By Molly Miller

A recent study by the Centers for Disease Control and Prevention found that the uninsured rate from January to March of 2015 stood at 9.2 percent – the lowest uninsured rate the country has seen in 50 years! This is great news for individuals who did not previously have health insurance, as it vastly improves the affordability of health care and reduces reliance on the emergency room as a form of primary care.

However, this increase in the number of individuals with health insurance has also increased the demand for health care services, with a recent study by the Commonwealth Fund projecting that primary care providers will see an average increase in the number of office visits of 1.34 visits per week. This could mean trouble for an already over-stretched primary care system.

As of April 2014, the United States and its territories had 6,087 Primary Care Health Professional Shortage Areas (HPSAs), which means that “primary medical professionals in contiguous areas are over-utilized, excessively distant or inaccessible to the population under consideration.” The large number of HSPAs means that, while patients may be able to afford health care, they may not be able to easily access high-quality health care.

To solve this issue, health policy experts are looking into a variety of solutions for decreasing shortages including fast-track medical programs for students interested in becoming primary care physicians. However, the solution to closing the gaps in primary care provision may already exist in the form of Community Health Workers.

Who are Community Health Workers? 

The World Health Organization provides the following widely accepted definition of community health worker:

“Community health workers should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional health workers.” 

While this definition may provide a vague answer to the question of who community health workers actually are, it does so intentionally in order to create a space for the layperson to impact the health of his or her community. In one state community health workers may have a professional certification while in another they receive only informal training. Some community health workers may focus on providing direct medical care while others may focus more on health education.

However, the common thread is that all community health workers, no matter where they are located, are deeply embedded in their community. This gives community health workers the opportunity to get to know their clients in a way that a 15-minute appointment with a primary care physician doesn’t allow. This provides the opportunity to better understand potential social and environmental impacts on the client’s health.

What can Community Health Workers do?

Community health workers can provide a variety of health and social services including, but not limited to:

• Connect vulnerable populations to appropriate health care providers
• Coordinate care for clients who are transitioning between health care providers (that is, from a primary care physician to a specialist or from an in-patient hospital setting to a home care setting)
• Help clients in determine their eligibility for, and enroll in, various health insurance and social service programs (Medicaid, Medicare, WIC, SNAP, etc…)
• Train health care providers in cultural competencies related to the vulnerable populations they serve
• Provide culturally appropriate health education
• Advocate for clients to ensure they receive the proper health and social services
• Provide informal counseling, interpretation, and translation services to clients
• Build community capacity to address specific health issues

What value do Community Health Workers provide?

Most services provided by community health workers are not direct medical services. But they are all vital to reducing patient burden placed on primary care physicians, especially in HSPAs and rural areas. Having an individual in the community who can travel to a client’s home and check their blood glucose levels or provide health education and counseling regarding chronic disease management can prevent unnecessary visits to a primary care physician. This saves time for the client and allows the physician to keep appointment slots open for patients who truly need to see a doctor.

Due to the large variation in program design and purpose, it is hard to measure the overall impact that community health workers have on the health care system. However, some randomized trials have shown the positive impact community health workers can have on patient outcomes.

One study found that patients who were assigned a community health worker upon hospital admission—to serve as a liaison between the patient and the patient care team and help the patient create a post-hospitalization action plan—were approximately 12 percent more likely to complete a post-hospitalization primary care follow-up than those patients who did not receive the intervention. Additionally, patients receiving the community health worker intervention had only 38 readmissions compared to 45 readmissions among the control group, with the intervention also significantly decreasing recurrent readmissions from 40 percent to just over 15 fifteen.

While this study represents only one community health worker intervention, it demonstrates the usefulness of integrating community health workers into the patient care team. Patients who have an advocate who can explain medical jargon in terms that a layperson can understand are more likely to follow the doctor’s orders, stay out of the hospital, and appropriately use health care facilities when needed.

The full benefit of robust community health worker programs is still being explored, but the existing body of research demonstrates that community health workers have the potential to serve as a vital part of the health care system.

Photo: Creative Commons