In value-based care, it takes a village of professionals to ensure patients are well cared for and practices meet benchmarks. Community health workers (CHWs) are emerging as key players in helping to achieve these goals.
CHWs are nonclinical healthcare professionals who support patients’ physical, mental, and social needs by connecting them to community resources and services. In doing so, they make sure patients receive comprehensive care when they are outside of their doctor’s office, while easing the burden on medical offices to do so.
Due to their deep understanding of the communities they serve—particularly the most vulnerable populations—CHWs recognize, and therefore are able to address, social determinants of health (SDOH) that often lead to disparities. CHWs also provide education, advocacy, and outreach opportunities, including:
According to Cynthia Adams, an Innovista Health community health worker, finding the right services for patients requires seeing the big picture. “I look at patients’ underlying conditions, SDOH, and if there are any risks or barriers. I also look within the home and entire community, and depending on what I identify, I research what’s available to help and come back with solutions.”
Services like these provided by Adams and other community health workers have proven to be highly beneficial to patients, providers, and payers.
Some of the biggest benefits and positive outcomes include:
In patients, studies show that CHW interventions can reduce hospitalizations and improve chronic disease control, mental health, and quality of care.
For providers and payers, CHWs boost the ability to achieve a significant return on investment (ROI)—a barrier that often prevents physicians from taking the leap into value-based care. One ROI analysis found that every $1.00 invested in CHW intervention would return $2.47 to an average Medicaid payer. Similarly, another study of CHW outreach resulted in an ROI of 2.28:1.00.
Innovista’s CHWs have produced similar cost savings to participating physician groups and payers. In 2020, Genovista ACO and Medicare/Medicaid insurance provider Amerigroup deployed CHWs to redirect patients who overutilized emergency departments (ED).
The community health workers identified SDOH that contributed to these patients’ healthcare utilization choices, found resources to lessen the impact of these SDOH, and educated them about less costly alternatives to the ED. This effort yielded a 40% drop in ED usage in just nine months.
While there’s no “typical” day for a community health worker since every day presents its own unique challenges and adventures, there are certain constants for CHWs like Adams.
Adams says much of her day is centered around performing or reviewing patient assessments. When she is not head down in a case, she is following up with existing patients or interviewing new ones with the goal of matching their needs with the best solutions.
She emphasizes the importance of scouring the communities she serves for new outreach providers, as one connection leads to many others. It’s all about networking, which helps her grow her portfolio of resources to offer patients. “I talk to community partners and they tell me what they have available, how their programs work, the eligibility requirements, and how new members can access their services. Many of these partners refer me to other organizations, and then those new organizations refer me to others, and so on. My goal is to always build on my portfolio of resources and services.”
After connecting with community-based organizations, Adams says she’s back on the phone to tell members what’s available and how to access those services. In fact, communication with members is constant and ongoing—it’s the key to making sure they follow through, receive the services they qualify for, and are satisfied with the outcome or resolution.
Another important and routine part of Adams’ job is embedment—where she spends one day a week at her assigned provider’s office, working directly with the physician, office staff, and patients.
“It starts at the front office. I check in and see if they have any assessments. Sometimes they want me to work on something in the front office—maybe it’s cancellations or no-shows, or a parent that wants to talk to me either before or after an appointment.
“Then from the front office, I go to middle office where the officer manager is. I also work closely with the physician’s assistant or nurse practitioner. If I have some time where I can catch the doctor between patients—even if it’s a brief three to five minutes—I can update him on things, or he can speak to me about a member.”
She continues, “From there, I often get a chance to work with other health providers outside of the clinic.” Some of these include local pharmacists and the hospital across the street from her medical practice.
Being a community health worker has its fair share of challenges and success stories.
One of Adams’ biggest challenges is helping patients understand and navigate their health plan and the healthcare system so they know how to use both appropriately.
Adams explains, “If you don’t understand your health plan, then you don’t utilize it, so you’re going to look for the easiest way to get care—and a lot of times that’s the ED. My challenge is how to change that behavior.”
Sometimes it takes time for members to make changes, but Adams always reinforces the fact that she is a phone call away any time they have questions or concerns. “I make sure that they know that I am a constant presence. I am always reachable.”
Amidst working through these types of challenges, Adams has experienced some heartwarming successes.
During a cervical cancer screening outreach program, she met a young mother who was overdue for a routine Pap test. Adams learned this mother had a negative experience with a gynecologist and also preferred a more holistic approach to healthcare, which is why she sought out a midwife for her child’s birth.
Adams introduced her to a doctor who understood holistic medicine, and she worked with the patient to increase her comfort level with that physician.
This is just one example of many illustrating how Adams and other CHWs can improve the lives of members on a physical and emotional level.
Community health workers are indeed an integral part of the value-based ecosystem. For providers and payers, they help reduce costs and gaps in care. For patients, they deliver much-needed resources in a sensitive, understanding, nonjudgmental way. CHWs have everyone’s best interests at heart—and because of that, everyone benefits.