(This was originally posted to the Peers for Progress blog.)
As the United States healthcare system evolves under the new insurance exchanges and Affordable Care Act, more states are implementing programs that incorporate community health workers and peer support workers in an effort to reduce medical costs.
A number of programs in different states have recently been highlighted in our blogs, including a case study in New York that demonstrated cost-savings by integrating community health workers (CHWs) into patient centered medical homes, and Georgia’s statewide initiative to secure Medicaid reimbursements for peer support services in mental health.
In February, the state of Illinois took a step towards expanding the CHW workforce by proposing a bill to formalize their work and increase their funding. This blog will review the steps that led to this bill and look at some of the reactions from across the state.
Proposed Policy Changes in the Illinois Healthcare System
In January 2014, the Illinois Healthcare Reform Implementation Council produced a 43 page report filled with recommendations for policy changes in the state’s healthcare system. The importance of increasing the recognition and roles of CHWs is summarized in 5 of the 11 policy development recommendations that explicitly mention CHWs:
- Adopt the American Public Health Association’s definition of a Community Health Worker
- Establish a CHW State Advisory Board at the Illinois Department of Public Health to assist in the development of training, curriculum, and certification of CHWs. Members of the board should include: CHWs (at least 50% plus 1), CHW employers, educators, social services professionals, members of public health associations, health researchers, and members of the public.
- Support legislative action to formalize and standardize CHW training, curriculum and certification.
- Once developed, provide training at various levels of education and in diverse geographic settings, consider a tiered system of classifications within the CHW field, develop a “grandfathering” protocol for existing CHWs to ensure adequate levels of competency, and identify positions in the healthcare career ladder (nursing, physicians, consultants, etc.) that CHWs can transition into.
- Educate the spectrum of health professionals about the roles of CHWs. Many professionals are unclear about the roles of CHWs and how the ACA encourages the development and utilization of this workforce.
These recommendations are important because they establish a standardized definition (1), incorporate multiple stakeholders (2), propose advocacy steps (3), provide concrete examples of policies to advance the CHW workforce (4), and establish a campaign to build support for CHWs within the healthcare system (5).
Reactions to the Bill in Illinois
Media coverage of the bill shows support from a variety of key stakeholders. In an article in the Chicago Healthcare Daily, Dr. Lamar Hasbrouck, Director of the Illinois Department of Public Health, stated the value of CHWs:
“We need some foot soldiers in the community that are embraced, that are understood, that are familiar and can translate the jargon into real, actionable items”
Denise Bockwoldt, Director of Diabetes and Endocrinology Services for Sinai Health System, also affirmed the importance of CHWs, citing that they live in the same neighborhoods as their patients, can tailor care plans and give the system overall credibility. Sinai Health System treats a large uninsured and poor population and recently released a Best Practice Guidelines for Implementing and Evaluating Community Health Worker Programs.
Many hope that the proposed bill may create new funding opportunities. Under the current system, hospitals, clinics and other providers often pay for CHWs through short-term grant funding. Dr. Hasbrouck believes that creating a formal certification process will help providers understand the resources they’re getting and may make them more likely to fund workers from their own operating budgets. This may be even more convincing if insurers and government payors provide incentives to health care providers for improving care coordination.
We will be closely following this bill as it moves forward in Illinois, and we look forward to seeing how it impacts funding for CHWs and community health outcomes. We encourage our readers to share resources and media coverage of other states that are formally integrating CHWs and peer support workers into their state healthcare systems.