Online Program

Community Health Workers Achieving the Triple Aim and Health Equity within Healthcare and Population Health in New England: Advanced Payment Models Aligned with the Affordable Care Act

Tuesday, November 3, 2015 : 1:00 p.m. - 1:30 p.m.

Barbara Ginley, MPH, Maine Migrant Health Program, Augusta, ME
Background: Community Health Workers (CHWs) are trusted, frontline public health personnel who improve population heath, care experience, and per-capita cost. Their work is vital in determining health equity.  CHWs are recognized under the Affordable Care Act (ACA); however, they are not often accepted as care-givers or public health workers by healthcare organizations, community outreach programs, or policy makers.  Although, CHWs are mostly funded through non-sustainable grants, our previous research indicates that some public payers and a national private payer are starting to adopt funding that conform to ACA payment guidelines for CHW workforce sustainability and recognition as a profession.

Objectives: To collect feedback from New England healthcare, public health, and payer representatives regarding sustainable funding for CHWs, and to recommend payment models encouraged through the ACA.
Methods: Models of sustainable funding for New England CHW programs will be reviewed based on environmental scans.   Healthcare reform programs, ACA payment model guidelines, and CHW feedback will be used to develop qualitative interviews for payers. Data will be coded to extract research findings.

Results:  Advanced payment models encouraged by the ACA for CHWs will be identified through literature review.  Findings of sustainable funding for CHWs will be evaluated. 

Conclusions: Collaboration with policy officials and healthcare and public health stakeholders will identify payment models that include reimbursement for CHWs within healthcare teams and community outreach programs in New England.   Recommendations for sustainability will be based on secondary research and feedback from payers. Implementation of these models will be discussed to help achieve health equity and the Triple Aim.

Learning Areas:

Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Describe how CHW interventions in New England will help improve population heath, care experience, healthy equity and lower per-capita costs. Assess the sustainable funding for CHWs in New England states in regards to ACA guidelines. Compare feedback and recommendations from CHWs, and public health and healthcare stakeholders regarding sustainable funding. Evaluate findings from public and private payers about their perception of implementing advanced payment models within healthcare reform programs for the CHW workforce. Identify different advanced payment models for the sustainability of CHWs in healthcare organizations and population health. Discuss future action steps for executing advanced payment models to achieve health equity and the Triple Aim.

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

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As the ED of a migrant health center, I have developed, implemented, and evaluated CHW programs and services for over 15 years. My current role under Maine SIM utilizes this direct experience to develop CHW capacity, infrastructure and policy to support and sustain the CHW workforce in our state and region through the Regional Health Equity Council.
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.