Home is Where the Heart Is: The Importance of Community Health Workers in Value-Based Care.

Maggie-SauerValue-based healthcare and population health are at the forefront of our state and national discussions. Community health workers in particular are receiving increased attention given their role in transitioning patients successfully, to the community from the hospital or simply recover in their own homes. Yet, they are often the least recognized for their work and their contribution to value-based care and population health. Further, they are paid minimum wage or just slightly more despite the fact that the care they provide is often the difference between someone staying out of the hospital or using other forms of more costly healthcare.

A recent News and Observer article highlights the poor working conditions and low pay received by many of these workers, particularly those who work in home care, and also points out the growing demand. According to The Bureau of Labor Statistics, “the country will need one million new home care workers by 2022, when the occupation is expected to have grown by 49 percent, more than four times the average rate for all professions.” Given this, and that community health workers provide such invaluable information regarding the home environment and support, it is incumbent on us to find innovative healthcare models that incorporate them as a valued team member.

The Foundation for Health Leadership and Innovation will work in partnership with programs like the certificate program created by Ruth Little, Vice Chair and Assistant Professor at East Carolina University’s School of Public Health and the Carolina Heart Alliance Networking for Greater Equity (CHANGE) project led by Dr. Samuel Cykert, a Professor of Medicine at UNC Chapel Hill in the Division of General Internal Medicine and Clinical Epidemiology. These programs standardize the training of the community health workers and recognize their importance in combatting chronic disease.

Happy holidays to all of our friends and partners and don’t forget the community health worker who helps so many of us enjoy our holidays in our homes with friends and family!

With growing evidence that the use of community health workers (CHWs) can increase access to care, improve patient outcomes, and reduce healthcare costs, CHWs are being progressively recognized as essential members of the modern healthcare team. A powerful force for bridging the gap between primary care practices and communities, CHWs can provide a variety of services from promoting healthy behavior to helping patients navigate the complicated health care system. Because of all this, it becomes increasingly important to engage CHWs in rural areas where disease rates are high.

Realizing the potential CHWs have for improving disease outcomes in high-risk populations, researchers from the UNC Center for Health Promotion and Disease Prevention (HPDP) are currently testing an innovative program called the Carolina Heart Alliance Networking for Greater Equity (CHANGE) project. Sponsored by the CDC, the CHANGE project aims to reduce the risk of cardiovascular disease in rural and medically underserved communities through the use of CHWs.


The CHANGE research team is led by Dr. Samuel Cykert, a Professor of Medicine at UNC Chapel Hill in the Division of General Internal Medicine and Clinical Epidemiology. Dr. Cykert brings extensive experience in addressing health disparities and chronic care management to the team. Additionally, he is a strong proponent of engaging CHWs in patient centered care.


[box] “CHWs are great providers of peer support, outreach, teaching and reengagement. They represent a way to engage and teach so that patients and other community members understand health and chronic illness better.” [/box]


acc-with-flagsFor this project, which began in 2014, Dr. Cykert and his team have partnered with both Roanoke Chowan Community Health Center and Hertford Public Health Authority to test their approach in Herford County, NC. After about a year of developing the plan, the team employed two community health workers to help identify and recruit individuals with uncontrolled cardiac risk factors and help them work on diet, exercise, tobacco cessation and medication adherence. The program also encourages family members or neighbors to join the teaching sessions so they can engage in primary prevention for themselves and form a social network to support the index patient. Additionally, the CHANGE research team uniquely uses electronic tablets to assist and support the CHWs, connect CHWs to the clinic, and gather program data.

While the project still has a long way to go, it’s been quite successful so far, with approximately 120 enrollees to date. In the first intervention group, 15 of the 18 patients with uncontrolled hypertension got it under control and 18 of the 36 overweight patients lost weight. Additionally, through screening for hypertension, the group has so far identified seven cases of untreated patients who are now all controlled. Seeing this success, Dr. Cykert hopes that one day this program can be expanded to other communities.

“If you could disseminate this to other underserved rural communities, these type of results would lead to an enormous reduction in cardiovascular events and a significant slowing of the diabetes epidemic,” he says.

As the research team at HPDP and others across the state work hard to gather more evidence to support the work of CHWs, it also becomes important for them to collaborate with others. In an effort to do just that, the Community Health Worker Summit was held just a few weeks ago in Greensboro, NC. The overall purpose of the event was to summarize findings of a group working to establish CHW workforce and come up with best use cases. Additionally, attendees of the meeting shared findings and engaged stakeholders among health systems, payers and other interested parties. This type of collaboration is what will hopefully lead to increased recognition and integration of CHWs into healthcare teams.

For more information about the CHANGE project, click here.

Community health workers (CHWs) play an important role in the healthcare system, serving as valuable resources to both communities and healthcare organizations. Their unique understanding of the communities they serve has allowed them to facilitate access to and improve overall quality of care for community members.

In recent years, their proven success has led to an increased standardization of the workforce. In 2009, CHWs became recognized as a distinct occupation, and in 2010 the Patient Protection and Affordable Care Act listed CHWs as “health professionals who function as members of health care teams.” Additionally, The United States Department of Labor estimates that there will be a 15% increase in demand for these workers by 2024.

2015_ruth_littleWhile this potential increase in demand is great news for the workforce, it has also raised concern about the lack of standardized training and certification programs available for workers. Currently, training across the United States varies from program to program, and as CHWs become increasingly recognized as a profession, the development of training standards is vital. Ruth Little, Vice Chair and Assistant Professor at East Carolina University’s School of Public Health agrees. “With any health profession, there has to be certain methods and consistency in place.”

Ruth was recruited to ECU in 2005 to help start the Master of Public Health Program, and has now been there ever since. A public health advocate, she has spent the last several years working to create a uniform curriculum for CHW education and certification in North Carolina. This curriculum will not only help to adequately prepare CHWs for their role in the healthcare team, but also help to promote the profession statewide.

Prior to working at ECU, Ruth was the Public Health Director of Jones County, a rural county near the eastern coast of North Carolina. Her continued work with Jones county while at ECU led to her writing a grant to the Office of Minority Health that would help her establish a standardized curriculum for the county.

After about a decade of work, Ruth and her team moved towards translating the curriculum to the community college system, and in September of 2015, it was approved. Now available in the Edgecombe Community College system, the curriculum is on the cusp of moving to other community colleges that want it.

2304874364_cd78bd8073An important part of developing any kind of new curriculum is testing it, and Ruth and her team have been measuring longitudinal outcomes for their curriculum for almost ten years. “We have data on almost 1,000 people and we’re trying to test an even larger group,” says Little. “We will also continue to look at outcomes so we can provide updates to the curriculum to ensure it is always current and valid.”

Ruth is also excited to have recently partnered with the Eastern Health Stewards group, who will help them continue to evaluate outcomes with an even larger, more diverse population. “Chronic disease does not discriminate,” she says. “There is a high prevalence of it across all socioeconomic classes, and we are looking forward to examining the effectiveness of community health workers in all types of populations.”

Overall, Ruth attributes the success of the development of this curriculum to the hard work and contributions of all the leaders and organizations involved. “The entities that represent and reflect the community have always been on the table and had a lot of input and that’s key,” says Ruth. “It’s not about one person, or a small group of people, it’s about bringing our expertise together.”