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Your top 3 questions about community health workers—answered

April 4, 2019

    Last month, Population Health Advisor members from the University of Pennsylvania joined us for a co-hosted webconference on how organizations can develop an evidence-based community health worker (CHW) program. As one listener remarked, "Wow—a CHW can transform a patient's life."

    ROI calculator: Assess the savings opportunity of your community health worker program

    But not every CHW program drives true returns. So the leaders of Penn's IMPaCT CHW program answered questions live about how their program achieved a 2:1 ROI. Here are some of the answers to your peers' questions about defining the CHW role, identifying successful candidates, and integrating CHWs into the care team.

    1. What is the difference between CHWs and health coaches? Does this position require a degree?

    Health coaches (as well as navigators, advocates, care coordinators, and case managers) are terms that are often confused with CHWs. The difference is that these terms describe functions (things that people do), whereas a CHW is an identity. CHWs can perform the functions of a health coach, but so can nurses, student volunteers, etc. What makes the CHW role unique is their combination of shared life experience and innate empathy. One of the elements of shared life experience is education, which is why the CHW position typically requires a high school diploma or a GED.

    2. How can we find successful candidates for the role? You mentioned you recruit from non-traditional areas in the community to source the right applicants. Where have you looked?

    The first step is to select the geographic focus of the CHW program. You'll likely target communities with high concentrations of at-risk patients, which you can identify with claims data, local health rankings, and payer mix. Then, recruit in community-based organizations (e.g. churches, food banks, block captain associations) that likely attract natural helpers who reflect the population you're trying to serve.

    3. How can we ensure our CHWs are able to adequately collaborate with the care team, without losing the essence of the role?

    It's important to have safeguards in place that help protect the CHW role to minimize the risk of being misused (e.g., tasked with clerical and administrative duties). Each CHW at IMPaCT has a dedicated manager trained in the model and manager responsibilities, which includes ensuring effective clinical integration and supporting CHWs in their day-to-day work. We use a ratio of four-to-eight CHWs per manager.

    However, CHWs still need to be able to coordinate effectively with the care team. We assign CHWs to specific teams across outpatient, inpatient, and home care. For each intake, we recommend a "CHW-first" model. In other words, the CHW is the first person to meet with the patient. They're more likely to get an accurate picture of what the patient needs because they can quickly build trust. They're also well-positioned to follow up on social needs and navigate patients to other care team members for clinical needs. In addition, CHWs are able to communicate patient needs and progress to the care team via our web-based platform, HOMEBASE, integrated into the EHR. This approach reduces fragmentation and controls costs—contributing to our 2:1 program ROI.

    Want tools to help you develop your own scalable program? Review our Five Steps to Design a Community Health Worker Program toolkit.

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