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The Importance of Dedicated, Sustainable Community Health Worker Pathways

There has been an increased need for Community Health Workers since the implementation of the Affordable Health Care Act and the COVID-19 pandemic. For decades, community health workers and promotores (CHW/Ps) have effectively provided culturally comfortable, person-centered services that bridge different systems and improve health and well-being. CHW/Ps perform many unique roles, including prevention services, supporting care transitions, providing resources and referrals, and heath motivation and education. In the Inland Empire, Health Care and Social Assistance is the largest industry sector, employing over a quarter of a million workers, followed by Retail Trade, Professional and Business Services, Educational Services, and Manufacturing. 1 Community Health Workers-CHWs are key components in the regional Health Care and Social Assistance workforce.

The CHW/P workforce is singularly effective because CHWs/Ps are innately able and trained to build trust and rapport with people they support, grounded in a shared lived experience and cultural connections. These characteristics may support better outcomes with complex medical needs and chronic conditions while creating positive healthcare systems’ improvement related to efficiency and effectiveness.

CHWs/Ps experience and training make them naturally “patient centered.”2 CHWs/Ps focus on building and sustaining authentic relationships based on knowledge, respect, and empathy. The California Healthcare Foundation defines the value that this workforce brings as follows, CHW/Ps engage with people in health-related activities and interventions and “help to change perceptions and encourage behaviors that contribute to better health outcomes.”Because of CHWs/Ps effectiveness and utility, California managed care plans (MCP) have unprecedented opportunities to support the growth of the CHW workforce so their members can benefit from CHW/P expertise and services. The California Advancing and Innovating Medi-Cal (CalAIM) initiative creates new imperatives for MCPs to meet member needs by supporting Social Determinant of Health (SDOH) support interventions to address health-related social needs and to reduce health inequities. These regulations also may usher in deeper partnerships between healthcare systems, community-based organizations and providers. MCPs can invest in CHW/P workforce strategies to help achieve SDOH goals.

CHW/Ps have been employed across public health, medical, and behavioral health settings with different job titles and in a range of roles. CHW/Ps have worked to support member engagement in chronic disease management, conduct outreach to individuals with complex needs, and facilitate improved birth outcomes, among many other diverse areas of focus.    

– Advancing California’s Community Health Worker & Promotor Workforce in Medi-Cal Report, California Healthcare Foundation

Two components in the CalAIM initiative ― enhanced care management (ECM) and Community Support/in lieu of services (ILOS) ― offer MCPs financial means to contract with organizations that employ CHW/Ps and innovate how patients and communities receive care. According to sector leaders, including California Healthcare Foundation, In responding to the requirements and opportunities of CalAIM, MCPs and community based organizations that deploy CHWs/Ps can learn from lessons from California’s Health Homes Program and Whole Person Care pilots, where MCPs either directly employed CHW/Ps or contracted with community partners that employ CHW/Ps, to better meet the complex social needs of people with chronic disease.

What is a Community-Connected Health Workforce?

 It is an collective term coined by the California Healthcare Foundation and stakeholders to describe the workforce of unlicensed health professionals who either have lived experience in or the trust of the communities served – including community health worker or promotor, recovery specialists, navigators, health coaches, and peer support workers. The term is used to emphasize the shared characteristics and broad importance of this workforce across medical, behavioral, and public health settings.

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Health care organizations often hire unlicensed professionals to serve in similar roles performed by CHW/Ps. However, these professionals may not have direct knowledge or experience in the communities served and therefore could not be classified as a community-connected health workforce .4
Advancing California’s CHW & Promotor Workforce in Medi-Cal 

Social Focus

El Sol Neighborhood Educational Center employs more than 150 CHW/Ps, the majority of whom thoroughly enjoy their job and role in the community. Serving Inland Empire communities for more than 30 years, our model has embraced a wide spectrum of financial compensation strategies. When we began, like many promotores de salud, CHW/Ps were volunteers. Subsequently our model provided financial stipends for CHW workforce. Currently, CHW’s are employees compensated with a liveable hourly wage and full benefits.

El Sol promotores have shared that they are passionate about their work, and like many employees in various workforce sectors, desire future opportunities for higher compensation

Sustainable Funding Mechanisms

CHWs are generally assumed to be a less expensive alternative compared with other clinical health workers, including salary, incentives and training costs. Concurrently, there is abundant evidence proving the effectiveness of CHWs in delivery of essential health services in low- and middle-income communities.5

Currently, CHW services are supported through a patchwork of largely vulnerable grant funding in the Inland Empire. However, developing factors, such as CalAIM, present the potential for sustainable financing mechanisms for CHW services, related to SDOH and quality of care, sustained through healthcare funding.6

“I was so excited when I received the [COVID Equity Collaboration] Vaccination clinic training, because the healthcare trainers said the paramedics and nurses are [needed] in the hospitals so we will train you can to give the tests. I said to myself, ‘wow’ this is fascinating, we are going to receive training and treated like medical personal. However, when I got home, my children said yes of course they are going have you handing out tests, because paramedics get paid $50-$60 an hour and they are going to pay you $20 an hour. After hearing this, I was not as excited, but I said to myself, it doesn’t matter, because we are going to be helping, saving lives…it could be my neighbors, or even ourselves.” – El Sol COVID 19 Response promotora

“Although CHW/P workforce is cost effective, it’s important that healthcare organizations don’t view CHW/Ps as cheap labor,” Alex Fajardo, Executive Director of El Sol Neighborhood Educational Center says. “CHWs need to be fully integrated into healthcare organizations with clearly defined roles, fair compensation, and specific social support goals.

Conclusion:

Given the effectiveness and proven wellness impacts that CHWs/Ps bring to healthcare, coupled with the opportunities and mandates for enhanced care with social supports ushered in by CalAIM regulations, MCPs and CBO’s have acute opportunities to invest in CHW/P workforce pipelines. Part two of El Sol’s series on Creating Dedicated CHW Pathways will explore compensation models and infrastructure in further detail.

[1] https://wp.sbcounty.gov/workforce/wp-content/uploads/sites/5/2021/08/IE-Regional-Plan-FINAL.pdf p. 10

[2]https://www.chcf.org/wp-content/uploads/2021/09/AdvancingCAsCHWPWorkforceInMediCal.pdf

[3]https://www.chcf.org/wp-content/uploads/2021/09/AdvancingCAsCHWPWorkforceInMediCal.pdf

[4]https://www.chcf.org/wp-content/uploads/2021/09/AdvancingCAsCHWPWorkforceInMediCal.pdf

[5]https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-015-0070-y

[6]https://www.cthealth.org/publication/policy-brief-addressing-social-determinants-of-health-through-community-health-workers-a-call-to-action/

[7]https://www.healthaffairs.org/do/10.1377/forefront.20190507.746358/full/ 

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