Institute of Medicine Discussion Paper on Community Health Workers, Part 2
Clayton Velicer, MPH
In part 1 of this blog we highlighted several policy developments for Community Health Workers (CHWs) and looked at some of the challenges facing the CHW workforce as outlined in the Institute of Medicine’s (IOM) recent discussion paper.
The IOM made 4 recommendations for the future of the CHW workforce (Note: these were written for California but are relevant to other states). In this blog, we’ll look at those recommendations and discuss their current status.
1) “Implement statewide infrastructure for CHW scope of practice, training, and certification that covers the role of CHWs in providing team-based primary care”
The IOM recommends assessing and defining the professional and practical skills of each member of the primary care team. The idea is that health care practices can maximize cost-effectiveness, quality, and outcomes if every member of the team operates at the top of their licensure and skills.
Defining a common scope of practice for CHWs has been an ongoing challenge. In 2008, the National Conference of State Legislatures provided guidance in this issue brief. By 2013, the CDC reported that 8 states had implemented scope of practice laws. As more calls are made for scope of practice legislation by groups like the IOM, the number and effectiveness of these laws will only increase.
Furthermore, the IOM recommends “conducting an independent assessment of the wide range of employer-based, independent and academic CHW training programs” that currently exist to strengthen training and ensure regional access to training. This kind of assessment lays the groundwork to develop competency-based certification standards for and new and existing training programs.
2) “Build the analytic capacity of safety net providers to document the value realized from CHWs”
Building analytic capacity could include prioritizing demonstration projects that require collaborative agreements among safety net providers, hospitals, and insurers. Community health centers will need technical assistance and better evaluation tools to monitor outcomes associated with CHWs.
3) “Promote sustainable financing mechanisms”
The first two recommendations are important for advancing sustainable payment models for CHWs. As a prime example of this kind of funding mechanism, the IOM cites the Centers for Medicare and Medicaid Services’ preventive services rule that allows Medicaid programs to reimburse personnel for community-based preventive services. IOM cites Alaska, Minnesota, San Francisco and Oregon as areas that are serving as models for sustainable funding for CHWs.
Highlighting ways that CHWs and peer support workers can be funded through the Affordable Care Act remains an important goal of this blog. Our upcoming blog will focus on ways that CHWs have been compensated through the ACA.
We previously highlighted Georgia’s reimbursement model, which paid peer support workers through Medicaid. Georgia reported that these peer specialists cost an average of $997 per year compared to $6,491 for in day treatment with standard care. As more states incorporate peer support workers and CHWs through sustainable financing mechanisms, it is important to document the return on investment so that other states will be encouraged to adapt similar models.
4) “Establish an information clearinghouse to document, disseminate and replicate innovations in the engagement of CHWs at scale”
Tied to recommendation number 3, IOM notes that innovations in CHW practice are occurring within each state and across the country but struggle from being fragmented and uncoordinated. The IOM notes that a clearinghouse could track and collect examples that address different barriers, including professional, financing and technical. Though perhaps not as systematic as what the IOM recommends, Peers for Progress provides best practices recommendations for the field of peer support as well as the latest scientific evidence.
Overall, we think these are excellent recommendations and hope highlighting them to our readers serves as inspiration for continuing to implementing peer support and community health workers programs. We welcome any suggestions on ways we can serve to contribute to the IOM’s recommendations.