Essential Role of Community Health Workers in the US, New Report

The Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai and the Office of the United Nations Secretary-General’s Special Envoy for Health in Agenda 2030 and for Malaria today released a special report detailing why community health workers (CHWs) are essential in improving the health of patients by bridging the gap between clinical and community settings. The report, published by a task force of global and domestic experts and frontline leaders, presents a framework for developing sustainable financial and organizational models for CHWs in the context of ongoing changes to the American health care system. Also included is a plan to pilot a sustainable CHW program in Newark, New Jersey, through a partnership among key stakeholders in city and state government, a public hospital, community advocates and the state’s largest health insurer.

CHWs are non-clinical workers who come from the communities of the patients they serve, whose job is to help patients live healthier lives, as well as to help providers better understand and respond to patient needs.  While CHWs have existed in the United States for decades, they have not been historically recognized as a core unit of U.S. health infrastructure the way they are in many countries abroad. This is due in large part to the American model of fee-for-service payment for care, which does not incentivize the types of preventive or maintenance support that CHWs often provide. CHW programs have also struggled within a U.S. context because health systems are designed on the basis of clinical care being delivered at hospitals and clinics, leaving many patients unable to comply with the medical advice they receive once they return home.

“We’ve known for a long time that the United States spends more on health care than its peer nations yet obtains poorer outcomes in many key health indicators,” said Prabhjot Singh, MD, PhD, Director of The Arnhold Institute for Global Health, and Chair, Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, and Chair of the Task Force on Sustainable, Effective Community Health Worker Programs in the United States. “It is unacceptable that a person born and raised in Manhattan’s Upper East Side can expect to live, on average, 16 years longer than someone in Bolivar County, Mississippi. Adding to this disconnect is a wide gap between clinical care and communities, leaving the realities of patients’ lives and perspectives out of the care plan.”

“A growing body of evidence shows that social, economic, genomic and cultural factors can impact an individual’s ability to build and maintain health, and community health workers can change the paradigm of medical care by making this rich context actionable,” said Dr. Singh. “Our findings indicate that with careful construction of the right care models, including all of the organizational and financial infrastructure needed to support them, CHWs can contribute enormous value to patients, communities, and health systems alike.”

The task force identified a number of principles for effective CHW programs, drawn from successful programs in Brazil, India, and Ethiopia.

These principles include:

• Prioritize the patient at the center of care;
• Reflect community needs in every aspect of design;
• Follow clearly defined, evidence-based protocols to meet patient needs;
• Build strong systems to support the service provided by CHWs;
• Select and develop a high-quality workforce;
• Make CHWs an integrated part of the full care team;
• Align programmatic, operational and financial models;
• Be a strong partner to health systems.

“Across the globe we’ve seen the value and impact of community health workers,” said Daniel Palazuelos, MD, MPH, Senior Health and Policy Advisor for Community Health Systems at Partners in Health and a task force member. “When CHWs are effectively selected, trained, supervised, remunerated, and integrated into care delivery teams, they help us understand our patients better, and provide an invaluable extension of care deep into the communities where they live.  I marvel at the health impacts we achieve abroad, and then I too often lament that the same is not available for my patients in Boston. Working with CHWs is simply a better way of practicing medicine.”

“RWJBarnabas Health is excited to test the community health worker (CHW) model, particularly in Newark, which provides tremendous opportunity to improve access to primary care and foster healthier communities,” said Jennifer Velez, Senior Vice President of Community and Behavioral Health, RWJBarnabas Health.

Additional collaborators on the task force report include Rutgers, the State University of New Jersey; Dalberg Global Development Advisors; Penn Center for Community Health Workers; AdvantageCare Physicians; LSU Health New Orleans School of Public Health; City Health Works; Partners in Health; CityMD; Center for Medicare and Medicaid Innovation;  Iora Health; New Jersey Medical School; RWJBarnabas Health; and The MCJ Amelior Foundation.