By EWA MATUSZEWSKI
I believe we witnessed a breakthrough in getting the role of the community health worker (CHW) into the vernacular of common healthcare terms. That’s because I saw a news story about CHWs on local television – not a healthcare special or a “news hour” but standard local news programming. Thank you, Henry Ford Cancer Institute, for sharing with WDIV (the local NBC affiliate in Detroit,) how your mobilization of healthcare workers in the hospital setting is putting patients and their families at ease by helping navigate some of the non-clinical aspects of illness, hospital stays and care coordination.
The timing of the local news piece couldn’t have been better as our nonprofit learning organization, Practice Transformation Institute (PTI), was celebrating the gradation of two cohort classes of CHWs the week the feature aired. We showed the clip at the graduation ceremonies as an example of how the need for community health workers was not only growing but gaining attention beyond the healthcare and public health environment.
I do hope I haven’t turned off readers with my many columns referencing CHWs. But it’s a message that bears repeating. And that’s ultimately how ideas including medical messaging stick: clinical, academic, community, word-of-mouth, media. The emergence of CHWs (actually reemergence, as CHWs have been around in different parts of the world since the 1930s – for example, the “barefoot doctors” with basic medical training who worked in rural Chinese villages,) reminds me of our efforts in the mid-to-late 2000’s to draw attention to the Patient Centered Medical Home (PCMH) model of primary care.
Oh, it was frustrating talking about a topic that very few people inside healthcare – much less outside of it – were interested in hearing. Like CHWs the PCMH wasn’t new. It was being reintroduced and tweaked by Dr. Paul Grundy and the Primary Care Collaborative in response to the need for chronic illness management provided by a multi-disciplinary team care in a primary care setting. It wasn’t until Blue Cross Blue Shield of Michigan (thank you again, Dr. Tom Simmer and PGIP) put its weight behind the value of the PCMH model that providers and Michigan’s health insurers started paying attention.
By “weight” of course I mean funding. Primary care practices that were designated by BCBSM (and other designating organizations) as Patient-Centered Medical Homes became eligible for reimbursement dollars after actively adopting the PCMH model and increasing quality scores as a result.
Money is at the core of what is getting CHWs noticed – and valued – now. This year, 2024, the Michigan Department of Health and Human Services began allowing Medicaid reimbursement for use of CHWs in various settings. As the WDIV feature pointed out, services encompassing a “circle of support” can include assistance with connecting to community resources, transportation, housing and food, to name a few.
Many of these services have traditionally been performed by Masters-level social workers. Yet, following the goal of utilizing multi-disciplinary care teams and individual members at their highest level of licensure, such responsibilities are better suited to CHWs. Degreed professionals can always be brought in to a situation that is too complex or inappropriate for a CHW to handle on their own.
I want to add here that CHWs generally work in the communities where they live; they understand the culture and speak the language. That’s a CHW advantage, especially when dealing with ethnic, immigrant or socio-economically disadvantaged communities where access to supportive resources may feel daunting or out of reach. That’s why the next step in reimbursement needs to cover CHW services more broadly and consistently to include primary care practices and non-clinical settings such as community centers, health fairs and massive government projects such as the current Medicaid Renewal efforts.
While TV was a great start, we still need to focus on other reimbursement channels to have CHWs working and receiving appropriate compensation for their knowledge and skill. To all the recent graduates of the Practice Transformation Institute’s CHW Program – which consists of 166 hours of learning: “Gracias por su dedicación y servicio a pacientes y clientes. Que continúen los éxitos del CHW.”