From Rhetoric to Reality-Community Health Workers in Post-Reform U.S. Health Care

Various policies and programs should accelerate the adoption and growth of U.S. CHW programs. The Center for Medicare and Medicaid Innovation is supporting several demonstrations of care models that include CHWs. Numerous health care providers and Medicaid payers have developed internal financing strategies to support CHW-based interventions for high utilizers of care. On the basis of a review of the literature, expert interviews, and our own experience, we believe CHW programs must address five key implementation barriers in order to succeed in the post-ACA era: insufficient integration with formal health care providers, fragmented and disease specific interventions, lack of clear work protocols, high turnover and variable performance of the workforce, and a history of low quality evidence.