Turning great ideas into healthier communities


PHI Expands Dialogue on Community Health Workers with New Releases

February 04, 2015

Community health workers (CHWs) have long been recognized as agents and advocates for improving health in local communities. In the era of the Affordable Care Act (ACA), there is increasing interest in integrating CHWs into team-based primary care as a key strategy to achieve Triple Aim goals of lower costs, better care and improved outcomes – and overall population health. However, despite its tremendous potential, the engagement of CHWs by health care institutions remains limited. PHI is working to change that.  

This week PHI releases a report, discussion paper and short video that make the case for how and why we should bring CHWs into the mainstream of health care delivery in California and beyond.



“As the ACA pushes the health care system to move beyond the traditional provider-centric model to one that also addresses the broader social determinants of health, engaging CHWs as full members of the primary care team is one of the most important strategies available to us,” says Pittman. “I am proud that PHI is in a strong position to provide research, resources and thought leadership to advance this critical issue in California and beyond.”

For the last two years, with support from the Blue Shield of California Foundation, CHWA has studied the use of CHWs within California’s safety net institutions and their contributions to Triple Aim goals. Its first report, “Taking Innovation to Scale: Community Health Workers, Promotores and the Triple Aim,” presented results of a statewide assessment which found that while many health centers utilized CHWs (in a variety of capacities), common barriers were preventing wider scale-up. These barriers included a lack of stable reimbursement mechanisms, limited analytic capacity and data access to document outcomes associated with CHW services, and limited knowledge of evidence-based practices.

CHWA followed up on Taking Innovation to Scale by holding three regional technical consultation meetings with approximately 70 clinical and administrative leaders from across the state’s health care safety net system. The meetings acquired detailed input on specific needs, challenges and emerging opportunities identified in the statewide assessment.  

“Clinic leaders and staff on the frontlines of caring for the most vulnerable populations are feeling most acutely both the pressures and opportunities in this new ACA era,” says Kevin Barnett, DrPH, co-director of CHWA. “We wanted to hear directly from them about the real day-to-day challenges for scaling up CHWs into team-based care so we could develop practical and effective recommendations.”

Community Health Workers in California: Sharpening Our Focus on Strategies to Expand summarizes the common themes emerging from the convening discussions and presents eight recommendations. The recommendations are designed to speed the rapid dissemination of CHW best practices and models as they emerge, improve CHW training and certification, accelerate clinics’ capacity to effectively evaluate the outcomes associated with CHW services, and leverage emerging mobile technologies to enhance CHW reach and effectiveness.

CA4Health was PHI’s federal Community Transformation Grant initiative, focused on reducing risk for chronic disease in California’s small and rural counties. As one of many interventions, CA4Health trained lay health workers to teach the evidence-based Chronic Disease Self-Management Program developed by Stanford University to hard-to-reach residents with conditions such as diabetes and high blood pressure.

Pittman has served on the IOM’s Roundtable on Population Health Improvement since 2013. The Roundtable’s mission is to catalyze urgently needed action toward a stronger, more healthful, and more productive society. In the conclusion to her discussion paper, she notes: “Today we face so many challenges providing care to complex patients, lowering healthcare costs and advancing a population health framework. An innovation like CHWs in team-based care, which can help address all three, is too valuable to let flounder at the margins. It’s time for our healthcare practice, financing and training to catch up. It’s time to bring CHW practice into the mainstream of U.S. healthcare."


Images courtesy of USAID and Christiana Care.