Blog Post

The Future of Community Health Workers

Aug. 17, 2016

by Rebecca Hargreaves, Senior Manager, Strategic Initiatives, Healthforce Center at UCSF

Last month I had the pleasure of spending the day with more than 60 people from across various health care and community-based organizations in California, all of whom are working to develop the capacity and impact of community health workers (CHWs) and promotores in their communities. The Healthforce Center at UCSF convening centered on learning about recent policy changes and initiatives (primarily from the ACA and Medi-Cal 2020 Waiver) that provide opportunities to better leverage CHW models and, most critically, provide potential mechanisms to pay for those models.

A fast and early lesson for me that day? State policies that directly or indirectly open the door for greater demand of CHWs and promotores are of interest, but remain out-of-reach for the majority of smaller community-based organizations represented at the convening.

It got me thinking about ways community-based organizations can better take advantage of emerging state-level policy initiatives. Some of those lessons include:

1. Build connections and partnerships.

Organizations already leveraging new policy opportunities have been able to successfully navigate our complex state system and make meaningful connections with employers and workforce trainers to find the right people and organizations with whom to network and, ultimately, build partnerships.  Identifying these key stakeholders is far from easy though, especially for smaller organizations. Efforts to improve transparency (i.e., who is the right person at which organization) and facilitate connections are needed. Further, many at the convening expressed frustration with not getting a “seat at the table” early in policy development, funding initiatives, and healthcare payment reform discussions.  How can we better connect grassroot organizations in the field to these other players?

2. Demonstrate impact in ways that speak to funders and partners.

At this point of the game, evaluation and demonstrating impact are cornerstones for most community-based organizations.  But, the ability to utilize robust evaluation methods is essential for demonstrating impact to funders and other partners. For example, one organization was able to conduct a randomized control trial (an extremely robust evaluation approach) and used metrics, like ‘reduction in emergency room visits,’ that they had previously identified were of significance to their partners.  For organizations that lack capacity to conduct these types of evaluations, university partnerships were suggested as one way to potentially gain this capability.

3. Leverage being in a clinical setting or create a partnership with a clinical setting.

As most of the new policy opportunities are grounded in health care, organizations based in clinical settings, such as community health centers, are in an easier position to take advantage of the shifting landscape. They are already established providers and, as the focus of reimbursement shifts to value over volume, are well positioned to further incorporate CHWs/promotores into care models. It is not as clear how organizations not connected to a clinical setting can maneuver into a better position, but one idea raised at the convening was to create a partnership with a clinical organization. 

4. Remain agile and nimble in exploring all opportunities.

We are operating in a new environment that is constantly shifting and changing. And the end results of in motion changes, particularly payment reform, will not be known for years.  Yet organizations shouldn’t wait to jump in and seek to leverage evolving policy opportunities that could better support CHWs/promotores. As one organization at the convening shared, their strategy is to explore every angle and opportunity and see what sticks. Just because there is no clear path forward does not mean there is not a path. Your organization just might be the first one down it.

Rebecca Hargreaves is the senior manager for strategic initiatives at Healthforce Center at UCSF.  She leads the development of new programs and projects that advance Healthforce Center’s mission to equip health care organizations with the workforce knowledge and leadership skills to effect positive change in health care.  Rebecca has a masters degree in public policy from Harvard University’s Kennedy School and a BA in economics from UC Berkeley.