Perspectives on Community Health Workers among Community Health Organizations and Insurers in Massachusetts

Massachusetts has been described as a leader in supporting community health workers – establishing community agencies to promote the services of community health workers, passing legislation to incorporate community health workers, and conducting a statewide study on the roles and recommendations for sustaining community health workers. However, the perceptions on the utilization and benefits of community health workers among clinical providers and private and public insurers have been understudied. The following research project sought to fill the void on this gap. A state-wide survey was conducted among community health organizations, with a select number of community health organizations being interviewed; and interviews were conducted with the 7 major insurers in the state. Community health workers were found to assume a variety of services, actively engaged in chronic disease prevention, and collaborating in primary care teams. Furthermore, community health centers viewed CHWs as beneficial in improving health outcomes and reducing medical costs for high-risk and/or high cost patient. Similarly, insurers recognized that the role of CHWs would be beneficial among complex, high-costs patients. However, understandings of the role of CHWs among insurers varied, primarily due to the broad definition of CHWs. Furthermore, as a result of global payments, insurers considered the usage of CHWs to be a provider decision.