Background: Community Health Workers (CHWs) are individuals who have direct knowledge of the communities they serve and are trusted, front-line public health personnel and improve population health, care experience, and decrease per-capita cost. They are instrumental in addressing the Social Determinants of Health (SDoH), can assess the range of issues that may impact an individual's, a family's or a community's health, and are able to facilitate improved individual and community well-being. CHWs are recognized and encouraged within healthcare reform programs. Several states now use the CHW workforce to a greater extent and have moved away from fee-for-service and transitioned to sustainable, alternative payment models that have garnered positive outcomes for delivery of care. Results: State representatives and payers are interested to understand metrics to support implementation and sustainability of CHW programs. Payers’ perspectives on the role and value of CHWs, as part of value-based care, in the context of social determinants of health will also be shown. Environmental scan and research will be conducted about effective implementation science frameworks. Implementation science is defined as “the study of methods to promote the adoption and integration of evidence-based practices, interventions and policies into routine health care and public health settings”. Previous research has been conducted on implementation of CHWs, however, this phase of research will focus on specific theoretical evidence-based, approaches of successful implementation science frameworks, which can be applied for CHW programs. Research will also further focus on metrics leading to alternative payment models for CHW programs, which will also be shown as an approach in implementation science frameworks. Methods: Mixed-methods will be used which will include contextual quotes to illustrate the “back-story” of the results and quantitative data will be shown to support the qualitative analysis. Primary research includes qualitative interviews with community, healthcare, and payer organizations. Atlas.Ti and Excel has been applied to collect contextual quotes and quantitative data. An overview of metrics to support alternative payment models and analysis of implementation science frameworks used for CHW programs will be discussed. Exemplar CHW programs showing multiple positive outcomes for patients, providers, and payers will be further discussed. Outcome measures will be analyzed for community organizations and clinical interventions. Conclusion: Results and steps of how sustainable CHW programs have been implemented will be disseminated to the Cross-Regional Health Equity CHW Coalition under the US Department of Health & Human Services/Office of Minority Health, and community, healthcare, and payer organizations. CHW programs using effective implementation science frameworks and metrics will be encouraged based on trends and evidence-based positive outcomes. Effective hybrid CHW programs will be recommended to help promote healthier communities and improve population health.

Community health workers (CHW)are individuals who have direct knowledge of the communities they serve, the social determinants of health (SoDH), and can assess the range of issues that may impact an individual's, a family's or a community's health and may facilitate improved individual and community well-being. As such many CHW initiatives are often intended to decrease health inequalities in oppressed communities. In many cases the reasons for improved outcomes has been their attention to SoDH. Thus funding and payment supporting these functions have been lacking. However, with calls for greater recognition of CHWs many entities now ask for data and evidence of their value. Networks and organizations that have demonstrated positive outcomes due to their recognition, understanding and attention to SoDH as part of their reasons for employing CHWs will be presented. Our primary research includes qualitative interviews with community, healthcare, and payer organizations that make SoDH an explicit reason for employing CHWs. Atlas. Ti and Excel has been used to collect contextual quotes and quantitative data. Analysis of sustainability, maintenance or institutionalization will be done with attention to implementation science frameworks used for CHW programs. Reviewing the literature and research on CHWs, it is evident that the history, underlying purposes and reasons for the employment of CHW remains under recognized and acknowledged We argue in the march to institutionalize their role of these workers their value in addressing and supporting their attention to SoDH should not be lost in translation. CHWs benefit to provide cost-efficient health care system is as much do to working to change the SoDH and root causes of illness. As we continue to uncover the inequities that limit access to social, economic, political, and environmental well-being, the foundation and history of CHWs becomes increasingly relevant.

From the payer perspective Community Health Workers (CHWs) can be a valuable workforce and front-line public health personnel who are key to improving population health, care experience, and per-capita cost. An important aspect of this research is focused on payers interest in understanding and using metrics to support implementation and sustainability of CHW programs. Payers employing CHWs will be presented. Exemplar CHW programs showing multiple positive outcomes for payers will be discussed. Outcome measures will be analyzed for community organizations, specifically for Social Determinants of Health interventions.