The Role of Community Health Workers in Improving Population Health Outcomes

Community Health Workers (CHWs) can effectively address the diverse health needs of organizations' accountable populations to help generate positive health outcomes and reduce avoidable morbidity and healthcare utilization. Are they part of your population health strategy?

Introduction

Population health is about improving community health outcomes by addressing the various factors influencing health. This includes reducing barriers to high-quality care, ensuring access to affordable health and wellness options, encouraging integration with community efforts to tackle social health drivers, and promoting active participation in personal health care. Community-based approaches effectively achieve these goals by leveraging local strengths and resources. This article examines the role of CHWs in bolstering community-based population health that can be leveraged by organizations responsible for the care and outcomes of select populations.

The Role of Community Health Workers (CHWs)

CHWs often serve critical roles in community health initiatives. They are frontline lay members of the community who usually share ethnicity, language, socioeconomic status, and life experiences with the community members they serve. CHWs may also be called community health advisors, lay health advocates, promotoras, outreach educators, and peer health promoters/educators. CHWs are trained to perform various tasks, including health screenings, patient education, and helping people navigate the healthcare system. Their connection to the community allows them to reach community members where they live, eat, play, work, and worship to help deliver access to services (e.g., health education, essential services, health screenings, nutrition recommendations) helping to address social drivers (determinants) of health and reduce health disparities . The Bureau of Labor Statistics projects a faster-then-average growth in CHW positions, with a median pay (2023) of $48,200 per year. This 2021 paper by the National Association of Community Health Workers (NACHW) is a good resource for additional background.

As outlined in this infographic from the NICM Foundation , CHWs assist with issues such as:

• Unstable housing
• Food insecurity
• Employment
• Racial discrimination
• Intimate partner violence

They provide services including:

• Outreach
• Education
• Informal counseling
• Social support
• Navigation of the healthcare system
• Translation/interpreting

Impact of CHWs on Health Outcomes

Many studies have shown the effectiveness of CHWs across a wide range of clinical and social situations (e.g., chronic medical conditions , mental health, maternal and child health, unhomed persons), vulnerable populations , and geography (e.g., urban , rural , and Native American communities). Some examples include:

• Approximately 300 adult patients insured by Medicaid (82%) or uninsured (18%), residents of high-poverty neighborhoods, and diagnosed with at least two chronic diseases were randomly assigned to a 15-month CHW intervention or control group. The intervention group had a 38% reduction in cost. The CHWs generated a return of $2.47 for every Medicaid dollar invested. A scenario analysis generated a range of $1.84 to $3.09 by varying the attribution of the reduction in admissions and outpatient visits to the intervention. Evidence-Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment | Health Affairs
• A pooled analysis of three randomized clinical trials of a CHW intervention covering over 1,300 patients demonstrated a lower mean number of hospitalizations per patient, a lower rate of rehospitalization among those hospitalized, and a shorter length of stay. Patients were less likely to be admitted outside the primary health system (18.8% vs. 34.8%), which helped reduce fragmentation of care.
• A systematic review of nine studies evaluating the ability of CHW interventions to improve diabetes control demonstrated a modest reduction in hemoglobin A1c compared to usual care and a larger reduction when the baseline hemoglobin A1c was higher.

This Quarterly Report from Kentucky Homeplace provides more context about the human aspects of CHWs' work. Starting on page 19, the report cites actual client encounters, including:

• Setting up transportation to help someone see a physician for the first time in over three years.
• Resolving financial issues preventing access to a needed surgical intervention.
• Completing an application for grant funding to support access to an expensive medication.
• Identifying an assistance program to order shoes for a person with diabetes.
• Helping an unhomed person secure Social Security benefits and apply for a senior housing apartment.

Barriers to Effective CHW Programs

Despite their potential, CHW-based health initiatives often face challenges including funding constraints, sustainability issues, and scalability problems. Many community health programs rely on grants and donations, which can be unpredictable and insufficient. Ensuring the sustainability of these programs is difficult without long-term financial support. Programs that work well in one community may not work in others due to differing needs and resources. While recruiting CHWs from the communities they serve can reduce issues of trust, CHWs’ connection to healthcare systems may still provoke some mistrust among certain community members. In addition, access to telehealth and digital applications can be difficult in some rural and underserved urban areas.

Some healthcare professionals are still reluctant to involve CHWs, in part because they perceive that CHWs are not required to have a specific level of training or certification, which CHWs may perceive as disrespectful. This can result in less-than-optimal clinical integration and data sharing.

Policy Implications and Recommendations

Supportive policies are essential for the success of community-based health initiatives. Policymakers can play a crucial role in providing the necessary resources and creating an enabling environment for these programs. Policymakers should prioritize funding for community health programs. Additionally, fostering partnerships between healthcare providers, local organizations, and community members can enhance the effectiveness and sustainability of these initiatives.

Conclusion

Community Health Workers can be integral members of the clinical team and provide supportive services to the organizations in which they serve and, often, communities in which they live. From the Population Health Alliance perspective, CHWs are well-placed to support identifying needs, initiating interventions, and generating desired outcomes for health plans, accountable care organizations, and attributed patients under value-based payment models.

Question

Does your organization work with CHWs? What results have you seen?

The Population Health Alliance (PHA) is committed to Quality and Continuity of Care.?Our key priorities are advancing value-based care, improving consumer engagement, and addressing social determinants and health equity. Join us. Find out more on our membership page .

Registration is open for the 2024 PHA Innovation and Adoption Summit.? The event is both in-person and webcast. https://phainnovationsummit.com/

Michael S. Barr, MD, MBA, MACP, FRCP

Sr. Director, Population Health Improvement