New payment methods and delivery system reforms can support sustainable funding for community health worker services

January 29, 2018
Katharine London
Katharine London, MS
Principal, Health Law & Policy

Extensive evidence shows that Community Health Workers (CHWs) can help health systems meet the triple aim:  improve population health, improve quality of care and contain costs, while also promoting health equity and community engagement. However, most CHW programs are grant funded, and when the funding ends, the program ends.

New payment methods and delivery system reforms give health care providers flexibility to provide sustainable funding for community health worker services for their high-risk patients, where these services are likely to result in better health outcomes and a positive return on investment. Providers can use the flexibility inherent in pay for performance, shared savings, bundled payment, and global payment systems to pay for community health worker services.

However, payers and providers need evidence to support investment in CHW services.  Producing the following evidence makes a convincing case for funding CHW services: 

  1. Documentation of unmet health needs in the community
  2. Description of the target population’s size, characteristics, and geographic location
  3. Documentation of cost effective CHW interventions from the published literature
  4. Projected (estimated) outcomes based on successful models, including health outcomes, social outcomes (e.g. working days gained), changes in utilization and cost of health care services, and expected return on investment

Compiling this evidence documenting the effectiveness of CHW services can help support payers’ and providers’ decisions to provide sustainable funding for CHW services.

On Saturday, January 27, 2018 I delivered this presentation to assist CHWs and other advocates in engaging with policymakers and payers to support CHW sustainability and develop a financial plan for their CHW work.  The session was part of a CHW Sustainability event held in connection with Families USA’s annual conference, Health Action 2018: Staying Strong for America’s Families, held at the Hyatt Regency Capitol Hill, Washington, DC.