by Janelle Schrag and Emily Schweich
Essential hospitals serve vulnerable patient populations that are disproportionately affected by chronic conditions. As lay health providers, community health workers (CHWs) — also known as health navigators, community educators, or promotras/es — play important roles in helping those vulnerable populations navigate their care and connecting them to the vital services they need.
Helping Communities Navigate Care
As patient navigators, CHWs can build trust with patients, share cultural and linguistic commonalities, and form strong social bonds. Not only do these services improve patient health, they also result in improved utilization patterns.
In a retrospective cohort study at essential hospital Boston Medical Center, the use of navigation services for patients with diabetes was associated with improved A1C levels, as well as better engagement with the diabetes clinic. Patients using navigation services scheduled and followed through with more appointments, visited the clinic more, and missed fewer appointments.
With a keen knowledge of community needs and resources, CHWs can have a powerful influence on health outside hospital walls. At association member UMass Memorial Health Care, in Worcester, Mass., CHWs conduct home visits with asthma patients to identify and mitigate environmental triggers. CHWs also help patients navigate legal issues that might result from property management. After one year, the program resulted in reduced emergency department (ED) visits, improved asthma outcomes, and fewer missed school days among pediatric participants.
CHWs as Integral Care Team Members
Essential hospitals can optimize the power of CHWs by integrating their roles as patient navigators and population health program staff into the care team. Hennepin Health is an accountable care organization (ACO) comprising Minneapolis health care providers that fill a safety-net role, including essential hospital Hennepin County Medical Center. This ACO’s robust care coordination program has:
- reduced ED visits and hospital stays;
- increased primary care visits;
- improved care for chronic conditions; and
- connected patients to food, housing, and other needed resources.
Clinicians might feel uncertain about increasing CHWs’ role on the care team or unsure how their new partners fit into the team. To create a smoother transition, Chicago-based Sinai Health System’s Sinai Urban Health Institute created best practice guidelines, which include information about the CHW position, how integration will shape existing responsibilities, and the personal expertise of new team members.
Financing also is an important consideration for hospitals when determining whether to expand the role of CHWs. Many positions are financed through grants or short-term limited financing, and Medicaid can provide a more sustainable long-term funding stream. Some states, including Arkansas, Arizona, Maine, Michigan, Minnesota, Oregon, Texas, Vermont, and Washington, and the District of Columbia have formal Medicaid reimbursement mechanisms for CHWs, while North Dakota and Rhode Island offer reimbursement for limited populations and services.
While finding sustainable financing and changing workplace culture are challenges, community health workers are worth the investment. Their expertise extends within and beyond hospital walls and is a valuable asset to patient navigation and population health programs at essential hospitals.