Community Health Workers – Doing It Right & Getting It Right

Social determinants of health (SDOH) represent the largest set of factors in determining healthcare outcomes & utilization. Despite understanding this, a fundamental problem remains: How to motivate & sustain healthful behavior, especially within communities experiencing profound social and economic obstacles such as unemployment, poverty, food insecurity, isolation, unsafe housing, etc. There is a tremendous amount of effective, innovative effort directed at this challenge.  But the current “screen & refer” approaches have limitations.  As we’ll discover in this podcast, Community Health Worker programs can overcome these limitations and serve as a keystone program in this domain.

Community Health Worker (CHW) programs connect professional and social-service resources with the individuals & communities they are attempting to benefit. It is a unique approach that takes lay individuals from the community and trains them to be a combination of life coach, social worker, and healthcare system liaison. The basic premise relies on the idea that health is social, contextual & communal; and the closer you are to the situation, the more likely you will be to catalyze & sustain behavior change. Like many other good ideas, this one is as much about execution as it is about intention.

Unfortunately, despite good intentions, many CHW programs have floundered and failed. To help us understand what is needed to create an effective and sustainable CHW model, we are fortunate to have with us Dr. Shreya Kangovi. Dr. Kangovi and her colleagues have pioneered a rigorous, evidence-based approach to building, deploying and measuring the impact of a CHW program.  Dr. Kangovi is the founder & executive director of the Penn Center for Community Health Workers – a national center of excellence dedicated to advancing health in low-income populations through CHW programs. The Penn Center spent seven years creating and refining an exemplary CHW model called IMPaCT (Individualized Management towards Patient-Centered Targets). It’s based on the application of human-centered design principles, implementation science, and robust qualitative & quantitative research methodology.

In this episode, we’ll discuss:

• The scope of services a Community Health Worker (CHW) performs, and what makes them effective.
• The most critical question each Penn Center CHW client is asked.
• The evidence-based clinical, economic and humanistic benefits of an effective CHW program.
• The 5 major pitfalls that have undermined the success of CHW programs in the past, and how to turn them into opportunities for success.
• The services the Penn Center offers to assist other medical centers in standing up their own CHW program.

From my perspective, CHW programs are a critical – but often absent – piece of the healthcare delivery ecosystem. Because they are treated as ‘soft’ programs, they often lack appropriate operational planning, resource allocation, and rigorous management and measurement.

The Penn CHW program has set the standard for efficiency and sustainability. It is a masterpiece of fiscal responsibility, operational excellence, evidence-based consumer-oriented design, and system integration. If the rest of healthcare operated this way, we would be in a far better place than we are now!

Zeev Neuwirth, MD