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

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.