Community Health Workers Key to Advancing Health Equity
Durham, NC–Community health workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community they serve. New research shows they also are critical in the pursuit of more equitable health care. A new paper from Duke-Margolis outlines policy recommendations to enhance and prioritize community health worker care models—and amplify their impact on health equity-into existing health care transformation reforms.
“Community health workers are effective, vital even, for addressing a range of systemic barriers, including providing culturally and linguistically accessible public health communication, access to existing healthcare systems, and building trust between health systems and community members,” said Dr. Warren Kibbe, RADx-UP Coordination and Data Collection Center (CDCC) MPI, Duke University. “Community health workers provide wrap-around services and help community members navigate gaps in traditional health services”
Evidence generated by the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics – Underserved Populations (RADx-UP) initiative demonstrates that community-based care delivery models that prioritize CHWs in the health care workforce not only respond during acute public health crises, but also should be incorporated long-term into the design and implementation of equitable health policy and practice. The Duke-Margolis paper, “RADx-UP Policy Brief: Opportunities to Enhance Health Equity by Integrating Community Health Workers into Payment and Care Delivery Reforms,” builds on the 2022 RADx-UP Health Equity Policy Framework, and summarizes the evidence from CHW models used across RADx-UP projects, the impact on health equity, and the policy steps needed to establish sustainable engagement of community health workers in current and future health care reform efforts.
This analysis comes as the Centers for Medicare & Medicaid Services’ (CMS) begins implementation of its newly introduced Framework for Health Equity and Meaningful Measures 2.0 Initiative, and increased potential to address longstanding systemic inequities through community-based care delivery models. CHWs are essential personnel in community-based care delivery models and assume critical roles both within and outside of clinical settings.
“Genuine trust building and relationship development are necessary for successful community-engaged interventions,” said Kamaria Kaalund, Duke-Margolis Health Equity Policy Analyst. “Efforts focused on increasing capacity to evaluate community-based interventions and involving community health workers in research design and implementation processes can foster improved partnerships with community-based organizations and a more trusted evidence-generation processes.”
“Training and certification requirements can make it challenging to effectively integrate community health workers into existing care delivery models but examples from this paper highlight strategies to navigate regulatory barriers and employ these workers through sustainable models” said Dr. Michael Cohen-Wolkowiez, RADx-UP CDCC MPI, Duke Clinical Research Institute.
The paper identifies five key policy recommendations to enhance and prioritize CHW models into existing health care transformation reforms:
Near-term Policy Recommendations
- Revise federal quality measures to reflect the contributions of CHWs in engaging communities and ensuring equitable access to care
- Expand sustainable alternative payment models to prioritize CHWs in health care transformation efforts
- Use existing competency frameworks to facilitate alignment of CHW roles and functions to reimbursement models
Long-term Policy Recommendations
- Develop multi-year funding grants to extend the time available for evaluating community-based interventions
- Support CHWs to hold leadership and decision-making roles in community-engaged researchers
“All of the recommendations outlined here emphasize the importance of multi-sectoral engagement and collaboration with community-based organizations” said Dr. Gaurav Dave, RADx-UP CDCC MPI, UNC Center for Health Equity Research. “Examples from the RADx-UP initiative exemplify how to implement bidirectional and shared leadership models that address disparities caused by existing systemic inequities.”
“Lessons learned from the RADx-UP initiative demonstrate the importance of community health worker care models to both to foster health system change and advance health equity,” said Andrea Thoumi MPP, MSc, Duke-Margolis Health Equity Policy Fellow. “The integration of community health workers into expanded care delivery settings has the significant potential to close equity gaps but the right health system incentive structures and payments mechanisms need to be in place.”
About the RADx® Underserved Populations Coordination and Data Collection Center (RADx-UP CDCC)
The RADx-UP Coordination and Data Collection Center (CDCC) is the central leadership and support team assisting the NIH and RADx-UP projects across the country as they serve their communities. The CDCC, led by The Duke Clinical Research Institute (DCRI) and UNC Center for Health Equity Research (CHER) and in partnership with Community Campus Partnerships for Health (CCPH) and the Duke-Margolis Center for Health Policy, oversees the RADx-UP program and its funding awards to more than 137 research teams across the United States and its territories as well as Tribal Nations. The CDCC is organized into four core support teams: the COVID-19 Testing Core; the Community engagement Core, the Data Science and Biostatistics Core; and the Administrative Core. For more information, visit https://radx-up.org/about/coordination-center/ and follow us on Twitter @RadxUp.
About the Duke-Margolis Center for Health Policy
The mission of the Duke-Margolis Center for Health Policy is to improve health, health equity, and the value of health care through practical, innovative, and evidence-based policy solutions. For more information, visit healthpolicy.duke.edu and follow us on Twitter @DukeMargolis.
About the UNC Center for Health Equity Research (CHER)
Part of the UNC School of Medicine, CHER brings together collaborative, multidisciplinary teams of stakeholders to improve health in North Carolina communities, with a shared commitment to innovation, collaboration, and health equity. CHER members generate new knowledge and contribute to the science of health equity research and implementations, thus driving innovation in collaboration with communities to improve well-being. For more information, visit med.unc.edu/cher and follow us on Twitter @uncCHER.
About Duke Clinical Research Institute (DCRI)
Part of the Duke University School of Medicine, DCRI is the world’s largest academic clinical research organization. They conduct innovative research to deliver on their mission to share knowledge that improves the care of patients around the world. For more information, visit dcri.org and follow us on Twitter @DCRINews.
Patricia Green, Duke-Margolis Center for Health Policy
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