On 8/28, the NY Times Fixes blog discussed the role of Community Health Workers (CHWs) in outreach and education efforts with individuals who have traditionally been hard to reach. Community Health Workers, much like social workers, have an important role to play in following up on medical care and working with patients to promote following the discharge plan of care.

They’re chosen for their ability to listen, support and encourage, without judgment. They are people from the same communities as their patients, and often with the same struggles. They help patients with the many factors keeping them sick that aren’t typical doctor problems.

As the blog points out, CHW models vary from ones that do focus on psychosocial aspects of individuals lives as well as on coordination activities, and other models utilize CHWs in only a medical sense, under the direct supervision of a nurse. Some approaches, such as the Pathways Model out of the Community Health Access Project in Ohio, have shown promising results in improving outcomes, such as a decline in the rate of low birthweight babies. Others have shown promising results in relation to return on investment for health systems – following up on care to prevent readmissions would reduce Medicare readmission penalties, and open up beds:

Hospitals profit most by filling beds with patients who need complex, specialty surgeries and care — especially when they carry private insurance. Many patients [such as those in the IMPaCT study highlighted in the blog], often need routine care, or non-medical help. They carry Medicaid (which brings in little revenue) or are uninsured (a total loss). Hospitals must accept these patients, so keeping them as healthy as possible — preferably outside the hospital — is good.

It has traditionally been difficult for programs that engage positions such as CHWs or social workers in care coordination activities to find sustainable funding that lasts beyond demonstration projects or foundation support. However, the blog points out that in the transition away from fee-for-service reimbursement structures and toward payment based on the value of care, there is promise that health systems and plans will have funds to invest in these positions:

‘If fee-for-service disappears, there is more emphasis on prevention, wellness and quality of life in the long term,’ said Heidi Behforouz, [associate physician in the global health equity division at Brigham and Women’s Hospital in Boston]. ‘Then everybody would be pushing for community-based models that kept people at home.’

As interdisciplinary care teams grow, there is growing recognition among social workers about the importance of CHWs and social workers working together with distinct roles on care teams to meet the needs of clients and communities. According to the National Association of Social Workers,

Together, social workers and community health workers have the opportunity to work collaboratively as team members… By conceptualizing care delivery by function, these professions begin working in tandem versus in opposition with each other. Many have recommended that social workers and CHWs be paired as teammates to more effectively impact vulnerable populations while promoting social work values.