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!

On October 19th and 20th more than 40 people from across North Carolina gathered at the NC State University McKimmon Center for the NC Rural Health Leadership Alliance’s (NCRHLA) inaugural events. The gathering kicked off on the 19th with an open reception that welcomed guests to learn more about the NCRHLA and connect new partners to its current members. The NCRHLA is a coordinated network of leaders and practitioners aimed at improving the health of rural North Carolinians through education and strategic partnerships. Their work is currently focused on achieving the recommendations of the NC Rural Health Action Plan.

thumbnail_20161020_091956bOn October 20th, a select group of participants from local, regional and state organizations supporting public health and economic development attended the Discovery & Practice Summit: Connections for Community Health and Economic Vitality. The goal of the Summit was to move North Carolina forward in improving economic and community health and wellbeing through collaboration. The Summit was organized on the premise that collaboration across sectors is essential for healthy, vibrant communities. The day was devoted to exploring opportunities for partnership between public health and economic development practitioners – just two of the many partners needed for successful community change. Through the day, sessions narrowed to focus on community strategies for healthy eating and active living (HEAL) that could have health and economic benefits.

Jamie Cousins, a current Jim Bernstein Health Leadership Fellow, led the coordination of the event. “Being a part of the Bernstein Fellowship, I’ve been inspired and challenged (in the best way) by Jim Bernstein’s commitment and leadership to rural North Carolina communities. The Summit and continued dialogue and action are humble efforts to carry forward his spirit and belief in our rural communities. I am truly grateful to the Kate B. Reynolds Charitable Trust for the support which made the Summit a reality. The NC Rural Health Leadership Alliance provided financial support through the National Rural Health Leadership grant and was a terrific partner in this event.”

In review of the event, participants shared that the Summit was a valuable investment of their time and that the three primary objectives of the Summit were well-met:

  • they were more aware of practical strategies that address the goals of public health and economic development while supporting healthy eating and active living;
  • they could identify collaborative opportunities for professionals, advocates, and residents to advance economic vitality and health for all;
  • they plan to take action to work jointly to advance public health and economic vitality.

20161020_111611Participants wrote Commitment Cards declaring at least one action to complete before the end of 2016.  Most of the commitments involved reaching out to local partners such as economic development professionals or chambers of commerce to talk about opportunities for collaboration. Other commitments included sharing information from the Summit and connecting with agencies to move work forward together. As Jamie Cousins continues her Bernstein Fellowship and supports the ideas and new collaborations from the Summit, participants will be contacted in early January to learn how they’ve progressed. Additionally, Summit proceedings will be shared, and several small group discussions are planned to continue to advance dialogue and action.

The Kate B. Reynolds Charitable Trust and the National Rural Health Association provided funding for the Summit, and the NC Rural Health Leadership Alliance, the Jim Bernstein Community Health Leadership Fellows Program, the Foundation for Health Leadership & Innovation, the North Carolina Institute of Medicine, and the NC Division of Public Health Community and Clinical Connections for Prevention and Health Branch all contributed resources for the event.


Mark your calendars! October 19th and 20th are going to be two exciting days packed with events designed to address the intersection of economic vitality and health.


First, on October 19th , 2016, the North Carolina Institute of Medicine (NCIOM) will have their annual meeting to address how North Carolina can develop health and economic policies to improve health outcomes and boost local economies. The event will take place at the McKimmon Center at North Carolina State University from 8am-4pm. For more information about this event, click here.



ncruralBuilding upon this event, the NC Rural Health Leadership Alliance (NCRHLA), program of the Foundation for Health Leadership & Innovation, will hold a reception immediately following the meeting (from 4pm-6pm) to celebrate progress in carrying forward the North Carolina Rural Health Action Plan published in 2014 by NCIOM. Come meet, mingle, and hear about emerging opportunities for rural health! To register
for this event by October 11th, click here.


Jamie Cousins, MPALastly, Bernstein Fellow Jamie Cousins, in partnership with the NCRHLA, will host the Discovery & Practice Summit: Connections for Community Health and Economic Vitality in Rural NC on October 20th from 8:15am-3:30pm. This event will convene selected teams from counties across the state to discuss connections between public health and economic vitality. Discussion will surround emerging strategies and practical solutions teams may pursue together to benefit their communities. With questions about the event, please contact Jamie.cousins@dhhs.nc.gov.

Funding for the NCRHLA Reception and Discovery & Practice Summit is provided by the Kate B. Reynolds Charitable Trust and the National Rural Health Association. The events are supported by the Foundation for Health Leadership & Innovation’s Jim Bernstein Community Health Leadership Fellows Program, the North Carolina Institute of Medicine, and the NC Division of Public Health, Community and Clinical Connections for Prevention and Health Branch.

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.”