Sustainable Financing Mechanisms for Community Health Worker Programs
State Community Health Worker
Financing Mechanisms
Pathways to Sustainable
Financing
CHWs’ Effect on Quality and Cost
•
Potential to improve quality and control or
decrease cost
•
Role of CHW aligns with goals of community
care teams, primary care providers and
patient-centered medical homes
•
Strengthen understanding of community
health needs
•
Enhanced cultural competence and
improved communication between
providers and patients
How do you obtain
financing?
Show Value
Connect to a problem and
show how you help solve it
Demonstrate Effectiveness
and Cost Savings
Once you obtain
financing, the trick then
becomes how do you
sustain that financing?
Show Value
Demonstrate Effectiveness
and Cost Savings
Financing Mechanisms
•
Reimbursement considerations often begin with
establishing credentialing
•
Encourage supportive state Medicaid payment
options
•
Consider state and federal grants (establish pilot
programs)
•
Work with managed care organizations and private
payers on reimbursement models
•
Add CHWs to health care teams focused on
integrated and patient-centered care
•
Support data collection and research on cost
benefits (limited cost savings research to date)
Competition for the
Health Care Dollar
State Community Health
Worker Program
Examples
Oregon
•
Patient Centered Medical Home Program
covers services provided by certified CHWs
•
Key Funding—Medicaid State Plan
Amendment
•
Example of CHW Services—Ensure patients
regularly see their health care provider and
receive chronic disease management (e.g.,
home visits to manage asthma treatment)
Kentucky
•
Kentucky Homeplace, established in 1994
•
Employs CHWs in underserved and rural
communities
•
Housed within the University of Kentucky (UK)
Center for Excellence in Rural Health
•
Key Funding—Kentucky Department for
Public Health contracts with UK Center for
Rural Health (GRF funding)
•
Helps patients access health resources,
including food, eyeglasses and dentures
South Carolina
•
South Carolina Department of Health and
Human Services’ (SCDHHS) Health Access at
the Right Time (HeART) initiative
•
Includes CHWs in primary care practices as
community liaisons
•
Key Funding—Eligible primary care physician
practices receive a grant from the SCDHHS
•
Two billing codes available for CHW services
Sustainable Financing
Post 2016 Election
•
What is the future of the
Affordable Care Act (ACA)?
•
How will ACA changes effect
health policy on the state and
federal level?
•
What is the future of CHWs and
program funding?
Resources
www.nursing.ohio.gov
http://www.ncsl.org/Portals/1/Documents/Health/CHWbrie
f2015.pdf
http://www.cdc.gov/dhdsp/pubs/docs/chw_state_laws.pd
f
http://www.nashp.org/state-community-health-worker-
models/
http://www.mchip.net/sites/default/files/mchipfiles/05_CH
W_Financing_0.pdf
Contact Information
Tom Dilling
Legislative Liaison/Adjudication Coordinator
Ohio Board of Nursing
17 S. High St., Suite 400
Columbus, OH 43215-7410
E-mail: tdilling@nursing.ohio.gov
Tel: (614) 644-5689
Fax: (614) 995-3686
Explore pathways to sustainable financing for Community Health Worker (CHW) programs, highlighting the impact on quality and cost in healthcare delivery. Learn how to obtain and sustain financing, demonstrate value, and leverage reimbursement mechanisms to support CHWs in integrated care teams. Discover examples of successful CHW programs like Oregon's Patient-Centered Medical Home Program.
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Presentation Transcript
State Community Health Worker Financing Mechanisms Pathways to Sustainable Financing
CHWs Effect on Quality and Cost Potential to improve quality and control or decrease cost Role of CHW aligns with goals of community care teams, primary care providers and patient-centered medical homes Strengthen understanding of community health needs Enhanced cultural competence and improved communication between providers and patients
How do you obtain financing?
Show Value Connect to a problem and show how you help solve it Demonstrate Effectiveness and Cost Savings
Once you obtain financing, the trick then becomes how do you sustain that financing?
Show Value Demonstrate Effectiveness and Cost Savings
Financing Mechanisms Reimbursement considerations often begin with establishing credentialing Encourage supportive state Medicaid payment options Consider state and federal grants (establish pilot programs) Work with managed care organizations and private payers on reimbursement models Add CHWs to health care teams focused on integrated and patient-centered care Support data collection and research on cost benefits (limited cost savings research to date)
Competition for the Health Care Dollar
State Community Health Worker Program Examples
Oregon Patient Centered Medical Home Program covers services provided by certified CHWs Key Funding Medicaid State Plan Amendment Example of CHW Services Ensure patients regularly see their health care provider and receive chronic disease management (e.g., home visits to manage asthma treatment)
Kentucky Kentucky Homeplace, established in 1994 Employs CHWs in underserved and rural communities Housed within the University of Kentucky (UK) Center for Excellence in Rural Health Key Funding Kentucky Department for Public Health contracts with UK Center for Rural Health (GRF funding) Helps patients access health resources, including food, eyeglasses and dentures
South Carolina South Carolina Department of Health and Human Services (SCDHHS) Health Access at the Right Time (HeART) initiative Includes CHWs in primary care practices as community liaisons Key Funding Eligible primary care physician practices receive a grant from the SCDHHS Two billing codes available for CHW services
Sustainable Financing Post 2016 Election What is the future of the Affordable Care Act (ACA)? How will ACA changes effect health policy on the state and federal level? What is the future of CHWs and program funding?
Resources www.nursing.ohio.gov http://www.ncsl.org/Portals/1/Documents/Health/CHWbrie f2015.pdf http://www.cdc.gov/dhdsp/pubs/docs/chw_state_laws.pd f http://www.nashp.org/state-community-health-worker- models/ http://www.mchip.net/sites/default/files/mchipfiles/05_CH W_Financing_0.pdf
Contact Information Tom Dilling Legislative Liaison/Adjudication Coordinator Ohio Board of Nursing 17 S. High St., Suite 400 Columbus, OH 43215-7410 E-mail: tdilling@nursing.ohio.gov Tel: (614) 644-5689 Fax: (614) 995-3686
