Community Health Workers

Policy Recommendations to the State of Illinois

Mid-America Regional Public Health Leadership Institute

Technical Assistance Project

December 2012

The MARPHLI Team• Marilyn Green, Edwardsville Regional Health Officer, IDPH• Mireya Hurtado, Director of Community Outreach, IDPH• Kelly Jordan-Licht, Assistant Director, Community Health Services,

Kendall County Health Department (IL)• Stephen Konya, Chief of Staff, IDPH• Amy Sagen, Health Policy Analyst, University of Illinois Hospital &

Health Sciences System (formerly Office of Governor Pat Quinn)

Team Mentors: • Rev. Kirsten Peachey, Director, Congregational Health Partnerships,

Advocate Health Care• Guddi Kapadia, Assistant Director, UIC-SPH, MCPHP

Background• Major Policy Shifts in Healthcare• Passage of the federal Affordable Care Act (ACA)• Medicaid Expansion in IL• Establishment of an IL Health Insurance Exchange

• “We Choose Health”• $25M Community Transformation Grant awarded to IDPH• Created by ACA, competitively funded through CDC• To promote healthy lifestyles, reduce health disparities, and

control healthcare spending• CHW priority proposed, but not funded

Business Case for CHWs

CHWs contribute to overall health system savings through;(1) improved prevention and chronic disease management, which reduces

costly inpatient and urgent care costs.(2) cost-shifting, with increased utilization of lower cost health services.(3) indirect savings associated with reallocation of expenditures within the

health care system, e.g., by appropriate team allocations within the patient centered medical home.

Studies show that savings and returns range from $2.28 to $4.80 for every $1.00 spent on CHWs.

Source: The New York State Community Health Worker Initiative

Problem Description• Inconsistent utilization of CHWs statewide

• Lack of statewide policies or common standards in Illinois• No standard definition of CHWs• Limited funding/reimbursement mechanisms• Uncoordinated statewide curriculum/certification

• Unidentified career pathways and career ladder opportunities

Mission

Initially, charged with developing recommendations to the State of Illinois related, but not limited to the following:1. A standard definition of a Community Health Worker2. A model for statewide certification3. Foundation for developing CHW curriculum4. Criteria to develop statewide performance standards and

measures

State Policies on CHWs“There’s no need to re-invent the wheel”

CA, TX, NY, MN, MA, MI

IL

Approach

Build on current efforts in IL and learn from other state models• Developed standardized questionnaires• One for in-state stakeholder groups• One for surveying current practices in other states

• Utilized questionnaires in telephone and in-person interviews• Researched other state models on-line• Attended in-state CHW stakeholder meetings• Attended CHW sessions at 2012 APHA Annual Meeting

Illinois Stakeholder Engagement

Current CHW efforts in Illinois: • Health Connect One• Center for Excellence in the Elimination of Disparities (CEED)• CHW Local Network• Sinai Urban Health Institute• HHS Region V, Dr. James Galloway• IL Workforce Investment Board (IWIB)• South Suburban College• Health and Medicine Policy Research Group• CHW Alliance (collaborative network)• Individual CHWs in Illinois

State Public Policy Analysis

Researched CHW policy models in other states and U.S. cities

• States– Alaska– California– Indiana– Massachusetts– Michigan– Minnesota– New York– Texas

• Cities– Boston– Minneapolis– New York City– San Francisco

Defining Community Health Workers

CHWs - Who are they???• Care Coordinator • Addiction Treatment Specialist • Case Worker • Asthma Educator • Community Follow-Up Worker • Asthma Family Support Worker • Community Health Advisor • Case Management Technician • Community Health Advocate • Diabetes Family Support Worker • Community Health Outreach Worker • HIV/AIDS Family Support Worker• Counselor Mental Health Aide

• Natural Researcher • Cultural Mediator • Nutrition Advisor • Eligibility Worker • Nutrition Educator • Family Advocate • Pre-Perinatal • Health Specialists • Family Support Worker • Outreach Worker • Health Advocate • Patient Navigator• Cultural Interpreter

Source: CHW Network of New York City

Definition

American Public Health Association (APHA) Definition

“A Community Health Worker (CHW) is 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 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 service delivery.

A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.”

Designing Curriculum in Illinois

Curriculum

Recommendations:• Inclusive – language/education• Popular education model• Clinical fieldwork required• Evidence based – best practices• Core skill set – first aid/CPR• Tiered advancement (levels 1, 2, 3, etc.)

Promising Practices Framework

Source: Community Health Worker National Education Collaborative (CHW – NEC)

Career Pathways, Reimbursement and Portability

Career Pathways

Recommendations:• Align current IL CHW advocacy groups with the IL Workforce

Investment Board (IWIB) • Provide training through various levels of educational and

geographic settings• Define a tiered system of classifications within the CHW field• Develop a “grandfathering” protocol for existing CHWs• Identify positions for CHWs to transition from and into, along

entire healthcare system’s career ladder (nursing, physicians, consultants, etc.)

Source: California Workforce Investment Board (CWIB), Health Workforce Development Council, Career Pathway Sub-Committee, Sept. 2012

Career Pathways

Source: The Community Health Worker Initiative of Boston

How will they get paid?

Reimbursement/Funding Sources

• Federal or State Government Agencies• Charitable Organizations• Insurance (both Public and Private)• Government General Funds• Private Sector Companies• Individual Consumer

Funding Mechanisms

Source: National Fund for Medical Education, Advancing Community Health Worker Practice and Utilization: The Focus on Financing

Govt. or Charitable Foundation Grants/Contracts

Source: National Fund for Medical Education, Advancing Community Health Worker Practice and Utilization: The Focus on Financing

Insurance – Direct Reimbursement

Source: National Fund for Medical Education, Advancing Community Health Worker Practice and Utilization: The Focus on Financing

Govt. General Funds – Operating Budgets

Source: National Fund for Medical Education, Advancing Community Health Worker Practice and Utilization: The Focus on Financing

Private Sector – Contract/Employment

Source: National Fund for Medical Education, Advancing Community Health Worker Practice and Utilization: The Focus on Financing

Reimbursement/Funding

Recommendations:• Sustainable funding sources need to be expanded (i.e.

Medicaid, private sector, health insurance plans, etc.)• Analyze current funding mechanisms for

effectiveness/expansion (pursue waiver or SPA for Medicaid)• Ensure a minimum living wage for CHWs, if chosen as a career

path• While establishing system for reimbursement, avoid creating

barriers for “volunteer” employees• Clarify/define which health professionals can serve as

supervisors of CHWs for Medicaid reimbursement models

Portability

Recommendations: • Consider standardized or widely accepted skills and

credentialing, to enable CHWs to work for different organizations both within the same state, as well as across state lines.

• Enable State credentialing authority to provide an “endorsement” of CHWs who have received certification in other states that meet similar standards.

• Ensure transferability of state recognized CHW course work/training into curriculums for other healthcare degrees/certifications (career ladder - advancement opportunities).

Establish a Statewide Board

Development of a Statewide Board

Recommendations:• Convene an internal state task force to conduct an assessment of the

potential impacts of incorporating CHWs into the state’s public health programs and the state health care system

• Consider legislative action to formalize and standardize CHW training, curriculum and certification that includes the establishment of an advisory board that will assist in the development of training, curriculum and certification of CHWs

• Establish an advisory board to assist in the development of training, curriculum and certification of CHWs. Members of the board should include, but not be limited to;• Community Health Worker(s)• CHW employers• Educators in community health worker related curriculums• Members of public health associations• Health researchers• Members of the public.

Integration of CHWs in Rural Areas

Rural Area Considerations• Be sensitive to rural community differences, such as;• Safety• Cultural/language barriers• Internet Access/Wireless Connectivity• Referrals• Resistance to change issues• Access to required education/credentialing

• Create a “fair playing ground” for;• Grants• Contracts• Reimbursement rates• Training

Next Steps• Present Recommendations • State government leadership• Statewide boards and commissions• CHW stakeholders

• Collaborate with partners to develop statewide standards and policies on CHWs

Thank You!

Questions?