Payment & Delivery Models

How community health workers can help improve outcomes, cut costs

Some may ask whether a community health worker —a person in the community to whom patients can go to for help, support and informal counseling—is new. The truth, though, is that it has existed for generations across the globe and in many different cultures. 

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Years ago, a community health worker may have assisted women in childbirth and helped teach them how to care for newborns.  

As the practice has evolved, today’s community health worker (CHW) can be a critical part of a health care team who helps patients tackle social determinants that physicians don’t have the expertise, time or resources to address.  

This includes housing, education, employment, and food or income insecurities that can come up during office visits and so often hold patients back from managing chronic illnesses or seeking proper care in the first place. Numerous studies over more than a decade show that CHWs help improve patients’ outcomes and reduce costs as payment models shift to reward practices that deliver these results. 

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During an event at the AMA’s Chicago headquarters, guest speaker Sergio Matos—founder of the National Association of Community Health Workers—spoke with Diana Derige, director of strategy and development in the AMA Center for Health Equity. They discussed how physicians and health systems can develop effective partnerships with CHWs to advance the quadruple aim without overmedicalizing a critical community role. 

“There is no prescription for you to write for the stressors and difficulties people are facing,” Matos said. “This is why there is a need for other players on a health care team that can deal with these issues.”  

Physicians are sometimes leery of turning control over to others, Matos said, stressing that CHWs don’t do clinical work. Through home visits, group meetings and calls, they delve into understanding what is going on in people’s lives, helping them to figure out how to get food on the table or how to keep the lights on by connecting them with social services. They also help patients navigate and trust a health care system that may seem alien. And they find the successes patients have had and help them build new ones to manage a chronic disease.

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Data supports CHWs’ positive impact 

CHWs “contributed substantially to improvements in care team productivity and outcomes” for patients, says a study, “Community Health Worker Integration into the Health Care Team Accomplishes the Triple Aim in a Patient-Centered Medical Home: A Bronx Tale,” published in the Journal of Ambulatory Care Management. Adding CHWs to the care team also reduced costs, with the hospital saving $2.30 for every $1 it invested in a CHW.  

The study, co-written by Matos and published in 2014, found that after adding CHWs to a patient-centered medical home in the South Bronx, New York: 

  • Emergency department visits fell by 5%. 
  • Hospitalizations dropped by 12.6% among patients with diabetes and other chronic health problems. 
  • There was a net savings of $1,135 per patient. 
  • There was a net savings of $170,213 annually generated by each CHW. 
  • The improvements led to the hospital achieving the additional $250 per member, per month enhanced reimbursement rate for care coordination. 

How you can incorporate CHWs 

The “Bronx Tale” study determined that there are seven things hospitals or physician practices can do to help ensure incorporating CHWs results in positive changes.  

  • Someone in medical leadership needs to champion CHWs. 
  • There must be a CHW administrator and supervisor for the CHW program. 
  • CHWs need to be supported in leading care management team meetings. 
  • Hospital administrators need to be committed to the CHW model. 
  • The right people—those who are empathetic, natural helpers, good communicators and experienced in the community culture—need to be recruited and hired as CHWs. 
  • Early on, evidence of the benefits of having CHWs need to be shown to gain organizational, administrative and teamwide support. 
  • Clinical teams need to be trained so that they understand the mission and vision of the CHW program.