Advancing Health Equity Through Community Health Workers and Peer Providers: Mounting Evidence and Policy Recommendations

As decision-makers seek to transform health care delivery and payment systems to increase value, improve outcomes, and control costs, they need clinical, health systems, and population health research, as well as other scientific evidence, to inform their decisions about what kinds of interventions and treatment to pay for, and how to organize care delivery. Given our nation’s demographic and economic context, health system transformation will succeed and remain sustainable only if it also addresses the long-standing health and health care inequities that affect communities of color and other underserved groups. However, our current evidence base is incomplete and often biased. Strengthening it by making it both transparent about who is included in the research and representative of all of our nation’s communities is imperative.

This report reviews results from nine recent studies funded by the Patient-Centered Outcomes Research Institute (PCORI) that provide further support for including community health workers (CHWs) and peer providers (PPs) as important components of health care delivery that are particularly effective in addressing health and health care inequities. These studies underscore the enormous value of CHWs and PPs, an often overlooked, usually underutilized, yet highly versatile health workforce, as powerful health equity change agents. To facilitate scaling and integration of CHWs and PPs across the health care system, we translate this evidence into equity-focused policy recommendations for advocates to promote and decision-makers to adopt.

Community Health Worker and Peer Provider Policy Recommendations Based on Research Funded by PCORI

We reviewed nine PCORI-funded studies that examined the effectiveness of interventions led by different types of CHWs and PPs across health conditions such as serious mental illness (SMI), chronic diseases, and traumatic physical injury. Study participants were of diverse ethnic, racial, linguistic, socioeconomic, and geographic backgrounds, including Black, Latinx, American Indian, monolingual Spanish-speaking, low-income, and rural patients. One study focused solely on women. Informed by our analysis of these studies, we developed 12 health system policy recommendations across four broad policy categories. In addition, we developed four recommendations to improve health equity-focused patient-centered outcomes research (PCOR) by making it more diverse, relevant, and transparent. These broad policy categories are:

1. Payers and providers should include CHWs and PPs in care teams to improve outcomes while reducing costs.
2. Payers and providers should include CHWs and PPs in care teams to improve outcomes for a variety of health conditions.
3. Payers and providers should include CHWs and PPs in care teams serving diverse communities affected by health inequities.
4. Payers and providers should include CHWs and PPs in care transition teams.
5. Research on CHWs and PPs should be improved to strengthen the evidence base for equity.

Overall, this research adds to the existing evidence of the power of CHWs and PPs as valuable health equity change agents. Advocates, decision-makers, and other health care stakeholders must prioritize the inclusion of this workforce in care delivery teams as a standard practice that health care payment systems support fully and sustainably. Download the report to read our 12 health system policy recommendations.