142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Achieving the Triple Aim through Community Health Workers: Reimbursement Models that Align with the Affordable Care Act

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Rumana Rabbani , Yale School of Public Health, Yale University, New Haven, CT
Jennifer Grasso , Yale School of Public Health, Yale University, Shelton, CT
Rongrong Wang , Yale School of Public Health, Yale University, New Haven, CT
Ahsan Malik, MD. , Department of Internal Medicine / Preventive Medicine. AP-MPH Candidate, Yale-Griffin Hospital / Yale School of Public Health, West Haven, CT
Background: Community Health Workers (CHWs) are trusted frontline public health personnel who improve access, quality of care, and cost effectiveness of healthcare, embodying the Triple Aim of the Affordable Care Act (ACA). The involvement of CHWs is recognized by the ACA, but they are not often accepted as care-givers by healthcare organizations.  CHWs are not typically eligible for reimbursement by public and private payers.  Payers should adopt reimbursement mechanisms that conform to ACA guidelines for CHW integration into the healthcare team.

Objectives: To collect feedback from CHWs and healthcare representatives concerning feasible reimbursement models and to identify reimbursement methods for different roles CHWs can have within ACA recommended reforms.

Methods: Models of effective CHW programs will be collected from other states based on literature and expert referrals. The perspectives of Connecticut CHWs will be integrated throughout the process of developing and conducting qualitative interviews with private and public payers.

Results: Reimbursement models that are aligned with the ACA will be identified and adapted for CHW roles within healthcare organizations.  The models will focus on the integration of CHWs into the healthcare reform paradigm through public and private payers.

Conclusions:  Collaboration with healthcare stakeholders and CHWs will take place to determine reimbursement models that can be adopted by healthcare organizations.  The recommendation of reimbursement models will be based on feedback from public and private payers who are involved in payment, health promotion, and delivery reforms.  Future action steps for sustaining these models will be discussed in order to achieve the Triple Aim of the ACA.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Describe how CHWs help accomplish the goals of ACA. Assess the reimbursement methods of other states in regard to ACA guidelines. Analyze feedback and recommendations from CHWs and healthcare representatives regarding reimbursement. Identify different reimbursement models for the various roles of CHWs in healthcare organizations. Discuss future action steps for reimbursement models that are in alignment with the payment, health promotion, and delivery reforms.

Keyword(s): Community Health Workers and Promoters, Affordable Care Act

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a healthcare consultant, projects involve the implementation of PPACA reforms.I have presented at CHW conference/panel discussion,worked on final reports with SWAHEC about payment methods for CHWs.I am a member of the NE CHW Coalition and NE Health Equity Council.I also work as a Research Assistant on women's,children's,and malpractice health policies.This background enables me to combine my knowledge of implementing PPACA programs and health policy while researching which reimbursement models could be sustainable for CHWs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3313.0: PHEHP Student Awards