Recommendations to the Health Policy Commission
Publicly Available: Yes
Billing and Reimbursement:
Certification: CHW input in process, Role of state government, State input in process
Policy: Building partnerships, General other, MCO contract language and reimbursement models
Sustainable Financing: Engaging state partners in general, General other, Education to HC orgs on payment options bundled etc., MCO or bundled payment reimbursement models, Documentation of how CHWs can work within care teams, Evidence-based interventions
Workforce Development: Chronic Disease, Data sharing between social services and clinical teams, General other (including mention of “employment practices”)
Our recommendations center on organizing principles and activities that will support the roles that CHWs play, particularly for underserved and vulnerable populations who face challenges in managing their health and for accessing care. We also recommend, under the relevant criterion, that ACOs demonstrate how they are employing CHWs to meet stated goals. A priority recommendation is that ACOs be directed to assure that community health workers are employed or contracted by member organizations to provide care coordination for high-risk patients and to provide direct wrap-around services or linkage to wrap-around services for such patients. ACOs should follow evidence-based community health worker caseload best practices for distinct health conditions and service contexts, which can be made available by knowledgeable practitioners and policy experts.