Sustainability for CHWs
Creating permanent CHW positions and stable workforce infrastructure have been challenging due to the lack of consistent, dependable funding. In Massachusetts and across the country, multiple efforts are focused on promoting sustainability. These include:
- Expanding the evidence base on CHW contributions to positive health outcomes and containment of costs;
- Organizing the CHW workforce to effectively advocate for the CHW role;
- Building national consensus on CHW roles, skills and qualities.
CHWs and key partners are educating health payers and providers about the workforce, the roles they play, the benefits they bring and how to integrate them into healthcare and other multidisciplinary teams.
- Achieving the Triple Aim: Success with Community Health Workers (PDF) | (DOC)
- “Community Health Workers: Part of the Solution,” Health Affairs, 2010
- Bureau of Labor Statistics CHW Standard Occupational Classification – Established in 2009 (SOC 21-1094).
- The Community Health Worker Core Consensus (C3) Project: 2016 Recommendations on CHW Roles, Skills, and Qualities
- National Academy for State Health Policy (NASHP) State Community Health Worker Models - Online network for health reform implementation, with a page to discuss community health workers and state implementation of health reform where questions, comments, ideas and resources are posted.
- Association of State and Territorial Health Officials (ASTHO) – Resources for state health agencies on CHWs.
- American Public Health Association (APHA) CHW Section
CHWs and health reform
Both state and federal health reform have provided natural opportunities for expanded inclusion of CHWs into clinical and community-based care.
The landmark 2006 Massachusetts health reform law included a provision requiring DPH to convene a statewide advisory council to investigate and make recommendations for the CHW workforce. One recommendation was to establish a CHW certification process, which led to the passage of Chapter 322 (Acts of 2010), the Massachusetts CHW certification law.
CHWs were also included in Massachusetts payment reform legislation of 2012 (Chapter 224), and are a key workforce in the Prevention and Wellness Trust Fund.
Massachusetts health reform served as a precursor to the 2010 federal health reform law, the Affordable Care Act (ACA), which identified CHWs as health professionals. Major federal initiatives in the ACA which promote CHWs include the CMS Innovation Center and expanded CDC support for CHWs.
Massachusetts health reform
- “An Act Providing Access to Affordable, Quality, Accountable Health Care”, Acts of 2006, Chapter 58, Section 110
- “Community Health Workers in Massachusetts: Improving Health Care and Public Health" PDF (Doc), Massachusetts Department of Public Health Community Health Worker Advisory Council
- The Public Health Council was reconstituted in 2007 as part of health care reform and includes a seat for CHWs representing the Massachusetts Association of Community Health Workers.
- “An Act Establishing a Board of Certification of Community Health Workers”, The 190th Court of the Commonwealth of Massachusetts
- “Winning Policy Change to Promote Community Health Workers: Lessons From Massachusetts in The Health Reform Era”, American Journal of Public Health
- “State Legislation Supports Professional Development of Community Health Workers, Leading to Greater Professional Recognition, Enhancements in Training, and Funding”, Agency for Healthcare Research and Quality (AHRQ)
Federal/national level health reform
- Affordable Care Act, see specifically sections 5101, 5102, 5313, 5403
- Center for Disease Control and Prevention (CDC) CHW Resources
- “Incorporating Community Health Workers into State Health Care Systems: Options for Policymakers”, National Conference of State Legislatures (NCSL) Policy Brief