Integrating Community Health Workers into Care Teams
Community health workers—the frontline lay workers who serve as a bridge between clinicians and their patients—have been around for several decades in the U.S., but they have rarely been fully integrated into care teams for a variety of practical and cultural reasons. This is in spite of a growing body of evidence that community health workers (CHWs) in the U.S. and overseas can help the sickest and neediest patients improve their health and avoid costly emergency department and hospital visits.
Many CHWs come from the communities they serve, and often speak the same language—literally or figuratively—as the patients living there. They call upon that shared experience to build relationships with patients, and in turn use their knowledge of patients’ neighborhoods and cultures to help providers fine-tune their approaches to the patients they serve. In this way, they differ from social workers, nurse case managers, or others tasked with helping people with complex needs.
The people CHWs help are often those who providers find are their most challenging and yet may have the most to gain from effective communication and encouragement. In some cases, the information they gather from frank conversations with patients has been life-saving, as happened for a 16-year-old on a kidney transplant list in New Mexico. Covered by Molina Healthcare, which operates Medicaid and Medicare managed care plans throughout the country, the teen was assigned a community health worker because her nephrologist and care manager were concerned her family was struggling with the pre-transplant care.
The concern escalated after her nephrologist discovered the girl wasn’t taking her medications. After trying for months to find out why, he gave up and recommended she be removed from the transplant list. Both the mother and daughter insisted to the CHW that the teen was taking the medications. Eventually, however, the teen admitted to her CHW that she had been lying to her mother—and had not been taking her medications because her cousins had been taunting her with texts about her “rotten kidney” and telling her it would be better for everyone if she let herself die. “She was passively letting herself die,” says Dodie Grovet, the program’s training manager.
The CHW was able to find the girl a counselor, get her a new cell phone number, and she eventually began taking her medications.
“Patients do not always tell their doctors the truth, or the whole story, and doctors are forced to make strategic decisions based on incomplete information,” says Sergio Matos, executive director of the Community Health Worker Network of New York City. “CHWs can get to the core issues and find information that clinicians don’t have access to.”
The Bronx-Lebanon Hospital Center in New York has used CHWs since 2007, beginning with a grant-funded pilot in one of its South Bronx medical homes that produced a return of $2 per $1 invested (based on reductions in admissions/emergency department visits and increased revenue from outpatient visits for patients who were considered high utilizers). The results led administrators to dedicate operational funds
