In 2015, the Rev. Nancy Butler, the charismatic founder of Glastonbury’s Riverfront Family Church who died earlier this month, was diagnosed with ALS, or Lou Gehrig’s disease. Neither the advanced degrees she and her husband, Gregory B. Butler, earned nor his experience as a corporate lawyer prepared them for the complexities of the health care system.
“My wife gets sick and I don’t have a clue how to navigate,” Greg Butler said. “This stuff is enormously complicated. What does your insurance cover? Or not? How do you appeal this stuff? How do you find the right specialist?”
In July 2015, the Connecticut Health Foundation, where Butler serves as board chair, funded a study that showed that community health workers, or CHWs, could help simplify certain parts of the health care system, and they serve a much-needed role that highly trained medical professionals, such as doctors, can find challenging.
“They know that Mrs. McGillicuddy is on insulin, and they can make sure she’s taken her insulin today,” said Greg Butler. “They know that Mrs. Hernandez’s kids have asthma, and they can make sure she’s vacuuming under the couch.”
A doctor can talk to a patient about the importance of proper diet, but a CHW is in the community already, and knows the patients, the culture, and the language. CHWs are health care workers who deliver more than basic medical care. They can connect patients with the proper medical care as needed, and they can influence a patient’s behavior for long-term benefits.
“They must have training but we cannot over-professionalize the CHW,” said Patricia Baker, Connecticut Health Foundation president and CEO. “They are the bridge between community and clinical care. They should be used in a targeted manner such as supporting complex patients.”
CHWs already have had some credible effects on underserved communities throughout the country.
Connecticut has had CHWs for a while, Baker said. They’ve been called navigators, patient advocates, and outreach workers. One Massachusetts study said CHWs go by as many as 50 different titles. The foundation has long supported CHW programs, but Baker said they’ve shifted their attention to more systemic investments. Otherwise, programs end when grant money runs out, Baker said.
The non-profit Project Access in New Haven uses CHWs to great success. Founded in 2009 by local physicians to overcome inequality of health care, 73 percent of Project Access patients are Hispanic or Latino; 63 percent are female; and 78 percent have a high school education or less. All the agency’s patients are poor, and all are uninsured. Community health workers are critical to the success of the program, Baker says.
Baker says the recent election of Donald J. Trump, who has promised to dismantle some or all of Obamacare, shouldn’t affect CHW programs.
“Even states that are considered red,” such as Texas, “are utilizing CHWs in their Medicaid Managed Care plans so this work is happening,” Baker said. Research shows that the workers curb health care costs, and deliver better health outcomes.
A 2012 American Cancer Society study found that community health workers generate lifetime benefits of $12,348 per person served, or $851,410 for every CHW who serves at least 69 individuals a year. The benefits come in the form of more taxes paid by people who live longer, as well as savings from a reduction in the use of emergency or urgent care facilities. Every $1 invested in a CHW yields $2.33 in return, according to the study. A similar study in Denver yielded the same results.
In Baltimore, a CHW intervention program saved an average of $2,245 per patient, for a total savings of $262,080 for 117 patients. The study said the intervention program also gave the patients a better quality of life.
The program works, and members of a state community health worker advisory committee within the Office of the Healthcare Advocate are studying what should be their training, promotion, and certification process. As of a year ago, 15 states had established or were moving toward establishing their own certification process. In neighboring Massachusetts, training includes 80 hours in the class, though for now, credit is given for work already completed. That pathway will be eliminated within the next few years.
In short, this is an approach the works. It saves money. It gives patients a shot at better outcomes. As we feel our way through the next few uncertain years, we could use a community-based program like this.
Susan Campbell is a distinguished lecturer at the University of New Haven. She can be reached at firstname.lastname@example.org.