The Office of the Assistant Secretary for Planning and Evaluation (ASPE) http://aspe.hhs.gov, within HHS, did an in depth review on using Community Health Workers (CHW) for the report “Community Health Workers: Roles and Opportunities in Healthcare Delivery System Reform”.
It has been reported that by 2020, 157 million people in the U.S will have one chronic condition and 81 million are anticipated to have multiple chronic conditions. The growing national burden of chronic illness is found in minority and low-income populations and therefore generally experience poorer health outcomes.
As a result, CHWs are most often deployed to help improve outcomes in communities with high levels of health disparities or a disproportionate prevalence of chronic disease. CHWs healthcare teams can increase access, deliver screening and preventive services, and improve system navigation, care coordination, and disease management outcomes. CHWs have the ability to develop rapport with patients and other community members due to shared cultures, community environment, and life experiences.
The report reviewed several challenges before the full potential of CHWs can be fully utilized to improve healthcare delivery. Despite growing interest in engaging CHWs, there are questions concerning standardizing CHW training, certification and licensure issues, establishing strong economic evidence to support their use, and how to secure reimbursement for their services.
CHWs are distinct from other members of healthcare teams since they are hired primarily for their understanding of the population and communities they serve rather than for expertise or credentials obtained through formal health education. Basically CHWs are hired to link patients within their communities to services.
Therefore training and credentialing CHWs to perform their roles but how they become certified or licensed to deliver care can vary greatly from state to state, based on state and organizational licensure requirements.
According to the Association of State and Territorial Health Officials (ASTHO) www.astho.org , legislative tracking of CHW training and certification requirements show that as of October 2015, only Florida, Maine, New Mexico, Ohio, Oregon, and Texas have laws or regulations which have established CHW certification program requirements.
So far, 33 states and the District of Columbia have not taken or introduced regulatory or legislative action around CHW education, certification requirements, or established Medicaid payments for CHW-provided services.
The report concludes that although existing research remains limited, some evidence suggests that using CHWs to provide healthcare services can be cost effective. In addition, patient navigation services provided by CHWs may make the integration of CHWs into care teams an appealing strategy for organizations and practices.
However, as the report concludes, “Although the use of CHWs is promising, the outcomes seen in the U.S to date make it difficult currently to justify broad, national policies to deploy CHWs into the health workforce and provide reimbursement for all of their services.
Go to https://aspe.hhs.gov/sites/default/files/pdf/168956/CHWPolicy.pdf to view the report.