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

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.