— Shawn Thomas / Coconino County Public Health Services District Policy Analyst
Betsy, an elderly woman whose only spoken language is Navajo, had test results that were indicative of some serious health issues which could lead to diabetes-induced blindness and kidney failure. However, her doctor’s messages were not coming across to her very clearly which is common for those whose first language is not English.
Providing culturally competent and efficient clinical care in remote and/or underserved areas continues to be a challenge for health care providers. However, community health workers (CHWs) could pave the way for increased care coordination.
So, what is a community health worker? The American Public Health Association (APHA) defines a CHW as “A frontline public health worker who is a trusted member of and/or has an in depth understanding of the community served. This trusting relationship enables the CHW 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 the service delivery.” (St. Lukes Health Initiative, 2015).
What kind of roles do CHWs play? CHWs provide:
- Community Outreach by increasing access to culturally sensitive healthcare.
- Patient education through early disease protection, self-management and health promotion.
- Care coordination by linking their patients to services to reduce acute care needs and hospital readmissions.
CHWs are known by a wide umbrella of terms, such as: health educators, case managers, lay health workers, and outreach workers but they all serve essentially the same purpose. The Coconino County Public Health Services District (CCPHSD) utilizes the services provided by these public health workers in many programs including the Health Start and Tobacco and Chronic Disease programs.
Across Arizona, CHWs are also known as Community Health Representatives (CHRs) who serve essentially the same purpose and cater to the Native American populations in rural and underserved areas in unison with the Indian Health Service (IHS) and 638 Tribal Clinics. However, most CHR programs are operated by tribal governments.
Presently, efforts are underway that seek to establish CHWs as frontline workers in the health care institutional setting through reimbursement and sustainability efforts. As of July 2015, the Center for Medicare and Medicaid Services (CMS) issued a ruling that now allows Medicaid programs to request an amendment to current rules that will allow for reimbursement of community-based preventative services such as those provided by CHWs/CHRs.
In 2001, the Arizona Community Health Worker Outreach Network (AzCHOW) was formed. The Coalition is coordinated by the Arizona Prevention Center at the University of Arizona and consists of over 60 organizations throughout the state including state and local health departments, community health clinics, hospitals, Arizona Health Education Centers (AHEC), community colleges, CHR programs, etc. Additionally, the Arizona Department of Health Services (ADHS) established the CHW Leadership Council in 2014 and most recently in 2015 the Arizona Advisory Council on Indian Health Care aided in the establishment of the CHR Movement.
The CHW model has been in place for decades, but more needs to be done to fully integrate CHWs into the primary care setting to improve health outcomes, reduce cost of care, and save provider time. Thus far, the biggest hurdle to utilize and integrate CHWs into the health care team is the ability to recognize and to reimburse and pay for their services.
CHWs are an integral and stabilizing part of clinical care through enhanced care coordination but it will take getting all stakeholders to the table so that CHWs hold a unique place in the public health process.
— Shawn Thomas is a policy analyst with the Coconino County Public Health Services District. Contact him at 928-679-7333 or sthomas@coconino.az.gov for more information.