Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform

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U.S. Department of Health and Human Services


Health care reform activities since the 2010 passage of the Affordable Care Act have resulted in significant and innovative shifts in health service delivery and reimbursement – with an overall movement towards increased value, coordination, and accountability in care. Accompanying these changes, many of the traditional roles and services of providers such as physicians, nurses, and other health care workers have expanded and evolved. In addition, some emerging, new occupations are playing an increasing role in patient-centered medical homes (PCMHs) and other team-based models for health care delivery.1

Although community health workers (CHWs) have been embedded in community-based outreach programs for decades, significant national policy interest is emerging for this the occupation due to the potential ability of CHWs to improve health care access, service delivery, and care coordination, and to provide enhanced value in health care investments. 2 Although there is some variability in how the U.S. Department of Labor3 and other organizations4 define a “Community Health Worker,” a CHW is typically a frontline public health worker who is a trusted member of, and/or has an unusually close understanding of, the community served. This trusting relationship enables the worker to serve as a link between community members and needed health and social services within their community. CHWs hold a unique position within an often rigid health care system in that they can be flexible and creative in responding to specific individual and community needs. Their focus is often on the social, rather than the medical, determinants of health – addressing the socioeconomic, cultural practices, and organizational barriers affecting wellness and access to care.5 CHWs are known by numerous names in their communities and in the health literature, including Promotores de Salud, Community Health Advisors, and related titles, 6,7,8 reflecting their widely variable roles and responsibilities. This variability can present a challenge for demonstrating their value through outcomes research and for attempts to standardize CHW educational pathways, certification, and reimbursement.9,10

This report reviews select health services research findings on CHW utilization that are relevant to U.S. policymakers and considers the key challenges to fully realizing and quantifying the potential for CHWs to improve health care delivery. Although not intended to be a comprehensive and critical analysis of the full body of research around CHWs, this paper builds on information from a number of recent reports from across the Department of Health and Human Services (HHS) – including a 2009 systematic review by the Agency for Healthcare Research and Quality (AHRQ),11 a 2014 evidence assessment published by the Centers for Disease Control and Prevention (CDC),12 a 2015 CDC policy brief on CHW interventions for chronic disease management,13 and a 2015 summary of findings by the CDC-supported Community Preventive Services Task Force on cardiovascular disease interventions.14 This material is supplemented with select additions from the primary health literature and reports by health policy research organizations. 


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