Achieving the Triple Aim: Success with Community Health Workers - May, 2015
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Achieving the Triple Aim:
Success with Community
Health Workers
May, 2015ACHIEVING THE TRIPLE AIM March 2015
Success with Community Health Workers
F or decades, community health workers (CHWs)
have played a critical role in public health
efforts in Massachusetts to improve population Improve
health and to ensure that all residents of the Health
state receive quality services. The Massachusetts
Department of Public Health (DPH) has long Reduce
been a national leader in supporting the CHW Health
Disparities
workforce through programmatic and policy Reduce
Improve
initiatives. Massachusetts’ comprehensive health Cost per
Care
Capita
care reform, as well as national health reform
(the Patient Protection and Affordable Care Act),
explicitly created opportunities to employ CHWs The Triple Aim+
as part of achieving what has become known as
the Triple Aim. DPH is committed to assuring that Evidence from research and the experience of
CHWs are integrated into primary care and related numerous provider organizations in Massachusetts
health care teams. and other states demonstrate that CHWs add
value to multidisciplinary care teams in the
To that end, DPH is working to ensure a following ways:
quality CHW workforce through imminent state
certification of CHWs and approval of CHW training 1. Reduce costs
programs, as well as promoting sustainable • Save costs through fewer emergency
financing of CHWs as part of healthcare teams. department (ED) visits and lower
This White Paper will help to inform healthcare hospitalization and readmission rates for
provider and payer decision-makers about the complex patients
growing evidence of CHWs’ multiple contributions
to achieving the cost, quality and health outcome 2. Improve health
goals of health reform, while reducing disparities • Help patients engage more fully in their
in health care and outcomes throughout the care and adhere to care plans
Commonwealth and the nation.
• Help patients control chronic conditions:
increase asthma-free days, lower blood
Community Health Workers’ Critical sugar and blood pressure levels
Role In Practice Transformation
3. Improve quality of care
Health reform offers new opportunities for primary • Improve health and care utilization,
care practices to transform their staffing and reflected in performance measures and
delivery models to provide higher quality and more standards promoted by the National
efficient services. CHWs, as part of integrated Committee on Quality Assurance (NCQA),
care teams, contribute to cost-effective services such as Healthcare Effectiveness Data
that advance the Triple Aim for which providers and Information Set (HEDIS), and other
are accountable: improved health, improved care, quality measures1
and reduced costs. CHWs also help reduce health
• Improve retention in care through
disparities, a goal of health reform that is closely
outreach to reduce no-shows and
linked to achieving the more commonly highlighted
assistance with insurance enrollment
dimensions of the Triple Aim.
and retention
Page 1Community Health Workers and the Triple Aim | March 2015
• Improve patient satisfaction through How Are Community Health Workers
better understanding of and help with Trained and Credentialed?
addressing their social needs
4. Reduce health disparities Massachusetts is a leader in advancing the skills
and recognition of the CHW workforce.
• Reduce health disparities and related
costs by strengthening communication hh Well-established CHW training centers exist
with underserved patient populations and in four regions of the state and there is an
by diversifying the healthcare workforce emerging center in a fifth region.
The value of CHWs in transforming health care hh A Board of Certification of Community Health
was acknowledged in Massachusetts’ healthcare Workers at the Massachusetts Department
reform laws in 2006 and in 2012, as well as in of Public Health (DPH) will begin approving
the national Patient Protection and Affordable training centers and certifying CHWs in 2015.
Care Act (ACA) of 2010. The Institute of Medicine’s hh The Board, appointed by the Governor,
(IOM) report on health disparities recommends developed ten detailed core competencies
integrating CHWs into multidisciplinary care which define the field. The core competencies
teams as “a strategy for improving care delivery, and other information related to certification
implementing secondary prevention strategies, can be found at:
and enhancing risk reduction.”2 http://www.mass.gov/eohhs/gov/
departments/dph/programs/hcq/dhpl/
Who Are Community Health Workers and community-health-workers/
What Do They Do?
How can CHWs help reduce health
Community health workers are trained frontline disparities and related costs?
staff who bridge the communication and cultural
gaps common between low-income, underserved, Health disparities in the United States represent
often high-cost patients and clinical staff. They significant human and social costs for the
also help to address the social, non-clinical communities that suffer from poor access to
challenges affecting patients’ health and care. health care and from a lack of services delivered
hh CHWs are hired primarily for their special by those who literally and figuratively “speak
understanding of and ability to relate to the their language.” There is also a high financial
populations and communities they serve, cost to healthcare systems as a result of such
through shared socio-economic and cultural disparities in access and care.
backgrounds and experiences.3
hh CHWs establish peer relationships with hh A disproportionate number of people with
patients that encourage trust and openness. poorly controlled chronic conditions, such as
diabetes, hypertension, and asthma, are
hh CHWs are trained to help patients deal low-income ethnic or racial minorities.4
with social, economic, and other barriers to
accessing and benefiting from services. hh A high proportion of those who do not receive
timely preventive screenings and treatment for
hh CHWs provide services through outreach, cancer are also from these communities.5
education, advocacy, and social support. Their
services increase access to preventive care hh CHWs play a key role in reaching
by connecting people to medical homes and the vulnerable and underserved. In
teaching them how to prevent, reduce risks for, Massachusetts over half of CHWs are
and manage chronic diseases. CHWs support themselves ethnic or racial minorities (23.7%
patients to make healthier lifestyle choices, African American, 20.6% Hispanic, 4.9% Asian
help patients access needed community or Pacific Islander, 0.2% Native American 1.4%
services, keep medical appointments, and one or more races). Fifty-eight percent are bi-
increase adherence to treatment plans. lingual or multi-lingual.6
Page 2Community Health Workers and the Triple Aim | March 2015
The Evidence hh CHW roles: Home visits to assess needs,
appointment support and reminders, health
I. CHWs REDUCE COSTS literacy education, advocacy, and assistance
to find medical homes, as well as to use
Evidence demonstrates that CHW interventions primary care and other services.
targeting patients with high resource utilization hh Cost analysis: Authors calculated a net
result in savings to the medical system. In cost savings for the MCO of $1,522,722
2013, the Institute for Clinical and Economic as a result of the CHW program: 1) The
Review (ICER) prepared a report for the New cost of the program for 25 months for 448
England Comparative Effectiveness Advisory patients was $521,343 (salaries, benefits for
Council (CEPAC) summarizing results of the best management employees plus a per-member
quality studies, primarily randomized controlled per-month payment to providers for services
trials, of interventions that include CHWs.7 The of six CHWs); 2) Total cost reduction for all
majority of the fourteen cost studies reviewed patients receiving CHW services (comparing
showed a net cost savings (i.e., “cost offsets from Medicaid claims pre- to post-intervention) was
reduced healthcare utilization were greater than $2,044,065. The utilization rates and costs for
the marginal costs of the intervention”) over six the comparison group of an equal number of
months to two years follow-up. Most economic high-risk, high-cost patients also dropped but
analyses took the perspective of a Patient to a significantly lesser degree.
Centered Medical Home (PCMH) provider who
would be responsible for expenditures for services hh Source of program funding: Private
and for financial risks incurred.8 foundations supported the research and
hh Cost reductions were generally due to a startup phase until contract revenues
reduction in urgent care use, including with Molina Healthcare began to pay for
hospitalization. the program. As a result of cost savings,
improved health outcomes, and positive
hh Leaders at most of the 32 Massachusetts member feedback, Molina Healthcare
community health centers employing CHWs expanded the program statewide and to all
that responded to a 2014 survey indicated of the 11 states in which they operate. Other
that CHWs’ greatest value is in supporting MCOs in New Mexico also adopted the model.
high-risk, high-cost patients.9
The Community Preventive Services Task Force,
EXAMPLE 1: Molina Healthcare, Inc. an independent panel of public health and
Multi-state managed care organization (MCO) prevention experts appointed by the head of the
providing CHW outreach, education, advocacy, Centers for Disease Control and Prevention (CDC),
and referral services for high-risk patients. Study recommends “the use of home-based multi-
services were offered in New Mexico. trigger, multi-component interventions with an
environmental focus for children and adolescents
hh Results: ED use, hospitalization, use of with asthma, based on strong evidence of
narcotic and other prescriptions showed a effectiveness in improving overall quality of life
statistically significant decline among 448 and productivity.” The Task Force economic review
“high-risk” (those with three or more ED visits of studies of such interventions also found they
in three months, with chronic conditions and/ represent good value for the money invested,
or substance abuse) Medicaid managed care in part based on savings from averted costs of
members receiving CHW services compared to asthma care.11
a matched comparison group of members.10
A number of strong studies have demonstrated
hh Healthcare setting: Six CHWs were located in
improved health and cost outcomes as a result of
three healthcare sites, including one Federally
home-based pediatric asthma programs employing
Qualified Health Center (FQHC), and overseen
trained CHWs as home visitors, including one by
by a nurse and a care coordinator at the MCO.
the Asthma Program at the Massachusetts DPH.12
Page 3Community Health Workers and the Triple Aim | March 2015
One systematic review of seven such programs of 102 patients enrolled in the program in
studied in randomized controlled trials found the calendar year 2006, after controlling for
consistent decreases in asthma symptoms, changes in a comparable population without
daytime activity limitations, and emergency and the intervention.15 The comparison group was
urgent care use.13 selected using similar criteria to those used
in the intervention sample and consisted
EXAMPLE 2: Boston Children’s Hospital Pediatric of children with asthma from a neighboring
Asthma Community-Based Case Management community. There was a significant reduction
Program in hospital costs compared to those in the
Private urban hospital enhanced asthma case comparison hospital. The program cost
management with nurse-supervised CHW home of $254,871 was offset by an estimated
visits for low-income patients, primarily African $349,790 in savings from decreased ED visits
American and Latino children on Medicaid. and admissions. The adj. ROI, calculated by
Children were selected for the enhanced care subtracting comparison from intervention
program based on recent hospitalization, one or group costs, was 1.33.
more ED visits, or courses of oral steroids. The hh Source of program funding: Currently the
program was initially piloted and evaluated in program is funded by government grants,
four Boston ZIP codes (intervention group). Cost the hospital’s Office of Community Health
analyses compared asthma hospitalization and (community benefits) and private donations.
ED visit costs for children from the intervention with Results were so impressive that they led
children from four demographically similar Boston Massachusetts legislature to establish a
ZIP codes (comparison group). MassHealth bundled payment pilot for high-
risk pediatric asthma patients. This pilot is
hh Results: Two hundred and eighty-three children set to begin in 2015 at several Massachusetts
were served in the initial study. After twelve pediatric medical homes, including Boston
months there was a significant decrease in Children’s Hospital, which will receive a per-
asthma ED visits (68%) and hospitalizations member-per-month rate to implement an
(84.8%), and significant decreases in activity enhanced pediatric asthma intervention that
limitations, missed school days, and parental includes CHW home visits.
missed work time.14
hh Healthcare setting: Private urban hospital, II. CHWs IMPROVE HEALTH
with nurse case manager supervising CHW
home visitors who were contracted through a The CDC has highlighted the effectiveness of CHWs
community-based organization in one of the in improving chronic disease health outcomes, and
targeted ZIP codes. The program has since has therefore promoted their integration into care
been institutionalized, with CHWs located teams.16 The IOM17 and the American Association
at the hospital as employees, for closer of Diabetes Educators18 have also recommended
supervision, coordination, and communication. engagement of CHWs as part of multidisciplinary
hh CHW roles: CHW home visits provided asthma teams. By helping patients remove barriers to
education, assessment and coaching around screening, treatment, care, and self-management
medication adherence and environmental CHWs have been found to cost-effectively prevent
triggers, trigger mitigation resources (e.g., and manage chronic conditions such as diabetes,
mattress encasements, low-emission asthma, hypertension, and cardiovascular disease.
vacuums), and referrals to community
resources. Supervising nurses coordinated Leadership at 32 community health centers in
care with primary care, specialty, and Massachusetts responding to a recent survey noted
community services. that promotion of chronic disease self-management
is among the most common and important roles
hh Cost analysis: A subsequent cost‑benefit that CHWs play in their organizations.19
analysis was used to determine an adjusted
return on investment (adj. ROI) for a subset
Page 4Community Health Workers and the Triple Aim | March 2015
“Why is a nurse/CHW team so effective? One hh CHW roles: CHWs reinforced NP instructions on
of our physicians told me there is a gap in care lifestyle changes and medications and helped
many providers may not be aware of. They develop patients design strategies for adherence and
a great plan that the patient is often not able to behavior change.
follow through on. The CHW builds trust, helps the
hh Cost analysis: The study calculated
patient understand that plan, and links them to the
incremental cost effectiveness ratios: $157
resources they need—but they also help patients
for every one percent drop in systolic BP, and
feel more confident in their ability so they can take
$190 for every one percent drop in diastolic
care of themselves and do the self-management
BP; $149 per one percent drop In HbA1c, and
they need to do.”
$40 per one percent drop in LDL-C.
Mark Lubberts, M.S.N, R.N. hh Source of program funding: Intervention
Director of Community Health Education, research was funded by the National Heart,
Spectrum Health, Grand Rapids, MI Lung, and Blood Institute.
III. CHWs IMPROVE QUALITY OF CARE
CHWs Chronic Disease Care and Self-
Management The Massachusetts Health Policy Commission’s
standards for PCMH certification emphasize the
Six of the eight rigorous quality studies reviewed
centrality of care coordination and integrated care
by CEPAC that looked at CHWs’ impact on diabetes
management. Quality measures include proactive
management revealed significant positive changes
management of preventive and chronic disease
in such measures as HbA1c and improved self-
care and support for self-care. High quality
reported dietary changes. Glycemic control, as
patient-centered care includes:
measured by HbA1c testing, is a performance
measure commonly used by healthcare providers
1. Open communication between patients and
and health plans. CHWs’ roles included education
providers
and support through home visits and/or group
sessions.20 Other research cited by the CDC 2. Culturally competent services
demonstrated the value of CHWs’ ability to improve 3. Support for chronic disease self-management
risk behaviors and health status measures related
to cardiovascular disease. 4. High levels of patient satisfaction with care and
services
EXAMPLE: Nurse Practitioner (NP) and CHW CHWs are selected for their strength in these
Teams Working with High-Risk Patients areas and are trained in core competencies and
Two health centers in Baltimore Medical Systems roles which enhance these abilities. As a result
had NP/CHW teams manage high risk patients they have been shown to improve numerous
with cardiovascular disease, type 2 diabetes, measures which are required of PCMHs, and in
hypercholesterolemia, or hypertension and levels of MassHealth programs such as the Primary Care
low-density lipoprotein cholesterol, blood pressure, Payment Reform Initiative (PCPRI). Such measures
or HbA1c that exceeded goals established by are similar to or the same as NCQA-promoted
national guidelines.21 measures, including HEDIS and other performance
improvement measures used by most health
hh Results: After one year, compared with
plans and many providers. Under global and other
enhanced usual care control patients,
alternative payment systems such performance
patients in the NP/CHW group had statistically
measures will affect financial payments from health
significant greater 12-month improvement in
payers to provider systems.
total cholesterol, LDL cholesterol, triglycerides,
systolic blood pressure, diastolic blood In each of the examples from healthcare provider
pressure, HbA1c, and perceptions of the organizations below, the improvements in health
quality of their chronic illness care. All of these status and/or utilization represent measures by
constitute NCQA/HEDIS measures of improved which the quality of healthcare providers and
quality of care. health plans are increasingly judged.
Page 5Community Health Workers and the Triple Aim | March 2015
CHWs Increase the Capacity of Primary “The physician’s patient volume will be enhanced
Care Teams to Provide Quality Care and can grow. The population we deal with has
lifestyle issues, challenges, socio-economic
CHWs help to expand the number of patients that challenges, family pressures—someone has to
clinical staff can care for effectively, through their be able to keep them focused on the piece their
role in education, care coordination, and engaging provider is focused on. The work the community
patients in their care. Their contribution to care health workers do can’t be left until the next time
teams allows clinicians to work “at the top of their the doctor sees the patient. CHWs are extending,
license” by providing educational and supportive enhancing the reach that providers have—and as
services that otherwise fall to physicians or nurses, a result we are taking care of more people more
or go unattended. effectively.”
Jay Breines, CEO, Holyoke Health Center
Selected Models for Integrating CHWs into
Holyoke, Massachusetts
Healthcare Teams
There are multiple ways to include CHWs in
healthcare teams. Here are three common CHWs Contribute to NCQA/HEDIS Quality
models. Two are described in examples provided Improvement Measures for Screenings and
in this document. Chronic Disease Care
1. CHW services, independent or paired hh Multiple prospective controlled studies
with those of a nurse, are contracted by involving CHWs resulted in statistically
the primary care entity from a separate significant increases in breast cancer
organization. Supervision is provided by screenings.23
the contracting care entity and usually hh One study, led by an urban teaching hospital
additionally at the organization where they collaborating with six primary care practices
are based; owned by the hospital, showed:
2. CHWs are supervised at and conduct • CHWs assigned to practices reached out
some activities in healthcare settings but to patients by phone, mail, or home visits;
spend much of their time with patients in provided support and education; met
community settings; or women at practices or imaging centers;
3. CHWs are staff at the healthcare facility, and assessed needs and helped with
where they are supervised, and their barriers including Medicaid coverage,
services are provided primarily at that facility. financial assistance, and transportation.
• Those receiving CHW services were
nearly three times as likely to receive
EXAMPLE: CHWs in Care Teams and Community mammograms.24
Settings Working with Diabetes Patients
hh Six quality studies showed significant positive
Holyoke Health Center in Massachusetts integrated
effects of CHW interventions on rates of
CHWs into primary care teams through nurse
cervical cancer screening.25
supervision and team meetings.22
hh The Edward M. Kennedy (EMK) Community
hh CHWs reduced the percentage of diabetes Health Center in Worcester, MA, engaged
patients not seen for a year from almost thirty CHWs, resulting in a significant increase in the
percent to six percent. percentage of women who are up-to-date in
their Pap smears.26
hh After 20.6 months’ participation, patients saw
clinically significant drops in HbA1C levels. hh CHWs significantly improved immunization
status among Dominican children in New
York City (75% up-to-date) compared to the
usual care controls (50%). The CHWs provided
education, support, and home visits.27
Page 6Community Health Workers and the Triple Aim | March 2015
hh In the EMK Community Health Center in hh Results: The CHW patients were significantly
Worcester, CHWs targeted children from more likely to obtain timely post-hospital
families who arrived in the U.S. as refugees primary care; report high quality discharge
(primarily from Iraq, Bhutan, and Burma), communication; and to show greater
who had significantly lower rates of up-to- improvements in mental health and patient
date well-child visits compared to other activation. Similar proportions of patients in
children. This resulted in an increase in well- both study arms received at least one
child visits of 22 percent for children from 30-day readmission, but CHW patients
Bhutan and Burma, and 20 percent for Iraqi were less likely to receive multiple 30-day
children, eliminating the marked disparities in readmissions. Among the 63 readmitted
comparison to other children.28 patients, recurrent readmissions were reduced
from 40 percent to 15.2 percent among the
“Our program was focused on diabetic care--we patients served by CHWs.
saw CHWs really help us with patient engagement- hh CHW Roles: Worked with patients in hospital
-reduction in glucose levels, lowered HbA1c... I did to prepare action plans for patients’ stated
not expect to see any impact in the three months goals for recovery. CHWs provided support for
of the pilot, and we saw tremendous impact with patients via telephone, text messages, or visits
this care model. Unbelievable! Because these were for a minimum of two weeks. CHWs served as
patients who physicians have never been able to liaison with patients, hospital clinical providers,
help to control their diabetes. Now we have the and in some cases with primary care providers.
tools. The community health worker.” They were supervised by a masters-level social
worker in the hospital.
Dr. Robert McGowen
Regional Director of Primary Care hh Source of program funding: The study
Southcoast Healthcare System, MA was funded by a variety of University of
Pennsylvania health improvement, Department
Community Health Workers Can Help to of Medicine and other private grants.
Reduce Hospital Readmissions
Conclusion
Avoiding hospital readmissions is one reflection of
successful care coordination within a healthcare This document highlights numerous ways
system. Many see readmission rates as evidence healthcare providers and payer organizations can
of gaps in discharge planning and in linkages to benefit from integrating CHWs into their teams to
follow-up care. Medicare has begun to reduce improve quality and outcomes while reducing costs.
payments for some types of readmissions, Guidance exists to effectively make this transition.
which can expose hospitals and Accountable If you are interested in integrating CHWs into your
Care Organizations to financial penalties if their practice(s), the Resources section of this document
readmission rates are judged to be too high.29 provides information for three types of resources to
MassHealth also applies a reduction to inpatient guide you in taking the next step. These resources
payment rates for hospitals with Potentially are:
Preventable Readmissions that are higher than
expected. 1. Published CHW program best practice reports;
EXAMPLE: CHWs and Posthospital Transitions 2. Examples and contact information of healthcare
At two academically-affiliated hospitals in organizations that have undertaken successful
Philadelphia, a randomized controlled trial pilot programs, with cost savings or ROI
employed two CHWs to work closely with the calculations; and
hospital-based care team to improve the care 3. List of experts who can offer information and
transition on release of high-risk Medicaid patients assistance.
with multiple conditions.30
Page 7Community Health Workers and the Triple Aim | March 2015
In addition, the Massachusetts DPH will provide The experience of a large managed care company
a “how to” toolkit and technical assistance to such as Molina Healthcare, Inc., cited above, is
primary care practices interested in integrating illustrative. Molina Healthcare implemented this
CHWs into teams. program with some initial grant funding, but largely
with their own funds, in response to underuse of
Healthcare provider organizations not yet ready to primary care by members who instead repeatedly
hire or contract with CHWs due to the challenges sought care for non-urgent, non-emergency
of covering them in a fee-for-service payment conditions in hospital EDs. The program led to
environment can prepare for opportunities in significant net cost savings and increased patient
global and other alternative payment systems. A satisfaction. As a result, the plan institutionalized
recent Center for Medicare and Medicaid (CMS) and expanded the CHW service model.
ruling (Jan. 2014) states that non-licensed health
providers (such as CHWs) can be reimbursed for The Massachusetts DPH believes that integrating
preventive services which are recommended by a CHWs into primary care and other multidisciplinary
licensed clinician. teams will improve health outcomes and
Decisions about implementing changes made reduce unnecessary and costly health care use.
possible by this ruling depend on state Medicaid Community health workers also play an important
offices through their state plan amendment role in reducing disparities in health care and in
process. This ruling is another indicator of how health status, a goal which is an additional aim
opportunities for transforming practices are of health reform, closely related to the Triple Aim.
increasingly facilitated by changes in payment rules To that end, DPH is committed to supporting the
and systems. widespread incorporation of this workforce into
health care.
Healthcare organizations are taking a range of
approaches to assess the financial viability of
integrating CHWs into innovative team practices. Acknowledgments: This document was funded by
The following include strategies utilized by the Massachusetts Department of Public Health
providers whose successes have been cited as produced by consultants and staff at John Snow,
examples in this document. These offer additional Inc. (JSI), in collaboration through a contract
ideas for next steps. from the DPH Office of Integrated Policy, Planning
and Management and Office of Community
1. Review the health data for your membership or Health Workers, in the Division of Prevention and
patient populations to look for patterns of poor Wellness. Terry Mason, PhD, consultant led the
health or common conditions that can lead to research and writing of the paper, with assistance
costly ER use and/or hospitalization. from Terry Greene and Kiely Houston of JSI in
design and editing. The Community and Healthcare
2. Review your data on preventable
Linkages Community of Practice and the Clinical
hospitalizations, including readmissions,
Community of Practice provided suggestions and
to assess where care utilization can be
feedback on this document. These Communities of
improved;
Practice are part of the Massachusetts Partnership
3. Target a patient population for whom extra for Health Promotion and Chronic Disease
support for improving chronic conditions and/ Prevention.
or care utilization seems warranted and plan a
program or a pilot to track effects of a CHW This document was supported by Grant Award
addition to the care team on costs and quality #5U58DP004813, funded by the Centers for
indicators; Disease Control and Prevention. Its contents are
4. Funding can be acquired through public or solely the responsibility of the authors and do
private grants, in combination with your health not necessarily represent the official views of the
system’s practice transformation funds, or, Centers for Disease Control and Prevention or the
when appropriate and in collaboration with Department of Health and Human Services.
community partners, using your system’s
Community Benefits resources.
Page 8Community Health Workers and the Triple Aim | March 2015
Resources
1. Published reports 2. Health systems with cost study experience
hh The Institute for Clinical and Economic Review Molina Healthcare, Inc. Dodie Grovet, LISW,
(ICER) offers Action Guides prepared by leading Clinical Programs Training Manager
policy experts to help provider organizations, Dodie.Grovet@MolinaHealthCare.com
payers, and policy makers interpret existing Spectrum Health, Mark Lubberts MSN, BSN,
evidence and apply recommendations for RN, Director of Community Health Education
integrating CHWs into healthcare systems: Mark.Lubberts@spectrumhealth.org
• New England Comparative Effectiveness 3. Expert consultants
Action Guide for Community Health hh Dr. Heidi Behforouz, Associate Professor at
Workers (CHWs): Guidance for Harvard Medical School; Attending Physician
Organizations Working with CHWs. at Brigham and Women’s Hospital Division of
September, 2013. http://cepac.icer-review. Global Health Equity
org/wp-content/uploads/2011/04/Action- hbehforouz@pchi.partners.org
Guide-for-Employers_09_05_13.pdf
• New England Comparative Effectiveness hh Project on CHW Policy & Practice, University
Action Guide for Community Health of Texas Institute for Health Policy, Héctor
Workers (CHWs): Guidance for Health Balcázar, PhD
Insurers. September, 2013. http:// Hector.G.Balcazar@uth.tmc.edu
cepac.icer-review.org/wp-content/
uploads/2011/04/Action-Guide-for-Health- hh The Penn Center for Community Health
Insurers_09-05-131.pdf Workers is also a source of consultation.
Consultation link:
hh Sinai Urban Health Institute. Best Practice http://chw.upenn.edu/consultation
Guidelines for Implementing and Evaluating
Community Health Worker Programs in Health hh Massachusetts Department of Public Health,
Care Settings. January 2014. Sinai Health Office of Community Health Workers.
System: Chicago Illinois. http://www.mass.gov/dph/
http://www.suhichicago.org/files/chw%20 communityhealthworkers
bpg_full_final.pdf
For technical assistance on CHW integration:
hh Penn Center for Community Health Workers Jessica Aguilera-Steinert
http://chw.upenn.edu/tools jessica.aguilera-steinert@state.ma.us
• Intervention Toolkit, guidelines for hiring, All other inquiries: Gail Hirsch, Director, Office
training course and manuals for CHWs, of Community Health Workers,
managers, and directors gail.hirsch@state.ma.us
• Online platform, CHW training videos,
applicant screening tools and a cloud-
based workflow management system
hh National Center for Chronic Disease and
Health Promotion, Addressing Chronic Disease
through Community Health Workers: A Policy
and Systems Level Approach. A Policy Brief on
Community Health Workers. Centers for Disease
Control and Prevention: Atlanta, Georgia.
http://www.cdc.gov/dhdsp/docs/chw_brief.pdf
Page 9Community Health Workers and the Triple Aim | March 2015
Notes
1 HEDIS refers to the Healthcare Effectiveness 7 Institute for Clinical and Economic Review.
Data and Information Set. HEDIS data are used Community Health Workers: A Review of
by the vast majority of health plans to measure Program Evolution, Evidence of Effectiveness
performance on important dimensions of and Value, and Status of Workforce
care and service. They are also used by many Development in New England. The New
healthcare providers. http://www.ncqa.org/ England Comparative Effectiveness Advisory
HEDISQualityMeasurement/WhatisHEDIS.aspx Council. Boston, Massachusetts: July, 2013.
The National Committee for Quality Assurance 8 ICER CEPAC Report, p.24.
(NCQA) is a non-profit organization widely 9 Auerbach, J and L Desrochers, Community
influential in measuring and improving health Health Workers in a Post-Health Care Reform
care quality. NCQA promotes HEDIS and other Era: The Current Practice in MA Community
standards for use in accrediting, ranking and Health Centers. Presentation at Unity
monitoring quality of services in health care. Conference 2014. May, 2014. Baltimore,
NCQA standards are used to accredit patient- Maryland.
centered medical homes (PCMH). Other
common measures include those devised by 10 Johnson D et al. Community health workers and
Centers for Medicare and Medicaid Services Medicaid Managed Care in New Mexico.
(CMS), and the Agency for Healthcare Research J Community Health. 2011;37:563-575.
and Quality (AHRQ). 11 The Guide to Community Preventive Services:
2 Institute of Medicine. Unequal Treatment: The Community Guide. Asthma Control:
Confronting Racial and Ethnic Disparities in Home-Based Multi-Trigger, Multicomponent
Health Care. Washington, DC: The National Environmental Interventions Task Force
Academies Press, 2003. Finding and Rationale Statement Interventions
for Children and Adolescents with Asthma.
3 Anthony S, Gowler R, Hirsch G, Wilkinson G, eds. Available at http://www.thecommunityguide.
Community Health Workers in Massachusetts: org/asthma/multicomponent.html
Improving Health Care and Public Health.
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