Supporting Community Health Workers in Comprehensive Asthma Care: Policy Innovations

Background: One in seven children in the U.S. is diagnosed with asthma, the leading cause of chronic childhood disease. While a manageable condition when recommended medication regimens are followed and environmental control measures implemented, asthma remains the third most common reason for hospitalization among children. As the primary health care home to a quarter of all low-income children who are especially vulnerable to asthma, community health centers play a critical role in providing comprehensive and preventive asthma care to their pediatric patients. Many community health centers rely on the services of community health workers (CHWs) as essential elements of their asthma care management teams. CHWs are particularly valuable for patient home assessments that are recommended components of evidence-based asthma care. Yet, sustainable reimbursement for services provided by CHWs is a frequent challenge. Methods: We conducted a policy scan of innovative approaches to securing adequate reimbursement for CHW services as part of evidence-based asthma care management programs. Results: We identified a number of models at the individual health center, Medicaid health plan, and Medicaid state program level for securing sustainable reimbursement for CHWs. While state-based approaches are preferable to more incremental options at the health center and health plan level, local approaches may be more feasible for some community health centers. Conclusions: CHWs provide essential, cost-effective services as part of childhood asthma care management programs. This analysis identifies creative solutions for community health centers and other health care organizations to consider as mechanisms for sustaining the important services of CHWs.