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Tuesday, August 22, 2017

New Connecticut Law Advances Recognition of Community Health Workers

Tekisha Dwan Everette, PhD

Executive Director, Health Equity Solutions

Maria Walawender

Health Equity Intern

Find out more about Families USA’s initiative to expand the use of community health workers.  

Connecticut just took an important step toward improving health outcomes for its most vulnerable residents. Earlier this summer, the governor signed a law that lays the foundation for the broader use and support of community health workers (CHWs). 

Community health workers can improve health in underserved communities 

Community health workers play a valuable role in helping people achieve better health. Because they are trusted community members, they are uniquely effective at connecting underserved communities to the health care system and helping people navigate social factors that pose barriers to good health. In doing so, CHWs help to improve health outcomes and narrow health disparities. 

CHWs can also reduce overall healthcare costs because they increase the use of preventive services, and help people manage chronic conditions more effectively to reduce complications. They also help their clients avoid expensive emergency department visits and hospitalizations drop as their clients’ health improves. 

Because of this track record, community leaders across the country are trying to increase funding for CHWs and the use of them in local and state health care systems, particularly as a strategy to reduce racial and ethnic health disparities.  

Collaboration yields new law validating community health workers 

On June 30, Connecticut Governor Dannel Malloy signed An Act Concerning Community Health Workers, which establishes a path forward to increase use of CHWs in the state’s health care system.  

The law defines CHWs, codifying a shared understanding of the role: “liaison[s] between individuals within the community and health care and social services providers” who have an “in-depth understanding of the experience, language, culture and socioeconomic needs of the community.”  

This definition not only highlights the importance of CHWs as possessing a unique knowledge of the community, it also validates their role in promoting better health. It establishes a baseline description of CHWs and their value, setting the stage for developing next steps, including their potential certification and how to sustainably fund their work. 

Collaboration among diverse stakeholders key to getting the law passed

Adoption of this law was the product of intense collaboration among many community leaders and organizations focused on health care and health equity.  

The process started with the State Innovation Model (SIM)* CHW Advisory Committee. Formed in 2016, the SIM CHW Advisory Committee involved key stakeholders including providers, nonprofits, local institutions of higher education, and CHWs themselves to develop recommendations on defining CHWs, their roles, and certification.  Involvement of CHWs themselves was essential in guaranteeing that the recommendations stayed true to CHWs’ purpose and supported their success.

Health Equity Solutions (HES) a nonprofit, nonpartisan advocacy organization, led a coalition that advocated for legislation based on the CHW Advisory Committee’s recommendations, and also analysis like the report published by the Connecticut Health Foundation that projected the potential impact different CHW models could have in Connecticut.

What’s next? 

In addition to establishing a CHW definition, the new law also calls for the director of the Connecticut SIM program, in consultation with the Department of Public Health and the CHW Advisory Committee, to conduct a study on the feasibility and impact of a certification program for CHWs, a complex issue in the CHW world.

On the one hand, some feel that certification would enhance consensus around the broader adoption of CHWs and the use of taxpayer dollars, including Medicaid, to fund their work. Standardizing the role and training required for it would ensure that all CHWs meet the same core requirements for safe and effective care and promote quality and accountability.  

Others have sincere concerns that certification requirements would exclude very effective CHWs.  Central to CHWs’ effectiveness is that they come from the same vulnerable, under-resourced communities they serve, so they face many of the same challenges.  

Barriers due to education, language, geography, immigration status, and income, among others, could make certification out of reach for some current or aspiring CHWs. The SIM CHW Advisory Committee currently recommends certification of CHWs in Connecticut, but with safeguards to not exclude longstanding community members doing this work. 

As the advisory committee studies certification, other CHW efforts continue.  Connecticut’s SIM program is committed to finding a sustainable way for the CHWs currently funded through SIM to continue their work even after the grant ends.  

The same coalition of leaders that helped enact the law hope to leverage broader healthcare payment and delivery reform efforts to secure sustainable funding. 
Connecticut demonstrates that prioritizing the achievement of health equity can be done, and that elevating the valuable role of CHWS in narrowing disparities, improving outcomes, and containing costs is achievable when community leaders, public health care programs, and other stakeholders come together.

*SIM is a national grant program administered by the federal Center for Medicare and Medicaid Innovation (CMMI) that provides funding and technical assistance to states to improve quality of care, reduce costs, and improve health.  When Connecticut was awarded a SIM grant in 2014 state leaders decided to prioritize health equity in their innovation efforts, which lead to a focus on CHWs as a key strategy to reach that goal. In addition, the SIM grant has directly funded CHW positions in a Federally Qualified Health Center and in two large health systems.  

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