- The transition to value-based care has expanded the definition of patient wellness to include both physical and social health. As patient care stretches into the community, the healthcare workforce begins to center on the community health worker.
Community health workers “are frontline public health workers who have a close understanding of the community they serve,” according to website Health Careers. “This trusting relationship enables them 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.”
Simply put, community healthcare workers help connect patients with social services that can help address their healthcare needs. These workers fill numerous roles, according to the World Health Organization (WHO). Community health workers can be used in developing nations an in the US.
“The use of community health workers has been identified as one strategy to address the growing shortage of health workers, particularly in low-income countries,” WHO says on its website. “Using community members to render certain basic health services to the communities they come from is a concept that has been around for at least 50 years. There have been innumerable experiences throughout the world with programmes ranging from largescale, national programmes to small-scale, community-based initiatives.”
Although the idea of the community health worker has been around for some time, these careers are currently on the rise. This is driven by two key factors.
First, the healthcare industry is focusing on the social determinants of health (SDOH), or social factors that impact one’s ability to obtain wellness. No longer is health only about dealing with pneumonia symptoms or chronic asthma. Instead, it’s also about the social forces – education, living environment, socioeconomic status, access to transportation – that influence the ability to be healthy.
Healthcare organizations are increasingly addressing those factors in addition to physical health needs. Community health workers have a breadth of knowledge that helps hospitals make these social connections. Typically, community healthcare workers serve as an intermediary between the hospital and the community service addressing the SDOH.
Second, the clinician shortage is pushing the use of community health workers. Medical facilities are trying to fill in all care gaps but are working with a smaller clinical workforce. And while investments in more clinical workers is one path to addressing shortage issues, some organizations are tapping frontline workers such as community health workers to take some non-clinical work off providers’ plates.
“We're seeing an uptick in organizations using community health workers, and the role itself has been codified by the fact that the Department of Labor now tracks community health workers,” says Kelly Aiken, the vice president of programs at the National Fund for Workforce Solutions and CareerSTAT, the fund's healthcare-specific initiative.
“There is some movement on reimbursement for community worker services. Increasingly, we're seeing providers wanting to create more structure and defined competencies for what a community health worker is and does.”
Supporting community health workers will supplement the healthcare workforce and make it easier for clinical workers to focus on their areas of expertise.
What kinds of jobs do they do?
The specific function of a community health worker is highly dependent upon unique patient, organizational, or community needs. A worker in California will serve a different function compared to a worker in Nebraska, for example.
According to the Rural Health Information Hub, community health workers may engage in:
- Outreach and enrollment
- Health services
- Social-emotional support
Many rural areas will use community health workers to connect patients with lower-cost care access opportunities. While health partnerships will create cost-cutting programs such as EMT chronic care visits, the community health worker will connect a high-needs patient with that program.
In other areas, a community health worker can connect a patient with housing. Housing is a social determinant of health that can indicate whether a patient will be healthy, according to University of Illinois Hospital & Health Sciences System (UI Health), where a $250,000 grant helped create a homelessness program.
At UI Health, a community health worker collaborates with the hospital to identify patients who may be homeless. The worker will then connect that patient with housing support, according to UI Health Director of Preventative Emergency Medicine Stephen Brown.
“We partner with an organization called Center for Housing and Health, which is part of the AIDS Foundation of Chicago,” Brown said. “They've always been strong advocates for housing. They do a lot of the quarterbacking after we refer homeless patients to them. They contract with outreach organizations and they have outreach workers.”
These community partners face the challenge of working directly with the homeless patients, Brown explained. Outreach workers will search under bridges and make themselves available 24 hours each day to be able to find these patients to arrange housing assistance.
At other healthcare organizations, community health workers connect patients with non-criminal legal assistance. There is a lot of overlap between high-needs Medicaid patients and patients who need legal help, according to Kathy Chan, director of policy at Cook County Health & Hospitals, a Chicago-area organization that has a medical legal partnership with LAF Chicago.
“There is an overlap between the clients that LAF serves – low income Cook County residents who have civil legal needs – as well as the patients that the Cook County Health & Hospitals System provides care for, especially if they're insured by Medicaid. That can be a proxy for having low income or they're uninsured,” Chan explained.
“Many of our patients have both complex healthcare needs and complex social needs, and so it was beneficial knowing that there is a model for medical legal partnerships out there that has been working in healthcare facilities,” she added.
Community health workers connect patients with lawyers who can help overcome the legal obstacles to achieving health and overcoming the social determinants of health, Chan noted.
How effective are community health workers?
Thus far, community health workers have filled an important social care gap with success, although there is limited data on the matter.
One study published in JAMA Oncology found that community health workers and healthcare navigators can help improve care quality metrics while decreasing healthcare costs.
A community health worker program yielded a 1:10 return on investment, with average costs for patients receiving layperson navigation services declining by $781.29 per patient per quarter. That created total cost savings of $19 million annually across a single care network.
Patients in the community care program utilized certain clinical services less frequently than patients without community support. ED visits declined by 6 percent, hospitalizations by 7.9 percent, and ICU admissions by 10.6 percent.
Anecdotally, many healthcare organizations working to forge community health partnerships have stated that community health workers are the linchpin that holds everything together. These partnerships require a lot of moving parts, and community health workers help hold it all together.
This emphasis on social health is a good thing for those in the community health career.
According to the Bureau of Labor Statistics, the job market for this profession should be up by 16 percent between 2016 and 2026, a rate which BLS says is faster than average industry growth.
“Growth will be driven by efforts to improve health outcomes and to reduce healthcare costs by teaching people healthy behaviors and explaining how to use available healthcare services,” BLS says.
As healthcare continues to address the social determinants of health, it must understand its community partners in the process. Efforts will require assistance from community health workers who can connect high-needs patient with community resources.