State Community Health Worker Financing Mechanisms

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Presentation transcript:

State Community Health Worker Financing Mechanisms Pathways to Sustainable Financing

CHWs’ Effect on Quality and Cost Potential to improve quality and control or decrease cost Role of CHW aligns with goals of community care teams, primary care providers and patient-centered medical homes Strengthen understanding of community health needs Enhanced cultural competence and improved communication between providers and patients

How do you obtain financing?

Show Value Connect to a problem and show how you help solve it Demonstrate Effectiveness and Cost Savings

Once you obtain financing, the trick then becomes how do you sustain that financing?

Show Value Demonstrate Effectiveness and Cost Savings

Financing Mechanisms Reimbursement considerations often begin with establishing credentialing Encourage supportive state Medicaid payment options Consider state and federal grants (establish pilot programs) Work with managed care organizations and private payers on reimbursement models Add CHWs to health care teams focused on integrated and patient-centered care Support data collection and research on cost benefits (limited cost savings research to date)

Competition for the Health Care Dollar

State Community Health Worker Program Examples

Oregon Patient Centered Medical Home Program covers services provided by certified CHWs Key Funding—Medicaid State Plan Amendment Example of CHW Services—Ensure patients regularly see their health care provider and receive chronic disease management (e.g., home visits to manage asthma treatment)

Kentucky Kentucky Homeplace, established in 1994 Employs CHWs in underserved and rural communities Housed within the University of Kentucky (UK) Center for Excellence in Rural Health Key Funding—Kentucky Department for Public Health contracts with UK Center for Rural Health (GRF funding) Helps patients access health resources, including food, eyeglasses and dentures

South Carolina South Carolina Department of Health and Human Services’ (SCDHHS) Health Access at the Right Time (HeART) initiative Includes CHWs in primary care practices as community liaisons Key Funding—Eligible primary care physician practices receive a grant from the SCDHHS Two billing codes available for CHW services

Sustainable Financing Post 2016 Election What is the future of the Affordable Care Act (ACA)? How will ACA changes effect health policy on the state and federal level? What is the future of CHWs and program funding?

Resources www.nursing.ohio.gov http://www.ncsl.org/Portals/1/Documents/Health/CHWbrief2015.pdf http://www.cdc.gov/dhdsp/pubs/docs/chw_state_laws.pdf http://www.nashp.org/state-community-health-worker-models/ http://www.mchip.net/sites/default/files/mchipfiles/05_CHW_Financing_0.pdf

Contact Information Tom Dilling Legislative Liaison/Adjudication Coordinator Ohio Board of Nursing 17 S. High St., Suite 400 Columbus, OH 43215-7410 E-mail: tdilling@nursing.ohio.gov Tel: (614) 644-5689 Fax: (614) 995-3686