Most Americans struggle to navigate health care. They worry about how expensive the health care system is and how hard it is to understand.
We often wish someone could walk us through insurance applications or help us understand doctor’s orders. The challenges can be amplified for uninsured patients and patients whose primary language isn’t English.
Thankfully, there is growing interest in Kansas and beyond in establishing the widespread practice of community health workers to help patients navigate our complicated health system.
A community health worker (CHW) is a member of the health care team who serves as a bridge between patients and providers. They translate doctor jargon. They fill out paperwork and connect patients to needed resources. CHWs help patients overcome obstacles to seeking care, such as transportation or language barriers.
CHWs make the system work better for patients and providers, which is why the United Methodist Health Ministry Fund has invested in supporting the use of CHWs in health care settings throughout Kansas and is partnering with the Kansas Department of Health and Environment, the Health Forward Foundation and over 20 health care and community stakeholders to create certification and payment policies to establish and sustain the profession in Kansas.
CHWs Impact: Lucy’s first patient
Lucy Watie of Bob Wilson Hospital is one of approximately 500 CHWs practicing in Kansas today. As a resident of Ulysses who works at her local hospital, she is passionate about improving the health of her neighbors and community.
“One of my first referrals was a 23-year-old, obstetric patient, mother of two,” said Watie. “The client had no insurance and was considering canceling her ultrasound appointment.”
This patient’s health was impacted by more than what happened at her doctor’s office. All of us are affected by the social determinants of health—the conditions where we live, learn, work and play. This patient lived in a deteriorating apartment with two small children and very little money.
She couldn’t afford to pay for a safe place to live. Paying for an ultrasound was out of the question. Watie helped her apply for Medicaid, SNAP, and WIC. During their time working together, the patient moved from an unsafe apartment to subsidized housing, obtained a library card for internet access, enrolled in the adult learning center to work on her diploma, and established care with a dentist.
“This young lady has endured trauma in her life and been diagnosed with mental illness,” said Watie. “It’s so rewarding to see how well this client is doing since her discharge. She is happier, healthier and has become very self-sufficient.”
Working with a CHW was a lifechanging experience.
Community health workers are becoming more common in Kansas as health care organizations realize their value as part of the care team. Although CHWs improve access to services while reducing disparities and the cost of care, there are challenges to implementing them.
A 2021 study commissioned by the United Methodist Health Ministry Fund identified opportunities to expand the use of CHWs in Kansas, including standardizing education and training, and exploring alternative funding sources because most CHW positions are largely dependent on grant funding. Until now, there has been no baseline education and training to becoming a CHW in Kansas.
Certification program announced
Kansas is one of a growing number of states that are recognizing the community health worker profession by formalizing the certification process. This week, the Kansas Department of Health and Environment (KDHE) and the Kansas Community Health Worker Coalition announced the certification process, which has two pathways. Interested individuals can become a CHW by completing a KDHE-approved CHW training program or through a combination of work experience and letters of recommendation.
The decision to move forward with the state certification process is the result of workgroup recommendations made by a group of health care professionals including providers, payers, community health advocates, and community health workers, convened by KDHE and the United Methodist Health Ministry Fund, with support from the Health Forward Foundation, that explored the role of community health workers in Kansas, a certification process and sustainability issues—including Medicaid payment policy. The group continues to work collaboratively to explore sustainability issues.
As momentum and support for the profession grows in Kansas and nationally, the state of Kansas has recently received two grants to support the use and deployment of nearly 100 community health workers to help Kansans navigate the health care system and challenges resulting from the COVID-19 pandemic.
Through return on investment, community health workers actually pay for themselves. They reduce reliance on emergency care and increase primary care use. A 2020 study at Penn Medicine found each dollar invested in their CHW program would have a $2.47 return on investment to an average Medicaid payer within the fiscal year.
To become a sustainable part of patient-centered health care, the next challenge to overcome will be creating sustainable funding for CHW positions. The 2021 research study found that more sustainable funding options could include Medicaid, service reimbursement strategies, and other innovative and unique payment ideas. Integrating CHWs into a care team can also create new possibilities for funding.
What’s clear is that CHWs can improve health and bring down costs. Recognizing the profession through a certification process is an important step forward. Establishing sustainable financing will ensure better patient care and reduce costs for providers and payers, like state Medicaid programs.
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