Community health workers are being dispatched to the front lines of care delivery to better understand patients' socioeconomic circumstances and steer them away from costly ER visits in favor of cost-efficient and proactive care.
This article first appeared in the July/August 2016 issue of HealthLeaders magazine.
Healthcare systems are trying to improve patient outcomes and reduce costs by ensuring high-risk patients receive preventive care and comply with medical orders. But oftentimes patients have obstacles in their lives clinicians are unaware of that keep them from engaging with the health system.
Enter the community health worker, or CHW—an emerging resource that is becoming a critical part of the integrated care team.
CHWs are being dispatched to the front lines of care delivery by primary care practices, health systems, and insurers to better understand patients' socioeconomic circumstances and steer them away from costly ER visits in favor of cost-efficient and proactive care.
The American Public Health Association, publisher of the American Journal of Public Health, defines a CHW as "a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served." APHA adds: "This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery."
While some healthcare organizations require CHWs to have college degrees or certification in a health-related field, others place more emphasis on a CHW's knowledge of community services, language skills, and shared life experiences with the target patient population.
Priority Health's Medicaid insurance plan, which has more than 100,000 members in Western Michigan, uses CHWs "to meet the patient where they live," says Sheila Wilson, director of care management for the Medicaid product at the nonprofit health plan in Michigan. CHWs work one-on-one to advocate for members, mentor them, and help them navigate the complex medical and social systems. They resolve barriers to care such as transportation, safe living conditions, jobs, nutrition, culture, and language. She puts the CHW need bluntly: "If people don't know where they're sleeping or getting their next meal, they can't get to the next step of care."