Blog Post

Overcome these 5 barriers to a successful community health worker program

February 25, 2019

    Community health workers (CHWs) are not a new role in health care. However, in the last several months, we've received more questions about how to start CHW programs than ever since launching this blog. Whether it's because of Medicaid expansion taking hold across the country or an increasing awareness of social determinants' impact on outcomes, provider organizations are getting serious about addressing complex patients' holistic needs in a sustainable way. CHWs, the non-clinical staff type specializing in community knowledge and patient trust, have potential to meet this need—and generate a positive ROI.

    How to build a successful CHW program

    However, there's no playbook for launching an effective CHW program. Provider organizations must confront five barriers to effective program design and implementation so that their models don't fail long term.

    1. Barrier: No nationwide standards exist, resulting in a broad range of possible models. Organization leaders have trouble conceptualizing how the role can integrate with the existing care team, which can halt program development before it begins.

      Solution: Determine program scope at the outset based on patient needs and organizational priorities. Leaders looking to inflect the total cost of care use CHWs to address the social determinants of health. Programs designed to influence clinical outcomes use CHWs to also drive chronic disease self-management.

    2. Barrier: Few provider stakeholders are familiar with the role or its value. Without clear communication of the staff's value proposition, executive leaders will not support funding. Programs typically rely on a mix of short term grants which ultimately peter out.

      Solution: Secure sustainable, internal program funding. Create a vision for why providers need to meet patients' social needs and support self-management that links to how CHWs help. Champions should tailor their pitch to the audience at hand, as different stakeholders (e.g., hospital c-suite, payers, philanthropists) will have different priorities.

    3. Barrier: Leaders rely on traditional hiring practices and fail to hire and train the right people. This contributes to high turnover rates and extraneous recruiting and training costs, threatening program ROI.

      Solution: Source talent using non-traditional methods. Providers who choose to own staffing should recruit applicants from the targeted community through qualitative interviews and meet and greets. Leaders should look to hire individuals that demonstrate a keen ability to build relationships.

    4. Barrier: Programs that don't use CHWs at top-of-license will lose momentum due to staff burnout. Programs with high turnover harm trusted relationships with patients, use unnecessary resources to recruit, rehire, and retrain, and are not as effective.

      Solution: Create a retention plan including sufficient training, standardized tools, and day-to-day management to support CHWs in the field and maximize role efficiency. Guidelines for day-to-day expectations should allow for flexibility to manage workload, protect time for administrative duties, and maintain lean patient panels. These tactics help CHWs work top-of-license across care teams but ensure CHWs are supported in challenging situations, reducing turnover.

    5. Barrier: Most programs start organically in pilot mode without a clear roadmap to analyze impact. Many providers are unsure of how to calculate an accurate ROI of CHW programs or communicate the ongoing value proposition with the right set of metrics.

      Solution: Demonstrate long-term performance by tracking estimated avoided costs due to reduced utilization. To track success in the short term, some providers use a dashboard to manage performance in real time, communicate expectations to staff at the outset, and intervene when CHWs need support.

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