad situation is an instant gratification for me.”
—Guadalupe Tredway, Community Health Worker

Community health workers (CHWs) are frontline public health workers who reflect the values, culture, and experiences of the communities in which they work. CHWs develop relationships of trust with their clients, which is different from the provider-patient relationships that are based on clinical experiences. 

There was a recent client confused about his mounting medical bills. He had tried to set up a payment plan, but he could not understand why he had to pay if he has medical insurance. He also struggles with severe hearing loss and that made coordinating payment plans and insurance clarification more difficult. We assigned a community health worker to his case. 

Guadalupe helped the patient clarify his accounts and understand why they were so high. She explained payment plans and how to request financial help. She then moved on to address his hearing impairment. Guadalupe helped him obtain the hearing aids to which he was entitled by his health insurance, and requested a captioned telephone so he can read the conversation and voice messages that come in. 

Community health workers bridge the cultural and linguistic gap that commonly exists between health providers and patients. CHWs speak the same language as their clients and have similar life experiences. They relate to their clients from a position of shared background and experiences, which encourages open communication about health-related issues, ultimately resulting in improved health care outcomes.

CHWs generally serve a variety of clients of all ages, genders, and race and nationalities, including seniors, adults with chronic conditions, pregnant women, and individuals without adequate financial resources. Through the development of a trusting relationship, the CHW is able to identify non-clinical needs that are impacting their client’s ability to live a healthy life. 

Non-clinical needs — such an innocent term for real problems that plague individuals. Guadalupe recently worked with a client who was reported to the Department of Children and Families by a social worker during a home visit. The social worker realized that the client’s daughters slept in bed with the client and her husband because they didn’t have beds for the girls. The client told her that she got in trouble for the situation; this issue soon outweighed her other non-clinical problems including lack of transportation and food insecurity, among others. Guadalupe was able to build trust with her client and enroll the family in a program called Twin Bunk Bed project that provided bunk beds for their daughters. After building trust and helping the client to address her primary concern — her daughters, Guadalupe ,  was able to work with the client to locate and accept resources that provide transportation, food, and paying for services.

Impact of community health workers 

Community health workers provide critical support and improve the health of a broad client population by:

• Educating clients about proper use of health care facilities and when to seek emergency medical attention.
• Supporting lifestyle changes like developing balanced diets, increasing exercise, and reducing tobacco or alcohol use.
• Leading clients through the health and social services systems by
  • Improving communication between the client and provider regarding the plan of care 
  • Setting clinical appointments
  • Locating community support and resources in a client’s geographic area
• Advocating for their clients and sharing self-advocacy strategies within the health and human service system to overcome social influencers of health. 
• Assisting clients to apply for benefits, such as Medicaid or Medicare, to increase rates of insurance coverage.
• Connecting clients to food, medicine, and other necessities to quarantine safely during the pandemic.

A 2018 KC Regional Community Health Worker Collaborative survey of six organizations found improved health and self-sufficiency from CHW efforts including:

• Increased well-baby checks, dental exams, and developmental screenings among children.
• Increased health coverage rates for individuals and families.
• Increased access to medications.
• Decreased pre-term deliveries and NICU admission days.

From that same survey, one organization reported a 59 percent reduction in emergency room visits and a 70 percent reduction in hospitalizations among their clients.

Goals in Kansas City

We would like to see more CHWs embedded in hospitals, clinics, and community-based organizations throughout the Kansas City region. By expanding the CHW workforce, more clients will receive comprehensive community care management beyond the walls of the clinical setting. 

Expansion of community care management will help clinical providers better understand the non-clinical needs of their patients, whether it is housing, transportation, digital access, food instability, or something else entirely. In addition, research and local experience support the conclusion that an expansion will result in improved health and reduced health costs. However, in order to integrate CHWs into staffing structures, organizations will need sustainable, long-term funding streams. 

Support from Medicare, Medicaid, and commercial insurers is imperative to wide-spread adoption. There are a variety of avenues providers could explore for possible, sustainable funding streams. Medicare Advantage organizations are emerging as a payer type to support social interventions like community health workers through pathways such as chronic care management. 

Additionally, the Centers for Medicare and Medicaid Services Supplemental Benefits for the Chronically Ill rule allows Medicare Advantage organizations to provide primarily non-clinical services to chronically ill clients, evidencing a policy shift to embrace non-clinical services to support high-risk clients. It provides a potentially new pathway to offer supportive social services.  

State Medicaid agencies should explore the multiple pathways available to them to sustain CHWs: 

• Including CHWs as an eligible provider type in the delivery of preventive services
• Incorporating CHWs into health home structures that provide comprehensive care management to high-need clients
• Encouraging managed care organizations (MCOs) to integrate CHWs into their care management efforts through the state Medicaid contracts with these MCOs

Given the success of CHWs in the KC region to date, we expect continued growth and long-term investment in the regional CHW workforce. The KC Regional CHW Collaborative is excited to continue to work with all stakeholders – CHWs, employers, state agencies, Medicare Advantage, and commercial insurance groups – to advocate for the expansion, sustainability, and widespread integration of CHWs into the regional network of health and social service providers.